Drug Information, Drug Interaction Checker, Drug ID

Mucinex Fast-Max, Mucinex Sinus-Max, Theraflu Warming Relief Cold & Chest Congestion, Tylenol Sinus Congestion & Pain Severe, Sudafed PE Triple Action

Acetaminophen-Ibuprofen

Advil Dual Action

Acetaminophen-Isometheptene-Dichloralphenazone

Midrine, Migragesic IDA, Nodolor

AcetaZOLAMIDE

Diamox

«bu»Altitude Illness Prevention«/bu» «b»Tablets IR«/b» - 500 to 1,000 mg/day in divided doses every 8 to 12 hours «b»Capsules ER«/b» - 500 to 1,000 mg/day divided every 12 to 24 hours - These doses are associated with more frequent and/or increased side effects. «b»Alternative Dosing Regimen«/b» - 125 mg PO bid - Beginning either the day before (preferred) or on the day of ascent - May be discontinued after staying at the same elevation for 2 to 3 days or if descent initiated - In situations of rapid ascent (such as rescue or military operations), 1,000 mg/day is recommended by the manufacturer. The Wilderness Medical Society recommends consideration of using dexamethasone in addition to acetazolamide in these situations «bu»Altitude Illness Treatment«/bu» - 250 mg PO bid - With high altitude cerebral edema, dexamethasone is the primary treatment; however, acetazolamide may be used adjunctively with the same treatment dose «bu»Edema«/bu» - 250 to 375 mg IV/PO daily «bu»Epilepsy«/bu» - 8 to 30 mg/kg/day PO in divided doses - A lower dosing range of 4 to 16 mg/kg/day in 1 to 4 divided doses has also been recommended - Maximum Dose: 30 mg/kg/day or 1 g/day - Minimal additional benefit with doses >16 mg/kg/day. - Extended release capsule is not recommended for treatment of epilepsy. «bu»Familial Periodic Paralysis«/bu» - 125 mg PO tid OR - 250 mg PO daily OR - 250 mg PO every 6 hours «bu»Chronic Open-Angle Glaucoma«/bu» - 250 mg PO 1 to 4 times/day OR - 500 mg extended release capsule PO bid «bu»Acute Closed-Angle Glaucoma«/bu» - Initial Dose: 250 to 500 mg PO x 1 dose, then, - 125 to 250 mg PO every 4 hours - 250 mg PO every 12 hours has been effective in short-term treatment of some patients «bu»Hydrocephalous, Normal Pressure«/bu» «b»Initial Dose«/b» - 125 mg/day - May increase dose up to 375 mg/day «bu»Metabolic Alkalosis«/bu» - 500 mg IV as a single dose - Reassess need based upon acid-base status «bu»Prevention of Cystine Renal Calculi«/bu» «b»Adjunctive Therapy«/b» - 500 mg PO daily at bedtime in combination with potassium citrate and captopril «bu»Respiratory Stimulant in Stable Hypercapnic COPD«/bu» - 250 mg PO bid

Acetylcholine

Miochol-E

Acetylcysteine

Acetadote, Cetylev, Mucomyst, NAC, N-acetylcysteine

«bu»Acetaminophen (Paracetamol) Overdose«/bu» - Continuous IV infusion recommended for acute ingestion (ideally within 8-10 hr following ingestion, but may administer if >10 hr) «b»Continuous IV Infusion«/b» - Acute ingestion (within 8-10 hr after ingestion) - Administer as 3 doses «bi»Loading Dose«/bi» - 150 mg/kg IV - Mix in 200mL of D5W and infuse over 1 hr «bi»Dose 2«/bi» - 50 mg/kg IV in 500mL D5W over 4 hr «bi»Dose 3«/bi» - 100 mg/kg IV in 1000 mL D5W over 16 hr «bi»>100 kg«/bi» - No specific studies have conducted - Limited data suggest a loading dose of 15,000 mg infused IV over 1 hr, then a first maintenance dose of 5,000 mg IV over 4 hr and a second maintenance dose of 10,000 mg over 16 hr «b»Intermittent IV Administration«/b» - Intermittent IV infusion may be considered for late presenting or chronic ingestion (more than 10 hr after ingestion) - Total treatment time 48 hr - Late presenting or chronic ingestion (>10 hr after ingestion) in patients >40 kg «bi»Loading Dose«/bi» - 140 mg/kg IV infused over 1 hr (dilute in 500 mL D5W) «bi»Maintenance Dose«/bi» - 70 mg/kg IV every 4 hour for at least 12 doses (dilute each dose in 250 mL of D5W and infuse over minimum 1 hr) «b»Oral Administration«/b» - May administer injectable orally «bi»Loading Dose«/bi» - 140 mg/kg PO x 1 dose - Start maintenance dose 4 hr after loading dose «bi»Maintenance Dose«/bi» - Start 4 hr after loading dose - 70 mg/kg PO every 4 hr for a total 17 doses - Repeat dose if emesis occurs within 1 hr of administration «bu»Mucolytic«/bu» - Face mask, mouth piece, tracheostomy - Acetylcysteine 10% and 20% solution (dilute 20% solution with sodium chloride or sterile water for inhalation); 10% solution may be used undiluted: 3 to 5 mL of 20% solution or 6 to 10 mL of 10% solution until nebulized given 3 to 4 times/day «bi»Dosing Range«/bi» - 1 to 10 mL of 20% solution or 2 to 20 mL of 10% solution every 2 to 6 hours «b»Inhalation, Nebulization«/b» - Dose must be individualized - May require up to 300 mL solution/treatment «b»Direct Instillation«/b» - Into tracheostomy: 1 to 2 mL of 10% to 20% solution every 1 to 4 hours - Through percutaneous intratracheal catheter: 1 to 2 mL of 20% or 2 to 4 mL of 10% solution every 1 to 4 hours via syringe attached to catheter «bu»Diagnostic Bronchogram«/bu» «b»Nebulization or Intratracheal«/b» - 1 to 2 mL of 20% solution or 2 to 4 mL of 10% solution administered 2 to 3 times prior to procedure - Refer to indication-specific dosing for obesity-related information (may not be available for all indications) «b»Effervescent Tablets (Cetylev)«/b» - Dissolve the effervescent tablets in the volume of water indicated below based upon patient weight; administer immediately: «bi»1 to <20 kg«/bi» - Dissolve two 2.5 g tablets in 100 mL of water to create a 50 mg/mL solution; administer an appropriate amount of this solution to deliver the calculated dose. «bi»20 to <60 kg«/bi» - Dissolve an appropriate number of tablets to deliver the calculated dose in 150 mL of water. «bi»≥60 kg«/bi» - Dissolve an appropriate number of tablets to deliver the calculated dose in 300 mL of water «bu»Contrast Agent-Associated Nephrotoxicity«/bu» «bi»Prevention«/bi» - 600 mg PO every 12 hr for 2 days on day before and day of contrast agent administration «bu»Keratoconjunctivitis Sicca«/bu» - 1 drop of 10% solution in eye(s) every 6-8 hr «b»Inhalation Administration«/b» - Acetylcysteine is incompatible with tetracyclines, erythromycin, amphotericin B, iodized oil, chymotrypsin, trypsin, and hydrogen peroxide - Administer separately. - Intermittent aerosol treatments are commonly given when patient arises, before meals, and just before retiring at bedtime. «b»Oral Effervescent Tablets (Cetylev) Administration«/b» - Use within 2 hours of preparation. - If the patient vomits within 1 hour of administration, repeat that dose. - If the patient is persistently unable to retain the orally administered acetylcysteine, acetylcysteine may be administered by nasoduodenal tube - An intravenous formulation of acetylcysteine may also be considered. «b»Oral Solution Administration«/b» - For the treatment of acetaminophen overdose, administer orally as a 5% solution - Use within 1 hour of preparation. The unpleasant odor (sulfur-like) becomes less noticeable as treatment progresses - If patient vomits within 1 hour of dose, readminister - It is helpful to put the acetylcysteine on ice, in a cup with a cover, and drink through a straw; alternatively, administer via an NG tube «b»IV (Acetadote) Administration«/b» Loading Dose - Administer over 1 hour. Second Dose - Administer over 4 hours. Third Dose - Administer over 16 hours. - If the commercial IV form is unavailable, the solution for inhalation has been used; each dose should be infused through a 0.2 micron Millipore filter (in-line) over 60 minutes; intravenous administration of the solution for inhalation is not USP 797-compliant. «b»IV Preparation of Solution for Inhalation/Oral«/b» - Using D5W, dilute acetylcysteine 20% inhalation/oral solution to a 3% solution. «bi»Solution for Injection (Acetadote)«/bi» - Volume of diluent based on weight; compatible diluents include D5W, 1/2NS, or SWFI: «bi»Patient Weight 5 to 20 kg«/bi» - Loading dose: Dilute dose in 3 mL/kg diluent - Second dose: Dilute dose in 7 mL/kg diluent - Third dose: Dilute dose in 14 mL/kg diluent «bi»Patient Weight 21 to 40 kg«/bi» - Loading Dose: Dilute dose in 100 mL diluent - Second Dose: Dilute dose in 250 mL diluent - Third Dose: Dilute dose in 500 mL diluent «bi»Patient Weight: ≥41 kg«/bi» In patients requiring fluid restriction, decrease diluent volume. - Loading Dose: Dilute dose in 200 mL diluent - Second Dose: Dilute dose in 500 mL diluent - Third Dose: Dilute dose in 1,000 mL diluent - Clinicians should be aware that undiluted injection solution (Acetadote) is hyperosmolar (2,600 mOsmol/L); when the diluent volume is decreased for patients ≤40 kg or requiring fluid restriction, the osmolarity of the solution may remain higher than desirable for intravenous infusion. To ensure tolerance of the infusion, osmolarity should be adjusted to a physiologically safe level (eg, ≥150 mOsmol/L in children). - Acetadote concentration: 7 mg/mL - Osmolarity in D5W: 343 mOsmol/L - Osmolarity in 1/2NS: 245 mOsmol/L - Osmolarity in SWFI: 91 mOsmol/L - Acetadote concentration: 24 mg/mL - Osmolarity in D5W: 564 mOsmol/L - Osmolarity in 1/2NS: 466 mOsmol/L - Osmolarity in SWFI: 312 mOsmol/L «b»Oral Solution Preparation«/b» - Dilute the 20% solution 1:3 with a cola, orange juice, or other soft drink to prepare a 5% solution - If being administered via a nasogastric tube or Miller-Abbott tube, water may be used as the diluent - Use within 1 hour of preparation

Acitretin

Soriatane

Aclidinium

Tudorza Pressair

Aclidinium-Formoterol

Duaklir Pressair

Acrivastine

Acrivastine-Pseudoephedrine

Semprex-D

Acyclovir

Zovirax, ACV

«bu»Herpes Simplex Virus (HSV), Genital Infection«/bu» «b»Immunocompetent«/b» «bi»Initial Episode«/bi» - 5 to 10 mg/kg IV every 8 hours x 2 to 7 days, then, - Oral therapy to complete at least 10 days of therapy - 200 mg 5 times PO daily x 7 to 10 days - 400 mg tid x 7 to 10 days «bi»Recurrence«/bi» - 400 mg tid x 5 days OR - 800 mg bid x 5 days OR - 800 mg tid x 2 days - Initiate within 1 day of lesion onset or during the preceding prodrome «bi»Chronic Suppression«/bi» - 400 mg bid x up to 12 months (followed by re-evaluation) - Safety and efficacy have been documented in patients receiving daily therapy with acyclovir for up to 6 years «bu»HSV Encephalitis«/bu» «b»Independent of HIV Status«/b» - 10 mg/kg IV every 8 hours x 14 to 21 days «bu»HSV, Mucocutaneous Treatment«/bu» «b»Immunocompromised«/b» - 5 to 10 mg/kg IV every 8 hours x 7 days - 400 mg 5 times PO daily x 7 days «bu»Herpes Zoster (Shingles) Treatment«/bu» «b»Immunocompromised«/b» - 10 mg/kg IV every 8 hours x 7 days - 800 mg 5 times PO daily x 7 to 10 day «b»HIV-infected Patients«/b» «bi»Extensive Cutaneous Lesions or Visceral Involvement«/bi» - 10 to 15 mg/kg IV every 8 hours until clinical improvement; switch to oral famciclovir or valacyclovir (preferred) or acyclovir (alternative) to complete a 10 to 14 day course when formation of new lesions has ceased and signs/symptoms of visceral infection are improving «b»Acute Localized Infection«/b» - As an alternative to valacyclovir or famciclovir - 800 mg PO 5 times daily x 7 to 10 days - Consider longer duration if lesions resolve slowly «bu»Bell Palsy«/bu» - 400 mg PO 5 times daily for 10 days in combination with corticosteroids - Benefit of the addition of antivirals to corticosteroid therapy has not been established and antivirals provide only marginal benefit over corticosteroid therapy alone «bu»Cytomegalovirus (CMV) Infection«/bu» - 500 mg/m2 /dose IV every 8 hours - 800 mg PO qid - Begin at engraftment and continue to day 100 - Requires close monitoring for CMV reactivation (due to weak activity) - Not for use in patients at high risk for CMV disease «bu»Herpes Simplex Virus (HSV)«/bu» «b»Genital Infection in HIV-infection«/b» Initial or Recurrent Episodes - 400 mg PO tid x 5 to 10 days Chronic Suppressive Therapy - 400 mg PO bid; continue indefinitely regardless of CD4 count in patients with severe recurrences of genital herpes or in patients who want to minimize frequency of recurrences or - 400 to 800 mg 2 to 3 times daily - In patients beginning antiretroviral therapy and concomitant acyclovir, a reduction in the incidence of HSV-2 genital ulcers is most evident after the first 3 months of ART initiation «b»Mucocutaneous Infection in HIV-infection«/b» - 5 mg/kg/dose IV every 8 hours - May switch to oral acyclovir after lesions begin to heal - After initial IV therapy, may switch to 400 mg PO 3 times daily - Continue until lesions are completely healed «b»Orolabial (Cold Sores) Infection in Immunocompetent«/b» «bi»Treatment: (Episodic/Recurrent)«/bi» - 200 to 400 mg PO times daily for 5 days «bi»Chronic Suppression«/bi» - 400 mg 2 times daily (has been clinically evaluated for up to 1 year) «b»Orolabial (Cold Sores) Infection in HIV-infection«/b» - Treatment: 400 mg PO tid x 5 to 10 days «bu»Varicella (Chickenpox) Treatment«/bu» «b»>40 kg (Immunocompetent)«/b» - 800 mg PO every 6 hr x 5 days «b»Immunocompromised«/b» - 10-15 mg/kg IV every 8 hr x 7-10 days

Acyclovir (Ophthalmic)

Avaclyr

Acyclovir (Topical, Buccal)

Sitavig, Zovirax

«b»Buccal Tablet Administration«/b» - Apply within 1 hour after onset of prodromal symptoms and before appearance of any signs of lesions - Apply tablet with a dry finger immediately after removing it from packaging blister - Place tablets to the upper gum just above the incisor tooth (canine fossa) on the same side of the mouth as the prodromal symptoms and hold in place with slight pressure over the upper lip for 30 seconds to ensure adhesion - The rounded side of the tablet should be placed on the upper gum (for comfort purposes, does not affect efficacy) - Do not crush, chew, suck, or swallow - If tablet falls off within the first 6 hours, reposition the same tablet immediately or apply a new tablet - If tablet is swallowed within the first 6 hours, drink a glass of water and apply a new tablet - If tablet falls out or is swallowed after the first 6 hours, do not reapply. - Patients may eat and drink normally while tablet is in place - Avoid gum chewing, brushing teeth, wearing an upper denture or touching/pressing the tablet after placement - Rinse mouth gently if teeth need to be cleaned while the tablet is in place - Drink plenty of liquids in case of dry mouth. «b»Topical Cream Administration«/b» - Apply as early as possible following the onset of prodromal symptoms or when lesions appear - Not for use on the genitals - Ensure the face and/or lips are clean and dry - Not for use in the eye, mouth or mucous membranes. Wash hands with soap and water prior to application and after application - Apply an amount to sufficiently cover the affected area, including the outer margin - Avoid unnecessary rubbing of the affected area - Do not apply other topical products to the affected area during therapy. «b»Topical Ointment Administration«/b» - Apply as early as possible following the onset of prodromal symptoms or when lesions appear - Not for use in the eye - Apply using a finger cot or rubber glove to avoid transmission to other parts of the body or to other persons.

Acyclovir-Hydrocortisone

Xerese, Xerclear

Adalimumab

Abrilada, Amjevita, Cyltezo, Hadlima, Hyrimoz, Hulio, Humira, Simlandi, Yusimry

«bu»Ankylosing Spondylitis«/bu» - 40 mg SC every other week - May continue methotrexate, other nonbiologic DMARDS, corticosteroids, NSAIDs and/or analgesics «bu»Crohn Disease«/bu» - 160 mg SC (given on day 1 or split and given over 2 consecutive days) THEN, - 80 mg SC 2 weeks later (day 15) «b»Maintenance Dose«/b» - 40 mg SC every other week beginning day 29 - Some patients may require 40 mg every week as maintenance therapy - May continue aminosalicylates and/or corticosteroids; if necessary, azathioprine, mercaptopurine, or methotrexate may also be continued «bu»Hidradenitis Suppurativa«/bu» Humira Only «b»Initial Dose«/b» - 160 mg SC (given on day 1 or split and given over 2 consecutive days) THEN - 80 mg SC 2 weeks later (day 15) «b»Maintenance Dose«/b» - 40 mg SC every week beginning day 29 «bu»Plaque Psoriasis«/bu» «b»Initial Dose«/b» - 80 mg SC x 1 dose «b»Maintenance Dose«/b» - 40 mg every other week beginning 1 week after initial dose «bu»Psoriatic Arthritis«/bu» - 40 mg SC every other week - May continue methotrexate, other nonbiologic DMARDS, corticosteroids, NSAIDs and/or analgesics «bu»Pyoderma Gangrenosum«/bu» - 40 to 80 mg SC every week or every other week «bu»Rheumatoid Arthritis«/bu» - 40 mg SC every other week - May continue methotrexate, other nonbiologic DMARDS, corticosteroids, NSAIDs, and/or analgesics - Patients not taking concomitant methotrexate may increase dose to 40 mg every week «bu»Ulcerative Colitis«/bu» «b»Initial Dose«/b» - 160 mg SC (given on day 1 or split and given over 2 consecutive days) THEN - 80 mg SC 2 weeks later (day 15) «b»Maintenance Dose«/b» - 40 mg SC every other week beginning day 29 - Only continue maintenance dose in patients demonstrating clinical remission by 8 weeks (day 57) of therapy. - May continue aminosalicylates and/or corticosteroids; if necessary, azathioprine, or mercaptopurine may also be continued) «bu»Uveitis«/bu» Humira only «b»Initial Dose«/b» - 80 mg SC x 1 dose «b»Maintenance Dose«/b» - 40 mg SC every other week beginning 1 week after initial dose

Adapalene

Differin

Adapalene-Benzoyl Peroxide

Epiduo, Epiduo Forte

Adefovir

Hepsera, Adefovir Dipivoxil

Adenosine

Adenocard, Adenoscan

Adenovirus Types 4 and 7

Adenovirus

AdoTrastuzumab Emtansine

Kadcyla

- Do not substitute ado-trastuzumab emtansine (US) or trastuzumab emtansine (Canada) for or with conventional trastuzumab; products are different and are NOT interchangeable. «bu»Breast Cancer«/bu» «b»Metastatic, HER2+«/b» - 3.6 mg/kg IV every 3 weeks until disease progression or unacceptable toxicity Maximum Dose - 3.6 mg/kg Missed or Delayed Doses - If a planned dose is missed or delayed, administer as soon as possible (at the dose and rate most recently tolerated), do not wait until the next planned cycle - Then adjust schedule to maintain a 3-week interval between doses. - After a dose reduction is implemented, do not re-escalate dose. Infusion-related Reaction - Slow infusion rate or interrupt infusion - Permanently discontinue if life-threatening infusion reactions occur. «b»Dose Levels for Dosage Reductions and/or Discontinuation«/b» Starting Dose - 3.6 mg/kg First Dose Reduction - Reduce dose to 3 mg/kg Second Dose Reduction - Reduce dose to 2.4 mg/kg Further Reductions Necessary - Discontinue treatment «b»Hematologic Toxicity«/b» Grade 3 Thrombocytopenia - Platelets 25,000/mm3 to <50,000/mm3 - Withhold treatment until platelet count recovers to ≤ grade 1 (platelets ≥75,000/mm3), then resume treatment at the same dose level. Grade 4 Thrombocytopenia - Platelets <25,000/mm3 - Withhold treatment until platelet count recovers to ≤ grade 1 (platelets ≥75,000/mm3), then resume treatment with one dose level reduction. «b»Cardiotoxicity«/b» LVEF >45% - Continue treatment. LVEF 40% to ≤45% and Decrease <10% Points from Baseline - Continue treatment and repeat LVEF assessment within 3 weeks. LVEF 40% to ≤45% and Decrease is ≥10% Points from Baseline - Withhold treatment and repeat LVEF assessment within 3 weeks; if repeat LVEF has not recovered to within 10% points from baseline, discontinue treatment. LVEF <40% - Withhold treatment and repeat LVEF assessment within 3 weeks - If repeat LVEF is confirmed <40%, discontinue treatment. HF (Symptomatic) - Discontinue treatment Peripheral Neuropathy, Grade 3 or 4 - Temporarily discontinue until resolves to ≤ grade 2. «b»Pulmonary Toxicity«/b» Interstitial Lung Disease or Pneumonitis - Permanently discontinue

Aducanumab

Aduhelm

Afamelanotide

Scenesse

Afatinib

Gilotrif

«bu»Non-small Cell Lung Cancer (NSCLC), Metastatic«/bu» - EGFR exon 19 deletions or exon 21 (L858R) substitution mutations - 40 mg once daily until disease progression or unacceptable toxicity «bu»Non-small Cell Lung Cancer (NSCLC), Metastatic Squamous«/bu» - 40 mg PO daily until disease progression or unacceptable toxicity «b»Missed Doses«/b» - Do not take a missed dose within 12 hours of next dose «b»Limitations of Use«/b» - Safety and efficacy have not been established in patients whose tumors express EGFR mutations other than exon 19 deletion or exon 21 (L858R) substitution. «b»P-gp Inhibitors«/b» - If concomitant therapy is not tolerated, reduce afatinib daily dose by 10 mg - Upon discontinuation of the P-gp inhibitor, resume previous dose as tolerated. «b»P-gp Inducers«/b» - Increase afatinib daily dose by 10 mg as tolerated if on chronic concomitant therapy with a P-gp inducer - Resume previous dose 2 to 3 days after discontinuation of P-gp inducer - Permanently discontinue for intolerability or severe reaction occurring at a dose of 20 mg daily. «b»Cardiovascular«/b» - Permanently discontinue for symptomatic left ventricular dysfunction. «b»Dermatologic«/b» - Withhold therapy for prolonged (>7 days) or intolerable grade 2 or higher cutaneous reactions - Upon improvement to baseline or ≤ grade 1, resume therapy at 10 mg per day less than previous dose - Discontinue permanently for life-threatening bullous, blistering, or exfoliative skin lesions, as well as for suspected toxic epidermal necrolysis (TEN) or Stevens Johnson syndrome (SJS). «b»Gastrointestinal«/b» «bi»Diarrhea«/bi» - Grade 2 or higher diarrhea that persists for ≥2 consecutive days despite antidiarrheal therapy: Interrupt therapy until resolution to ≤ grade 1, then resume at 10 mg per day less than previous dose. «bi»Nausea/Vomiting«/bi» - For intolerable grade 2 or persistent (≥7 days) nausea/vomiting despite antiemetic therapy, the following recommendations have been made: Interrupt therapy for up to 14 days until resolution to ≤ grade 1, then resume at 10 mg per day less than previous dose; if symptoms do not resolve within 14 days, discontinue permanently. «b»Ocular«/b» - Interrupt therapy for suspected keratitis; consider discontinuation if diagnosis of ulcerative keratitis is confirmed. Permanently discontinue for persistent ulcerative keratitis. «b»Pulmonary«/b» - Interrupt therapy for suspected interstitial lung disease (ILD); permanently discontinue if diagnosis is confirmed. «b»Other Toxicity«/b» «bi»Grade 3 or Higher Adverse Reactions«/bi» - Withhold therapy for ≥ grade 3 adverse reactions. Upon improvement to baseline or ≤ grade 1, resume therapy at 10 mg per day less than previous dose.

Aflibercept

Eylea

«b»Intravitreal Administration«/b» - For ophthalmic intravitreal injection only - Each vial should only be used for the treatment of a single eye. - If the contralateral eye requires treatment, a new vial should be used and the sterile field, syringe, gloves, drapes, eyelid speculum, filter, and injection needles should be changed before aflibercept is administered to the other eye. - Inspect vial prior to administration; do not use if particulates, cloudiness, or discoloration are present. - Intravitreal injection should be done under aseptic conditions, which include surgical hand disinfection and the use of sterile gloves, a sterile drape, and a sterile eyelid speculum (or equivalent). - Prior to injection, adequate anesthesia and a topical broad–spectrum microbicide - Monitor patient immediately following administration for elevation in intraocular pressure - Appropriate monitoring may consist of a check for perfusion of the optic nerve head or tonometry - If required, a sterile paracentesis needle should be available - If contralateral eye requires treatment, use a new sterile prefilled syringe or vial and change the sterile field, syringe, gloves, drapes, eyelid speculum, filter, and injection needles before administration to the other eye - After injection, discard any unused product «b»Reconstitution«/b» - Using aseptic technique, remove entire contents of vial using a 5 micron, 19-gauge 11/2 inch filter needle (supplied) attached to a 1 mL syringe (supplied); keep the needle bevel submerged to avoid introducing excess air. - Draw plunger rod back to completely empty the filter needle, then remove and discard filter needle and replace with a sterile 30-gauge 1/2 inch needle (supplied) for intravitreal injection procedure (do not use filter needle for intravitreal injection). - Expel air bubbles and slowly depress plunger to expel excess medication (plunger tip should align with the 0.05 mL marking on syringe). - The intravitreal injection should be performed under controlled aseptic conditions, which include surgical hand disinfection and the use of sterile gloves, a sterile drape, and a sterile eyelid speculum (or equivalent). - Adequate anesthesia and a topical broad-spectrum antimicrobial agent should be administered prior to the procedure

Agalsidase Alfa

Replagal

Agalsidase Beta

Fabrazyme

Albendazole

Albenza

Albiglutide

Tanzeum

Albumin Human

Buminate, Plasbumin, Human Albumin Grifols, Albuminar, Alba, Albuked, Albutein, Flexbumin, Kedbumin

Albuterol

ProAir HFA, Proventil HFA, Ventolin HFA, VoSpire

Albuterol-Budesonide

Airsupra Inhalation Aerosol

Alcaftadine

Lastacaft

Alclometasone

Aclovate

Aldesleukin

Proleukin, Thymocyte Stimulating Factor

«bu»Metastatic Renal Cell Carcinoma«/bu» - 600,000 units/kg IV every 8 hours - Maximum of 14 doses - Repeat after 9 days for a total of 28 doses per course - Re-treat if tumor shrinkage observed (and if no contraindications) at least 7 weeks after hospital discharge date «b»Off-label Dosing«/b» - 720,000 units/kg every IV 8 hours for up to 12 doses - Repeat with a second cycle 10 to 15 days later «bu»Metastatic Melanoma«/bu» «b»Single-agent Use«/b» - 600,000 units/kg every IV 8 hours - Maximum of 14 doses - Repeat after 9 days for a total of 28 doses per course - Re-treat if tumor shrinkage observed (and if no contraindications) at least 7 weeks after hospital discharge date «b»Off-label Dosing«/b» - 720,000 units/kg IV every 8 hours for 12 to 15 doses - Repeat with a second cycle ~14 days after the first dose of the initial cycle «b»Combination Biochemotherapy«/b» - 9 million units/m2/day IV infusion over 24 hours for 4 days every 3 weeks x up to 4 cycles - 9 million units/m2/day IV infusion over 24 hours days 5 to 8, 17 to 20, and 26 to 29 every 42 days x up to 5 cycles - 9 million units/m2/day IV infusion over 24 hours for 4 days every 3 weeks x 6 cycles «b»Re-treatment with Aldesleukin is Contraindicated with the Following Toxicities«/b» - Sustained ventricular tachycardia (≥5 beats) - Uncontrolled or unresponsive cardiac arrhythmias - Chest pain with ECG changes consistent with angina or MI - Cardiac tamponade - Intubation >72 hours - Renal failure requiring dialysis for >72 hours - Coma or toxic psychosis lasting >48 hours - Repetitive or refractory seizures - Bowel ischemia/perforation - GI bleeding requiring surgery «b»Limitations of Use«/b» - Careful patient selection is necessary. - Assess performance status (PS); patients with a more favorable PS (Eastern Cooperative Oncology Group [ECOG] PS 0) at treatment initiation respond better to aldesleukin (higher response rate and lower toxicity). - Experience in patients with ECOG PS >1 is limited «b»Premedication Prior to IV Administration«/b» - Consider premedication with an antipyretic to reduce fever, an H2 antagonist for prophylaxis of gastrointestinal irritation/bleeding, antiemetics, and antidiarrheals; continue for 12 hours after the last aldesleukin dose - Antibiotic prophylaxis is recommended to reduce the incidence of infection. - Aldesleukin doses >12 to 15 million units/m2 are associated with a moderate emetic potential; antiemetics are recommended to prevent nausea and vomiting.

Alectinib

Alecensa

Alemtuzumab

Campath, Lemtrada, MabCampath

Alendronate

Fosamax, Binosto

Alendronate-Cholecalciferol

Fosamax Plus D

Alfentanil

Alfentanyl, Alfenta, Rapifen

Alfuzosin

Alfutral, UroXatral, Xatral

Alirocumab

Praluent

Aliskiren

Tekturna

Aliskiren-Amlodipine

Tekamlo

Aliskiren-Amlodipine-Hydrochlorothiazide

Amturnide

Aliskiren-Hydrochlorothiazide

Tekturna HCT

Alitretinoin

Panretin

Allopurinol

Zyloprim, Aloprim

Almotriptan

Axert

Alogliptin

Nesina

Alogliptin-Metformin

Kazano

Alogliptin-Pioglitazone

Oseni

Alosetron

Lotronex

Alpelisib

Piqray, Vijoice

Alpha1 Proteinase Inhibitor

Glassia, Prolastin-C, Aralast NP, Zemaira

ALPRAZolam

Xanax, Xanax XR, Niravam

Alprostadil

Prostin VR, Edex, Caverject, Muse, Prostaglandin E

«bu»Erectile Dysfunction«/bu» «bi»Vasculogenic, Psychogenic or Mixed Etiology«/b» «bi»Caverject, Caverject Impulse, Edex«/bi» - Initiate dosage titration at 2.5 mcg x 1 dose intracavernous - If there is a partial response, increase dose by 2.5 mcg to a dose of 5 mcg (Caverject, Caverject Impulse) and 7.5mcg (Edex) and then, in increments of 5 to 10 mcg (depending on erectile response) until the dose that produces an erection suitable for intercourse and not exceeding a duration of 1 hour is reached. - Individualize dose by careful titration - Initial dose must be titrated in health care provider setting - No more than 2 doses during the initial titration should be given within a 24 hour period. - If there is a response, then there should be at least a 24 hour interval before the next dose is given. «b»Neurogenic (Spinal Cord Injury)«/b» «bi»Caverject«/bi» - Initiate dosage titration at 1.25 mcg - If there's a partial response, may increase to a dose of 2.5 mcg within 1 hour and if necessary, to a dose of 5 mcg - May increase further in increments of 5 mcg until the dose is reached that produces an erection suitable for intercourse, not lasting >1 hour. «bi»Maintenance Dose«/bi» - Once an appropriate dose has been determined, patient may self-administer injections at a frequency of no more than 3 times/week with at least 24 hours between doses. «b»Intraurethral«/b» «bi»Muse Pellet«/bi» Initial Dose - 125 to 250 mcg x 1 dose Maintenance Dose - Administer as needed to achieve an erection; duration of action is about 30 to 60 minutes - Use only two systems per 24-hour period «bu»Raynaud Phenomenon«/bu» «b»Loading Dose«/b» - 60 mcg IV over 3 hours once daily for 5 consecutive days «b»Maintenance Dose«/b» - 60 mcg IV over 3 hours once every 30 days for 2 doses OR - 60 mcg IV over 3 hours once daily for 6 consecutive days OR - 40 mcg (at a rate of 3 to 5 ng/kg/minute) bid for a minimum duration of 7 days and repeated every 3 to 4 weeks «b»Prostin VR Pediatric Adminstration«/b» «bi»Patent Ductus Arteriosus«/bi» - IV continuous infusion into a large vein or alternatively through an umbilical artery catheter placed at the ductal opening Maximum Recommended Concentration (IV Infusion) - 20 mcg/mL «b»Caverject Administration«/b» - Use a 1/2 inch, 29- or 30-gauge needle - Inject into the dorsolateral aspect of the proximal third of the penis, avoiding visible veins; alternate side of the penis for injections. - Compress the site of injection with an alcohol swab or sterile gauze for 5 minutes after administration. «b»Caverject Impulse Administration«/b» - Supplied as a disposable, single-dose, dual chamber syringe system - After attaching the provided needle assembly, select dose and inject into the dorsolateral aspect of the proximal third of the penis, avoiding visible veins; alternate side of the penis for injections. - Compress the site of injection with an alcohol swab or sterile gauze for 5 minutes after administration. «b»Edex Administration«/b» - Use a 1/2 inch, 27- to 30-gauge needle - Inject into the dorsolateral aspect of the proximal third of the penis, avoiding visible veins; alternate side of the penis for injections - Administer over a 5- to 10-second interval - Compress the site of injection with an alcohol swab for 5 minutes after administration. «b»Caverject Impulse«/b» - Provided as a dual-chamber syringe with diluent in one chamber - To mix, hold syringe with needle pointing upward and rotate plunger clockwise until it goes all the way in and stops (do not push on the plunger while trying to rotate it); turn upside down several times to evenly mix solution. - Device can be set to deliver specified dose, each device can be set at various increments. «b»Caverject Powder«/b» - Use only the supplied diluent for reconstitution (bacteriostatic/sterile water with benzyl alcohol 0.945%) «b»Edex Reconstitution«/b» - Reconstitute with NS; use immediately following reconstitution. - Discard any remaining solution in cartridge. «b»Prostin VR Pediatric Reconstitution«/b» - Prior to infusion, dilute with D5W, D10W, or NS to a maximum concentration of 20 mcg/mL per the manufacturer; use within 24 hours - Refer to manufacturer's labeling for detailed dilution recommendations. - Avoid direct contact of undiluted alprostadil with the plastic walls of volumetric infusion chambers because the drug will interact with the plastic and create a hazy solution; discard solution and volumetric chamber if this occurs.

Alteplase

Activase, Cathflo Activase, tPA, Tissue Plasminogen Activator

«bu»Acute Ischemic Stroke«/bu» «b»Recommended Total Dose«/b» - 0.9 mg/kg «b»Maximum Total Dose«/b» - 90 mg «b»Weight ≤100 kg«/b» Loading Dose - 0.09 mg/kg (10% of 0.9 mg/kg dose) IV bolus over 1 minute Maintenance Dose - 0.81 mg/kg (90% of 0.9 mg/kg dose) IV continuous infusion over 60 minutes «b»Weight >100 kg«/b» Loading Dose - 9 mg (10% of 90 mg) IV bolus over 1 minute Maintenance Dose - 81 mg (90% of 90 mg) IV continuous infusion over 60 minutes «b»Recommended Criteria«/b» - Within 3 hours of the onset of symptom onset (label use) OR - within 3 to 4.5 hours of symptom onset (off-label use) - Perform non-contrast-enhanced CT or MRI prior to administration. - Initiation of anticoagulants (heparin) or antiplatelet agents (aspirin) within 24 hours after starting alteplase is not recommended; however, initiation of aspirin within 24 to 48 hours after stroke onset is recommended «bu»Acute Peripheral Arterial Occlusion«/bu» «b»Weight-based Regimen«/b» - Intra-arterial Route Initial Dose - 0.001 to 0.02 mg/kg/hour intra-arterial infusion Maximum Dose - 2 mg/hour «b»Fixed-dose Regimen«/b» - 0.12 to 2 mg/hour intra-arterial continuous infusion «bu»Central Venous Catheter Clearance«/bu» Cathflo Activase (1 mg/mL) Intracatheter «b»Weight <30 kg«/b» - 110% of the internal lumen volume of the catheter - Not to exceed 2 mg/2 mL - Retain in catheter for 0.5 to 2 hours - May instill a second dose if catheter remains occluded. «b»Weight ≥30 kg«/b» - 2 mg/2 mL - Retain in catheter for 0.5 to 2 hours - May instill a second dose if catheter remains occluded «bu»Frostbite«/bu» - For use in patients with deep frostbite injury with potential significant morbidity (extending proximally to the proximal interphalangeal joints of digits), without contraindications to the use of alteplase, who present within 24 hours of injury. - Use of alteplase in the field is not recommended - Administer treatment in a facility capable of intensive-care monitoring «b»Intra-arterial«/b» - 2 to 4 mg bolus x 1 dose, followed by - 0.5 to 1 mg/hour continuous intra-arterial infusion (total dose if bilateral extremity involvement) via femoral or brachial artery - Administer with continuous infusion heparin via an intra-arterial catheter. - Discontinue alteplase if fibrinogen levels decrease to <150 mg/dL, if reperfusion is complete (as evidenced by angiography), or after a period of 48 hours whether or not reperfusion is achieved «bu»Parapneumonic Effusions and Empyema«/bu» - Intrapleural Route - 10 mg (diluted in 30 mL of NS) bid x total of 3 days - Each alteplase dose was followed >2 hours later by an intrapleural dornase alfa dose (with a 1-hour dwell time for each drug) «bu»Acute Pulmonary Embolism«/bu» «b»Hemodynamically Stable/Submassive«/b» - 100 mg as an infusion over 2 hours - Institute or resume parenteral anticoagulation near the end of or immediately following the alteplase infusion when the partial thromboplastin time or thrombin time returns to twice normal or less. - Not recommended for most patients with acute PE without hypotension - Use only in select patients showing signs of clinical deterioration despite maintaining a systolic BP >90 mm Hg where benefits outweigh risks «b»Hemodynamically Unstable/Massive«/b» - 100 mg as an infusion over 2 hours - Institute or resume parenteral anticoagulation near the end of or immediately following the alteplase infusion when the partial thromboplastin time or thrombin time returns to twice normal or less. «bu»Catheter-Directed Thrombolysis«/bu» - 24 mg administered either as 1 mg/hour for 24 hours via a unilateral catheter or as 1 mg/hour/catheter for 12 hours via bilateral catheters. - Due to insufficient evidence, catheter directed thrombolysis (CDT) is not recommended for acute PE unless there is access to the expertise and resources necessary to perform CDT; intravenous administration of a systemic thrombolytic is preferred. «b»Associated with Cardiac Arrest«/b» - IV or Intraosseous (if IV access cannot be obtained) - 50 mg IV/IO bolus over 2 minutes - Repeat a second 50 mg bolus 15 minutes later if return of spontaneous circulation (ROSC) is not achieved. - Early administration is recommended when PE is presumed or confirmed. - Systemic anticoagulation (unfractionated heparin) should be administered with or shortly after administration of alteplase - When administered via intraosseous catheter, monitor for extravasation and subcutaneous bleeding at the intraosseous catheter insertion site «bu»ST-Elevation MI (STEMI)«/bu» «b»3-hour Infusion Regimen«/b» «bi»Weight ≥65 kg«/bi» - 6 to 10 mg IV bolus over 1 to 2 minutes THEN, - 50 to 54 mg IV infusion rest of the 1st hour THEN, - 20 mg IV infusion over 2nd hour THEN, - 20 mg IV infusion over 3rd hour - Maximum Total Dose: 100 mg «bi»Weight <65 kg«/bi» - 0.075 mg/kg IV bolus over 1 to 2 minutes THEN, - 0.675 mg/kg IV infusion rest of the 1st hour THEN, - 0.25 mg/kg IV infusion over 2nd hour THEN, - 0.25 mg/kg IV infusion over 3rd hour - Maximum Total Dose: 100 mg «b»Accelerated (1.5-hour) Regimen«/b» «bi»Weight >67 kg«/bi» - 15 mg IV bolus over 1 to 2 minutes THEN, - 50 mg IV infusion over 30 minutes THEN, - 35 mg over infusion over 1 hour - Maximum Total Dose: 100 mg - Total Dose: 100 mg over 1.5 hours «bi»Weight ≤67 kg«/bi» - 15 mg IV bolus over 1 to 2 minutes THEN, - 0.75 mg/kg (not to exceed 50 mg) over 30 minutes THEN, - 0.5 mg/kg (not to exceed 35 mg) over 1 hour - Maximum Total Dose: 100 mg - Thrombolytic should be administered within 30 minutes of hospital arrival «b»Limitations of Use«/b» - The risk of stroke may outweigh the benefit produced by thrombolytic therapy in patients whose acute myocardial infarction (MI) puts them at low risk for death or heart failure. «b»Recommended Criteria for Treatment«/b» «bi»STEMI (ACCF/AHA)«/bi» - Ischemic symptoms within 12 hours of treatment or evidence of ongoing ischemia 12 to 24 hours after symptom onset with a large area of myocardium at risk or hemodynamic instability. «bi»STEMI ECG Definition«/bi» - New ST-segment elevation at the J point in at least 2 contiguous leads of ≥2 mm (0.2 mV) in men or ≥1.5 mm (0.15 mV) in women in leads V2-V3 and/or of ≥1 mm (0.1 mV) in other contiguous precordial leads or limb leads. New or presumably new left bundle branch block (LBBB) may interfere with ST-elevation analysis and should not be considered diagnostic in isolation. - At non-PCI-capable hospitals, the ACCF/AHA recommends thrombolytic therapy administration when the anticipated first medical contact (FMC)-to-device time at a PCI-capable hospital is >120 minutes due to unavoidable delays. «bu»IV Activase«/bu» «b»ST-elevation MI or Acute Ischemic Stroke«/b» - Administer bolus dose (prepared by one of three methods) over 1 minute followed by an infusion. «bi»Infusion«/bi» - Remaining dose for STEMI or AIS may be administered as follows: Any quantity of drug not to be administered to the patient must be removed from vial(s) prior to administration of remaining dose. «bi»50 mg Vial«/bi» - Either PVC bag or glass vial and infusion set «bi»100 mg Vial«/bi» - Insert spike end of the infusion set through the same puncture site created by transfer device and infuse from vial. - If further dilution is desired, may be diluted in equal volume of 0.9% sodium chloride or D5W to yield a final concentration of 0.5 mg/mL. «b»PE Hemodynamically Unstable/mMssive or Stable/Submassive«/b» (off-label use) - Administer as an IV infusion using a peripheral vein «b»PE Associated with Cardiac Arrest«/b» (off-label use) - During cardiopulmonary resuscitation, administer as a rapid IV bolus over 2 minutes. - When IV access cannot be established, some experts have suggested administration via intraosseous catheter; must monitor for extravasation and subcutaneous bleeding at the intraosseous catheter insertion site «b»Intracatheter«/b» «bi»Cathflo Activase«/bi» - Instill dose into occluded catheter. - Do not force solution into catheter. - After a 30-minute dwell time, assess catheter function by attempting to aspirate blood. - If catheter is functional, aspirate 4 to 5 mL of blood in patients ≥10 kg or 3 mL in patients <10 kg to remove Cathflo Activase and residual clots. - Gently irrigate the catheter with NS. - If catheter remains nonfunctional, let Cathflo Activase dwell for another 90 minutes (total dwell time: 120 minutes) and reassess function. - If catheter function is not restored, a second dose may be instilled. «b»Intrapleural Parapneumonic Pleural Effusions and Empyemas«/b» (off-label use) - Instill dose into chest tube and clamp drain. - Although the optimum dwell time has not been determined, clinical trials more often have used either a 45-minute (Hawkins 2004) or 1-hour dwell time; after dwell period, release clamp and connect chest tube to continuous suction. «bi»50 mg Vial Activase «/bi» - Use accompanying diluent (50 mL vial of sterile water for injection) - Let stand undisturbed for several minutes to allow large bubbles to dissipate - Mix by gentle swirling and/or slow inversion; do not shake - Vacuum is present in 50 mg vial. Final concentration: 1 mg/mL. «bi»100 mg Vial Activase«/bi» - Use transfer set with accompanying diluent (100 mL vial of sterile water for injection) - Let stand undisturbed for several minutes to allow large bubbles to dissipate - Mix by gentle swirling; do not shake. No vacuum is present in 100 mg vial. Final concentration: 1 mg/mL. «b»ST-elevation MI«/b» «bi»Activase Accelerated Infusion«/bi» - Bolus dose may be prepared by one of three methods: - 1) Removal of 15 mL reconstituted (1 mg/mL) solution from vial - 2) Removal of 15 mL from a port on the infusion line after priming - 3) Programming an infusion pump to deliver a 15 mL bolus at the initiation of infusion «b»Ischemic Stroke«/b» «bi»Activase«/bi» Bolus dose (10% of total dose) may be prepared by one of three methods: - 1) Removal of the appropriate volume from reconstituted solution (1 mg/mL) - 2) Removal of the appropriate volume from a port on the infusion line after priming - 3) Programming an infusion pump to deliver the appropriate volume at the initiation of infusion «b»Cathflo Activase«/b» - Add 2.2 mL sterile water for injection to vial - Let the vial stand undisturbed to allow large bubbles to dissipate - Mix by gently swirling until completely dissolved (complete dissolution should occur within 3 minutes); do not shake - Final concentration: 1 mg/mL

Altretamine

Hexalen

Alvimopan

Entereg

Amantadine

Symmetrel, Gocovri, Osmolex ER

Ambrisentan

Letairis

Amcinonide

Amcort, Cyclocort

Amifampridine

Firdapse, Ruzurgi

Amifostine

Ethyol, Ethiofos, Gammaphos

Amikacin

Amikin

«bu»General Dosing, Severe, Susceptible Infections«/bu» «b»Infants, Children, and Adolescents«/b» - 15 to 22.5 mg/kg/day IV divided every 8 hours or - 15 to 20 mg/kg/dose every 24 hours - Dosage should be based on an estimate of ideal body weight. In morbidly obese children and adolescents, dosage requirement may best be estimated using a dosing weight of IBW + 0.4 (TBW - IBW) «bu»Meningitis«/bu» «b»Infants and Children«/b» - 20 to 30 mg/kg/day divided every 8 hours «b»Adolescents«/b» - 15 mg/kg/day IV divided every 8 hours «bu»VP-shunt Infection, Ventriculitis«/bu» «b»Infants, Children, and Adolescents«/b» - Intraventricular/intrathecal (use a preservative free preparation) - 5 to 50 mg IV daily - Usual Dose: 30 mg/day «bu»Cystic Fibrosis, Pulmonary Infection«/bu» «b»Infants, Children, and Adolescents«/b» - Traditional Dosing: 10 mg/kg/dose IV/IM every 8 hours - Extended-Interval Dosing: 30 mg/kg/dose IV every 24 hours - The CF Foundation recommends extended-interval dosing as preferred over traditional dosing. «bu»Cystic Fibrosis, Pulmonary Infection«/bu» - Inhalation for nebulization «b»Adolescents ≥14 years«/b» - Monotherapy: Refer to adult dosing «b»Children ≥3 years and Adolescents«/b» - Adjunctive therapy: Refer to adult dosing «bu»Endocarditis Treatment«/bu» «b»Children and Adolescents«/b» - 15 mg/kg/day IV divided every 8 to 12 hours - Use in combination with other antibiotics dependent upon organism and source of infection (valve-type) «bu»Intra-abdominal Infection, Complicated«/bu» «b»Infants, Children, and Adolescents«/b» - 15 to 22.5 mg/kg/day IV divided every 8 to 24 hours «bu»Mycobacterium, Avium Complex Infection (MAC)«/bu» HIV-exposed/-positive «b»Infants and Children«/b» - 15 to 30 mg/kg/day IV divided every 12 to 24 hours as part of a multiple drug regimen - Maximum Daily Dose: 1,500 mg/day «b»Adolescents«/b» - 10 to 15 mg/kg/day IV every 24 hours as part of a multiple drug regimen «bu»Peritonitis (CAPD)«/bu» «b»Infants, Children, and Adolescents«/b» - Intraperitoneal: Continuous - Loading Dose: 25 mg per liter of dialysate - Maintenance Dose: 12 mg per liter «bu»Tuberculosis, Drug-Resistant«/bu» «b»Infants, Children, and Adolescents ≤14 years«/b» - 15 to 30 mg/kg/dose IV/IM once daily as part of a multiple drug regimen - Maximum Daily Dose: 1,000 mg/day «b»Adolescents ≥15 years, HIV-exposed/-positive«/b» - 15 mg/kg/dose IV/IM once daily as part of a multiple drug regimen for the first 2 to 3 months - Maximum Daily Dose: 1,000 mg/day

Amikacin Liposome Inhalation

Arikayce

AMILoride

Midamor

AMILoride-HydroCHLOROthiazide

Moduretic

Amino Acid Electrolyte Infusion

Aminosyn, Clinimix, Clinisol, FreAmine, Hepatamine, NephrAmine, Plenamine, Premasol, Prosol, Synthamin, Travasol, TrophAmine

Aminocaproic Acid

Amicar

«bu»Acute Bleeding«/bu» «b»Loading Dose«/b» - 4 to 5 g IV during the first hour «b»Maintenance Dose«/b» - 1 g/hour IV x 8 hours (or 1.25 g/hour PO) or until bleeding controlled «b»Maximum Daily Dose«/b» - 30 g «bu»Control of Bleeding with Severe Thrombocytopenia«/bu» «b»Loading Dose«/b» - 100 mg/kg (maximum dose: 5 g) IV over 30 to 60 minutes «b»Maintenance Dose«/b» - 1 to 4 g IV/PO every 4 to 8 hours or 1 g/hour «b»Maximum Daily Dose«/b» - 24 g «bu»Control of Oral Bleeding in Congenital and Acquired Coagulation Disorder«/bu» - 50 to 60 mg/kg PO every 4 hours «bu»Control of Refractory Bleeding Associated with Extracorporeal Membrane Oxygenation«/bu» «b»Loading Dose«/b» - 4 to 5 g IV x 1 dose «b»Maintenance Dose«/b» - 1 to 1.25 g/hour IV infusion until bleeding controlled «bu»Intracranial Hemorrhage Associated with Thrombolytics«/bu» - Plasminogen-activator: Alteplase, Rteplase, Tenecteplase - 4 to 5 g IV (as an alternative to cryoprecipitate) - Check fibrinogen levels after administration, if fibrinogen <150 mg/dL, cryoprecipitate is recommended. «bu»Prevention of Dental Procedure Bleeding«/bu» «b»Oral Anticoagulant Therapy«/b» - Hold 4 g/10 mL in mouth for 2 minutes then spit out - Repeat every 6 hours for 2 days after procedure - Concentration and frequency may vary by institution and product availability. «bu»Prevention of Perioperative Bleeding«/bu» «b»Cardiac Surgery«/b» - Loading Dose: 75 to 150 mg/kg IV (typically 5 to 10 g) - Maintenance Dose: 10 to 15 mg/kg/hour (typically 1 g/hour) - May add 2 to 2.5 g/L of cardiopulmonary bypass circuit priming solution - Loading Dose: 10 g IV x 1 dose - Maintenance Dose: 2 g/hour during surgery - No medication added to the bypass circuit - Loading Dose: 10 g over 20 to 30 minutes prior to skin incision, then, - 10 g after heparin administration, then, - 10 g at discontinuation of cardiopulmonary bypass «bu»Subarachnoid Hemorrhage«/bu» - 4 g IV - 1 g/hour infusion for up to 72 hours after SAH onset - Discontinue infusion 4 hours prior to angiography or 2 hours prior to endovascular ablation of aneurysm «bu»Traumatic Hyphema«/bu» - 50 mg/kg/dose PO every 4 hours «b»Maximum Daily Dose«/b» - 30 g for 5 day

Aminolevulinic Acid

Ameluz (Topical), Levulan Kerastick (Topical)

- Should only be applied by qualified medical personnel (not intended for application by patients). - For topical use only - Not for ophthalmic, oral, or intravaginal use - During light treatment, both patients and health care personnel should wear appropriate eye protection. «b»Gel Administration«/b» - Carefully wipe all lesions with an ethanol or isopropanol-soaked cotton pad (to degrease skin) and remove any scaling or crusts prior to application - Gently roughen lesion surfaces (avoid bleeding) - Using a gloved fingertip or a spatula, apply gel ~1 mm thick and include ~5 mm of surrounding skin - Application area should not exceed 20 cm2 and no more than 2 g should be used at one time - May be applied to healthy skin around the lesion(s) - Avoid mucous membranes (eyes, nostrils, mouth or ears); maintain a distance of 1 cm from these areas; rinse thoroughly if accidental contact with these areas occurs - Allow gel to dry ~10 minutes before covering with a light-blocking occlusive dressing. - After 3 hours, remove dressing and wipe off residual gel. Immediately after removing dressing and residual gel, illuminate the treatment area with red light source - Position lamp 5 to 8 cm from patient’s skin - Healthy untreated skin does not need protection during illumination. - If unable to perform red light illumination within 3 hours of gel application, rinse off gel with saline and water. - rotect lesion sites and surrounding skin from sunlight or prolonged intense light (tanning beds, sun lamps) for 2 days. «b»Solution Administration«/b» - Clean and dry lesion prior to application - Dab lesion gently with wet applicator tip (apply enough to uniformly wet lesion without excess running or dripping) - Only apply to affected skin. Do not apply to periorbital area, ocular tissue, or mucosal surfaces - Allow to dry, then reapply to same lesion - Apply to either scalp or facial lesions, but not to both simultaneously - Follow application with blue light exposure in 14 to 18 hours - Do not wash the application area during the time between application and photosensitization; after photosensitization, gently rinse actinic keratosis with water and pat dry - Stinging or burning may occur during blue light treatment - Following blue light treatment, the lesion will temporarily redden, swell and/or scale, which should resolve within 4 weeks after treatment. - If unable to perform the blue light treatment after topical application or if treatment with the blue light is interrupted or stopped, advise patient to avoid sunlight/bright light exposure to treated lesions (and wear a wide brimmed hat or other protective apparel) for at least 40 hours after application (burning/stinging sensation may still occur). «b»Levulan Kerastick Administration«/b» - Prepare solution by holding applicator tube with cap pointing up, applying finger pressure to "Position A" on cardboard sleeve to crush ampul containing solution vehicle. - Apply finger pressure to "Position B" to crush ampul containing aminolevulinic acid powder - Shake gently for at least 30 seconds to dissolve; point applicator cap away from face while shaking tube - Remove cap; dab dry applicator tip on gauze pad until wet with solution.

Aminosalicylic Acid

Paser

Amiodarone

Cordarone, Pacerone, Nexterone

- Lower loading and maintenance doses are preferable in women and all patients with low body weight. «bu»Ventricular Arrhythmias«/bu» - Prevention of recurrent life-threatening ventricular arrhythmias (VF or hemodynamically unstable VT) «b»Initial Dose«/b» - 800 to 1600 mg PO daily in 1 to 2 doses for 1 to 3 weeks «b»Maintenance Dose«/b» - when adequate arrhythmia control is achieved, decrease to 600 to 800 mg daily in 1 to 2 doses for 1 month «b»Usual Maintenance Dose«/b» - 400 to 600 mg PO daily «bu»Pulseless Ventricular Tachycardia (VT)«/bu» «b»Initial Dose«/b» - 300 mg IV Push/IO rapid bolus - If pulseless VT or VF continues after subsequent defibrillation attempt or recurs, administer supplemental dose of 150 mg - In this setting, administering undiluted is preferred. - Experience limited with I.O. administration of amiodarone - Maximum recommended total daily dose is 2.2 g «b»Maintenance Dose«/b» - Upon return of spontaneous circulation, follow with an infusion of 1 mg/minute for 6 hours, then 0.5 mg/minute for 18 hours (mean daily doses >2.1 g daily have been associated with hypotension) «bu»Pulseless Ventricular Fibrillation (VF)«/bu» «b»Initial Dose«/b» - 300 mg IV Push/IO rapid bolus - If pulseless VT or VF continues after subsequent defibrillation attempt or recurs, administer supplemental dose of 150 mg - In this setting, administering undiluted is preferred. - Experience limited with I.O. administration of amiodarone - Maximum recommended total daily dose is 2.2 g «b»Maintenance Dose«/b» - Upon return of spontaneous circulation, follow with an infusion of 1 mg/minute for 6 hours, then 0.5 mg/minute for 18 hours (mean daily doses >2.1 g daily have been associated with hypotension). «bu»Stable Ventricular Tachycardia (VT)«/bu» «b»Initial Dose«/b» - 150 mg IV over 10 minutes «b»Maintenance Dose«/b» - 1 mg/minute IV for 6 hours THEN, - 0.5 mg/minute IV for at least 18 hours (total infusion duration: 24 hours) or until complete transition to oral «bu»Breakthrough Stable Ventricular Tachycardia (VT)«/bu» - 150 mg supplemental doses in 100 mL D5W or NS over 10 minutes (mean daily doses >2.1 g/day have been associated with hypotension) «bu»Atrial Fibrillation«/bu» «b»(1) Pharmacologic Cardioversion«/b» - 600 to 800 mg PO daily in divided doses until 10 g total THEN - 200 mg PO daily as maintenance - Maintenance dose of 100 mg PO daily is commonly used especially for the elderly or patients with low body mass «b»(2) Pharmacologic Cardioversion«/b» - 800 mg PO daily for 14 days THEN, - 600 mg PO daily for the next 14 days THEN, - 300 mg PO daily for the remainder of the first year THEN, - 200 mg PO daily thereafter «b»(3)Pharmacologic Cardioversion«/b» - 10 mg/kg/day PO x 14 days THEN, - 300 mg daily PO x 4 weeks THEN, - Maintenance dosage of 200 mg PO daily «b»(4)Pharmacologic Cardioversion«/b» - 150 mg IV over 10 minutes THEN, - 1 mg/minute IV for 6 hours THEN, - 0.5 mg/minute IV for 18 hours or change to oral maintenance dosing (100 to 200 mg once daily) «bu»Maintenance of Sinus Rhythm«/bu» - 400 to 600 mg PO daily in divided doses for 2 to 4 weeks THEN, - 100 to 200 mg PO daily maintenance dose «bu»Prevention of Postoperative Atrial Fibrillation and Atrial Flutter associated with Cardiothoracic Surgery«/bu» - A variety of regimens have been used in clinical trials, including oral and intravenous regimens: - 200 mg PO tid x 7 days prior to surgery THEN, - 200 mg PO daily until hospital discharge «b»Preoperative Regimen«/b» - 150 mg loading dose THEN, - 0.4 mg/kg/hour (~0.5 mg/minute for a 70 kg patient) for 3 days prior to surgery and for 5 days postoperative «b»Postoperative Regimen«/b» - Starting at postop recovery, 1000 mg infused over 24 hours for 2 days «bu»Heart Rate Control«/bu» «b»Loading Dose«/b» - 300 mg IV over 1 hour THEN, - 10 to 50 mg/hour IV over 24 hours followed by an oral maintenance dose «b»Maintenance Dose«/b» - 100 to 200 mg PO once daily - Amiodarone requires a longer time to achieve rate control as compared to nondihydropyridine calcium channel blockers (diltiazem) (7 hours vs 3 hours, respectively) «bu»Supraventricular Tachycardia (SVT)«/bu» - Amiodarone is usually reserved for use when other therapies have failed or are contraindicated - Most patients do not require chronic long-term treatment with antiarrhythmic therapy «b»(1)Pharmacologic Cardioversion«/b» Loading Dose - 400 to 600 mg PO daily in divided doses for 2 to 4 weeks - In an inpatient monitoring setting, loading doses up to 1,200 mg daily may be considered Maintenance Dose - 100 to 200 mg PO daily Maximum Maintenance Dose - 200 mg PO daily «b»(2)Pharmacologic Cardioversion«/b» - 150 mg IV over 10 minutes THEN, - 1 mg/minute for 6 hours THEN, - 0.5 mg/minute for 18 hours or may change to oral dosing «b»Conversion from IV to PO«/b» <1-week IV infusion - 800 to 1600 mg PO daily 1- to 3-week IV infusion - 600 to 800 mg PO daily >3-week IV infusion - 400 mg PO daily «b»Conversion from IV to Oral Therapy«/b» - Has not been formally evaluated - Some experts recommend a 1 to 2 day overlap when converting from IV to oral therapy especially when treating ventricular arrhythmias. «b»Conversion from PO to IV«/b» - During long-term amiodarone therapy (≥4 months), the mean plasma-elimination half-life of the active metabolite of amiodarone is 61 days. - Replacement therapy may not be necessary in such patients if oral therapy is discontinued for a period <2 weeks, since any changes in serum amiodarone concentrations during this period may not be clinically significant. «b»Oral Administration«/b» - Administer consistently with regard to meals. Take in divided doses with meals if GI upset occurs or if taking large daily dose. If GI intolerance occurs with single-dose therapy, use twice daily dosing. «b»IV Administration«/b» - For infusions >1 hour, use concentrations ≤2 mg/mL unless a central venous catheter is used; commercially-prepared premixed solutions in concentrations of 1.5 mg/mL and 1.8 mg/mL are available. Use only volumetric infusion pump; use of drop counting may lead to underdosage. Administer through an IV line located as centrally as possible. For continuous infusions, an in-line filter has been recommended during administration to reduce the incidence of phlebitis. During pulseless VT/VF, administering undiluted is preferred - The Handbook of Emergency Cardiovascular Care and the ACLS guidelines do not make any specific recommendations regarding dilution of amiodarone in this setting. - Adjust administration rate to urgency (give more slowly when perfusing arrhythmia present). Slow the infusion rate if hypotension or bradycardia develops. Infusions >2 hours must be administered in a non-PVC container (eg, glass or polyolefin). PVC tubing is recommended for administration regardless of infusion duration. Incompatible with heparin; flush with saline prior to and following infusion. Note: IV administration at lower flow rates (potentially associated with use in pediatrics) and higher concentrations than recommended may result in leaching of plasticizers (DEHP) from intravenous tubing. DEHP may adversely affect male reproductive tract development. Alternative means of dosing and administration (1 mg/kg aliquots) may need to be considered. «b»IV Reconstitution«/b» - Injection must be diluted in D5W before continuous IV infusion use. - Dilute to final concentration of 1 to 6 mg/mL. - Premixed solutions are available. «b»Oral Suspension Preparation«/b» - 5 mg/mL Oral Suspension - A 5 mg/mL oral suspension may be made with tablets and either a 1:1 mixture of Ora-Sweet and Ora-Plus or a 1:1 mixture of Ora-Sweet SF and Ora-Plus adjusted to a pH between 6-7 using a sodium bicarbonate solution (5 g/100 mL of distilled water). - Crush five 200 mg tablets in a mortar and reduce to a fine powder. - Add small portions of the chosen vehicle and mix to a uniform paste; mix while adding the vehicle in incremental proportions to almost 200 mL; transfer to a calibrated bottle, rinse mortar with vehicle, and add quantity of vehicle sufficient to make 200 mL. - Label “shake well” and “protect from light.” - Stable for 42 days at room temperature or 91 days refrigerated (preferred)

Amitriptyline

Elavil, Levate

«bu»Depression«/bu» Initial Dose - 25 to 50 mg daily single dose at bedtime or in divided doses; initial doses of 100 mg daily may be considered in hospitalized patients Maintenance Dose - May increase dose to 100 to 300 mg daily «bu»Chronic Pain Management«/bu» Initial Doe - 25 to 50 mg at bedtime Maintenance Dose - May increase as tolerated to 150 mg daily «bu»Diabetic Neuropathy«/bu» - 25 to 100 mg daily «bu»Fibromyalgia«/bu» - 10 to 50 mg daily at bedtime - Higher doses (50 mg) may not be more effective than lower doses «bu»Insomnia«/bu» - 25 to 100 mg daily at bedtime in healthy adults - Up to 150 mg daily in patients with depression «bu»Interstitial Cystitis (Bladder Pain Syndrome)«/bu» - 10 to 25 mg daily titrated weekly over several weeks to a target dose of 75 to 100 mg as tolerated «bu»Irritable Bowel Syndrome«/bu» Initial Dose - 10 to 25 mg daily at bedtime Maintenance Dose - May increase dose based on response and tolerability up to 75 mg «bu»Migraine Prophylaxis«/bu» Initial Dose - 10 to 25 mg at bedtime Maintenance Dose - May increase at weekly increments of 10 to 25 mg daily based on response and tolerability up to 150 mg daily «bu»Postherpetic Neuralgia«/bu» - 10 to 25 mg, given once daily at bedtime or divided into twice daily doses - Consider starting with 10 to 12.5 mg once daily at bedtime for patients older than 65 years. - Increase dose based on response and tolerability in increments of 10 to 25 mg every 2 to 7 days up to 200 mg/day «bu»Post-traumatic Stress Disorder (PTSD)«/bu» Initial Dose - 50 mg PO daily Maintenance Dose - May increase at 25 mg increments as tolerated to 100 mg within the first week - May increase to 150 mg daily, then, - May increase to 200 mg daily before the end of 2 weeks - Increase further if necessary and tolerated «bu»Sialorrhea«/bu» Initial Dose - 10 to 25 mg once daily at bedtime or 10 mg 3 times daily Maintenance Dose - May increase dose based on response and tolerability up to 100 mg/day «b»Discontinuation of Therapy«/b» - Upon discontinuation of antidepressant therapy, gradually taper the dose to minimize the incidence of withdrawal symptoms and allow for the detection of re-emerging symptoms. Evidence supporting ideal taper rates is limited. APA and NICE guidelines suggest tapering therapy over at least several weeks with consideration to the half-life of the antidepressant; antidepressants with a shorter half-life may need to be tapered more conservatively. In addition for long-term treated patients, WFSBP guidelines recommend tapering over 4 to 6 months. If intolerable withdrawal symptoms occur following a dose reduction, consider resuming the previously prescribed dose and/or decrease dose at a more gradual rate «b»Switching to or from an MAO Inhibitor«/b» - Allow 14 days to elapse between discontinuing an MAO inhibitor intended to treat depression and initiation of amitriptyline. - Allow 14 days to elapse between discontinuing amitriptyline and initiation of an MAO inhibitor intended to treat depression.

Amivantamab

Rybrevant

«bu»Non-Small Cell Lung Cancer (NSCLC)«/bu» - Dose based on baseline body weight «b»<80 kg«/b» Week 1, Day 1 - 350 mg IV x 1 dose Week 1, Day 2 - 700 mg IV x 1 dose Weeks 2-4 - 1050 mg IV weekly Subsequent weeks (after Week 4) - 1050 mg IV every 2 weeks - Continue until disease progression or unacceptable toxicity «b»≥80 kg«/b» Week 1, Day 1 - 350 mg IV x 1 dose Week 1, Day 2 - 1050 mg IV x 1 dose Weeks 2-4 - 1400 mg IV weekly Subsequent weeks (after Week 4) - 1400 mg IV every 2 weeks - Continue until disease progression or unacceptable toxicity «b»Premedication Before All Infusions«/b» - Administer both antihistamine and antipyretic IV 15-30 min or PO 30-60 min before infusion - Diphenhydramine (25-50 mg) or equivalent IV/PO - Acetaminophen (650-1000 mg) IV/PO «b»Premedication Before Week 1, Days 1 and 2 Doses«/b» - Dexamethasone (10 mg IV) or methylprednisolone (40 mg IV) or equivalent - Administer IV 45-60 min before infusion - May continue to premedicate for subsequent infusions, if necessary. «b»Contraception«/b» Females of Reproductive Potential - Use effective contraception during treatment and for 3 months after final dose «b»Dose Reductions for Adverse Reactions«/b» «bi»<80 kg«/bi» First Dose Reduction - 700 mg Second Dose Reduction - 350 mg «bi»≥80 kg«/bi» First Dose Reduction - 1050 mg Second Dose Reduction - 700 mg - Unable to tolerate second dose reduction: Discontinue treatment «b»Infusion-Related Reactions (IRRs)«/b» «bi»All Grades«/bi» - Interrupt infusion if suspected or confirmed and administer supportive care medications; monitor until symptoms resolve - Resume infusion at 50% of the infusion rate at which the reaction occurred; may increase rate in 30 minutes if no additional symptoms occur - Include corticosteroids with premedication for subsequent dose «bi»Permanently Discontinue«/bi» - Recurrent Grade 3 - Grade 4 «bi»Interstitial lLung Disease (ILD)/Pneumonitis«/bi» Suspected ILD/Pneumonitis - Withhold Confirmed ILD/Pneumonitis - Permanently discontinue «bi»Dermatologic Adverse Reactions«/bi» - Includes dermatitis acneiform, pruritus, dry skin Grade 2 - Initiate supportive care management - Reassess after 2 weeks; consider dose reduction if rash does not improve Grade 3 - Withhold; initiate supportive care management - Upon recovery to Grade ≤2, resume at reduced dose - Permanently discontinue - Grade 2 with no improvement within 2 weeks, permanently discontinue Grade 4 - Severe bullous blistering or exfoliating skin conditions (eg, toxic epidermal necrolysis [TEN]) «bi»Other Adverse Reactions«/bi» Grade 3 - Withhold until recovery to Grade ≤1 or baseline - Resume at same dose if recovery occurs ≤1 week - Resume at reduced dose if recovery occurs >1 to ≤4 weeks Grade 4 - Withhold until recovery to Grade ≤1 or baseline - Resume at reduced dose if recovery occurs ≤4 weeks Permanently Discontinue - Unable to recover within 4 weeks - Recurrent Grade 4 reactions

AmLODIPine

Katerzia, Norliqva, Norvasc

Amlodipine-Atorvastatin

Caduet

Amlodipine-Benazepril

Lotrel

Amlodipine-Olmesartan

Azor

Amlodipine-Valsartan

Exforge

Amlodipine-Valsartan-Hydrochlorothiazide

Exforge HCT

Ammonium Molybdate

Molybdenum, Molypen

Amobarbital Sodium

Amytal Sodium, Amylobarbitone

Amoxapine

Asendin

«bu»Depression«/bu» - 50 mg once to 3 times daily - Doses may be increased to 100 mg 2 to 3 times daily by the end of the first week based on response and tolerability - if 300 mg daily has been reached and maintained for at least 2 weeks and no response is observed, then, - May further increase to 400 mg daily. - Hospitalized patients refractory to antidepressant therapy (and no history of seizures) may be cautiously titrated to 600 mg daily in divided doses. «b»Usual Dose Range«/b» - 100 to 400 mg daily - Once an effective dose is reached, doses ≤300 mg may be given once daily at bedtime and doses >300 mg daily should be divided. «b»Maximum Daily Dose«/b» - 400 mg (outpatient) - 600 mg (inpatient) «b»Discontinuation of Therapy«/b» - Upon discontinuation of antidepressant therapy, gradually taper the dose to minimize the incidence of withdrawal symptoms and allow for the detection of re-emerging symptoms. Evidence supporting ideal taper rates is limited. APA and NICE guidelines suggest tapering therapy over at least several weeks with consideration to the half-life of the antidepressant; antidepressants with a shorter half-life may need to be tapered more conservatively. In addition for long-term treated patients, WFSBP guidelines recommend tapering over 4 to 6 months. If intolerable withdrawal symptoms occur following a dose reduction, consider resuming the previously prescribed dose and/or decrease dose at a more gradual rate. «b»MAO Inhibitor Recommendations«/b» - Allow 14 days to elapse between discontinuing an MAO inhibitor intended to treat psychiatric disorders and initiation of amoxapine. - Allow 14 days to elapse between discontinuing amoxapine and initiation of an MAO inhibitor intended to treat psychiatric disorders. «bi»Use with Reversible MAO Inhibitors«/bi» - Such as linezolid or IV methylene blue - Do not initiate amoxapine in patients receiving linezolid or IV methylene blue; consider other interventions for psychiatric condition. - If urgent treatment with linezolid or IV methylene blue is required in a patient already receiving amoxapine and potential benefits outweigh potential risks, discontinue amoxapine promptly and administer linezolid or IV methylene blue. - Monitor for serotonin syndrome for 2 weeks or until 24 hours after the last dose of linezolid or IV methylene blue, whichever comes first. May resume amoxapine 24 hours after the last dose of linezolid or IV methylene blue.

Amoxicillin

Amoxil, Trimox, Moxatag

Amoxicillin-Clarithromycin-Lansoprazole

Prevpac

Amoxicillin-Clarithromycin-Omeprazole

Omeclamox-Pak

Amoxicillin-Omeprazole-Rifabutin

Talicia

Amoxicillin-Potassium Clavulanate

Augmentin

«bu»Usual Dosage Range«/bu» «b»Infants <3 months«/b» - Amoxicillin 30 mg/kg/day divided every 12 hours using the 125 mg per 5 mL suspension only «b»Infants ≥3 months, Children <40 kg«/b» «bi»Mild to Moderate Infections«/bi» - Amoxicillin 25 mg/kg/day in divided doses twice daily - Amoxicillin 20 mg/kg/day in divided doses 3 times daily - Maximum Single Dose: 500 mg amoxicillin «bi»Severe Infections«/bi» - Amoxicillin 45 mg/kg/day in divided doses twice daily - Maximum single dose: Amoxicillin 875 mg - Amoxicillin 40 mg/kg/day in divided doses 3 times daily - Maximum Single Dose: Amoxicillin 500 mg) «b»Children and Adolescents ≥40 kg«/b» «bi»Mild to Moderate Infections«/bi» - Amoxicillin 500 mg every 12 hours - 250 mg amoxicillin every 8 hours «bi»Severe Infections«/bi» - Amoxicillin 875 mg every 12 hours - Amoxicillin 500 mg every 8 hours - Amoxicillin 2,000 mg ER every 12 hours «bu»Group A Streptococci Chronic Carrier«/bu» «b»Infants ≥3 months, Children, and Adolescents«/b» - Amoxicillin 40 mg/kg/day divided every 8 hours x 10 days «bu»Impetigo«/bu»(off-label use) «b»Infants ≥3 months, Children, and Adolescents«/b» - Amoxicillin 25 mg/kg/day in divided doses twice daily - Maximum Single Dose: 875 mg amoxicillin «bu»Acute Otitis Media«/bu» «b»Infants ≥6 months and Children«/b» - Amoxicillin 90 mg/kg/day divided every 12 hours x 7 to 10 days - Use for severe illness, those who have received amoxicillin in the past 30 days, who have treatment failure at 48 to 72 hours on first-line therapy, and when coverage for beta-lactamase positive H. influenzae and M. catarrhalis is needed. «bu»Community Acquired Pneumonia (CAP) and Lower Respiratory Tract Infections«/bu» «b»Infants ≥3 months, Children <40 kg«/b» - Amoxicillin 45 mg/kg/day in divided doses twice daily - Maximum Single Dose: Amoxicillin 875 mg - Amoxicillin 40 mg/kg/day in divided doses 3 timees - Maximum Single Dose: Amoxicillin 500 mg «b»Children weighing ≥40 kg«/b» - Amoxicillin 875 mg IR every 12 hours - Amoxicillin 500 mg IR every 8 hours - Amoxicillin 2,000 mg ER every 12 hours «b»Beta-Lactamase Positive H. Influenzae Strains«/b» «bi»Standard Dose«/bi» - Amoxicillin 45 mg/kg/day in divided doses 3 times daily - Maximum Single Dose: Amoxicillin 500 mg «bi»High Dose«/bi» - Amoxicillin 90 mg/kg/day in divided doses 2 times daily - Dosing Range: 80 to 100 mg/kg/day divided every 8 hours «bu»Acute Bacterial Sinusitis«/bu» «b»Infants ≥3 months, Children <40 kg«/b» «bi»Standard Dose«/bi» - Amoxicillin 45 mg/kg/day divided every 12 hours x 10 to 14 days «bi»High Dose (off-label dose)«/bi» - Amoxicillin 90 mg/kg/day divided every 12 hours for 10 to 14 days - Use recommended when initial therapy fails (as second-line therapy), in areas with high endemic rates of penicillin-nonsusceptible S. pneumoniae, those with severe infections, daycare attendance, age <2 years, recent hospitalization, antibiotic use within the past month, or who are immunocompromised «b»Children ≥40 kg«/b» - Amoxicillin 80 to 90 mg/kg/day divided every 12 hours x 10 to 28 days - Some have suggested discontinuation of therapy 7 days after resolution of signs and symptoms of infection «bu»Urinary Tract Infections«/bu» - Amoxicillin 20 to 40 mg/kg/day in divided doses 3 times daily - Maximum Single Dose: Amoxicillin 500 mg

Amphetamine

Adzenys, Dyanavel, Evekeo, Adzenys XR-ODT, Dyanavel XR, Adzenys ER, Evekeo ODT, Amphetamine Sulfate

Amphetamine-Dextroamphetamine

Adderall, Adderall XR, Mydayis

- Use lowest effective individualized dose; administer first dose as soon as awake. «bu»Attention-Deficit/Hyperactivity Disorder (ADHD)«/bu» - Interrupt therapy occasionally to determine if there is a recurrence of behavioral symptoms sufficient to require continued therapy. «b»Children <3 years«/b» - Use is not recommended «b»Children 3 to 5 years«/b» - Initial Dose: 2.5 mg once daily in the morning - May increase daily dose in 2.5 mg increments at weekly intervals until optimal response is obtained - Usual Dosage Range: 2.5 to 40 mg/day in 1 to 3 divided doses. «b»Children ≥6 years«/b» «bi»Immediate Release«/bi» - Initial: 5 mg once daily or bid - May increase daily dose in 5 mg increments at weekly intervals until optimal response is obtained - Usual Dosage Range: 5 to 40 mg/day in 1 to 3 divided doses. «bi»Extended Release«/bi» Adderall XR - 5 to 10 mg PO once daily in the morning - May increase daily dose in 5 to 10 mg increments at weekly intervals until optimal response is obtained - Maximum Dose: 30 mg/day. Conversion from Adderall IR to XR - Switch to Adderall XR at the same total daily dose. «b»Adolescents«/b» «bi»Immediate Release«/bi» - Initial Dose: 5 mg once or twice daily - May increase daily dose in 5 mg increments at weekly intervals until optimal response is obtained - Usual Dosage Range: 5 to 40 mg/day in 1 to 3 divided doses. «b»Extended Release«/b» Adderall XR - Initial Dose: 10 mg PO once daily in the morning - May increase to 20 mg daily after 1 week prn - Higher doses (up to 60 mg/day) have been evaluated; however, there is not adequate evidence that higher doses afforded additional benefit. Conversion from Adderall IR to XR - Switch to Adderall XR at the same total daily dose. «b»Mydayis«/b» - Initial Dose: 12.5 mg once daily in the morning - May increase daily dose by 12.5 mg no sooner than weekly - Maximum Dose: 25 mg/day. Conversion from other dextroamphetamine and amphetamine formulations to Mydayis - Discontinue previous formulation and titrate using above schedule; do not substitute on a mg-per-mg basis. «bu»Narcolepsy«/bu» «b»Children ≥6 years«/b» - Initial Dose: 5 mg IR PO daily - May increase daily dose in 5 mg increments at weekly intervals until optimal response is obtained - Usual Dosage: 5 to 60 mg/day IR PO in 1 to 3 divided doses. «b»Adolescents«/b» - Refer to adult dosing «b»Children Pharmacokinetics«/b» - Children eliminated amphetamine faster than adults. The elimination half-life is approximately 1 hour shorter for d-amphetamine and 2 hours shorter for l-amphetamine in children than in adults. However, children had higher systemic exposure to amphetamine (Cmax and AUC) than adults for a given dose of ER capsules, which was attributed to the higher dose administered to children on a mg/kg basis compared with adults. Upon dose normalization on a mg/kg basis, children showed 30% less systemic exposure compared with adults.

Amphotericin B

Amphocin

Amphotericin B Cholesteryl Sulfate

Amphotec, ABCD

Amphotericin B Lipid Complex

Abelcet

Amphotericin B Liposome

AmBisome, Liposomal Amphotericin B

Ampicillin

Principen, Amficot, Ampi, Omnipen, Penglobe

Ampicillin-Sulbactam

Unasyn

Amyl Nitrite

Anagrelide

Agrylin

Anakinra

Kineret

Anastrozole

Arimidex

Angiotensin II

Giapreza, Synthetic Human Angiotensin II

Anidulafungin

Eraxis

«bu»Candidemia, Intra-abdominal or Peritoneal Candidiasis«/bu» - 200 mg IV on day 1, then, - 100 mg IV daily - Treatment should continue until 14 days after last positive culture. - Transition to fluconazole (after 5 to 7 days in nonneutropenic patients) in clinically stable patients with fluconazole-susceptible isolates and negative repeat cultures «bu»Candidiasis«/bu» «b»Chronic Disseminated«/b» - 200 mg IV on day 1, then, - 100 mg IV daily for several weeks, followed by oral fluconazole therapy «b»Empiric Therapy«/b» - Suspected invasive candidiasis in nonneutropenic ICU patients - 200 mg IV on day 1, then, - 100 mg IV daily - Treatment should continue for 14 days in patients with clinical improvement - Consider discontinuing after 4 to 5 days in patients with no clinical response «b»Intravascular Infections«/b» - Native or prosthetic valve endocarditis - Infection of implantable cardiac devices - Suppurative thrombophlebitis - 200 mg IV daily - Native or prosthetic valve endocarditis, therapy should continue for at least 6 weeks after valve replacement surgery (longer durations in patients with abscesses or other complications) - Patients with implantable cardiac devices, therapy should continue for 4 to 6 weeks after surgery (4 weeks for infections limited to generator pockets and at least 6 weeks for infections involving the wires) - Suppurative thrombophlebitis, continue for at least 2 weeks after candidemia has cleared - Step-down to fluconazole therapy is recommended in clinically stable patients with fluconazole-susceptible isolates and negative repeat cultures «b»Osteoarticular Infections«/b» «bi»Osteomyelitis or Septic Arthritis«/bi» - 100 mg IV daily for at least 14 days - Followed by fluconazole «b»Prophylaxis Against Invasive Candidiasis«/b» - High-risk ICU patients in units with a high incidence of invasive candidiasis - 200 mg IV on day 1, then, - 100 mg daily «b»Esophageal«/b» - 100 mg IV on day 1, then, - 50 mg IV daily - Treatment should continue for a minimum of 14 days and for at least 7 days after symptom resolution «bi»Alternate Recommendations«/bi» - 200 mg IV daily - May transition to oral fluconazole therapy once oral intake tolerable - In patients with fluconazole-refractory disease, continue anidulafungin for 14 to 21 days «b»Oropharyngeal«/b» - Refractory disease - 200 mg IV on day 1, then, - 100 mg IV daily

Anifrolumab

Saphnelo

Ansuvimab

Ebanga

«b»IV Administration«/b» - Administer as IV infusion; do NOT administer as IV push or bolus - Do not coadminister other drugs simultaneously through same infusion line - Prepare IV infusion line with 1.2-micron in-line filter extension set - Infuse over 60 minutes; can be infused via a central line or peripheral catheter - Infusions may be slowed or stopped if necessary, to alleviate any effects «bi»At End of Infusion«/bi» Syringe Pump - Remove syringe and flush line with 2-5 mL of diluent, but not to exceed the total infusion volume Infusion Bag - Replace empty bag and flush line by infusing at least 25 mL of diluent, to ensure complete product administration «b»IV Reconstitution«/b» - Calculate dose and number of vials required - Remove vials from refrigerator and allow vials to reach room temperature (15-27ºC [59-81ºF]) for ~20 min - Vials that cannot immediately be reconstituted can be kept at room temperature, protected from light, for no more than 24 hr - Reconstitute each vial with 7.7 mL of sterile water for injection diluent - Slowly inject diluent along vial wall by angling needle down at a ~45º angle above powder cake and without any air to avoid foaming and bubbles - Gently swirl (do NOT shake) for ~10 seconds; then set vial down to rest for at least 10 seconds; repeat until cake is dissolved; may take up to 20 minutes - Upon reconstitution, 1 vial yields 8 mL (final concentration: 50 mg/mL); solution appears clear to slightly opalescent and colorless to slightly yellow; discard if reconstituted solution is discolored or contains visible particles «b»IV Dilution«/b» - Refer to prescribing information for exact diluent and drug volumes - Following reconstitution, ansuvimab must be further diluted with 0.9% NaCl or LR before administering «bi»Weight 0.5 to <2 kg«/bi» - Use a 10-mL syringe compatible with IV infusion pump - Fill 10-mL syringe with appropriate amount of diluent - Add calculated drug volume to 10-mL syringe - Gently invert diluted solution 3-5x until admixed; do NOT shake - Final concentration of diluted solution is ~8-30 mg/mL «bi»Weight >2 kg«/bi» - Use either a PVC 0.9% NaCl infusion bag or a non-PVC or non-DEHP LR IV infusion bag - Based on body weight, select an infusion bag with the appropriate volume - Withdraw and discard from bag a volume that accounts for drug and final infusion volume according to patient’s weight - Add calculated drug volume to bag based on patient’s weight - Gently invert IV bag 5-10x until diluted solution is mixed; do NOT shake - Final concentration of diluted solution is ~8-30 mg/mL - Discard vial(s) and all unused contents

Anthrax Vaccine Adsorbed

BioThrax

Antihemophilic Factor (AHF)

Factor VIII, Monoclate-P, Koate, Hemofil M

Antihemophilic Factor (Recomb)

Kogenate, Kogenate FS Bio-Set, Afstyla, Helixate, Helixate FS, Nuwiq, Xyntha, Xyntha Solofuse, Advate, Kovaltry, Novoeight,

Antihemophilic Factor Rcmb PEG

Adynovate, Rurioctocog Alfa Pegol, Factor VIII

Antihemophilic Factor rFVIIIFc

Eloctate, rAHF

Antihemophilic Factor rpFVIII

Obizur, Susoctocog Alfa

Antiinhibitor Coagulant Complex

FEIBA

- Anti-inhibitor coagulant complex (Human) contains mainly non-activated therapeutic levels of factors II, IX, and X and mainly activated factor VII «bu»Hemophilia A & B«/bu» - Control and prevention of bleeding episodes in patients with hemophilia - Considered a first-line treatment when factor VIII inhibitor titer is >5 Bethesda units (BU) (antihemophilic factor may be preferred when titer <5 BU) «b»General Dosing Guidelines«/b» - 50 to 100 units/kg/dose - Dosage and duration of treatment depend on the location and extent of bleeding and clinical condition of the patient. «b»Joint Hemorrhage«/b» - 50 to 100 units/kg every 12 hours until pain and acute disabilities are improved - Maximum Dose: 100 units/kg/dose; 200 units/kg/day «b»Mucous Membrane Bleeding«/b» - 50 to 100 units/kg every 6 hours for at least 1 day or until bleeding is resolved - Maximum Dose: 100 units/kg/dose; 200 units/kg/day «b»Soft Tissue Hemorrhage«/b» - 100 units/kg every 12 hours until resolution of bleed - Maximum Dose: 100 units/kg/dose; 200 units/kg/day «b»Other Severe Hemorrhage«/b» - Intracranial Hemorrhage - 100 units/kg every 6 to 12 hours - Continue until resolution of bleed - Maximum: 100 units/kg/dose; 200 units/kg/day «b»Perioperative Management«/b» «bi»Preoperative«/bi» - 50 to 100 units/kg (single dose) administered immediately prior to surgery. «bi»Postoperative«/bi» - 50 to 100 units/kg every 6 to 12 hours until resolution of bleed and healing is achieved - Maximum Dose: 100 units/kg/dose; 200 units/kg/day «bi»Routine Prophylaxis«/bi» - 85 units/kg every other day «bu»Acquired Hemophilia Hemorrhage«/bu» (off-label use) - 50 to 100 units/kg every 8 to 12 hours until bleeding controlled has been suggested - May continue for 24 to 72 hours based on site, type, and severity of bleeding - Maximum Dose: 200 units/kg/day «bu»Intracranial Hemorrhage Associated with Non-vitamin K Antagonist Anticoagulants«/bu» (off-label use) «b»Oral Direct Factor Xa Inhibitor-mediated«/b» «bi»Apixaban, Edoxaban, Rivaroxaban«/bi» - 50 units/kg if ICH occurred within 3 to 5 terminal half-lives of drug exposure or when liver failure co-exists. «b»Direct Thrombin Inhibitor-mediated«/b» «bi»Argatroban, Dabigatran, Bivalirudin, Desirudin«/bi» - 50 units/kg if direct thrombin inhibitor was administered within a period of 3 to 5 half-lives prior and there is no evidence of renal failure or there is renal impairment leading to drug exposure beyond 3 to 5 half-lives. «b»Pentasaccharide-mediated (Fondaparinux)«/b» - 20 units/kg - In patients receiving fondaparinux for venous thromboembolism prophylaxis (ie, not a full therapeutic dose), the NCS/SCCM guidelines suggest against reversal unless there is evidence of bioaccumulation or impaired clearance.

Antipyrine

Antipyrine-Benzocaine

Auralgan (Otic), A/B Otic, Aurodex (Otic)

Antithrombin III (Human)

Thrombate III, ATryn, Antithrombin Recombinant, Antithrombin alfa

«bu»Antithrombin Deficiency«/bu» «b»ATryn«/b» - Prophylaxis of thrombosis during perioperative and peripartum procedures: Dosing is individualized based on pretherapy antithrombin (AT) activity levels. - Therapy should begin before delivery or ~24 hours prior to surgery to obtain target AT activity levels. - Dosing should be targeted to keep levels between 80% to 120% of normal. - Loading dose should be given as a 15-minute infusion, followed by maintenance dose as a continuous infusion. - Doses may be calculated based on the following formulas: «bi»Surgical Non-Pregnant Patients«/bi» - Loading Dose: [(100 - baseline AT activity level) divided by 2.3] x body weight (kg) = units of antithrombin required - Maintenance Infusion: [(100 - baseline AT activity level) divided by 10.2] x body weight (kg) = units of antithrombin required/hour «bi»Surgical Pregnant Patients«/bi» - Pregnant women undergoing surgical procedures (other than a Cesarean section) should also be dosed according to the formula below. - Loading Dose: [(100 - baseline AT activity level) divided by 1.3] x body weight (kg) = units of antithrombin required - Maintenance Infusion: [(100 - baseline AT activity level) divided by 5.4] x body weight (kg) = units of antithrombin required/hour «bi»Dosing Adjustments«/bi» - Adjustments should be made based on AT activity levels to maintain levels between 80% to 120% of normal - Surgery or delivery may rapidly decrease AT levels; check AT level just after surgery or delivery - The first AT level should be obtained 2 hours after initiation and adjusted AT Activity Level <80% - Increase dose by 30%; recheck AT level 2 hours after adjustment - Alternatively, an additional bolus dose (using loading dose formula) may be needed to rapidly restore AT levels - Calculate the additional bolus/loading dose using the last available AT activity result - After additional loading/bolus dose given, resume maintenance infusion at the same rate prior to bolus administration AT Activity Level 80% to 120% - No dosage adjustment needed; recheck AT level in 6 hours AT Activity Level >120% - Decrease dose by 30%; recheck AT level 2 hours after adjustment «b»Thrombate III«/b» - Prophylaxis of thrombosis during surgical or obstetrical procedures or treatment of thromboembolism: - Initial Loading Dose: Dosing is individualized based on pretherapy antithrombin (AT) levels. - The initial dose should raise AT levels to 120% and may be calculated based on the following formula: - [(desired AT level % - baseline AT level %) x body weight (kg)] divided by 1.4 = units of antithrombin required Maintenance Dose - In general, subsequent dosing should be targeted to keep levels between 80% to 120% which may be achieved by administering 60% of the initial loading dose every 24 hours. Adjustments may be made by adjusting dose or interval. Maintain level within normal range for 2-8 days depending on type of procedure/situation.

AntiThymocyte Glob (Rabbit)

Thymoglobulin, Antithymocyte Immunoglobulin, rATG

«b»Premedicatation«/b» - Premedicate with corticosteroids, acetaminophen, and/or an antihistamine 1 hour prior to infusion to reduce the incidence and severity of infusion-related reactions. Administer antifungal and antibacterial prophylaxis therapy if clinically indicated. Antiviral prophylaxis is recommended in patients who are CMV-seropositive at the time of transplant and for CMV-seronegative patients scheduled to receive a kidney from a CMV-seropositive donor. «bu»Renal Transplant«/bu» «b»Acute Rejection Treatment«/b» - 1.5 mg/kg IV daily for 7 to 14 days «b»Induction Therapy«/b» - 1.5 mg/kg IV daily for 4 to 7 days - The first dose should be administered prior to reperfusion of the donor kidney - WBC count 2,000 to 3,000 cells/mm3 or platelet count 50,000 to 75,000 cells/mm3: Reduce dose by 50%. - WBC count <2,000 cells/mm3 or platelet count <50,000 cells/mm3: Consider discontinuing treatment. «b»Off-label Induction Dosing«/b» - 1.5 mg/kg IV once daily for 5 to 7 days - 1 mg/kg IV once daily for 3 to 6 days - 2 mg/kg IV once daily for 3 days - Dosing based on peripheral blood CD3+ lymphocyte counts has also been described with an initial dose of 1.5 mg/kg followed by repeat doses when CD3+ count is >20 cells/mm3 «bu»Chronic Graft-versus-Host Disease Prevention«/bu» (off-label use) - 0.5 mg/kg IV administered 2 days prior to transplant, then, - 2 mg/kg IV administered 1 day before and 1 day after transplant - 2.5 mg/kg IV once daily for 3 days beginning 3 days prior to transplant «bu»Heart Transplant«/bu» (off-label use) «b»Induction Therapy in High Risk Patients«/b» - 1 to 1.5 mg/kg IV once daily for up to 7 days «b»Acute Cellular Rejection Treatment«/b» (off-label use) - 0.75 to 1.5 mg/kg IV for 5 to 14 days «bu»Intestinal and Multivisceral Transplantation«/bu» (off-label use) «b»Induction Therapy«/b» - 2 mg/kg IV on postoperative days 0, 2, 4, 6, and 8 (in combination with rituximab) «bu»Lung Transplant«/bu» (off-label use) «b»Induction Therapy«/b» - 1.5 mg/kg IV daily for 3 days - The first dose was administered within 24 hours of transplantation

Apalutamide

Erleada

Apixaban

Eliquis

«bu»Deep Venous Thrombosis (DVT)«/bu» «b»Treatment«/b» - 10 mg PO bid x 7 days THEN, - 5 mg PO bid - LMWH is preferred over oral anticoagulation for treatment of patients with cancer. «b»Duration of Therapy«/b» - Unknown and is dependent on many factors, such as whether provoking events were present, patient risk factors for recurrence and bleeding, and individual preferences «bi»Long-term (First 3 Months)«/bi» - 3 months is the minimum duration for most patients without cancer following their first episode of VTE (provoked or unprovoked) «bi»Extended Therapy«/bi» - After first 3 months and no scheduled stop date - May be considered in patients with unprovoked first DVT of the leg who do not have a high bleeding risk - Extended therapy is recommended in patients with unprovoked second DVT of the leg who do not have a high risk of bleeding. In patients with cancer, extended therapy is recommended, although high bleeding risk confers a lower grade of recommendation - All patients receiving extended therapy should be reassessed at periodic intervals for continuing use of therapy «b»Reduction in the Risk of Recurrence«/b» - 2.5 mg bid after at least 6 months of treatment for DVT «bu»Non-valvular Atrial Fibrillation«/bu» - 5 mg PO bid to prevent stroke and systemic embolism Unless patient has any 2 of the following: - Age ≥80 years or - Body weight ≤60 kg, or - SCr ≥1.5 mg/dL THEN, - Reduce dose to 2.5 mg PO bid «bu»Post-operative Venous Thromboprophylaxis«/bu» «b»Hip Replacement Surgery«/b» - 2.5 mg PO bid beginning 12 to 24 hours postoperatively - Duration: 35 days «b»Knee Replacement Surgery«/b» - 2.5 mg PO bid beginning 12 to 24 hours post-operatively - Duration: 12 days «bu»Pulmonary Embolism (PE)«/bu» «b»Treatment«/b» - 10 mg PO bid x 7 days THEN, - 5 mg PO bid - LMWH is preferred over oral anticoagulation for treatment of patients with cancer. «b»Duration of Therapy«/b» - Optimal duration of therapy is unknown and is dependent on many factors, such as whether provoking events were present, patient risk factors for recurrence and bleeding, and individual preferences; however, ACCP guidelines recommend the following: «bi»Long-term (First 3 Months)«/bi» - 3 months is the minimum duration for most patients without cancer following their first episode of VTE (provoked or unprovoked) «bi»Extended Therapy«/bi» - After first 3 months and no scheduled stop date - May be considered in patients with unprovoked first PE who do not have a high bleeding risk - Extended therapy is recommended in patients with unprovoked PE who do not have a high risk of bleeding - In patients with cancer, extended therapy is recommended, although high bleeding risk confers a lower grade of recommendation - All patients receiving extended therapy should be reassessed at periodic intervals for continuing use of therapy «b»Reduction in the Risk of Recurrence«/b» - 2.5 mg PO bid after at least 6 months of treatment for PE «b»Warfarin to Apixaban Conversion«/b» - Discontinue warfarin and initiate apixaban when INR is <2 «b»Apixaban to Warfarin Conversion«/b» - Apixaban affects the INR - Measuring the INR during co-administration with warfarin therapy may not be useful for determining an appropriate dose of warfarin - If continuous anticoagulation is necessary, discontinue apixaban and begin both a parenteral anticoagulant with warfarin when the next dose of apixaban is due; discontinue parenteral anticoagulant when INR reaches an acceptable range - Alternatively, some recommend continuing apixaban during initiation of warfarin or other vitamin K antagonist (VKA) at usual starting doses until INR ≥2, then discontinue apixaban - During concomitant therapy, initiating INR testing on day 3 and just prior to each dose of apixaban is also recommended «b»Apixaban to Other Non-Warfarin Anticoagulants (PO/IV) Conversion«/b» - Discontinue apixaban and begin taking the new non-warfarin anticoagulant at the usual time of the next scheduled dose of apixaban. «b»Other Non-warfarin Anticoagulants (PO/IV) to Apixaban Conversion«/b» - Discontinue the other non-warfarin anticoagulant and begin taking apixaban at the usual time of the next scheduled dose of the other non-warfarin anticoagulant. «b»Strong CYP3A4 and P-gP Inhibitors«/b» Apixaban doses >2.5 mg PO bid - Reduce apixaban dose by 50% - Avoid concomitant use with dual strong CYP3A4 and P-glycoprotein inhibitors if patient is already taking apixaban 2.5 mg PO bid or patient meets 2 of the following criteria: Age ≥80 years, body weight ≤60 kg, or serum creatinine ≥1.5 mg/dL. «b»Obesity«/b» - Avoid the use of apixaban (and other direct oral anticoagulants) in patients with a BMI >40 kg/m2 or weight >120 kg due to the lack of clinical data in this population. - If used in a patient with a BMI >40 kg/m2 or weight >120 kg, measure peak and trough levels using an antifactor Xa assay or mass spectrometry - If drug level is below the expected range, ISTH suggests changing to a vitamin K antagonist rather than adjusting the dose of apixaban

Apomorphine

Apokyn, Kynmobi

«bu»Parkinson Disease, “off” Episode«/bu» «b»Subcutaneous (Apokyn)«/b» Initial Test Dose - 2 mg SC x 1 dose; medical supervision required - Subsequent dosing is based on both tolerance and response to initial test dose. - If patient tolerates test dose and responds: Starting dose: 2 mg as needed; may increase dose in 1 mg increments every few days - Maximum Dose: 6 mg - If patient tolerates but does not respond to 2 mg test dose: Second test dose: 4 mg - If patient tolerates and responds to 4 mg test dose: Starting dose: 3 mg, as needed for “off” episodes; may increase dose in 1 mg increments every few days; maximum dose: 6 mg - If patient does not tolerate 4 mg test dose: Third test dose: 3 mg - If patient tolerates 3 mg test dose: Starting dose: 2 mg as needed for “off” episodes; after a few days, may increase dose up to 3 mg - If therapy is interrupted for >1 week, restart at 2 mg and gradually titrate dose. - Medical supervision is required for all test doses with standing and supine blood pressure monitoring predose and 20-, 40-, and 60 minutes postdose (and after 60 minutes, if there is significant hypotension at 60 minutes). - If subsequent test doses are required, wait >2 hours before another test dose is given; next test dose should be timed with another “off” episode. - If a single dose is ineffective for a particular “off” episode, then a second dose should not be given. The average dosing frequency was 3 times/day in the development program with limited experience in dosing >5 times/day, single doses >6 mg, and with total daily doses >20 mg «b»Sublingual (Kynmobi)«/b» Initial Dose - 10 mg SL prn Maximum Dose - 5 doses/day - Separate doses by at least 2 hr; if a single dose is ineffective for a particular “off” episode, a second dose should not be given for that “off” episode Maximum Single Dose - 30 mg/dose «b»Premedication«/b» - High incidence of nausea and vomiting with treatment; initiate an antiemetic (trimethobenzamide 300 mg tid) 3 days prior to the initial apomorphine dose - Treatment with trimethobenzamide should only be continued as long as necessary to control nausea and vomiting, and generally no longer than 2 months after initiation of treatment - Trimethobenzamide increases the incidence of somnolence, dizziness, and falls - Contraindicated with 5HT3 antagonist antiemetics (ondansetron, granisetron, dolasetron, palonosetron) due to profound hypotension and loss of consciousness when coadministered - Apomorphine is intended to be used as adjunctive therapy with other anti-Parkinson agents

Apraclonidine (Ophthalmic)

Lopidine

Apremilast

Otezla

Aprepitant

APONVIE, Emend, Cinvanti

Arformoterol

Brovana, Erdotin

Argatroban

Acova

Arginine

R-Gene, L-Arginine

ARIPiprazole

Abilify, Abilify Maintena, Abilify MyCite, Aristada, Aristada Initio

«bu»Schizophrenia«/bu» «b»Oral Monotherapy«/b» Initial Dose - 10-15 mg PO daily - May increase after 2 weeks at each dose strength Maximum Dose: - 30 mg/day PO when administered as tablet formulation - Efficacy not significantly greater above 15 mg/day «b»Abilify Maintena«/b» - Patients who have never taken aripiprazole - 400 mg IM once monthly initially - Establish tolerability with aripiprazole PO prior to initiating treatment with Abilify Maintena - May take up to ~ 2 weeks to fully assess tolerability - Continue aripiprazole PO (10-20 mg/day) or other antipsychotics PO in patients with known aripiprazole tolerance for 14 consecutive days after initial injection Patients Stabilized or Aripiprazole Tolerant - 400 mg IM once monthly - Administer monthly dose no sooner than 26 days after previous injection (also see Dosage Modifications) - Consider dose reduction to 300 mg/month if adverse reaction occurs «b»Aristada«/b» - Establish tolerability with PO aripiprazole before initiating Aristada; may take up to 2 weeks to fully assess tolerability - Base initial Aristada dose on current aripiprazole PO dose; coadminister aripiprazole PO for 21 consecutive days - 10 mg/day PO: 441 mg IM once monthly - 15 mg/day PO: 662 mg IM once monthly or 882 mg IM q6wk or 1064 mg IM q2mo - ≥20 mg/day PO: 882 mg IM once monthly - Adjust dose and dosing interval as needed; take into consideration the pharmacokinetics and prolonged-release characteristics of Aristada In the event of early dosing, Aristada should not be given earlier than 14 days after the previous injection «b»Aristada Initio«/b» - Indicated in combination with aripiprazole PO for the initiation of Aristada when used for the treatment of schizophrenia - Used a single dose to initiate Aristada treatment or as a single dose to re-initiate Aristada treatment following a missed dose of Aristada - Establish tolerability with aripiprazole PO prior to initiating treatment with Aristada Initio - May take up to ~ 2 weeks to fully assess tolerability - After establishing tolerability with aripiprazole PO, administer the first Aristada IM injection (441 mg, 662 mg, 882 mg, or 1064 mg) in conjunction with both: One dose of Aristada Initio 675 mg IM and one dose of aripiprazole 30 mg PO - Aristada Initio is only to be used as a single dose and is not for repeated dosing - First Aristada extended-release IM injection may be administered on the same day as Aristada Initio or up to 10 days thereafter «bu»Bipolar Mania«/bu» - Indicated for acute and maintenance treatment of manic or mixed episodes associated with bipolar I disorder, either as monotherapy or as adjunct to lithium or valproate «b»Oral Monotherapy«/b» - 15 mg/day PO initially; may be increased gradually - Not to exceed 30 mg/day - Adjunct to lithium or valproate: 10-15 mg/day PO initially; recommended daily dose is 15 mg/day; may be gradually increased; not to exceed 30 mg/day - Continue stabilization dose for up to 6 weeks; treatment >6 weeks not studied «b»Abilify Maintena«/b» - Patients who have never taken aripiprazole - 400 mg IM once monthly initially - Administer only by deep IM injection into deltoid or gluteal muscle by healthcare professional - Establish tolerability with aripiprazole PO prior to initiating treatment with - Abilify Maintena; may take up to ~ 2 weeks to fully assess tolerability - Continue aripiprazole PO (10-20 mg/day) or other PO antipsychotics in patients with known aripiprazole tolerance for 14 consecutive days after initial injection Patients Stabilized or Aripiprazole Tolerant - 400 mg IM once monthly - Administer monthly dose no sooner than 26 days after previous injection - Consider dose reduction to 300 mg/month if adverse reaction occurs «bu»Major Depressive Disorder«/bu» - Initial Dose: 2-5 mg PO daily - Increased weekly PRN by ≤5 mg/day to dose range of 2-15 mg/day - Used adjunctively with other antidepressants «b»Oral Monotherapy Dosage Modifications«/b» Known CYP2D6 Poor Metabolizers - Administer half of recommended dose Known CYP2D6 Poor Metabolizers with Concomitant Strong CYP3A4 Inhibitors - Administer 25% of the recommended dose - Decrease dose by 75% Strong CYP2D6 or CYP3A4 Inhibitors - Administer half of recommended dose Strong CYP2D6 AND CYP3A4 Inhibitors - Administer 25% of the recommended dose - Decrease dose by 75% Strong CYP3A4 Inducers - Double recommended dose over 1-2 weeks «b»Abilify Maintena Dosage Modifications«/b» CYP2D6 Poor Metabolizers - 300 mg IM CYP2D6 Poor Metabolizers with Concomitant CYP3A4 Inhibitor - 200 mg IM Patients taking 400 mg IM - Strong CYP2D6 OR CYP3A4 Inhibitors: 300 mg IM - CYP2D6 AND CYP 3A4 Inhibitors: 200 mg IM - CYP3A4 Inducers: Avoid use Patients taking 300 mg IM - Strong CYP2D6 OR CYP3A4 Inhibitors: 200 mg IM - CYP2D6 AND CYP3A4 Inhibitors: 160 mg IM - CYP3A4 Inducers: Avoid use «b»Aristada Dosage Modifications«/b» - No dosage changes if CYP450 modulators are added for <2 wk Strong CYP3A4 inhibitor for >2 wk - Reduce the dose to the next lower strength No dosage adjustment necessary in patients taking 441 mg, if tolerated Poor CYP2D6 Metabolizers - Reduce dose to 441 mg from 662 mg, 882 mg, or 1064 mg; no dosage adjustment necessary in patients taking 441 mg, if tolerated Strong CYP2D6 Inhibitor for >2 wk - Reduce the dose to the next lower strength - No dosage adjustment necessary in patients taking 441 mg, if tolerated Poor CYP2D6 Metabolizers - No dose adjustment required Both strong CYP3A4 and CYP2D6 Inhibitors for >2 wk - Avoid use for patients taking 662 mg, 882 mg, or 1064 mg - No dosage adjustment necessary in patients taking 441 mg, if tolerated CYP3A4 Inducers for >2 wk - No dose adjustment for 662 mg, 882 mg, or 1064 mg - Increase the 441 mg dose to 662 mg «b»Aristada Initio Dosage Modifications«/b» - Only available at a single strength as a single-dose prefilled syringe - No dosage adjustments are possible CYP2D6 Poor metabolizers, Strong CYP3A4 Inhibitors, and Strong CYP3A4 Inducers - Avoid use «b»Discontinuation of Therapy«/b» - American Psychiatric Association (APA), Canadian Psychiatric Association (CPA), and World Federation of Societies of Biological Psychiatry (WFSBP) guidelines recommend gradually tapering antipsychotics to avoid withdrawal symptoms and minimize the risk of relapse «bu»Schizophrenia«/bu» - Indicated for treatment of schizophrenia in adolescents aged 13-17 years «b»<13 years«/b» - Safety and efficacy not established «b»13-17 years«/b» - Initial Dose: 2 mg PO daily - Increase to 5 mg/day after 2 days - May further increase to recommended dose of 10 mg/day after additional 2 days - Subsequent doses may increase by 5 mg/day - Maintenance Dose: 10-30 mg/day «bu»Bipolar Mania«/bu» - Indicated for acute manic or mixed episodes, either as monotherapy or as adjunct to lithium or valproate «b»10-17 years«/b» - Initial Dose: 2mg PO daily - Increased to 5 mg/day after 2 days - May further increase to recommended dosage of 10 mg/day after additional 2 days - Subsequent doses may increase by 5 mg/day - Maintenance Dose: 10-30 mg/day «bu»Autism«/bu» - Indicated for irritability associated with autistic disorder «b»<6 years«/b» - Safety and efficacy not established «b»6-17 years«/b» - Initial Dose: 2 mg PO daily - Increase gradually at ≥1 week intervals to target dosage of 5 mg/day - May gradually be further increase PRN to 10 mg/day or higher - Not to exceed 15 mg/day «bu»Tourette Disorder«/bu» - Indicated for treatment of Tourette disorder «b»<6 years«/b» - Safety and efficacy not established «b»6-18 years (<50 kg)«/b» - Initial Dose: 2 mg PO daily with a target dose of 5 mg/day after 2 days - The dose can be increased to 10 mg/day in patients who do not achieve optimal control of tics - Dosage adjustments should occur gradually at intervals of no less than 1 week «b»6-18 years (≥50 kg)«/b» - Initial Dose 2 mg PO daily for 2 days, then, - Increase to 5 mg/day for 5 days, with a target dose of 10 mg/day on day 8 - The dose can be increased up to 20 mg/day for patients who do not achieve optimal control of tics - Dosage adjustments should occur gradually in increments of 5 mg/day at intervals of no less than 1 week «b»Oral Dosage Modifications«/b» - Known CYP2D6 poor metabolizers: Administer half of recommended dose - Known CYP2D6 poor metabolizers taking concomitant strong CYP3A4 Inhibitors - Administer a quarter of the recommended dose (ie, decrease dose by 75%) Strong CYP2D6 or CYP3A4 Inhibitors - Administer half of recommended dose Strong CYP2D6 AND CYP3A4 Inhibitors - Administer a quarter of the recommended dose (ie, decrease dose by 75%) Strong CYP3A4 Inducers - Double recommended dose over 1-2 weeks «b»Injection Administration«/b» - For IM use only; do not administer SC or IV - Immediate-release and extended-release parenteral products are not interchangeable. - Immediate release: Inject slowly into deep muscle mass - Extended release: Inject slowly into deltoid or gluteal muscle using the appropriate provided needle; for non-obese patients, use the 1 inch (25 mm) needle with deltoid administration or the 1.5 inch (38 mm) needle with gluteal administration; for obese patients, use the 1.5 inch (38 mm) needle with deltoid administration or the 2 inch (51 mm) needle with gluteal administration. Do not massage muscle after administration. Rotate injection sites between the two deltoid or gluteal muscles. Administer monthly (doses should be separated by ≥26 days). «b»Aristada IM Administration«/b» - Administer via IM injection in the deltoid muscle (441 mg dose only) or gluteal muscle over <10 seconds. Prior to administration, tap the syringe at least 10 times and then shake the syringe vigorously ≥30 seconds to ensure a uniform suspension. If the syringe is not used within 15 minutes, shake again for 30 seconds. Use the appropriate sized needle for the injection site; 1- to 1.5-inch needle for deltoid injection and 1.5- or 2-inch needle for gluteal injection. Patients with a larger amount of subcutaneous tissue overlaying the injection site muscle should use the longer of the needles provided «b»Oral Administration«/b» - Administer with or without food. Tablet and oral solution may be interchanged on a mg-per-mg basis, up to 25 mg. Doses using 30 mg tablets should be exchanged for 25 mg oral solution. Orally disintegrating tablets (Abilify Discmelt) are bioequivalent to the immediate-release tablets (Abilify). «b»Orally Disintegrating Tablet Administration«/b» - Remove from foil blister by peeling back (do not push tablet through the foil). Place tablet in mouth immediately upon removal. Tablet dissolves rapidly in saliva and may be swallowed without liquid. If needed, can be taken with liquid. Do not split tablet. «b»Tablet with Sensor«/b» - Swallow tablets whole; do not divide, crush, or chew. Each tablet is embedded with an ingestible event marker (IEM). The patch that accompanies the tablets is a wearable sensor that detects a signal from the IEM sensor after the tablet is ingested and transmits data to a smartphone within 30 minutes to 2 hours of ingestion. If the detection system fails (ie, tablet is not detected after ingestion), do not repeat the dose. Before use, ensure that the patient is capable and willing to use smartphones and apps, and that the app is compatible with the patient’s specific smartphone. Apply patch only when instructed by the app to the left side of the body just above the lower edge of the rib cage. Do not place the patch in areas where the skin is scraped, cracked, inflamed, or irritated, or in a location that overlaps the area of the most recently removed patch. Instruct patients to keep the patch on when showering, swimming, or exercising. The patch should be changed weekly or sooner as needed. The app will prompt patient to change the patch and will direct patient to apply and remove the patch correctly. Patients undergoing an MRI need to remove their patch and replace with a new one as soon as possible. If there is skin irritation, instruct patients to remove the patch. Refer to the information provided in the product packaging and electronic instructions for use with the Mycite app. «b»Injection Powder (extended release) Reconstitution«/b» Prefilled Syringe - Reconstitute at room temperature. Rotate the syringe plunger rod to release diluent. Shake vigorously for 20 seconds or until the suspension is uniform; the resulting suspension will be milky white and opaque. (Refer to manufacturer’s labeling for full preparation technique.) Inject full syringe contents immediately following reconstitution. Vial for Reconstitution - Reconstitute using 1.5 mL sterile water for injection (SWFI) (provided) for the 300 mg vial or 1.9 mL SWFI (provided) for the 400 mg vial to a final concentration of 200 mg/mL; residual SWFI should be discarded after reconstitution. Shake vigorously for 30 seconds or until the suspension is uniform; the resulting suspension will be milky white and opaque. If the suspension is not administered immediately after reconstitution, shake vigorously for 60 seconds prior to administration

Armodafinil

Nuvigil

Arsenic Trioxide

Trisenox

Artemether

Artemether-Lumefantrine

Coartem

Artesunate

Articaine

Articaine-Epinephrine

Articadent, Orabloc, Zorcaine, Septocaine, Zorcaine with Epinephrine

Asciminib

Scemblix

«bu»Chronic Myeloid Leukemia«/bu» «b»Previously Treated Patients«/b» - 80 mg PO once daily OR 40 mg PO every 12 hours for (Ph+ CML) in chronic phase (CP) in adults previously treated with ≥2 tyrosine kinase inhibitors (TKIs) - Continue until disease progression or unacceptable toxicity occurs «b»Patients with T3151 Mutation«/b» - 200 mg PO every 12 hours for (Ph+ CML) in CP in adults with the T315I mutation - Continue until disease progression or unacceptable toxicity occurs «b»Missed Dose«/b» «bi»Once-daily Dosing Regimen«/bi» - If dose is missed by >12 hr, skip dose and take the next dose as scheduled «bi»Twice-daily Dosing Regimen«/bi» - If dose is missed by >6 hr, skip dose and take the next dose as scheduled «b»Contraception«/b» «bi»Females of Reproductive Potential«/bi» - Use effective contraception during treatment and for 1 week after last dose «b»Dosage Reductions for ADR«/b» «bi»Previously Treated Ph+ CP-CML«/bi» - 40 mg PO once daily OR - 20 mg PO every 12 hours «bi»Ph+ CP-CML with T315I«/bi» - 160 mg PO every 12 hours «bi»Permanently Discontinue«/bi» - All patients unable to tolerate first dose reduction «b»Thrombocytopenia and/or Neturopenia«/b» «bi»ANC <1x 10^9/L and/or platelets <50x 10^9/L«/bi» - Withhold until ANC ≥1x 109/L and/or platelets ≥50x 109/L - Resolved within 2 weeks: Resume at starting dose - Resolved >2 weeks: Resume at reduced dose - If recurs, withhold until ANC ≥1x 109/L and/or platelets ≥50x 109/L, then resume at reduced dose «bi»Asymptomatic Amylase and/or Lipase Elevations«/bi» - Elevation >2x ULN - Withhold until <1.5x ULN - If resolved, resume at reduced dose - If not resolved, permanently discontinue, and perform diagnostic tests to exclude pancreatitis - If recurs at reduced dose, permanently discontinue «b»Nonhematologic Adverse Reactions«/b» «bi»Grade ≥3«/bi» - Withhold until Grade ≤1; once resolved, resume at reduced dose - If not resolved, permanently discontinue

Ascorbic Acid

Vitamin C, Acerola-C, C-Time, BProtected Vitamin C, Vita-C, Asco-Tabs, Chew-C, Fruit C, Cemill

Asenapine

Saphris

Asfotase Alfa

Strensiq

Asparaginase Erwinia Chrysanth

Erwinaze, Crisantaspase

- If administering IV, consider monitoring nadir serum asparaginase activity (NSAA) levels; if desired levels are not achieved, change to IM administration. «bu»Acute Lymphoblastic Leukemia (ALL)«/bu» «b»As a Substitute for Pegaspargase«/b» - 25,000 units/m2 3 times weekly (Mon, Wed, Fri) for 6 doses for each planned pegaspargase dose «b»As a Substitute for Asparaginase (E. coli)«/b» - 25,000 units/m2 for each scheduled asparaginase (E. coli) dose «b»Hemorrhagic or Thrombotic Event«/b» - Discontinue treatment; may resume treatment upon symptom resolution. «b»Pancreatitis«/b» «bi»Mild Pancreatitis«/bi» - Withhold treatment until signs and symptoms subside and amylase levels return to normal; may resume after resolution. «bi»Severe or Hemorrhagic Pancreatitis«/bi» - Abdominal pain >72 hours and amylase ≥2 x ULN - Discontinue treatment; further use is contraindicated. «b»Serious Hypersensitivity Reaction«/b» - Discontinue treatment. «b»Hyperammonemia-related Fatigue«/b» - Continue therapy for grade 2 toxicity. - If grade 3 toxicity occurs, reduce dose by 25%; resume full dose when toxicity ≤ grade 2 (make up for missed doses) - If grade 4 toxicity occurs, reduce dose by 50%; resume full dose when toxicity ≤ grade 2 (make up for missed doses). «b»Hyperglycemia«/b» - Continue therapy for uncomplicated hyperglycemia. If hyperglycemia requires insulin therapy, hold asparaginase (and any concomitant corticosteroids) until blood glucose controlled; resume dosing at prior dose level. For life-threatening hyperglycemia or toxicity requiring urgent intervention, hold asparaginase (and corticosteroids) until blood glucose is controlled with insulin; resume asparaginase and do not make up for missed doses. «b»Hypersensitivity Reactions«/b» - May continue dosing for urticaria without bronchospasm, hypotension, edema, or need for parenteral intervention. If wheezing or other symptomatic bronchospasm with or without urticaria, angioedema, hypotension, and/or life-threatening hypersensitivity reactions occur, discontinue asparaginase. «b»Hypertriglyceridemia«/b» - If serum triglyceride level <1000 mg/dL, continue asparaginase but monitor closely for pancreatitis. If triglyceride level >1,000 mg/dL, hold asparaginase and monitor; resume therapy at prior dose level after triglyceride level returns to baseline. «b»Thrombosis and Bleeding, CNS«/b» Thrombosis - Continue therapy for abnormal laboratory findings without a clinical correlate. If grade 3 toxicity occurs, discontinue therapy; if CNS signs/symptoms are fully resolved and further asparaginase doses are required, may resume therapy at a lower dose and/or longer intervals between doses. Discontinue therapy for grade 4 toxicity. Hemorrhage - Discontinue therapy; do not withhold therapy for abnormal laboratory findings without a clinical correlate. If grade 3 toxicity occurs, discontinue therapy; if CNS signs/symptoms are fully resolved and further asparaginase doses are required, may resume therapy at a lower dose and/or longer intervals between doses. Discontinue therapy for grade 4 toxicity. «b»Thrombosis and bleeding, non-CNS«/b» Thrombosis - Continue therapy for abnormal laboratory findings without a clinical correlate. If grade 3 or 4 toxicity occurs, withhold therapy until acute toxicity and clinical signs resolve and anticoagulant therapy is stable or completed. Do not withhold therapy for abnormal laboratory findings without clinical correlate. Hemorrhage - If grade 2 bleeding in conjunction with hypofibrinogenemia occurs, withhold therapy until bleeding ≤ grade 1. Do not withhold therapy for abnormal laboratory findings without clinical correlate. For grade 3 or 4 bleeding, withhold therapy until bleeding ≤ grade 1 and until acute toxicity and clinical signs resolve and coagulant replacement therapy is stable or completed

Asparaginase Erwinia Chrysanthemi Recombinant

Rylaze

Aspirin

Acetylsalicylic Acid, Ecotrin, ASA, Halfprin, Bufferin, Durlaza

Aspirin-Caffeine-Codeine-Butalbital

Fiorinal with Codeine, Ascomp with Codeine

Aspirin-Citric Acid-Sodium Bicarbonate

Effervescent Pain Relief, Alka-Seltzer, Alka-Seltzer Extra Strength, Neutralin, Medi-Seltzer, Acetylsalicylic Acid-Citric Acid-Sodium Bicarbonate

Aspirin-Dipyridamole

Aggrenox, Acetylsalicylic Acid-Dipyridamole ER

Aspirin-Omeprazole

Yosprala, Acetylsalicylic Acid-Omeprazole

Atazanavir

Reyataz, ATV

Atazanavir-Cobicistat

Evotaz

Atenolol

Tenormin

Atenolol-Chlorthalidone

Tenoretic

Atezolizumab

Tecentriq

Atogepant

Qulipta

Atoltivimab

Atoltivimab-Maftivimab-Odesivimab

Inmazeb, Ebola Monoclonal Antibodies

Atomoxetine

Strattera, Tomoxetine

Atorvastatin

Lipitor

«bu»Hyperlipidemia«/bu» «b»Primary Hypercholesterolemia and Mixed Dyslipidemia«/b» - Initial Dose: 10-20 mg PO daily - Starting dose in patients requiring larger LDL-C reduction (ie, >45%): 40 mg PO qDay - Maintenance Dose: 10-80 mg PO daily - After initiation and/or upon dose titration, check lipid levels after 2-4 weeks and adjust dose accordingly «b»Primary Dysbetalipoproteinemia«/b» - Dysbetalipoproteinemia (Fredrickson type III) in patient with inadequate response to diet - Maintenance Dose: 10-80 mg PO daily - After initiation and/or upon dose titration, check lipid levels after 2-4 weeks and adjust dose accordingly «bu»Hypertriglyceridemia«/bu» - Adjunct to diet for elevated TG levels (Fredrickson type IV) - Initial Dose: 10 mg PO daily - Maintenance Dose: 10-80 mg PO daily - After initiation and/or upon dose titration, check lipid levels after 2-4 weeks and adjust dose accordingly «bu»Homozygous Familial Hypercholesterolemia«/bu» - Reduction of total-C and LDL-C in HoFH as an adjunct to other lip-lowering treatments (eg, LDL apheresis) or if such treatments are unavailable - 10-80 mg PO daily «bu»Cardiovascular Disease Prevention«/bu» - 10-80 mg PO daily - Reduction of risk of stroke and heart attack in type 2 diabetes patients without evidence of heart disease but with other CV risk factors - Reduction of risk of stroke, heart attack, and revascularization procedures in patients without evidence of coronary heart disease (CHD) but with multiple risk factors other than diabetes (eg, smoking, HTN, low HDL-C, family history of early CHD) - Patients with CHD, to reduce risks of MI, stroke, revascularization procedures, hospitalization for CHF, and angina «b»Coadministration with other Drugs Dosage Modifications«/b» «bi»Bile Acid Sequestrant«/bi» - Administer atorvastatin/ezetimibe ≥2 hr before or ≥4 hr after administering bile acid sequestrant «bi»Cyclosporine, Tipranavir plus Ritonavir, Gemfibrozil«/bi» - Avoid coadministration with atorvastatin (increased risk of rhabdomyolysis) «bi»Lopinavir plus Ritonavir«/bi» - Use lowest dose of atorvastatin necessary «bi»Clarithromycin, Itraconazole, Saquinavir plus Ritonavir, Darunavir plus Ritonavir, Fosamprenavir«/bi» - Do not exceed atorvastatin dose of 20 mg/day «bi»Nelfinavir«/bi» - Do not exceed atorvastatin dose of 40 mg/day «b»Overdose Management«/b» - Generally considered safe in acute overdose, although not formally studied - Adverse drug reactions from overdose may include peripheral neuropathy, diarrhea, increased K+, myopathy, rhabdomyolysis, acute renal failure, elevated LFTs, eye lens opacities - Treatment is supportive

Atovaquone

Mepron

Atovaquone-Proguanil

Malarone

Atracurium

Tracrium

«bu»Adjunct to Surgical Anesthesia«/bu» «b»Loading Dose«/b» - 0.4 to 0.5 mg/kg IV x 1 dose «b»Maintenance Dose«/b» - 0.08 to 0.1 mg/kg IV administered 20 to 45 minutes after initial dose to maintain neuromuscular block - Repeat dose at 15- to 25-minute intervals as needed - Initial dose may be reduced to 0.3 to 0.4 mg/kg IV in patients with significant cardiovascular disease or history of elevated risk of histamine release (eg, severe anaphylactoid reactions or asthma). Initial dose after succinylcholine for intubation (balanced anesthesia) - 0.3 to 0.4 mg/kg «bu»Endotracheal Intubation«/bu» - Calculate dose based on ideal body weight «b»Loading Dose«/b» - 0.4-0.5 mg/kg IVP over 60 seconds «b»Maintenance Dose«/b» - 0.08-0.1 mg/kg IV 20-45 minutes after initial dose to maintain neuromuscular block, repeat maintenance dose every 15-25min prn «b»Continuous Infusion«/b» - 0.005-0.01 mg/kg/min IV (ranges from 0.002-0.015 mg/kg/min) OR - 0.2-0.4 mg/kg IVP if following succinylcholine for intubation «bu»Mechanical Ventilation«/bu» - Calculate dose based on ideal body weight «b»Loading Dose«/b» - 0.4-0.5 mg/kg IVP over 60 seconds «b»Maintenance Dose«/b» - 0.08-0.1 mg/kg IV 20-45 minutes after initial dose to maintain neuromuscular block, repeat maintenance dose every 15-25min prn «b»Continuous Infusion«/b» - 0.005-0.01 mg/kg/min IV (ranges from 0.002-0.015 mg/kg/min) OR - 0.2-0.4 mg/kg IVP if following succinylcholine for intubation «b»Obesity«/b» - Morbidly-obese patients should be dosed using ideal body weight or an adjusted body weight (between IBW and total body weight [TBW]). - In a bariatric surgical population of morbidly-obese patients who were administered an induction dose of atracurium based on TBW as compared to IBW, time to recovery of twitch response was prolonged «b»Note«/b» - For IV administration only (not to be used IM) - Dose to effect; doses must be individualized due to interpatient variability

Atropine

AtroPen, Atreza, Atropine PO, SalTropine

Atropine (Ophthalmic)

Atropine Care, Isopto Atropine

Atropine-Pralidoxime

ATNAA, Duodote

Auranofin

Ridaura

Avacopan

Tavneos

Avalglucosidase Alfa

Nexviazyme

«b»IV Administration«/b» - Use of in-line, low-protein–binding, 0.2-micron filter recommended for infusion - Administer infusion incrementally, as determined by the patient’s response and comfort - Consider pretreating with antihistamines, antipyretics, and/or corticosteroids - Flush IV line with D5W after infusion complete - Discard any unused diluted product after 9 hr «bi»20 mg/kg Dose Infusion Rate«/bi» Initial and Subsequent Infusions - 1 mg/kg/hr IV; if no signs of infusion-associated reactions (IARs), gradually increase infusion rate every 30min to 3 mg/kg/hr, 5 mg/kg/hr, and then 7 mg/kg/hr - Maintain infusion rate at 7 mg/kg/hr until infusion completed - Total infusion duration ~4-5 hr «bi»40 mg/kg Dose Infusion Rate«/bi» Initial Infusion - 1 mg/kg/hr IV; if no signs of infusion-associated reactions (IARs), gradually increase infusion rate q30min to 3 mg/kg/hr, 5 mg/kg/hr, and then 7 mg/kg/hr - Maintain infusion rate at 7 mg/kg/hr until infusion completed - Total infusion duration ~7 hr Subsequent Infusions - 1 mg/kg/hr IV; if no signs of IARs, gradually increase infusion rate every 30min to 3 mg/kg/hr, 5-6 mg/kg/hr, 7-8 mg/kg/hr, and optionally up to 10 mg/kg hr - Maintain infusion rate at highest tolerated rate until infusion completed - Total infusion duration ~7 hr (4 steps) or ~5 hr (5 steps) «bi»After Desensitzation«/bi» - Desensitization may be considered for hypersensitivity reactions - If decision is made to readminister therapy, ensure patient tolerates infusion; if tolerated, may increase dose and/or rate to reach approved recommended dosage; - If mild or moderate hypersensitivity reaction occurs, infusion rate may be slowed or temporarily stopped «b»IV Reconstitution«/b» - Remove required number of vials for calculated dose from refrigerator and set aside for ~30 minutes to allow them to reach room temperature - Reconstitute each vial with 10 mL of sterile water for injection by a slow drop-wise addition down the inside of vial and not directly onto the lyophilized powder - Do NOT invert, swirl, or shake vials; tilt and roll each vial gently; avoid forceful impact of the diluent on the lyophilized powder and avoid foaming - Allow solution to become dissolved; after reconstitution, each vial will yield 100 mg/10 mL (10 mg/mL) - Dilute reconstituted solution without delay; refrigerate if immediate use is not possible «b»IV Dilution«/b» - Slowly withdraw dosage volume of reconstituted solution from each vial - Add reconstituted solution slowly and directly into D5W for recommended total infusion volume based on the patient’s weight (see below) - Avoid foaming, agitation of infusion bag - Avoid air introduction into infusion bag - Discard any unused reconstituted solution remaining in vial - Mix infusion bag contents by gently inverting or massaging infusion bag; do NOT shake - After dilution, final concentration of solution is 0.5-4 mg/mL - Administer diluted solution without delay - Recommended infusion duration is 4-7 hr - Discard unused diluted solution after 9 hr «b»Total Infusion Volume (20 mg/kg dose)«/b» 30-34.9 kg: 200 mL 35-49.9 kg: 250 mL 50-59.9 kg: 300 mL 60-99.9 kg: 500 mL 100-119.9 kg: 600 mL 120-140 kg: 700 mL «b»Total Infusion Volume (40 mg/kg dose)«/b» - 5-9.9 kg: 100 mL - 10-19.9 kg: 200 mL - 20-29.9 kg: 300 mL

Avanafil

Stendra

Avapritinib

Ayvakit

«bu»Gastrointestinal Stromal Tumors«/bu» - 300 mg PO daily - Continue until disease progression or unacceptable toxicity - Unresectable or metastatic gastrointestinal stromal tumor (GIST) harboring a platelet-derived growth factor receptor alpha (PDGFRA) exon 18 mutation, including PDGFRA D842V mutation «b»Missed Dose«/b» - Do not make up for a missed dose within 8 hr of the next scheduled dose - Do not take an additional dose if vomiting occurs after administration; continue with the next scheduled dose «b»Contraception«/b» «bi»Females of Reproductive Potential«/bi» - Use effective contraception during treatment and for 6 weeks after the final dose «bi»Males with Female Partners of Reproductive Potential«/bi» - Use effective contraception during treatment and for 6 weeks after the final dose «b»Infertility«/b» - Based on findings from animal studies, may impair fertility for both males and females «b»Dosage Modifications for Adverse Reactions«/b» «bi»First Dose Reduction«/bi» - 200 mg PO daily «bi»Second Dose Reduction«/bi» - 100 mg PO daily - Permanently discontinue in patients who are unable to tolerate a 100-mg dose «b»Intracranial Hemorrhage«/b» «bi»First Occurrence of Grade 1 or 2«/bi» - Withhold until resolution; resume at reduced dose «bi»Subsequent Occurrence of Grade 1 or 2«/bi» - Permanently discontinue «bi»Grade 3 or 4«/bi» - Permanently discontinue «b»CNS Effects«/b» «bi»Grade 1«/bi» - Continue dose at the same dose or withhold until improvement to baseline or resolution; resume at same dose or reduced dose «bi»Grade 2 or 3«/bi» - Withhold until improvement to baseline, Grade 1, or resolution - Resume at same dose or reduced dose «bi»Grade 4«/bi» - Permanently discontinue «b»Other Adverse Reactions«/b» «bi»Grade 3 or 4«/bi» - Withhold until improvement to Grade ≤2, or resolution - Resume at same dose or reduced dose, as clinically appropriate «b»Strong-Moderate CYP3A4 Inhibitors«/b» - Avoid use - If concomitant use with a moderate CYP3A inhibitor is unavoidable, reduce starting dose of avapritinib to 100 mg daily

Avatrombopag

Doptelet

«bu»Thrombocytopenia«/bu» «b»Chronic Liver Disease«/b» - Initiate 10-13 days before the scheduled procedure - Patients should undergo their procedure 5-8 days after the last dose - Dose based on pre-procedure platelet count - Platelet Count <40 x 109/L: 60 mg PO daily x 5 days - Platelet Count 40 to <50 x 109/L: 40 mg PO daily x 5 days «b»Chronic Immune Thrombocytopenia«/b» - Use lowest dose needed to achieve and maintain a platelet count ≥50 x109/L to reduce the risk for bleeding - Initial Dose: 20 mg PO daily - Not to exceed 40 mg PO daily «b»Missed Dose«/b» - In the case of a missed dose, administer next dose as soon as possible - Do not take 2 doses at one time to make up for a missed dose; take the next dose at the usual time the next day «b»Dose Adjustments by Platelet Count«/b» - Platelet count <50 x109/L after ≥2 weeks: Increase by 1 dose level; wait 2 wk to assess effects before further adjustment - Platelet count 200-400 x109/L: Decrease 1 dose level; wait 2 wk to assess effects before further adjustment - Platelet count >400 x109/L: Stop treatment and increase platelet monitoring to twice weekly; may restart by decreasing 1 dose level when platelets <150 x109/L - Platelet count <50 x109/L after 4 weeks at 40 mg/day: Discontinue treatment - Platelet count >400 x109/L after 2 weeks at 20 mg/week: Discontinue treatment «b»Dose Levels for Titration«/b» - Dose level 6: 40 mg daily - Dose level 5: 40 mg 3x/week and 20 mg on the 4 remaining days each week - Dose level 4: 20 mg daily - Dose level 3: 20 mg 3x/week - Dose level 2: 20 mg 2x/week OR 40 mg weekly - Dose level 1: 20 mg weekly «b»Discontinue Treatment«/b» - Platelet count does not increase ≥50 x109/L after 4 weeks at 40 mg daily (maximum dose) - Platelet count is >400 x109/L after 2 weeks at 20 mg weekly «b»Moderate or Strong dual Inhibitors of CYP2C9 and CYP3A4«/b» - Start avatrombopag 20 mg 3x/week «b»Moderate or Strong dual Inducers of CYP2C9 and CYP3A4«/b» - Start avatrombopag 40 mg daily

Avelumab

Bavencio

Avibactam

Axicabtagene Ciloleucel

Yescarta

«bu»Large B-Cell Lymphoma«/bu» - One treatment course consists of fludarabine- and cyclophosphamide-lymphodepleting chemotherapy followed by IV infusion of axicabtagene ciloleucel «b»Lymphodepleting Chemotherapy«/b» - 3 doses of fludarabine and cyclophosphamide infused IV on the fifth, fourth, and third day BEFORE infusion of axicabtagene ciloleucel «bi»Fludarabine«/bi» - 30 mg/m2 IV daily x 3 days on the 5th, 4th, and 3rd day «b»BEFORE«/b» infusion of axicabtagene ciloleucel «bi»Cyclophosphamide«/bi» - 500 mg/m2 IV daily x 3 days starting with the first dose of fludarabine «bi»Premedication«/bi» Acetaminophen - 650 mg PO 30-60 minutes before Axicabtagene Ciloleucel infusion Diphenhydramine - 25 to 50 mg IV/PO ~30-60 minutes before Axicabtagene Ciloleucel infusion - Avoid prophylactic use of systemic corticosteroids at all times (may interfere with Axicabtagene Ciloleucel activity), except in the case of a life-threatening emergency «bi»Axicabtagene Ciloleucel«/bi» - Administer after completing lymphodepleting chemotherapy - Dosing of axicabtagene is based on the number of chimeric antigen receptor (CAR)-positive viable T cells - Target dose is 2,000,000 CAR-positive viable T cells/kg body weight, not to exceed 200,000,000 CAR-positive viable T cells - Administer autologously prepared, weight-based IV infusion for individual patient within 30 minutes by either gravity or peristaltic pump - Do not use a leukocyte-depleting filter «bu»Follicular Lymphoma«/bu» «b»Lymphodepleting Chemotherapy«/b» «bi»Fludarabine«/bi» - 30 mg/m2 IV daily x 3 days on the 5th, 4th, and 3rd day «b»BEFORE«/b» infusion of axicabtagene ciloleucel «bi»Cyclophosphamide«/bi» - 500 mg/m2 IV daily x 3 days starting with the first dose of fludarabine «bi»Axicabtagene Ciloleucel«/bi» - Administer after completing lymphodepleting chemotherapy - Dosing of axicabtagene is based on the number of chimeric antigen receptor (CAR)-positive viable T cells - Target dose is 2,000,000 CAR-positive viable T cells/kg body weight - Maximum Dose: 200,000,000 CAR-positive viable T cells - Administer autologously prepared, weight-based IV infusion for individual patient within 30 minutes by either gravity or peristaltic pump - Do not use a leukocyte-depleting filter «b»Cytokine Release Syndrome (CRS) Management«/b» «bi»Grade 1«/bi» Symptoms - Fever, nausea, fatigue, headache, myalgia, malaise - Symptomatic treatment only «bi»Grade 2«/bi» - 1 or more of the following: Symptoms require moderate intervention; oxygen requirement <40% FiO2 or hypotension responsive to fluids or low dose of one vasopressor or Grade 2 organ toxicity - Administer tocilizumab 8 mg/kg IV infused over 1 hr (not to exceed 800 mg) - Repeat tocilizumab q8hr as needed if not responsive to IV fluids or increasing supplemental oxygen - Not to exceed 3 doses in a 24-hr period or 4 doses in total - Manage per Grade 3 if no improvement within 24 hr after initiating tocilizumab «bi»Grade 3«/bi» 1 or more of the following - Symptoms require aggressive intervention; oxygen requirement ≥40% FiO2 or hypotension requiring high-dose or multiple vasopressors or Grade 3 organ toxicity or Grade 4 transaminitis - Administer tocilizumab (see doses in CRS Grade 2) - Administer methylprednisolone 1 mg/kg IV BID or equivalent dexamethasone (eg, 10 mg IV q6hr) - Continue corticosteroid use until event is ≤Grade 1, then taper over 3 days «bi»Grade 4«/bi» 1 or more of the following - Life-threatening symptoms; requires ventilator support, continuous venovenous hemodialysis (CVVHD), or Grade 4 organ toxicity (excluding transaminitis) - Administer methylprednisolone 1000 mg/day IV for 3 days; if improvement, then manage as above «b»Neurologic Toxicity Grading and Management«/b» «bi»Grade 2 with Concurrent CRS«/bi» - Administer tocilizumab (see doses in CRS Grade 2) - If no improvement within 24 hr after starting tocilizumab, administer dexamethasone 10 mg IV q6hr if not already taking other corticosteroids; continue dexamethasone use until the event is ≤Grade 1, then taper over 3 days - Consider nonsedating, antiseizure medicines (eg, levetiracetam) for seizure prophylaxis «bi»Grade 2 or 3 with NO Concurrent CRS«/bi» - Administer dexamethasone 10 mg IV q6hr if not already taking other corticosteroids - Continue until event is ≤Grade 1, then taper over 3 days «bi»Grade 3 with Concurrent CRS«/bi» - Administer tocilizumab (see doses in CRS Grade 2) AND - Administer dexamethasone 10 mg IV q6hr if not already taking other corticosteroids; continue dexamethasone until event is ≤Grade 1, then taper over 3 days - Consider nonsedating, antiseizure medicines (levetiracetam) for seizure prophylaxis «bi»Grade 4 with Concurrent CRS«/bi» - Administer tocilizumab (see doses in CRS Grade 2) - Administer methylprednisolone 1000 mg/day for 3 days with first dose of tocilizumab; if improvement, then manage as above «bi»Grade 4 with NO Concurrent CRS«/bi» - Administer methylprednisolone 1000 mg/day for 3 days; if improvement, then manage as above «b»Contraception«/b» - See the prescribing information for fludarabine and cyclophosphamide for information on the need for effective contraception in patients who receive the lymphodepleting chemotherapy; limited exposure data available concerning the duration of contraception following treatment with axicabtagene ciloleucel «b»Dosing Considerations«/b» - For autologous use only - Administer axicabtagene at a certified healthcare facility - Monitor signs/symptoms of CRS and neurologic toxicities for at least daily for 7 days following infusion - Instruct patients to remain within proximity of the certified healthcare facility for at least 4 weeks following infusion «b»Limitation of Use«/b» - Not indicated for primary central nervous system lymphoma

Axitinib

Inlyta

«bu»Renal Cell Cancer, Advanced«/bu» Initial Dose - 5 mg PO bid (approximately every 12 hours) - If dose is tolerated (no adverse events above grade 2, blood pressure is normal and no antihypertensive use) for at least 2 consecutive weeks, may increase the dose to 7 mg twice daily, and then further increase (using the same tolerance criteria) to 10 mg twice daily. «b»Dose Decreases«/b» - For adverse events, reduce dose from 5 mg bid to 3 mg bid; further reduce to 2 mg bid if adverse events persist. «b»Strong CYP3A4 Inhibitors«/b» - Avoid concomitant administration with strong CYP3A4 inhibitors - Clarithromycin, itraconazole, ketoconazole, nefazodone, protease inhibitors, telithromycin, voriconazole, grapefruit juice - If concomitant administration with a strong CYP3A4 inhibitor cannot be avoided, ~50% dosage reduction is recommended; adjust dose based on individual tolerance and safety. - When the strong CYP3A4 inhibitor is discontinued, resume previous axitinib dose after 3 to 5 half-lives of the inhibitor have passed. «bu»Thyroid Cancer«/bu» «b»Differentiated, Advanced«/b» «bi»Initial Dose«/bi» - 5 mg PO bid on an empty stomach - Increase or decrease dose in 20% increments based on response or toxicity - Continue until disease progression or unacceptable toxicity - If tolerated for 2 consecutive weeks, may increase to 7 mg bid, and then to 10 mg bid (unless receiving antihypertensive medication or blood pressure >150/90 mm Hg); for grade 3 or higher toxicity, interrupt therapy and/or reduce dose to 3 mg bid, if further dose reduction necessary, reduce to 2 mg bid; continue until disease progression or unacceptable toxicity «b»Adverse Events«/b» - May require temporary interruption, dose decreases (reduce dose from 5 mg bid to 3 mg bid; further reduce to 2 mg bid) or discontinuation «bi»Cardiac Failure«/bi» - May require permanent discontinuation «bi»Hypertension«/bi» - Treat with standard antihypertensive therapy. «bi»Persistent Hypertension«/bi» - May require dose reduction «bi»Severe Persistent (despite antihypertensives and dose reduction), or Evidence of Hypertensive Crisis«/bi» - Discontinue treatment «bi»Hemorrhage«/bi» - Any bleeding requiring medical intervention: Temporarily interrupt treatment. «b»Proteinuria (Moderate-to-Severe)«/bi» - Reduce dose or temporarily interrupt treatment.

AzaCITIDine

Vidaza, Onureg

AzaTHIOprine

Imuran, Azasan

«bu»Renal Transplant«/bu» «b»Initial Therapy Following Transplant«/b» - 3 to 5 mg/kg IV/PO once daily (usually given as a single daily dose), then, - 1 to 3 mg/kg IV/PO (usual dose: 50 to 150 mg/day) once daily maintenance «bu»Rheumatoid Arthritis«/bu» «b»Initial PO Dose«/b» - 1 mg/kg/day PO (50 to 100 mg) given once daily or divided twice daily - After 6 to 8 weeks, may increase by 0.5 mg/kg PO every 4 weeks until response or up to 2.5 mg/kg/day - An adequate trial should be a minimum of 12 weeks «b»Maintenance PO Dose«/b» - Reduce dose by 0.5 mg/kg PO (~25 mg daily) every 4 weeks until lowest effective dose is reached - Optimum duration of therapy not specified - May be discontinued abruptly (monitor for delayed toxicities) - IV is indicated only in patients unable to tolerate oral medications (dosing should be transitioned from IV to oral as soon as tolerated) «b»Initial IV Dose«/b» - ~1 mg/kg/day IV (50 to 100 mg) given once daily or divided twice daily - After 6 to 8 weeks, may increase by 0.5 mg/kg IV every 4 weeks until response or up to 2.5 mg/kg/day - An adequate trial should be a minimum of 12 weeks «b»Maintenance IV Dose«/b» - Reduce dose by 0.5 mg/kg IV (~25 mg daily) every 4 weeks until lowest effective dose is reached - Optimum duration of therapy not specified; may be discontinued abruptly (monitor for delayed toxicities) «bu»Crohn Disease«/bu» - Remission Maintenance or Reduction of Steroid Use (off-label use) - 2 to 3 mg/kg PO daily «bu»Dermatomyositis/Polymyositis«/bu» (off-label use) «b»Adjunctive Management«/b» - 50 mg/day PO in conjunction with prednisone - Increase by 50 mg/week to total dose of 2 to 3 mg/kg/day - Onset of beneficial effects may take 3 to 6 months; however, may be preferred over methotrexate in patients with pulmonary or hepatic toxicity. «bu»Eosinophilic Granulomatosis with Polyangiitis (Churg-Strauss Syndrome)«/bu» (off-label use) - 2 mg/kg PO daily for 6 months «bu»Autoimmune Hepatitis«/bu» (off-label use) - 1 mg/kg IV/PO daily (usual dose: 50 mg once daily) in combination with corticosteroids - May increase to 2 mg/kg/day in patients who relapse or do not respond - Most patients who are in complete remission for at least one year may continue azathioprine (without corticosteroids) at 2 mg/kg/day without relapse «bu»Chronic Immune Thrombocytopenia«/bu» (off-label use) «b»Refractory or Relapsed«/b» - 1 to 2 mg/kg PO daily - Maximum Dose: 150 mg/day - Initial response is observed at 30 to 90 days - May take up to 6 months for peak response «bu»Lupus Nephritis«/bu» (off-label use) «b»Maintenance«/b» - Initial Dose: 2 mg/kg PO daily - Reduce to 1.5 mg/kg/day after 1 month (if proteinuria <1 g/day and serum creatinine stable) or target dose: 2 mg/kg/day «bu»Multiple Sclerosis«/bu» (off-label use) - 2 to 3 mg/kg PO daily «bu»Recurrent Pericarditis«/bu» (off-label use) - 150 mg once PO daily for 2 to 3 months, then, - 100 mg PO once daily to suppress clinical symptoms «bu»Psoriasis«/bu» (off-label use) - Initial Dose: 0.5 mg/kg PO daily - If no occurrence of cytopenia after 6 to 8 weeks of therapy, may increase by 0.5 mg/kg/day every 4 weeks until response - Usual Dosage: 75 to 150 mg/day «bu»Ulcerative Colitis«/bu» (off-label use) «b»Remission Maintenance or Reduction of Steroid Use«/b» - 1.5 to 2.5 mg/kg PO daily «bu»Uveitis«/bu» (off-label use) - 2 to 3 mg/kg PO daily given either alone or in conjunction with corticosteroids and/or immunosuppressants «b»Dosage Adjustment for Concomitant Use with Allopurinol«/b» - Reduce azathioprine dose to one-third or one-fourth the usual dose when used concurrently with allopurinol. - Patients with low or absent TPMT activity may require further dose reductions or discontinuation. Rapid WBC Count Decrease, Persistently Low WBC Count, or Serious Infection - Reduce dose or temporarily withhold treatment Severe Toxicity (Hematologic or Other) in Renal Transplantation - May require discontinuation Hepatic Sinusoidal Obstruction Syndrome (SOS; Veno-occlusive Disease) - Permanently discontinue

Azelaic Acid

Azelex, Finacea, Lepargylic Acid, Anchoic Acid

Azelastine

Astelin Nasal Spray, Astepro (Nasal), Rhinolast

Azelastine (Ophthalmic)

Optivar

Azelastine-Fluticasone

Ticalast, Dymista

Azilsartan

Edarbi

Azithromycin

Zithromax, Z-Pak, TRI-Pak

«bu»Acute Bacterial Exacerbations of COPD«/bu» «b»Recommended Regimen«/b» - 500 mg PO x 1 dose THEN, - 250 mg once daily for 4 days «b»Alternative Regimen«/b» 500 mg PO daily x 3 days «bu»Acute Otitis Media«/bu» - 500 mg PO once THEN, - 250 mg once daily for 4 days «bu»Genital Ulcer Disease (Chancroid)«/bu» - 1 g PO x 1 dose «bu»Acute Bacterial Sinusitis«/bu» «b»Recommended Regimen«/b» - 500 mg PO daily x 3 days «b»Alternative Regimen«/b» - 2 g PO x 1 dose «bu»Community-Acquired Pneumonia (CAP)«/bu» «b»Recommended Regimen«/b» - 500 mg PO x 1 dose THEN, - 250 mg once daily x 4 days «b»Alternative Regimens«/b» - 2 g extended release suspension PO x 1 dose - 500 mg IV daily for at least 2 days THEN, - 500 mg PO daily to complete 7-10 days course of therapy «bu»Pharyngitis/Tonsillitis«/bu» «b»Recommended Regimen«/b» - 500 mg PO x 1 dose THEN, - 250 mg PO once daily for 4 days «b»Alternative Regimen«/b» - 12 mg/kg PO x 1 dose (Maximum: 500 mg) THEN, - 6 mg/kg PO (Maximum: 250 mg) on days 2 through 5 «bu»Skin/Skin Structure Infections«/bu» - 500 mg PO x 1 dose THEN, - 250 mg PO once daily x 4 days «bu»Acute Pelvic Inflammatory Disease«/bu» - 500 mg IV over 1 hour once daily x 1-2 days THEN, - 250 mg PO daily x 5 days to complete a 7 day therapy «bu»Gonococcal Infections«/bu» «b»Pharynx, Cervix, Urethra, or Rectum«/b» - 1 g PO x 1 dose Plus - Ceftriaxone 250 mg IM x 1 dose «b»Sexual Assault«/b» - Prophylaxis of sexually transmitted diseases (STDs) such as gonorrhea after sexual assault per CDC guidelines includes the following 3-drug regimen: - 1g PO x 1 dose PLUS - Ceftriaxone 250 mg IM x 1 dose PLUS - Metronidazole or tinidazole 2 g PO x 1 dose - If alcohol has been recently ingested or emergency contraception is provided, metronidazole or tinidazole can be taken by the victim at home rather than as directly observed therapy to avoid drug interactions «bu»Mycobacterium Avium Complex Infection«/bu» «b»Prevention«/b» «bi»Primary Prophylaxis«/bi» - 1.2 g PO once weekly +/- rifabutin 300 mg once daily OR - 600 mg PO twice weekly +/- rifabutin 300 mg once daily «bi»Secondary Prophylaxis«/bi» - 500-600 mg PO daily + ethambutol «b»Treatment«/b» - 250 mg PO once daily PLUS - Ethambutol 15 mg/kg/day +/- - Rifabutin 300 mg/day - Alternative regimen: 500 mg PO 3 times weekly in combination with ethambutol 15 mg/kg/day with or without rifabutin 300 mg/day «bu»Cat Scratch Disease«/bu» «b»>45.5 kg«/b» - 500 mg PO once, then, - 250 mg PO once daily x 4 days «bu»Pertussis«/bu» - 500 mg PO x 1 dose THEN, - 250 mg PO once daily x 4 days «bu»Endocarditis Prophylaxis«/bu» - 500 mg PO 30-60 min before procedure

Azithromycin (Ophthalmic)

AzaSite

Aztreonam

Azactam

Aztreonam (Inhalation)

Cayston

Bacitracin

BACiiM

Bacitracin (Ophthalmic)

AK-Tracin

Bacitracin (Topical)

Bacitin, Baciderm, Bacitran

Bacitracin-Neomycin-Polymyxin B-Hydrocortisone

Cortisporin (Topical)

Baclofen

Fleqsuvy, Gablofen, Lioresal, Lyvispah, Ozobax

«bu»Spasticity«/bu» «b»Initial Dose«/b» - 5 mg PO tid «b»Maintenance Dose«/b» - May increase by 5 mg PO per dose every 3 days - 5 mg PO tid x 3 days THEN, - 10 mg PO tid x 3 days until optimal response is reached «b»Usual Dosage Range«/b» - 40 to 80 mg PO once daily «b»Maximum Dose«/b» - 80 mg PO daily «bu»Alcoholic Liver Disease«/bu» «b»Initial Dose«/b» - 5 mg PO tid x 3 days «b»Maintenance Dose«/b» - 10 mg PO tid «bu»Alcohol Abstinence«/bu» «b»Initial Dose«/b» - 5 mg PO tid x 3 days «b»Maintenance Dose«/b» - 10 mg PO tid «bu»Gastroesophageal Reflux Disease (GERD)«/bu» - 10 mg PO qid «bu»Hiccups«/bu» - 5 to 10 mg PO tid «b»Maximum Dose«/b» - 75 mg daily in divided doses «bu»Nystagmus«/bu» «b»Initial Dose«/b» - 5 mg PO tid «b»Maintenance Dose«/b» - May increase at weekly intervals until optimal response is reached or intolerable adverse effects occur «b»Dose Range«/b» - 15 to 120 mg daily in divided doses «bu»Trigeminal Neuralgia«/bu» «b»Initial Dose«/b» - 5 to 10 mg PO tid - Dose may be as low as 10 mg daily «b»Maintenance Dose«/b» - May increase dose by 10 mg every other day over 1 to 2 weeks «bu»Spasticity Intrathecal«/bu» «b»Screening Dose«/b» Initial Dose - 50 mcg x 1 dose Maintenance Dose - Following initial administration, observe patient for 4 to 8 hours - A positive response consists of a significant decrease in muscle tone and/or frequency and/or severity of spasms. - If response is inadequate, may give 75 mcg as a second screening dose 24 hours after the first screening dose; observe patient for 4 to 8 hours. - If response is still inadequate, may repeat a final screening dose of 100 mcg given 24 hours after the second screening dose. - Patients not responding to screening dose of 100 mcg should not be considered for chronic infusion/implanted pump. «b»Dose Titration Following Pump Implant«/b» - After positive response to screening dose, a maintenance intrathecal infusion can be administered via an implanted intrathecal pump. «b»Initial Total Daily Dose via Pump«/b» - Double the screening dose that gave a positive response and administer over 24 hours, unless efficacy of the bolus dose was maintained for >8 hours, then infuse a dose equivalent to the screening dose over 24 hours. - Do not increase dose in first 24 hours (to allow steady state to be achieved); thereafter, dosage adjustments may be made by increasing daily dose slowly by 10% to 30% (spasticity of spinal cord origin) or 5% to 15% (spasticity of cerebral origin) once every 24 hours until satisfactory response. «b»Maintenance«/b» - Daily dose may be increased 5% to 20% (maximum increase: 20%) (spasticity of cerebral origin) or by 10% to 40% (maximum increase: 40%) (spasticity of spinal cord origin) - Dose may also be decreased 10% to 20% for adverse effects - Most patients have been adequately maintained on 90 mcg to 703 mcg daily (spasticity of cerebral origin) or 300 mcg to 800 mcg daily (spasticity of spinal cord origin) - Experience with doses >1,000 mcg daily is limited. - Dosage adjustments may be required often during the first few months of therapy to adjust for life style changes due to alleviation of spasticity. Maintain lowest dose that produces adequate response. Most patients require gradual increases over time to maintain optimal response. Sudden large requirements for a dose increase may indicate a catheter complication (eg, kink, dislodgement).Titrate dose to allow sufficient muscle tone and occasional spasms to optimize activities of daily living, support circulation, and possibly prevent DVT formation. Use extreme caution when filling the pump; follow manufacturer instructions carefully. 5% to 10% of patients receiving chronic therapy become refractory to dose adjustments; may consider a drug holiday (hospitalized patients only) with a gradual withdrawal over 2 to 4 weeks and use of alternative spasticity management methods. Following the drug holiday intrathecal baclofen may be resumed at the initial continuous infusion dose. - Use the lowest effective dose - Patients who fail to respond within a reasonable amount of time should be slowly withdrawn from therapy (avoid abrupt withdrawal of drug). «bu»Spasticity«/bu» «b»Children ≥12 years«/b» - Refer to adult dosing. «b»Children ≥2 and <12 years«/b» - Dose-related side effects (sedation) may be minimized by slow titration - Lower initial doses than described below (2.5 to 10 mg daily) may be used with subsequent titration to 8 hourly doses «b»Infants ≥4 months and Children <2 years«/b» - 10 to 20 mg daily divided every 8 hours - Begin at low end of range and titrate dose to patient response, titration intervals of every 3 days to weekly have been used in pediatric patients ≥2 years - To minimize dose-related side effects (eg, sedation), lower initial doses (eg, 2.5 mg once daily) and slower titration may be considered (eg, weekly) and has been reported in pediatric patients >2 years «b»2 to 7 years«/b» - 20 to 40 mg daily divided every 8 hours; begin at low end of range (or even lower [2.5 to 10 mg daily] and titrate dose to patient response; titration intervals of every 3 days to weekly have been used in pediatric patients - Maximum Daily Dose: 60 mg/day «b»≥8 years and Adolescents«/b» - 30 to 40 mg daily divided every 8 hours; begin at low end of range (or even lower [10 mg to 15 mg daily in 3 divided doses]) and titrate dose to patient response, titration intervals of every 3 days to weekly have been used - Some patients ≥12 years may require every 6 hour dosing; usual maximum daily dose range: 60 to 80 mg/day - Higher maximum daily doses (up to 200 mg/day) have been described in some patients in a retrospective review, usually the higher doses were needed over time «b»Intrathecal: Children ≥4 years and Adolescents«/b» - Screening dose: Refer to adult dosing. Note: A 25 mcg initial screening dose may be considered in very small pediatric patients. - Dose titration following pump implant: After positive response to screening dose, a maintenance intrathecal infusion can be administered via an implanted intrathecal pump. - Initial total daily dose via pump: Double the screening dose that gave a positive response and administer over 24 hours, unless efficacy of the bolus dose was maintained for >8 hours, then infuse a dose equivalent to the screening dose over 24 hours. Do not increase dose in first 24 hours (to allow steady state to be achieved); thereafter, increase daily dose slowly by 5% to 15% once every 24 hours until satisfactory response. - Maintenance Dose: Daily dose may be increased 5% to 20% (maximum increase: 20%). Dose may also be decreased 10% to 20% for adverse effects. Patients <12 years required lower daily doses in clinical trials (average dose: 274 mcg daily; dosage range: 24 mcg to 1,199 mcg/day). - Dosage adjustments may be required often during the first few months of therapy to adjust for life style changes due to alleviation of spasticity. Maintain lowest dose that produces adequate response. Most patients require gradual increases over time to maintain optimal response. Sudden large requirements for a dose increase may indicate a catheter complication (eg, kink, dislodgement).Titrate dose to allow sufficient muscle tone and occasional spasms to optimize activities of daily living, support circulation, and possibly prevent DVT formation. Use extreme caution when filling the pump; follow manufacturer instructions carefully. 5% to 10% of patients receiving chronic therapy become refractory to dose adjustments; may consider a drug holiday (hospitalized patients only) with a gradual withdrawal over 2 to 4 weeks and use of alternative spasticity management methods. Following the drug holiday intrathecal baclofen may be resumed at the initial continuous infusion dose.

Baloxavir Marboxil

Xofluza

Balsalazide Disodium

Colazal, Giazo

Balsam Peru

Balsam Peru-Castor Oil

Amberderm, Proderm, Venelex

Bamlanivimab

LY-CoV555, Eli Lilly COVID-19 Monoclonal Antibody

Baricitinib

Olumiant

«bu»Rheumatoid Arthritis«/bu» - 2 mg PO daily - May be used as monotherapy or in combination with methotrexate or other nonbiologic disease-modifying antirheumatic drugs (DMARDs) «bu»Alopecia Areata«/bu» - 2 mg PO daily - May increase to 4 mg PO daily if inadequate response - Consider 4 mg PO daily with nearly complete or complete scalp hair loss, with or without substantial eyelash or eyebrow hair loss - Once adequate response achieved with 4 mg/day, decrease to 2 mg/day «bu»COVID-19«/bu» - 4 mg PO daily x 14 days or until hospital discharge, whichever comes first - Indicated for hospitalized adults who require supplemental oxygen, noninvasive or invasive mechanical ventilation, or extracorporeal membrane oxygenation (ECMO) «b»Dosing Considerations«/b» - Do not initiate if ALC <500 cells/mm3, ANC <1000 cells/mm3, or Hgb level <8 g/dL - Avoid in patients with active, serious infection, including localized infections - Before initiating, test patients for latent tuberculosis (TB); if positive, consider treating for TB prior to initiating «b»Absolute Lymphocyte Count (ALC)«/b» «bi»ALC ≥500 cells/mm3«/bi» - Maintain dose «bi»ALC <500 cells/mm3«/bi» - Avoid initiation or interrupt dosing until ALC ≥500 cells/mm3 «b»Absolute Neutrophil Count (ANC)«/b» «bi»ANC ≥1000 cells/mm3«/bi» - Maintain dose «bi»ANC <1000 cells/mm3«/bi» - Avoid initiation or interrupt dosing until ANC ≥1000 cells/mm3 «b»Anemia«/b» «bi»Hgb ≥8 g/dL«/bi» - Maintain dose «bi»Hgb <8 g/dL«/bi» - Avoid initiation or interrupt dosing until Hgb ≥8 g/dL «b»Organic Anion Transporter 3 (OAT3) Inhibitors«/b» - Decrease baricitinib to 1 mg/day «b»Limitations of Use«/b» - Not recommended for use in combination with other janus kinase (JAK) inhibitors, biologic DMARDs, or with potent immunosuppressants (azathioprine, cyclosporine) «bu»COVID-19«/bu» - Emergency Use Authorization with suspected or laboratory confirmed COVID-19 who require supplemental oxygen, invasive mechanical ventilation, or extracorporeal membrane oxygenation (ECMO) - 4 mg PO daily «b»Absolute Lymphocyte Count (ALC)«/b» «bi»ALC ≥200 cells/mm3«/bi» - Maintain dose «bi»ALC <200 cells/mm3«/bi» - Avoid initiation or interrupt dosing until ALC ≥200 cells/mm3 «b»Absolute Neutrophil Count (ANC)«/b» «bi»ANC ≥1500 cells/mm3«/bi» - Maintain dose «bi»ANC <1000 cells/mm3«/bi» - Avoid initiation or interrupt dosing until ANC ≥500 cells/mm3 «b»Dosing Considerations«/b» - Evaluate baseline eGFR, liver enzymes, and CBC count to determine treatment suitability and dose - Monitor closely patients with abnormal baseline and post-baseline laboratory values - Not recommended with known active TB - Data are limited in patients receiving systemic corticosteroids - Has not been studied in combination with other JAK inhibitors or with biologic DMARDs (biologic treatments targeting cytokines, B-cells, or T-cells)

Basiliximab

Simulect

BCG Live (Intravesical)

Bacillus Calmette-Guérin Live (Intravesical), Tice BCG, TheraCys

BCG Vaccine

BCG Vaccine (Tice strain), Bacillus Calmette-Guérin (BCG) Vaccine

Bebtelovimab

Eli Lilly COVID-19 Monoclonal Antibody, LY-CoV1404, LY3853113

Becaplermin

Regranex, rPDGF-BB, Recombinant Human Platelet-Derived Growth Factor B

Beclomethasone (Nasal)

Beconase AQ, Vancenase AQ, Qnasl

Beclomethasone Dipropionate (Oral Inhalation)

Qvar, Vanceril, RediHaler

Bedaquiline

Sirturo

«b»Oral Administration«/b» - Administer by directly observed therapy (DOT) - Only use in combination with at least 3 other drugs to which the patient’s MDR-TB isolate has been shown to be susceptible in vitro - Must take with food - Swallow 100-mg tablets whole with water «bi»20-mg Tablets«/bi» - Functionally scored tablets that can be split into 2 equal halves of 10 mg each «b»Patients Unable to Swallow 20-mg Tablet(s)«/b» - Disperse in water and administer with beverage or soft food - Disperse tablets in water (maximum of 5 tablets in 5 mL of water) in a drinking cup - Mix contents well until tablets are completely dispersed and then orally administer immediately with food To aid with administration, dispersed mixture can be further mixed with at least 5 mL of beverage (eg, water, milk products, apple juice, orange juice, cranberry juice, carbonated beverage) or 1 teaspoonful of soft food (eg, yogurt, apple sauce, mashed banana, porridge) and then orally administer the contents of the cup immediately - If total dose requires >5 tablets, repeat above preparation steps with appropriate number of additional tablets until the desired dose is reached - Ensure no tablet residue is left in cup, rinse with beverage or add more soft food and orally administer contents immediately «b»Crush and Mix with Soft Food«/b» - 20-mg tablet can be crushed and mixed with soft food (eg, yogurt, apple sauce, mashed banana, porridge) immediately before administration - Ensure no tablet residue is left in container, add more soft food and administer the contents immediately «b»Administration via NG Tube«/b» - 8 French or greater - Disperse <5 tablets in 50-mL of noncarbonated water and mix well - Mixture should be white to almost white with visible particles expected - Administer through the nasogastric tube immediately - Repeat with additional tablets until desired dose is reached - Rinse and flush with 25 mL of additional water to ensure no tablet residue is left in materials used for preparation or the nasogastric tube

Belantamab

Blenrep

«bu»Multiple Myeloma«/bu» «b»Relapsed or Refractory«/b» - 2.5 mg/kg IV every 3 weeks - Continue until disease progression or unacceptable toxicity «b»Recommended Dose Reduction for Adverse Reactions«/b» «bi»First Dose Reduction«/bi» - 1.9 mg/kg IV every 3 weeks Unable to Tolerate First Dose Reduction: - Discontinue «b»Corneal Adverse Reactions«/b» «bi»Grade 1«/bi» Corneal Examination Finding: - Mild superficial keratopathy Change in Best-Corrected Visual Acuity (BCVA): - Decline from baseline of 1 line on Snellen Visual Acuity - Continue treatment at current dose «bi»Grade 2«/bi» Corneal Examination Finding: - Moderate superficial keratopathy Change in BCVA: - Decline from baseline of 2 or 3 lines on Snellen visual acuity and not worse than 20/200 - Withhold until improvement in both corneal examination findings and change in BCVA to Grade ≤1 and resume at same dose «bi»Grade 3«/bi» Corneal Examination Finding: - Severe superficial keratopathy Change in BCVA: - Decline from baseline by >3 lines on Snellen visual acuity and not worse than 20/200 Withhold until improvement in both corneal examination findings and change in BCVA to Grade ≤1 and resume at reduced dose «bi»Grade 4«/bi» Corneal Examination Finding: - Corneal epithelial defect Change in BCVA: - Snellen visual acuity worse than 20/200 - Consider permanent discontinuation; if continuing treatment, withhold until improvement in both corneal examination findings and change in BCVA to Grade ≤1 and resume at reduced dose «b»Thrombocytopenia«/b» «bi»Platelet Count 25,000 to <50,000/mcL«/bi» - Consider withholding and/or reducing dose «bi»Platelet Count <25,000«/bi» - Withhold until platelet count improves to Grade ≤3; consider resuming at a reduced dose «b»Infusion-related Reactions«/b» «bi»Grade 2 or 3«/bi» - Interrupt infusion and provide supportive care - Once symptoms resolve, resume at lower infusion rate; reduce infusion rate by at least 50% «bi»Grade 4«/bi» - Permanently discontinue and provide emergency care «b»Other Adverse Reactions«/b» «bi»Grade 3«/bi» - Withhold until improvement to Grade ≤1 - Consider resuming at a reduced dose «bi»Grade 4«/bi» - Consider permanent discontinuation - If continuing treatment, withhold until improvement to Grade ≤1 and resume at reduced dose «b»Dosing Considerations«/b» - Perform an ophthalmic examination before initiation and during treatment - Advise patients to use preservative-free lubricant eye drops and avoid contact lenses unless directed by an ophthalmologist «b»Contraception«/b» «bi»Females of Reproductive Potential«/bi» - Use effective contraception during treatment and for 4 months after last dose «bi»Males with Female Partners of Reproductive Potential«/bi» - Use effective contraception during treatment and for 6 months after last dose «b»IV Administration«/b» - Hazardous drug; follow applicable special handling and disposal procedures - If refrigerated, allow diluted infusion solution to equilibrate to room temperature (68-77ºF [20-25ºC]) before administration - Diluted infusion solution may be kept at room temperature for no more than 6 hr (including infusion time) - Administer by IV infusion over ~30 minutes using an infusion set made of PVC or PO - Filtration of the diluted solution is not required; however, if filtered, use a polyethersulfone-based filter (0.2 micron) - Do not mix or administer as an infusion with other products - Product does not contain a preservative «b»IV Reconstitution«/b» - Calculate dose (mg), total volume (mL) of solution required, and number of vials needed based on patient’s actual body weight - More than 1 vial may be needed for a full dose; do not round down for partial vials - Remove vial(s) from refrigerator and allow to stand for ~10 minutes to reach room temperature (68-77ºF [20-25ºC]) - Reconstitute each 100-mg vial with 2 mL of sterile water for injection to obtain a final concentration of 50 mg/mL - Gently swirl vial to aid dissolution; do not shake - Visually inspect for particulate matter and discoloration before administration, whenever solution and container permit; reconstituted solution should be clear to opalescent, colorless to yellow to brown liquid - Discard if extraneous particulate matter is observed «b»IV Dilution«/b» - Withdraw calculated drug volume and dilute in a 250-mL infusion bag of 0.9% NaCl, to a final concentration of 0.2-2 mg/mL - Infusion bags must be made of polyvinylchloride (PVC) or polyolefin (PO) - Mix diluted solution by gentle inversion; do not shake - Discard any unused reconstituted solution left in vial(s) - Visual inspect for particulate matter and discoloration before administration, whenever solution and container permit; diluted infusion solution should be clear and colorless; discard if particulate matter is observed

Belatacept

Nulojix

Belimumab

Benlysta

«b»IV Administration«/b» - Administer IV over 1 hour through a dedicated IV line - Do NOT administer as an IV push or bolus. - Discontinue infusion for severe hypersensitivity reaction (anaphylaxis, angioedema). - The infusion may be slowed or temporarily interrupted for minor reactions. - Consider premedicating with an antihistamine and antipyretic for prophylaxis against hypersensitivity or infusion reactions. «b»SC Administration«/b» - Allow prefilled syringe and autoinjector to warm to room temperature for 30 minutes prior to administration; do not warm product in any other way. - Administer SC using a different injection site on the same day each week; do not administer into tender, bruised, red, or hard skin. - Initial use is recommended under supervision of physician; self-injection may occur after proper training. «b»IV Reconstitution«/b» - To reconstitute, remove vial from the refrigerator and allow to stand 10 to 15 minutes to reach room temperature. - Reconstitute 120 mg vial with 1.5 mL of SWFI. - Reconstitute 400 mg vial with 4.8 mL of SWFI. - A 21- to 25-gauge needle is recommended to use for piercing the vial stopper for reconstitution and dilution. - To minimize foaming, direct SWFI toward the side of the vial. - Gently swirl for 60 seconds every 5 minutes until powder has dissolved (usual reconstitution time is 10 to 15 minutes, but may take up to 30 minutes); do not shake. - If utilizing a mechanical reconstitution device, do not exceed 500 rpm or 30 minutes. - Further dilute reconstituted solution in 250 mL of NS, 0.45% NS, or lactated Ringer's by first removing and discarding the volume equivalent to the volume of the reconstituted solution to be added to prepare the appropriate dose; add the appropriate volume of the reconstituted solution to the infusion container and gently invert to mix solution. «b»SC Preparation«/b» - Remove the autoinjector or prefilled syringe from the refrigerator and allow to sit at room temperature for 30 minutes prior to administration; do not warm product in any other way. - Visually inspect the window of the autoinjector or prefilled syringe for particulate matter or discoloration. - Do not use if product exhibits discoloration or if dropped on a hard surface.

Belinostat

Beleodaq

Belladonna Alkaloids

Belladonna Alkaloids-Opium

B&O

Belumosudil

Rezurock

Belzutifan

Welireg

«bu»Von Hippel-Lindau Disease«/bu» - 120 mg PO daily - Continue until disease progression or unacceptable toxicity - Adults with von Hippel-Lindau (VHL) disease who require therapy for associated renal cell carcinoma, CNS hemangioblastomas, or pancreatic neuroendocrine tumors, not requiring immediate surgery «b»Missed Dose«/b» - Take as soon as possible on the same day - Resume regular dosing schedule for next day; do NOT double dose «b»Vomited Dose«/b» - Do not retake dose - Take the next dose on the next day «b»Dose Reductions for Adverse Reactions«/b» First Dose Reduction - 80 mg PO daily Second Dose Reduction - 40 mg PO daily Third Dose Reduction - Permanently discontinue «b»Anemia«/b» Hemoglobin <9 g/dL or Transfusion Indicated - Withhold until hemoglobin ≥9 g/dL - Resume at reduced dose or discontinue depending on severity Life-threatening or Urgent Intervention Indicated - Withhold until hemoglobin ≥9 g/dL - Resume at reduced dose or permanently discontinue «b»Hypoxia«/b» Decreased Oxygen Saturation with Exercise (pulse oximeter <88%) - Consider withholding until resolved - Resume at same dose or at reduced dose depending on severity Decreased Oxygen Saturation at Rest (pulse oximeter <88% or PaO2 ≤55 mm Hg) or Urgent Intervention Indicated - Withhold until resolved - Resume at reduced dose or discontinue depending on severity Life-threatening or Recurrent Symptomatic Hypoxia - Permanently discontinue «b»Other Adverse Reactions«/b» Grade 3 - Withhold until resolved to Grade ≤2 - Consider resuming at a reduced dose (reduce by 40 mg) Recurrent Grade 3 or Grade 4 - Permanently discontinue «b»Dosing Considerations«/b» - Verify pregnancy status in females of childbearing potential before initiation - Closely monitor for adverse reactions in patients who are dual UGT2B17 and CYP2C19 poor metabolizers «b»Contraception«/b» - Belzutifan can render some hormonal contraceptives ineffective Females of Reproductive Potential - Use effective nonhormonal contraception during treatment and for 1 week after final dose Male Patients with Female Partners of Reproductive Potential - Use effective contraception during treatment and for 1 week after final dose «b»Infertility«/b» - Therapy may impair fertility in males and females of reproductive potential - Reversibility of the effect on fertility is unknown

Bempedoic Acid

Nexletol

Bempedoic Acid-Ezetimibe

Nexlizet

Benazepril

Lotensin

Benazepril-Hydrochlorothiazide

Lotensin HCT

Bendamustine

Bendeka, Treanda, Cytostasan

Bendroflumethiazide

Benralizumab

Fasenra

Benzalkonium Chloride

Benzalkonium Chloride-Benzocaine

Cold Sore Products, Orajel Single Dose

Benznidazole

Benzocaine

EjectDelay

Benzonatate

Tessalon Perles

Benzoyl Peroxide

Acne-10, Clearskin, PanOxyl, Riax, Benzac AC Gel, Desquam-X, Clearasil Vanishing Acne Treatment Cream

Benzoyl Peroxide-Erythromycin (Topical)

Aktipak, Benzamycin

Benzoyl Peroxide-Tretinoin (Topical)

Twyneo

Benzphetamine

Didrex, Regimex

Benztropine Mesylate

Cogentin

Benzylpenicilloyl Polylysine

Pre-Pen, Penicilloyl-polylysine, PPL

«bu»Diagnostic Aid for Detection of Penicillin Allergy«/bu» - Should always be applied first via the puncture technique. - Do not administer intradermally to patients who have a positive reaction to the puncture test. «b»Puncture Test«/b» - Apply a small drop of the skin test solution using a 22- to 28-gauge needle and make a single shallow puncture of the epidermis through the drop of solution. - A positive reaction consists of a pale wheal surrounding the puncture site which develops within 10 minutes and ranges from 5-15 mm or more in diameter (wheal may be surrounded by erythema and variable degrees of itching). - If a positive response is evident, the solution should be wiped off immediately. - If the puncture test is negative or equivocal (<5 mm wheal, with little or no erythema and no itching) 15 minutes following the puncture test, an intradermal test may be performed. «b»Intradermal Test«/b» - Using a 0.5-1 mL tuberculin syringe with a 3/8 to 5/8 inch, 26- to 30-gauge short bevel needle, inject a volume of skin test solution sufficient to raise a small intradermal bleb ~3 mm in diameter intradermally, in duplicate at least 2 cm apart. - A control of 0.9% sodium chloride or allergen-diluting solution should be injected at least 5 cm from the antigen test site. - Most skin responses to the intradermal test will develop within 5-15 minutes. - A response to the skin test is read at 20 minutes. «b»Interpretation of Intradermal Test«/b» - (-) Negative: No increase in size of original bleb or no greater reaction compared to the control site - (±) Ambiguous: Wheal only slightly larger than original bleb with or without erythematous flare and slightly larger than control site; OR discordance between duplicate test sites - (+) Positive: Itching and marked increase in size of original bleb to ≥5 mm. Wheal may exhibit pseudopods and be >20 mm in diameter. - Control site should be reactionless. If wheal >2-3 mm develops at control site, repeat the test. If same reaction occurs, consultation is necessary.

Bepotastine (Ophthalmic)

Bepreve

Beractant

Survanta, Bovine Lung Surfactant

Beremagene geperpavec

Vyjuvek Topical Gel

Berotralstat

Orladeyo

Besifloxacin

Besivance

Betamethasone

Betaject, Betamethasone Sodium Phosphate, Flubenisolone, Celestone Soluspan

Betamethasone Dipropionate (Topical)

Alphatrex, BetaVal, Dermabet, Diprolene, Diprolene AF, Diprolene Glycol, Diprosone, Luxiq, Sernivo, Valnac

«b»Cream, Ointment«/b» - Apply topical sparingly to affected areas. Not for use on broken skin or in areas of infection. - Do not apply to wet skin unless directed; do not cover with occlusive dressing. - Do not apply very high potency agents to face, groin, axillae, or diaper area. - Not for oral, ophthalmic, or intravaginal use. «b»Lotion«/b» - Apply topical sparingly to affected areas. - Massage in gently until lotion disappears. - Not for use on broken skin or in areas of infection. - Do not apply to wet skin unless directed; do not cover with occlusive dressing. - Do not apply very high potency agents to face, groin, axillae, or diaper area. Not for oral, ophthalmic, or intravaginal use. «b»Foam«/b» - Invert can and dispense a small amount onto a saucer or other cool surface - Do not dispense directly into hands. - Pick up small amounts of foam and gently massage into affected areas until foam disappears. - Repeat until entire affected scalp area is treated. - Do not cover with occlusive dressing unless directed otherwise by health care provider. - Not for ophthalmic use. Avoid getting into eyes. «b»Patch«/b» (Canadian product) - Clean and dry area to be treated prior to each application - May cut patch to size to cover lesion - Peel off protective film and apply adhesive medicated side to affected area; patch should be worn for 20 to 24 hours. - After removing patch wait at least 30 minutes before applying a new one. - Keep dry; if patch becomes wet, remove and wait until next scheduled dose before applying a new one. - Do not cover with occlusive dressing. Patch should not be reused if it comes off; if edges of patch start to lift, apply medical adhesive tape to detached part only. «b»Spray«/b» - Spray directly onto affected areas (spray only enough to sufficiently cover the area); rub in gently and wash hands after applying. - Shake well before use. - Do not use if atrophy is present at the treatment site. - Do not cover with occlusive dressing unless directed otherwise by health care provider. - For topical use only; not for oral, ophthalmic or vaginal use; avoid use on the face, scalp, axilla, groin, or other intertriginous areas.

Betaxolol

Kerlone

Betaxolol (Ophthalmic)

Betoptic, Betoptic-S

Bethanechol

Urecholine

Betrixaban

Bevyxxa

Bevacizumab

Alymsys, Avastin, Mvasi, Vegzelma, Zirabev

Bexagliflozin

Brenzavvy

Bexarotene

Targretin

Bexarotene (Topical)

Targretin

Bezlotoxumab

Zinplava

Bicalutamide

Casodex, CDX

Bictegravir

Bictegravir-Emtricitabine-Tenofovir AF

Biktarvy

Bimatoprost

Durysta, Latisse, Lumigan, Vistitan

Binimetinib

Mektovi

Bisacodyl

Dulcolax, Biscolax, Ducodyl, Doxidan, Correctol, BisacEvac, Bisacolax, Codulax, Alophen

Bismuth Subcitrate

Bismuth Subcitrate-Metronidazole-Tetracycline

Pylera

Bismuth Subgallate

Devrom

Bismuth Subsalicylate

Kaopectate, Pepto Bismol, Maalox Total Relief

Bisoprolol

Zebeta, Monocor

Bisoprolol-Hydrochlorothiazide

Ziac

Bivalirudin

Angiomax, Hirulog

«bu»Non-ST-Elevation Acute Coronay Syndromes«/bu» «b»Undergoing Early Invasive Strategy«/b» - 0.75 mg/kg bolus prior to procedure THEN, - 1.75 mg/kg/hour continuous IV infusion - If patient received unfractionated heparin (UFH) prior to procedure, wait 30 minutes before initiating bivalirudin «b»Initiating Prior to PCI or Diagnostic Angiography«/b» - Administer an initial 0.1 mg/kg bolus THEN, - 0.25 mg/kg/hour - Continue until diagnostic angiography or PCI - Once PCI is determined to be necessary, give an additional bolus of 0.5 mg/kg and increase infusion rate to 1.75 mg/kg/hour during PCI «bu»PTCA/PCI with or without HIT/HITTS«/bu» - I0.75 mg/kg bolus immediately prior to procedure THEN, - 1.75 mg/kg/hour continuous IV infusion for the duration of procedure - During the procedure, may determine ACT 5 minutes after bolus dose and administer an additional bolus of 0.3 mg/kg if necessary - After the procedure, may continue the infusion at 1.75 mg/kg/hour for up to 4 hours if needed - If continued anticoagulation is needed after the initial 4-hour postprocedure infusion, the infusion may be continued at 0.2 mg/kg/hour for up to an additional 20 hours. «bu»STEMI Undergoing Primary PCI«/bu» - 0.75 mg/kg bolus THEN, - 1.75 mg/kg/hour contentious IV infusion for the duration of procedure. - Consider continuation of the infusion at 1.75 mg/kg/hour for up to 4 hours to mitigate risk of stent thrombosis. - If the infusion is continued and an additional infusion is clinically necessary, may continue the infusion at a reduced dose of 0.2 mg/kg/hour for up to 20 hours. - Of note, a single-center, open-label, randomized controlled trial comparing heparin to bivalirudin in patients with STEMI undergoing primary PCI (mostly with a radial approach) demonstrated that heparin reduces the incidence of major adverse cardiovascular events with no increase in bleeding as compared to bivalirudin - If patient received unfractionated heparin (UFH) prior to procedure and bivalirudin is the desired anticoagulant: Discontinue heparin if infusing; without measurement of ACT, may initiate bivalirudin ≥30 minutes after the last UFH bolus but before PCI occurs (Stone 2008). Switching patients from UFH to bivalirudin has been shown to be safe compared to continuing with UFH and as needed glycoprotein IIb/IIIa inhibition; median time from prerandomization UFH bolus to bivalirudin administration within the HORIZONS-AMI trial was 64 ± 61 minutes. «bu»Cardiac Surgery«/bu» - Patients with acute or subacute heparin-induced thrombocytopenia, urgent surgery required Intraoperative «b»Off-pump«/b» - 0.75 mg/kg bolus THEN, - 1.75 mg/kg/hour continuous IV infusion to maintain ACT >300 seconds - If patient needs to go on-pump, some have recommended an additional 0.25 mg/kg bolus and increasing the infusion rate to 2.5 mg/kg/hour «b»On-pump«/b» - 1 mg/kg bolus THEN, - 2.5 mg/kg/hour continuous IV infusion; 50 mg bolus added to priming solution of cardiopulmonary bypass (CPB) circuit. - Additional boluses of 0.1 to 0.5 mg/kg may be given to maintain ACT >2.5 times baseline ACT. - Discontinue infusion 10 to 15 minutes prior to weaning from CPB (Salter 2016) - Special maneuvers needed to prevent stasis and consequent clotting within CPB circuit during or after surgery. - After completion of CPB, provision to allow recirculation of the circuit may be done by administering 50 mg into the circuit followed by a continuous infusion of 50 mg/hour into the bypass circuit; continue infusion until it is evident the patient will not require an urgent return to CPB. If separation from circuit does not occur within 20 minutes of stopping infusion, redose patient with 0.5 mg/kg and restart infusion at 2.5 mg/kg/hour. «bu»Heparin-Induced thrombocytopenia (HIT)«/bu» - 0.15 to 0.2 mg/kg/hour - Adjust to aPTT 1.5 to 2.5 times baseline value - Although the use of bivalirudin is not a currently recommended treatment for HIT due to insufficient evidence, the American College of Chest Physicians recommends overlapping administration of warfarin for a minimum of 5 days until INR is within target range - Recheck INR after the non-heparin anticoagulant effect has dissipated

Bleomycin

Blenoxane, BLM

- The risk for pulmonary toxicity increases with age >70 years and cumulative lifetime dose of >400 units. «bu»Hodgkin Lymphoma«/bu» (off-label dosing) «b»ABVD Regimen«/b» - 10 units/m2 days 1 and 15 of a 28-day treatment cycle (in combination with doxorubicin, vinblastine, and dacarbazine) «b»BEACOPP Regimen«/b» - 10 units/m2 day 8 of a 21-day treatment cycle (in combination with etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, and prednisone) «b»Stanford V Regimen«/b» - 5 units/m2/dose in weeks 2, 4, 6, 8, 10 and 12 (in combination with mechlorethamine, vinblastine, vincristine, doxorubicin, etoposide, and prednisone) «bu»Test Dose for Lymphoma Patients«/bu» «b»IM, IV, SC«/b» - Due to the possibility of an anaphylactoid reaction, the manufacturer recommends administering bleomycin 2 units or less before the first 2 doses; if no acute reaction occurs, then the regular dosage schedule may be followed. - Monitor carefully, particularly following the first 2 doses. - Test doses may not be predictive of a reaction and/or may produce false-negative results. «bu»Testicular Cancer«/bu» (off-label dosing) «b»BEP Regimen«/b» - 30 units/dose days 1, 8, and 15 of a 21-day treatment cycle for 4 cycles (in combination with etoposide and cisplatin) «bu»Malignant Pleural Effusion«/bu» «b»Intrapleural«/b» - 60 units as a single instillation; mix in 50 to 100 mL of NS «bu»Ovarian Germ Cell Cancer«/bu» (off-label use) «b»BEP Regimen«/b» - 30 units/dose days 1, 8, and 15 of a 21-day treatment cycle for 3 cycles (in combination with etoposide and cisplatin) - 15 units/m2 day 1 of a 21-day treatment cycle for 4 cycles (in combination with etoposide and cisplatin) «bi»Pulmonary Toxicity«/bi» - Discontinue until determined not to be drug-related. - Pulmonary diffusion capacity for carbon monoxide (DLCO) <30% to 35% of baseline: Discontinue treatment. - Pulmonary diffusing capacity for carbon monoxide corrected for hemoglobin content [DLCOc] decrease of more than 25% during therapy (compared with baseline): Consider discontinuing bleomycin to avoid further pulmonary toxicity - The risk for pulmonary toxicity increases with cumulative lifetime dose of >400 units. «bu»Hodgkin Lymphoma«/bu» (off-label use) «b»ABVD Regimen«/b» «bi»High-risk Disease«/bi» - 10 units/m2IV on days 1 and 15 of a 28-day treatment cycle (in combination with doxorubicin, vinblastine, and dacarbazine) for up to 6 cycles «b»ABVE-PC Regimen«/b» «bi»Intermediate or High-risk Disease«/bi» Children and Adolescents - 5 units/m2 IV/SC on day 1 and 10 units/m2 on day 8 of a 21-day cycle (in combination with doxorubicin, vincristine, etoposide, prednisone, and cyclophosphamide) for 2 to 4 cycles «b»BEACOPP«/b» «bi»High-risk Disease«/bi» - 10 units/m2 IV on day 7 of a 21-day treatment cycle (in combination with etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, and prednisone) for 4 cycles «b»Stanford V Regimen«/b» «bi»High-risk Disease«/bi» Adolescent ≥16 years - 5 units/m2 in weeks 2, 4, 6, 8, 10, and 12 of a single 12-week treatment cycle (in combination with mechlorethamine, vinblastine, vincristine, doxorubicin, etoposide, and prednisone) «b»Test Dose for Lymphoma Patients«/b» «bi»IM, IV, SC«/bi» - Due to the possibility of an anaphylactoid reaction, the manufacturer recommends administering bleomycin 2 units or less before the first 2 doses; if no acute reaction occurs, then the regular dosage schedule may be followed. - Monitor carefully, particularly following the first 2 doses. - Test doses may not be predictive of a reaction and/or may produce false-negative results. «bu»Germ Cell Tumors, Malignant«/bu» (off-label use) «b»BEP Regimen«/b» Infants - 0.5 mg/kg IV on day 1 of a 21-day treatment cycle (in combination with cisplatin and etoposide) for 4 cycles. Children ≥1 year and Adolescents - 15 units/m2 IV on day 1 of a 21-day treatment cycle (in combination with etoposide and cisplatin) for 4 cycles «b»Children Pharmacokinetics«/b» - Children younger than 3 years have a higher total body clearance than adults.

Blinatumomab

Blincyto

Bortezomib

Velcade

Bosentan

Tracleer

Bosutinib

Bosulif

- Bosutinib is associated with a moderate emetic potential; nausea and vomiting may be managed with antiemetics and fluid replacement. «bu»Chronic Myelogenous Leukemia«/bu» «b»Newly-diagnosed Chronic Phase Philadelphia Chromosome Positive«/b» - 400 mg PO daily with food «b»Chronic, Accelerated, or Blast Phase Philadelphia Chromosome Positive«/b» «bi»Resistant to or Intolerant to Other Therapies Including Imatinib«/bi» - 500 mg PO daily with food «b»Dose Escalation«/b» - Dose escalation allowed in patients with Ph+ CML who did not achieve or maintain a hematologic, cytogenetic, or molecular response and did not have ≥Grade 3 adverse reactions at the recommended starting dose - May increase dose by 100-mg increments once daily; not to exceed 600 mg/day «b»Missed Doses«/b» - If a dose is missed beyond 12 hours, skip the dose and resume the usual dose the following day. «b»Hepatotoxicity«/b» «bi»Liver Transaminases >5X ULN«/bi» - Hold dosing until recovery to ≤2.5X ULN - Resume at 400 mg daily thereafter - Discontinue if recovery takes longer than 4 weeks «bi»Liver Transaminase Elevations ≥3X ULN Concurrently with Bilirubin Elevations >2X ULN and Alkaline Phosphatase <2X ULN«/bi» - Discontinue treatment «b»Diarrhea«/b» «bi»Grade 3-4 Diarrhea«/bi» - ≥7 stools/day over baseline/pretreatment - Hold dosing until recovery to Grade ≤1 - May resume dose at 400 mg qDay «b»Other Moderate or Severe Non-hematologic Toxicities«/b» - Withhold dose until toxicity resolved, and then consider reducing dose by 100 mg/day - If clinically appropriate, consider re-escalating to the starting dose taken daily - Doses <300 mg/day have been used in patients; however, efficacy has not been established «b»Myelosuppression«/b» «bi»ANC <1000 x10^6/L or Platelets <50,000 x10^6/L«/bi» - Withhold dose until ANC ≥1000x10^6/L and platelets ≥50,000x10^6/L - Resume treatment with same dose if recovery occurs within 2 weeks - If blood counts remain low for >2 weeks, upon recovery, reduce dose by 100 mg and resume treatment - If cytopenia recurs, reduce dose by an additional 100 mg upon recovery and resume treatment - Doses <300 mg/day have been used in patients; however, efficacy has not been established «b»Coadministration with CYP3A and/or P-gp Inhibitors«/b» «bi»Strong or Moderate CYP3A and/or P-gp Inhibitors«/bi» - Avoid concomitant use; increase bosutinib plasma concentration expected and possible increased risk for toxicities - Concomitant Ketoconazole increased bosutinib Cmax 5.2-fold and AUC 8.6-fold compared to bosutinib alone «b»Coadministration with CYP3A Inducers«/b» «bi»Strong or Moderate CYP3A Inducers«/bi» - Avoid concomitant use; large reduction in exposure to bosutinib expected - Coadministration with Rifampin (strong inducer) decreased bosutinib Cmax by 86% and AUC by 94% compared to bosutinib alone «b»Coadministration with Proton Pump Inhibitors«/b» - Avoid concomitant use - As an alternative to PPIs, use short acting antacids or H2 blockers and separate dosing by more than 2 hours from bosutinib dose «b»Newly-diagnosed Chronic Phase Ph+ CML«/b» - Approved under accelerated approval based on molecular and cytogenetic response rates - Continued approval for this indication may be contingent upon verification and confirmation of clinical benefit in an ongoing long term follow up trial

Bremelanotide

Vyleesi

Brentuximab

Adcetris

«bu»Hodgkin Lymphoma«/bu» «b»Relapsed or Refractory«/b» - 1.8 mg/kg (maximum dose: 180 mg) IV every 3 weeks - Continue until disease progression or unacceptable toxicities «bu»Hodgkin Lymphoma HSCT«/bu» - Consolidation therapy after autologous hematopoietic stem cell transplantation (HSCT) - 1.8 mg/kg (maximum dose: 180 mg) IV every 3 weeks - Continue until a maximum of 16 cycles, disease progression, or unacceptable toxicity - Begin therapy within 4 to 6 weeks post HSCT or upon recovery from HSCT. «bu»Mycosis Fungoides«/bu» «b»CD-30 Expressing«/b» - 1.8 mg/kg (Maximum Dose: 180 mg) IV every 3 weeks - Continue until a maximum of 16 cycles, disease progression, or unacceptable toxicity «bu»Primary Cutaneous Anaplastic Large Cell Lymphoma (pcALCL)«/bu» «b»Relapsed«/b» - 1.8 mg/kg (Maximum Dose: 180 mg) IV every 3 weeks - Continue until a maximum of 16 cycles, disease progression, or unacceptable toxicity «bu»Systemic Anaplastic Large Cell Lymphoma (sALCL)«/bu» «b»Relapsed«/b» - 1.8 mg/kg (Maximum Dose: 180 mg) IV every 3 weeks - Continue until disease progression or unacceptable toxicities «b»Hematologic Toxicity«/b» «bi»Grade 3 or 4 Neutropenia«/bi» - Withhold treatment until resolves to baseline or ≤ grade 2, consider growth factor support in subsequent cycles. «bi»Recurrent Grade 4 Neutropenia«/bi» Despite the use of growth factor prophylaxis - Consider reducing the dose to 1.2 mg/kg (maximum dose: 120 mg) or discontinuing treatment «b»Nonhematologic Toxicities«/b» «bi»Anaphylaxis«/bi» - Discontinue immediately and permanently «bi»Infusion Reaction«/bi» - Interrupt infusion and administer appropriate medical intervention - Premedicate subsequent infusions with acetaminophen, an antihistamine, and/or a corticosteroid. «bi»Peripheral Neuropathy«/bi» New or Worsening Grade 2 or 3 - Withhold treatment until improves or returns to grade 1 or baseline; then resume with dose reduced to 1.2 mg/kg (Maximum Dose: 120 mg) Grade 4 - Discontinue treatment «bi»Progressive Multifocal Leukoencephalopathy (PML)«/bi» - Withhold treatment with new-onset symptoms suggestive of PML; discontinue if PML diagnosis confirmed «bi»Pulmonary Toxicity«/bi» - Withhold treatment with new-onset or worsening pulmonary symptoms during evaluation and until symptomatic improvement «bi»Stevens-Johnson Syndrome or Toxic Epidermal Necrolysis«/bi» - Discontinue and administer appropriate medical intervention «b»Contraception«/b» - Verify pregnancy status of females of reproductive potential prior to initiation Advise females of reproductive potential to avoid pregnancy during treatment and for at least 6 months after final dose; immediately report pregnancy - May damage spermatozoa and testicular tissue, resulting in possible genetic abnormalities - Use effective contraception in males with female sexual partners of reproductive potential during treatment and for at least 6 months after final dose «b»Fertility«/b» - Based on findings in rats, male fertility may be compromised by brentuximab

Bretylium

Brexanolone

Zulresso

Brexpiprazole

Rexulti

Brexucabtagene Autoleucel

Tecartus, KTE-X19

«bu»Mantle Cell Lymphoma«/bu» - One treatment course consists of fludarabine- and cyclophosphamide-lymphodepleting chemotherapy followed by IV infusion of brexucabtagene autoleucel «b»Lymphodepleting Chemotherapy«/b» - 3 doses of Fludarabine and Cyclophosphamide infused IV on the 5th, 4th, and 3rd day «bi»BEFORE«/bi» infusion of «bi»Brexucabtagene Autoleucel«/bi» «bi»Fludarabine«/bi» - 30 mg/m2 IV daily x 3 days «bi»Cyclophosphamide«/bi» - 500 mg/m2 IV daily x 3 days starting with the first dose of Fludarabine «b»Premedication«/b» «bi»Acetaminophen«/bi» - 650 mg PO 30-60 minutes before brexucabtagene autoleucel infusion «bi»Diphenhydramine«/bi» - 25 to 50 mg IV/PO ~30-60 minutes before brexucabtagene autoleucel infusion - Avoid prophylactic use of systemic corticosteroids at all times (may interfere with brexucabtagene autoleucel activity), except in the case of a life-threatening emergency «b»Brexucabtagene Autoleucel«/b» - IV Infusion - For autologous use only - Administer after completing lymphodepleting chemotherapy «bi»Dosing«bi» - Number of Chimeric Antigen Receptor (CAR)-Positive Viable T Cells - Target dose is 2x 106 CAR-positive viable T cells/kg body weight - Not to exceed 2x 108 CAR-positive viable T cells - Administer autologously prepared, weight-based IV infusion for individual patient within 30 minutes by either gravity or peristaltic pump - Do not use a leukocyte-depleting filter «b»Cytokine Release Syndrome (CRS) Management«b» «bi»Grade 1«/bi» Symptoms - Fever, nausea, fatigue, headache, myalgia, malaise - If not improving after 24 hr administer: Tocilizumab 8 mg/kg IV over 1 hr (Maximum Dose: 800 mg) «bi»Grade 2«/bi» Symptoms Require Moderate Intervention - Oxygen requirement <40% FiO2 or hypotension responsive to fluids or low dose of one vasopressor or Grade 2 organ toxicity - Tocilizumab 8 mg/kg IV infused over 1 hr (Maximum Dose: 800 mg) - Repeat tocilizumab every 8 hours prn if not responsive to IV fluids or increasing supplemental oxygen - Not to exceed 3 doses in a 24-hr period or 4 doses in total - If improving, discontinue tocilizumab - If no improvement after 24 hr of starting tocilizumab, administer methylprednisolone (1 mg/kg IV bid or dexamethasone 10 mg IV every 6 hour) until Grade 1, then taper corticosteroids «bi»Grade 3«/bi» Symptoms require aggressive intervention: - Oxygen requirement ≥40% FiO2 or hypotension requiring high-dose or multiple vasopressors or Grade 3 organ toxicity or Grade 4 transaminitis - Tocilizumab administration per Grade 2; if improving, discontinue - Corticosteroid dose as for Grade 2; taper if improving or manage as Grade 4 if not improving «bi»Grade 4«/bi» - Life-threatening symptoms; requires ventilator support, continuous venovenous hemodialysis, or Grade 4 organ toxicity (excluding transaminitis) - Tocilizumab administration per Grade 2; if improving, discontinue - Methylprednisolone 1000 mg IV qDay for 3 days; taper if improving or consider alternate immunosuppressants if not improving «b»Neurologic Toxicity Grading and Management«/b» - Grades 2, 3, or 4: Consider nonsedating, antiseizure medicines (eg, levetiracetam) for seizure prophylaxis «bi»Grade 1 with Concurrent CRS«/bi» - Administer tocilizumab as described for Grade 1 CRS «bi»Grade 1 with No Concurrent CRS«/bi» - Supportive care «bi»Grade 2 with concurrent CRS«/bi» - Administer tocilizumab (see doses in CRS Grade 2) - If no improvement within 24 hr after starting tocilizumab, administer dexamethasone 10 mg IV everu 6 hours if not already taking other corticosteroids - Continue dexamethasone use until the event is ≤Grade 1, then taper over 3 days «bi»Grade 2 or 3 with NO Concurrent CRS«/bi» - Administer dexamethasone 10 mg IV every 6 hours if not already taking other corticosteroids - Continue until event is ≤Grade 1, then taper over 3 days - If Grade 3 and not improving, manage as Grade 4 (IV methylprednisolone) «bi»Grade 3 with Concurrent CRS«/bi» - Administer tocilizumab (see doses in CRS Grade 2) AND - Administer dexamethasone 10 mg IV every 6 hours if not already taking other corticosteroids; continue dexamethasone until event is ≤Grade 1, then taper over 3 days «bi»Grade 4 with Concurrent CRS«/bi» - Administer tocilizumab (see doses in CRS Grade 2) - Administer methylprednisolone 1000 mg/day IV for 3 days with first dose of tocilizumab; if improvement, then manage as above «bi»Grade 4 with NO Concurrent CRS«/bi» - Administer methylprednisolone 1000 mg/day IV for 3 days; if improvement, then manage as above - If not improving, consider alternate immunosuppressants «b»Contraception«/b» - See the prescribing information for fludarabine and cyclophosphamide for information on the need for effective contraception in patients who receive the lymphodepleting chemotherapy - Limited exposure data available concerning the duration of contraception following treatment

Brigatinib

Alunbrig

Brilliant Blue G Ophthalmic

TissueBlue

Brimonidine Tartrate (Ophthalmic)

Alphagan P, Qoliana, Lumify

Brimonidine Tartrate (Topical)

Mirvaso

Brincidofovir

Tembexa

Brinzolamide

Azopt

Brinzolamide-Brimonidine Tartrate (Ophthalmic)

Simbrinza (Ophthalmic)

Brivaracetam

Briviact

Brodalumab

Siliq

Brolucizumab

Beovu

«b»Intravitreal Administration«/b» - Administer immediately after dose preparation - Intravitreal injection procedure must be carried out under aseptic conditions, which includes the use of surgical hand disinfection, sterile gloves, a sterile drape and a sterile eyelid speculum (or equivalent), and the availability of sterile paracentesis equipment (if required) - Adequate anesthesia and a broad-spectrum topical microbicide to disinfect the periocular skin, eyelid, and ocular surface should be administered beforehand - Inject slowly until the rubber stopper reaches the end of the syringe to deliver the volume of 0.05 mL; confirm delivery of the full dose by checking that the rubber stopper has reached the end of the syringe barrel - Immediately following the intravitreal injection, monitor for elevated IOP; check for perfusion of the optic nerve head or tonometry; if required, a sterile paracentesis needle should be available - Following injection, instruct patient to report any symptoms suggestive of endophthalmitis or retinal detachment (eye pain, redness of the eye, photophobia, blurring of vision) without delay - Vial is for treatment of a single eye; if the contralateral eye requires treatment, a new vial should be used and the sterile field, syringe, gloves, drapes, eyelid speculum, filter, and injection needles should be changed before brolucizumab is administered to the other eye - Dispose of unused medicinal product or waste material according to local regulations «b»Intravitreal Preparation«/b» - Before use, unopened glass vial may be kept at room temperature (20-25ºC [68-77ºF]) for up to 24 hr - After vial is opened, proceed under aseptic conditions - Inspect visually before administration; do not use if particulates, cloudiness, or discoloration are visible - Kit includes sterile glass vial and filter needle which are for single use only - Do not use if packaging, vial and/or filter needle are damaged or expired - See prescribing information with diagrams for precise steps to aseptically prepare dose

Bromfenac (Ophthalmic)

Bromday BromSite, Prolensa, Xibrom

Bromocriptine

Parlodel, Cycloset

Brompheniramine

Respa-BR, Dimetane

Brompheniramine-Dextromethorphan-Phenylephrine

Dimaphen DM Cold/Cough, Alahist DM, Glenmax PEB DM FORTE, LoHist-PEB-DM, M-Hist DM, Niva-Hist DM,Relcof DM, Rynex DM, BPM-DM-Phen,

Brompheniramine-Pseudoephedrine

Bromadrine, Lodrane D, Brotapp, Bromhist Pediatric Drops, Bromhist-NR Drops, Bromfed, Bromfed-PD

Brompheniramine-Pseudoephedrine-Dextromethorphan

Brotapp-DM, Q-Tapp DM, Bromfed DM, Dimetane DX, Neo DM,

Budesonide

Entocort EC, Nefecon, Ortikos, Tarpeyo, Uceris

Budesonide (Foam, Rectal)

Uceris

«b»Rectal Foam Administration«/b» - For rectal use only; not for oral use. - Wash hands before and after use. - Prior to use, patients should use the bathroom to empty the bowel. - Attach applicator to canister nozzle. Each applicator is coated with a lubricant. - If additional lubrication is needed, petrolatum or petroleum jelly can also be used. - Warm the canister in the hands while shaking it vigorously for 10 to 15 seconds prior to use. - Unlock the canister by twisting the domed canister top until it is aligned with the nozzle. May be used in a standing, lying or sitting position (eg, while sitting on the toilet). - Turn the canister upside down and gently insert applicator tip into rectum as far as is comfortable. - Push down on the pump dome with forefinger and hold for 2 seconds; release finger pressure on pump dome and hold applicator in place for 10 to 15 seconds. Only use applicator provided by manufacturer; do not insert any part of the aerosol container in the rectum. - After administering, withdraw and discard the used applicator in provided plastic trash bag. - Evening doses should be applied immediately prior to bedtime. - Patient should try not to empty the bowel again until the next morning. - Avoid fire, flame and smoking during and immediately following administration. - Temporarily discontinue use before initiation of bowel preparation for colonoscopy; consult provider prior to resuming therapy. «b»Rectal Enema Administration«/b» - For rectal use only; not for oral use. - Patient should lie down on left side, shake the reconstituted enema bottle, remove protective cap and then empty contents into rectum. - Patient should roll over on stomach and remain in this position for 5 minutes, then lie in a comfortable position. - Enema should be retained the whole night if possible or as long as possible. «b»Enema Preparation«/b» - Remove nozzle and protective cap from enema bottle; place one dispersible tablet into enema bottle. - Place nozzle back on the bottle, ensure protective cap is secured, then shake bottle vigorously for at least 10 seconds or until tablet is completely dissolved (suspension should turn slightly yellowish). - Volume of reconstituted enema is 115 mL.

Budesonide (Nasal)

Rhinocort Allergy, Rhinocort Aqua

Budesonide (Oral Inhalation)

Pulmicort Flexhaler, Pulmicort

Budesonide-Formoterol

Symbicort

«b»Metered-Dose Inhaler«/b» - For oral inhalation only administered every morning and evening, approximately 12 hours apart - Prior to first use, inhaler must be primed by releasing 2 test sprays into the air; shake well for 5 seconds before each spray. - Inhaler must be reprimed if not used for >7 days or if it has been dropped. - Shake well for 5 seconds before each use. Discard inhaler after the labeled number of inhalations have been used or within 3 months after removal from foil pouch. - Rinse mouth with water (spit out without swallowing) after each use. - Do not wash inhaler with water; clean mouthpiece using a dry wipe every 7 days. «bi»Delivery of Dose«/bi» - Instruct patient to place mouthpiece gently between teeth, closing lips around inhaler. - Instruct patient to inhale deeply, press the top counter, and hold breath for up to 10 seconds or as long as they comfortably can. - Remove mouthpiece from mouth prior to exhalation. - Patient should not breathe out through the mouthpiece. - Wait ≥30 seconds prior to the second inhalation dose. «b»Dry Powder Inhaler: Symbicort Turbuhaler«/b» - To “load” inhaler: Turn red grip on inhaler as far as it will move in one direction, then turn in opposite direction as far as it will go (inhaler is “loaded” with a dose, indicated by a “click”). - Prior to first use, this procedure should be done twice, it does not need to be repeated with subsequent uses even when not used regularly. «bi»Delivery of Dose«/bi» - Instruct patient to place mouthpiece gently between teeth, closing lips around inhaler - Instruct patient to inhale deeply and hold breath for as long as they comfortably can. - Remove mouthpiece prior to exhalation. - Patient should not breathe out through the mouthpiece. - Dose is lost if patient drops, shakes, or exhales into inhaler after a dose has been loaded. - After use of the inhaler, patient should rinse mouth/oropharynx with water and spit out rinse solution. - Do not wash inhaler with water; clean mouthpiece using a dry wipe every 7 days.

Budesonide-Formoterol-Glycopyrrolate

Breztri (INH)

Bumetanide

Bumex, Burinex

Bupivacaine

P-Care M, Marcaine, Sensorcaine, Posimir

- Dose varies with procedure, depth of anesthesia, vascularity of tissues, duration of anesthesia, and condition of patient. Do not use solutions containing preservatives for caudal or epidural block. «bu»Local Anesthesia«/bu» - Infiltration: 0.25% infiltrated locally - Maximum Dose: 175 mg - Aspiration should be performed prior to each injection; however, absence of blood in the syringe does not guarantee that intravascular injection has been avoided «bu»Caudal Block«/bu» - Preservative free - 15 to 30 mL of 0.25% or 0.5% «bu»Epidural Block«/bu» - Other than caudal block; preservative free - Administer in 3 to 5 mL increments, allowing sufficient time to detect toxic manifestations of inadvertent IV or intrathecal administration: 10 to 20 mL of 0.25% or 0.5% «bu»Surgical Procedures Requiring a High degree of Muscle Relaxation and Prolonged Effects Only«/bu» - 10 to 20 mL of 0.75% (Note: Not to be used in obstetrical cases) «bu» Peripheral Nerve Block«/bu» - 5 mL of 0.25% or 0.5% - Maximum: 400 mg/day «bu»Sympathetic Nerve Block«/bu» - 20 to 50 mL of 0.25% «bu»Retrobulbar Anesthesia«/bu» - 2 to 4 mL of 0.75% «bu»Spinal Anesthesia«/bu» - Preservative free solution of 0.75% bupivacaine in 8.25% dextrose - Lower extremity and perineal procedures: 1 mL - Lower abdominal procedures: 1.6 mL - Normal vaginal delivery: 0.8 mL (higher doses may be required in some patients) - Cesarean delivery: 1 to 1.4 mL - Combined spinal-epidural (CSE) technique for labor analgesia (off-label dosing [spinal component]): 1.75 to 2.5 mg combined with fentanyl 15 mcg «bu»Combined Spinal-epidural (CSE) Technique for Anesthesia for Cesarean Delivery«/bu» - 9 to 12 mg combined with fentanyl 15 mcg; in addition to fentanyl, may also include a longer-acting opioid (ie, morphine 100 to 150 mcg) for postoperative analgesia «bu»Postsurgical Analgesia for Arthroscopic Subacromial Decompression«/bu» «b»Posimir Only«/b» - 660 mg once into subacromial space «b»Dosing Considerations«/b» - Doses of any local anesthetic administered varies with anesthetic procedure, area to be anesthetized, vascularity of tissues, number of neuronal segments to be blocked, depth of anesthesia and degree of muscle relaxation required, duration of anesthesia desired, individual tolerance, and physical condition of patient - Use smallest dose and concentration required to produce desired result «bi»Posimir«/bi» - Different formulations are not bioequivalent even if dosage is the same - Do not substitute «b»Limitations of Use«/b» - Not all blocks are indicated for use given clinically significant risks associated with use «bi»Posimir«/bi» - Safety and efficacy not established in other procedures (soft tissue surgical procedures, other orthopedic procedures, boney procedures, used for neuraxial or peripheral nerve blockade)

Bupivacaine Implant

XaraColl

Bupivacaine Liposome

Exparel

Bupivacaine-Meloxicam

Zynrelef

Buprenorphine

Belbuca, Butrans, Buprenex, Sublocade, Subutex, Probuphine Implant Kit

«bu»Moderate to Severe Acute Pain«/bu» - Long-term use is not recommended - Doses should be titrated to pain relief/prevention. - Buprenorphine has an analgesic ceiling. «b»IM (IR) Injection«/b» - Initial Dose: 0.3 mg every 6 to 8 hours as needed; initial dose (up to 0.3 mg) may be repeated once in 30 to 60 minutes after the initial dose if needed «b»Slow IV (IR) Injection«/b» - Initial Dose: 0.3 mg every 6 to 8 hours as needed - 0.3 mg may be repeated once in 30 to 60 minutes after the initial dose if needed «bu»Moderate to Severe Chronic Pain«/bu» «b»Buccal Film«/b» - 600, 750, and 900 mcg are only for use following titration from lower doses - Maximum Dose: 900 mcg every 12 hours). «b»Opioid-naive and Opioid-non-tolerant«/b» - Initial Dose: 75 mcg once daily - If tolerated, every 12 hours for at least 4 days, then, - increase to 150 mcg every 12 hours. «b»Opioid-experienced«/b» - Conversion from other opioids to buprenorphine - Discontinue all other around-the-clock opioids when buprenorphine is initiated - Taper patient's current opioid to no more than 30 mg oral morphine sulfate equivalents daily before initiating buprenorphine - Following analgesic taper, base the initial buprenorphine dose on the patient's daily opioid dose prior to taper - Patients may require additional short-acting analgesics during the taper period. Patients who were receiving daily dose of <30 mg of oral morphine equivalents - Initial Dose: 75 mcg once daily or every 12 hours Patients who were receiving daily dose of 30 to 89 mg of oral morphine equivalents - Initial Dose: 150 mcg every 12 hours Patients who were receiving daily dose of 90 to 160 mg of oral morphine equivalents - Initial Dose: 300 mcg every 12 hours Patients who were receiving daily dose of >160 mg of oral morphine equivalents - Buprenorphine buccal film may not provide adequate analgesia; consider the use of an alternate analgesic. Conversion From Methadone - Close monitoring is required when converting methadone to another opioid - Ratio between methadone and other opioid agonists varies widely according to previous dose exposure - Methadone has a long half-life and can accumulate in the plasma. Dose Titration (opioid-naive or opioid-experienced patients) - Individually titrate in increments of 150 mcg every 12 hours, no more frequently than every 4 days, to a dose that provides adequate analgesia and minimizes adverse reactions (maximum dose: 900 mcg every 12 hours; doses up to 450 mcg every 12 hours were studied in opioid naive patients). Patients may require additional short-acting analgesics during titration. Discontinuation of Therapy - Use a gradual downward titration of the dose to prevent withdrawal; do not abruptly discontinue. - Patients with oral mucositis: Reduce the starting dose and titration incremental dose by 50%. «b»Transdermal Patch«/b» Opioid-naive - Initial Dose: 5 mcg/hour applied once every 7 days Opioid-experienced - Conversion from other opioids to buprenorphine - Discontinue all other around-the-clock opioid drugs when buprenorphine therapy is initiated. - Short-acting analgesics as needed may be continued until analgesia with transdermal buprenorphine is attained. There is a potential for buprenorphine to precipitate withdrawal in patients already receiving opioids. Patients who were receiving daily dose of <30 mg of oral morphine equivalents - Initial Dose: 5 mcg/hour applied once every 7 days Patients who were receiving daily dose of 30 to 80 mg of oral morphine equivalents - Taper the current around-the-clock opioid for up to 7 days to ≤30 mg/day of oral morphine or equivalent before initiating therapy. Initial: 10 mcg/hour applied once every 7 days Patient who were receiving daily dose of >80 mg of oral morphine equivalents - Buprenorphine transdermal patch, even at the maximum dose of 20 mcg/hour applied once every 7 days, may not provide adequate analgesia; consider the use of an alternate analgesic. Dose Titration (opioid-naive or opioid-experienced patients) - May increase dose in 5 mcg/hour, 7.5 mcg/hour, or 10 mcg/hour increments (using no more than two patches), based on patient's supplemental short-acting analgesic requirements, with a minimum titration interval of 72 hours (maximum dose: 20 mcg/hour applied once every 7 days; risk for QTc prolongation increases with doses >20 mcg/hour patch). Discontinuation of Therapy - Taper dose gradually every 7 days to prevent withdrawal in the physically dependent patient; consider initiating immediate-release opioids, if needed. «bu»Opioid Withdrawal in Heroin-dependent Hospitalized Patients«/bu» «b»Immediate-release Injection«/b» - 0.3 to 0.9 mg (diluted in 50 to 100 mL of NS) IV infusion over 20 to 30 minutes every 6 to 12 hours «bu»Opioid Dependence«/bu» «b»ER Injection«/b» Initial Dose - 300 mg SC monthly x first 2 months - After treatment has been inducted and adjusted with 8 to 24 mg of a transmucosal buprenorphine-containing product for a minimum of 7 days Maintenance Dose - 100 mg SC monthly - Increasing to 300 mg SC monthly for patients who tolerate the 100 mg dose but do not demonstrate a satisfactory clinical response (as evidenced by self-reported illicit opioid use or urine drug screens positive for illicit opioid use) - Administer doses at least 26 days apart. «b»Subdermal Implant«/b» - Insert 4 implants subdermally in the inner side of the upper arm - Remove no later than 6 months after the date of insertion; if continued treatment is desired, insert 4 new implants subdermally in the inner side of the contralateral arm. - After one insertion in each arm, discontinue treatment with subdermal implants. Converting Back to Tablet (SL) - On day of implant removal, resume buprenorphine treatment at previous sublingual dose. «b»Sublingual Tablet«/b» - The combination product, buprenorphine and naloxone, is preferred therapy over buprenorphine monotherapy for induction treatment (and stabilization/maintenance treatment) for short-acting opioid dependence Induction Dose - Day 1: 8 mg - Day 2 and subsequent induction days: Induction usually accomplished over 3 to 4 days. Treatment should begin only when objective and clear signs of moderate opioid withdrawal appear, and not less than 4 hours after last use of heroin or other short-acting opioids or not less than 24 hours after last use of methadone or other long-acting opioids. Titrating dose to clinical effectiveness should be done as rapidly as possible to prevent undue withdrawal symptoms and patient drop-out during the induction period. Dosing on the first day may be given in 2 mg to 4 mg increments. Maintenance Dose - Target dose: 16 mg/day; doses higher than 24 mg/day have not been demonstrated to provide any clinical advantage; patients should be switched to the buprenorphine/naloxone combination product for maintenance and unsupervised therapy. - After induction and titration, daily dose usually ≥8 mg/day. In patients continuing to use opioids, consider increasing the dose by 4 to 8 mg to a daily dose of ≥12 to 16 mg/day. «bu»Perineural Anesthesia«/bu» «b»Immediate-release (IR) Perineural Injection«/b» - 200 to 300 mcg added to local anesthetic (eg, bupivacaine, mepivacaine, tetracaine) with or without epinephrine and administered as a single injection «b»Extended-release (ER) Injection«/b» - Use only the syringe and safety needle included with product - Remove product from refrigerator and bring to room temperature over at least 15 minutes - Do not open the foil pouch or attach the needle until immediately prior to injection. «b»IM Administration«/b» - Administer immediate-release injection via deep IM injection. «b»IV Administration«/b» - Administer immediate-release injection slowly, over at least 2 minutes. Administration over 20 to 30 minutes preferred when managing opioid withdrawal in heroin-dependent hospitalized patients (Welsh 2002). «b»Buccal Film Administration«/b» - Prior to placing the film, moisten inside of cheek with tongue or water. Apply film with a dry finger immediately after removing it from packaging. Place yellow side of film against the inside of the moistened cheek; press and hold the film in place for 5 seconds with finger (film should stay in place after this period). Keep film in place until it dissolves completely (usually within 30 minutes of application). Do not chew, swallow, touch, or move film after placement. Avoid eating or drinking until film dissolves. Do not cut or tear the film. Avoid application to areas of the mouth with any open sores or lesions. To dispose of film; remove foil overwrap from any unused, unneeded films and dispose by flushing down the toilet. «b»Sublingual Tablet Administration«/b» - Tablet should be placed under the tongue until dissolved; should not be chewed or swallowed (swallowing tablets before dissolved reduces bioavailability). If two or more tablets are needed per dose, all may be placed under the tongue at once, or two at a time. To ensure consistent bioavailability, subsequent doses should always be taken the same way. «b» Subcutaneous Injection Administration«/b» - Administer extended-release injection as an abdominal subcutaneous injection only, using only the syringe and safety needle included with product. Do not administer IV or IM. Inject between the transpyloric and transtubercular planes in an area with adequate subcutaneous tissue that is free of skin conditions (eg, nodules, lesions, excessive pigment.) Rotate the injection site between injections. Subsequent precipitation following injection results in a solid depot which will gradually release buprenorphine. The patient may have a lump for several weeks that will decrease over time; advise not to rub or massage the injection site. In the event the depot from an extended-release injection must be removed, it can be surgically excised under local anesthesia within 14 days of injection. See prescribing information for details. For insertion by health care providers trained in the injection technique and certified through the REMS program. «b»Subdermal Implant Administration«/b» - For insertion under local anesthesia by health care providers trained in the insertion and removal procedure through the REMS program. See prescribing information for details. «b»Transdermal Patch Administration«/b» - Apply patch to intact, nonirritated skin only. Apply to a hairless or nearly hairless skin site. If hairless site is not available, do not shave skin; hair at application site should be clipped. Prior to application, if the site must be cleaned, clean with clear water and allow to dry completely; do not use soaps, alcohol, oils, lotions, or abrasives due to potential for increased skin absorption. Do not use any patch that has been damaged, cut or manipulated in any way. Remove patch from protective pouch immediately before application. Remove the protective backing, and apply the sticky side of the patch to one of eight possible application sites (upper outer arm, upper chest, upper back or the side of the chest [each site on either side of the body]). Up to 2 patches may be applied at the same time adjacent to one another at the same application site. Firmly press patch in place and hold for ~15 seconds. Change patch every 7 days. Rotate patch application sites whenever a patch is replaced or added; wait ≥21 days before reapplying another patch to the same skin site. Avoid exposing application site to external heat sources (eg, heating pad, electric blanket, heat lamp, hot tub). Incidental exposure to water while bathing or showering is acceptable based on experience during clinical studies. If there is difficulty with patch adhesion, the edges of the system may be taped in place with first-aid tape. If ineffective, the system may be covered with waterproof or semipermeable adhesive dressings suitable for 7 days of wear. If the patch falls off during the 7-day dosing interval, dispose of the patch and apply a new patch to a different skin site. Dispose of patches using the Patch-Disposal Unit or by folding the adhesive sides of the patch together and then flushing down the toilet. In Canada, disposal via a pharmacy take back program is recommended; trash disposal is not advised. «b»Oral Solution Preparation«/b» - A 0.075 mg/mL solution can be made using the 0.3 mg/mL injection, 95% ethanol, and simple syrup. Add 1.26 mL of 95% ethanol to 0.3 mg buprenorphine obtained from an 0.3 mg/1 mL ampule, mix well, and add quantity of simple syrup sufficient to obtain 4 mL (final volume). Solution is stable under refrigeration and at room temperature for 30 days when stored in amber glass bottles and for 7 days when stored in oral syringes

Buprenorphine-Naloxone

Suboxone, Zubsolv, Bunavail, Cassipa

«bu»Opioid Dependence«/bu» «b»Buprenorphine SL Induction«/b» Day 1 - 4 mg SL initially; may be repeated after 2 hours if withdrawal symptoms are not relieved; not to exceed 8 mg Day 2 - If no withdrawal symptoms are present, 4 mg SL; if withdrawal symptoms are present, dose is increased by 4 mg; if symptoms are not relieved after >2 hr, 4 mg is administered; not to exceed 16 mg SL - Switch to buprenorphine/naloxone for unsupervised maintenance «b»Suboxone Induction«/b» - Caution: Suboxone induction is only for patients dependent on short-acting opioids (eg, heroin) and not for those dependent on long-acting opioids (eg, methadone) - Buprenorphine monotherapy is recommended for induction for long-acting opioids Day 1 - 2 mg/0.5 mg or 4 mg/1 mg SL initially; may titrate upwards in 2-4 mg increments at 2 hr intervals, under supervision; not to exceed 8 mg/2 mg Day 2 - Up to 16 mg/4 mg SL as a single daily dose «b»Zubsolv Induction«/b» - Caution: Zubsolv induction is only for patients dependent on short-acting opioids (eg, heroin) and not for those dependent on long-acting opioids (eg, methadone); - Buprenorphine monotherapy is recommended for induction for long-acting opioids Day 1 - An induction dose of up to 5.7 mg/1.4 mg is recommended, given in divided doses; initiate with 1.4 mg/0.36 mg SL; give remainder of Day 1 dose of up to 4.2 mg/1.08 mg should be divided into doses of 1 to 2 tablets of 1.4 mg/0.36 mg at 1.5 to 2 hr intervals Some patients (eg, those with recent exposure to buprenorphine) may tolerate up to 3 x 1.4 mg/0.36 mg SL as a single, second dose Day 2 - A single daily dose up to 11.4 mg/2.9 mg SL is recommended «b»Bunavail Induction«/b» - Caution: Bunavail induction is only for patients dependent on short-acting opioids (eg, heroin) and not for those dependent on long-acting opioids (eg, methadone); - Buprenorphine monotherapy is recommended for induction for long-acting opioids Day 1 - The first dose should not be administered <6 hr after the patient last used an opioid An induction dose of up to 4.2 mg/0.7 mg is recommended; initiate with 2.1 mg/0.3 mg and repeat at ~2-hr, under supervision, to a total dose of 4.2 mg/0.7 mg based on control of acute withdrawal symptoms Day 2 - A single daily dose up to 8.4 mg/1.4 mg buccal is recommended «b»Suboxone Maintenance«/b» - Target Dose: 12-16 mg/4 mg buprenorphine/naloxone SL as a single daily dose - Dose Range: 16-24 mg buprenorphine component; not to exceed 32 mg/day - Progressively adjust buprenorphine/naloxone dose in increments or decrements of 2 mg/0.5 mg or 4 mg/1 mg to level that holds patient in treatment and suppresses opioid withdrawal signs and symptoms «b»Zubsolv Maintenance«/b» - Target Dose: 11.4/2.9 mg as a single daily dose - Dose Range: 2.9/0.71 mg to 17.2/4.2 mg - Progressively adjust buprenorphine/naloxone dose in increments or decrements of 1.4/0.36 mg or 2.9/0.71 mg to level that holds patient in treatment and suppresses opioid withdrawal signs and symptoms «b»Bunavail Maintenance«/b» - Target Dose: 8.4/1.4 mg as a single daily dose - Dose Range: 2.1/0.3 mg to 12.6/2.1 mg - Progressively adjust dose in increments or decrements of 2.1/0.3 mg to a level that holds patient in treatment and suppresses opioid withdrawal signs and symptoms There is no maximum recommended duration of maintenance treatment; for some patients, treatment may continue indefinitely «b»Cassipa Maintenance«/b» - Used after induction and stabilization of the patient, and after buprenorphine dose titrated to 16 mg using another marketed product - If dose needs adjustment in order to maintain treatment and suppress opioid withdrawal signs and symptoms, a different product will be needed; Cassipa comes in a single dose and cannot be adjusted (ie, SL film available only as 16 mg buprenorphine/4 mg naloxone) - There is no maximum recommended duration of maintenance treatment; for some patients, treatment may continue indefinitely «b»Bunavail Buccal Film Administration«/b» - Immediately before placing the film, moisten inside of cheek with tongue or water. Apply film with a dry finger immediately after removing it from packaging. Place film with the text (BN2, BN4, or BN6) against the inside of the moistened cheek; press and hold the film in place for 5 seconds with finger (film should stay in place after this period). Keep film in place until it dissolves completely. Do not chew, swallow or move film after placement. Liquids and food can be consumed after film dissolves. If using more than 1 film simultaneously, the additional film should be placed on the inside of the other cheek; no more than 2 films should be applied to the inside of one cheek at a time. Do not cut or tear the film. «b»Suboxone Buccal Administration«/b» - Administer film whole; do not cut, chew, or swallow. Place one film on the inside of the right or left cheek. If more than one film is needed, the additional film should be placed on the inside of the opposite cheek. Keep the film on the inside of the cheek until completely dissolved. Do not move film after placement. If a third film is necessary, place it on the inside of the right or left cheek after the first two films have dissolved. «b»Suboxone Sublingual Film Administration«/b» - Administer film whole; do not cut, chew, or swallow. Place one film under the tongue until the film completely dissolves, close to the base on the left or right side. If more than one film is needed, the additional film should be placed under the tongue on the opposite side from the first film. Place the film in a manner to minimize overlapping as much as possible. Do not move film after placement. If a third film is necessary to achieve the prescribed dose, place it under the tongue on either side after the first 2 films have dissolved. «b»Sublingual Tablet Administration«/b» - Immediately after removal from blister pack, tablet should be placed under the tongue until dissolved. If 2 or more tablets are needed per dose, all may be placed under the tongue at once, or 2 at a time. In patients requiring more than one sublingual tablet, place all tablets in different places under the tongue at the same time. To ensure consistent bioavailability, subsequent doses should always be taken the same way. Patients should not eat or drink anything until the tablet(s) are completely dissolved. If a sequential mode of administration is preferred, patients should follow the same manner of dosing with continued use of the product, to ensure consistency in bioavailability. Do not chew or swallow sublingual tablets.

BuPROPion

Aplenzin, Budeprion, Fortivo, Wellbutrin, Zyban

«bu»Depression«/bu» - Treatment should be periodically evaluated at appropriate intervals to ensure lowest effective dose is used. «b»Immediate Release«/b» - Initial Dose: 100 mg PO bid - After 3 days may increase to the usual dose of 100 mg 3 PO tid - If no clinical improvement after several weeks, may increase to a maximum dose of 450 mg/day in 3 or 4 divided doses - Do not exceed 150 mg in a single dose «b»Sustained Release«/b» - Initial Dose: 150 mg daily in the morning - If tolerated, after 3 days, may increase to a target dose of 150 mg bid - If no clinical improvement after several weeks, may increase to a maximum dose of 200 mg twice daily - Do not exceed 200 mg in a single dose «b»Extended Release (Wellbutrin XL)«/b» - Initial Dose: 150 mg once daily in the morning - If tolerated, as early as day 4, may increase to 300 mg once daily - Maximum Dose: 300 mg/day; however, guidelines suggest up to 450 mg/day may be used «b»Extended Release HCl (Forfivo XL)«/b» - Switching from Wellbutrin immediate release, SR, or XL to Forfivo XL - Patients receiving 300 mg daily of bupropion hydrochloride for at least 2 weeks and requiring a dose increase or patients already taking 450 mg daily of bupropion hydrochloride may switch to Forfivo XL 450 mg once daily. «b»Extended Release HBr (Aplenzin)«/b» - Initial Dose: 174 mg once daily in the morning - May increase as early as day 4 of dosing to 348 mg once daily (target dose) «bu»Seasonal Affective Disorder (SAD)«/bu» «b»Wellbutrin XL«/b» - 150 mg PO daily - May increase to 300 mg PO daily «b»Aplenzin«/b» - Initial Dose: 174 mg PO daily (equivalent to 150 mg bupropion HCl), then after 1 week - May increase to usual target dose of 348 mg/day (equivalent to 300 mg bupropion HCL) «b»Dosing Considerations (SAD)«/b» - Initiate treatment in the autumn prior to onset of seasonal depressive symptoms and continue through the winter season - Prophylactic treatment should be reserved for those patients with frequent depressive episodes and/or significant impairment. - Initiate treatment in the Autumn prior to symptom onset, and discontinue in early Spring with dose tapering. - Doses >300 mg daily (Wellbutrin XL) or >348 mg daily (Aplenzin) have not been studied in SAD «bu»Smoking Cessation«/bu» (Zyban) - Initial Dose: 150 mg once daily for 3 days - Increase to 150 mg twice daily - Maximum Dose: 300 mg/day). - Therapy should begin at least 1 week before target quit date. - Target quit dates are generally in the second week of treatment. - If patient successfully quits smoking after 7 to 12 weeks, may consider ongoing maintenance therapy based on individual patient risk:benefit. - Efficacy of maintenance therapy (300 mg daily) has been demonstrated for up to 6 months. - Conversely, if significant progress has not been made by the seventh week of therapy, success is unlikely and treatment discontinuation should be considered. «bu»Antidepressant-induced Sexual Dysfunction«/bu» «b»Sustained Release«/b» - Initial Dose: 150 mg once daily for the first 3 days - Increase to 150 mg twice daily, based on response and tolerability «bu»Attention Deficit Hyperactivity Disorder (ADHD)«/bu» «b»Sustained Release«/b» - Initial Dose: 100 mg once daily in the morning - Increase weekly in 100 mg/day increments based on response and tolerability up to 200 mg twice daily «b»Extended Release«/b» - Initial Dose: 150 mg once daily in the morning for 1 week - Increase to 300 mg once daily for 3 weeks - May further increase dose based on response and tolerability up to 450 mg once daily «bu»Depression Associated with Bipolar Disorder«/bu» - Initial Dose: 100 mg/day - Increase based on response and tolerability at 2-week intervals up to 450 mg/day (average dose in clinical trials was 250 mg/day) «bu»Obesity«/bu» «b»Sustained Release«/b» - Initial Dose: 150 mg once daily in the morning - Increase to 150 mg twice daily after 3 days; may further increase dose after 2 weeks based on response and tolerability to 200 mg PO bid «b»Discontinuation of Therapy«/b» - Upon discontinuation of antidepressant therapy, gradually taper the dose to allow for the detection of re-emerging symptoms. - Withdrawal symptoms resulting from abrupt discontinuation are unlikely because bupropion has minimal serotonergic activity «b»MAO Inhibitor Recommendations«/b» «bi»Switching to or from an MAO Inhibitor Antidepressant«/bi» - Allow 14 days to elapse between discontinuing an MAO inhibitor intended to treat depression and initiation of bupropion. - Allow 14 days to elapse between discontinuing bupropion and initiation of an MAO inhibitor intended to treat depression.

Burosumab

Crysvita

«bu»X-Linked Hypophosphatemia«/bu» «b»<6 months«/b» - Safety and efficacy not established «b»≥6 months and <10 kg«/b» - 1 mg/kg SC every 2 weeks - Round dose to nearest 1 mg «b»≥6 months and ≥10 kg«/b» - 0.8 mg/kg SC every 2 weeks - Round dose to nearest 10 mg - Minimum weight-based starting dose is 10 mg up to a maximum dose of 90 mg «b»Dosage Modifications«/b» - Reassess fasting serum phosphorus level 4 weeks after dose adjustment - Do not adjust dose more frequently than every 4 weeks «b»Dose Increase <10 kg«/b» - If serum phosphorus is below the reference range for age, may increase dose to 1.5 mg/kg, rounded to the nearest 1 mg, administered every 2 weeks - If additional dose increases are needed, may increase to maximum of 2 mg/kg, rounded to the nearest 1 mg, administered every 2 weeks «b»Dose Increase >10 kg«/b» - If serum phosphorus is below the reference range for age, may increase dose in stepwise method up to ~2 mg/kg, administered every 2 weeks by 5- to 10-mg increments - Not to exceed 90 mg/dose «b»Dose Decrease <10 kg«/b» - If serum phosphorus is >5 mg/dL, withhold the next dose and reassess the serum phosphorus level in 4 weeks - Reinitiate drug only when serum phosphorus is below the reference range for age to reinitiate drug - Once serum phosphorus is below the reference range for age, restart treatment according to the reduced dose schedule described in the prescribing information - Reassess serum phosphorus level 4 weeks after dose adjustment If the level remains below the reference range for age after the reinitiation dose, adjust dose according to initial dose instructions - Restart at 0.5 mg/kg every 2 weeks - Round dose to nearest 1 mg «b»Dose Decrease ≥10 kg«/b» Previous Dose of 10-mg - Restart at 5 mg Previous Dose of 15-mg, 20-mg, or 30-mg - Restart at 10 mg Previous Dose of 40-mg or 50-mg - Restart at 20 mg Previous Dose of 60-mg or 70-mg - Restart at 30 mg Previous Dose of 80-mg or 90-mg - Restart at 40 mg

BusPIRone

BuSpar, Buspirex, Bustab, LinBuspirone

Busulfan

Myleran, Busulphan, Busulfanum

«b»Premedication«/b» - Premedicate with prophylactic anticonvulsant therapy (eg, phenytoin, levetiracetam, benzodiazepines, or valproic acid) beginning 12 hours prior to high-dose busulfan treatment and continuing for 24 hours after the last busulfan dose. Busulfan is associated with a moderate emetic potential (depending on dose and/or administration route); antiemetics may be recommended to prevent nausea and vomiting. Antiemetics are recommended when used for transplantation «bu»Chronic Myeloid Leukemia (CML)«/bu» - Remission Induction: 60 mcg/kg/day or 1.8 mg/m²; 4-8 mg PO qDay usual range - Maintenance Doses: 1-4 mg/day to 2 mg/week PO to maintain WBC 10,000-20,000 cells/mm³ may withhold drug when leukocyte count has declined to approximately 15,000/mcL «bu»Essential Thrombocythemia«/bu» (off-label use) «b»Adults >60 years«/b» - 2 to 4 mg PO once daily «bu»Hematopoietic Stem Cell Transplant (HSCT)«/bu» - 0.8 mg/kg/dose IV (ideal or actual body weight, whichever is lower) every 6 hours for 4 days (a total of 16 doses) beginning 7 days prior to transplant (followed by cyclophosphamide). - For obese or severely-obese patients, use of an adjusted body weight «b»Conditioning Regimens«/b» - Myeloablative conditioning regimens generally include total busulfan doses >8 mg/kg (per course) and reduced intensity conditioning regimens typically include total busulfan doses ≤8 mg/kg (per course). «b»Bu4/Cy Regimen«/b» - 0.8 mg/kg IV every 6 hours x 16 doses - Total busulfan dose of 12.8 mg/kg over 4 days - Followed by 2 days of cyclophosphamide, then allogeneic HSCT after 1 day of rest «b»Flu/Bu4 Regimen«/b» - 0.8 mg/kg IV every 6 hours for 16 doses beginning 6 days before allogeneic transplant (total busulfan dose 12.8 mg/kg over 4 days; in combination with 4 days of fludarabine) or (reduced intensity conditioning regimen): 0.8 mg/kg once daily for 4 days beginning 5 days before allogeneic transplant (total busulfan dose 3.2 mg/kg over 4 days; in combination with 4 days of fludarabine) «b»Flu/Bu4 (once daily) Regimen«/b» - 130 mg/m2 IV over 3 hours once daily for 4 days (in combination with 4 days of fludarabine ± thymoglobulin [administer busulfan after fludarabine each day], followed by allogeneic transplant) «b»Bu/Cy Regimens«/b» - 1 mg/kg PO every 6 hours for 16 doses (total busulfan dose of 16 mg/kg over 4 days; followed by 2 days of cyclophosphamide, then allogeneic HSCT 2 days later on day 8) or 1 mg/kg every 6 hours for 16 doses (total busulfan dose of 16 mg/kg over 4 days; followed by 2 days of cyclophosphamide, followed by allogeneic marrow transplant) or 1 mg/kg every 6 hours for 16 doses beginning 9 days prior to transplant (total busulfan dose of 16 mg/kg over 4 days; followed by 4 days of cyclophosphamide, followed by allogeneic or autologous marrow transplant) «b»Bu/Mel Regimen«/b» - 1 mg/kg PO every 6 hours for 16 doses beginning 6 days prior to transplant (total busulfan dose of 16 mg/kg over 4 days; followed by IV melphalan, followed by autologous transplant) «b»Bu/Mel/TT Regimen«/b» - 1 mg/kg PO every 6 hours for 12 doses beginning 8 days prior to transplant (total busulfan dose of 12 mg/kg over 3 days; followed by 2 days of IV melphalan and then 2 days of thiotepa «b»Flu/Bu2 Regimen«/b» - 1 mg/kg PO every 6 hours for 8 doses beginning 6 days prior to transplant (total busulfan dose of 8 mg/kg over 2 days; in combination with 6 days of fludarabine and 4 days of ATG) «b»Flu/Bu4 Regimen«/b» - 1 mg/kg PO every 6 hours for 16 doses (total busulfan dose of 16 mg/kg over 4 days; in combination with 4 days of fludarabine) «bu»Polycythemia Vera, Refractory/Resistant«/bu» (off-label use) - Initial Dose: 2 to 4 mg once daily «b»Infertility«/b» Females - Ovarian suppression and amenorrhea commonly occur in premenopausal women undergoing chronic, low-dose busulfan therapy for chronic myelogenous leukemia; therapy may also cause temporary or permanent infertility in prepubertal girls or in females of child-bearing potential treated with high-dose busulfan in the conditioning regimen prior to allogeneic hematopoietic progenitor cell transplantation Males - Sterility, azoospermia, and testicular atrophy reported in male patients «b»IV Administration«/b» - Busulfan is associated with a moderate emetic potential (depending on dose and/or administration route); antiemetics may be recommended to prevent nausea and vomiting. - Antiemetics are recommended when used for transplantation. - Intravenous busulfan should be infused over 2 hours via central line. Once daily IV busulfan (off-label dose) has been infused over 3 hours. Use an administration set with a minimal residual priming volume (2 to 5 mL for adults and 1 to 3 mL for pediatrics). Flush line before and after each infusion with 5 mL D5W or NS. Do not use polycarbonate syringes or filters for preparation or administration. Busulfan injection contains N,N-dimethylacetamide, which is incompatible with many closed-system transfer devices (CSTDs); the plastic components of CSTDs may dissolve and result in subsequent leakage and potential infusion of dissolved plastic into the patient. «b»Oral Administration«/b» (HSCT only) - To facilitate ingestion of high oral doses, may place multiple tablets into an empty gelatin capsule. «b»IV Preparation«/b» - Dilute in NS or D5W - The dilution volume should be 10 times the volume of busulfan injection, ensuring that the final concentration of busulfan is 0.5 mg/mL. - Always add busulfan to the diluent, and not the diluent to the busulfan. - Mix with several inversions. - Do not use polycarbonate syringes or filters for preparation or administration. - Busulfan for injection contains N,N-dimethylacetamide, which is incompatible with many closed-system transfer devices (CSTDs); the plastic components of CSTDs may dissolve and result in subsequent leakage and potential infusion of dissolved plastic into the patient «b»Oral Suspension Preparation«/b» - A 2 mg/mL oral suspension can be prepared in a vertical flow hood with tablets and simple syrup. - Crush one-hundred-twenty 2 mg tablets in a mortar and reduce to a fine powder. - Add small portions of simple syrup and mix to a uniform paste; mix while adding the simple syrup in incremental proportions to almost 120 mL; transfer to a graduated cylinder, rinse mortar and pestle with simple syrup, and add quantity of vehicle sufficient to make 120 mL. - Transfer contents of the graduated cylinder into an amber prescription bottle. - Label “shake well”, “refrigerate”, and “caution chemotherapy”. - Stable for 30 days.

Butabarbital

Butisol

Butalbital

Butalbital-Acetaminophen

Bucet, Allzital, Bupap, Phrenilin Forte, Marten-Tab, Orbivan CF

Butalbital-Acetaminophen-Caffeine

Alagesic LQ, Dolgic Plus, Esgic Plus, Fioricet, Margesic, Orbivan, Zebutal

Butalbital-Acetaminophen-Caffeine-Codeine

Fioricet with Codeine

Butalbital-Aspirin-Caffeine

Butalbital Compound, Fiorinal

Butenafine

Lotrimin, Lotrimin Ultra, Mentax, Mentax-TC

Butoconazole Nitrate

Gynazole-1, Femstat 3

Butorphanol Tartrate

Stadol

- These are guidelines and do not represent the maximum doses that may be required in all patients. - Doses should be titrated to pain relief/prevention. - Butorphanol has an analgesic ceiling. «bu»Pain Management«/bu» «b»IM Dose«/b» - Initial Dose: 2 mg IM x 1 dose - May repeat every 3 to 4 hours as needed - Usual Dose Range: 1 to 4 mg IM every 3 to 4 hours as needed «b»IV Dose«/b» - Initial Dose: 1 mg IV x 1 dose - May repeat every 3 to 4 hours as needed - Usual Dose Range: 0.5 to 2 mg every 3 to 4 hours as needed «b»Intranasal (Spray) Dose«/b» - Initial Dose: One spray (1 mg per spray) in 1 nostril - If adequate pain relief is not achieved within 60 to 90 minutes, an additional 1 spray in 1 nostril may be given - May repeat initial dose sequence in 3 to 4 hours after the last dose as needed. - Alternatively, an initial dose of 2 mg (1 spray in each nostril) may be used in patients who will be able to remain recumbent (in the event drowsiness or dizziness occurs); additional 2 mg doses should not be given for 3 to 4 hours «b»Discontinuation of Therapy«/b» - For patients on long term opioid therapy, decrease dose by 25% to 50% every 2 to 4 days - Monitor carefully for signs/symptoms of withdrawal. - If patient displays withdrawal symptoms, increase dose to the previous level and then reduce dose more slowly by increasing interval between dose reductions, decreasing amount of daily dose reduction, or both. «bu»Preoperative Medication«/bu» «b»IM Dose«/b» - 2 mg IM x 1 dose 60 to 90 minutes before surgery «bu»Supplement to Balanced Anesthesia«/bu» «b»IV Dose«/b» - 2 mg IV shortly before induction and/or an incremental dose of 0.5 to 1 mg IV (up to 0.06 mg/kg), depending on previously administered sedative, analgesic, and hypnotic medications «bu»Pain During Labor«/bu» Fetus >37 weeks gestation and no signs of fetal distress: «b»IM, IV Dose«/b» - 1 to 2 mg IV/IM x 1 dose - May repeat in 4 hours - Alternative analgesia should be used for pain associated with delivery or if delivery is anticipated within 4 hours «b»Limitations of Use«/b» Reserve for use in patients for whom alternative treatment options (eg, nonopioid analgesics, opioid combination products) are ineffective, not tolerated, or would be otherwise inadequate to provide sufficient management of pain.

C1 Esterase Inhibitor (Human)

Berinert, Cinryze, Haegarda, C1-Inhibitor

«b»IV Adminstration«/b» Berinert (500 units) - Administer intravenously at ~4 mL/minute by a separate infusion line. Berinert (1,500 units) - Administer intravenously by slow injection by a separate infusion line. Cinryze (500 units) - Administer intravenously at 1 mL/minute - As a guideline, administer 1,000 units over 10 minutes «b»SC Adminstration«/b» Haegarda (2,000 or 3,000 units) - For SC injection only in the abdominal area or other SubQ injection sites - Rotate injection sites «b»Self-Administration«/b» - Following patient training and instructions on self-administration, patient may self-administer treatment (Berinert) or prophylaxis (Cinryze, Haegarda) therapy. - Epinephrine should be available during self-administration in the event of an acute, severe hypersensitivity reaction. Patient suffering from an acute laryngeal hereditary angioedema (HAE) attack and self-administering should be informed to seek immediate medical attention following treatment (potential for airway obstruction to occur). - A silicone-free syringe may be required for administration (refer to manufacturer's labeling). «b»Reconstitution«/b» - Allow vial and diluent (SWFI) to come to room temperature prior to reconstitution. - Reconstitute each vial with 5 mL (Cinryze 500 units), 10 mL (Berinert 500 units), 4 mL (Haegarda 2,000 units), 6 mL (Haegarda 3,000 units), or 3 mL (Berinert 1,500 units [Canadian product]) of SWFI using a double-ended transfer needle or the provided transfer set. - A silicone-free syringe may be required for reconstitution (refer to manufacturer's labeling). - Do not use product if there is no vacuum in the vial. After combining with diluent, gently swirl vial (do not shake) to completely dissolve powder. - Reconstituted product should be clear and colorless or slightly blue (Cinryze only); do not use if turbid, discolored, or contains particles. - The provided filter needle or transfer set should be used to withdraw the reconstituted product. - Remove filter needle and attach reconstituted solution to infusion set or appropriate needle for infusion. Do not mix with other medicinal products.

C1 Esterase Inhibitor (Recombinant)

Ruconest, Conestat Alfa, Recombinant C1 Inhibitor

Cabazitaxel

Jevtana

«b»Premedication«/b» Premedicate at least 30 minutes prior to each dose of cabazitaxel with: - Antihistamine: Diphenhydramine IV 25 mg or equivalent AND - Corticosteroid: Dexamethasone 8 mg IV or equivalent AND - H2 Antagonist: Ranitidine 50 mg IV or equivalent Per the manufacturer, antiemetic prophylaxis (oral or IV) is also recommended. «bu»Prostate Cancer, Metastatic«/bu» - 20 mg/m2 IV once every 3 weeks (in combination with prednisone) - 25 mg/m2 IV once every 3 weeks (in combination with prednisone) may be used in select patients at the discretion of the prescriber «b»Contraception«/b» - Based on findings in animal reproduction studies, advise male patients with female partners of reproductive potential to use effective contraception during treatment and for 3 months after administering final dose «b»Infertility«/b» Based on animal toxicology studies, cabazitaxel injection may impair human fertility in males of reproductive potential «b»Strong CYP3A Inhibitors«/b» - Concomitant use with strong CYP3A inhibitors (eg, ketoconazole, itraconazole, clarithromycin, protease inhibitors, nefazodone, telithromycin, voriconazole) may increase cabazitaxel plasma concentrations - Avoid concurrent use - If concomitant use cannot be avoided, consider reducing cabazitaxel dose by 25%. - If receiving cabazitaxel 20 mg/m2 and a dose reduction is required, decrease the dose to 15 mg/m2. - If receiving cabazitaxel 25 mg/m2, the dose should decrease to 20 mg/m2; one additional dose reduction to 15 mg/m2 may be considered. «b»Hematologic Toxicity«/b» - Neutropenia ≥ grade 3 for >1 week despite WBC growth factors: Delay treatment until ANC >1,500/mm3 and then reduce dose by one dose level with continued WBC growth factor secondary prophylaxis. - Neutropenic fever or neutropenic infection: Delay treatment until improvement/resolution and ANC >1,500/mm3 and then reduce dose by one dose level with continued WBC growth factor secondary prophylaxis. - Persistent hematologic toxicity (despite dosage reduction): Discontinue treatment. «b»Nonhematologic Toxicity«/b» - Severe hypersensitivity: Discontinue immediately. - Diarrhea ≥ grade 3 or persistent despite appropriate medication, fluids, and electrolyte replacement: Delay treatment until improves or resolves and then reduce dose by one dose level. - Persistent diarrhea (despite dosage reduction): Discontinue treatment. - Peripheral neuropathy (grade 2): Delay treatment until improves or resolves and then reduce dose by one dose level. - Peripheral neuropathy ≥ grade 3: Discontinue treatment. - Pulmonary symptoms (new or worsening): Interrupt cabazitaxel treatment, monitor closely and promptly investigate and manage symptoms. May require discontinuation (carefully evaluate the potential benefits of treatment resumption).

Cabergoline

Dostinex

Cabotegravir

Vocabria, Apretude

«bu»HIV-1 Infection«/bu» «b»Oral Lead-in Dosing Prior to Cabenuva«/b» - 30 mg PO daily plus rilpivirine 25 mg PO daily x at least 28 days - Take last oral dose on the same day injections with Cabenuva are started «b»Planned Missed Cabenuva Injections«/b» - If patient plans to miss scheduled Cabenuva (cabotegravir; rilpivirine) ER injectable suspensions by >7 days, take daily PO therapy to replace up to 2 consecutive monthly injection visits - 30 mg PO daily plus rilpivirine 25 mg PO daily as replacement for up to 2 consecutive months - Take first oral dose ~1 month after the last injection of Cabenuva and continue until the day injection dosing restarted «b»Missed Dose«/b» - Take as soon as remembered «bu»HIV Pre-exposure Prophylaxis (PrEP)«/bu» «b»IM Initiation Injections«/b» «bi»Weight ≥35 kg«/bi» - 600 mg IM x 2 doses 1 month apart - May administer second initiation injection up to 7 days before or after the date scheduled to receive injection. - May be initiated with oral cabotegravir before starting IM injections or may proceed directly to injection without an oral lead-in. - If an oral lead-in is used, administer initiation injections on last day of oral lead-in or within 3 days thereafter «b»IM Continuation Injections«/b» «bi»Weight ≥35 kg«/bi» - 600 mg IM every 2 months «b»Oral«/b» «bi»Indication Specifics«/bi» - Oral lead-in to assess tolerability of cabotegravir before starting ER IM injections (Apretude) - Oral PrEP for patients who will miss planned IM injection «bi»Oral Lead-in Dosing Before Apretude IM«/bi» - 30 mg PO once daily for ~1 month (at least 28 days) - Following oral lead-in, initiate cabotegravir IM on last day of oral lead-in or within 3 days «b»PO Replacement Dose for Planned Missed Injections«/b» - If patient plans to miss scheduled Apretude (cabotegravir) ER injectable suspension by >7 days, take daily PO therapy to replace up to 2 consecutive monthly injection visits - 30 mg PO daily as replacement for up to 2 consecutive months. - Take first oral dose ~2 months after the last injection of cabotegravir IM injection Restart cabotegravir IM every 2 months on day oral dosing completes or within 3 days «b»Dosing Considerations«/b» - Individuals must have a negative HIV-1 test before initiating PrEP «b»Oral Administration«/b» - Take on regular dosing schedule with a meal at the same time as rilpivirine - Do not stop taking the drug or run out of cabotegravir due to risk for viral resistance «bi»Missed Dose«/bi» - Take as soon as remembered «b»IM Administration«/b» - Administer as single IM injection in gluteal muscle by health care provider every 2 months - May administer injection up to 7 days before or after the date scheduled to receive injection «bi»Injection Site«/bi» - Ventrogluteal site recommended - Dorsogluteal approach (upper outer quadrant) acceptable, if preferred by healthcare professional - Do not administer by any other route or anatomical site «bi»Missed Dose«/bi» Planned Missed Injection ≥7 days - Daily oral cabotegravir for up to 2 consecutive months to replace 1 missed scheduled 600-mg every 2-month injection - Take first dose of oral PrEP ~2 months after last 600-mg IM - Restart injection on day oral dosing completes or within 3 days For oral PrEP durations >2 months, an alternative oral regimen is recommended Unplanned Missed Injections - If a scheduled injection visit is missed or delayed by >7 days and oral dosing has not been taken in the interim, clinically reassess individual to determine if resumption of injection dosing remains appropriate - Injection dosing recommendations after second missed injection Time since first injection ≤2 months - 600 mg IM as soon as possible, then continue with q2month schedule Time since first injection >2 months - Restart with 600 mg IM, followed by second 600-mg initiation injection 1 month later, then continue with q2month schedule thereafter Injection dosing recommendations after third or subsequent missed injection Time since last injection ≤3 months - 600 mg IM as soon as possible, then continue with q2month schedule Time since last injection >3 months - Restart with 600 mg IM, followed by second 600-mg initiation injection 1 month later, then continue with q2month schedule thereafter

Cabotegravir-Rilpivirine

Cabenuva

Cabozantinib

Cometriq, Cabometyx

- Do not substitute cabozantinib tablets and capsules. - Cabozantinib is associated with a moderate emetic potential; antiemetics are recommended to prevent nausea/vomiting. «bu»Renal Cell Carcinoma, Advanced«/bu» «b»Cabometyx«/b» - 60 mg once daily - Continue as long as benefiting clinically or until unacceptable toxicity occurs - Do not exceed 80 mg daily «bu»Medullary Thyroid Cancer, Metastatic«/bu» «b»Cometriq«/b» - 140 mg once daily until disease progression or unacceptable toxicity occurs - Do not exceed 180 mg daily «b»Missed Doses«/b» - Do not take a missed dose within 12 hours of the next dose «bu»Hepatocellular Carcinoma«/bu» «b»Cabometyx«/b» - 60 mg PO daily - Continue until disease progression or unacceptable toxicity occurs - Indicated for patients with hepatocellular carcinoma (HCC) who have been previously treated with sorafenib «b»Strong CYP3A4 Inhibitors«/b» «bi»Cabometyx«/bi» - Reduce the daily dose of cabozantinib by 20 mg (from 60 mg to 40 mg daily or from 40 mg to 20 mg daily). - If the strong inhibitor is discontinued, allow ~2 to 3 days to elapse prior to adjusting the cabozantinib dose upwards to the dose used prior to the initiation of the strong inhibitor. «bi»Cometriq«/bi» - Avoid concomitant use - If concomitant use is required, reduce the daily dose of cabozantinib by 40 mg (ie, from 140 mg to 100 mg daily or from 100 mg to 60 mg daily) - If the strong inhibitor is discontinued, allow ~2 to 3 days to elapse prior to adjusting the cabozantinib dose upwards to the dose used prior to the initiation of the strong inhibitor. «b»Strong CYP3A4 Inducers«/b» «bi»Cabometyx«/bi» - Increase the daily dose of cabozantinib by 20 mg (from 60 mg to 80 mg daily or from 40 mg to 60 mg daily) as tolerated; do not exceed 80 mg daily. If the strong inducer is discontinued, allow ~2 to 3 days to elapse prior to reducing the cabozantinib dose to the dose used prior to the initiation of the strong inducer. «bi»Cometriq«/bi» - Avoid concomitant use; if concomitant use is required, increase the daily dose of cabozantinib by 40 mg (ie, from 140 mg to 180 mg daily or from 100 mg to 140 mg daily); do not exceed 180 mg. - If the strong inducer is discontinued, allow ~2 to 3 days to elapse prior to reducing the cabozantinib dose to the dose used prior to the initiation of the strong inducer. «b»Dosage Adjustment for Surgery«/b» - Withhold treatment for at least 28 days prior to scheduled surgery (including dental surgery). - Resume therapy based on clinical judgment of adequate wound healing. «b»Grade ≤3 Adverse Reactions«/b» - Dosage modifications and/or supportive care may be required - If dose reduction is required, a 20 mg decrease from the previously administered dose is recommended «b»Permanently Discontinue«/b» - Development of unmanageable fistula or gastrointestinal perforation - Hypertensive crisis, severe uncontrolled hypertension despite optimal therapy - Nephrotic syndrome - Reversible posterior leukoencephalopathy syndrome (RPLS) - Serious arterial thromboembolic event (eg, MI or cerebral infarction) - Severe hemorrhage

Caffeine

Cafcit, Ban Drowz, NoDoz, Vivarin,Stay Awake, Keep Alert

Calaspargase

Asparlas

«bu»Acute Lymphoblastic Leukemia (ALL)«/bu» «b»≤21 years«/b» - 2500 units/m² IV no more frequently than every 21 days - Conduct pregnancy testing in females of reproductive potential before initiating treatment - Monitor patients at least weekly, with bilirubin, transaminases, glucose, and clinical examinations until recovery from the therapy cycle «b»Infusion or Hypersensitivity Reaction«/b» «bi»Grade 1«/bi» - Reduce infusion rate by 50% «bi»Grade 2«/bi» - Interrupt infusion and treat symptoms; when symptoms resolve, resume infusion and reduce rate by 50% «bi»Grade 3«/bi» - Discontinue permanently «b»Hemorrhage«/b» «bi»Grade 3-4«/bi» - Hold dosing - Evaluate for coagulopathy and consider clotting factor replacement - Resume dosing with next scheduled dose if bleeding controlled «b»Pancreatitis«/b» «bi»Grade 3-4«/bi» - Hold dosing for elevated lipase or amylase >3x ULN until enzymes levels stabilize or are declining - Discontinue permanently if clinical pancreatitis confirmed «b»Thromboembolism«/b» «bi»Uncomplicated DVT«/bi» - Hold dosing - Treat with appropriate antithrombotic therapy - Consider resuming upon resolution of symptoms, while continuing antithrombotic therapy «bi»Severe or Life-threatening Thrombosis«/bi» - Discontinue permanently - Treat with appropriate antithrombotic therapy «b»Hepatotoxicity«/b» «bi»Total bilirubin >3 to ≤10x ULN«/bi» - Hold dosing until total bilirubin decreases to ≤1.5x ULN «bi»Total bilirubin >10x ULN«/bi» - Discontinue dose and do not make up for missed doses «b»Contraception«/b» - Advise females of reproductive potential to avoid becoming pregnant while receiving calaspargase pegol - Effective contraceptive methods, including a barrier method, should be used during treatment and for at least 3 months after the last dose - Since there is a potential for an indirect interaction between calaspargase pegol and oral contraceptives, concomitant use is not recommended - Another, non-oral contraceptive method should be used in women of childbearing potential

Calcifediol ER

Rayaldee, Calcidiol, 25-Hydroxycholecalciferol

Calcipotriene

Calcitrene, Dovonex, Sorilux

Calcipotriene-Betamethasone

Enstilar, Taclonex, Wynzora

Calcitonin (Salmon)

Miacalcin, Fortical, Salcatonin

Calcitriol

Rocaltrol, 1,25 Dihydroxycholecalciferol

Calcitriol (Topical)

Vectical, 1,25 Dihydroxycholecalciferol

Calcium Acetate

Calcate, PhosLo, Phoslyra, Calphron, Eliphos

Calcium Carbonate

Antacid, Caltrrate, Maalox, Tums, Oysco 500, Oscal, Cal-Carb Forte, Florical

Calcium Chloride

Calcium Chloride (IV)

«b»IV Administration«/b» - For IV administration only - For intermittent IV infusion, dilute to a maximum concentration of 20 mg/mL. - Not for IM or SC administration (severe necrosis and sloughing may occur) - Avoid rapid administration (do not exceed 100 mg/minute except in emergency situations). - For intermittent IV infusion, infuse diluted solution over 1 hour or no greater than 45-90 mg/kg/hour (0.6 to 1.2 mEq/kg/hour); administration via a central or deep vein is preferred; do not use scalp, small hand or foot veins for IV administration (severe necrosis and sloughing may occur) - Monitor ECG if calcium is infused faster than 2.5 mEq/minute; stop the infusion if the patient complains of pain or discomfort. - Warm solution to body temperature prior to administration. - Do not infuse calcium chloride in the same IV line as phosphate-containing solutions. - Vesicant; ensure proper needle or catheter placement prior to and during IV infusion. Avoid extravasation. «b»Extravasation Management«/b» - If extravasation occurs, stop infusion immediately and disconnect (leave needle/cannula in place); gently aspirate extravasated solution (do NOT flush the line). - Early/acute calcium extravasation: Initiate hyaluronidase antidote; remove needle/cannula; apply dry cold compresses; elevate extremity Hyaluronidase Intradermal or SC - Inject a total of 1 to 1.7 mL (15 units/mL) as five separate 0.2 to 0.3 mL injections (using a 25-gauge needle) into area of extravasation at the leading edge in a clockwise manner - May also inject hyaluronidase through the catheter that caused the infiltration «b»Delayed Calcium Extravasation«/b» - Closely monitor site; most calcifications spontaneously resolve - However, if a severe manifestation of calcinosis cutis occurs, may initiate sodium thiosulfate antidote. Sodium Thiosulfate - 12.5 g IV over 30 minutes - May increase gradually to 25 g 3 times per week - Monitor for non-anion gap acidosis, hypocalcemia, severe nausea

Calcium Citrate

Cal-Citrate, Cal-Cee, Cal-C-Cap

Calcium Disodium Versenate

CaEDTA, Edetate Calcium Disodium

Calcium Gluconate

Cal-Glu

- One gram of calcium gluconate salt is equal to 93 mg of elemental calcium. - Dosages are expressed in terms of the calcium gluconate salt (unless otherwise specified as elemental calcium) - Dosages expressed in terms of the calcium gluconate salt are based on a solution concentration of 100 mg/mL (10%) containing 0.465 mEq (9.3 mg)/mL elemental calcium, except where noted. «bu»Calcium Supplementation«/bu» «b»19-50 years old«/b» - 1000 mg/day PO divided every 8-12hr - Preferably 1-2 hours after meals «b»>50 years old«/b» - 1200 mg/day PO divided every 8-12hr - Preferably 1-2 hours after meals «b»Pregnant or Breastfeeding Patient«/b» - 1000/day PO divided every 8-12hr - Preferably 1-2 hours after meals «bu»Hypocalcemia«/bu» «b»Mild«/b» - Ionized Calcium: 4 to 5 mg/dL [1 to 1.2 mmol/L - 1,000 to 2,000 mg IV over 2 hours - Asymptomatic patients may be given oral calcium «b»Moderate«/b» - Without seizure or tetany; Ionized calcium: <4 mg/dL [<1 mmol/L]) - 4,000 mg IV over 4 hours «b»Severe«/b» - Severe symptomatic (seizure, tetany) - 1,000 to 2,000 mg IV over 10 minutes - May repeat every 60 minutes until symptoms resolve - Repeat ionized calcium measurement 6 to 10 hours after completion of administration. - Check for hypomagnesemia and correct if present. - Consider continuous infusion if hypocalcemia is likely to recur due to ongoing losses «bi»Continuous Infusion«/bi» - 5 to 20 mg/kg/hour «b»Induced by Citrate-based Replacement Fluid during CRRT«/b» - IV administered via return line - Prior to initiation of CRRT, check ionized calcium and administer calcium gluconate if <4 mg/dL (<1 mmol/L) until >4 mg/dL (>1 mmol/L). - During CRRT, a continuous infusion sliding scale may be initiated (may use calcium gluconate 20 gram/1,000 mL NS or D5W solution) «b»The Following Schema has been Employed«/b» - If ionized calcium is <3.6 mg/dL (<0.9 mmol/L): Notify nephrology. - If ionized calcium is 3.6 to 4 mg/dL (0.9 to 1 mmol/L): 1,400 mg/hour - If ionized calcium is 4 to 4.4 mg/dL (1 to 1.1 mmol/L): 1,200 mg/hour - If ionized calcium is 4.4 to 5.2 mg/dL (1.1 to 1.3 mmol/L): 1,000 mg/hour - If ionized calcium is >5.2 mg/dL (>1.3 mmol/L): Notify nephrology. «bu»Cardiac Arrest or Cardiotoxicity in the Presence of Hyperkalemia, Hypocalcemia, or Hypermagnesemia«/bu» - 1,500 to 3,000 mg IV over 2 to 5 minutes «bu»Parenteral Nutrition, Maintenance Requirement«/bu» - 10 to 20 mEq elemental calcium IV daily - Adjust dose based on total or ionized calcium «bu»Calcium Channel Blocker Overdose«/bu» (off-label use) - Hypotension/conduction disturbances - 60 mg/kg/dose IV over 5 to 10 minutes - Maximum Dose: 3,000 to 6,000 mg/dose - May repeat every 10 to 20 minutes for 3 to 4 additional doses or initiate a continuous infusion of 60 to 150 mg/kg/hour titrated to improve blood pressure - Maintain ionized calcium at a goal of twice normal. - In life-threatening situations, 1,000 mg has been administered every 2 to 3 minutes until clinical effect is achieved. - In one report, 18 g was administered over a 3-hour period «bu»Beta-blocker Overdose«/bu» (off-label use) - Hypotension/conduction disturbances - 60 mg/kg IV over 5 to 10 minutes, then followed by, - Infusion of 60 to 150 mg/kg/hour - Titrate to adequate hemodynamic response «bu»Hydrofluoric Acid Burns Treatment«/bu» (off-label use) - SC 5% to 10% Solution - 0.5 mL/cm2 of burned tissue - Infiltration should be carried 0.5 cm away from the margin of the injured tissue into the surrounding uninjured areas - Repeat if pain recurs - Local anesthesia may be required to perform procedure; pain resolution is the therapeutic endpoint and if a local anesthetic is utilized, it may be difficult to determine the success of therapy - Never use calcium chloride for subcutaneous injection). - One gram of calcium gluconate salt is equal to 93 mg of elemental calcium. - Dosages are expressed in terms of the calcium gluconate salt (unless otherwise specified as elemental calcium) - Dosages expressed in terms of the calcium gluconate salt are based on a solution concentration of 100 mg/mL (10%) containing 0.465 mEq (9.3 mg)/mL elemental calcium, except where noted. «bu»Calcium Supplementation«/bu» «b»0-6 months old«/b» - 210 mg/day PO divided ever 8-12 hr - Preferably 1-2 hours after meals «b»7-12 months old«/b» - 270 mg/day PO divided every 8-12 hr - Preferably 1-2 hours after meals «b»1-3 years old«/b» - 500 mg/day PO divided every 8-12 hr - Preferably 1-2 hours after meals «b»4-8 years old«/b» - 800 mg/day PO divided every 8-12 hr - Preferably 1-2 hours after meals «b»9-18 years old«/b» - 1300 mg/day PO divided every 8-12 hr - Preferably 1-2 hours after meals «bu»Hypocalcemia«/bu» «b»Infants, Children, and Adolescents«/b» - 200 to 500 mg/kg/day IV as a continuous infusion or in 4 divided doses - Maximum Dose (Infants, Children): 1,000 mg/dose - Maximum Dose (Adolescents): 2,000 to 3,000 mg/dose «b»Symptomatic Hypocalcemia (seizures, tetany)«/b» «b»Infants, Children, and Adolescents«/b» - 100 to 200 mg/kg/dose over 5 to 10 minutes - May repeat after 6 hours or follow with a continuous infusion of 200 to 800 mg/kg/day «bu»Cardiac Arrest or Cardiotoxicity in the presence of Hyperkalemia, Hypocalcemia, or Hypermagnesemia«/bu» «b»Infants, Children, Adolescents«/b» - 60 to 100 mg/kg/dose IV/IO - Maximum: 3,000 mg/dose - May repeat in 10 minutes if necessary; if effective, consider IV infusion «bu»Parenteral Nutrition, Maintenance Requirement«/bu» «b»Infants and Children (≤50 kg)«/b» - Dose expressed as elemental calcium: 0.5 to 4 mEq elemental calcium/kg/day «b»Children (>50 kg) and Adolescents«/b» - Refer to adult dosing. «bu»Calcium Channel Blocker Overdose«/bu» - Hypotension/conduction disturbances - Infants, Children, and Adolescent - 60 mg/kg/dose IV/IO over 30 to 60 minutes - Calcium chloride may provide a more rapid increase of ionized calcium in critically-ill children. - Calcium gluconate may be substituted if calcium chloride is not available. «bu»Hydrofluoric Acid Burns Treatment«/bu» «b»Children and Adolescents«/b» - Refer to adult dosing. «b»Oral Administration«/b» - Administer with plenty of fluids with or following meals. - The 10% calcium gluconate injection may be administered orally in young pediatric patients «b»IV Administration«/b» - For bolus or continuous infusion. - Administer bolus slowly (not to exceed 200 mg/minute in adults or 100 mg/minute in pediatric patients). - For continuous infusions, adjust rate as needed based on serum calcium levels. - Due to the potential presence of particulates, American Regent, Inc recommends the use of a 0.22 micron inline filter for IV administration (1.2 micron filter if admixture contains lipids); a similar recommendation has not been noted by other manufacturers. - Not for IM administration. - In acute situations of symptomatic hypocalcemia, infusions over 5 to 10 minutes have been described in pediatric patients. - Vesicant; ensure proper needle or catheter placement prior to and during IV infusion. - Avoid extravasation «b»Extravasation Management«b» - If extravasation occurs, stop infusion immediately and disconnect (leave needle/cannula in place); gently aspirate extravasated solution (do NOT flush the line). - Early/acute calcium extravasation: Initiate hyaluronidase antidote; remove needle/cannula; apply dry cold compresses; elevate extremity. Hyaluronidase Intradermal or SC - Inject a total of 1 to 1.7 mL (15 units/mL) as five separate 0.2 to 0.3 mL injections (using a 25-gauge needle) into area of extravasation at the leading edge in a clockwise manner - May also inject hyaluronidase through the catheter that caused the infiltration «b»Delayed Calcium Extravasation«/b» - Closely monitor site; most calcifications spontaneously resolve. However, if a severe manifestation of calcinosis cutis occurs, may initiate sodium thiosulfate antidote. Sodium Thiosulfate - 12.5 g IV over 30 minutes - May increase gradually to 25 g 3 times per week; monitor for non-anion gap acidosis, hypocalcemia, severe nausea «b»Treatment of Hydrofluoric Acid Burns«/b» - Off-label Use SC Infiltration - Using a 27- or 30-gauge needle, approach the wound from the distal point of injury and infiltrate directly into the affected dermis and subcutaneous tissue. - The infiltration should be carried 0.5 cm away from the margin of the injured tissue into the surrounding uninjured areas - Avoid excessive administration as it can cause compartment syndrome and further exacerbate tissue damage. - Following subungual exposure, administer to the affected area via the lateral or volar route through the fat pad (under digital nerve block); administration may also require removal of the nailbed, splitting the distal nail from the nailbed, or trimming the nail to the nailbed to reach the affected area «b»Intra-arterial Administration«/b» - Requires radiology to place an arterial catheter in an artery supplying blood to the area of exposure; infuse over four hours - This intervention should be used only by those accustomed to this technique. - Care should be taken to avoid the extravasation. - A poison information center or clinical toxicologist should be consulted prior to implementation. «b»Inhalation Administration«/b» - Dilute 10% calcium gluconate solution to a 2.5% solution and administer via nebulization. «b»IV Bolus Reconstitution«/b» - Observe the vial for the presence of particulates. - If particulates are observed, place vial in a 60°C to 80°C water bath with occasional agitation until solution is clear; shake vigorously; cool to room temperature before use. - Do not use vial if particulates do not dissolve. Prior to administration, dilute in D5W or NS and use immediately: - Dilute to a concentration of 10 to 50 mg/mL. «b»Continuous IV Infusion Reconstitution«/b» - Dilute to a concentration of 5.8 to 10 mg/mL. - Due to the potential presence of particulates, American Regent, Inc recommends the use of a 5 micron filter when preparing calcium gluconate-containing IV solutions; a similar recommendation has not been noted by other manufacturers. - Usual concentrations: 1 g/100 mL D5W or NS; 2 g/100 mL D5W or NS. - Maximum concentration in parenteral nutrition solutions is variable depending upon concentration and solubility «b»Inhalation 2.5% Nebulization Solution Preparation«/b» - Mix 1.5 mL of 10% calcium gluconate solution with 4.5 mL NS to make a 2.5% solution and administer via nebulization «b»Intra-arterial Preparation«/b» - Add 10 mL of a 10% solution to 50 mL of D5W - Infuse over 4 hours into the artery that provides the vascular supply to the affected area - Pain usually resolves by the end of the infusion; repeat if pain recurs. - This intervention should be used only by those accustomed to this technique. - Extreme care should be taken to avoid the extravasation. - A poison information center or clinical toxicologist should be consulted prior to implementation

Calcium Lactate

Cal-Lac

Calcium-Magnesium-Potassium-Sodium Oxybates

Xywav

Calfactant

Infasurf, Bovine Lung Surfactant

Camphor

JointFlex, Vicks Vapo Steam, Cemphire

Camphor-Menthol

Icy Hot Arthritis Lotion (Topical)

Canagliflozin

Invokana

Canagliflozin-Metformin

Invokamet

Canakinumab

Ilaris

Candesartan

Atacand

Candesartan-Hydrochlorothiazide

Atacand HCT

Cangrelor

Kengreal

Cannabidiol

Epidiolex

«bu»Lennox-Gastaut Syndrome (LGS)«/bu» «b»Initial Dose«/b» - 2.5 mg/kg PO bid x 1 week «b»Maintenance Dose«/b» - After 1 week, dose may be increased to maintenance dose of 5 mg/kg bid - If 5 mg/kg PO bid tolerated and further seizure reduction required, patient may benefit from a dosage increase up to a maximum recommended maintenance dosage of 10 mg/kg BID (20 mg/kg/day) - Increasing to 10 mg/kg bbid may be achieved by increased weekly increments of 2.5 mg/kg bid, as tolerated - If a more rapid titration from 10 mg/kg/day to 20 mg/kg/day is warranted, the dosage may be increased no more frequently than every other day - Administration of the 20-mg/kg/day dosage resulted in somewhat greater reductions in seizure rates than the recommended maintenance dosage of 10 mg/kg/day, but with an increase in adverse reaction «bu»Dravet Syndrome (DS)«/bu» «b»Initial Dose«/b» - 2.5 mg/kg PO bid x 1 week «b»Maintenance Dose«/b» - After 1 week, dose may be increased to maintenance dose of 5 mg/kg bid - If 5 mg/kg PO bid tolerated and further seizure reduction required, patient may benefit from a dosage increase up to a maximum recommended maintenance dosage of 10 mg/kg BID (20 mg/kg/day) - Increasing to 10 mg/kg bbid may be achieved by increased weekly increments of 2.5 mg/kg bid, as tolerated - If a more rapid titration from 10 mg/kg/day to 20 mg/kg/day is warranted, the dosage may be increased no more frequently than every other day - Administration of the 20-mg/kg/day dosage resulted in somewhat greater reductions in seizure rates than the recommended maintenance dosage of 10 mg/kg/day, but with an increase in adverse reaction «b»Discontinuing«/b» - Dose should be decreased gradually - As with all antiepileptic drugs, avoid abrupt discontinuation when possible, to minimize the risk of increased seizure frequency and status epilepticus «b»Hepatocellular Injury«/b» - Because of the risk of hepatocellular injury, obtain serum transaminases (ALT and AST) and total bilirubin levels in all patients before initiating and at 1 month, 3 months, and 6 months, and periodically thereafter or as clinically indicated - Existing transaminase elevations >3 x ULN in presence of elevated bilirubin without alternative explanation are important predictors of severe liver injury and should be evaluated before initiating cannabidiol «bu»Lennox-Gastaut Syndrome (LGS)«/bu» «b»<2 years«/b» - Safety and efficacy not established «b»≥2 years«/b» «bi»Initial Dose«/bi» - 2.5 mg/kg PO bid «bi»Maintenance Dose«/bi» - After 1 week, dose may be increased to maintenance dose of 5 mg/kg bid - If 5 mg/kg PO bid tolerated and further seizure reduction required, patient may benefit from a dosage increase up to a maximum recommended maintenance dosage of 10 mg/kg BID (20 mg/kg/day) - Increasing to 10 mg/kg bbid may be achieved by increased weekly increments of 2.5 mg/kg bid, as tolerated - If a more rapid titration from 10 mg/kg/day to 20 mg/kg/day is warranted, the dosage may be increased no more frequently than every other day - Administration of the 20-mg/kg/day dosage resulted in somewhat greater reductions in seizure rates than the recommended maintenance dosage of 10 mg/kg/day, but with an increase in adverse reaction «bu»Dravet Syndrome (DS)«/bu» «b»<2 years«/b» - Safety and efficacy not established «b»≥2 years«/b» «bi»Initial Dose«/bi» - 2.5 mg/kg PO bid «bi»Maintenance Dose«/bi» - After 1 week, dose may be increased to maintenance dose of 5 mg/kg bid - If 5 mg/kg PO bid tolerated and further seizure reduction required, patient may benefit from a dosage increase up to a maximum recommended maintenance dosage of 10 mg/kg BID (20 mg/kg/day) - Increasing to 10 mg/kg bbid may be achieved by increased weekly increments of 2.5 mg/kg bid, as tolerated - If a more rapid titration from 10 mg/kg/day to 20 mg/kg/day is warranted, the dosage may be increased no more frequently than every other day - Administration of the 20-mg/kg/day dosage resulted in somewhat greater reductions in seizure rates than the recommended maintenance dosage of 10 mg/kg/day, but with an increase in adverse reaction «b»Discontinuing«/b» - Dose should be decreased gradually - As with all antiepileptic drugs, avoid abrupt discontinuation when possible, to minimize the risk of increased seizure frequency and status epilepticus

Capecitabine

Xeloda, CAPE

Caplacizumab

Cablivi

Capmatinib

Tabrecta

«bu»Non-Small Cell Lung Cancer (NSCLC)«/bu» - 400 mg PO bid - Continue until disease progression or unacceptable toxicity «b»Missed or Vomited Dose«/b» - Do not make up dose - Take next dose at its scheduled time «b»Pregnancy«/b» - Verify pregnancy status for females of reproductive potential before starting treatment «b»Contraception«/b» Females of Reproductive Potential - Use effective contraception during treatment and for 1 week after final dose Males with Female Partners of Reproductive Potential - Use effective contraception during treatment and for 1 week after final dose «b»Dose Reductions for Adverse Reactions«/b» «bi»First Occurrence«/bi» - Restart at 300 mg PO bid «bi»Second Occurrence«/bi» - Restart at 200 mg PO bid «bi»Unable to Tolerate 200 mg PO BID«/bi» - Permanently discontinue «b»Interstitial Lung Disease/Pneumonitis«/b» «bi»Any Grade«/bi» - Permanently discontinue «b»Liver Function Test Abnormalities«/b» «bi»ALT and/or AST >3x ULN with TB >2x ULN«/bi» - Permanently discontinue «bi»Increased ALT and/or AST without Increased TB«/bi» Grade 3 - Withhold until recovery to baseline ALT/AST - If recovered to baseline within 7 days, then resume at the same dose; otherwise, resume at reduced dose Grade 4 - Permanently discontinue «bi»Increased TB without Concurrent Increased ALT and/or AST«/bi» Grade 2 - Withhold until recovery to baseline ALT/AST - If recovered to baseline within 7 days, then resume at the same dose; otherwise, resume at reduced dose Grade 3 - Withhold until recovery to baseline ALT/AST - If recovered to baseline within 7 days, then resume at reduced dose; otherwise, permanently discontinue Grade 4 - Permanently discontinue «b»Other Adverse Reactions«/b» «bi»Grade 2«/bi» - Maintain dose level - If intolerable, consider withholding until resolved, then resume at reduced dose «bi»Grade 3«/bi» - Withhold until resolved, then resume at reduced dose «bi»Grade 4«/bi» - Permanently discontinue

Capreomycin

Capastat

Capsaicin

Trixaicin, Zostrix, Capzasin, Aflexeril MC, Flexin

Captopril

Capoten

Captopril-Hydrochlorothiazide

Capozide

Carbachol

Miostat

CarBAMazepine

Carbatrol, Equetro, TEGretol, Epitol, CBZ, Carnexiv

«bu»Epilepsy«/bu» «b»Oral Tablet«/b» Initial Dose - 400 mg/day in 2 divided doses or 4 divided doses (oral suspension only) Maintenance Dose - May increase by up to 200 mg/day at weekly intervals using a twice daily regimen of extended-release capsule or tablet, or a 3 to 4 times/day regimen of other formulations until optimal response and therapeutic levels are achieved Usual Dose Range - 800 to 1,200 mg/day Maximum Recommended Dose - 1,600 mg/day «b»Oral Suspension«/b» Initial Dose - 10 mL (200 mg) PO every 6 hours Maintenance Dose - May increase weekly by up to 200 mg/day PO divided every 8 to 8 hours «b»IV Solution«/b» - The total daily dose of carbamazepine IV is 70% of the total daily PO dose - Equally divide the total daily dose of the IV in four 30-minute infusions, separated by 6 hr - IV administration has not been studies for >7 days - Approved as temporary use (≤7 days) for Partial seizures with complex symptomatology, Generalized tonic-clonic seizures, Mixed seizure patterns which include the above, or other partial or generalized seizures «b»Limitations of Use«/b» - Carbamazepine is not indicated for the treatment of absence seizures (petit mal); it has been associated with increased frequency of generalized convulsions in these patients. - Dosage must be adjusted according to patient's response and serum concentrations. When converting from an immediate-release formulation to an extended-release formulation, the same total daily mg dose of carbamazepine should be administered, divided into twice daily dosing. Avoid abrupt withdrawal «bu»Trigeminal or Glossopharyngeal Neuralgia«/bu» Initial Dose - 200 mg/day in a single dose (extended-release capsule), 2 divided doses (tablet forms) or 4 divided doses (oral suspension), gradually increasing in increments of 200 mg/day as needed. - Administer extended-release capsule in 2 divided doses if total daily dose exceeds 200 mg. Maintenance Dose Range - 400 to 800 mg daily in 2 divided doses or 4 divided doses (oral suspension only) Maximum Dose - 1,200 mg/day «bu»Bipolar Disorder«/bu» «b»Equetro«/b» Initial Dose - 400 mg/day in 2 divided doses Maintenance Dose - May adjust by 200 mg/day increments Maximum Dose - 1,600 mg/day «bu»Neuropathic Pain«/bu» Initial Dose - 50 to 100 mg bid in combination with IV opioids Maintenance Dose - 100 to 200 mg every 4 to 6 hours Maximum Dose - 1,200 mg/day «bu»Neuropsychiatric Symptoms of Dementia«/bu» Initial Dose - 100 mg once or twice daily Maintenance Dose - May be increased by 50 to 100 mg every 2 to 7 days to a maximum of 400 to 600 mg daily in 2 to 4 divided doses - Treatment duration ranged from 6 to 8 weeks «bu»Restless Legs Syndrome«/bu» - 100 to 600 mg PO daily for up to 5 weeks «b»Chewable or Immediate-release Tablets Administration«/b» - Administer with food «b»Oral Suspension Administration«/b» - Shake well before administration. - Must be given on a 3 to 4 times/day schedule versus tablets, which can be given 2 to 4 times/day. - Because a given dose of suspension will produce higher peak and lower trough levels than the same dose given as the tablet form, patients given the suspension should be started on lower doses given more frequently (same total daily dose) and increased slowly to avoid unwanted side effects. - When carbamazepine suspension has been combined with chlorpromazine or thioridazine solutions, a precipitate forms, which may result in loss of effect. - Therefore, it is recommended that the carbamazepine suspension dosage form not be administered at the same time with other liquid medicinal agents or diluents. - Should be administered with meals. «b»Extended-release Capsule (Carbatrol, Equetro) Administration«/b» - Consists of three different types of beads: immediate release, extended release, and enteric release - The bead types are combined in a ratio to allow twice daily dosing - May be opened and contents sprinkled over food such as a teaspoon of applesauce; may be administered with or without food; do not crush or chew capsule or beads inside capsule. «b»Extended-release Tablet Administration«/b» - Should be inspected for damage. - Damaged extended-release tablets (without release portal) should not be administered. - Should be administered with meals; swallow whole, do not crush or chew. «b»IV Administration«/b» - For IV use only - Administer IV over 30 minutes «b»IV Solution Preparation«/b» - Injection, solution: Dilute the single dose in 100 mL of NS, LR, or D5W. Mix gently. «b»Oral Suspension (40 mg/mL) Preparation«/b» - Crush twenty 200 mg tablets in a mortar and reduce to a fine powder.A - Add small portions of Simple Syrup, NF and mix to a uniform paste; mix while adding the vehicle in incremental proportions to almost 100 mL; transfer to a calibrated bottle, rinse mortar with vehicle, and add sufficient quantity of vehicle to make 100 mL. - Label "shake well" and "refrigerate". - Stable for 90 days.

Carbidopa

Lodosyn

5 additional boluses/day, consider increasing the maintenance dose «bu»Restless Legs Syndrome (RLS)«/bu» «b»Immediate-release Tablet«/b» - Carbidopa 25 mg/levodopa 100 mg (0.5 to 1 tablet) given in the evening, at bedtime, or upon waking during the night with RLS symptoms «b»Controlled-release Tablet«/b» - Carbidopa 25 mg/levodopa 100 mg (1 tablet) before bedtime for RLS symptoms that awaken patient during the night «b»Intestinal Suspension (Duopa)«/b» Dyskinesias or levodopa-related adverse reactions within 1 hour of morning dose on preceding day - Decrease morning dose by 1 mL. Dyskinesias or adverse reactions lasting ≥1 hour on the preceding day - Decrease the continuous dose by 0.3 mL per hour. Dyskinesias or adverse reactions lasting for 2 or more periods of ≥1 hour on the preceding day - Decrease the continuous dose by 0.6 mL per hour.,Safety and efficacy not established" class="list-group-item active pb-0 drug">

Carbidopa-Levodopa

Rytary, Duopa, Sinemet, Sinemet CR, Parcopa, Duodopa

«bu»Parkinson Disease«/bu» «b»Immediate Release Tablet, ODT«/b» - Carbidopa/levodopa tablets are available in a 1:4 ratio of carbidopa to levodopa as well as 1:10 ratio. - Tablets of the two ratios may be given separately or combined as needed to provide the optimum dosage. «bi»Initial Dose«/bi» - Carbidopa 25 mg/levodopa 100 mg 3 times daily (preferred) or carbidopa 10 mg/levodopa 100 mg 3 to 4 times daily (typically does not provide an adequate amount of carbidopa for most patients) Patients Previously Treated with Levodopa <1,500 mg Daily - Carbidopa 25 mg/levodopa 100 mg 3 or 4 times daily Patients Previously Treated with Levodopa >1,500 mg Daily - Carbidopa 25 mg/levodopa 250 mg 3 or 4 times daily - Discontinue levodopa at least 12 hours before starting therapy with carbidopa/levodopa. Substitute the combination drug at a dosage that will provide approximately 25% of the previous levodopa dosage. «bi»Dosage Adjustment«/bi» - Alternate tablet strengths may be substituted according to individual carbidopa/levodopa requirements. Use of more than 1 dosage strength or dosing 4 times daily may be required - Maximum Dose: 8 tablets of any strength daily or 200 mg of carbidopa and 2,000 mg of levodopa Carbidopa 10 mg/levodopa 100 mg - Increase by 1 tablet daily or every other day, as necessary, to 2 tablets 4 times daily Carbidopa 25 mg/levodopa 100 mg - Increase by 1 tablet daily or every other day Carbidopa 25 mg/levodopa 250 mg - Increase by 1/2 or 1 tablet daily or every other day «b»Controlled-Release Tablet«/b» «bi»Patients NOT Currently Receiving Levodopa«/bi» - Initial Dose: Carbidopa 50 mg/levodopa 200 mg 2 times daily, at intervals not <6 hours «bi»Patients Currently Receiving Levodopa«/bi» - Discontinue levodopa at least 12 hours before starting carbidopa/levodopa therapy. «bi»Initial Dose«/bi» - Substitute at a dosage that will provide approximately 25% of the previous levodopa dosage; usual initial dose in mild to moderate disease is carbidopa 50 mg/levodopa 200 mg 2 times daily «bi»Converting from IR to CR formulation«/bi» Initial Dose - Dosage should be substituted at an amount that provides ~10% more of levodopa/day; total calculated dosage is administered in divided doses 2 to 3 times/day (or ≥3 times/day for patients maintained on levodopa ≥700 mg) - Intervals between doses should be 4 to 8 hours while awake; when divided doses are not equal, smaller doses should be given toward the end of the day. - Depending on clinical response, dosage may need to be increased to provide up to 30% more levodopa/day. «bi»Dosage Adjustment«/bi» - May adjust every 3 days; intervals should be >4 hours during the waking day (maximum dose: 8 tablets/day) «b»Extended-Release Capsule«/b» - Carbidopa/levodopa extended-release capsules are not interchangeable with other carbidopa/levodopa products. «bi»Patients NOT Currently Receiving Levodopa«/bi» Initial Dose - Carbidopa 23.75 mg/levodopa 95 mg 3 times daily for 3 days; on day 4, increase to carbidopa 36.25 mg/levodopa 145 mg 3 times daily - May increase dose up to carbidopa 97.5 mg/levodopa 390 mg 3 times a day; frequency of dosing may be increased to a maximum of 5 times daily if needed and tolerated - Maximum Dose carbidopa 612.5 mg/levodopa 2,450 mg per day «bi»Conversion from IR to ER Capsules«/bi» Initial Dose - Initial dose based off of total current daily dose of levodopa in immediate-release carbidopa/levodopa as follows (frequency of dosing may be increased to a maximum of 5 times daily if needed and tolerated): If Total Daily Dose of Levodopa is Between 400 mg to 549 mg - 3 capsules of carbidopa 23.75 mg/levodopa 95 mg 3 times daily (levodopa total daily dose: 855 mg) If Total Daily Dose of Levodopa is Between 550 mg to 749 mg - 4 capsules of carbidopa 23.75 mg/levodopa 95 mg 3 times daily (levodopa total daily dose: 1,140 mg). If Total Daily Dose of Levodopa is Between 750 mg to 949 mg - 3 capsules of carbidopa 36.25 mg/levodopa 145 mg 3 times daily (levodopa total daily dose: 1,305 mg). If Total Daily Dose of Levodopa is Between 950 mg to 1249 mg - 3 capsules of carbidopa 48.75 mg/levodopa 195 mg 3 times daily (levodopa total daily dose: 1,755 mg). If Total Daily Dose of Levodopa is ≥1,250 mg - 4 capsules of carbidopa 48.75 mg/levodopa 195 mg 3 times daily (levodopa total daily dose: 2,340 mg) or 3 capsules of carbidopa 61.25/levodopa 245 mg 3 times daily (levodopa total daily dose: 2,205 mg) «bi»Dosage Adjustment«/bi» - Adjust dose as needed (maximum dose: carbidopa 612.5 mg/levodopa 2,450 mg per day). «b»Concomitant Therapy«/b» - For patients currently treated with carbidopa/levodopa plus catechol-O-methyl transferase (COMT) inhibitors (eg, entacapone), the initial total daily dose of carbidopa/levodopa may need to be increased - Use of carbidopa/levodopa extended-release capsules in combination with other levodopa products has not been studied. «b»Intestinal Infusion via PEG-J Tube: Intestinal Suspension (Duopa)«/b» - Prior to initiation of therapy, convert patients from all forms of levodopa to oral immediate-release carbidopa/levodopa tablets (1:4 ratio) «bi»Total Daily Dose«/bi» - Expressed in terms of levodopa - Consists of a morning dose, a continuous dose and extra doses «bi»Maximum Dose«/bi» - 2,000 mg of the levodopa component (one cassette per day) over 16 hours. - Patients should receive their routine night-time dosage of oral immediate-release carbidopa/levodopa after discontinuation of daily infusion. «bi»Morning Dose and Continuous Dose«/bi» - Refer to manufacturer’s labeling for morning dose and continuous dose calculations and titration instructions. «bi»Extra Doses«/bi» - Can be used to manage acute "off" symptoms that are not controlled by the morning and continuous dose. - Set extra dose function at 1 mL (20 mg of levodopa) initially; adjust in 0.2 mL increments if needed. - Maximum Dose: One extra dose every 2 hours. Note: Frequent extra doses may cause or worsen dyskinesias. «b»Discontinuation«/b» - Avoid sudden discontinuation or rapid dose reduction; taper dose or switch patients to oral immediate-release carbidopa-levodopa. «b»Intestinal Bel (Duodopa)«/b» - Conversion to/from oral levodopa tablet formulations and the intestinal gel formulation can be done on a 1:1 ratio. Total daily dose (expressed in terms of levodopa) consists of a morning bolus dose, a continuous maintenance dose, and additional bolus doses when necessary. Nighttime dosing may be necessary in certain rare situations (eg, nocturnal akinesia). Dosage adjustments should be carried out over a period of a few weeks. Patients should receive their routine night-time dosage of oral levodopa/carbidopa after discontinuation of daily infusion «bi»Morning Bolus Dose«/bi» Day 1 - Based on a percentage of the previous morning levodopa intake and volume to fill intestinal tubing: - Previous morning dose of levodopa ≤200 mg: Administer Duodopa at 80% of dose - Previous morning dose of levodopa 201 to 399 mg: Administer Duodopa at 70% of dose - Previous morning dose of levodopa ≥400 mg: Administer Duodopa at 60% of dose Day 2 and Beyond Till Dose is Stable - Adjust dose based on response to the previous morning levodopa intake and volume to fill intestinal tubing): Usual: Levodopa 100 to 200 mg (5 to 10 mL); Maximum: Levodopa 300 mg (15 mL) «bi»Continuous Maintenance Dose«/bi» - Adjustable in increments of 2 mg/hour (0.1 mL/hour) and based on previous daily intake of levodopa - Usual Dose: Levodopa 40 to 120 mg/hour (2 to 6 mL/hour) infused up to 16 hours; - Dose Range: Levodopa 20 to 200 mg/hour (1 to 10 mL/hour) - Higher doses may be necessary in exceptional cases. «bi»Additional Bolus Doses«/bi» - Usual Dose: Levodopa: 10 to 40 mg (0.5 to 2 mL), if needed for rapid deterioration of motor functions (eg, hypokinesia) - May give additional doses hourly until stable dose is established then give every 2 hours as needed. - In patients requiring >5 additional boluses/day, consider increasing the maintenance dose «bu»Restless Legs Syndrome (RLS)«/bu» «b»Immediate-release Tablet«/b» - Carbidopa 25 mg/levodopa 100 mg (0.5 to 1 tablet) given in the evening, at bedtime, or upon waking during the night with RLS symptoms «b»Controlled-release Tablet«/b» - Carbidopa 25 mg/levodopa 100 mg (1 tablet) before bedtime for RLS symptoms that awaken patient during the night «b»Intestinal Suspension (Duopa)«/b» Dyskinesias or levodopa-related adverse reactions within 1 hour of morning dose on preceding day - Decrease morning dose by 1 mL. Dyskinesias or adverse reactions lasting ≥1 hour on the preceding day - Decrease the continuous dose by 0.3 mL per hour. Dyskinesias or adverse reactions lasting for 2 or more periods of ≥1 hour on the preceding day - Decrease the continuous dose by 0.6 mL per hour. «b»Intestinal Suspension (Duopa) Administration«/b» - Remove one cassette from refrigerator 20 minutes prior to use (failure to use at room temperature may result in inaccurate dosage) - Administer as a 16-hour infusion through either a naso-jejunal tube (temporary administration) or through a percutaneous endoscopic gastrostomy-jejunostomy (PEG-J) tube (long-term administration) connected to the CADD-Legacy 1400 pump - At the end of administration, disconnect the tube from the pump at the end of the infusion and flush with room-temperature drinking water with a syringe. - Following discontinuation of the daily infusion, patients should administer their routine night-time dosage of oral immediate-release carbidopa/levodopa. «b»Intestinal Gel (Duodopa) Administration«/b» - Gel is administered directly to the jejunum via a portable infusion pump (CADD-legacy Duodopa pump) - Administer through a temporary nasojejunal tube for a short-term test period to evaluate patient response and for dose optimization. - Long-term administration requires placement of PEG-J tube for intestinal infusion. Continuous maintenance dose is infused throughout the day for up to 16 hours if necessary, may administer at night (eg, nocturnal akinesia). - Disconnect PEG-J tube from infusion pump at end of infusion and flush with room temperature water to prevent occlusion of tubing. - Following discontinuation of the daily infusion, patients should administer their routine night-time dosage of oral levodopa/carbidopa. «b»Extended-release Capsule Administration«/b» - Administer with or without food; a high-fat, high-calorie meal may delay the absorption of levodopa by ~2 hours. - Swallow capsules whole; do not chew, divide, or crush capsules. - Patients who have difficulty swallowing intact capsules may open the capsule, sprinkle entire contents on a small amount of applesauce (1 to 2 tablespoons) and consume immediately (do not store for future use). «b»Oral Tablet Formulations Administration«/b» - Space doses evenly over the waking hours. - Administer with meals to decrease GI upset. - Controlled release product should not be chewed or crushed. - Orally disintegrating tablets do not require water; the tablet should disintegrate on the tongue's surface before swallowing. «b»Oral Suspension Preparation«/b» - An oral suspension containing carbidopa 1.25 mg and levodopa 5 mg per mL may be made with tablets. - Crush ten tablets each containing carbidopa 25 mg and levodopa 100 mg and reduce to a fine powder. - Add small portions of a 1:1 mixture of Ora-Sweet® and Ora-Plus® and mix to a uniform paste; mix while adding the vehicle in equal proportions to almost 200 mL; transfer to a calibrated bottle, rinse mortar with vehicle, and add sufficient quantity of vehicle to make 200 mL. - Label "shake well" and "refrigerate". - Stable 42 days under refrigeration. - Also stable 28 days at room temperature.

Carbidopa-Levodopa-Entacapone

Stalevo

Carbinoxamine

Arbinoxa, Palgic, Karbinal, RyVent

CARBOplatin

Paraplatin, CBDCA

Carfilzomib

Kyprolis, CFZ

Carglumic Acid

Carbaglu, N-Carbamoyl-L-Glutamic Acid

Cariprazine

Vraylar

- Due to the long half-life of cariprazine and its active metabolites, changes in dose will not be fully reflected in plasma for several weeks. «bu»Bipolar I Disorder«/bu» «b»Manic or Mixed Episodes«/b» - Initial Dose: 1.5 mg once daily - Adjust dose based on response and tolerability to 3 mg on day 2 - Make further adjustments in increments of 1.5 or 3 mg - Recommended Dosing Range: 3 mg to 6 mg once daily - Maximum Dose: 6 mg/day «b»Depressive Episodes«/b» - Initial Dose: 1.5 mg once daily - Depending upon clinical response and tolerability, dosage can be increased to 3 mg daily on Day 15 - Maximum Dose: 3 mg/day «bu»Schizophrenia«/bu» - Initial Dose: 1.5 mg once daily; adjust dose based on response and tolerability to 3 mg on day 2 and make further adjustments in increments of 1.5 or 3 mg - Recommended Dosing Range: 1.5 mg to 6 mg once daily - Maximum Dose: 6 mg/day «b»Strong CYP3A4 Inhibitor Initiated While on Cariprazine«/b» - Reduce the current dose of cariprazine by 50%. - For patients taking 4.5 mg daily, reduce the dose to 1.5 mg or 3 mg daily. - For patients taking 1.5 mg daily, adjust the dose to every other day. - The cariprazine dose may need to be increased if the CYP3A4 inhibitor is withdrawn. «b»Initiating Therapy While on a Strong CYP3A4 Inhibitor«/b» - Administer cariprazine 1.5 mg on day 1 and day 3 (no dose administered on day 2) - Administer 1.5 mg daily starting on day 4 and increase to a maximum of 3 mg/day. - The cariprazine dose may need to be increased if the CYP3A4 inhibitor is withdrawn. «b»Concomitant Use with CYP3A4 Inducers«/b» - Use is not recommended. «b»Discontinuation of Therapy«/b» - American Psychiatric Association (APA), Canadian Psychiatric Association (CPA), and World Federation of Societies of Biological Psychiatry (WFSBP) guidelines recommend gradually tapering antipsychotics to avoid withdrawal symptoms and minimize the risk of relapse. - Risk for withdrawal symptoms may be highest with highly anti-cholinergic or dopaminergic antipsychotics - When stopping antipsychotic therapy in patients with schizophrenia, the CPA guidelines recommend a gradual taper over 6 to 24 months, and the APA guidelines recommend reducing the dose by 10% each month - Continuing anti-parkinsonism agents for a brief period after discontinuation may prevent withdrawal symptoms - When switching antipsychotics, three strategies have been suggested: Cross-titration (gradually discontinuing the first antipsychotic while gradually increasing the new antipsychotic), overlap and taper (maintaining the dose of the first antipsychotic while gradually increasing the new antipsychotic, then tapering the first antipsychotic), and abrupt change (abruptly discontinuing the first antipsychotic and either increasing the new antipsychotic gradually or starting it at a treatment dose) - Evidence supporting ideal switch strategies and taper rates is limited, and results are conflicting.

Carisoprodol

Soma, Isobamate

Carisoprodol-Aspirin

Soma Compound

Carisoprodol-Aspirin-Codeine

Soma Compound with Codeine

Carmustine

BiCNU, BCNU, Gliadel Wafer, Becenum

- Carmustine (IV) is associated with a moderate to high emetic potential (dose-related); antiemetics are recommended to prevent nausea and vomiting «bu»Brain Tumors, Hodgkin Lymphoma, Multiple Myeloma Non-Hodgkin Lymphoma«/bu» - 150 to 200 mg/m2 IV every 6 weeks or - 75 to 100 mg/m2/day IV for 2 days every 6 weeks (as a single agent in previously untreated patients; lower doses are used in combination with other chemotherapy agents) «bu»Glioblastoma Multiforme (Recurrent), Glioma, Malignant«/bu» «b»Implantation (Wafer)«/b» «bi»Newly-diagnosed High-grade«/bi» - 8 wafers (7.7 mg each) implanted intracranially into in the resection cavity - Total dose 61.6 mg - Should the size and shape not accommodate 8 wafers - Maximum number of wafers feasible (up to 8) should be placed «bu»Brain Tumor, Primary«/bu» - 80 mg/m2/day IV for 3 days every 8 weeks x 6 cycles - 200 mg/m2 every 8 weeks - Maximum Cumulative Dose: 1,500 mg/m2 «bu»Hodgkin Lymphoma«/bu» «b»Relapsed or Refractory«/b» «bi»Mini-BEAM Regimen«/bi» - 60 mg/m2 day 1 every 4 to 6 weeks (in combination with etoposide, cytarabine, and melphalan) «bu»Multiple Myeloma«/bu» «b»Relapsed or Refractory«/b» «bi»VBMCP Regimen«/bi» - 20 mg/m2 IV day 1 every 35 days (in combination with vincristine, melphalan, cyclophosphamide, and prednisone) «bu»Mycosis Fungoides, Early Stage«/bu» «b»Early Stage«/b» «bi»Ointment (10 mg/100 grams Petrolatum)«/bi» - Apply (with gloves) once daily to affected areas «bi»Solution (0.2% Solution in alcohol; dilute 5 mL in 60 mL water)«/bi» - Apply (with gloves) once daily to affected areas. «bu»Stem Cell or Bone Marrow (autologous) Transplant Conditioning Regimen«/bu» «b»BEAM Regimen«/b» - 300 mg/m2 IV as a single dose 6 days prior to transplant (in combination with etoposide, cytarabine, and melphalan) «b»CBV Regimen«/b» - 600 mg/m2 as a single dose 3 days prior to transplant (in combination with cyclophosphamide and etoposide) «b»Hematologic Toxicity«/b» «bi»Based on Nadir Counts with Previous Dose«/bi» If leukocytes ≥3,000/mm3 and platelets ≥75,000/mm3 - Administer 100% of dose If leukocytes 2,000 to 2,999/mm3 or platelets 25,000 to 74,999/mm3 - Reduce dose to 70% of usual dose If leukocytes <2,000/mm3 or platelets <25,000/mm3 - Reduce dose to 50% of usual dose «b»IV Administration«/b» - Carmustine (IV) is associated with a moderate to high emetic potential (dose-related); antiemetics are recommended to prevent nausea and vomiting - Infuse slowly over at least 2 hours (infusions <2 hours may lead to injection site pain or burning); infuse through a free-flowing saline or dextrose infusion, or administer through a central catheter to alleviate venous pain/irritation. Do not exceed a rate of 1.66 mg/m2/minute. - Irritant; infiltration may result in local pain, erythema, swelling, burning and skin necrosis; the alcohol-based diluent may be an irritant, especially with high doses. Avoid extravasation. Monitor infusion site. «bi»High-dose Carmustine (Transplant Dose)«/bi» - Infuse over a least 2 hours to avoid excessive flushing, agitation, and hypotension; was infused over 1 hour in some trials - High-dose carmustine may be fatal if not followed by stem cell rescue. Monitor vital signs frequently during infusion; patients should be supine during infusion and may require the Trendelenburg position, fluid support, and vasopressor support. «b»Implant Administration«b» - Double glove before handling; outer gloves should be discarded as chemotherapy waste after handling wafers. - Any wafer or remnant that is removed upon repeat surgery should be discarded as chemotherapy waste - The outer surface of the external foil pouch is not sterile - Open pouch gently; avoid pressure on the wafers to prevent breakage - Wafers that are broken in half may be used, however, wafers broken into more than 2 pieces should be discarded in a biohazard container - Slight overlapping of wafers during placement is acceptable - Oxidized regenerated cellulose (Surgicel) may be placed over the wafer to secure; irrigate cavity prior to closure. «b»Topical Administration«/b» - Apply solution with brush or gauze pads; ointment and solution should be applied while wearing gloves to involved areas only; avoid contact with eyes or mouth «b»IV Reconstitution«/b» - Reconstitute initially with 3 mL of supplied diluent (dehydrated alcohol injection, USP); then further dilute with SWFI (27 mL), this provides a concentration of 3.3 mg/mL in ethanol 10%; protect from light; further dilute for infusion with 500 mL D5W or NS using a non-PVC container (eg, glass, polypropylene or polyolefin) to a concentration of 0.2 mg/mL. «b»Implant Preparation«/b» - Each wafer is packaged within 2 nested aluminum foil pouches; the inner pouch is sterile and is designed to maintain sterility and protect from moisture; the outer wrap is not sterile. - Deliver to the operating room in the unopened outer aluminum foil pouch. - Do not open until the wafers are ready to be implanted. - Follow manufacturer’s instructions for opening the pouch, being careful not to apply pressure to the wafer.

Carteolol (Ophthalmic)

Ocupress

Carvedilol

Coreg, Coreg CR

- Reduce dosage if heart rate drops to <55 beats/minute «bu»Hypertension«/bu» «b»Immediate Release«/b» - 6.25 mg PO bid - If tolerated, dose should be maintained for 1 to 2 weeks, then increased to 12.5 mg bid. - If necessary, dosage may be increased to a maximum of 25 mg twice daily after 1 to 2 weeks - Usual Dosage Range: 6.25 to 25 mg twice daily. «b»Extended Release«/b» - Initial Dose: 20 mg once daily - If tolerated, dose should be maintained for 1 to 2 weeks then increased to 40 mg once daily if necessary - If this dose is tolerated, maintain for 1 to 2 weeks then, if necessary, increase to 80 mg once daily - Maximum Dose: 80 mg once daily «bu»Heart Failure«/bu» «b»Immediate Release«/b» - Initial Dose: 3.125 mg twice daily for 2 weeks - If this dose is tolerated, may increase to 6.25 mg bid - Double the dose every 2 weeks to the highest dose tolerated by patient - Prior to initiating therapy, other heart failure medications should be stabilized and fluid retention minimized «bi»Maximum Recommended Dose«/bi» Mild-to-Moderate Heart Failure - <85 kg: 25 mg PO bid - >85 kg: 50 mg PO bid Severe Heart Failure - 25 mg PO bid «b»Extended Release«/b» - Initial Dose: 10 mg once daily for 2 weeks - If the dose is tolerated, increase dose to 20 mg, 40 mg, and 80 mg over successive intervals of at least 2 weeks - Maintain on lower dose if higher dose is not tolerated - Maximum Dose: 80 mg once daily «bu»Left Ventricular Dysfunction Post-MI«/bu» - Should be initiated only after patient is hemodynamically stable and fluid retention has been minimized. «b»Immediate Release«/b» - Initial Dose: 3.125 to 6.25 mg PO bid - Increase dosage incrementally (from 6.25 to 12.5 mg PO bid) at intervals of 3 to 10 days, based on tolerance, to a target dose of 25 mg PO bid - Maximum Dose: 50 mg twice daily «b»Extended Release«/b» - Initial Dose: 10 to 20 mg once daily - Increase dosage incrementally at intervals of 3 to 10 days, based on tolerance, to a target dose of 80 mg once daily. «bu»Angina Pectoris«/bu» «b»Immediate Release«/b» - 25 to 50 mg PO bid «bu»Atrial Fibrillation«/bu» «b»Rate Control«/b» - Usual Maintenance Dose: 3.125 to 25 mg PO bid - In patients with heart failure, the initial dose of 3.125 mg PO bid may be increased at 2-week intervals to a target dose of 25 mg PO bid - Target Dose Weighing >85 kg: 50 mg PO bid «bu»Gastroesophageal Varices«/bu» - Initial Dose: 6.25 mg once daily - May increase after 1 week to 12.5 mg once daily if heart rate ≥55 bpm - Increasing doses beyond 12.5 mg daily increases unwanted adverse effects without additional benefit

Casimersen

Amondys 45

Casirivimab

Casirivimab-Imdevimab

REGEN-COV2, Regeneron COVID-19 Monoclonal Antibody

«bu»Mild to Moderate COVID-19«/bu» «b»Casirivimab-Imdevimab«/b» - 1200-1200 mg as a single IV infusion x 1 dose over 60 minutes (250 mL/hr) via pump or gravity - Recommended to be given within 10 days of symptoms onset - Clinically monitor patients during infusion and observe patients for at least 1 hour after infusion is complete «b»Limitations of Authorized Use«/b» Casirivimab and Imdevimab are NOT authorized for use in patients: - who are hospitalized due to COVID-19 OR - who require oxygen therapy due to COVID-19, OR - who require an increase in baseline oxygen flow rate due to COVID-19 in those on chronic oxygen therapy due to underlying non-COVID-19 related comorbidity. «b»Patient Selection Criteria«/b» High risk is defined as patients who meet at least one of the following criteria: - Body Mass Index (BMI) ≥35 - Chronic kidney disease - Diabetes Mellitus - Immunosuppressive disease - Currently receiving immunosuppressive treatment - Age ≥65 years - Age ≥55 years of age AND have cardiovascular disease, or hypertension or chronic obstructive pulmonary disease/other chronic respiratory disease «bi»12 – 17 years of age AND Have«/bi» - BMI ≥85th percentile for their age and gender based on CDC growth charts https://www.cdc.gov/growthcharts/clinical_charts.htm OR - Sickle cell disease OR - Congenital or acquired heart disease OR - Neurodevelopmental disorders, for example, cerebral palsy OR - A medical-related technological dependence, for example, tracheostomy, gastrostomy, or positive pressure ventilation (not related to COVID-19) OR - Asthma, reactive airway or other chronic respiratory disease that requires daily medication for control «b»Overdosage«/b» - Doses up to 8,000 mg (4,000 mg each of casirivimab and imdevimab, greater than 3 times the recommended dose) have been administered in clinical trials without dose-limiting toxicity - Treatment of overdose should consist of general supportive measures including monitoring of vital signs and observation of the clinical status of the patient - There is no specific antidote for overdose with casirivimab and imdevimab. «b»IV Administration«/b» - Casirivimab and Imdevimab infusion solution should be administered by a qualified healthcare professional using aseptic technique - This product is preservative-free and therefore, the diluted infusion solution should be administered immediately. - If refrigerated, allow the infusion solution to equilibrate to room temperature for approximately 30 minutes prior to administration. - Gather the recommended materials for infusion: a) Polyvinyl chloride (PVC), Polyethylene (PE)-lined PVC, or Polyurethane (PU) infusion set b) In-line or add-on 0.2 micron polyethersulfone (PES) filter - Attach the infusion set to the IV bag. - Prime the infusion set. - Administer as an IV infusion via pump or gravity over at least 60 minutes through an intravenous line containing a sterile, in-line or add-on 0.2-micron polyethersulfone (PES) filter - The prepared infusion solution should not be administered simultaneously with any other medication. The compatibility of casirivimab and imdevimab injection with IV solutions and medications other than 0.9% Sodium Chloride Injection is not known. - After infusion is complete, flush with 0.9% Sodium Chloride Injection. - Discard unused product. - Clinically monitor patients during administration and observe patients for at least 1 hour after infusion is complete «b»IV Preparation«/b» - Casirivimab and imdevimab are each supplied in individual single-dose vials. Casirivimab and imdevimab solutions must be diluted prior to administration. - Casirivimab and imdevimab infusion solution should be prepared by a qualified healthcare professional using aseptic technique: - Remove the casirivimab and imdevimab vials from refrigerated storage and allow to equilibrate to room temperature for approximately 20 minutes before preparation. Do not expose to direct heat. Do not shake the vials. - Inspect casirivimab and imdevimab vials visually for particulate matter and discoloration prior to administration. Should either be observed, the solution must be discarded, and fresh solution prepared. The solution for each vial should be clear to slightly opalescent, colorless to pale yellow. - Obtain an IV infusion bag containing 250 mL of 0.9% Sodium Chloride Injectin. Withdraw and discard 20 mL of 0.9% Sodium Chloride Injection from the infusion bag prior to adding casirivimab and imdevimab - Withdraw 10 mL of casirivimab and 10 mL of imdevimab from each respective vial using two separate syringes and dilute together in the infusion bag containing 0.9% Sodium Chloride Injection. Discard any product remaining in the vial. - Gently invert infusion bag by hand approximately 10 times. Do not shake. - This product is preservative-free and therefore, the diluted infusion solution should be administered immediately - If immediate administration is not possible, store the diluted casirivimab and imdevimab infusion solution in the refrigerator between 2°C to 8°C (36°F to 46°F) for no more than 36 hours and at room temperature up to 25°C (77°F) for no more than 4 hours, including infusion time - If refrigerated, allow the infusion solution to equilibrate to room temperature for approximately 30 minutes prior to administration.

Caspofungin

Cancidas

«bu»Aspergillosis«/bu» «b»Invasive (Salvage Therapy)«/b» - Initial Dose: 70 mg on day 1 - Subsequent Dosing: 50 mg once daily - Duration of therapy should be a minimum of 6 to 12 weeks and depends on site of infection, extent of disease, and level/duration of immunosuppression «b»Limitations of Use«/b» - Has not been studied as initial therapy for invasive aspergillosis. «bu»Candidemia and Other Candida Infections«/bu» - Initial Dose: 70 mg on day 1 - Subsequent Dosing: 50 mg once daily - Generally continue for at least 14 days after the last positive culture or longer if neutropenia warrants «b»Limitations of Use«/b» - Has not been studied in endocarditis, osteomyelitis, and meningitis due to Candida. «bu»Candida Infection«/bu» «b»Prophylaxis in Neutropenic Cancer Patients at Substantial Risk«/b» - 50 mg once daily «bu»Candidiasis«/bu» «b»Chronic Disseminated Hepatosplenic«/b» - Initial Dose: 70 mg on day 1 - Subsequent Dosing: 50 mg daily for several weeks - Followed by oral fluconazole therapy «b»Empiric Therapy«/b» - Initial Dose: 70 mg on day 1 - Maintenance Dosing: 50 mg once daily - Consider discontinuing after 4 to 5 days in patients with no clinical response; continue treatment for 2 weeks in patients who improve on antifungal therapy «b»Prophylaxis Against Invasive Candidiasis«/b» - Loading Dose: 70 mg on day 1, then, - Maintenance Dose: 50 mg daily «b»Esophageal«/b» - 50 mg once daily - Continue for 7 to 14 days after symptom resolution «bi»Alternate Recommendations«/bi» - Initial Dose: 70 mg on day 1 - Maintenance Dosing: 50 mg daily - May transition to oral fluconazole therapy once oral intake tolerable - In patients with fluconazole-refractory disease, continue caspofungin for 14 to 21 days «bi»Limitations of Use«/bi» - Not approved for the treatment of oropharyngeal candidiasis (OPC). «bi»HIV-infected Patients«/bi» - 50 mg once daily - Continue for 14 to 21 days - A higher rate of relapse has been reported with echinocandins than with fluconazole «b»Intravascular Infections«/b» «bi»Native or Prosthetic Valve Endocarditis«/bi» - 150 mg daily - Therapy should continue for at least 6 weeks after valve replacement surgery (longer durations in patients with abscesses or other complications) «bi»Infection of Implantable Cardiac Devices«/bi» - 150 mg PO daily - Therapy should continue for 4 to 6 weeks after surgery (4 weeks for infections limited to generator pockets and at least 6 weeks for infections involving the wires) «bi»Suppurative Thrombophlebitis«/bi» - 150 mg PO daily - Therapy should continue for at least 2 weeks after candidemia has cleared - Step-down to fluconazole therapy is recommended in clinically stable patients with fluconazole-susceptible isolates and negative repeat cultures «bu»Candidiasis, Osteoarticular Infections«/bu» - Osteomyelitis or septic arthritis (alternative therapy) (off-label use) - 50 to 70 mg daily for at least 14 days, followed by fluconazole «b»Oropharyngeal«/b» «bi»Refractory Disease«/bi» - Initial Dose: 70 mg on day 1 - Subsequent Doses: 50 mg once daily «bu»Fungal Infections«/bu» «b»Empiric Therapy«/b» «bi»Neutropenic Patients«/bi» - Initial Dose: 70 mg on day 1 - Subsequent Dose: 50 mg once daily - Continue until resolution of neutropenia - If fungal infection confirmed, continue for a minimum of 14 days (continue for at least 7 days after resolution of both neutropenia and clinical symptoms) - If clinical response inadequate, may increase up to 70 mg once daily if tolerated «b»Concomitant Use of an Enzyme Inducer«/b» Patients Receiving Rifampin - 70 mg caspofungin once daily Patients Receiving Carbamazepine, Dexamethasone, Efavirenz, Nevirapine, or Phenytoin (and possibly other enzyme inducers) - May require an increased dose of caspofungin 70 mg once daily

Castor Oil

Cedazuridine

Cedazuridine-Decitabine

Inqovi

«bu»Myelodysplastic Syndrome (MDS)«/bu» - 1 tablet PO daily on days 1-5 of each cycle - Each cycle is 28 days - Continue for a minimum of 4 cycles until disease progression or unacceptable toxicity - A complete or partial response may take longer than 4 cycles «b»Contraception«/b» «bi»Females of Reproductive Potential«/bi» - Use effective contraception during treatment and for 6 months after the last dose «bi»Males with Female Partners of Reproductive Potential«/bi» - Use effective contraception during treatment and for 3 months after the last dose «b»Infertility«/b» - Based on findings of decitabine and cedazuridine in animals, male fertility may be impaired - Reversibility of the effect on fertility is unknown «b»Missed Dose«/b» - Within 12 hr of the scheduled time: Take missed dose as soon as possible, then resume the normal daily dosing schedule - More than 12 hr of the scheduled time: Do not take additional doses to make up dose; take next scheduled dose on the following day - Extend dosing period by 1 day for every missed dose to complete 5 daily doses for each cycle «b»Vomiting After Administration«/b» - Do not take an additional dose, but continue with the next schedule dose «b»Hematologic Adverse Reactions«/b» - Obtain complete blood cell (CBC) count prior to initiation and before each cycle - Delay next cycle if absolute neutrophil count (ANC) <1,000/mcL and platelets <50,000/mcL in the absence of active disease - Monitor CBC count until ANC ≥1,000/mcL and platelets ≥50,000/mcL «bi»Hematologic Recovery (ANC ≥1,000/mcL and Platelets ≥50,000/mcL)«/bi» - ANC and platelets recover within 2 weeks of achieving remission: Resume at the same dose - ANC and platelet recovery not achieved within 2 weeks of achieving remission: Delay for up to 2 additional weeks; resume at reduced dose (ie, administering on Days 1-4); consider further dose reductions in the order listed below if myelosuppression persists after dose reduction - Maintain or increase dose in subsequent cycles as clinically indicated - Manage persistent severe neutropenia and febrile neutropenia with supportive treatment «bi»Dose Reductions for Myelosuppression«/bi» First Dose Reduction - 1 tablet PO daily on Days 1-4 Second Dose Reduction - 1 tablet PO daily on Days 1-3 Third Dose Reduction - 1 tablet PO daily on Days 1, 3, and 5 «b»Nonhematologic Adverse Reactions«/b» - Delay next cycle and resume at same or reduced dose upon resolution - Serum creatinine ≥2 mg/dL - Serum bilirubin ≥2x ULN - AST or ALT ≥2x ULN - Active or uncontrolled infection

Cefaclor

Raniclor, Ceclor

Cefadroxil

Duricef, Ultracef

CeFAZolin

Ancef, Kefzol

«b»Usual Dosage Range: IM, IV«/b» - 1 to 1.5 g every 8 hours, depending on severity of infection - Maximum: 12 g daily «bu»Catheter-related Bloodstream Infections«/bu» - 2 g IV every 8 hours «bu»Cholecystitis«/bu» «b»Mild-to-Moderate«/b» - 1 to 2 g IV every 8 hours x 4 to 7 days (provided source controlled) «bu»Endocarditis«/bu» «b»Prophylaxis«/b» - Dental and upper respiratory procedures - 1 g IV/IM 30 to 60 minutes before procedure. «b»Treatment«/b» - 1 to 1.5 g IV every 6 hours «b»Native Valve«/b» - 2 g IV every 8 hours for 6 weeks «b»Prosthetic Valve«/b» - 2 g IV every 8 hours for a minimum of 6 weeks (in combination with rifampin for entire course of therapy and gentamicin for the first 2 weeks) «bu»Group B Streptococcus«/bu» «b»Prophylaxis«/b» - 2 g IV once, then, - 1 g IV every 8 hours until delivery «bu»Intra-abdominal Infection«/bu» «b»Complicated Community-acquired«/b» - 1 to 2 g every 8 hours for 4 to 7 days (provided source controlled) in combination with metronidazole «bi»Moderate to Severe Infections«/bi» - 500 mg to 1 g every 6 to 8 hours «bi»Mild Infection with Gram-positive Cocci«/bi» - 250 to 500 mg every 8 hours «bu»Osteomyelitis«/bu» (off-label dose) «b»Native Vertebral«/b» «bi»Staphylococci Oxacillin-susceptible)«/bi» - 1 to 2 g every 8 hours for 6 weeks «bu»Perioperative Prophylaxis«/bu» - 1 to 2 g initiated 30 to 60 minutes prior to surgery - May repeat after 2 hours if procedure is lengthy with 500 mg to 1 g intraoperatively - Followed by 500 mg to 1 g every 6 to 8 hours for 24 hours postoperatively. «bu»Cardiothoracic Surgery«/bu» - 1 g initiated 30 to 60 minutes prior to surgery (usually at the time of anesthetic induction) - Repeat dose if the duration of operation exceeds 3 hours «bu»Peritonitis«/bu» «b»Intraperitoneal Treatment«/b» «bi»Intermittent Exchange«/bi» - 15 mg/kg per exchange every 24 hours in the long dwell (≥6 hours) «bi»Continuous Exchange«/bi» - Loading Dose: 500 mg per liter of dialysate - Maintenance Dose: 125 mg per liter of dialysate. «bu»Pneumococcal Pneumonia«/bu» - 500 mg every 12 hours «bu»Total Joint Replacement Patients Undergoing Dental Procedures«/b» «b»Bacteremia Prophylaxis«/b» - 1 g IV/IM 1 hour prior to procedure - In general, patients with prosthetic joint implants do not require prophylactic antibiotics prior to dental procedures - In planning an invasive oral procedure, dental consultation with the patient's orthopedic surgeon may be advised to review the risks of infection «bu»Prosthetic Joint Infection«/bu» «b»Staphylococcal Oxacillin-susceptible«/b» - 1 to 2 g every 8 hours for 2 to 6 weeks (in combination with rifampin) followed by oral antibiotic treatment and suppressive regimens «b»Severe Infection«/b» - 1 to 1.5 g IV every 6 hours «bu»Skin and Soft Tissue Infection«/bu» «b»MSSA including Pyomyositis«/b» - 1 g every 8 hours for 7 to 14 days - Treat pyomyositis for 14 to 21 days «b»Necrotizing Infection due to MSSA«/b» - 1 g every 8 hours - Continue until further debridement is not necessary - Patient has clinically improved, and patient is afebrile for 48 to 72 hours «b»Streptococcal Skin Infections«/b» - 1 g every 8 hours «bu»Surgical Site Infection«/bu» «b»Trunk or Extremity«/b» - Away from axilla or perineum - 500 mg to 1 g every 8 hours «bu»Urinary Tract Infection«/bu» - 1 g IV/IM every 12 hours - Refer to indication-specific dosing for obesity-related information - May not be available for all indications «b»Infants >1 month, Children«/b» - 25 to 100 mg/kg/day IV/IM divided every 6 to 8 hours - Maximum Dose: 6 g IV/IM daily «bu»Community-Acquired Pneumonia (CAP)«/bu» «b»Infants >3 months and Children«/b» «bi»Moderate-to-Severe Infection, S. aureus (Methicillin-susceptible)«/bi» - 150 mg/kg/day IV/IM divided every 8 hours «bu»Endocarditis«/bu» (off-label use) - Dental and upper respiratory procedures «b» Infants, Children, and Adolescents«/b» «bi»Prophylaxis«/bi» - 50 mg/kg IV/IM 30 to 60 minutes before procedure - Maximum Dose: 1,000 mg «b»Children and Adolescents«/b» «bi»Treatment«/bi» - 100 mg/kg/day IV in divided doses every 8 hours - Usual Adult Dose: 2,000 mg/dose - Maximum Daily Dose: 12 g/day - Treat for at least 4 weeks; longer durations may be necessary - May use with or without gentamicin «bu»Perioperative Prophylaxis«/bu» «b»Children ≥1 year«/b» - 30 mg/kg (maximum dose: 2,000 mg) administered within 60 minutes prior to surgical incision. - May be repeated intraoperatively in 4 hours if procedure is lengthy or if there is excessive blood loss - For procedures requiring anaerobic coverage (appendectomy, small bowel surgery with intestinal obstruction, colon procedures), combine cefazolin with metronidazole as an alternative to a second generation cephalosporin with anaerobic activity (eg, cefoxitin or cefotetan). «bu»Peritonitis Treatment«/bu» «b»Infants, Children, and Adolescents«/b» «bi»Intermittent Exchange«/bi» - 20 mg/kg Intraperitoneal every 24 hours in the long dwell «bi»Continuous Exchange«/bi» - Loading Dose: 500 mg per liter of dialysate - Maintenance Dose: 125 mg per liter of dialysate. «bu»Skin and Soft Tissue Infection«/bu» «b»Infants and Children«/b» «bi»MSSA including pyomyositis«/bi» - 50 mg/kg/day IV divided every 8 hours x 7 to 14 days - Treat pyomyositis for 14 to 21 days «bi»Necrotizing Infections due to MSSA«/bi» - 33 mg/kg every 8 hours - Continue until further debridement is not necessary, patient has clinically improved, and patient is afebrile for 48 to 72 hours «bu»Streptococcal Skin Infections«/bu» «b»Infants and Children«/b» - 33 mg/kg IV every 8 hours

Cefdinir

Omnicef, CFDN

Cefditoren

Spectracef

Cefepime

Maxipime

Cefiderocol

Fetroja

Cefixime

Suprax

Cefotaxime

Claforan

«b»Usual Dose Range«/b» «bi»Uncomplicated Infections«/bi» - 1 g IV/IM every 12 hours «bi»Moderate-to-Severe Infections«/bi» - 1 to 2 g IV/IM every 8 hours «bi»Life-threatening Infections«/bi» - 2 g IV every 4 hours «bu»Acute Bacterial Rhinosinusitis«/bu» - 2 g IV every 4 to 6 hours x 5 to 7 days «bu»Septic Arthritis«/bu» - 1 g IV every 8 hours «bu»Bacterial Enteric Infections«/bu» «b»Empiric Therapy in HIV Infected Patients«/b» - 1 g IV every 8 hours «bu»Bite Wounds«/bu» - 1 to 2 g IV every 6 to 8 hours in combination with clindamycin or metronidazole for anaerobic coverage «bu»Brain Abscess, Meningitis«/bu» - 2 g IV every 4 to 6 hours in combination with other antimicrobial therapy as warranted «bu»Cesarean Section«/bu» - 1 g IV as soon as the umbilical cord is clamped, then, - 1 g IV or IM at 6 and 12 hours after the first dose «bu»Complicated Community-Acquired Intra-abdominal Infection«/bu» «b»Mild-to-Moderate Severity«/b» - Including hepatic abscess in combination with metronidazole - 1 to 2 g IV every 6 to 8 hours x 4 to 7 days provided source controlled «bu»Gonorrhea«/bu» «b»Cervix or Grethra (Males or Females)«/b» - 0.5 g IM x 1 dose «b»Rectum (Females)«/b» - 0.5 g IM x 1 dose «b»Uncomplicated, Rectum (Males)«/b» - 1 g IM x 1 dose «b»Disseminated Infections«/b» «bi»Arthritis and Arthritis-dermatitis Syndrome)«/bi» - 1 g IV every 8 hours in combination with azithromycin - Continue for 24 to 48 hours after improvement begins, then switch to oral therapy guided by antimicrobial susceptibility testing. Total duration of therapy at least 7 days «bu»Lyme Disease«/bu» «b»Cardiac Manifestations«/b» - 2 g IV every 8 hours for 14 to 21 days «b»CNS Manifestations«/b» - 2 g IV every 8 hours for 10 to 28 days «bu»Community-Acquired Pneumonia (CAP)«/bu» - 1 to 2 g IV every 8 hours «b»Empiric Therapy«/b» «bi»Critically Ill Patients«/bi» - Use in combination with azithromycin or a respiratory fluoroquinolone (eg, levofloxacin or moxifloxacin) «bi»Non-critically Ill Patients«/bi» - Use in combination with a macrolide (preferred) or doxycycline - Duration of therapy is ≥5 days «bu»Surgical Perioperative Prophylaxis«/bu» - 1 g IV within 60 minutes prior to surgical incision - Doses may be repeated in 3 hours if procedure is lengthy or if there is excessive blood loss. «b»Obesity«/b» - Recommend that for patients weighing ≥120 kg (or alternatively defined as BMI >30 kg/m2) - 2 g within 60 minutes prior to surgical incision should be administered «bu»Spontaneous Bacterial Peritonitis«/bu» - 2 g IV every 8 hours «bu»Sepsis«/bu» - 2 g IV every 6 to 8 hours «bu»Skin and Soft Tissue Necrotizing Infections«/bu» (off-label use): «b»Polymicrobial Infection«/b» - 2 g IV every 6 hours, in combination with metronidazole or clindamycin for empiric therapy of polymicrobial infections. - Continue until further debridement is not necessary, patient has clinically improved, and patient is afebrile for 48 to 72 hours «b»Vibrio Vulnificus«/b» - 2 g IV every 8 hours, in combination with doxycycline - Continue until further debridement is not necessary, patient has clinically improved, and patient is afebrile for 48 to 72 hours

CefoTEtan

Cefotan

CefOXitin

Mefoxin

Cefpodoxime

Vantin

Cefprozil

Cefzil

Ceftaroline

Teflaro

CefTAZidime

Fortaz, Tazicef, Tazidime

«bu»Cystic Fibrosis«/bu» «b»Recommended Regimen«/b» - 90 to 150 mg/kg/day IV every 8 hours - Maximum Daily Dose: 6 g daily «b»Alternative Regimens«/b» - Intermittent IV Infusion:200 to 400 mg/kg/day divided every 6 to 8 hours - Maximum Daily Dose: 8 to 12 g daily - Continuous IV infusion: 100 to 200 mg/kg/day - Maximum Daily Dose: 12 g daily «b»Empiric Therapy in Immunocompromised«/b» - 2 g IV every 8 hours «bu»Endophthalmitis«/bu» - 2 to 2.25 mg/0.1 mL NS intravitreally in combination with vancomycin «bu»Intra-abdominal Infection«/bu» «b»Severe«/b» - 2 g IV every 8 hours x 4 to 7 days + Metronidazole - Not recommended for hospital-acquired intra-abdominal infections (IAI) associated with multidrug-resistant gram negative organisms or in mild-to-moderate community-acquired IAIs due to risk of toxicity and the development of resistant organisms «bu»Melioidosis«/bu» «b»Severe, Acute Phase«/b» - 50 mg/kg/dose every 8 hours - Maximum dose: 2 g/dose - Switching to meropenem therapy is indicated if patient condition worsens (eg, organ failure, new infection focus development, repeat blood cultures remained positive). Oral eradication therapy is recommended after the intensive (acute) phase treatment is complete «bu»Non-cystic Fibrosis Bronchiectasis«/bu» Inhalation for Nebulization - 250 to 1,000 mg IV every 12 hours or - 500 mg every 6 hours for up to 12 months «bu»Osteomyelitis«/bu» - 2 g IV every 8 hours x 6 weeks - Double coverage may be considered (ceftazidime plus an aminoglycoside or ciprofloxacin) «bu»Peritonitis«/bu» «b»Intraperitoneal«/b» «bi»Intermittent«/bi» - 1 to 1.5 g every 24 hours per exchange in the long dwell (≥6 hours) «bi»Continuous (per liter exchange)«/bi» - Loading Dose: 500 mg - Maintenance Dose: 125 mg - If patient has residual renal function (eg, >100 mL/day urine output), empirically increase each dose by 25%. «bu»Pneumonia (HAP)«/bu» «b»Uncomplicated«/b» - 500 mg to 1 g IM/IV every 8 hours «b»Hospital-acquired or Ventilator-associated«/b» - 2 g IV/IM every 8 hours for 7 days - May consider shorter or longer duration depending on rate of clinical improvement - When used as empiric therapy, use in combination with an agent active against S. aureus with or without an additional antipseudomonal agent (dependent on patient and institution-specific risk factors) «bu»Prosthetic Joint Infection«/bu» «b»Pseudomonas Aeruginosa«/b» - Alternative to cefepime or meropenem - 2 g IV every 8 hours for 4 to 6 weeks (consider addition of an aminoglycoside) «bu»Skin and Soft Tissue Infections«/bu» - 500 mg to 1 g every 8 hours «bu»Meningitis, CNS infection«/bu» - 2 g every 8 hours «bu»Urinary Tract Infections«/bu» «b»Uncomplicated«/b» - 250 mg IV/IM every 12 hours «b»Complicated«/b» - 500 mg IV/IM every 8 to 12 hours «b»IM Administration«/b» - Ceftazidime can be administered deep IM into large mass muscle. «b»IV Administration«/b» - Can be administered IVP over 3 to 5 minutes, or by IV intermittent infusion over 15 to 30 minutes. «b»Intravitreal Administration«/b» - Ceftazidime may be administered intravitreally as 2 to 2.25 mg/0.1 mL NS in combination with vancomycin (separate syringes) «b»Intraperitoneal Administration«/b» - Intraperitoneal administration may be used in conjunction with IV use for systemic infections if continuous peritoneal dialysis is used (added to the dialysate in each exchange). - Intraperitoneal administration alone may also be used for the treatment of peritonitis and added to the dialysate in intermittent (added to the longest dwell time per day) or continuous (loading dose, followed by a maintenance dose per liter of exchange) peritoneal dialysis. «b»Inhalation for Nebulization«/b» - Use with standard jet nebulizer connected to an air compressor - Administer 1,000 mg diluted in 8 mL NS with mouthpiece or face mask «b»IM Reconstitution«/b» - Using SWFI, bacteriostatic water, lidocaine 0.5%, or lidocaine 1%, reconstitute the 500 mg vials with 1.5 mL or the 1 g vials with 3 mL; final concentration of ~280 mg/mL «b»IV Reconstitution«/b» - Reconstitute intact vials as follows (Note: After reconstitution, may dilute further with a compatible solution [eg, D5W, NS] to administer via IV infusion): «bi»Fortaz, Tazicef ~100 mg/mL Solution«/bi» 500 mg Vial - 5.3 mL SWFI (withdraw 5 mL from the reconstituted vial to obtain a 500 mg dose) 1 g Vial - 10 mL SWFI (withdraw 10 mL from the reconstituted vial to obtain a 1 g dose) 6 g Vial - 56 mL SWFI (withdraw 10 mL from the reconstituted vial to obtain a 1 g dose) «bi»Fortaz, Tazicef ~170 mg/mL Solution«/bi» 2 g Vial - 10 mL SWFI (withdraw 11.5 mL from the reconstituted vial to obtain a 2 g dose) «bi»Fortaz, Tazicef ~200 mg/mL Solution«/bi» 6 g Vial - 26 mL SWFI (withdraw 5 mL from the reconstituted vial to obtain a 1 g dose) «b»Duplex Container«/b» - Unlatch side tab, unfold, remove foil strip from drug chamber - Point set port in downward direction, fold container just below the diluent meniscus, and squeeze the diluent chamber until the seal between the diluent and drug powder opens - Agitate until dissolved.

Ceftazidime-Avibactam

Avycaz

Ceftibuten

Cedax

Ceftolozane

Ceftolozane-Tazobactam

Zerbaxa

CefTRIAXone

Rocephin

«b»Usual Dose Range«/b» - 1 to 2 g IV every 12 to 24 hours - Depending on the type and severity of infection «bu»Acute Bacterial Rhinosinusitis«/bu» - Severe infection requiring hospitalization - 1 to 2 g IV every 12 to 24 hours «bu»Septic Arthritis«/bu» - 1 to 2 g IV once daily «bu»Bacterial Enteric Infections with HIV«/bu» «b»Empiric Treatment«/b» - 1 g IV every 24 hours «bu»Animal Bite Wounds«/bu» - 1 g IV every 12 hours in combination with clindamycin or metronidazole for anaerobic coverage «bu»Brain Abscess«/bu» - 2 g IV every 12 hours in combination with other antibiotics «bu»Chancroid«/bu» (Off-label use) - 250 mg IM x 1 dose «bu»Cholecystitis«/bu» «b»Mild-to-Moderate«/b» - 1 to 2 g IV every 12 to 24 hours for 4 to 7 days «bu»Cystitis«/bu» «b»Acute Complicated«/b» - 1 to 2 g IV once daily «bu»Endocarditis«/bu» «b»Prophylaxis«/b» - Dental and upper respiratory procedures (patients allergic to penicillins and/or unable to take oral) - 1 g IV/IM 30 to 60 minutes before procedure «bu»Endocarditis Treatment«/bu» (Off-label use) «b»Enterococcus, Native or Prosthetic Valve«/b» - 2 g every 12 hours IV for 6 weeks with concomitant ampicillin «b»HACEK Organisms, Native or Prosthetic Valve«/b» Native Valve - 2 g once daily for 4 weeks Prosthetic Valve - 2 g once daily for 6 weeks «b»Viridans Group Streptococcus (VGS) and S. Bovis«/b» Native Valve: Highly Penicillin-Susceptible (MIC ≤0.12 mcg/mL) - 2 g once daily for 4 weeks or for 2 weeks with concomitant gentamicin Prosthetic Valve: Highly Penicillin-Susceptible (MIC ≤0.12 mcg/mL) - 2 g once daily for 6 weeks (with or without concomitant gentamicin for the first 2 weeks) Prosthetic Valve: Relatively or Fully Penicillin-resistant (MIC >0.12 mcg/mL) - 2 g once daily with concomitant gentamicin for 6 weeks «bu»Acute Epididymitis«/bu» «b»Caused by Sexually Transmitted Chlamydia and Gonorrhea«/b» - 250 mg IM x 1 dose plus doxycycline «b»Caused by Sexually Transmitted Chlamydia and Gonorrhea and Enteric Organisms in Men Practice Insertive Anal Sex«/b» - 250 mg IM x 1 dose plus oral levofloxacin or oral ofloxacin «bu»Gonococcal Infections«/bu» - 250 mg IM x 1 dose plus azithromycin 1 g PO once (preferred) or - 250 mg IM x 1 dose plus doxycycline 100 mg PO q12hr for 7 days «b»Conjunctivitis«/b» - 1 g IM x 1 dose plus oral azithromycin - Consider a one-time saline lavage of the infected eye. «b»Endocarditis«/b» - 1 to 2 g IV every 12 to 24 hours plus oral azithromycin - Continue ceftriaxone for at least 28 days «b»Meningitis«/b» - 1 to 2 g IV every 12 to 24 hours plus oral azithromycin - Continue ceftriaxone for 10 to 14 days «bu»Uncomplicated Gonorrhea«/bu» «b»Cervicitis, Proctitis, Urethritis, Pharyngitis«/b» - 250 mg IM x 1 dose plus oral azithromycin «bu»Lyme Disease«/bu» «b»Neurologic«/b» - 2 g IV once daily for 14 days «b»Carditis«/b» - 2 g IV once daily for 21 to 28 days «b»Arthritis with Neurologic Manifestations«/b» - 2 g IV once daily for 28 days «bu»Meningitis, Community-Acquired«/bu» «b»Empiric Treatment«/b» - 2 g IV every 12 hours for 7 to 14 days «bu»Meningococcal Disease, Invasive«/bu» (Off-label use) «b»High-risk Patient Contacts (Chemoprophylaxis)«/b» - 250 mg IM in a single dose «bu»Osteomyelitis, Native Vertebral«/bu» «b»Staphylococci, Oxacillin-Susceptible«/b» (off-label dose) - 2 g every 24 hours for 6 weeks «b»Streptococci (beta-hemolytic), Cutibacterium Acnes or Salmonella«/b» (off-label use) - 2 g every 24 hours for 6 weeks - In the treatment of Salmonella a 6- to 8-week duration is recommended «bu»Pelvic Inflammatory Disease«/bu» «b»Mild to Moderately Severe«/b» - 250 mg IM in a single dose plus oral doxycycline (with or without oral metronidazole) «bu»Community-Acquired Pneumonia«/bu» (in combination with other antibiotics) - 1 to 2 g/day in 1 or 2 divided doses. «b»Alternate Dosing«/b» - 1 g once daily «bu»Proctitis, Proctocolitis, Enteritis«/bu» (off-label use) - 250 mg IM in a single dose plus oral doxycycline «bu»Sexually Transmitted Diseases«/bu» «b»Prophylaxis Following Sexual Assault«/b» - 250 mg IM as a single dose in combination with azithromycin plus metronidazole (or tinidazole) «bu»Prosthetic Joint Infection«/bu» «b»Streptococci Beta-hemolytic«/b» - 2 g IV every 24 hours for 4 to 6 weeks «bu»Pyelonephritis«/bu» «b»Acute Uncomplicated«/b» - 1 to 2 g IV once daily - After improvement, may be switched to an oral regimen to complete a 1- to 2-week treatment course - In females, some clinicians administer a single dose of 1 g before initiating oral outpatient empiric therapy «bu»Salmonellosis in HIV-infected patients«/bu» - 1 g IV every 24 hours - Duration of therapy in patients with CD4 count ≥200 cells/mm3 is 7 to 14 days (without concurrent bacteremia) or ≥14 days (patients with concurrent bacteremia); patients with CD4 count <200 cells/mm3 should be treated for 2 to 6 weeks (regardless of presence of bacteremia) «bu»Skin and Soft Tissue Necrotizing Infection«/bu» - Continue until further debridement is not necessary, patient has clinically improved, and patient is afebrile for 48 to 72 hours. «b»Due to Aeromonas hydrophilia«/b» - 1 to 2 g IV once daily in combination with doxycycline «b»Due to Vibrio Vulnificus«/b» - 1 g IV once daily in combination with doxycycline «bu»Spontaneous Bacterial Peritonitis«/bu» «b»Prevention«/b» - 1 g IV once daily during active gastrointestinal bleeding (may be transitioned to an oral antibiotic after oral intake is resumed) for total duration of antibiotic therapy of 7 days «bu»Surgical (Perioperative) Prophylaxis«/bu» - 1 g IV 30 minutes to 2 hours before surgery «b»Alternate Dosing«/b» - 1 to 2 g within 60 minutes prior to surgery «bi»Colorectal Procedures«/bi» - 2 g within 60 minutes prior to surgery with concomitant metronidazole «bu»Cholecystectomy«/bu» - 1 to 2 g every 12 to 24 hours - Discontinue within 24 hours unless infection outside gallbladder suspected «bu»Surgical Site Infections«/bu» (Off-label use) «b»Intestinal or Genitourinary Tract Surgery, Surgery of Axilla, or Perineum«/b» - 1 g IV every 24 hours, in combination with metronidazole «bu»Syphilis«/bu» «b»Penicillin Allergic Patients«/b» (off-label use) Primary or Secondary - 1 to 2 g IV once daily for 10 to 14 days «bu»Neurosyphilis«/bu» - 2 g once daily for 10 to 14 days «bu»Typhoid Fever«/bu» (off-label use) - 2 g every 12 to 24 hours for 10 to 14 days - Usually reserved for fluoroquinolone resistant disease «bu»Whipple Disease«/bu» (off-label use) - Initial Dose: 2 g once daily for 10 to 14 days, then, - Oral therapy of Sulfamethoxazole and trimethoprim preferred «b»IM Administration«/b» - Inject deep IM into large muscle mass; a concentration of 250 mg/mL or 350 mg/mL is recommended for all vial sizes except the 250 mg size (250 mg/mL is suggested); can be diluted with 1:1 water or 1% lidocaine for IM administration only. «b»IV Administration«/b» - Infuse as an intermittent infusion over 30 minutes. - IV push administration over 1 to 4 minutes has been reported in children ≥12 years, adolescents, and adults (concentration: 100 mg/mL), primarily in patients outside the hospital setting, although a 2 g dose administered IV push over 5 minutes resulted in tachycardia, restlessness, diaphoresis, and palpitations in one patient. - IV push administration in young infants may also have been a contributing factor in risk of cardiopulmonary events occurring from interactions between ceftriaxone and calcium. - Do not coadminister with calcium-containing solutions. «b»IM Injection Reconstitution«/b» - Vials should be reconstituted with appropriate volume of diluent (including D5W, NS, SWFI, bacteriostatic water, or 1% lidocaine) to make a final concentration of 250 mg/mL or 350 mg/mL. «bi»Volume to Add to Create a 250 mg/mL Solution«/bi» - 250 mg vial: 0.9 mL - 500 mg vial: 1.8 mL - 1 g vial: 3.6 mL - 2 g vial: 7.2 mL «bi»Volume to Add to Create a 350 mg/mL Solution«/bi» - 500 mg vial: 1.0 mL - 1 g vial: 2.1 mL - 2 g vial: 4.2 mL «b»IV Infusion Preparation«/b» - Infusion is prepared in two stages: Initial reconstitution of powder, followed by dilution to final infusion solution. «bi»Vials«/bi» - Reconstitute powder with appropriate IV diluent (including SWFI, D5W, D10W, NS) to create an initial solution of ~100 mg/mL. Recommended volume to add: - 250 mg vial: 2.4 mL - 500 mg vial: 4.8 mL - 1 g vial: 9.6 mL - 2 g vial: 19.2 mL - After reconstitution of powder, further dilution into a volume of compatible solution (eg, 50-100 mL of D5W or NS) is recommended. «bi»Piggyback Bottle«/bi» - Reconstitute powder with appropriate IV diluent (D5W or NS) to create a resulting solution of ~100 mg/mL. Recommended initial volume to add: - 1 g bottle:10 mL - 2 g bottle: 20 mL - After reconstitution, to prepare the final infusion solution, further dilution to 50 mL or 100 mL volumes with the appropriate IV diluent (including D5W or NS) is recommended.

Cefuroxime

Zinacef, Ceftin

«b»Severe or Complicated Infections«/b» - 1.5 g IV every 8 hours - Up to 1.5 g every 6 hours in life-threatening infections «bu»Acute Maxillary Sinusitis«/bu» - 250 mg PO bid x 10 days «bu»Bone and Joint Infections«/bu» - 1.5 g IV every 8 hours (adjunctive surgical intervention may be necessary) upon completion of parenteral therapy follow with oral antibiotic therapy if indicated. «bu»Acute Bacterial Exacerbations of Chronic Bronchitis«/bu» - 250 to 500 mg PO every 12 hours x 10 days - 500 to 750 mg IV every 8 hours - Complete therapy with oral dosing «bu»Cholecystitis«/bu» - 1.5 g IV every 8 hours x 4 to 7 days «bu»Intra-abdominal Infection«/bu» «b»Complicated Community-Acquired«/b» «bi»Mild to Moderate«/bi» - 1.5 g IV every 8 hours x 4 to 7 days in combination with metronidazole «bu»Lyme Disease«/bu» - 500 mg PO bid x 20 days «bu»Pharyngitis/Tonsillitis«/bu» - 250 mg PO bid x 10 days «bu»Community-Acquired Pneumonia (CAP)«/bu» - 500 mg PO every 12 hour x 10 days - 750 mg IV/IM every 8 hours «b»Alternate Dosing«/b» - 1.5 g IV/IM every 8 hours - This higher dose should be considered in hospitalized patients, especially if bacteremic «bu»Skin/Skin Structure Infection,«/bu» «b»Uncomplicated«/b» - 250 to 500 mg PO every 12 hours for 10 days - 750 mg IV/IM every 8 hours «bu»Surgical (Perioperative) Prophylaxis«/bu» - 1.5 g IV 30 minutes to 1 hour prior to procedure - If procedure is prolonged can give 750 mg every 8 hours IV or IM «b»Open Heart«/b» - 1.5 g IV every 12 hours for a total of 4 doses starting at anesthesia induction - 1.5 g IV within 60 minutes prior to surgical incision. - Doses may be repeated in 4 hours if procedure is lengthy or if there is excessive blood loss «bu»Urinary Tract Infection«/bu» «b»Uncomplicated«/b» - 250 mg PO bid x 7 to 10 days - 750 mg IV/IM every 8 hours «bu»Animal Bite Wounds«/bu» - 500 mg PO bid in combination with clindamycin or metronidazole for anaerobic coverage

Celecoxib

CeleBREX, Elyxyb

Celecoxib-Tramadol

Seglentis

«bu»Acute Pain«/bu» - 2 tablets PO every 12 hrs prn for management of acute pain in adults that requires opioid analgesic and for which alternative treatments are inadequate - Do NOT exceed recommended dose - Closely monitor for respiratory depression, especially within first 24-72 hr of therapy and after dosage increases; adjust dosage accordingly - When initiating, consider severity of pain, patient response, prior analgesic treatment experience, and risk factors for addiction, abuse, and misuse - Do not use concomitantly with other tramadol- or celecoxib-containing products - Assess need for naloxone upon initiating and renewing treatment «b»Consider Prescribing Naloxone«/b» - Based on patient’s risk factors for overdose (eg, concomitant use of CNS depressants, a history of opioid use disorder, prior opioid overdose); presence of risk factors should not prevent proper pain management - Household members (including children) or other close contacts at risk for accidental ingestion or overdose «bi»Consult Patients & Caregivers Regarding«/bi» - Availability of naloxone for emergency treatment of opioid overdose - How to obtain naloxone as permitted by individual state dispensing and prescribing requirements or guidelines (eg, by prescription, directly from a pharmacist, as part of a community-based program) «b»Discontinuation«/b» - Do not abruptly discontinue in patients who may be physically dependent on opioids - Rapid discontinuation of opioid analgesics has resulted in serious withdrawal symptoms, uncontrolled pain, and suicide - For physically opioid-dependent: Initiate small increment taper (eg, 10-25% of total daily dose) to avoid withdrawal symptoms, and proceed with decreasing dose every 2-4 weeks - Patients who have been taking opioids for shorter periods may tolerate a more rapid taper - Reassess frequently to manage pain and withdrawal symptoms «b»Limitations of Use«/b» - Due to risks of addiction, abuse, and misuse with opioids, reserve use in patients for whom alternative treatment options (eg, nonopioid analgesics) - Not tolerated, or not expected to tolerate - Have not provided, or are not expected to provide, adequate analgesia

Cemiplimab

Libtayo

Cenegermin

Oxervate

Cenobamate

Xcopri

Centruroides (Scorpion) Immune Fab

Anascorp, Scorpion Antivenin, Antivenom Scorpion

Cephalexin

Keflex, Daxbia

Ceritinib

Zykadia

- Ceritinib is associated with a moderate emetic potential; antiemetics may be needed to prevent nausea and vomiting. «bu»Non-Small Cell Lung Cancer«/bu» «b»ALK-Positive Metastatic«/b» - 450 mg once daily with food - Continue until disease progression or unacceptable toxicity «b»Missed Doses«/b» - If a dose is missed, take the missed dose unless the next dose is due within 12 hours - If vomiting occurs, do not administer an additional dose, patients should continue with the next scheduled dose. «b»Strong CYP3A Inhibitors«/b» - Avoid concomitant use of strong CYP3A inhibitors; if concurrent administration cannot be avoided, reduce ceritinib dose by approximately one-third (rounded to the nearest multiple of the 150 mg strength). - After discontinuation of the strong CYP3A inhibitor, resume ceritinib therapy at the dose used prior to initiation of the CYP3A inhibitor. «b»Strong CYP3A Inducers«/b» - Avoid concurrent use of strong CYP3A inducers during treatment with ceritinib. «b»Recommended Dosage Adjustment«/b» Initial Starting Dose - 450 mg once daily First Dose Reduction - 300 mg once daily Second Dose Reduction - 150 mg once daily - Discontinue if patients are unable to tolerate 150 mg daily. «b»Bradycardia«/b» «bi»Symptomatic Bradycardia (Not Life-threatening)«/bi» - Interrupt therapy and evaluate concomitant medications known to cause bradycardia. - Upon recovery to asymptomatic bradycardia or to a heart rate ≥60 beats per minute, adjust the dose. - Alternatively, the following recommendations have been made: Upon recovery to asymptomatic bradycardia or to a heart rate ≥60 beats per minute. - If concomitant medication is identified and discontinued or its dose adjusted, reinitiate ceritinib at its previous dose. - If no concomitant medication is identified or if it is identified but not discontinued or not dose-adjusted, reinitiate ceritinib with the dose reduced by 150 mg «bi»Symptomatic Bradycardia (Life-threatening or Requiring Intervention) in Patients Taking Concomitant Medications Known to Cause Bradycardia/Hypotension«/bi» - Interrupt therapy until recovery to asymptomatic bradycardia or to a heart rate ≥60 beats per minute. - If the concomitant medication can be adjusted or discontinued, resume ceritinib therapy with the dose reduced by 150 mg. - Alternatively, the following recommendations have been made: If concomitant medication can be discontinued or its dose adjusted, resume ceritinib with the dose reduced by 300 mg; monitor frequently; permanently discontinue ceritinib for recurrence «bi»Symptomatic Bradycardia (Life-threatening or Requiring Intervention) in Patients NO Taking Concomitant Medications Known to Cause Bradycardia/Hypotension«/bi» - Permanently discontinue therapy «b»QTc Prolongation«/b» «bi»QTc Interval >500 msec on at least 2 Separate ECGs«/bi» - Interrupt therapy until QTc interval is <481 msec or recovers to baseline if baseline QTc is ≥481 msec, then resume therapy with a 150 mg dose reduction. «bi»QTc Prolongation in Combination with Torsades de Pointes, Polymorphic Ventricular Tachycardia, or Signs/Symptoms of Serious Arrhythmia«/bi» - Permanently discontinue therapy. «b»Severe or Intolerable Nausea, Vomiting, or Diarrhea«/b» - Despite appropriate management - Interrupt therapy until improved, then resume treatment with a 150 mg dose reduction. «b»Lipase or Amylase Elevation >2 x ULN«/b» - Interrupt therapy and monitor serum lipase and amylase - Upon recovery to <1.5 times ULN, resume treatment with a 150 mg dose reduction. «b»Persistent Hyperglycemia >250mg/dL«/b» - Despite optimal antihyperglycemic therapy - Interrupt therapy until hyperglycemia is adequately controlled, then resume therapy with a 150 mg dose reduction - If hyperglycemia cannot be controlled (with optimal medical management), discontinue ceritinib. «b»Pulmonary«/b» - Treatment-related interstitial lung disease/pneumonitis (any grade) - Permanently discontinue therapy.

Cerliponase Alfa

Brineura

Certolizumab Pegol

Cimzia

Cetirizine

ZyrTEC, Quzyttir, PediaCare Children's 24 Hour Allergy, Aller-Tec, Wal-Zyr

Cetirizine-Pseudoephedrine

ZyrTEC-D

Cetrorelix

Cetrotide

Cetuximab

Erbitux

«b»Premedication«/b» - Premedicate with an H1 antagonist (diphenhydramine) IV 30 to 60 minutes prior to the first dose; premedication for subsequent doses is based on clinical judgment. «bu»Colorectal Cancer«/bu» «b»Metastatic KRAS Wild-type without Mutation«/b» - Initial Loading Dose: 400 mg/m2 infused over 120 minutes - Maintenance Dose: 250 mg/m2 infused over 60 minutes weekly until disease progression or unacceptable toxicity - If given in combination with FOLFIRI (irinotecan, fluorouracil, and leucovorin), complete cetuximab infusion 1 hour prior to FOLFIRI «b»Advanced«/b» - 500 mg/m2 every 2 weeks (biweekly administration) - Initial dose infused over 120 minutes - Subsequent doses infused over 60 minutes in combination with irinotecan «b»Limitation of Use«/b» - Cetuximab is not indicated for the treatment of RAS-mutant colorectal cancer or when results of the RAS mutation tests are unknown. «bu»Head and Neck Cancer«/bu» «b»Squamous Cell«/b» - Initial Loading Dose: 400 mg/m2 infused over 120 minutes - Maintenance Dose: 250 mg/m2 infused over 60 minutes weekly - Monotherapy weekly doses should be continued until disease progression or unacceptable toxicity - If given in combination with radiation therapy, administer loading dose 1 week prior to initiation of radiation course; weekly maintenance dose should be completed 1 hour prior to radiation for the duration of radiation therapy (6 to 7 weeks). - If given in combination with chemotherapy, administer loading dose on the day of initiation of platinum and fluorouracil-based chemotherapy, cetuximab infusion should be completed 1 hour prior to initiation of chemotherapy; weekly maintenance dose should be completed 1 hour prior to chemotherapy; continue until disease progression or unacceptable toxicity. «bu»Non-small Cell Lung Cancer (NSCLC)«/bu» «b»EGFR-expressing, Advanced«/b» - Initial Loading Dose: 400 mg/m2 IV x 1 dose - Maintenance Dose: 250 mg/m2 weekly in combination with cisplatin and vinorelbine for up to 6 cycles, then, - Monotherapy until disease progression or unacceptable toxicity «bu»Squamous Cell Skin Cancer«/bu» «b»Unresectable«/b» - Initial Loading Dose: 400 mg/m2 IV x 1 dose, then, - Maintenance Dose: 250 mg/m2 weekly until disease progression «b»Infusion Reactions, Grade 1 or 2 and Non-serious Grade 3«/b» - Reduce the infusion rate by 50% and continue to use prophylactic antihistamines «b»Infusion Reactions, Severe«/b» - Immediately and permanently discontinue treatment «b»Pulmonary Toxicity«/b» «bi»Acute Onset or Worsening Pulmonary Symptoms«/bi» - Hold treatment «bi»Interstitial Lung Disease«/bi» - Permanently discontinue «b»Skin Toxicity, Mild to Moderate«/b» - No dosage modification required «b»Acneiform Rash, Severe (Grade 3 or 4)«/b» «bi»First Occurrence«/bi» - Delay cetuximab infusion 1 to 2 weeks - If improvement, continue at 250 mg/m2 - If no improvement, discontinue therapy «bi»Second Occurrence«/bi» - Delay cetuximab infusion 1 to 2 weeks - If improvement, continue at reduced dose of 200 mg/m2 - If no improvement, discontinue therapy «bi»Third Occurrence«/bi» - Delay cetuximab infusion 1 to 2 weeks - If improvement, continue at reduced dose of 150 mg/m2 - If no improvement, discontinue therapy - Fourth occurrence: Discontinue therapy

Cevimeline

Evoxac

Charcoal, Activated

Actidose-Aqua, Actidose/Sorbitol, Kerr Insta-Char

Chenodiol

Chenodal, Chenodeoxycholic Acid, CDCA

Chlophedianol

Chlophedianol-Dexbrompheniramine

Chlo Hist

Chlorambucil

Leukeran, Chlorbutinum, Chlorambucilum

- Reduce initial dose if full-dose radiation or myelotoxic drugs have been administered within the last month. - With bone marrow lymphocytic infiltration involvement (in CLL, Hodgkin lymphoma, or NHL), the maximum dose is 0.1 mg/kg/day. While short treatment courses are preferred, if maintenance therapy is required, the maximum dose is 0.1 mg/kg/day. «bu»Chronic Lymphocytic Leukemia (CLL)«/bu» - 0.1 mg/kg/day for 3 to 6 weeks or - 0.4 mg/kg pulsed doses administered intermittently, biweekly, or monthly (increased by 0.1 mg/kg/dose until response/toxicity observed) «b»Off-label Dosing«/b» - 0.4 mg/kg day 1 every 2 weeks - If tolerated may increase by 0.1 mg/kg with each treatment course to a maximum dose of 0.8 mg/kg and maximum of 24 cycles or - 30 mg/m2 day 1 every 2 weeks (in combination with prednisone) or - 40 mg/m2 day 1 every 4 weeks until disease progression or complete remission or response plateau for up to a maximum of 12 cycles «b»CLL in Previously Untreated Patients«/b» «bi»In Combination with Obinutuzumab«/bi» - 0.5 mg/kg on days 1 and 15 every 28 days for 6 cycles «bi»In Combination with Ofatumumab«/bi» - 10 mg/m2 once daily for 7 days (days 1 to 7) every 28 days for a minimum of 3 cycles and up to 12 cycles or best response - If necessary, reduce dose to 7.5 mg/m2/day and then to 5 mg/m2/day for hematologic toxicity «bu»Hodgkin Lymphoma«/bu» - 0.2 mg/kg PO daily for 3 to 6 weeks «bu»Non-Hodgkin Lymphomas (NHL)«/bu» - 0.1 mg/kg PO daily for 3 to 6 weeks «bu»Waldenström Macroglobulinemia«/bu» - 0.1 mg/kg PO daily (continuously) for at least 6 months or - 0.3 mg/kg PO daily for 7 days every 6 weeks for at least 6 months «b»Skin Reactions«/b» - Discontinue treatment «b»Hematologic Monitoring«/b» «bi»WBC or Platelets Below Normal«/bi» - Reduce dose. «bi»Severely depressed WBC or Platelet Counts«/bi» - Discontinue. «bi»Persistently Low Neutrophil or Platelet Counts or Peripheral Lymphocytosis«/bi» - May be suggestive of bone marrow infiltration; if infiltration confirmed, do not exceed 0.1 mg/kg/day. «bi»Concurrent or within 4 weeks (before or after) of Chemotherapy/Radiotherapy«/bi» - Initiate treatment cautiously - Reduce dose - Monitor closely

Chloramphenicol

Chloromycetin, Chloracol

ChlordiazePOXIDE

Librium, Methaminodiazepoxide

Chlordiazepoxide-Amitriptyline

Limbitrol, Limbitrol DS

«bu»Depression and Anxiety«/bu» - Initial Dose: 3 or 4 tablets daily in one or more divided doses - Titrate to response - Usual Dose Range: 2 to 6 tablets daily in one or more divided doses. - Maximum Daily Dose: amitriptyline 150 mg/chlordiazepoxide 60 mg. «b»Discontinuation of Therapy«/b» - Upon discontinuation of antidepressant therapy, gradually taper the dose to minimize the incidence of withdrawal symptoms and allow for the detection of re-emerging symptoms - Evidence supporting ideal taper rates is limited. - APA and NICE guidelines suggest tapering therapy over at least several weeks with consideration to the half-life of the antidepressant; antidepressants with a shorter half-life may need to be tapered more conservatively - In addition for long-term treated patients, WFSBP guidelines recommend tapering over 4 to 6 months. - If intolerable withdrawal symptoms occur following a dose reduction, consider resuming the previously prescribed dose and/or decrease dose at a more gradual rate «b»Switching to or from an MAO Inhibitor«/b» - Allow 14 days to elapse between discontinuing an MAO inhibitor intended to treat psychiatric disorders and initiation of amitriptyline/chlordiazepoxide. - Allow 14 days to elapse between discontinuing amitriptyline/chlordiazepoxide and initiation of an MAO inhibitor intended to treat psychiatric disorders. «b»Use with Reversible MAO Inhibitors«/b» - Such as linezolid or IV methylene blue - Do not initiate amitriptyline/chlordiazepoxide in patients receiving linezolid or IV methylene blue; consider other interventions for psychiatric condition. - If urgent treatment with linezolid or IV methylene blue is required in a patient already receiving amitriptyline/chlordiazepoxide and potential benefits outweigh potential risks, discontinue amitriptyline/chlordiazepoxide promptly and administer linezolid or IV methylene blue. Monitor for serotonin syndrome for 2 weeks or until 24 hours after the last dose of linezolid or IV methylene blue, whichever comes first. May resume amitriptyline/chlordiazepoxide 24 hours after the last dose of linezolid or IV methylene blue.

Chlordiazepoxide-Clidinium

Librax

Chloroprocaine

Nesacaine, Clorotekal

«bu»Local Anesthesia«/bu» - Use the smallest dose and concentration required to produce the desired result - Dosage varies with anesthetic procedure, the vascularity of the tissues, depth of anesthesia required, degree of muscle relaxation required, duration of anesthesia, and physical condition of the patient - Use reduced doses in debilitated patients and patients with cardiovascular disease. - During epidural administration, a test dose (3 mL of 3% or 5 mL of 2%) is recommended prior to induction of complete block and all reinforcing doses with continuous catheter technique. «bu»Subarachnoid Block«/bu» (Spinal Anesthesia) «b»Intrathecal«/b» - 1%: 50 mg single dose (effective block to the T 10 level) - Other preservative- and antioxidant-free formulations (eg, Nesacaine-MPF) have also been used off-label (dosage range: 20 to 60 mg) for spinal anesthesia for short-duration ambulatory procedures; ensure that preservative-free products do not contain the antioxidant sodium bisulfite prior to administration «bu»Central Nerve Block«/bu» - Nesacaine-MPF 2% and 3% injection in single-dose vials without a preservative indicated for production of local anesthesia by central nerve block, including lumbar and caudal epidural blocks «b»Caudal Block 2-3% Solution«/b» - 15-25 mL initially; repeat doses may be given at 40-60 min intervals «b»Lumbar Epidural 2-3% Solution«/b» - 2-2.5 mL per segment; usual total volume is 15-25 mL; repeat doses of 2-6 mL less than the original dose may be given at 40-50 min intervals «b»Nesacaine, Nesacaine-MPF«/b» Maximum Single Dose (without epinephrine): 11 mg/kg Maximum Total Dose: 800 mg - Maximum Single Dose (with epinephrine 1:200,000): 14 mg/kg - Maximum Total Dose: 1,000 mg «b»Limitations of Use«/b» «bi»Nesacaine, Nesacaine-MPF«/bi» - The manufacturer recommends against using either formulation (with or without preservatives) for subarachnoid administration (ie, spinal anesthesia); however, the use of chloroprocaine without preservatives (Nesacaine-MPF) has been safely used off-label for spinal anesthesia. - Do not use chloroprocaine with preservatives (Nesacaine) for epidural or spinal anesthesia. «b»Caudal Block Preservative Free«/b» - 2% or 3%: 15 to 25 mL - May repeat at 40- to 60-minute intervals «bu»Infiltration and Peripheral Nerve Block«/bu» - Digital (without epinephrine): 1%; 3 to 4 mL; total dose: 30 to 40 mg - Infraorbital: 2%: 0.5 to 1 mL; total dose 10 to 20 mg - Mandibular: 2%: 2 to 3 mL; total dose 40 to 60 mg - Paracervical: 1%; 3 mL per each of four sites; total dose: up to 120 mg - Pudendal: 2%; 10 mL each side; total dose: 400 mg «bu»Lumbar Epidural Anesthesia for Cesarean Delivery«/bu» «bi»Preservative Free 3%«/bi» - 15 to 25 mL total dose (includes test dose of 2 or 3 mL) «bu»Lumbar Epidural Anesthesia, Non-Parturient«/bu» «bi»Preservative Free 2% or 3%«/bi - 2 to 2.5 mL per segment - Usual Total Volume: 15 to 25 mL - May repeat with doses that are 2 to 6 mL less than initial dose every 40 to 50 minutes.

Chloroprocaine Ophthalmic

Iheezo Ophthalmic

Chloroquine

Aralen

Chlorothiazide

Diuril

Chlorpheniramine

Chlor-Trimeton, Aller-Chlor, CTM, Diabetic Tussin

Chlorpheniramine-Codeine

Tuzistra XR, Codar AR, Z-Tuss AC

Chlorpheniramine-Phenylephrine

Triaminic Cold/Allergy Child, Actifed Cold/Allergy, Rescon-Jr, Sudafed PE Sinus/Allergy, Ed A-Hist, Nasohist

Chlorpheniramine-Phenylephrine-Dextromethorphan

Rhinosyn DM, Corfen-DM, De-Chlor DM, NoHist DM

Chlorpheniramine-Phenylephrine-Ibuprofen

Advil Allergy & Congestion

Chlorpheniramine-Pseudoephedrine-Dextromethorphan

Maxichlor PSE DM, Pedia Relief Cough-Cold

ChlorproMAZINE

Thorazine, CPZ

«bu»Bipolar Disorder, Psychotic Disorders, Schizophrenia«/bu» - 30 to 800 mg PO daily in 2 to 4 divided doses - Initiate at lower doses and titrate as needed - Usual Dose Range: 200 to 800 mg daily; some patients may require 1 to 2 g daily, however, therapeutic gain is limited at doses >1 g daily - Initial Dose: 25 mg IM x 1 dose - May give additional 25 to 50 mg in 1 hour if needed - Based on response and tolerability - May gradually increase subsequent IM doses over several days - Usual dosage 200 mg/day «bu»Intractable Hiccups«/bu» - 25 to 50 mg PO tid or qid «b»Refractory to PO Treatment«/b» «bi»IM«/bi» - 25 to 50 mg IM x 1 dose - If symptoms persist after one dose, administer IV dose. «bi»IV«/bi» - 25 to 50 mg via slow IV infusion with patients lying flat in bed - Monitor blood pressure. «bu»Nausea and Vomiting«/bu» - 10 to 25 mg PO every 4 to 6 hours as needed - Initial Dose: 25 mg IM x 1 dose - If no hypotension occurs, can administer 25 to 50 mg every 3 to 4 hours as needed until vomiting stops «b»During Surgery«/b» - Initial Dose: 12.5 mg x 1 dose - Repeat in 30 minutes if necessary and if no hypotension occurs «b»IV During Surgery«/b» - 2 mg per fractional injection at 2 minute intervals using a 1 mg/mL solution - Do not exceed 25 mg «bu»Acute Intermittent Porphyria«/bu» - 25 to 50 mg PO tid or qid - Usually may be discontinued after several weeks although maintenance therapy may be necessary - 25 mg IM tid or qid until patient can tolerate oral administration «bu»Pre-surgical Apprehension«/bu» - 25 to 50 mg PO 2 to 3 hours prior to surgery - 12.5 to 25 mg IM 1 to 2 hours prior to surgery «bu»Migraine Headache«/bu» (Off-label) - 5-50 mg IV x 1 dose «bu»Tetanus«/bu» - 25 to 50 mg IM tid or qid - Titrate to response «b»Discontinuation of Therapy«/b» - The manufacturer and American Psychiatric Association (APA), Canadian Psychiatric Association (CPA), and World Federation of Societies of Biological Psychiatry (WFSBP) guidelines recommend gradually tapering antipsychotics to avoid withdrawal symptoms and minimize the risk of relapse; risk for withdrawal symptoms may be highest with highly anti-cholinergic or dopaminergic antipsychotics - When stopping antipsychotic therapy in patients with schizophrenia, the CPA guidelines recommend a gradual taper over 6 to 24 months, and the APA guidelines recommend reducing the dose by 10% each month - Continuing anti-parkinsonism agents for a brief period after discontinuation may prevent withdrawal symptoms. When switching antipsychotics, three strategies have been suggested: Cross-titration (gradually discontinuing the first antipsychotic while gradually increasing the new antipsychotic), overlap and taper (maintaining the dose of the first antipsychotic while gradually increasing the new antipsychotic, then tapering the first antipsychotic), and abrupt change (abruptly discontinuing the first antipsychotic and either increasing the new antipsychotic gradually or starting it at a treatment dose). Evidence supporting ideal switch strategies and taper rates is limited, and results are conflicting

ChlorproPAMIDE

Diabinese

Chlorthalidone

Hygroton

Chlorzoxazone

Lorzone, Parafon Forte

Cholecalciferol

Ergocalciferol, Drisdol, Delta D3, D-Vita, D-Vi-Sol, Calciferol, Vitamin D3, D3-50, Decara, Dialyvite Vitamin D, Pronutrients Vitamin D3

Cholera Vaccine (Live Attenuated)

Vaxchora

Cholestyramine

Prevalite, Questran

Cholic Acid

Cholbam

Choline Magnesium Trisalicylate

CMT, Tricosal, Tricosal

Choriogonadotropin Alfa

Chorionic Gonadotropin (Recomb), Ovidrel, r-hCG

Chorionic Gonadotropin (Human)

Chorex-10, Novarel, Pregnyl, hCG, CG

Ciclesonide (Inhalation)

Alvesco

Ciclesonide (Nasal)

Zetonna, Omnaris

Ciclopirox

Ciclodan, Loprox, Pedipirox-4 Nail, Penlac, CNL8 Nail

Cidofovir

Vistide

Cilastatin

Cilostazol

Pletal

Cimetidine

Tagamet

Cinacalcet

Sensipar

Ciprofloxacin

Cipro, Cipro XR, Proquin XR

Ciprofloxacin (Ophthalmic)

Ciloxan

Ciprofloxacin (Otic)

Cetraxal, Otiprio

Ciprofloxacin-Dexamethasone

Ciprodex (Otic)

Ciprofloxacin-Fluocinolone Acetonide (Otic)

Otovel

Ciprofloxacin-Hydrocortisone

Cipro HC (Otic)

Cisapride

Propulsid

Cisatracurium

Nimbex

CISplatin

PLatinol, CDDP

Citalopram

CeleXA

Citric Acid

Citric Acid-Sodium Citrate-Potassium Citrate

Virtrate-3, Cytra-3, Polycitra

Cladribine

Mavenclad, Leustatin

Clarithromycin

Biaxin

«b»Usual Dosage Range«/b» - 250 to 500 mg every 12 hours or - 1000 mg ER once daily x 7 to 14 days «bu»Acute Bacterial Bronchitis Exacerbation«/bu» «b»M. Catarrhalis and S. Pneumonia«/b» - 250 mg every 12 hours x 7 to 14 days OR - 1,000 mg ER once daily x 7 days «b»H. Influenza«/b» - 500 mg every 12 hours for 7 to 14 days OR - 1,000 mg ER once daily x 7 days «b»H. Parainfluenzae«/b» - 500 mg every 12 hours for 7 days OR - 1,000 mg ER once daily for 7 days «bu»Balloonists in HIV-infected«/bu» «b»Treatment«/b» - 500 mg bid x at least 3 months «b»Long-term Suppressive Therapy«/b» - 500 mg bid - May discontinue if completed 3 to 4 months therapy and CD4 >200 cells/mm3 for at least 6 months. - Some clinicians would discontinue only if Bartonella titers have also decreased four-fold «bu»H. Pylori Eradication«/bu» «b»Clarithromycin Triple Therapy«/b» - 500 mg bid in combination with a standard-dose or double-dose proton pump inhibitor, and either amoxicillin 1 g bid or metronidazole 500 mg tid - Continue regimen x 14 days - Avoid use of clarithromycin triple therapy in patients with risk factors for macrolide resistance (prior macrolide exposure, local clarithromycin resistance rates ≥15%, eradication rates with clarithromycin-based regimens ≤85%) «b»Concomitant Regimen«/b» - 500 mg bid in combination with amoxicillin 1 g bid, and a standard-dose proton pump inhibitor bid, and either metronidazole or tinidazole 500 mg bid - Continue treatment for 10 to 14 days. «b»Sequential Regimen«/b» - Amoxicillin 1 g bid plus a standard-dose proton pump inhibitor bid for 5 to 7 days; then follow with clarithromycin 500 mg bid, and a standard-dose proton pump inhibitor bid, and either metronidazole or tinidazole 500 mg bid x 5 to 7 days. «b»Hybrid Regimen«/b» - Amoxicillin 1 g twice daily plus a standard-dose proton pump inhibitor bid for 7 days; then follow with amoxicillin 1 g bid, clarithromycin 500 mg bid, a standard-dose PPI bid, and either metronidazole or tinidazole 500 mg bid x 7 days. «bu»Lyme Disease«/bu» - 500 mg PO bid x 14 to 21 days «bu»Mycobacterial Infection«/bu» «b»Disseminated Prophylaxis and Treatment«/b» - 500 mg bid use with other antimycobacterial drugs (ethambutol or rifampin) - Continue therapy if clinical response is observed - May discontinue when patient is considered at low risk of disseminated infection. «bu»Mycobacterium Avium Complex Disease (MAC)«/bu» «b»HIV-infected«/b» «bi»Primary Prophylaxis«/bi» - Patients with CD4 count <50 cells/mm3) - 500 mg bid - May discontinue when CD4 count >100 cells/mm3 for ≥3 months in response to ART - If effective ART is initiated immediately and viral suppression is achieved, some experts do not recommend routine initiation of MAC primary prophylaxis, regardless of initial CD4 count «bi»Treatment and Chronic Maintenance Therapy«/bi» - 500 mg PO bid with ethambutol - Consider additional agents (rifabutin, aminoglycoside, fluoroquinolone) for CD4 <50 cells/mm3, high mycobacterial load, or ineffective antiretroviral therapy - May discontinue chronic maintenance if no signs/symptoms of MAC disease, have maintained a CD4 count >100 cells/mm3 for >6 months in response to ART, and completed at least 12 months of therapy «bu»Pertussis«/bu» - 500 mg PO bid x 7 days «bu»Pharyngitis, Tonsillitis«/bu» - 250 mg PO every 12 hours x 10 days «bu»Community-Acquired Pneumonia (CAP)«/bu» «b»C. Pneumonia, M. Pneumonia, and S. Pneumonia«/b» - 250 mg PO every 12 hours x 7 to 14 days or - 1,000 mg ER PO once daily x 7 days «b»H. Influenza«/b» - 250 mg PO every 12 hours for 7 days - 1,000 mg ER PO once daily for 7 days «b»H. Parainfluenzae and M. Catarrhalis«/b» - 1000 mg ER PO once daily x 7 days «b»Outpatient Empiric Therapy«/b» - 500 mg PO bid x 5 days in combination with a beta-lactam «bu»Endocarditis«/bu» - 500 mg 30 to 60 minutes prior to procedure «bu»Sinusitis«/bu» - 500 mg PO every 12 hours for 14 days - 1,000 mg ER PO once daily for 14 days «bu»Skin and Skin Structure Infection, Uncomplicated«/bu» - 50 mg every 12 hours x 7 to 14 days «bu»Usual Dosage Range«/bu» «b»Infants ≥6 months, Children, Adolescents«/b» - 7.5 mg/kg PO every 12 hours x 10 days Maximum Dose - 500 mg/dose «bu»Balloonists in HIV-infected«/bu» «b»Adolescents«/b» - Refer to adult dosing «bu»Lyme Disease«/bu» «b»Infants, Children, Adolescents«/b» - 7.5 mg/kg/dose PO bid x 14-21 days Maximum Dose - 500 mg/dose «bu»Disseminated Mycobacterium Avium Complex (MAC)«/bu» «b»Infants and Children«/b» «bi»Prevention and Treatment«/bi» - 7.5 mg/kg/dose PO bid Maximum Dose - 500 mg/dose - Use in combination with other antimycobacterial agents for the treatment of disseminated MAC - Safety of clarithromycin for MAC not studied in children <20 months «bu»Otitis Media«/bu» «b»Infants ≥6 months, Children, Adolescents«/b» - 7.5 mg/kg/dose every 12 hours for 10 days Maximum Dose - 500 mg/dose - Due to increased S. Pneumonia and H. Influenzae resistance, macrolides are not routinely recommended as a treatment option «bu»Pertussis«/bu» «b»Infants ≥1 month, Children, Adolescents«/b» - 7.5 mg/kg/dose every 12 hours for 7 days Maximum Dose - 500 mg/dose «bu»Pharyngitis, Tonsillitis«/bu» - 7.5 mg/kg/dose every 12 hours for 10 days Maximum Dose - 250 mg/dose «bu»Community-Acquired Pneumonia (CAP)«/bu» - A beta-lactam antibiotic should be added if typical bacterial pneumonia cannot be ruled out. «b»Infants >3 months, Children«/b» «bi»M. Pneumonia, C. Pneumonia, C. Trachomatis«/bi» - 7.5 mg/kg/dose every 12 hours Maximum Dose - 500 mg/dose «bu»Endocarditis«/bu» «b»Children, Adolescents«/b» - 15 mg/kg/dose 30-60 minutes before procedure Maximum Dose - 500 mg/dose «bu»Sinusitis«/bu» «b»Infants ≥6 months, Children, Adolescents«/b» - 7.5 mg/kg/dose every 12 hours for 10 days Maximum Dose - 500 mg/dose «bu»Skin/skin Structure Infections, Uncomplicated«/bu» «b»Infants ≥6 months, Children, Adolescents«/b» - 7.5 mg/kg/dose every 12 hours for 10 days Maximum Dose - 250 mg/dose

Clascoterone

Winlevi

Clemastine

Allerhist-1, Dayhist Allergy, Tavist Allergy

Clevidipine

Cleviprex

Clindamycin

Cleocin

Clindamycin (Topical)

Clinda-Derm, Cleocin, Clindesse, Clindagel, ClindaMax,Cleocin-T, Clindacin ETZ, Evoclin, Xaciato

Clindamycin-Benzoyl Peroxide

Acanya, BenzaClin, Duac, Neuac, Onexton

Clindamycin-Tretinoin

Veltin, Ziana

Clioquinol

Clioquinol-Hydrocortisone

Corque, Ala-Quin, Dermasorb AF

CloBAZam

Onfi

Clobetasol Propionate

Impoyz, Temovate, Temovate E, Olux, Olux-E, Clodan, Clobex, Cormax Scalp Application

Clofarabine

Clolar, Clofarex, CAFdA

- Calculate body surface area (BSA) prior to each cycle, utilizing actual body weight. «b»Premedications«/b» - Antiemetics are recommended to prevent nausea and vomiting - Prophylactic corticosteroids (hydrocortisone 100 mg/m2 on days 1 to 3) to prevent signs/symptoms of capillary leak syndrome or systemic inflammatory response syndrome (SIRS) - Hydration - Antihyperuricemic therapy to reduce the risk of tumor lysis syndrome/hyperuricemia) «bu»Acute Lymphoblastic Leukemia (ALL), Relapsed or Refractory«/bu» «b»Adults ≤21 years«/b» - 52 mg/m2/day days 1 through 5 - Repeat every 2 to 6 weeks - Subsequent cycles should begin no sooner than 14 days from day 1 of the previous cycle - Subsequent cycles may be administered when ANC ≥750/mm3 Off-label Dosing - 20 to 30 mg/m2 once daily on days 1 through 5 (in combination with cyclophosphamide and etoposide [CLOVE regimen]) as a bridging regimen to hematopoietic stem cell transplant in patients with relapsed or very high risk disease «b»Induction«/b» - 40 mg/m2 IV once daily for 5 days - May repeat induction cycle once in 3 to 6 weeks if needed (depending on marrow response and recovery) «b»Consolidation«/b» - 30 mg/m2 IV once daily for 5 days (or last tolerated induction dose, whichever is lower); repeat every 4 weeks for up to a maximum of 6 consolidation cycles «bu»Acute Myeloid Leukemia (AML), Refractory «/bu» (off-label use) «b»Adults <70 years: Induction«/b» - 25 mg/m2/day for 5 days (in combination with cytarabine and filgrastim) may repeat one time after 21 days if needed «b»Adults <70 years: Consolidation«/b» - 20 mg/m2/day for 5 days (in combination with cytarabine and filgrastim) for 1 or 2 cycles (Becker 2011) «b»Hematologic Toxicity«/b» - ANC <500/mm3 lasting ≥4 weeks: Reduce dose by 25% for next cycle «b»Nonhematologic Toxicity«/b» Clinically Significant Infection - Withhold treatment until infection is under control, then restart at full dose Grade 3 Toxicity excluding infection, nausea and vomiting controlled by antiemetics, or transient elevations in transaminases and bilirubin - Withhold treatment; may reinitiate with a 25% dose reduction with resolution or return to baseline Grade 4 toxicity (noninfectious) - Discontinue clofarabine. Capillary leak or systemic inflammatory response syndrome (SIRS) early signs/symptoms (eg, hypotension, tachycardia, tachypnea, pulmonary edema) - Discontinue clofarabine; institute supportive measures - May consider reinitiating with a 25% dose reduction after patient is stable and organ function recovers to baseline. Dermatologic Toxicity, Exfoliative or bullous rash, or suspected Stevens-Johnson syndrome or toxic epidermal necrolysis - Discontinue clofarabine. Hypotension (during the 5 days of infusion) - Discontinue clofarabine.

Clofazimine

Lamprene

ClomiPHENE

Serophene, Clomid

ClomiPRAMINE

Anafranil

ClonazePAM

KlonoPIN

«bu»Panic Disorder«/bu» Initial Dose - 0.25 mg bid Maintenance Dose - May increase in increments of 0.125 to 0.25 mg bid every 3 days Target Dose - 1 mg daily Maximum Dose - 4 mg/day «b»Discontinuation of Treatment«/b» - To discontinue, treatment should be withdrawn gradually - Decrease dose by 0.125 mg twice daily every 3 days until medication is completely withdrawn. «bu»Seizure Disorders«/bu» - Initial daily dose not to exceed 1.5 mg given in 3 divided doses - May increase by 0.5 to 1 mg every third day until seizures are controlled or adverse effects seen Maximum Dose - 20 mg/day Usual Maintenance Dose - 2 to 8 mg daily in 1 to 2 divided doses «bu»Bipolar Disorder«/bu» «b»Mixed or Manic Episodes«/b» - 2 to 8 mg daily, in 2 to 4 divided doses - Total daily doses as high as 16 mg have been studied «bu»Burning Mouth Syndrome«/bu» Initial Dose - 0.25 at bedtime for 1 week Maintenance Dose - May increase dose by ≤0.25 mg every week Maximum Dose - 3 mg daily in 3 divided doses - Use should be limited «b»Topical«/b» - May administer topically with 1 mg 3 times daily (after each meal) - Patient should be instructed to suck on the tablet, retain saliva in mouth near the pain sites without swallowing for 3 minutes, and then expectorate saliva «bu»Essential Tremor«/bu» Initial Dose - 0.5 mg at bedtime Maintenance Dose - Increase Dose by 0.5 mg every 3 to 4 days Maximum Dose - 6 mg daily «bu»REM Sleep Behavior Disorder«/bu» - 0.25 to 2 mg 30 minutes prior to bedtime Maximum Dose - 4 mg 30 minutes prior to bedtime - Use with caution in patients with dementia, gait disorders, or obstructive sleep apnea «bu»Restless Leg Syndrome«/bu» Initial Dose - 1 mg 30 minutes prior to bedtime Maintenance Dose - May increase dose by 0.5 to 1 mg at weekly intervals - Doses up to 2 mg once daily have been used in clinical trials «bu»Tardive Dyskinesia«/bu» Initial Dose - 1 mg/day Maintenance Dose - Adjust dosage based on response and tolerability by 1 mg/day every 3 to 4 days up to a maximum dose of 4.5 mg/day «bu»Tic Disorders«/bu» Initial Dose - 0.5 mg at bedtime Maintenance Dose - Adjust dose by 0.5 mg every 2 weeks based on response and tolerability - Dosing range in clinical studies was 1 to 12 mg/day

CloNIDine

Catapres, Duraclon, Kapvay

Clonidine-Chlorthalidone

Combipres

Clopidogrel

Plavix

«bu»Acute Coronary Syndrome«/bu» «b»Unstable Angina, NSTEMI«/b» - Loading Dose: 300 mg, then, - Maintenance Dose: 75 mg/day PO for up to 12 months - May administer beyond 12 months if used in combination with aspirin (75-100 mg/day) - Long-term combination therapy with aspirin, following stent placement, is individualized depending on how a patient tolerates long-term dual antiplatelet therapy (DAPT), whether they have stable coronary artery disease, and do NOT have risk factors (eg, TIA or stroke, age >75 years, bleeding risk, low body wt, concurrent medications) «b»ST-segment Elevation MI (STEMI)«/b» - 75 mg/day PO in combination with aspirin 162-325 mg/day and then 81-162 mg/day «bi»<75 years«/bi» - Loading Dose: 300 mg x 1 dose, then, - 75 mg for 14 days up to 12 months (if no bleeding) «bi»>75 years«/bi» - No loading dose - 75 mg for 14 days up to 12 months (if no bleeding) «b»Concomitant Therapy with Aspirin«/b» - Administer in combination with aspirin 75-325 mg daily with or without thrombolytics «bu»Recent MI, Stroke, or Peripheral Arterial Disease«/bu» - 75 mg PO daily without a loading dose - Recommended as alternative to aspirin or concomitantly with aspirin if patient not at increased risk for bleeding but at high risk for cardiovascular disease «bu»Coronary Artery Disease«/bu» - 75 mg PO daily «bu»Cardioembolic Stroke«/bu» - Prophylaxis if patient not candidate for oral anticoagulation - 75 mg PO daily «bu»Carotid Artery Stenting«/bu» - 300 mg PO plus aspirin 81-325 mg for 1 dose on day before carotid artery stenting (CAS), then, - 75 mg/day PO plus aspirin 81-325 mg/day for at least 30 days after CAS «b»Alternative Dosing«/b» - 300-600 mg PO once, then, - 75 mg/day for 4 days before CAS in combination with aspirin 81-325 mg/day «b»CYP2C19 Poor Metabolizers«/b» - Associated with diminished antiplatelet response to clopidogrel; although higher-dose regimen (600 mg loading dose followed by 150 mg once daily) in poor metabolizers increases antiplatelet response, no appropriate dosing regimen for poor metabolizers has been established in clinical outcome trials

Clorazepate

Tranxene

Clotrimazole

Mycelex

Clotrimazole (Topical)

Lotrimin AF, Desenex, Lotrimin, 3 Day Vaginal, Alevazol, Shopko Athletes Foot, Gyne-Lotrimin

Clotrimazole-Betamethasone

Lotrisone

CloZAPine

Clozaril, Versacloz, FazaClo

Coagulation Factor IX

AlphaNine, Factor IX (Human), Mononine

Coagulation Factor IX (Recombinant)

BeneFIX, Ixinity, Rixubis, Nonacog Alfa, rFIX

Coagulation Factor IX (rFIXFc)

Alprolix, Eftrenonacog Alfa, rFIX

Coagulation Factor IX (rIXFP)

Idelvion, Albutrepenonacog Alfa

Coagulation Factor VIIa (Recombinant)

NovoSeven RT, Eptacog Alfa (Activated), rFVIIa, Sevenfact

Coagulation Factor X (Human)

Coagadex, Stuart-Prower Factor

«bu»Factor X Deficiency«/bu» - Indicated for hereditary factor X deficiency for on-demand treatment and control of bleeding episodes, and for perioperative management of bleeding in patients with mild hereditary factor X deficiency - Dose and duration depend on the severity of the factor X deficiency, location and extent of the bleeding, and the patient’s clinical condition - Base the dose and frequency on the individual clinical response - Do not administer >60 IU/kg daily - Each vial is labeled with the actual factor X potency/content in International Units (IU) «b»Estimate in vivo Peak Increase in Factor X«/b» - Estimated Increment of Factor X (IU/dL or % of normal) = (Total Dose (IU)/Body Weight (kg)) x 2 «b»Calculate Desired in vivo Peak Increase in Factor X«/b» - Dose (IU) = Body Weight (kg) x Desired Factor X Rise (IU/dL) x 0.5 - The desired factor X rise is the difference between the patient’s plasma factor X level and the desired level - The dosing formula is based on the observed recovery of 2 IU/dL per IU/kg «b»On-demand Treatment and Control of Bleeding Episodes«/b» - Infuse 25 IU/kg when the first sign of bleeding occurs - Repeat at intervals of 24 hr until the bleeding stops «b»Perioperative Management of Bleeding«/b» - Measure postinfusion plasma factor X levels for each patient before and after surgery to ensure that hemostatic levels are obtained and maintained «bi»Presurgery«/bi» - Calculate the dose to raise plasma factor X levels to 70-90 IU/dL using the following formula: Required dose (IU) = Body Weight (kg) x Desired Factor X Rise (IU/dL) x 0.5 «bi»Postsurgery«/bi» - Repeat dose as necessary to maintain plasma factor X levels at a minimum of 50 IU/dL until the patient is no longer at risk of bleeding «b»Prophylaxis of Bleeding Episodes«/b» - 25 mg IV twice weekly - Due to inter-and intra-patient variability, it is recommended that trough blood levels of FX should be monitored at intervals, especially in the first weeks of therapy or after dosages changes - Adjust dosage regimen to clinical response and trough levels of FX of at least 5 IU/dL - Not to exceed peak level of 120 IU/d «b»Limitations of Use«/b» - Perioperative management of bleeding in major surgery in patients with moderate and severe hereditary Factor X deficiency has not been studied. «bu»Factor X Deficiency«/bu» - Indicated for hereditary factor X deficiency for on-demand treatment and control of bleeding episodes, and for perioperative management of bleeding in patients with mild hereditary factor X deficiency - Dose and duration depend on the severity of the factor X deficiency, location and extent of the bleeding, and the patient’s clinical condition - Base the dose and frequency on the individual clinical response - Do not administer >60 IU/kg daily - Each vial is labeled with the actual factor X potency/content in International Units (IU) «b»Estimate in vivo Peak Increase in Factor X«/b» <12 years - Estimated Increment of Factor X (IU/dL or % of normal) = [Total Dose (IU)/Body Weight (kg)] x 1.7 ≥12 years - Estimated Increment of Factor X (IU/dL or % of normal) = [Total Dose (IU)/Body Weight (kg)] x 2 «b»Calculate Desired in vivo Peak Increase in Factor X«/b» <12 years - Dose (IU) = Body Weight (kg) x Desired Factor X Rise (IU/dL) x 0.6 ≥12 years - Dose (IU) = Body Weight (kg) x Desired Factor X Rise (IU/dL) x 0.5 - The desired factor X rise is the difference between the patient’s plasma factor X level and the desired level - The dosing formula is based on the observed recovery of 2 IU/dL per IU/kg «b»On-demand Treatment and Control of Bleeding Episodes«/b» <12 years - 30 IU/kg IV ≥12 years - 25 IU/kg IV - Infuse when the first sign of bleeding occurs - Repeat at intervals of 24 hr until the bleeding stops «b»Perioperative Management of Bleeding«/b» - Measure postinfusion plasma factor X levels for each patient before and after surgery to ensure that hemostatic levels are obtained and maintained «bi»Presurgery«/bi» - Calculate the dose to raise plasma factor X levels to 70-90 IU/dL - Required dose (IU) = Body Weight (kg) x Desired Factor X Rise (IU/dL) x 0.5 (aged ≥12 yr) OR x 0.6 (aged <12 yr) «bi»Postsurgery«/bi» - Repeat dose as necessary to maintain plasma factor X levels at a minimum of 50 IU/dL until the patient is no longer at risk of bleeding «b»Prophylaxis of Bleeding Episodes«/b» <12 years - 40 IU/kg IV twice weekly ≥12 years - 25 IU/kg IV twice weekly - Due to inter-and intra-patient variability, it is recommended that trough blood levels of FX should be monitored at intervals, especially in the first weeks of therapy or after dosages changes - Adjust dosage regimen to clinical response and trough levels of FX of at least 5 IU/dL - Not to exceed peak level of 120 IU/dL

Coagulation Factor Xa Recombinant

AndexXa, Andexanet Alfa

Coagulation Factor XIII A Subunit

Tretten, Catridecacog, rFXIII

Cobicistat

Tybost

Cobimetinib

Cotellic

Cocaine

Cocaine topical, Goprelto, Numbrino

Codeine

Methylmorphine

«bu»Analgesic/Pain Management«/bu» - These are guidelines and do not represent the maximum doses that may be required in all patients - Doses should be titrated to pain relief/prevention. «b»Immediate Release«/b» «bi»Tablet, Oral Solution«/bi» - Initial Dose: 15 to 60 mg every 4 hours as needed - Maximum Total Daily Dose: 360 mg/day; patients with prior opioid exposure may require higher initial doses. - The American Pain Society recommends an initial dose of 30 to 60 mg for adults with moderate pain «bi»Discontinuation of Therapy«/bi» - For patients on long-term opioid therapy, decrease dose by 25% to 50% every 2 to 4 days; monitor carefully for signs/symptoms of withdrawal - If patient displays withdrawal symptoms, increase dose to the previous level and then reduce dose more slowly by increasing interval between dose reductions, decreasing amount of daily dose reduction, or both - Do not abruptly discontinue. «b»Controlled Release«/b» - Titrate at intervals of ≥48 hours until adequate analgesia has been achieved. - Daily doses >600 mg/day should not be used; patients requiring higher doses should be switched to an opioid approved for use in severe pain - In patients who receive both Codeine Contin and an immediate release or combination codeine product for breakthrough pain, the rescue dose of immediate release codeine product should be ≤12.5% of the total daily Codeine Contin dose. «bi»Opioid-naive Patients«/bi» - Initial Dose: 50 mg every 12 hours «bi»Conversion from Codeine IR to CR«/bi» - Immediate release codeine preparations contain ~75% codeine base - Therefore, patients who are switching from immediate release codeine preparations may be transferred to a ~25% lower total daily dose of Codeine Contin, equally divided into 2 daily doses every 12 hours. «bi»Conversion from Another Opioid Analgesic«/bi» - Using the patient's current opioid dose, calculate an equivalent daily dose of immediate release codeine. - A ~25% lower dose of Codeine Contin should then be initiated, equally divided into 2 daily doses. «bi»Discontinuation of Therapy«/bi» - Gradual dose reduction is recommended if clinically appropriate - Initially reduce the total daily dose by 50% and administer equally divided into 2 daily doses for 2 days followed by a 25% reduction every 2 days thereafter. «bu»Cough«/bu» (off-label use) - Reported doses vary with a range of 7.5 to 120 mg/day as a single dose or in divided doses. - Some experts recommend 30 to 60 mg 4 times daily in specific patient populations (lung cancer) «bu»Diarrhea«/bu» «b»Persistent, Palliative Care«/b» - 15 to 30 mg every 4 hours as needed «bu»Restless Leg Syndrome«/bu» - Initial Dose: 30 mg once daily at bedtime or during the night - May increase to 60 mg if needed - Maximum Dose: 180 mg in 2 to 3 divided doses - May be used alone or in combination with other medications used to treat RLS «b»Limitations of Use«/b» - Reserve codeine for use in patients for whom alternative treatment options (eg, nonopioid analgesics, opioid combination products) are ineffective, not tolerated, or would be otherwise inadequate.

Colchicine

Mitigare, Colcrys, Gloperba

«bu»Gout«/bu» «b»Treatment of Acute Gout Flares«/b» «bi»Colcrys«/bi» - 1.2 mg PO at first sign of flare, then, - 0.6 mg 1 hour later - Not to exceed 1.8 mg in 1-hr period «b»Prophylaxis«/b» «bi»Colcrys, Mitigare, Gloperba«/bi» - Indicated for prophylaxis of gout flares - 0.6 mg PO daily or every 12 hours - Not to exceed 1.2 mg/day - After gout flare, wait 12 hr to continue prophylaxis «bu»Familial Mediterranean Fever«/bu» «bi»Colcrys«/bi» - 1.2-2.4 mg/day PO in single daily dose or divided q12hr - Increase in 0.3-mg/day increments as necessary to control disease - Decrease in 0.3-mg/day increments if intolerable adverse effects develop - Maximum Dose: 2.4 mg/day «bu»Post-STEMI Pericarditis«/bu» - Treatment of pericarditis after STEMI - 0.6 mg PO every 12 hour «b»Strong CYP3A4 Inhibitors«/b» «bi»Mitigare or Gloperba«/bi» - Avoid use - If coadministration with strong CYP3A4 inhibitor is necessary, consider reducing the colchicine dose and closely monitor «bi»Colcrys«/bi» Treatment of Acute Gout Flares - 0.6 mg, then 0.3 mg 1 hr later - To be repeated no earlier than 3 days later Prophylaxis of Acute Gout Flares - If original colchicine regimen was 0.6 mg bid, decrease dose to 0.3 mg daily - If original colchicine regimen was 0.6 mg qDay, decrease dose to 0.3 mg once every other day FMF - Not to exceed 0.6 mg/day; 0.6 mg can be given as 0.3 mg every 12 hour «b»Moderate CYP3A4 Inhibitors«/b» «bi»Colcrys«/bi» Gout - 1.2 mg PO once; to be repeated no earlier than 3 days later FMF - Not to exceed 1.2 mg/day - 0.6 mg can be given as 0.6 mg every 12 hour «b»P-gp Inhibitors«/b» «bi»Mitigare or Gloperba«/bi» - Avoid use; if coadministration with P-gp inhibitor is necessary, consider reducing the colchicine dose and closely monitor «bi»Colcrys«/bi» Gout - 0.6 mg PO once - To be repeated no earlier than 3 days later FMF - Not to exceed 0.6 mg/day - 0.6 mg can be given as 0.3 mg every 12 hr «b»Limitations of Use«/b» - Safety and effectiveness for acute treatment of gout flares during prophylaxis has not been studied - Not an analgesic medication and should not be used to treat pain from other causes

Colchicine-Probenecid

Col-Probenecid, ColBenemid

Colesevelam

Welchol

Colestipol

Colestid

Colistimethate Sodium

Colistin, Coly-Mycin M, Colistin Sulfomethate

- Dosage expressed in terms of mg of colistin base activity (CBA). CBA 1 mg is defined to be equivalent to colistimethate sodium (CMS) 30,000 units which is equivalent to ~2.4 mg CMS «bu»Susceptible Infections«/bu» - 2.5 to 5 mg CBA/kg/day IV/IM in 2 to 4 divided doses - Maximum Dose: 5 mg/kg/day «bu»Severe Infections«/bu» - Due to multidrug-resistant organisms susceptible to colistin in the critically - 300 mg CBA IV/IM, then, - 150 mg CBA IV/IM bid «bu»Bronchiectasis, Pulmonary Colonization/Infection«/bu» «b»Susceptible Organisms in Cystic Fibrosis and Noncystic Fibrosis«/b» - 30 to 150 mg CBA via nebulizer 1 to 3 times daily - Maximum Dose: 150 mg bid «bu»Cystic Fibrosis«/bu» - 3 mg CBA/kg/day IV in 3 divided doses «bu»Meningitis«/bu» «b»Susceptible Gram-negative Organisms«/b» - Intrathecal/intraventricular (off-label route) - 4.2 mg CBA/day (equivalent to 10 mg CMS/day) «bu»Hospital-Acquired Pneumonia (HAP) or Ventilator-Associated Pneumonia (VAP)«/bu» - Due to susceptible multidrug-resistant gram-negative bacilli (Pseudomonas aeruginosa, Acinetobacter spp) «b»Nebulization (via Ventilator Circuit)«/b» - 150 mg CBA every 8 hours delivered over 60 minutes for 14 days or until successful wean from mechanical ventilation - Treatment duration range: 7 to 19 days - May consider using as an adjunct in patients receiving IV colistin; may improve clinical outcomes «b»Intravenous (IV)«/b» - Loading Dose: 5 mg CBA/kg/dose for 1 dose (use the lower of ideal or actual body weight) - Maintenance Dose: beginning 24 hours following the loading dose; the daily maintenance dose (in mg) may be calculated by multiplying 2.5 by (1.5 x CrCl + 30) and administered in divided doses every 8 to 12 hours based on CrCl - Caution is advised when administering doses >300 mg CBA/day (single loading doses or total maintenance daily doses) due to limited experience; therefore, the maintenance dose algorithm should be used with caution in patients with moderate-to-good renal function and is not recommended for use in patients with CrCl >70 mL/minute/1.73 m2 - Consider using adjunctive inhaled colistin. When used for empiric treatment of ventilator-associated pneumonia, use in combination with an agent with MRSA activity (or MSSA activity, if appropriate), with or without an additional antipseudomonal agent (dependent on risk factors) «b»CNS Toxicity«/b» - Dose reduction may reduce neurologic symptoms. «b»Nephrotoxicity«/b» - Withhold treatment if signs of renal impairment occur during treatment. - Doses should be based on ideal body weight in obese patients. «b»Parenteral Administration«/b» - Administer by IM, direct IV injection over 3 to 5 minutes, intermittent infusion over 30 minutes, or by continuous IV infusion - For continuous IV infusion, one-half of the total daily dose is administered by direct IV injection over 3 to 5 minutes followed 1 to 2 hours later by the remaining one-half of the total daily dose diluted in a compatible IV solution infused over 22 to 23 hours. - The final concentration for continuous infusion administration should be based on the patient's fluid needs; infusion should be completed within 24 hours of preparation. «b»Inhalation Administration«/b» (off-label route) - Administer solution via nebulizer (vibrating plate nebulizer may be preferred promptly following preparation to decrease possibility of high concentrations of colistin from forming which may lead to potentially life-threatening lung toxicity - Consider use of a bronchodilator (eg, albuterol) within 15 minutes prior to administration - If patient is on a ventilator, place medicine in a T-piece at the midinspiratory circuit of the ventilator - One study in adult patients with VAP administered colistimethate over 60 minutes using a vibrating plate nebulizer positioned on the inspiratory limb 10 cm proximal to the Y-piece «b»Intrathecal/Intraventricular Administration«/b» - Off-label route - Administer only preservative-free solutions via intrathecal/intraventricular routes. - Administer promptly after preparation. Discard unused portion of vial «b»IV or IM Reconstitution«/b» - Reconstitute each vial containing 150 mg of colistin base activity with 2 mL of SWFI resulting in a concentration of 75 mg colistin base activity/mL; swirl gently to avoid frothing. - May further dilute in D5W or NS for IV infusion. «b»Intrathecal/Intraventricular Reconstitution«/b» - Reconstitute with preservative-free diluent (SWFI or NS) only - Use promptly after preparation; discard unused portion of vial «b»Inhalation via Nebulizer Reconstitution«/b» - Reconstitute vial containing 150 mg of colistin base activity with NS - Further dilute dose with NS to a final concentration between 3 to 30 mg colistin base activity/mL - Optimal dosing regimens have not been determined and final concentrations used in studies vary widely; the nebulizer reservoir volume may also determine the final concentration - Storing for >24 hours may increase the risk for potential lung toxicity; preparation immediately prior to administration is recommended

Collagenase (Topical)

Santyl

Collagenase Clostridium Histolyticum

Xiaflex, Qwo

«bu»Xiaflex Intralesional Administration«/bu» - Inject intralesionally into a palpable cord or plaque using a 1 mL syringe with 0.01 mL graduations with a 27-gauge 1/2-inch needle. «b»Dupuytren Contracture«/b» - Divide dose into 3 injections; after correct needle placement, inject 1/3 of the dose, then reposition the needle in a distal location ~2 to 3 mm from the initial injection for the second injection (1/3 of the dose), followed by the final injection (1/3 of the dose) positioned ~2 to 3 mm proximal to the initial injection - To avoid tendon rupture when injecting a cord affecting a PIP joint of the fifth finger, needle insertion should not be >2 to 3 mm in depth or >4 mm distal to the palmar digital crease - Do not administer local anesthetic agent prior to administration due to possible interference with proper needle placement - When administering two injections in the same hand during a treatment, begin with the affected finger in the most medial aspect of the hand and continue toward the lateral aspect (eg, fifth finger to index finger) - When administering two injections in a cord affecting two joints in the same finger, begin with the affected joint in the most proximal aspect of the finger and continue toward the distal aspect (eg, MP to PIP). «b»Peyronie Disease«/b» - Local anesthetic may be administered prior to injection - The penis should be in a flaccid state before injection - The first injection should be into the plaque at the point of maximum concavity (or focal point) in the bend of the penis; second injection of each treatment cycle should be made ~2 to 3 mm apart from the first injection - Inject only into the plaque; avoid injection into the urethra, nerves, blood vessels, corpora cavernosa, or other collagen-containing structures of the penis to avoid damage to these structures and possible corporal rupture - Do not advance the needle beneath the plaque or perpendicularly towards the corpora cavernosum - Withdraw the needle slowly to deposit the full dose along the needle track within the plaque «bu»Qwo SC Administration«/bu» - Using 1-mL syringes with removable needles (not supplied), draw up 0.9 mL of the reconstituted solution into each syringe (0.21 mg/0.9 mL) - Single treatment visit: Four syringes totaling 0.84 mg - Two treatment visit: Eight syringes totaling 1.68 mg - Mark injection sites while the patient is standing - Inject SC while patient is in prone position - Each injection should be administered as three 0.1-mL aliquots to 3 different positions (see prescribing information image for angle and direction of each injection); for a total injection volume of 0.3 mL - Injection depth is 0.5 inches (corresponding to the length of the needle) without downward pressure - Each treatment area may receive up 12 injections - Patient should remain prone for at least 5 minutes after completion «bu»Xiaflex Lyophilized Powder Reconstitution«/bu» - Must be reconstituted with the provided diluent - Allow powder and diluent to warm to room temperature for at least 15 minutes and no longer than 60 minutes prior to reconstitution - Volume needed for reconstitution is dependent on intended site of injection - Using a 1 mL syringe with 0.01 graduations and a 27-gauge 1/2-inch needle, reconstitute powder (containing 0.9 mg collagenase clostridium histolyticum) with the following volume of diluent: «b»Cords Affecting MP joints or Peyronie Plaque«/b» - Dilute with 0.39 mL diluent; provides 0.58 mg/0.25 mL concentration; inject diluent slowly into the sides of the vial and swirl to dissolve; do not invert vial or shake «b»Cords Affecting PIP Joints«/b» - Dilute with 0.31 mL diluent; provides 0.58 mg/0.20 mL concentration; inject diluent slowly into the sides of the vial and swirl to dissolve; do not invert vial or shake - Each vial is for a single injection; if two joints on the same hand are to be treated during a treatment, use separate vials and syringes for each reconstitution and injection. - If reconstituted solution is refrigerated, warm to room temperature for ~15 to 60 minutes before use. Refer to product labeling for additional administration details «bu»Qwo Preparation«/bu» - Before reconstitution, remove vials from refrigerator and let stand at room temperature for at least 15 minutes - Inspect Vials: yophilized powder cake should be white in color and intact, showing no signs of erosion; diluent solution should appear colorless and free of particulate matter - After removal of the flip-off cap from the vial(s), using aseptic technique swab the rubber stopper and surrounding surface of the vial(s) with sterile alcohol (no other antiseptics should be used) - Use only the supplied diluent for reconstitution - Using appropriate sized syringe and needle (not supplied), withdraw the amount of supplied diluent based on the number of injection sites - Inject diluent slowly into the sides of vial containing lyophilized powder - Do not invert or shake solution; slowly swirl solution to ensure that all of the lyophilized powder has gone into solution «b»Sterile Diluent Volume«/b» - 1 treatment area: Reconstitute 0.92-mg vial with 4 mL diluent - 2 treatment areas: Reconstitute 1.84-mg vial with 8 mL diluent - Resulting concentration is 0.23 mg/mL

Conivaptan

Vaprisol

Copanlisib

Aliqopa

«bu»Follicular Lymphoma«/bu» - Indicated for relapsed follicular lymphoma (FL) in patients who have received at least 2 prior systemic therapies - 60 mg IV on Days 1, 8, and 15 of a 28-day treatment cycle on an intermittent schedule (21 days on and 7 days off) - Continue treatment until disease progression or unacceptable toxicity «b»Dosage Modifications«/b» - Avoid concomitant use with strong CYP3A inducers - Concomitant use with strong CYP3A4 inhibitors: Reduce dose to 45 mg «b»Infections«/b» «bi»Grade ≥3«/bi» - Withhold treatment until resolution «bi»Suspected Pneumocystis Jiroveci Pneumonia (PJP) Infection (All grades)«/bi» - Withhold treatment; if confirmed, treat infection until resolution, and then resume treatment at previous dose with concomitant PJP prophylaxis «b»Hyperglycemia«/b» - Predose fasting blood glucose (FBG) ≥160 mg/dL or random/non-FBG ≥200 mg/dL: Withhold treatment until predose FBG ≤160 mg/dL or random/non-FBG ≤200 mg/dL - Predose or postdose blood glucose ≥500 mg/dL «bi»First Occurrence«/bi» - Withhold treatment until FBG is ≤160 mg/dL, or a random/non-FBG ≤200 mg/dL; then reduce dose from 60 mg to 45 mg and maintain at 45 mg «bi»Subsequent Occurrences«/bi» - Withhold treatment until FBG is ≤160 mg/dL, or a random/non-FBG ≤200 mg/dL; then reduce dose from 45 mg to 30 mg and maintain at 30 mg - Discontinue treatment if it persists at 30 mg «b»Hypertension«/b» «bi»Predose Blood Pressure (BP) ≥150/90 mm Hg«/bi» - Withhold treatment until BP <150/90 mm Hg based on 2 consecutive BP measurements at least 15 minutes apart «bi»Postdose Elevated BP with Life-threatening Consequences«/bi» - Discontinue treatment «bi»Non-life Threatening Postdose Blood pressure (BP) ≥150/90 mm Hg«/bi» - Antihypertensive treatment is not required: Continue treatment at previous dose - Antihypertensive treatment is required: Consider dose reduction from 60 mg to 45 mg or from 45 mg to 30 mg - Discontinue treatment if BP remains uncontrolled (BP >150/90 mm Hg) despite antihypertensive treatment «b»Noninfectious Pneumonitis (NIP)«/b» «bi»Grade 2«/bi» - Withhold copanlisib and treat NIP; resume treatment at 45 mg once NIP recovers to grade 1 or less «bi»Grade 2 Recurs«/bi» - Discontinue treatment Grade ≥3 - Discontinue treatment «b»Neutropenia«/b» - Absolute neutrophil count (ANC) 0.5-1.0 x 10³cells/mm³: Maintain dose; monitor ANC at least weekly - ANC <0.5 x 10³cells/mm³: Withhold treatment; monitor ANC at least weekly until ANC ≥0.5 x 10³cells/mm³, then resume treatment at previous dose - If ANC ≤0.5 x 10³cells/mm³ recurs, then reduce dose to 45 mg «b»Severe Cutaneous Reactions«/b» «bi»Grade 3«/bi» - Withhold treatment until toxicity is resolved and reduce dose from 60 mg to 45 mg, or from 45 mg to 30 mg «bi»Life-threatening«/bi» - Discontinue treatment «b»Thrombocytopenia«/b» «bi»<25 X 10^9/L«/bi» - Withhold treatment; resume when platelet levels return to ≥75 x 10^9/L; reduce dose from 60 mg to 45 mg, or from 45 mg to 30 mg if recovery occurs within 21 days - If recovery does not occur within 21 days, discontinue treatment «b»Other Severe and Non-life Threatening Toxicities«/b» «bi»Grade 3«/bi» - Withhold treatment until toxicity is resolved and reduce dose from 60 mg to 45 mg, or from 45 mg to 30 mg

Copper Chloride

Coppermin, Cu-5, Cupric Chloride

Copper CU 64 Dotatate

Detectnet

«b»IV Administration«/b» - Administer as IV bolus over ~1 minute - Flush IV with 0.9% NaCl - Use within 2 hr after calibration time - Dispose of any unused drug in a safe manner in compliance with applicable regulations - Patients must drink and void frequently during the first hours following administration to reduce radiation exposure - Image patients just prior to dosing with somatostatin analogs (also see warnings for washout period) - A negative scan after administration in patients without history of NET disease does not rule out disease «bi»Image Acquisition«/bi» - A whole-body acquisition from the skull vertex to mid thigh recommended - Image acquisition can begin 45-90 minutes after IV bolus - Adapt copper CU 64 dotatate uptake time and scan duration according to the equipment used and the patient and tumor characteristics, to obtain the optimal image quality «b»IV Preparation«/b» - See full prescribing information for drug preparation using a lead glass shield for radioprotection purposes «bi»Drug Handling«/bi» - Use waterproof gloves, effective radiation shielding, and appropriate safety measures when preparing and handling - Radiopharmaceuticals should be used by or under the control of physicians and nuclear pharmacists who are qualified by specific training and experience in the safe use and handling of radionuclides, and whose experience and training have been approved by the appropriate governmental agency authorized to license the use/preparation of radionuclides - Inspect visually for particulate matter and discoloration before administration; do not use if solution contains particulate matter or is discolored; copper CU 64 dotatate is a clear, colorless- to-yellow solution - Calculate necessary volume to administer based on measured activity, volume, calibration time, and date - Use dose calibrator to measure dose immediately before administration «bi»Patient Preparation«/bi» - Instruct patients to drink a sufficient amount of water to ensure adequate hydration prior to administration

Corticorelin

Acthrel

Corticotropin

HP Acthar, ACTH, Adrenocorticotropic Hormone

Cortisone

Compound E

Cosyntropin

Cortrosyn, Synacthen, Tetracosactide

COVID19 Vaccine (Janssen)

Ad26.COV2.S (Johnson & Johnson)

COVID19 Vaccine (Moderna)

mRNA-1273 (Moderna), SpikeVax

«bu»COVID-19 Prevention«/bu» «b»Age ≥18 years«/b» - 0.5 mL IM administered x 2 doses 1 month apart «b»Third Dose«/b» - A third 0.5 mL primary series dose at least 1 month following the second dose is authorized for administration to individuals at least 18 years of age who have undergone solid organ transplantation, or who are diagnosed with conditions that are considered to have an equivalent level of immunocompromise. «b»Booster Vaccination«/b» - 0.25 mL IM x 1 dose - May be administered IM at least 6 months after completing a primary series with the Moderna COVID-19 Vaccine to individuals: - 65 years of age and older - 18 through 64 years of age at high risk of severe COVID-19 - 18 through 64 years of age with frequent institutional or occupational exposure to SARSCoV-2 - The eligible population(s) and dosing interval for the heterologous booster dose are the same as those authorized for a booster dose of the vaccine used for primary vaccination. «b»Limitations of Effectiveness«/b» - May not protect all vaccine recipients «b»Third Dose for Severely Immunocompromised (EUA)«/b» - Emergency Use Authorization (EUA) reauthorized to allow a third dose (0.5 mL [100 mcg]) administered at least 28 days following the 2-dose regimen of an mRNA vaccine in individuals who have undergone solid organ transplantation or who are diagnosed with conditions that are considered to have an equivalent level of immunocompromise - CDC recommends booster dose (4th dose) given 5 months after the third primary dose «b»Homologous Booster Dose (EUA)«/b» The EUA was amended to allow a single booster dose to be administered at least 5 months after completing the primary series for all adults aged ≥18 years Booster dose: 0.25 mL (50 mcg) IM «b»Heterologous (“Mix & Match”) Booster (EUA)«/b» - The EUA use of each of the available COVID-19 vaccines as a heterologous (or “mix and match”) booster dose in eligible individuals following completion of primary vaccination with a different available COVID-19 vaccine - 0.25 mL (50 mcg) IM may be administered as a heterologous booster dose following completion of primary vaccination with another authorized or approved COVID-19 vaccine - Eligible population(s) and dosing interval are the same as those authorized for a booster dose of the vaccine used for primary vaccination (at least 6 months after Comirnaty [Pfizer] vaccine or 2 months after single-dose Janssen [Johnson & Johnson] vaccine) «b»Use With Other Vaccines«/b» - There is no information on the co-administration of the Moderna COVID-19 Vaccine with other vaccines.

COVID19 Vaccine (Novavax)

NVX-CoV2373

COVID19 Vaccine (Pfizer)

BNT-162b2, Tozinameran, Comirnaty

«bu»COVID-19 Prevention«/bu» - Purple Cap and label border multiple-dose vial (after dilution yields six [30-mcg] doses/vial) - 0.3 mL IM administered x 2 doses 21 days apart «b»Third Dose«/b» «bi»Severely Immunocompromised «/bi» - Emergency Use Authorization (EUA) re-authorized to allow a third dose (0.3 mL) administered at least 28 days following the 2-dose regimen of an mRNA vaccine in individuals who have undergone solid organ transplantation or who are diagnosed with conditions that are considered to have an equivalent level of immunocompromise «b»Booster Dose 1«/b» - 0.3mL IM x 1 dose (a single booster dose) to be administered 5 months after completing the primary series «b»Booster Dose 2«/b» - 0.3mL IM x 1 dose (a single booster dose) at least 4 months after booster dose 1 for persons aged ≥50 yr «b»Limitations of Effectiveness«/b» - May not protect all vaccine recipients «b»Vaccines Interchangeability«/b» - There are no data available on the interchangeability of the Pfizer-BioNTech COVID-19 Vaccine with other COVID-19 vaccines to complete the vaccination series. - Individuals who have received one dose of Pfizer-BioNTech COVID-19 Vaccine should receive a second dose of Pfizer-BioNTech COVID-19 Vaccine to complete the vaccination series b»Heterologous (“Mix & Match”) Booster«/b» - The EUA allows use of each of the available COVID-19 vaccines as a heterologous (or “mix and match”) booster dose in eligible individuals following completion of primary vaccination with a different available COVID-19 vaccine - 0.3 mL (30 mcg) IM may be administered as a heterologous booster dose following completion of primary vaccination with another authorized or approved COVID-19 vaccine - Eligible population(s) and dosing interval are the same as those authorized for a booster dose of the vaccine used for primary vaccination (at least 6 months after SpikeVax Moderna vaccine or 2 months after single-dose Janssen (Johnson vaccine) «b»IM Administration«/b» - Visually inspect each dose in the dosing syringe prior to administration - The vaccine will be an off-white suspension «bi»During the Visual Inspection«/bi» - Verify the final dosing volume of 0.3 mL - Confirm there are no particulates and that no discoloration is observed. - Do not administer if vaccine is discolored or contains particulate matter - Using aseptic technique, cleanse the vial stopper with a single-use antiseptic swab, and withdraw 0.3 mL of the vaccine. - Administer the vaccine intramuscularly immediately «b»Preparation«/b» «bi»Prior to Dilution«/bi» - Multiple Dose Vial contains a frozen suspension that does not contain preservative and must be thawed and diluted prior to administration. - Vials may be thawed in the refrigerator [2ºC to 8ºC (35ºF to 46ºF)] or at room temperature [up to 25ºC (77ºF)] (See Storage) - Refer to thawing instructions in the panels below «bi»Thawing Prior to Dilution«/bi» Thaw vial(s) of Pfizer-BioNTech COVID-19 Vaccine before use either by: - Allowing vial(s) to thaw in the refrigerator [2ºC to 8ºC (35ºF to 46ºF)] - A carton of vials may take up to 3 hours to thaw, and thawed vials can be stored in the refrigerator for up to five days (120 hours). - Allowing vial(s) to sit at room temperature [up to 25ºC (77ºF)] for 30 minutes. - Using either thawing method, vials must reach room temperature before dilution and must be diluted within 2 hours - Before dilution invert vaccine vial gently 10 times - Do not shake. - Inspect the liquid in the vial prior to dilution - The liquid is a white to offwhite suspension and may contain white to off-white opaque amorphous particles. - Do not use if liquid is discolored or if other particles are observed. «bi»Dilution«/bi» - Dilute the vial contents using 1.8 mL of NS, USP (not provided) to form the Pfizer-BioNTech COVID-19 Vaccine - This diluent is not packaged with the vaccine and must be sourced separately - Do not use bacteriostatic 0.9% Sodium Chloride Injection or any other diluent - Obtain sterile 0.9% Sodium Chloride Injection, USP - Use only this as the diluent. - Using aseptic technique, withdraw 1.8 mL of diluent into a transfer syringe (21-gauge or narrower needle). - Cleanse the vaccine vial stopper with a single-use antiseptic swab. - Add 1.8 mL of 0.9% Sodium Chloride Injection, USP into the vaccine vial - Equalize vial pressure before removing the needle from the vial by withdrawing 1.8 mL air into the empty diluent syringe - Gently invert the vial 10 times to mix. - Do not shake. - Inspect the vaccine in the vial. - The vaccine will be an off-white suspension - Do not use if vaccine is discolored or contains particulate matter - Record the date and time of dilution on the vaccine vial label. - Store between 2°C to 25°C (35°F to 77°F) - Discard any unused vaccine 6 hours after dilution «b»Dilution: Aged ≥12 years«/b» - Select vial for aged ≥12 years («b»Purple Vial Cap«/b» and label border) - Dilute vial contents using 1.8 mL of 0.9% NaCl (do NOT use bacteriostatic 0.9% NaCl or any other diluent); equalize vial pressure before removing the needle from the vial by withdrawing 1.8 mL air into the empty diluent syringe - After dilution, 1 vial contains 6 doses of 0.3 mL (30 mcg); vial labels and cartons may state vial contains 5 doses, however, the latest EAU information supersedes the number of doses stated on vial labels «b»Dilution: Aged 5-11 years«/b» - Select vial for aged 5-11 years («b»Orange Vial Cap«/b» and label border) - Dilute vial contents using 1.3 mL of 0.9% NaCl (do NOT use bacteriostatic 0.9% NaCl or any other diluent); equalize vial pressure before removing the needle from the vial by withdrawing 1.3 mL air into the empty diluent syringe - After dilution, 1 vial contains 10 doses of 0.2 mL (10 mcg)

Crisaborole

Eucrisa

Crizanlizumab

Adakveo

Crizotinib

Xalkori

- Crizotinib is associated with a moderate emetic potential; antiemetics may be needed to prevent nausea and vomiting. «bu»Non-small Cell Lung Cancer (NSCLC)«/bu» «b»Metastatic (ALK- or ROS1-positive)«/b» - 250 mg PO bid - Continue treatment until disease progression or unacceptable toxicity «b»Missed Doses«/b» - If a dose is missed, take as soon as remembered unless it is <6 hours prior to the next scheduled dose (skip the dose if <6 hours before the next dose); do not take 2 doses at the same time to make up for a missed dose - If vomiting occurs after dose, administer the next dose at the regularly scheduled time. - If dose reduction is necessary, reduce dose to 200 mg orally twice daily; if necessary, further reduce to 250 mg once daily. If unable to tolerate 250 mg once daily, permanently discontinue therapy. «b»Hematologic Toxicity«/b» - Except lymphopenia, unless lymphopenia is associated with clinical events such as opportunistic infection «bi»Grade 3 Toxicity«/bi» - WBC 1,000 to 2,000/mm3, ANC 500 to 1,000/mm3, platelets 25,000 to 50,000/mm3, grade 3 anemia - Withhold treatment until recovery to ≤ grade 2, then resume at the same dose and schedule. «b»Grade 4 Toxicity«/bi» - WBC <1,000/mm3, ANC <500/mm3, platelets <25,000/mm3, grade 4 anemia - Withhold treatment until recovery to ≤ grade 2, then resume at 200 mg twice daily. Recurrent Grade 4 Toxicity on 200 mg twice daily - Withhold treatment until recovery to ≤ grade 2, then resume at 250 mg once daily. Recurrent grade 4 toxicity on 250 mg once daily - Permanently discontinue. «b»Cardiovascular Toxicities«/b» «bi»Grade 3 QTc Prolongation«/bi» QTc >500 msec without life-threatening signs or symptoms on at least 2 separate ECGs - Withhold treatment until recovery to baseline or to ≤ grade 1 (QTc <481 msec), then resume at 200 mg twice daily. Recurrent grade 3 QTc prolongation at 200 mg twice daily - Withhold treatment until recovery to baseline or to ≤ grade 1, then resume at 250 mg once daily. Recurrent grade 3 QTc prolongation at 250 mg once daily - Permanently discontinue. «bi»Grade 4 QTc Prolongation«/bi» - QTc >500 msec or ≥60 msec change from baseline with life-threatening symptoms - Permanently discontinue. «bi»Grade 2 Bradycardia or Grade 3 Bradycardia«/bi» - Grade 2 Bradycardia (symptomatic with medical intervention indicated) - Grade 3 Bradycardia (severe/medically significant with intervention indicated) - Withhold until recovery to asymptomatic bradycardia or to a heart rate of ≥60 beats/minute and evaluate concomitant medications - If contributing concomitant medication is identified and discontinued (or dose adjusted), then resume crizotinib at the previous dose. If no contributing concomitant medication is identified (or cannot be discontinued or dose adjusted), resume crizotinib at a reduced dose. «bi»Grade 4 Bradycardia«/bi» - Life-threatening with urgent intervention indicated - Withhold until recovery to asymptomatic bradycardia or to a heart rate of ≥60 beats/minute and evaluate concomitant medications - If contributing concomitant medication is identified and discontinued (or dose adjusted), then resume crizotinib at 250 mg once daily with frequent monitoring - If no contributing concomitant medication is identified, permanently discontinue crizotinib. Permanently discontinue for recurrence. «b»Hepatotoxicity«/b» - Refer to dosage adjustment in hepatic impairment «b»Ocular Toxicity«/b» - Visual loss (grade 4 visual disorder) or new onset of severe visual loss (best corrected vision less than 20/200 in one or both eyes) - Discontinue during evaluation of severe vision loss. «b»Pulmonary Toxicity«/b» - Interstitial lung disease (ILD)/pneumonitis (any grade; not attributable to disease progression, infection, other pulmonary disease or radiation therapy) - Permanently discontinue

Crofelemer

Fulyzaq, Mytesi, Provir

Cromolyn (Ophthalmic)

Crolom, Cromoglicate, Cromoglycic Acid

Cromolyn Sodium

Gastrocrom

Cromolyn Sodium (Nasal)

NasalCrom

Cromolyn Sodium (Oral Inhalation)

Intal

Crotalidae Polyvalent Immune Fab (Ovine)

CroFab, North American Antisnake-Bite Serum, Copperhead Antivenom (Immune FAB), Cottonmouth Antivenom (Immune FAB), Diamondback Antivenom (Immune FAB), Fab Crotalidae polyval AD

Crotamiton

Eurax

Cyanocobalamin

Cobal-1000, Vitamin B-12, Nascobal, CaloMist

Cyclobenzaprine

Amrix, Flexeril, Tabradol, Fexmid

Cyclopentolate

Cyclogyl, AK-Pentolate

Cyclopentolate-Phenylephrine

Cyclomydril

Cyclophosphamide

Cytoxan, Neosar

- Cyclophosphamide is associated with a moderate to high emetic potential (depending on dose, regimen, or administration route); antiemetics are recommended to prevent nausea and vomiting «bu»Malignant Diseases«/bu» «b»IV Intermittent Therapy«/b» - 40 to 50 mg/kg (400 to 1800 mg/m²) divided over 2-5 days - May be repeated at intervals of 2-4 weeks «b»IV Continuous Daily Therapy«/b» - 60 to 120 mg/m²/day (1-2.5 mg/kg/day) «b»PO Intermittent Therapy«/b» - 400 to 1000 mg/m² divided over 4-5 days «b»PO Continuous Daily Therapy«/b» - 50 to 100 mg/m²/day or 1-5 mg/kg/day «bu»Nephrotic Syndrome«/bu» - 2 to 3 mg/kg/day for up to 12 weeks when corticosteroids unsuccessful «bu»Non-Hodgkin Lymphoma«/bu» - 600 to 1500 mg/m² IV with other antineoplastics (part of CHOP regimen); dose intensification possible «bu»Breast Cancer«/bu» - 600 mg/m² IV with other antineoplastics; dose intensification possible «bu»Juvenile Idiopathic Arthritis/Vasculitis«/bu» (Off-label) - 10 mg/kg IV every 2 weeks «bu»Lupus Nephritis«/bu» «b»Induction Therapy«/b» «bi»Low Dose«/bi» - 500 mg IV every 2 weeks for 6 doses plus corticosteroids, then maintenance with mycophenolate mofetil or azathioprine «bi»High Dose«/bi» - 500 to 1000 mg/m² IV monthly for 6 doses plus corticosteroids «b»Bladder Toxicity«/b» - To minimize bladder toxicity, increase normal fluid intake during and for 1 to 2 days after cyclophosphamide dose - Most adult patients will require a fluid intake of at least 2 L/day - High-dose regimens should be accompanied by vigorous hydration with or without mesna therapy - Morning administration may be preferred to ensure adequate hydration throughout the day. «b»Hematopoietic Stem Cell Transplant«/b» - Approaches to reduction of hemorrhagic cystitis include infusion of 0.9% NaCl 3 L/m2/24 hours, infusion of 0.9% NaCl 3 L/m2/24 hours with continuous 0.9% NaCl bladder irrigation 300 to 1000 mL/hour, and infusion of 0.9% NaCl 1.5 to 3 L/m2/24 hours with intravenous mesna - Hydration should begin at least 4 hours before cyclophosphamide and continue at least 24 hours after completion of cyclophosphamide - The daily mesna dose (as a percentage of cyclophosphamide dose) may vary; refer to protocol and/or primary literature for mesna dose - Mesna can be administered as a continuous 24-hour intravenous infusion or be given in divided doses every 4 hours. - Mesna should begin at the start of treatment, and continue at least 24 hours following the last dose of cyclophosphamide.

CycloSERINE

Seromycin

CycloSPORINE

Gengraf, SandIMMUNE, Neoral, Ciclosporin

- Neoral/Gengraf (cyclosporine modified) and Sandimmune (cyclosporine non-modified) are not bioequivalent and cannot be used interchangeably - Use caution when selecting, dispensing, and administrating cyclosporine products; in general, cyclosporine (modified) is more commonly used clinically. «bu»Solid Organ Transplantation«/bu» - Prophylaxis of organ rejection in kidney, liver, and heart allogeneic transplants; has been used in combination with azathioprine and corticosteroids - Adjust dosage according to trough levels, general dosage guidelines listed below «b»Oral«/b» 4-12 hr Pre-transplant - 15 mg/kg PO for 1 dose 1-2 wk Post-transplant - 15 mg/kg/day PO divided bid Reduce 5% per wk until - 5-10 mg/kg/day PO divided bid «b»IV«/b» 4-12 hr Pre-transplant IV - 5-6 mg/kg IV for 1 dose over 2-6 hours Post-transplant, until can tolerate oral therapy - 5-6 mg/kg IV daily «bu»Focal Segmental Glomerulosclerosis«/bu» - Initial Dose: 3.5 to 5 mg/kg/day in 2 divided doses (every 12 hours; in combination with oral prednisone) «bu»Immune Thrombocytopenia«/bu» «b»Refractory«/b» - 5 mg/kg/day in 2 divided doses (every 12 hours) for 6 days, then, - 2.5 to 3 mg/kg/day - Titrate to serum levels of 100 to 200 ng/mL «bu»Interstitial Cystitis«/bu» «b»Bladder Pain Syndrome«/b» - 2 to 3 mg/kg/day in 2 divided doses - Maximum Daily Dose: of 300 mg/day - Once symptom relief is established, the dose can be tapered as tolerated (to as low as 1 mg/kg as a single daily dose) and in some cases can be stopped with continued benefit «bu»Lung Transplant«/bu» «b»Prevention of Acute Rejection«/b» «bi»IV followed by PO«/bi» - 1 mg/kg/day IV beginning immediately after transplantation (in combination with other transplant immunosuppressants) - Convert to oral cyclosporine as soon as possible post extubation - Target cyclosporine levels were maintained between 250 and 350 ng/mL during the first month, and around 200 ng/mL thereafter «bu»Nephrotic Syndrome«/bu» «b»Cyclosporine (Modified)«/b» - 3.5 mg/kg/day in 2 divided doses (every 12 hours) - Titrate for induction of remission and renal function - Adjunct therapy with low-dose oral corticosteroids is recommended for patients with an inadequate response to cyclosporine (particularly if steroid-resistant). - Maintenance: Dose is individualized based on proteinuria, serum creatinine, and tolerability but should be maintained at lowest effective dose; maximum dose: 5 mg/kg daily - Discontinue if no improvement is observed after 3 months. «bu»Lupus Nephritis«/bu» «b»Cyclosporine (Modified)«/b» - Initial Dose: 4 mg/kg/day for 1 month (reduce dose if trough concentrations >200 ng/mL) - Reduce dose by 0.5 mg/kg every 2 weeks to a maintenance dose of 2.5 to 3 mg/kg/day «bu»Ulcerative Colitis, Severe Steroid-refractory«/bu» (Off-label use) «b»Cyclosporine (Non-modified)«/b» - 2 to 4 mg/kg/day, infused continuously over 24 hours «b»Cyclosporine (Modified)«/b» - 2.3 to 3 mg/kg every 12 hours - Patients responsive to IV therapy should be switched to oral therapy when possible. «bu»Uveitis«/bu» - 2.5 to 5 mg/kg/day in 2 divided doses - Gradually decrease to maintenance dose; used alone or in conjunction with other corticosteroids

CycloSPORINE (Ophthalmic)

Cequa, Ciclosporin, Restasis, Verkazia

Cyproheptadine

Periactin

Cysteamine (Ophthalmic)

Cystaran, Cystadrops

Cysteine

Elcys, Nouress, Cystech

«b»IV Administration«/b» - Component of parenteral nutrition solution; must dilute in parenteral nutrition solution as a fixed ratio to crystalline amino acid solution; infuse TPN at rate as directed - Must dilute in TPN; dilute with crystalline amino acid solution in a ratio of 40 mg cysteine to 1 g amino acid (500 mg cysteine is added to 12.5 g [250 mL] of crystalline amino acid solution 5%). - Not for direct IV infusion - Prepare only in a suitable work area such as a laminar flow hood (or an equivalent clean-air compounding area) - Use aseptic technique to avoid inadvertent touch contamination during mixing of solutions and addition of other nutrients - For addition to AA solutions prior to further admixing with dextrose injection using a parenteral nutrition container - IV lipid emulsions can be infused concurrently into the same vein as AA and dextrose solutions by a Y-connector located near the infusion site; flow rates of each solution should be controlled separately by infusion pumps - For administration without lipid emulsion, use a 0.22-micron in-line filter - To prevent air embolism, use a nonvented infusion set or close the vent on a vented set; avoid multiple connections - If infused with lipid emulsion, do not use administration sets and lines that contain di-2-ethylhexyl phthalate (DEHP); administration sets that contain polyvinyl chloride (PVC) components have DEHP as a plasticizer - Visually inspect diluted parenteral nutrition solution for particulate matter before admixing, after admixing, and prior to administration - Solution should be clear and there should be no precipitates; a slight yellow color does not alter the quality and efficacy of this product «b»IV Preparation«/b» - Must be diluted and used as an admixture in parenteral nutrition solutions - Remove vial from the carton and inspect for particulate matter - Transfer required amount of cysteine to an AA solution using strict aseptic techniques to avoid microbial contamination - AA solution containing cysteine can then be used to prepare admixtures in the parenteral nutrition container using strict aseptic techniques «bi»Follow the Proper Mixing Sequence to Minimize pH-related Problems«/bi» - Transfer dextrose injection to the parental nutrition-pooling container - Transfer phosphate salt - Transfer cysteine-containing AA solution - Transfer electrolytes Transfer trace elements - Use gentle agitation during admixing to minimize localized concentration effects; shake containers gently after each addition - Inspect the final parenteral nutrition solution containing cysteine to ensure that precipitates have not formed during mixing or addition of additives - Discard if any precipitates are observed

Cytarabine

Ara-C, Cytosar-U, Cytarabine (Conventional)

Dabigatran

Pradaxa

Dabrafenib

Tafinlar

Dacarbazine

DTIC, Imidazole Carboxamide

Dacomitinib

Vizimpro

DACTINomycin

Cosmegen, Actinomycin, DACT

Dalbavancin

Dalvance, Zeven

Dalfampridine ER

Ampyra, Fampridine, 4-aminopyridine

Dalfopristin

Dalteparin

Fragmin

- Each 2,500 units of anti-Xa activity is equal to dalteparin 16 mg «bu»Unstable Angina and Non-Q-Wave Myocardial Infarction«/bu» - Indicated for prophylaxis of ischemic complications in unstable angina and non-Q-wave myocardial infarction, when concurrently administered with aspirin therapy - 120 IU/kg total body weight (TBW) SC every 12 hr with concurrent oral aspirin (75-165 mg daily) therapy - Maximum Dose: 10,000 IU every 12 hour - Continued until patient is clinically stabilized - Usual Duration of Administration: 5-8 days - Concurrent aspirin therapy is recommended except when contraindicated «b»Weight-based Dosing«/b» - <50 kg: 5500 IU SC every 12 hr - 50-59 kg: 6500 IU SC every 12 hr - 60-69 kg: 7500 IU SC every 12 hr - 70-79 kg: 9000 IU SC every 12 hr - ≥80 kg: 10,000 IU SC every 12 hr «bu»Anticoagulation Therapy«/bu» - 200 IU/kg SC daily or 100 units/kg SC every 12 hours «bu»Venous Thromboembolism«/bu» «b»Patients with Cancer«/b» - Begin therapy with initial VTE treatment and continues for 6 months «bi»Month 1«/bi» - Administer 200 IU/kg TBW SC daily - Total daily dose should not exceed 18,000 IU ≤56 kg: 10,000 SC daily 57-68 kg: 12,500 SC daily 69-82 kg: 15,000 SC daily ≥83 kg: 18,000 SC daily «bi»Months 2-6«/bi» - Administer at a dose of ~150 IU/kg SC daily during Months 2-6 - Total daily dose should not exceed 18,000 IU ≤56 kg: 7,500 SC daily 57-68 kg: 10,000 SC daily 69-82 kg: 12,500 SC daily 83-98 kg: 15,000 SC daily ≥99 kg: 18,000 SC daily «bu»Deep Vein Thrombosis (DVT)«/bu» «b»Hip Replacement Surgery«/b» «bi»10-14 hr Before Surgery«/bi» - 5000 IU SC preoperative; start the evening before surgery, allow ~24 hr between doses OR - Within 2 hr before surgery: 2500 IU SC preoperative; start day of surgery «bi»4-8 hr After Surgery«/bi» - Postoperative Start: 2,500 IU SC - Preoperative Start, Day of Surgery: 2,500 IU SC - Preoperative Start, evening before surgery: 5,000 IU SC - Allow at least 6 hr between this dose and dose to be given on postoperative Day 1 - Adjust timing of dose on postoperative Day 1 accordingly «bi»Postoperative Period«/bi» - Postoperative start: 5,000 IU SC daily - Preoperative start, day of surgery: 5,000 IU SC qDay - Preoperative start, evening before surgery: 5,000 IU SC qDay - Usual duration of treatment was 5-10 days postoperatively; up to 14 days of treatment was well tolerated in clinical trials «b»Abdominal Surgery«/b» - Patients with a risk of thromboembolic complications 2,500 IU SC daily, starting 1-2 hr prior to surgery and repeated daily postoperatively - Usual duration of administration is 5-10 days - Patients with a high risk of thromboembolic complications (eg, malignant disorder) - 5,000 IU SC the evening before surgery, THEN daily postoperatively - Usual duration of administration is 5-10 days - Alternatively, in patients with malignancy, 2,500 IU SC 1-2 hr before surgery followed by 2,500 IU SC 12 hr later, and then 5,000 IU qDay postoperatively - Usual duration of administration is 5-10 days «b»Patients with Severely Restricted Mobility During Acute Illness«/b» - 5,000 IU SC daily - In clinical trials, usual duration of administration was 12-14 days «bu»Dosage Adjustment«/bu» - If platelet count between 50,000 to 100,000/mm3, reduce daily dose by 2,500 units until platelet count recovers to ≥100,000/mm3. - If platelet count <50,000/mm3, discontinue dalteparin until platelet count recover to >50,000/mm3. «b»Obesity«/b» - Use actual body weight to calculate dose; a fixed upper dose limit is not recommended, however, increased monitoring may be warranted. However, the manufacturer recommends a maximum dose of 18,000 units per day; ASCO guidelines on VTE prophylaxis/treatment in patients with cancer states the optimal dose in patients >120 kg is unclear «b»Conversion from UFH IV Infusion to Dalteparin SC«/b» - Calculate specific dose for dalteparin based on indication, discontinue UFH and begin dalteparin within 1 hour «b»Conversion from Dalteparin SC to UFH IV Infusion«/b» - The following recommendations are based on use of therapeutic doses of dalteparin (eg, 100 units/kg twice daily). - If converting from a prophylactic dalteparin dose (5,000 units once daily) to a therapeutic IV UFH dose, there should not be any delay in starting the IV UFH infusion and may include an UFH bolus/loading dose, when indicated. - Discontinue dalteparin, calculate specific dose for IV UFH infusion based on indication, omit UFH bolus/loading dose «bi»Converting from Dalteparin SC Dosed every 12 Hours«/bi» - Start IV UFH infusion 10 to 11 hours after last dose of dalteparin «bi»Converting from Dalteparin SC Dosed every 24 Hours«/bi» - Start IV UFH infusion 22 to 23 hours after last dose of dalteparin

Danazol

Danocrine

Dantrolene

Dantrium, Revonto, Ryanodex

Dapagliflozin

Farxiga

Dapagliflozin-Metformin

Xigduo XR

Dapagliflozin-Metformin-Saxagliptin

Qternmet XR

Dapagliflozin-Saxagliptin

Qtern

Dapsone

Diaminodiphenylsulfone

«bu»Dermatitis Herpetiformis«/bu» - Start at 50 mg PO daily - Increase to 300 mg daily, or higher to achieve full control - Reduce to minimum maintenance dosage as soon as possible «bu»Leprosy«/bu» - 100 mg PO daily in combination with other antileprosy drugs «bu»Tuberculoid«/bu» «b»Paucibacillary«/b» - 100 mg PO daily in combination with rifampin for 6 to 12 months «bu»Lepromatous Disease«/bu» «b»Multibacillary«/b» - 100 mg PO daily in combination with rifampin and clofazimine for 12 to 24 months «bu»Aphthous Ulcers«/bu» «b»Severe«/b» - 25 mg daily x 3 days THEN, - Increase dose in increments of 25 mg daily every 3 days up to 100 mg daily x 3 days THEN, - Increase by 25 mg daily every 7 days up to 150 mg daily. Administer in 2 divided doses (75 mg dose is administered in 3 divided doses). Maintenance Dose - 100 to 150 mg daily in 2 divided doses with or without concomitant colchicine «bu»Bullous Systemic Lupus Erythematosus«/bu» - 100 mg PO once daily with or without prednisone «bu»Immune Thrombocytopenia (ITP)«/bu» - 75 to 100 mg PO daily or 1 to 2 mg/kg/day - Duration of therapy is ≥21 days «bu»Pemphigus Vulgaris«/bu» - 25 mg PO aily for 7 days - Increase dose in increments of 25 mg PO daily every 7 days up to 100 mg daily for 7 days (4 weeks total therapy) with concomitant prednisone. THEN, - Administer in 2 divided doses (a 75 mg dose is administered in 3 divided doses) - If patient becomes lesion free, taper and discontinue gradually by decreasing dose 25 mg daily over 7 days - If no new lesions are seen, gradual taper is continued - If lesions recur, dose is increased by 25 mg daily at 7-day intervals until the patient develops no new lesions. Taper is usually ~4 weeks total. «bu»Pneumocystis Pneumonia (PCP) in HIV-infected Patients«/bu» «b»Primary or Secondary Prophylaxis«/b» - 100 mg daily once daily or in 2 divided doses as monotherapy OR - 50 mg daily in combination with weekly pyrimethamine and leucovorin OR - 200 mg weekly in combination with weekly pyrimethamine and leucovorin «b»Mild to Moderate Disease Treatment«/b» - 100 mg PO once daily in combination with trimethoprim for 21 days «bu»Toxoplasma Gondii Encephalitis in HIV-infected Patients«/bu» «b»Primary Prophylaxis«/b» - 50 mg daily in combination with weekly pyrimethamine and leucovorin OR - 200 mg weekly in combination with weekly pyrimethamine and leucovorin «bu»Dermatitis Herpetiformis«/bu» «b»Infants, Children«/b» - 0.5 to 2 mg/kg/day in 1 to 2 divided doses Maximum Initial Dose - 50 mg/day - Once lesions controlled, the dose may be decreased as tolerated for chronic therapy Usual Dose Range - 0.125 to 0.5 mg/kg/day «bu»Leprosy«/bu» «b»Children and Adolescents«/b» «bi»Tuberculoid (Paucibacillary)«/bi» - 1 to 2 mg/kg daily (maximum daily dose: 100 mg/day) in combination with rifampin for 12 months - <10 years: 2 mg/kg daily in combination with rifampin for 6 months. - ≥10 years to ≤14 years: 50 mg daily in combination with rifampin for 6 months. - >14 years: Refer to adult dosing. «bu»Lepromatous«/bu» «b»Multibacillary«/b» - 1 mg/kg daily (maximum daily dose: 100 mg/day) in combination with rifampin and clofazimine for 24 months «bi»<10 years«/bi» - 2 mg/kg daily in combination with rifampin and clofazimine for 12 months. «bi»≥10 years to ≤14 years«/bi» - 50 mg daily in combination with rifampin and clofazimine for 12 months. «bi»>14 years«/bi» - Refer to adult dosing «bu»Immune Thrombocytopenia«/bu» (off-label use) «b»Children ≥3 years and Adolescents«/b» - 1 to 2 mg/kg/day «bu»Pneumocystis Pneumonia (PCP) in HIV-Exposed/-Positive«/bu» «b»Infants and Children«/b» «bi»Prophylaxis (Primary or Secondary)«/bi» - 2 mg/kg/day once daily (maximum dose: 100 mg daily) - 4 mg/kg/dose once weekly (maximum dose: 200 mg) «b»Adolescents«/b» «bi»Prophylaxis (Primary or Secondary)«/bi» - Refer to adult dosing «b»Infants and Children«/b» «bi»Mild to Moderate Disease Treatment«/bi» - 2 mg/kg/day once daily (maximum dose: 100 mg daily) in combination with trimethoprim for 21 days «b»Adolescents«/b» «bi»Mild to Moderate Disease Treatment«/bi» - Refer to adult dosing «bu»Toxoplasma Gondii Encephalitis in HIV-exposed/-Positive«/bu» «b»Infants and Children«/b» «bi»Primary Prophylaxis«/bi» - 2 mg/kg/dose or 15 mg/m2/dose once daily (maximum daily dose: 25 mg/day) in combination with pyrimethamine and leucovorin «b»Adolescents«/b» «bi»Primary Prophylaxis«/bi» - Refer to adult dosing.

Dapsone (Topical)

Aczone

DAPTOmycin

Cubicin, Dapcin

«bu»Diabetic Foot Infections without Osteomyelitis«/bu» - 4 mg/kg IV once daily «bu»Endocarditis«/bu» «b»Treatment of Staph Aureus«/b» «bi»Right-sided, Native Valve«/bi» - 6 mg/kg once daily for 2 to 6 weeks - Alternate Recommendation: 8 to 10 mg/kg once daily «bi»Left-sided Native Valve«/bi» - ≥8 mg/kg once daily for 6 weeks - Consultation with infectious disease specialist recommended for dosage selection «b»Enterococcus«/b» «bi»Penicillin-, Aminoglycoside-, Vancomycin-resistant«/bi» - 10 to 12 mg/kg IV once daily for a minimum of 6 weeks - Combination therapy with ampicillin, ceftaroline, or another antibiotic may be considered in patients with persistent bacteremia or strains with relatively high MICs to daptomycin within the susceptible range (<4 mcg/mL) «bu»Osteomyelitis«/bu» «b»MRSA«/b» - 6 mg/kg once daily for a minimum of 8 weeks - Some experts combine with rifampin in patients with concurrent bacteremia, initiate rifampin after clearance of bacteremia «b»Native Vertebral«/b» «bi»Staphylococci Oxacillin-susceptible or -resistant«/bi» - 6 to 8 mg/kg IV once daily for 6 weeks «b»Enterococcus«/b» «bi»Penicillin-susceptible or -resistant«/bi» - 6 mg/kg IV once daily for 6 weeks - In patients with infective endocarditis, the addition of an aminoglycoside for 4 to 6 weeks is recommended «bu»Prosthetic Joint Infection«/bu» «b»Enterococcus«/b» «bi»Penicillin-susceptible or -resistant«/bi» - 6 mg/kg IV every 24 hours for 4 to 6 weeks (consider adding an aminoglycoside), followed by an oral antibiotic suppressive regimen if a debridement and retention strategy or 1-stage exchange is chosen «bu»Septic Arthritis«/bu» «b»MRSA«/b» - 6 mg/kg IC once daily for 3 to 4 weeks «bu»Skin and Skin Structure Infections«/bu» «b»Complicated«/b» - 4 mg/kg once daily for 7 to 14 days «bu»VRE Bacteremia«/bu» - 6 to 8 mg/kg IV once daily - Up to 12 mg/kg IV once daily may be appropriate for difficult to treat infections

Daratumumab

Darzalex

Darbepoetin Alfa

Aranesp, Erythropoiesis-Stimulating Agent (ESA)

«bu»Chronic Kidney Disease-Associated Anemia«/bu» «b»CKD not on Dialysis«/b» Recommended Starting Dose - 0.45mcg/kg IV/SC every 4 weeks - Consider initiating ESA treatment only when the hemoglobin level is <10 g/dL and the following considerations apply: 1) The rate of hemoglobin decline indicates the likelihood of requiring a red blood cell transfusion AND 2) Reducing the risk of alloimmunization and/or other red blood cell transfusion-related risks is a goal - If the hemoglobin level exceeds 10 g/dL, reduce or interrupt ESA dose and use the lowest dose sufficient to reduce the need for red blood cell transfusions «b»CKD on Dialysis«/b» Recommended Starting Dose - 0.45 mcg/kg IV or SC every week OR - 0.75 mcg/kg IV/SC every 2 weeks - The IV route is recommended for patients on HD - Initiate ESA treatment when the hemoglobin level is <10 g/dL - If the hemoglobin level approaches or exceeds 11 g/dL, reduce or interrupt the dose of ESA «bu»Chemotherapy-Related Anemia with Non-myeloid Malignancies«/bu» - 2.25 mcg/kg SC weekly - 500 mcg SC every 3 weeks - If Hgb increases <1 g/dL after 6 weeks, may increase dose no more than 4.5 mcg/kg - Reduce dose by 40% if rapid increase in Hgb (>1 g/dL in 2-week period) - Discontinue if no response after 8 weeks «b»Dose Adjustment & Monitoring«/b» - Evaluate iron status before and during treatment and maintain iron repletion - When initiating or adjusting therapy, monitor hemoglobin levels at least weekly until stable, then monitor at least monthly - When adjusting therapy consider hemoglobin rate of rise, rate of decline, ESA responsiveness and hemoglobin variability - A single hemoglobin excursion may not require a dosing change - Do not increase the dose more frequently than once every 4 weeks - Decreases in dose can occur more frequently; avoid frequent dose adjustment - If the hemoglobin rises rapidly (eg, more than 1 g/dL in any 2-week period), reduce the dose by 25% or more as needed to reduce rapid responses - For patients who do not respond adequately, if the hemoglobin has not increased by more than 1 g/dL after 4 weeks of therapy, increase the dose by 25% «b»Dosing Information«/b» - For patients who do not respond adequately over a 12-week escalation period, increasing the dose further is unlikely to improve response and may increase risks - Use the lowest dose that will maintain a hemoglobin level sufficient to reduce the need for RBC transfusions - Evaluate other causes of anemia - Discontinue if responsiveness does not improve - Hemoglobin target removed from labeling: The drug label previously recommended that ESAs should be dosed to achieve and maintain hemoglobin levels within the target range of 10-12 g/dL in CKD patients; this target concept is now removed from the labeling - Withhold dose if Hgb continues to increase after dosage decrease «b»Limitations of Use«/b» - Darbepoetin alfa has not demonstrated improved quality of life, fatigue, or well-being. Darbepoetin alfa is not indicated for use under the following conditions: - Cancer patients receiving hormonal therapy, therapeutic biologic products, or radiation therapy unless also receiving concurrent myelosuppressive chemotherapy - Cancer patients receiving myelosuppressive chemotherapy when the expected outcome is curative - Cancer patients receiving myelosuppressive chemotherapy when anemia can be managed by transfusion - As a substitute for red blood cell (RBC) transfusion in patients requiring immediate correction of anemia

Daridorexant

Quviviq

Darifenacin ER

Enablex

Darolutamide

Nubeqa

Darunavir

Prezista, DRV

Darunavir-Cobicistat

Prezcobix

Dasabuvir

Dasatinib

Sprycel

«bu»Chronic Myeloid Leukemia (CML)«/bu» «b»Newly Diagnosed«/b» - Newly diagnosed adults with Philadelphia chromosome-positive (Ph+) chronic myeloid leukemia (CML) in chronic phase - Start 100 mg PO daily (morning or evening) - May increase to 140 mg daily if inadequate response «b»Advanced CML«/b» - Chronic, accelerated, or myeloid or lymphoid blast phase Ph+ CML with resistance or intolerance to prior therapy including imatinib - Start 140 mg PO daily - May increase to 180 mg daily if inadequate response «bu»Acute Lymphoblastic Leukemia (ALL)«/bu» - Philadelphia chromosome-positive (Ph+) acute lymphoblastic leukemia (ALL) with resistance or intolerance to prior therapy - Start 140 mg PO daily - May increase to 180 mg PO daily if inadequate response «b»Gastric Acid Reducing Agents«/b» - Do not administer H2 antagonists or proton pump inhibitors with dasatinib; consider the use of antacids in place of H2 antagonists or proton pump inhibitors - Administer the antacid at least 2 hr prior to or 2 hr after dasatinib dose - Avoid simultaneous administration of dasatinib with antacids «b»Strong CYP3A4 Inducers«/b» - Avoid use - If co-administration of strong CYP3A4 inducer is unavoidable, consider increasing dasatinib dose and monitor for toxicity «b»Strong CYP3A4 Inhibitors«/b» - Avoid use - Recommend an alternate concomitant medication with no or minimal enzyme inhibition potential, if possible - Recommended dosage adjustment if concomitant strong CYP3A4 inhibitors must be administered - Patient currently taking 140 mg PO daily: Decrease to 40 mg PO daily - Patient currently taking 100 mg PO daily: Decrease to 20 mg PO daily - Patient currently taking 70 mg PO daily: Decrease to 20 mg PO daily - Patients currently taking 40 or 60 mg PO qDay: Hold treatment until inhibitor is discontinued - If therapy is not tolerated after dose reduction, either discontinue strong CYP3A4 inhibitor or interrupt dasatinib until inhibitor is discontinued; allow a washout period of ~1 week after inhibitor is stopped before increasing dose of dasatinib «b»Neutropenia and Thrombocytopenia«/b» - ANC <0.5 X 10^9 or platelets <10 X 10^9 «bi»Chronic Phase CML«/bi» - Hold treatment until ANC ≥1.0 X 10^9/L and platelets ≥50 X 10^9/L - Resume treatment at original starting dose if recovery occurs in ≤7 days - If platelets <25 x 10^9/L or recurrence of ANC <0.5 x 10^9/L for >7 days, hold treatment until ANC ≥1.0 X 10^9/L and platelets ≥50 X 10^9/L and resume at a reduced dose of 80 mg PO daily for second episode - For third episode, further reduce dose to 50 mg PO daily (for newly diagnosed patients) or discontinue dasatinib (for patients resistant or intolerant to prior therapy including imatinib) «bi»Accelerated Phase CML, Blast Phase CML and Ph+ ALL«/bi» - Check if cytopenia is related to leukemia (marrow aspirate or biopsy) - If cytopenia is unrelated to leukemia, hold dasatinib until ANC ≥1 X 10^9/L and platelets ≥20 X 10^9/L and resume at original starting dose - Recurrence of cytopenia, check if cytopenia is related to leukemia and resume dasatinib at a reduced dose of 100 mg PO daily (second episode) or 80 mg PO daily (third episode) - If cytopenia is related to leukemia, consider dose escalation to 180 mg PO daily

Dasiglucagon

Zegalogue

DAUNOrubicin

Cerubidine, Daunomycin, Rubidomycin

Daunorubicin-Cytarabine

Vyxeos, Daunorubicin-Cytarabine Liposomal

- Calculate dose based on the daunorubicin component. Prior to each dose, calculate the cumulative anthracycline exposure. Assess cardiac function, liver, and renal function prior to therapy initiation; also evaluate complete blood counts in addition to cardiac function and liver/renal function prior to each consolidation cycle. Therapy consists of 1 to 2 induction cycles followed by up to 2 consolidation cycles. Administer antiemetics prior to treatment to prevent nausea and vomiting. «bu»Acute Myeloid Leukemia (AML)«/bu» «b»Induction«/b» «bi»First cycle«/bi» - Daunorubicin 44 mg/m2 and cytarabine 100 mg/m2 (liposomal) IV on days 1, 3, and 5 «b»Induction«/b» «bi»Second cycle«/bi» - Patients who do not achieve remission with first cycle - Daunorubicin 44 mg/m2 and cytarabine 100 mg/m2 (liposomal) IV on days 1 and 3 - The second induction cycle may be administered 2 to 5 weeks after the first induction cycle (if no unacceptable toxicity with previous cycle). «b»Consolidation«/b» - Daunorubicin 29 mg/m2 and cytarabine 65 mg/m2 (liposomal) IV on days 1 and 3 - Administer the first consolidation cycle 5 to 8 weeks after the start of the last induction - Administer the second consolidation cycle 5 to 8 weeks after the start of the first consolidation cycle. «b»Missed Dose«/b» - If a planned dose is missed, administer the dose as soon as possible and adjust the schedule accordingly (maintain the treatment interval). «b»Cardiotoxicity«/b» - Discontinue daunorubicin and cytarabine (liposomal) in patients with impaired cardiac function unless the benefits of continued treatment outweigh the toxicity risks. «b»Hematologic Toxicity«/b» - Do not initiate a new cycle until ANC recovers to >500/mm3 and platelets recover to >50,000/mm3. Hematologic toxicity may require platelet transfusion support. «b»Hypersensitivity Reactions«/b» Mild Symptoms - Interrupt infusion immediately and manage symptoms as clinically appropriate - Upon symptom resolution, reinitiate infusion at 50% of the previous infusion rate; consider premedication with antihistamines and/or corticosteroids with subsequent daunorubicin and cytarabine (liposomal) doses. Moderate Symptoms - Interrupt infusion immediately and manage symptoms as clinically appropriate. Do not reinitiate infusion. Premedicate with antihistamines and/or corticosteroids with subsequent daunorubicin and cytarabine (liposomal) doses prior to initiating infusion at the same rate. Severe or Life-threatening Symptoms - Interrupt infusion immediately and manage symptoms as clinically appropriate; monitor until symptom resolution. Permanently discontinue daunorubicin and cytarabine (liposomal) «b»Contraception«/b» - Advise females and males with female partners of reproductive potential to use effective contraception during treatment and for at least 6 months after last dose

DaxibotulinumtoxinA

Daxxify

Decitabine

Dacogen, Deoxyazacytidine

Deferasirox

Jadenu, Exjade

Deferiprone

Ferriprox

Deferoxamine

Desferal

Deflazacort

Emflaza, Deflazacorte

Degarelix

Firmagon

Delafloxacin

Baxdela

Demeclocycline

Declomycin

Dengue Vaccine

Dengvaxia

Denosumab

Prolia, Xgeva

Deoxycholic Acid

Kybella

Desipramine

Norpramin,

«bu»Bulimia Nervosa«/bu» (off-label use) - Initial Dose: 25 mg/day for 3 days, then, - Increase in 25 to 50 mg increments every 3 to 5 days based on response and tolerability up to 300 mg/day «bu»Depression«/bu» - Initial Dose: 25 to 50 mg once daily or in divided doses, then, - Increase based on tolerance and response - Usual Maintenance Dose: 100 to 200 mg once daily or in divided doses - Maximum Dose: 300 mg/day «bu»Diabetic Neuropathy«/bu» - Initial Dose: 12.5 mg once daily at bedtime, then, - Increase based on response and tolerability in 12.5 to 25 mg increments every 2 to 3 days to a maximum dose of 250 mg/day «bu»Irritable Bowel Syndrome (IBS)«/bu» - Initial Dose: 5 to 10 mg daily at bedtime - Increase gradually based on response and tolerability - Maximum Dose: 150 mg/day «bu»Postherpetic Neuralgia«/bu» - Initial Dose: 12.5 to 25 mg once or twice daily - Increase dose every 2 to 7 days based on response and tolerability up to 150 mg/day «b»Discontinuation of Therapy«/b» - Upon discontinuation of antidepressant therapy, gradually taper the dose to minimize the incidence of withdrawal symptoms and allow for the detection of re-emerging symptoms. - Evidence supporting ideal taper rates is limited. - APA and NICE guidelines suggest tapering therapy over at least several weeks with consideration to the half-life of the antidepressant; antidepressants with a shorter half-life may need to be tapered more conservatively. - In addition for long-term treated patients, WFSBP guidelines recommend tapering over 4-6 months. - If intolerable withdrawal symptoms occur following a dose reduction, consider resuming the previously prescribed dose and/or decrease dose at a more gradual rate. «b»Switching to or from an MAO Inhibitor Intended to Treat Psychiatric Disorders«/b» - Allow 14 days to elapse between discontinuing an MAO inhibitor intended to treat psychiatric disorders and initiation of desipramine. - Allow 14 days to elapse between discontinuing desipramine and initiation of an MAO inhibitor intended to treat psychiatric disorders.

Desirudin

Iprivask, r-Hirudin

Desloratadine

Clarinex

Desmopressin

DDAVP, Stimate, Octostim, Noctiva, Nocdurna

«bu»Diabetes Insipidus«/bu» «b»Intranasal (DDAVP)«/b» - 10-40 mcg (0.1-0.4 mL) intranasal daily either as a single dose or divided into 2 or 3 doses - Usual Dose: 20 mcg (0.2 mL) daily in 2 divided doses - Adjust morning and evening doses separately for an adequate diurnal rhythm of water turnover «b»Tablet«/b» - Initial Dose: 0.05 mg PO every 12 hour - Effective Dose Range: 0.1-1.2 mg divided q8-12hr - Observe fluid restriction - If switching to PO from intranasal, start PO at least 12 hours after last intranasal dose «b»IV/SC«/b» - 2-4 mcg/day IV/SC divided every 12 hour or one-tenth the maintenance of intranasal dose «bu»Hemophilia A«/bu» «b»IV«/b» - 0.3 mcg/kg IV over 15-30 minutes (for pre-op, 30 min before procedure) «b»Intranasal (Stimate)«/b» <50 kg: 150 mcg; for pre-op, give 2 hr before procedure >50 kg: 300 mcg; for pre-op, give 2 hr before procedure «bu»Von Willebrand Disease (Type I)«/bu» «b»Intranasal (Stimate)«/b» «bi»<50 kg«/bi» - 150 mcg ; for pre-op, give 2 hr before procedure «bi»>50 kg«/bi» - 300 mcg; for pre-op, give 2 hr before procedure «b»IV«/b» - 0.3 mcg/kg IV over 15-30 minutes (for pre-op, 30 min before procedure) «bu»Nocturnal Enuresis«/bu» «b»Tablet«/b» - Not intranasal - 0.2 mg PO at bedtime (up to 0.6 mg/day) «bu»Nocturia«/bu» «b»Nasal Spray (Noctiva)«/b» - Indicated for nocturia due to nocturnal polyuria in adults who awaken at least 2 times per night to void «bi»>50 to <65 years«/bi» - 1 spray of 1.66 mcg in either nostril nightly ~ 30 min before going to bed «bi»≥65 years«/bi» - 0.83 mcg in either nostril nightly ~ 30 min before going to bed - 0.83 mcg dose may have a lower risk of hyponatremia - May be increased to 1 spray of 1.66 mcg after at least 7 days, prn, provided serum sodium has remained normal «b»Sublingual Tablets (Nocdurna)«/b» - Nocturia due to nocturnal polyuria in adults who awaken at least 2 times per night to void - Before starting or resuming, assess the sodium concentration and only start or resume in patients with a normal serum sodium concentration «b»Women«/b» - 27.7 mcg SL daily, 1 hr before bedtime - Administered SL without water «b»Men«/b» - 55.3 mcg SL daily, 1 hr before bedtime - Administered SL without water «bu»Uremic Bleeding in Acute or Chronic Renal Failure«/bu» - 0.4 mcg/kg IV over 10 minutes «b»Switching Between Desmopressin Formulations«/b» «bi»From Injection to Nasal Spray«/bi» - Administer 10x the amount of desmopressin acetate, rounding down to the nearest 10 mcg «bi»From Tablets to Nasal Spray«/bi» - Individual dose titration is required because intranasal desmopressin is ~10 to 40-fold more potent than oral (tablet) desmopressin «b»Sublingual Tablets and Preservative-free Nasal Spray«/b» «bi»Sublingual Tab Only«/bi» - Recommended dose for women is lower than for men due to women being more sensitive to the effects of the sublingual tablets and having a higher risk of hyponatremia with the 55.3 mcg dose in clinical trials «bi»Before Starting Treatment«/bi» - Evaluate patient for possible causes for the nocturia, including excessive fluid intake prior to bedtime, and address other treatable causes of nocturia - Confirm diagnosis of nocturnal polyuria with a 24-hr urine collection, if not obtained previously «bi»Sodium Monitoring«/bi» - Ensure serum sodium concentration is normal prior to initiating or resuming treatment - Contraindicated in patients with hyponatremia or a history of hyponatremia (see Contraindications) - Check serum sodium concentration within the first week and again at 1 month after initiating or resuming therapy - Periodically monitor serum sodium during therapy, as clinically appropriate; closely monitor patients ≥65 years and patients at risk of hyponatremia - If patient develops hyponatremia, consider temporarily or permanently discontinuing therapy, and institute treatment for hyponatremia, depending on the clinical circumstances, including the duration and severity of the hyponatremia «b»Limitations of Use«/b» «bi»Stimate«/bi» - Not to be used in patients with Type IIB von Willebrand's disease since platelet aggregation may be induced «bi»Noctiva«/bi» - Not studied in patients <50 years «bi»Nasal Spray«/bi» - Treatment of nephrogenic diabetes insipidus or primary nocturnal enuresis - Use in patients with conditions that compromise the intranasal route of administration (severe nasal congestion and blockage, nasal mucosa atrophy, severe atrophic rhinitis, recent nasal surgery such as transsphenoidal hypophysectomy) - Use in patients with an impaired level of consciousness Use in patients requiring doses <10 mcg or doses that are not multiples of 10 mcg «bu»IV Push, SC Injection Administration«/bu» «b»Central Diabetes Insipidus«/b» - Withdraw dose from ampule into appropriate syringe size (eg, insulin syringe) - Further dilution is not required - Administer as direct injection. «b»Octostim«/b» - May administer SC undiluted by direct injection. «bu»IV Infusion Administration«/bu» «b»Hemophilia A, von Willebrand Disease (type 1), and Prevention of Surgical Bleeding in Uremia«/b» (off-label in US) - Infuse over 15 to 30 minutes «b»Octostim«/b» - Infuse over 20 to 30 minutes; infusion should not be less than 20 minutes. - If used preoperatively, administer 30 minutes prior to procedure. «b»Acute Uremic Bleeding«/b» (off-label in US) - May infuse over 10 minutes «b»Uremic Bleeding«/b» Octostim - Bleeding time should be normalized by administering a test dose once bleeding disorder is diagnosed or at least 72 hours prior to surgical procedures. Infuse over 20 to 30 minutes. When used pre-operatively administer 30 minutes prior to procedure. Intranasal - Ensure that nasal passages are intact, clean, and free of obstruction prior to administration. DDAVP Nasal Pump Spray - Delivers 0.1 mL (10 mcg); for doses <10 mcg or for other doses which are not multiples, use rhinal tube. DDAVP Nasal spray delivers fifty 10 mcg doses. For 10 mcg dose, administer in one nostril. Any solution remaining after 50 doses should be discarded. Pump must be primed prior to first use. DDAVP Rhinal Tube - Insert top of dropper into tube (arrow marked end) in downward position. Squeeze dropper until solution reaches desired calibration mark. Disconnect dropper. Grasp the tube 3/4 inch from the end and insert tube into nostril until the fingertips reach the nostril. Place opposite end of tube into the mouth (holding breath). Tilt head back and blow with a strong, short puff into the nostril (for very young patients, an adult should blow solution into the child's nose). Reseal dropper after use. Octostim - Gently blow nose to clear nasal passages. Prior to initial use, prime the pump by pressing down at least 5 times until an even spray appears. Spray is then ready for use. Dip tube inside bottle must always be submerged in the liquid when spraying. Tilt head back slightly and insert nasal applicator into one nostril. Hold breath as dose is administered. Repeat in opposite nostril if an additional spray is required. If used preoperatively, administer 2 hours prior to procedure. If spray pump is not used for 48 hours it must be primed again by pressing down a couple of times until an even spray appears. Pump will only deliver 150 mcg dose(s); if a different dose is needed, use the injection. Note: A test dose to measure response is recommended prior to initiating therapy. Stimate - Press pump down 4 times to prime prior to initial use. Once ready, tilt pump, place nozzle tip in nostril, then spray. If pump has not been used for one week it must be primed again by pressing down once or until a fine mist is present. Discard after 25 sprays (excluding priming sprays) - A test dose to measure response is recommended prior to initiating therapy. «bu»Oral Administration«/bu» «b»Diabetes Insipidus«/b» - Fluid restriction should be observed. «b»Primary Nocturnal Enuresis«/b» - Minimize fluid intake beginning 1 hour prior to administration and continue until the morning (for at least 8 hours). - May administer with or without food. Food may reduce/delay absorption although does not affect antidiuretic activity «b»Sublingual Administration«/b» [Canadian products] - Fluid restriction should be observed. For primary nocturnal enuresis or nocturia, minimize fluid intake beginning 1 hour prior to administration and continue until the morning (for at least 8 hours). «bu»DDAVP IV Preparation«/bu» «b»Hemophilia A and von Willebrand Disease (type 1)«/b» - Dilute solution for injection in 10 or 50 mL NS for IV infusion (10 mL for children ≤10 kg; 50 mL for children, adolescents, and adults >10 kg). «bu»Octostim IV Preparation«/bu» [Canadian product] - Dilute solution for injection in 10 mL or 50 mL NS for IV infusion (10 mL for children <10 kg; 50 mL for children, adolescents, and adults ≥10 kg).

Desogestrel

Opill

Desogestrel-Ethinyl Estradiol

Azurette, Bekyree, Kariva, Kimidess, Mircette, Pimtrea, Viorele, Apri 28, Cyred, Desogen, Emoquette, Enskyce, Isibloom, Juleber,Ortho-Cept 28, Reclipsen, Solia, Caziant, Cyclessa, Velivet

Desonide

DesOwen, Tridesilon, Verdeso, Desonate, LoKara

Desoximetasone

Topicort

Desvenlafaxine Succinate ER

Khedezla, Pristiq

Deucravacitinib

Sotyktu

Deutetrabenazine

Austedo

Dexamethasone

Adrenocot, Baycadron, DoubleDex, DexPak, Decadron

«bu»Adrenal Crisis«/bu» «b»Shock due to Adrenal Insufficiency«/b» - 4 to 10 mg IV x 1 dose - May be repeated prn - Hydrocortisone is the preferred agent in this setting «bu»Anti-inflammatory/Immunosuppressive/Endocrine Disorders«/bu» - 0.5 to 9 mg/day PO/IM/IV in divided doses every 6 to 12 hours - Dose depends upon condition being treated and response of patient «bu»Intra-articular, Intralesional, or Soft Tissue Injection«/bu» - Dosage and frequency depend on the condition and the site of injection - Frequency Range: Once every 3 to 5 days to once every 2 to 3 weeks Large Joints (Knee) - Single Dose: 2 to 4 mg Small Joints (Interphalangeal, Temporomandibular) - Single Dose: 0.8 to 1 mg Bursae - Single Dose: 2 to 4 mg Tendon Sheaths - Single Dose: 0.4 to 1 mg Soft Tissue Infiltration - Single Dose: 2 to 6 mg Ganglia - 1 to 2 mg «bu»Brain tumor«/bu» «b»Palliative Management of Cerebral Edema or Neurological Deficits Associated with Recurrent or Inoperable Brain Tumors«/b» - 2 mg IV/PO 2 to 3 times daily may be effective - Individualize dose based on disease response and patient tolerance. «bu»Cerebral Edema«/bu» «b»Associated with Brain Tumor or Craniotomy«/b» - 10 mg IV immediately, then, - 4 mg IM every 6 hours until cerebral edema subsides, then switch to oral regimen, - Dosage may be reduced after 2 to 4 days and gradually discontinued over 5 to 7 days «bu»Cushing Syndrome Diagnostic«/bu» - 1 mg PO at 11 PM - Draw blood at 8 AM - Greater accuracy for Cushing syndrome may be achieved with 0.5 mg every 6 hours for 48 hours (with 24-hour urine collection for 17-hydroxycorticosteroid excretion) «b»Differentiation of Cushing Syndrome due to ACTH excess from Cushing due to other causes«/b» - 2 mg PO every 6 hours for 48 hours (with 24-hour urine collection for 17-hydroxycorticosteroid excretion) «bu»Immune Thrombocytopenia (ITP)«/bu» - Initial Therapy 40 mg once daily for 4 consecutive days - If platelet count continues to remain <30,000/mm3 or bleeding symptoms occur by day 10 - May administer an additional 4-day course of 40 mg once daily (Wei 2016) or 40 mg once daily for 4 consecutive days, if platelets fall below 30,000/mm3 within 6 months a second course may be administered, followed by a prednisone taper. - Pulsed dexamethasone dosing of 40 mg once daily for 4 days every 14 or 28 days for 4 to 6 cycles has also been used «bu»Multiple Sclerosis«/bu» «b»Acute Exacerbation«/b» - Treatment guidelines recommend the use of high dose IV or oral methylprednisolone for acute exacerbations of multiple sclerosis - 30 mg/day PO for 1 week - Followed by 4 to 12 mg every other day for 1 month «bu»Acute Mountain Sickness (AMS)/High Altitude Cerebral Edema (HACE)«/bu» «b»Prevention«/b» - 2 mg IV/IM/PO every 6 hours or 4 mg IV/IM/PO every 12 hours starting on the day of ascent - May be discontinued after staying at the same elevation for 2 to 3 days or if descent is initiated - Do not exceed a 10 day duration - In situations of rapid ascent to altitudes >3500 meters (such as rescue or military operations), 4 mg IV/IM/PO every 6 hours may be considered «b»AMS Treatment«/b» - 4 mg IV/IM/PO every 6 hours «b»HACE Treatment«/b» - Initial Dose: 8 mg IV/IM/PO x 1 dose - Maintenance Dose: 4 mg IV/IM/PO every 6 hours until symptoms resolve «bu»Accelerated Fetal Lung Maturation«/bu» - 6 mg IM every 12 hours for a total of 4 doses. - A single course is recommended for women between 24 and 34 weeks of gestation, including those with ruptured membranes or multiple gestations, who are at risk of delivering within 7 days - A single course may be appropriate in some women beginning at 23 weeks gestation or late preterm (between 34 0/7 weeks and 36 6/7 weeks gestation). A single repeat course may be considered in some women with pregnancies less than 34 weeks gestation at risk for delivery within 7 days and who had a course of antenatal corticosteroids >14 days prior «bu»Airway Edema or Extubation«/bu» - 0.5 mg/kg/dose IV (maximum dose: 10 mg/dose) 6 to 12 hours prior to extubation, then, - 0.5 mg/kg/dose IV every 6 hours for 5 doses or - 5 mg IV every 6 hours for 4 doses with extubation performed 24 hours after last injection. «bu»Chemotherapy-associated Nausea and Vomiting, Prevention«/bu» (off-label use) «b»Highly Emetic Chemotherapy«/b» - In combination with an NK1 receptor antagonist, a 5-HT3 antagonist, and olanzapine; dexamethasone dose depends on specific NK1 receptor antagonist In combination with oral aprepitant, or netupitant-palonosetron - 12 mg on day 1, followed by 8 mg once daily on days 2 to 4 In combination with IV fosaprepitant - 12 mg on day 1, followed by 8 mg on day 2, and 8 mg twice daily on days 3 and 4 In combination with rolapitant - 20 mg on day 1, followed by 8 mg twice daily on days 2 to 4 If NK1 receptor antagonist not used - 20 mg day 1, followed by 8 mg twice daily on days 2 to 4 «b»High Emetic Potential Anthracycline/Cyclophosphamide Chemotherapy«/b» - 12 mg IV/PO with aprepitant, fosaprepitant, or netupitant/palonosetron in combination with a 5HT3 antagonist on day 1 and olanzapine on days 1 to 4 or - 20 mg IV/PO with rolapitant; in combination with a 5HT3 antagonist on day 1 and olanzapine on days 1 to 4 «b»Moderate Emetic Potential Chemotherapy«/b» - 8 mg on day 1 prior to chemotherapy (in combination with a 5HT3 antagonist on day 1) and 8 mg on days 2 and 3 - May be administered as 4 mg twice daily «b»Low Emetic Potential Chemotherapy«/b» - 4 to 8 mg prior to chemotherapy «b»Dosing in combination with Granisetron ER«/b» Day 1 - 20 mg (for highly emetic chemotherapy) or 8 mg (for moderately emetic chemotherapy) IV Days 2, 3, and 4 - 8 mg PO bid (for highly emetic chemotherapy) «b»Dosing in combination with IV Aprepitant (and a 5HT3 antagonist)«/b» Highly Emetic Chemotherapy - 12 mg PO on day 1, then, - 8 mg PO on day 2, then, - 8 mg PO bid on days 3 and 4 Moderately Emetic Chemotherapy - 12 mg PO on day 1 only «bu»Dexamethasone Suppression Test«/bu» «b»Depression/Suicide Indicator«/b» (off-label use) - 1 mg at 11 PM, draw blood at 8 AM the following day for plasma cortisol determination «bu»Glucocorticoid Remediable Aldosteronism Treatment«/bu» - Initial Dose: 0.125 to 0.25 mg PO once daily - Preferably at bedtime to suppress early morning ACTH surge «bu»Multiple Myeloma«/bu» - Multiple dexamethasone-containing regimens are available for the treatment of multiple myeloma - 40 mg PO once daily on days 1 to 4, 9 to 12, and 17 to 20 (as induction therapy) in combination with bortezomib and doxorubicin for 3 cycles - 40 mg PO once weekly on days 1, 8, 15, and 22 every 28 days (in combination with lenalidomide) until disease progression - 40 mg PO once weekly on days 1, 8, 15, and 22 every 28 days (in combination with pomalidomide) until disease progression or unacceptable toxicity - 40 mg PO once weekly on days 1, 8, 15, and 22 every 28 days (in combination with ixazomib and lenalidomide) until disease progression or unacceptable toxicity - 28 mg PO orally plus 8 mg IV (prior to elotuzumab) on days 1, 8, 15, and 22 every 28 days for 2 cycles, followed by 28 mg orally plus 8 mg IV (prior to elotuzumab) on days 1 and 15 and 40 mg orally on days 8 and 22 every 28 days thereafter until disease progression or unacceptable toxicity (in combination with elotuzumab and lenalidomide) - 20 mg IV/PO once daily days 1, 2, 4, 5, 8, 9, 11, and 12 every 21 days (in combination with daratumumab and bortezomib) for 8 cycles - 20 mg on days 1 (prior to daratumumab infusion) and 2 each week (in combination with daratumumab and lenalidomide) until disease progression or unacceptable toxicity «bu»COVID-19«/bu» «b»Adjunct Therapy«/b» - 6 mg IV/PO once daily x 10 days - Management of hospitalized patients with COVID-19 who require oxygen or ventilation «bu»Anti-inflammatory/Immunosuppressive/Endocrine Disorders«/bu» «b»Infants, Children, Adolescents«/b» Initial Dose Range - 0.02 to 0.3 mg/kg/day (0.6 to 9 mg/m2/day) IV/IM/PO in divided doses every 6 to 12 hours - Dose depends upon condition being treated and response of patient - Dosage for infants and children should be based on disease severity and patient response «bu»Asthma Exacerbation«/bu» «b»Infants, Children, Adolescents«/b» - 0.6 mg/kg IV/IM/PO once daily as a single dose or once daily for 2 days - Maximum Dose: 16 mg/dose IV/IM/PO - Single dose regimens as low as 0.3 mg/kg/dose and as high as 1.7 mg/kg/dose have also been reported - Duration greater than 2 days is not recommended due to increased risk of metabolic effects «bu»Cerebral Edema«/bu» «b»Infants, Children, and Adolescents«/b» - Loading Dose: 1 to 2 mg/kg/dose IV/IM/PO x 1 dose - Maintenance Dose: 1 to 1.5 mg/kg/day IV/IM/PO in divided doses every 4 to 6 hours - Maximum Dose: 16 mg/day «bu»Congenital Adrenal Hyperplasia«/bu» «b»Adolescents (fully grown)«/b» - 0.25 to 0.5 mg PO once daily - For younger patients who are still growing, hydrocortisone or fludrocortisone are preferred. «bu»Physiologic Replacement«/bu» «b»Infants, Children, and Adolescents«/b» - 0.03 to 0.15 mg/kg/day IV/IM/PO in divided doses every 6 to 12 hours - 0.2 to 0.25 mg/m2/day IV/IM/PO once daily, some patients may require 0.3 mg/m2/day «bu»Acute Mountain Sickness (AMS) (Moderate) and High Altitude Cerebral Edema (HACE)«/bu» (off-label use) «b»Infants, Children, and Adolescents«/b» - 0.15 mg/kg/dose IV/IM/PO every 6 hours - Mximum Dose: 4 mg/dose - Consider using for high altitude pulmonary edema because of associated HACE with this condition «bu»Airway Edema or Extubation«/bu» (off-label use) «b»Infants, Children, and Adolescents«/b» - 0.5 mg/kg/dose IV (maximum dose: 10 mg/dose) 6 to 12 hours prior to extubation then every 6 hours for 5 doses - Total Dexamethasone Dose: 3 mg/kg «bu»Bacterial Meningitis«/bu» (H. influenzae type b) (off-label use) «b»Infants >6 weeks and Children«/b» - 0.15 mg/kg/dose IV every 6 hours for the first 2 to 4 days of antibiotic treatment - Start dexamethasone 10 to 20 minutes before or with the first dose of antibiotic - if antibiotics have already been administered, dexamethasone use has not been shown to improve patient outcome and is not recommended «bu»Chemotherapy-Associated Nausea and Aomiting, Prevention«/bu» (off-label use): «b»Infants, Children, and Adolescents«/b» High Emetic Potential Chemotherapy - 6 mg/m2/dose IV/PO every 6 hours (in combination with a 5HT3 antagonist and aprepitant [if no interaction with aprepitant and if ≥12 years]) - Reduce dexamethasone dose by 50% if administered concomitantly with aprepitant Moderate Emetic Potential Chemotherapy - BSA ≤0.6 m2: 2 mg IV/PO every 12 hours (in combination with a 5HT3 antagonist) - BSA >0.6 m2: 4 mg IV/PO every 12 hours (in combination with a 5HT3 antagonist) «bu»Croup«/bu» (laryngotracheobronchitis) (off-label use) «b»Infants and Children«/b» - 0.6 mg/kg IV/IM/PO x 1 dose - Usual Maximum Dose: 16 mg (doses as high as 20 mg have been used) - A single oral dose of 0.15 mg/kg has been shown effective in children with mild to moderate croup «bu»Immune Thrombocytopenia (ITP)«/bu» (off-label use) «b»Children and Adolescents«/b» - 0.6 mg/kg/day PO for 4 days every 4 weeks up to 6 cycles - Consider a maximum daily dose cap (24 mg or 40 mg) based on response, individual tolerance and/or institutional policy. Refractory (off-label use) - 0.6 mg/kg/day PO for 4 days every 4 weeks for 6 cycles - 28 to 40 mg/m2/day PO for 4 days every 4 weeks for 6 cycles (response usually observed within 3 days) - Maximum Dose: 40 mg/day - Consider a maximum daily dose cap (24 mg or 40 mg) based on response, individual tolerance and/or institutional policy.

Dexamethasone (Ophthalmic)

Dexycu, Maxidex, Ozurdex

Dexbrompheniramine

Dexchlorpheniramine

Dexchlor

Dexlansoprazole

Dexilant, Dexilant SoluTab, Kapidex

Dexmedetomidine

Precedex, Igalmi

«bu»Schizophrenia Agitation«/bu» «b»Mild or Moderate«/b» - 120 mcg SL or BUC x 1 dose - May give 60 mcg for up to 2 doses at least 2 hr apart if agitation persists - Assess vital signs including orthostatic measurements before administering - Maximum Dose: 240 mcg/day «b»Severe«/b» - 180 mcg SL or BUC x 1 dose - May give 90 mcg for up to 2 doses at least 2 hr apart if agitation persists - Assess vital signs including orthostatic measurements before administering - Maximum Dose: 360 mcg/day «bu»Bipolar Disorder Agitation«/bu» «b»Mild or Moderate«/b» - 120 mcg SL or BUC x 1 dose - May give 60 mcg for up to 2 doses at least 2 hr apart if agitation persists - Assess vital signs including orthostatic measurements before administering - Maximum Dose: 240 mcg/day «b»Severe«/b» - 180 mcg SL or BUC x 1 dose - May give 90 mcg for up to 2 doses at least 2 hr apart if agitation persists - Assess vital signs including orthostatic measurements before administering - Maximum Dose: 360 mcg/day «bu»ICU Sedation«/bu» «b»Initial Loading Infusion«/b» - 1 mcg/kg IV over 10 minutes - The loading dose may be omitted for this indication if patient is either being converted from another sedative and patient is adequately sedated or there are concerns for hemodynamic compromise «b»Maintenance Infusion«/b» - 0.2 to 0.7 mcg/kg/hour IV - Adjust rate to desired level of sedation - Titration no more frequently than every 30 minutes may reduce the incidence of hypotension - Although infusion rates as high as 2.5 mcg/kg/hour have been used, it is thought that doses >1.5 mcg/kg/hour do not add to clinical efficacy - Manufacturer recommends duration of infusion should not exceed 24 hours; however, randomized clinical trials have demonstrated efficacy and safety comparable to lorazepam and midazolam with longer-term infusions of up to ~5 days «bu»Procedural Sedation«/bu» «b»Initial Loading Infusion«/b» - 1 mcg/kg (or 0.5 mcg/kg for less invasive procedures) over 10 minutes «b»Maintenance Infusion«/b» - 0.6 mcg/kg/hour - Titrate to desired effect «b»Usual Range«/b» - 0.2 to 1 mcg/kg/hour «bu»Fiberoptic Intubation«/bu» «b»Initial Loading Infusion«/b» - 1 mcg/kg over 10 minutes «b»Maintenance Infusion«/b» - 0.7 mcg/kg/hour until endotracheal tube is secured «bu»Craniotomy«/bu» «b»Initial Loading Infusion«/b» - 0.5 to 1 mcg/kg over 10 to 20 min «b»Maintenance Infusion«/b» - 0.5 mcg/kg/hour - Titrate to desired effect «b»Usual Range«/b» - 0.1 to 0.7 mcg/kg/hour «bu»ICU Delirium«/bu» - 0.2 to 0.7 mcg/kg/hr - Adjust rate every 30 minutes to desired level

Dexmethylphenidate

Focalin, Focalin XR

Dexrazoxane

Totect, Zinecard

«bu»IV Adminstration Prevention of Doxorubicin Cardiomyopathy«/bu» - Administer doxorubicin within 30 minutes after completion of the dexrazoxane infusion - Do not administer doxorubicin before dexrazoxane). «b»Zinecard«/b» - Administer by rapid drip infusion over 15 minutes - Do not administer by IV push «b»Dexrazoxane Generic Formulation (Mylan)«/b» - Administer by slow IV push or rapid drip infusion «bu»Anthracycline Extravasation Treatment«/bu» - Stop vesicant infusion immediately and disconnect IV line (leave needle/cannula in place); gently aspirate extravasated solution from the IV line (do NOT flush the line); remove needle/cannula; elevate extremity - Administer dexrazoxane IV over 1 to 2 hours; begin infusion as soon as possible, within 6 hours of extravasation. Day 2 and 3 doses should be administered at approximately the same time (± 3 hours) as the dose on day 1. Infusion solution should be at room temperature prior to administration. Infuse in a large vein in an area remote from the extravasation. For IV administration only; not for local infiltration into extravasation. - Apply dry cold compresses for 20 minutes 4 times daily for 1 to 2 days; withhold cooling beginning 15 minutes before dexrazoxane infusion; continue withholding cooling until 15 minutes after infusion is completed - Do not use DMSO in combination with dexrazoxane; may lessen efficacy «b»Totect IV Reconstitution«/b» - Reconstitute 500 mg vial with 50 mL of 0.167 Molar sodium lactate injection solution to a reconstituted concentration of 10 mg/mL - To prepare the diluent, add 1.67 mL of 5 mEq/mL sodium lactate injection to 50 mL SWFI to make 50 mL of 0.167 Molar sodium lactate injection - Prior to infusion, further dilute reconstituted dexrazoxane solution in NS 1,000 mL. «b»Zinecard IV Reconstitution«/b» - Reconstitute vial with sterile water for injection to a reconstituted concentration of dexrazoxane 10 mg/mL - Prior to infusion, further dilute reconstituted dexrazoxane solution in LR injection to a final concentration of 1.3 to 3 mg/mL. «b»Dexrazoxane Generic Formulation (Mylan) IV Reconstitution«/b» - Reconstitute with the supplied diluent (0.167 Molar sodium lactate injection) to a reconstituted concentration of 10 mg/mL - Prior to infusion, further dilute reconstituted dexrazoxane solution with D5W or NS to a final concentration of 1.3 to 5 mg/mL

Dextran

Gentran, LMD, Rheomacrodex

Dextroamphetamine

Dexedrine, ProCentra, Zenzedi, Dextroamphetamine Transdermal (Xelstrym)

Dextromethorphan

Delsym, DM

Dextromethorphan-Menthol

Delsym Cough Relief, Delsym Cough+ Soothing Action

Dextromethorphan-QuiNIDine

Nuedexta

Diatrizoate Meglumine

Diatrizoate Meglumine-Diatrizoate Sodium

Gastrografin, Renocal 76, Renografin, MD-Gastrovie

Diatrizoate Sodium

Diazepam

Valium, Diastat, Diastat AcuDial, Di Tran

Diazepam Intranasal

Valtoco

Diazoxide

Proglycem

Dichloralphenazone

Dichlorphenamide

Keveyis

Diclofenac

Zorvolex, Zipsor, Cambia, Cataflam, Voltaren, Dyloject

Diclofenac Sodium (Ophthalmic)

Voltaren, Vofenal

Diclofenac Sodium (Topical)

Rexaphenac, Solaraze, Voltaren, Flector, Pennsaid, Diclo Gel, DST Plus Pak, Vopac MDS, Klofensaid II, Pennsaid

«b»Gel Administration«/b» - Do not apply to open wounds, eyes, or mucous membranes - Do not cover with occlusive dressings or apply heat, sunscreens, cosmetics, lotions, moisturizers, insect repellents, or other topical medications to affected area - Showering/bathing should be avoided for at least 1 hour following application. - Wash hands immediately after application (unless hands are treated joint, then wait at least 1 hour to wash hands) - Avoid sunlight to exposure areas - Avoid wearing clothes or gloves for ≥10 minutes after application. «bi»1% Formulation«/bi» - Use dosing card to measure dose. Apply to affected area or joint and rub into skin gently, making sure to apply to entire affected area or joint. «bi»3% Formulation«/bi» - Apply to lesion and smooth into skin gently. «b»Voltaren Emulgel Administration«/b» «bi»1.16% Formulation«/bi» - Apply to affected area and rub gently into skin; 1 g equals a strip ~2 cm long «bi»2.32% Formulation«/bi» - Use dosing card to measure dose - Apply to affected area or joint and rub into skin gently, making sure to apply to entire affected area or joint. «b»Solution Administration«/b» - Apply to clean, dry, intact skin; do not apply to eyes, mucous membranes, or open wounds - Wash hands before and after use - Do not shower or bathe for at least 30 minutes after applying - Allow knee to dry before applying clothing - Do not apply heat or occlusive dressing to treated knee; protect treated knee from sunlight - Cosmetics, insect repellant, lotion, moisturizer, sunscreens, or other topical medication may be applied to treated knee once solution has dried. «bi»1.5% Formulation«/bi» - Apply 10 drops at a time either directly onto knee or into hand then onto knee (helps avoid spillage) - Spread evenly around knee (front, back, sides) - Repeat procedure until total dose applied and the knee is completely covered with solution. «bi»2% Formulation«/bi» - The pump must be primed before first use - To prime, fully depress the pump 4 times while holding the bottle in an upright position - This portion should be discarded to ensure proper priming of the pump - No further priming of the bottle is required - Press the pump 2 times to deliver the solution onto the palm of the hand, and apply evenly around the front, back, and sides of the affected knee. «b»Patch Administration«/b» - Apply to intact, nondamaged skin - Remove transparent liner prior to applying to skin. Wash hands after applying, handling, or removing the patch - May tape down edges of patch, if peeling occurs; if problems with adhesion persist, may overlay the patch with a mesh netting sleeve - Should not be worn while bathing or showering - Fold used patches so the adhesive side sticks to itself; dispose of used patches out of reach of children and pets.

Diclofenac-Misoprostol

Arthrotec

Dicloxacillin

Dycill

Dicyclomine

Bentyl

Didanosine

Videx, Dideoxyinosine

Dienogest

Diethylpropion

Tenuate, Tenuate Dospan, Amfepramone, Depletite

Difelikefalin

Korsuva

Difenoxin

Difenoxin-Atropine

Motofen

Diflorasone

Psorcon, ApexiCon, ApexiCon E

Diflunisal

Dolobid

Difluprednate

Durezol

Digoxin

Lanoxin, Digitek, Lanoxicaps, Digitalis

Digoxin Immune Fab

DigiFab, Digibind

Dihydrocodeine

Dihydrocodeine-Aspirin-Caffeine

Dihydrocodeine Compound

Dihydroergotamine

D.H.E. 45, Migranal, Trudhesa

DilTIAZem

Cardizem, Cardizem LA, Cartia, Cartia XT, Dilacor, Diltzac, Taztia,Taztia XT, Dilt-XR, Matzim LA

«b»Tablet (IR)«/b» - Administer before meals and at bedtime - The manufacturers of the film-coated tablets recommend to swallow the tablet whole; do not split, crush, or chew. - According to these manufacturers, crushing immediate release tablets may alter pharmacokinetics. However, crushing tablets that are prepared using a direct compression technique is acceptable - An oral suspension has been made using the immediate release tablets manufactured using a direct compression technique -Brand name Cardizem tablets are prepared using a direct compression technique and may be crushed. «b»Long Acting Dosage Forms«/b» - Do not open, chew, or crush; swallow whole - Administer at same time of day either morning or evening «bi»Cardizem CD, Cardizem LA, Cartia XT, Matzim LA«/b» - Administer without regard to meals. «bi»Dilacor XR«/bi» - Administer on an empty stomach. «bi»Dilt XR«/bi» - Administer on an empty stomach in the morning. «bi»Taztia XT, Tiazac«/bi» - Capsules may be opened and sprinkled on a spoonful of applesauce - Applesauce should not be hot and should be swallowed without chewing, followed by drinking a glass of water. «b»IV Administration«/b» - Bolus doses given over 2 minutes with continuous ECG and blood pressure monitoring. - Continuous infusion should be via infusion pump - May increase infusion rate in 5 mg/hour increments as needed (maximum: 15 mg/hour) - Response to bolus may require several minutes to reach maximum - Response may persist for several hours after infusion is discontinued. «b»Continuous IV Infusion Reconstitution«/b» - Further dilute with NS, D5W, or D5 1/2NS to a maximum final concentration of 1 mg/mL. «b»Oral Suspension (12 mg/mL) Preparation«/b» - A 12 mg/mL oral suspension may be made from tablets (regular, not extended release) and one of three different vehicles (cherry syrup, a 1:1 mixture of Ora-Sweet® and Ora-Plus®, or a 1:1 mixture of Ora-Sweet® SF and Ora-Plus®) - Crush sixteen 90 mg tablets in a mortar and reduce to a fine powder - Add 10 mL of the chosen vehicle and mix to a uniform paste; mix while adding the vehicle in incremental proportions to almost 120 mL; transfer to a calibrated bottle, rinse mortar with vehicle, and add quantity of vehicle sufficient to make 120 mL - Label “shake well” and “protect from light" - Stable for 60 days when stored in amber plastic prescription bottles in the dark at room temperature or refrigerated - The tablets used within the supportive study were tablets manufactured using a direct compression technique and were not film-coated. Use of film-coated tablets to prepare an oral suspension has not been formally evaluated and may result in an unsuitable suspension - The manufacturers of the film-coated tablets do not recommend crushing - Brand name Cardizem tablets are prepared using a direct compression technique and may be crushed.

DimenhyDRINATE

Dramamine, Driminate, Motion Sickness

Dimercaprol

BAL

Dimethyl Fumarate (DMF)

Tecfidera, BG-12

Dinoprostone

Prepidil, Cervidil, Prostin E2, Prostaglandin E2

«bu»Termination of Intrauterine Pregnancy«/bu» «b»Vaginal Suppository«/b» - Insert 20 mg (1 suppository) high in vagina - Repeat at 3- to 5-hour intervals until abortion occurs - Continued administration for longer than 2 days is not advisable «bu»Cervical Ripening«/bu» «b»Endocervical Gel«/b» - Using catheter supplied with gel, insert 0.5 mg into the cervical canal - May repeat every 6 hours if needed - Maximum Cumulative Dose: 1.5 mg/24 hours «b»Oral Tablet«/b» «bi»Induction«/bi» - Initial Dose: 0.5 mg PO x 1 dose, then, - Repeat 0.5 mg dose 1 hour later - May give additional 0.5 mg dose on an hourly basis as needed for satisfactory uterine response - Maintain patient at the lowest effective dose. - Failure to induce regular contractions after 8 hours indicates failed induction and alternative management of patient should be considered - If patient vomits an intact tablet during therapy repeat dose - If patient vomits intact tablets following 2 successive doses, withhold therapy until next scheduled dose - If patient vomits a partial tablet or if no tablet is visible, continue at next regularly scheduled dose. «bi»Parity ≥2 times or Bishop Score of ≥6«/bi» - Administer 0.5 mg hourly throughout induction (discontinue hourly dose for excessive uterine activity) «bi»Nulliparous or Multiparous and Resistant to Induction (Bishop Score <6)«/bi» - If inadequate response after 2 hours of therapy may increase dose in 0.5 mg increments at hourly intervals up to a maximum single dose of 1.5 mg. - Maintenance of labor: 0.5 mg dose; may occasionally withhold hourly dose to assess need for further dosing «b»Vaginal Gel«/b» - Initial Dose: Using prefilled syringe, insert 1 mg into the posterior fornix of the vaginal canal - My give 1 additional dose of 1-2 mg 6 hours later if needed. «b»Vaginal Insert«/b» - Insert 10 mg transversely into the posterior fornix of the vagina (to be removed at the onset of active labor or after 12 hours). «b»Endocervical Gel Administration«/b» - Bring to room temperature just prior to use. Do not force the warming process (eg, water bath, microwave). Avoid contact with skin while handling; wash hands thoroughly with soap and water after administration. For cervical ripening, patient should be supine in the dorsal position. The appropriate catheter length should be based on degree of effacement; 20 mm for no effacement; 10 mm if 50% effaced. Patient should remain supine for 15-30 minutes following administration. The manufacturer recommends waiting 6-12 hours after dinoprostone gel administration before initiating oxytocin. «b»Oral Tablet Administration«/b» - Administer with small amount of water. Use of oxytocin should be avoided until ≥1 hour after administration of the last oral tablet. «b»Vaginal Gel Administration«/b» - For intravaginal use only (not for intracervical use). Using prefilled syringe, dose is placed in the posterior fornix of the vagina. Patient should remain in lateral or supine position for 30 minutes to prevent leakage. Syringe contains overfill and is designed to deliver a dose of 1 mg or 2 mg dinoprostone. Syringe is for single use only. Use of oxytocin should be avoided for 12-24 hours after administration of vaginal gel. «b»Vaginal Insert Administration«/b» - Keep frozen until use; product does not need warmed prior to use. Only open package along the tear mark; do not open with sharp objects which may compromise or cut the knitted polyester pouch which is the retrieval system for the polymeric slab. To use, remove from the foil package and immediately place one vaginal insert transversely in the posterior fornix of the vagina. A water miscible lubricant may be used to facilitate insertion (avoid excessive use of lubricant which could prevent optimal swelling and release of dinoprostone from the vaginal insert). Patients should remain in the recumbent position for 2 hours after insertion, but thereafter may be ambulatory (ensure the vaginal insert remains in place). Do not use without retrieval system. Ensure complete removal of system at completion of therapy. The manufacturer recommends waiting ≥30 minutes after removing the dinoprostone vaginal insert before initiating oxytocin. «b»Vaginal Suppository Administration«/b» - Insert high into vagina after removal from its foil package. Bring to room temperature just prior to use. Patient should remain supine for 10 minutes following insertion.

Dinutuximab

Unituxin

DiphenhydrAMINE

Benadryl, AllerMax, Diphenhist, Q-Dryl

DiphenhydrAMINE (Topical)

Anti-Itch, Banophen, Benadryl

Diphenoxylate

Diphenoxylate-Atropine

Di-Atro, Lomotil

Diphtheria-Tetanus-Acellular Pertussis-Poliovirus

DTaP/ IPV, Kinrix, Quadracel

Dipyridamole

Persantine

Diroximel Fumarate

Vumerity

Disopyramide

Norpace

Disulfiram

Antabuse

Divalproex

Depakote

«bu»Seizures«/bu» - Administer doses >250 mg/day in divided doses «bu»Simple and Complex Absence Seizure«/bu» «b»Initial Dose«/b» - 15 mg/kg/day (PO) «b»Maintenance Dose«/b» - Increase by 5 to 10 mg/kg/day PO at weekly intervals until therapeutic levels are achieved «b»Maximum Dose«/b» - 60 mg/kg/day (PO) «bu»Complex Partial Seizure«/bu» «b»Initial Dose«/b» - 10 to 15 mg/kg/day (PO) «b»Maintenance Dose«/b» - Increase by 5 to 10 mg/kg/day at weekly intervals until therapeutic levels are achieved «b»Maximum Dose«/b» - 60 mg/kg/day (PO) «b»Oral Dose«/b» - Regular release and delayed release formulations are usually given in 2 to 4 divided doses per day; extended release formulation (Depakote ER) is usually given once daily - In patients previously maintained on regular release valproic acid therapy (Depakene) who convert to delayed release valproate tablets or capsules (Depakote, Stavzor, Epival), the same daily dose and frequency as the regular release should be used; once therapy is stabilized, the frequency of Depakote, Stavzor, or Epival may be adjusted to 2 to 3 times daily. «b»Conversion from a Stable Dose of Depakote to Depakote ER«/b» - May require an increase in the total daily dose between 8% and 20% to maintain similar serum concentrations. «b»Conversion from Adjunctive Therapy to Monotherapy«/b» - The concomitant antiepileptic drug (AED) can be decreased by ~25% every 2 weeks - Dosage reduction of the concomitant AED may begin when valproate therapy is initiated or 1 to 2 weeks following valproate initiation. «b»IV Dose«/b» - Total daily IV dose should be equivalent to the total daily dose of the oral valproate product - Administer dose as a 60-minute infusion (≤20 mg/minute) with the same frequency as oral products; switch patient to oral products as soon as possible. «bu»Mania«/bu» «b»Depakote Tablet, Stavzor, Epival«/b» «bi»Initial Dose«/bi» - 750 mg/day PO in divided doses «bi»Maintenance Dose«/bi» - Dose should be adjusted as rapidly as possible to desired clinical effect «bi»Maximum Recommended Dosage«/bi» - 60 mg/kg/day «b»Depakote ER«/b» «bi»Initial Dose«/bi» - 25 mg/kg/day given once daily «bi»Maintenance Dose«/bi» Dose should be adjusted as rapidly as possible to desired clinical effect «bi»Maximum Recommended Dose«/bi» - 60 mg/kg/day «bu»Migraine Prophylaxis«/bu» «b»Depakote tablet, Stavzor«/b» «bi»Initial Dose«/bi» - 250 mg PO bid - Adjust dose based on patient response, up to 1,000 mg/day «b»Depakote ER«/b» - 500 mg PO once daily for 7 days, then, - Increase to 1,000 mg once daily - Adjust dose based on patient response - Usual Dosage Range: 500 to 1,000 mg/day «bu»Painful Diabetic Neuropathy«/bu» - Initial Dose: 500 mg/day - Increase to 1,000 mg/day after 1 week «bu»Postherpetic Neuralgia«/bu» - Usual Dose: 1,000 mg daily «bu»Status Epilepticus«/bu» - Loading Dose: 20 to 40 mg/kg IV administered at rate of 3 to 6 mg/kg/minute - If necessary, may give an additional dose of 20 to 40 mg/kg administered at rate of 3 to 6 mg/kg/minute - If necessary, may give an additional dose of 20 mg/kg 10 minutes after the loading infusion «bu»Traumatic Brain Injury related Agitation and Aggression«/bu» «b»Usual Dosage Range«/b» - 1,250 to 1,800 mg/day «b»Maintenance Dose«/b» - Adjust dose based on patient response - Doses as high as 3,500 mg/day have been reported

DOBUTamine

Dobutrex

DOCEtaxel

Taxotere, Docefrez

Docusate

Aqualax, Stool Softener, Colace, Docu Soft, DSS, DulcoEase, Phillips Liqui Gels, Silace, Soflax, Promolaxin

Dofetilide

Tikosyn

Dolasetron

Anzemet

Dolutegravir

Tivicay

Dolutegravir-Lamivudine

Dovato

Dolutegravir-Rilpivirine

Juluca

Donepezil

Adlarity (Transdermal), Aricept, Aricept ODT

DOPamine

Intropin

Doravirine

Pifeltro

Doravirine-Lamivudine-Tenofovir DF

Delstrigo

Doripenem

Doribax

Dornase Alfa

Pulmozyme, rhDNase

Dorzolamide

Trusopt

Dorzolamide-Timolol

Cosopt, Cosopt PF

Dostarlimab

Jemperli

Doxapram

Dopram

Doxazosin

Cardura, Cardura XL

Doxepin

Silenor, Sinequan

Doxepin (Topical)

Prudoxin, Zonalon, Xepin

Doxercalciferol

Hectorol

«bu»Secondary Hyperparathyroidism«/bu» «b»Dialysis Patients«/b» «bi»Initial Dose«/bi» - iPTH >400 pg/mL: 10 mcg PO 3 times/week at dialysis for 8 weeks «bi»Dose Titration«/bi» - iPTH level >300 pg/mL (dose should be titrated to lower iPTH to within the range of 150 to 300 pg/mL): Increase to 12.5 mcg 3 times/week at dialysis for 8 more weeks - This titration process can continue at 8-week intervals in 2.5 mcg/dose increments - Maximum Dose: 20 mcg 3 times/week - iPTH level 150 to 300 pg/mL: Maintain current dose - iPTH level <100 pg/mL: Suspend doxercalciferol for 1 week; resume at a reduced dose; decrease each dose (not weekly dose) by at least 2.5 mcg - Hypercalcemia, hyperphosphatemia, or serum calcium times serum phosphorus product >55 mg2/dL2: Decrease or suspend dose and/or adjust dose of phosphate binders; if dose is suspended, resume at a reduced dose; decrease each dose (not weekly dose) by at least 2.5 mcg. «b»Predialysis Patients«/b» «bi»Initial Dose«/bi» - iPTH >70 pg/mL with stage 3 disease or >110 pg/mL with stage 4 disease: 1 mcg/day for 2 weeks «bi»Titration Dose«/bi» - iPTH level >70 pg/mL with stage 3 disease or >110 pg/mL with stage 4 disease (dose should be titrated to lower iPTH to 35 to 70 pg/mL with stage 3 disease or to 70 to 110 pg/mL with stage 4 disease): Increase dose by 0.5 mcg per day every 2 weeks as necessary (maximum dose: 3.5 mcg/day) - iPTH level 35 to 70 pg/mL with stage 3 disease or 70 to 110 pg/mL with stage 4 disease: Maintain current dose - iPTH level is <35 pg/mL with stage 3 disease or <70 pg/mL with stage 4 disease: Suspend doxercalciferol for 1 week, then resume at a reduced dose (at least 0.5 mcg per day lower) - Hypercalcemia, hyperphosphatemia, or serum calcium times serum phosphorus product >55 mg2/dL2: Decrease or suspend dose and/or adjust dose of phosphate binders; if dose is suspended, resume at a reduced dose (at least 0.5 mcg per day lower). «b»Dialysis Patients«/b» «bi»Initial Dose«/bi» - iPTH level >400 pg/mL: 4 mcg 3 times/week at the end of dialysis; adjust as needed to lower iPTH into a range of 150 to 300 pg/mL «b»Dose Titration«/bi» - Increase dose at 8-week intervals - iPTH level decreased by <50% and >300 pg/mL (dose should be titrated to lower iPTH to within a range of 150 to 300 pg/mL): Increase by 1 to 2 mcg at 8-week intervals, as necessary (doses >18 mcg/week have not been studied). - iPTH level decreased by >50% and >300 pg/mL: Maintain current dose - iPTH level 150 to 300 pg/mL: Maintain current dose - iPTH level <100 pg/mL: Suspend doxercalciferol for 1 week; resume at a reduced dose (at least 1 mcg lower) - Hypercalcemia, hyperphosphatemia, or serum calcium times serum phosphorus product >55 mg2/dL2: Decrease or suspend dose and/or adjust dose of phosphate binders; if dose is suspended, resume at a reduced dose (at least 1 mcg lower)

DOXOrubicin (Conventional)

Adriamycin, Caelyx, Rubex

DOXOrubicin (Liposomal)

Doxil, Lipodox, Myocet

Doxycycline

Vibramycin, Doryx, Morgidox, Adoxa, Oracea, Okebo, Monodox, Mondoxyne, Alodox, Doxy, Acticlate, TargaDOX

Doxylamine

Nitetime Sleep-Aid, Sleep Aid, Unisom

Dronabinol

Marinol, Syndros, Tetrahydrocannabinol, THC

- Use caution when increasing the dose of dronabinol because of the increased frequency of dose-related adverse reactions at higher dosages. «bu»Anorexia in Patients with AIDS«/bu» «b»Capsules«/b» «bi»Initial Dose«/bi» - 2.5 mg PO bid (1 hour before lunch and dinner) «bi»Maintenance Dose«/bi» - For patients unable to tolerate this dosage may reduce to 2.5 mg once daily (1 hour before dinner or at bedtime to reduce the risk of CNS symptoms) - May increase dose gradually based on response and tolerability «bi»Maximum Dose«/bi» - 20 mg per day «b»Oral Solution«/b» «bi»Initial Dose«/bi» - 2.1 mg PO bid (1 hour before lunch and dinner) «bi»Maintenance Dose«/bi» - Although most patients respond to this dose, if further therapeutic effect is desired and if tolerated may gradually increase to 2.1 mg 1 hour before lunch and 4.2 mg 1 hour before dinner, and then (if needed) to 4.2 mg PO bid (1 hour before lunch and dinner) - In patients unable to tolerate 2.1 mg PO bid cnsider 2.1 mg once daily (1 hour before dinner or at bedtime) to reduce the risk of CNS effects «bi»Maximum Dose«/bi» - 16.8 mg per day «b»CNS Adverse Reactions«/b» - Reduce dose if needed. - Administering the dose later in the day may reduce the frequency of CNS adverse effects. - Dizziness, somnolence, confusion, or euphoria: Adverse effects typically resolve within 1 to 3 days and usually do not require dose reduction. «b»Severe or Persistent CNS Adverse Effects«/b» - Reduce dose to 2.1 mg once daily 1 hour before dinner or in the evening at bedtime. - In patients unable to tolerate 2.1 mg twice daily, consider 2.1 mg once daily (1 hour before dinner or at bedtime) to reduce the risk of CNS effects. «bu»Chemotherapy-Induced Nausea and Vomiting«/bu» «b»Capsules«/b» - 5 mg/m2 administered 1 to 3 hours before chemotherapy THEN - Give 5 mg/m2/dose every 2 to 4 hours after chemotherapy for a total of 4 to 6 doses/day - Increase dose in increments of 2.5 mg/m2 based on response and tolerability «bi»Maximum Dose«/bi» - 15 mg/m2/dose «b»Oral Solution«/b» «bi»Initial Dose«/bi» - 4.2 mg/m2 (rounded to the nearest 0.1 mg increment [or to the nearest 0.1 mL measurable increment on the calibrated oral dosing syringe]) 1 to 3 hours prior to chemotherapy and then every 2 to 4 hours after chemotherapy for a total of 4 to 6 doses/day - Titrate dose in 2.1 mg/m2 increments (during a cycle or in subsequent cycles) to clinical response «bi»Maximum Dose«/i» - 12.6 mg/m2/dose and 4 to 6 doses/day «b»Monitor for Adverse Reactions«/b» - Consider reducing dose to 2.5 mg once daily 1 to 3 hours prior to chemotherapy to reduce the risk of CNS adverse reactions. «b»CNS Adverse Reactions«/b» - Consider decreasing the dose to 2.1 mg once daily 1 to 3 hours prior to chemotherapy to reduce the risk of CNS adverse reactions «b»Refractory«/b» - 2.5 to 10 mg tid or qid

Dronedarone

Multaq

Droperidol

Inapsine

Drospirenone

Drospirenone-Estradiol

Angeliq

Drospirenone-Ethinyl Estradiol

Gianvi, Loryna, Nikki, Ocella, Syeda, Vestura, Yaz, Yasmin, Zarah, Beyaz, Rajani, Yaela, Safyral

«bu»Acne Vulgaris«/bu» «b»Gianvi, Loryna, Nikki, Vestura, Yaz«/b» Females - Refer to dosing for contraception. «bu»Premenstrual Dysphoric Disorder«/bu» «b»Yaz, Beyaz, Gianvi, Rajani«/b» Females - Refer to dosing for contraception. «bu»Contraception«/bu» «b»Yasmin, Ocella, Syeda, Yaela, Zarah, Safyral«/b» - One active tablet (3 mg drospirenone/0.03 mg EE) PO daily x 21 days, then, - One inert tablet PO daily x 7 days «b»Yaz, Beyaz, Gianvi, Loryna, Rajani, Vestura«/b» - One active tablet (3 mg drospirenone/0.02 mg EE) PO daily x 24 days, then, - One inert tablet PO daily x 4 days «b»Switching from a Different Contraceptive«/b» «bi»Oral Contraceptive«/bi» - Start on the same day that a new pack of the previous oral contraceptive would have been taken «bi»Transdermal Patch, Vaginal Ring, Injection«/bi - Start on the day the next dose would have been due «bi»IUD or Implant«/bi» - Start on the day of removal «b»Use after Childbirth or After 2nd Trimester Abortion«/b» - Therapy may be started ≥4 weeks postpartum - Pregnancy should be ruled out prior to treatment if menstrual periods have not restarted and an additional method of contraception (nonhormonal) should be used until after the first 7 days of consecutive administration. «b»Missed or Late Doses«/b» «bi»If one dose is late (<24 hours since dose should have been taken) or if one dose is missed (24 to <48 hours since dose should have been taken)«/bi» - Take dose as soon as possible - Continue remaining doses at the usual time (even if that means 2 doses on the same day). «bi»If ≥2 consecutive doses are missed (≥48 hours since dose should have been taken)«/b» - Take the most recently missed dose as soon as possible, discard any other missed doses. - Continue remaining doses at the usual time (even if that means taking 2 doses on the same day); use back-up contraception until hormonal pills have been taken for 7 consecutive days - If doses were missed during the last week of hormonal (active) tablets (days 15 to 21 of a 28-day pack), omit the hormone-free interval by finishing the current pack and starting a new pack - If unable to start a new pack immediately, back up contraception is needed until hormonal pills from a new pack have been taken for 7 consecutive days - Consider use of emergency contraception in some situations

Droxidopa

Northera

DTaP Hepatitis B Recomb Poliovirus (Inactivated) V

DTaP-Hepatitis B Recomb-PIV, Pediarix

DTaP-IPV Vaccine

Kinrix, Quadracel, Adacel-Polio

DTaP-IPV-Hib Vaccine

Pentacel, Infanrix-IPV/Hib, Pediacel

Dulaglutide

Trulicity

DULoxetine

Cymbalta, Irenka, Drizalma Sprinkle

«bu»Major Depressive Disorder«/bu» Initial Dose - 40 to 60 mg daily - Dose may be divided (20 or 30 mg bid) or given as a single daily dose of 60 mg - For some patients it may be desirable to start at 30 mg once daily for 1 week before increasing to 60 mg once daily Maintenance Dose - 60 mg once daily - Doses up to 120 mg/day were studied in clinical trials but did not confer any additional benefit. «bu»Diabetic Neuropathy«/bu» Initial Dose - 60 mg once daily Maintenance Dose - Lower initial doses may be considered in patients where tolerability is a concern and/or renal impairment is present Maximum Dose - 60 mg once daily - Doses up to 120 mg/day were studied in clinical trials but did not confer any additional benefit. «bu»Fibromyalgia«/bu» «b»Excluding Irenka«/b» Initial Dose - 30 mg once daily for 1 week Maintenance Dose - Increase to 60 mg once daily as tolerated Maximum Dose - 60 mg daily - Doses up to 120 mg/day were studied in clinical trials but did not confer any additional benefit. «bu»Generalized Anxiety Disorder«/bu» Initial Dose - 60 mg once daily - For some patients it may be desirable to start at 30 mg once daily for 1 week before increasing to 60 mg once daily Maintenance Dose - For doses >60 mg once daily, titrate dose in increments of 30 mg once daily over 1 week as tolerated - Doses up to 120 mg/day were studied in clinical trials but did not confer any additional benefit. «bu»Chronic Musculoskeletal Pain«/bu» - Includes patients with chronic low back pain or osteoarthritis of the knee Initial Dose - 30 mg once daily for 1 week Maintenance Dose - Increase to 60 mg once daily as tolerated Maximum Dose - 60 mg once daily. «bu»Osteoarthritis of the Knee«/bu» Initial Dose - 30 mg once daily for 1 week Maintenance Dose - 60 mg once daily - May further increase to 120 mg once daily (dose was increased after week 2 or 6 weeks in trials) Effective Dosage Range - 60 to 120 mg once daily Maximum Dose - 120 mg/day «bu»Stress Urinary Incontinence«/bu» «b»Women«/b» - 40 mg PO bid - Lower initial doses have been used to reduce adverse effects: 20 mg PO bid for 2 weeks titrated to or followed by 40 mg PO bid «b»Discontinuation of Therapy«/b» - Upon discontinuation of antidepressant therapy, gradually taper the dose to minimize the incidence of withdrawal symptoms and allow for the detection of re-emerging symptoms - Evidence supporting ideal taper rates is limited. APA and NICE guidelines suggest tapering therapy over at least several weeks with consideration to the half-life of the antidepressant; antidepressants with a shorter half-life may need to be tapered more conservatively. In addition for long-term treated patients, WFSBP guidelines recommend tapering over 4 to 6 months. If intolerable withdrawal symptoms occur following a dose reduction, consider resuming the previously prescribed dose and/or decrease dose at a more gradual rate «b»MAO Inhibitor Recommendations«/b» - Allow 14 days to elapse between discontinuing an MAO inhibitor intended to treat psychiatric disorders and initiation of duloxetine. - Allow ≥5 to 14 days to elapse between discontinuing duloxetine and initiation of an MAO inhibitor intended to treat psychiatric disorders.

Dupilumab

Dupixent

Durvalumab

Imfinzi

Dutasteride

Avodart

Dutasteride-Tamsulosin

Jalyn

Duvelisib

Copiktra

Ebola Zaire Vaccine

Ervebo

Ecallantide

Kalbitor

Echothiophate Iodide

Phospholine Iodide

Econazole

Ecoza, Spectazole

Eculizumab

Soliris

«bu»Atypical Hemolytic Uremic Syndrome (aHUS)«/bu» «b»Induction Dose«/b» - 900 mg IV weekly for 4 doses «b»Maintenance Dose«/b» - 1,200 mg IV at week 5 THEN, - 1,200 mg IV every 2 weeks thereafter - Patients must receive meningococcal vaccine at least 2 weeks prior to treatment initiation; revaccinate according to current guidelines - Administer eculizumab at the recommended time interval or within 2 days of the interval. «b»Supplemental Dosing for Patients Receiving Plasmapheresis or Plasma Exchange«/b» - If most recent dose was ≥600 mg, administer 600 mg within 60 minutes after each plasmapheresis or plasma exchange. - If most recent dose was 300 mg, administer 300 mg within 60 minutes after each plasmapheresis or plasma exchange. «b»Supplemental Dosing for Patients Receiving Fresh Frozen Plasma Infusion«/b» - If most recent dose was ≥300 mg, administer 300 mg within 60 minutes prior to each infusion of fresh frozen plasma «bu»Generalized Myasthenia Gravis (gMG)«/bu» «b»Induction Dose«/b» - 900 mg IV weekly for 4 doses «b»Maintenance Dose«/b» - 1,200 mg IV at week 5 THEN, - 1,200 mg IV every 2 weeks thereafter «b»Supplemental Dosing for Patients Receiving Plasmapheresis or Plasma Exchange«/b» - If most recent dose was ≥600 mg, administer 600 mg within 60 minutes after each plasmapheresis or plasma exchange - If most recent dose was 300 mg, administer 300 mg within 60 minutes after each plasmapheresis or plasma exchange «b»Supplemental Dosing for Patients Receiving Fresh Frozen Plasma Infusion«/b» - If most recent dose was ≥300 mg, administer 300 mg within 60 minutes prior to each infusion of fresh frozen plasma «bu»Paroxysmal Nocturnal Hemoglobinuria (PNH)«/bu» «b»Induction Dose«/b» - 600 mg weekly for 4 doses «b»Maintenance Dose«/b» - 900 mg at week 5 THEN, - 900 mg every 2 weeks thereafter «bu»Neuromyelitis Optica Spectrum Disorder«/bu» «b»Doses 1-4«/b» - 900 mg IV every week for first 4 weeks «b»Dose 5«/b» - 1200 mg IV 1 week after the 4th dose «b»Dose 6 and thereafter«/b» - 1200 mg IV every 2 weeks after the 5th dose and thereafter

Edaravone

Radicava, Radicava ORS

Edoxaban

Savaysa

«bu»Pulmonary Embolism (PE) Treatment«/bu» - LMWH is preferred over oral anticoagulation for treatment of patients with cancer. «b»Patient weight >60 kg«/b» - 60 mg PO once daily after 5 to 10 days of initial therapy with a parenteral anticoagulant «b»Patient weight ≤60 kg«/b» - 30 mg PO once daily «bu»Deep Vein Thrombosis (DVT) Treatment«/bu» - LMWH is preferred over oral anticoagulation for treatment of patients with cancer. «b»Patient weight >60 kg«/b» - 60 mg PO once daily after 5 to 10 days of initial therapy with a parenteral anticoagulant «b»Patient weight ≤60 kg«/b» - 30 mg PO once daily «b»Concomitant Therapy with P-gp Inhibitors«/b» - 30 mg PO once daily «bu»Stroke Prophylaxis with Atrial Fibrillation«/bu» - 60 mg PO Daily - Indicated to reduce risk of stroke and systemic embolism associated with nonvalvular atrial fibrillation (NVAF) «b»Limitation of Use«/b» - Prior to initiation of edoxaban, assess creatinine clearance (CrCl) using the Cockcroft-Gault equation - For patients with nonvalvular atrial fibrillation, do not use edoxaban if CrCl is >95 mL/minute - Dosage reduction necessary in all patients with CrCl 15 to 50 mL/minute - Increased risk of ischemic stroke compared with warfarin in NVAF trial «b»Conversion from Continuous Infusion Unfractionated Heparin«/b» - Discontinue heparin infusion and initiate edoxaban 4 hours later. «b»Conversion from LMWH«/b» - Discontinue LMWH and initiate edoxaban at the time of the next scheduled administration of LMWH. «b»Conversion from Oral Anticoagulants (other than warfarin and vitamin K antagonists)«/b» - Discontinue current oral anticoagulant and initiate edoxaban at the time of the next scheduled dose of the other oral anticoagulant. «b»Conversion from Warfarin or Other Vitamin K Antagonists«/b» - Discontinue warfarin and initiate edoxaban as soon as INR falls to ≤2.5. «b»Conversion to a Non-vitamin-K dependent Oral Anticoagulant«/b» - Discontinue edoxaban and initiate the other oral anticoagulant at the time the next dose of edoxaban would have been taken. «b»Conversion to a Parenteral Anticoagulant«/b» - Discontinue edoxaban and initiate the parenteral anticoagulant at the time the next dose of edoxaban would have been taken. «b»Conversion to Warfarin«/b» - For patients taking edoxaban 60 mg once daily, reduce the dose to 30 mg once daily and begin warfarin concomitantly - For patients taking edoxaban 30 mg once daily, reduce the dose to 15 mg once daily and begin warfarin concomitantly - Measure INR at least weekly and just prior to the daily dose of edoxaban to minimize influence of edoxaban on INR measurements - Discontinue edoxaban once a stable INR ≥2 is achieved; continue warfarin. «b»Conversion for Surgery and Invasive Procedures«/b» - Always consider renal function and how that might affect drug clearance when determining when to hold edoxaban prior to surgery or invasive procedures «b»Conversion for Low Bleeding Risk Associated with the Surgery/Procedure«/b» - Do not discontinue edoxaban for noninvasive procedures with low procedural bleeding risk (eg, minor dental, minor dermatologic, ophthalmologic, endoscopy without biopsy) «b»Conversion for Moderate or High Bleeding Risk Associated with the Surgery/Procedure«/b» - Discontinue edoxaban at least 48 hours prior to surgery/procedures associated with a moderate or high bleeding risk - Anticoagulation bridging using parenteral anticoagulation during the edoxaban interruption is recommended only in patients undergoing a procedure/surgery associated with a high procedural bleeding risk (eg, cardiovascular/thoracic surgery, intra-abdominal/pelvic surgery, major orthopedic surgery, neurosurgery, cardiac catheterization via femoral artery) and who have a moderate to high thromboembolic risk (eg, recent pulmonary embolism, certain mechanical valve prosthesis) «b»Conversion for Cardiac Catheterization and Percutaneous Coronary Intervention (PCI)«/b» - Patients receiving edoxaban undergoing cardiac catheterization or PCI who have stable ischemic heart disease and who are not at a high risk for thrombosis should have edoxaban withheld until the anticoagulant effect has dissipated (at least 24 hours in advance) - In the absence of high risk thrombotic features, patients should not be bridged with a heparin before or after the procedure - Radial access catheterization is preferred due to lower risk of hemorrhagic complications compared to femoral access - Following PCI, routine use of edoxaban (coupled with clopidogrel alone or with dual antiplatelet therapy (DAPT), cannot be recommended at present due to a paucity of available data «b»Conversion for Catheter Ablation of AF«/b» - Continuous or interrupted edoxaban may be used pre-ablation - Use of edoxaban before the procedure results in a need for increased heparin doses compared to patients on warfarin - Following ablation, if hemostasis has been achieved, edoxaban can generally be reintroduced within 4 to 8 hours after sheath removal - Edoxaban therapy should continue for a minimum of 2 to 3 months after ablation and further use should be based on CHA2DS2-VASc score «b»Conversion for Electronic Device Implantation«/b» - Edoxaban should be discontinued at least 24 hours in advance of the procedure - Typically, edoxaban can be restarted 24 to 48 hours after the procedure «b»Conversion for Neuraxial Anesthesia«/b» - No guidance is provided

Efavirenz

Sustiva

Efavirenz-Emtricitab-Tenofovir DF

Atripla

Efgartigimod

Vyvgart

Efinaconazole

Jublia

Eflapegrastim

Rolvedon

Elacestrant

Orserdu

Elagolix

Orilissa

Elagolix-Estradiol-Norethindrone

Oriahnn

Elapegademase

Revcovi

Elbasvir

Elbasvir-Grazoprevir

Zepatier

Eletriptan

Relpax

Elexacaftor-Tezacaftor-Ivacaftor

Trikafta

Eliglustat

Cerdelga

Elivaldogene Autotemcel

Skysona

«bu»Cerebral Adrenoleukodystrophy«/bu» - Slow the progression of neurologic dysfunction with early, active CALD. - Early, active CALD is defined as asymptomatic or mildly symptomatic (Neurologic Function Score [NFS] ≤1) boys who have gadolinium enhancement on brain MRI and Loes scores of 0.5-9 «b»Age: 4 to 17 years«/b» Minimum Recommended Dose: - 5 x 106 CD34+ cells/kg - Dose is calculated based on patient’s weight before first apheresis - See the Lot Information Sheet provided with product shipment for additional information pertaining to dose - One single dose for infusion containing a suspension of CD34+ cells in 1-2 infusion bags - Full myeloablative and lymphodepleting conditioning must be administered before infusion; consult prescribing information for conditioning agents before treatment - After completion of conditioning, allow at least 48 hour of washout before infusion «b»Contraception«/b» - Consult prescribing information of mobilization and conditioning agents for information on need for effective contraception - There are insufficient exposure data to provide a precise recommendation on duration of contraception following treatment - Males capable of fathering a child and their female partners of childbearing potential: Use effective method of contraception (intrauterine device or combination of hormonal and barrier contraception) from start of mobilization through at least 6 months after elivaldogene autotemcel «b»Infertility«/b» - There are no data on effects on fertility - Data are available on the risk of infertility with myeloablative conditioning - Advise patients of option to cryopreserve semen before treatment if appropriate «b»Before Therapy«/b» - Screen for hepatitis B virus (HBV), hepatitis C virus (HCV), human immunodeficiency virus 1 and 2 (HIV-1/HIV-2) and human T-lymphotropic virus 1 and 2 (HTLV-1/HTLV-2) in accordance with clinical guidelines before collecting cells for manufacturing «b»Mobilization and Apheresis«/b» - Confirm HSC transplantation is appropriate for patient - Patients are required to undergo HSC mobilization followed by apheresis to obtain CD34+ cells for product manufacturing - Weigh patient before first apheresis collection; collect a minimum target number of CD34+ cells of 12 x 106 CD34+ cells/kg - A backup collection of CD34+ cells ≥1.5 x 106 CD34+ cells/kg (if collected by apheresis) or ≥1 x 108 TNC/kg (Total Nucleated Cells, if collected by bone marrow harvest) is required - Backup collection may be needed for rescue treatment, if drug is compromised after initiation of conditioning and before its infusion, primary engraftment failure, or loss of engraftment after infusion with this drug - Collect and cryopreserve these cells before initiating conditioning and infusion with this product «b»Limitations of Use«/b» - Does not treat or prevent adrenal insufficiency - An immune response to therapy may cause rapid loss of efficacy in patients with full deletions of the human adenosine triphosphate binding cassette, sub family D, member 1 (ABCD1) gene - Not studied in CALD secondary to head trauma - Due to the risk of hematologic malignancy, and unclear long-term durability of therapy and human adrenoleukodystrophy protein (ALDP) expression, carefully consider the appropriateness and timing of treatment for each boy, especially for boys with isolated pyramidal tract disease, based on available treatment options since their clinical symptoms do not usually occur until adulthood «b»IV Administration«/b» - Autologous use only - Patient’s identity must match patient identifiers on cassette(s) and infusion bag(s) - Do not infuse if information on patient-specific label does not match intended patient - Do NOT use an inline blood filter or an infusion pump - Prime tubing of infusion set with 0.9% NaCl before infusing - Tear off the protective wrap on infusion bag to expose sterile port - Access infusion bag and infuse per treatment center’s standard procedures for administration of cell therapy products - Complete infusion as soon as possible, and ≤4 hr after thawing - Administer each infusion bag of IV infusion (drip) by gravity flow over a period of less than 60 minutes - After the entire content of the infusion bag is infused, flush remnants in infusion bag and any associated tubing with at least 50 mL of 0.9% NaCl to ensure that as many cells as possible are infused into patient - If >1 infusion bag is provided, administer each infusion bag completely before proceeding to thaw and infuse next infusion bag like in the above steps - Maintain second infusion bag, if applicable, within cold-storage dewar to maintain temperature ≤-140ºC (-220ºF) until time to thaw - After administering elivaldogene autotemcel, standard procedures for patient management after HSC transplantation should be followed - Irradiate any blood products required within first 3 months after elivaldogene autotemcel - Treated patients should not donate blood, organs, tissues, or cells at any time in the future «b»IV Preparation«/b» - Coordinate timing of thawing and infusion; confirm infusion time in advance and adjust start time of thawing such that it will be available for infusion when patient and healthcare providers are ready -Drug contains human blood cells that are genetically modified with replication-incompetent, self-inactivating Lenti-D lentiviral vector - Follow universal precautions and local biosafety guidelines for handling and disposal of elivaldogene autotemcel to avoid potential transmission of infectious diseases - Remove each metal cassette from liquid nitrogen storage - Confirm that elivaldogene autotemcel is printed on the infusion bag(s) label(s) - Confirm that patient identity matches the unique patient identification information located on infusion bag(s) - Do not infuse if information on patient-specific label on infusion bag does not match intended patient, and contact bluebird bio at 1-833-999-6378 - Dose may be contained in 1 or 2 patient-specific infusion bags; ensure that the correct number of infusion bags are present - Use the accompanying Lot Information Sheet to confirm that each infusion bag is within the expiration date before preparation for infusion - Remove overwrap and inspect each infusion bag for any breaches of integrity before thawing and infusion - If a bag is compromised, follow the local guidelines and contact bluebird bio immediately at 1-833-999-6378 - Thaw infusion bag at 37ºC (98.6ºF) in a water bath or dry bath, which may take ~2-4 minutes - Promptly remove infusion bag from bath once thawed - Do not leave bag unattended and do not submerge the infusion ports if thawed in a water bath - After thawing, massage infusion bag to gently mix and disperse clumps of cellular material until all the contents are uniform - If visible cell clumps remain, continue to gently mix the contents of the bag - Do not filter, wash, spin down and/or resuspend elivaldogene autotemcel in new media before infusing - Do not sample, alter, irradiate, or refreeze

Elosulfase Alfa

Vimizim

Elotuzumab

Empliciti

«b»IV Adminstration«/b» - For IV infusion only - Do not administer IV push or as a bolus - Premedicate with dexamethasone, acetaminophen, and an H1- and H2-blocker (see Dosing) approximately 45 to 90 minutes prior to administration - Infuse in an environment equipped to monitor for and manage infusion reactions. - Administer with an infusion set and a sterile, non-pyrogenic, low protein-binding filter (0.2 to 1.2 micrometer) using an automated infusion pump - Do not mix with or infuse with other medications - Infusion should be completed within 24 hours of reconstitution - Monitor for infusion reaction - Interrupt infusion for grade 2 or higher infusion reactions; if the reaction resolves or improves to ≤ grade 1, may resume infusion (see Dosage Adjustment for Toxicity). - Monitor vital signs every 30 minutes during and for 2 hours after the end of the infusion in patients who experience an infusion reaction. «b»Infusion Rate«/b» «bi»First Infusion (Cycle 1, Dose 1)«/bi» - Infuse at 0.5 mL/minute for the first 30 minutes - If no infusion reactions occur, may increase the rate to 1 mL/minute for the next 30 minutes - If tolerated, may then increase the rate to 2 mL/minute until infusion completion - Maximum Rate: 2 mL/minute «bi»Second Infusion (Cycle 1, Dose 2)«/bi» - If no infusion reactions occurred during the prior infusion, initiate at 3 mL/minute for the first 30 minutes - If tolerated, may then increase the rate to 4 mL/minute until infusion completion - Maximum Rate: 4 mL/minute «bi»Subsequent Infusions«/bi» - Cycle 1, Doses 3 and 4 and all subsequent infusions - If no infusion reactions occurred during the prior infusion, initiate and infuse at 5 mL/minute until completion - Maximum rate: 5 mL/minute «b»IV Reconstitution«/b» - Reconstitute the 300 mg vial with 13 mL of SWFI, and the 400 mg vial with 17 mL of SWFI (to a concentration of 25 mg/mL) with an 18-gauge or lower (eg, 17-gauge) needle. Slight back pressure may occur during reconstitution - Rotate the vial to dissolve the lyophilized powder (holding the vial upright) - To dissolve any powder on the stopper or top of the vial, invert the vial several times; avoid vigorous agitation - Do not shake - The powder should dissolve in <10 minutes - After dissolution, allow the reconstituted vials to stand for 5 to 10 minutes (solution should be colorless to slightly yellow, clear to slightly opalescent) - Discard if any particulate matter or discoloration is observed. - Each vial contains overfill to allow for withdrawal of 12 mL (300 mg vial) and 16 mL (400 mg vial), respectively - Withdraw appropriate dose from each vial (maximum of 12 mL from the 300 mg vial and 16 mL from the 400 mg vial) - Further dilute with 230 mL of NS or D5W in a polyvinyl chloride or polyolefin infusion bag; the volume of diluent may be adjusted in order to not exceed 5 mL/kg of body weight. - Do not mix with other medications. - To minimize manipulation and preparation steps, dilution in 250 mL NS or D5W (instead of 230 mL) has been reported; dilution in 500 mL NS or D5W was used if the concentration exceeded 6 mg/mL - Infusion rates followed the manufacturer's product labeling

Eltrombopag

Promacta, Revolade

- Do not use eltrombopag to normalize platelet counts. «bu»Chronic Immune (Idiopathic) Thrombocytopenia (ITP)«/bu» «b»Initial Dose«/b» - 50 mg PO once daily - 25 mg once daily for patients of East-Asian ethnicity «b»Maintenance Dose«/b» - Dose should be titrated based on platelet response - Use the lowest dose to achieve and maintain platelet count ≥50,000/mm3 as needed to reduce the risk of bleeding - Discontinue if platelet count does not respond to a level that avoids clinically important bleeding after 4 weeks at the maximum of 75 mg/day «bi»Platelet Count <50,000/mm3«/bi» - ≥2 weeks after treatment initiation or a dose increase - Increase daily dose by 25 mg (if taking 12.5 mg once daily, increase dose to 25 mg once daily prior to increasing the dose amount by 25 mg daily) - Maximum Dose: 75 mg/day «bi»Platelet Count ≥200,000/mm3 and ≤400,000/mm3 (at any time)«/bi» - Reduce daily dose by 25 mg (if taking 25 mg once daily, decrease dose to 12.5 mg once daily) - Reassess in 2 weeks «bi»Platelet Count >400,000/mm3«/bi» - Withhold dose - Assess platelet count twice weekly - When platelet count <150,000/mm3, resume with the daily dose reduced by 25 mg (if taking 25 mg once daily, resume with 12.5 mg once daily) «bi»Platelet Count >400,000/mm3 after 2 weeks at the Lowest Dose«/bi» - Discontinue treatment «b»Maximum Dose«/b» - 75 mg/day «bu»Chronic Hepatitis C-associated Thrombocytopenia«/bu» «b»Initial Dose«/b» - 25 mg PO once daily «b»Maintenance Dose«/b» - Dose should be titrated based on platelet response - Use the lowest dose to achieve the target platelet count necessary to initiate antiviral therapy (peginterferon and ribavirin) or to avoid dose reductions of peginterferon during antiviral therapy. - Discontinue when antiviral therapy is stopped «bi»Platelet Count <50,000/mm3 (after at least 2 weeks)«/bi» - Increase daily dose by 25 mg every 2 weeks - Maximum dose: 100 mg/day «bi»Platelet Count ≥200,000/mm3 and ≤400,000/mm3 (at any time)«/bi» - Reduce daily dose by 25 mg - Reassess in 2 weeks «bi»Platelet Count >400,000/mm3«/bi» - Withhold dose - Assess platelet count twice weekly - When platelet count <150,000/mm3, resume with the daily dose reduced by 25 mg (if taking 25 mg once daily, resume with 12.5 mg once daily) «bi»Platelet Count >400,000/mm3 after 2 weeks at the lowest dose«/bi» - Discontinue treatment «b»Maximum Dose«/b» - 100 mg/day «bu»Severe Aplastic Anemia«/bu» Initial Dose - 50 mg PO once daily - 25 mg once daily for patients of East-Asian ethnicity Maintenance Dose - Dose should be titrated based on platelet response - Use the lowest dose to achieve and maintain hematologic response. Hematologic response may take up to 16 weeks and requires dose titration - Discontinue therapy if hematologic response is not achieved after 16 weeks of treatment, for excessive platelet responses or for liver function abnormalities. Maximum Dose - 150 mg/day «b»Dosage Adjustment Based on Platelet«/b» Platelet count <50,000/mm3 - ≥2 weeks after treatment initiation or a dose increase - Increase daily dose by 50 mg (if taking 25 mg once daily - Increase dose to 50 mg once daily prior to increasing the dose amount by 50 mg daily) - Maximum Dose: 150 mg/day Platelet count ≥200,000/mm3 and ≤400,000/mm3 (at any time) - Reduce daily dose by 50 mg - Reassess in 2 weeks Platelet count >400,000/mm3 - Withhold dose for 1 week; when platelet count <150,000/mm3, resume with the daily dose reduced by 50 mg Platelet count >400,000/mm3 after 2 weeks at the lowest dose - Discontinue treatment - For patients who achieve tri-lineage response, including transfusion independence, lasting at least 8 weeks, may reduce the dose by 50% - If counts remain stable after 8 weeks at the reduced dose, discontinue and monitor blood counts. If platelets counts drop to <30,000/mm3, hemoglobin to <9 g/dL, or ANC to <500/mm3, may reinitiate at the prior effective dose «b»Limitations of Use«/b» - For ITP, eltrombopag should only be used if the degree of thrombocytopenia and clinical condition increase the risk for bleeding. - For chronic hepatitis C (CHC), eltrombopag should only be used if the degree of thrombocytopenia prevents initiation of or limits the ability to maintain interferon-based therapy - Safety and efficacy have not been established when used in combination with direct-acting antiviral agents without interferon for treatment of CHC infection - Eltrombopag is not indicated for the treatment of myelodysplastic syndromes (MDS).

Eluxadoline

Viberzi

Elvitegravir

Elvitegravir-Cobicistat-Emtricitabine-Tenofovir AF

Genvoya

Elvitegravir-Cobicistat-Emtricitabine-Tenofovir DF

Stribild

Emapalumab

Gamifant

«bu»Hemophagocytic Lymphohistiocytosis«/bu» Initial Dose - 1 mg/kg IV twice weekly (every 3-4 days) «b»Subsequent Doses After Initiation«/b» - Dose may be increased based on clinical laboratory criteria - Day 3: Increase to 3 mg/kg - From Day 6 onwards: Increase to 6 mg/kg - From Day 9 onwards: Increase to 10 mg/kg; increase only if assessment by physician determines a further increased dose is beneficial as based on initial signs of response «b»Platelet Count«/b» - If baseline <50,000/mm³ and no improvement to >50,000/mm³ - If baseline >50,000/mm³ and <30% improvement - If baseline >100,000/mm³ any decrease to <100,000/mm³ «b»Neutrophil Count«/b» - If baseline <500/mm³ and no improvement to >500/mm³ - If baseline >500-1000/mm³ and decrease to <500/mm³ - If baseline 1,000-1,500/mm³ and decrease to <1,000/mm³ «b»Ferritin«/b» - If baseline ≥3,000 ng/mL and <20% decrease - If baseline <3,000 ng/mL and any increase to >3,000 ng/mL «b»Fibrinogen«/b» - If baseline levels ≤100 mg/dL and no improvement - If baseline levels >100 mg/dL and any decrease to <100 mg/dL «b»Other Criteria«/b» - Fever: Persistence or recurrence - Splenomegaly: Any worsening - Coagulopathy (both D-dimer and fibrinogen must apply): D-dimer abnormal at baseline and no improvement «b»Premedication«/b» «bi»Dexamethasone«/bi» - If not already taking dexamethasone, begin daily dose of at least 5-10 mg/m² the day before initiating emapalumab; patients already receiving baseline dexamethasone, continue regular dose provided if at least 5 mg/m² - Administer prophylaxis for herpes zoster, Pneumocystis jirovecii infection, and fungal infections before initiating emapalumab «b»Before Initiating Treatment«/b» - Conduct testing for latent TB infections using purified protein derivative (PPD) or IFN-gamma release assay and evaluate patients for TB risk factors - Administer TB prophylaxis to patients at risk or who have tested positive «b»During Treatment«/b» - Monitor for TB, adenovirus infection, EBV infection, and CMV infection q2wk and as clinically indicated

Emedastine Difumarate

Emadine

Emicizumab

Hemlibra

Empagliflozin

Jardiance

Empagliflozin-Linagliptin

Glyxambi

Empagliflozin-Metformin

Synjardy

Emtricitabine

Emtriva, Coviracil

Emtricitabine-Rilpivirine-Tenofovir AF

Odefsey

Emtricitabine-Rilpivirine-Tenofovir DF

Complera

Emtricitabine-Tenofovir AF

Descovy

Emtricitabine-Tenofovir DF

Truvada

Enalapril

Vasotec, Epaned

- Administer without regard to meals «b»Oral Solution (1 mg/mL) Preparation«/b» - Kit contains 1 bottle of enalapril powder and 1 bottle of Ora-Sweet SF dilution to be added to the enalapril powder prior to dispensing - Firmly tap the enalapril powder for oral solution bottle on a hard surface 5 times - Add approximately one-half (75 mL) of the Ora-Sweet SF diluent to the enalapril 150 mL oral solution bottle and shake well for 30 seconds - Add the remainder of the Ora-Sweet SF diluent and shake well for an additional 30 seconds - May be used for 60 days after reconstitution. «b»Oral Suspension (1 mg/mL) Preparation«/b» - A 1 mg/mL oral suspension may be made with tablets, Bicitra [discontinued] or equivalent, and Ora-Sweet SF - Place ten 20 mg tablets in a 200 mL polyethylene terephthalate bottle; add 50 mL of Bicitra [discontinued] or equivalent and shake well for at least 2 minutes - Let stand for 1 hour then shake for 1 additional minute; add 150 mL of Ora-Sweet SF and shake well - Label "shake well" and "refrigerate" - Stable for 30 days when stored in a polyethylene terephthalate bottle and refrigerated - A 1 mg/mL oral suspension may be made with tablets and one of three different vehicles (cherry syrup, a 1:1 mixture of Ora-Sweet and Ora-Plus, or a 1:1 mixture of Ora-Sweet SF and Ora-Plus) - Crush six 20 mg tablets in a mortar and reduce to a fine powder - Add 15 mL of the chosen vehicle and mix to a uniform paste; mix while adding the vehicle in incremental proportions to almost 120 mL; transfer to a calibrated bottle, rinse mortar with vehicle, and add quantity of vehicle sufficient to make 120 mL - Label “shake well” and “protect from light” - Stable for 60 days when stored in amber plastic prescription bottles in the dark at room temperature or refrigerated «b»Oral Suspension (0.1 mg/mL) Preparation«/b» - A more dilute, 0.1 mg/mL oral suspension may be made with tablets and an isotonic buffer solution at pH 5.0 - Grind one 20 mg tablet in a glass mortar and reduce to a fine powder - Mix with isotonic citrate buffer (pH 5.0) and filter; add quantity of buffer solution sufficient to make 200 mL - Label "shake well", "protect from light", and "refrigerate" - Stable for 90 days

Enalapril-Hydrochlorothiazide

Vaseretic

Enalaprilat (IV)

Vasotec (IV)

Enasidenib

IDHIFA, Idhifa

Encorafenib

Braftovi

Enfortumab Vedotin

Padcev

«bu»Urothelial Carcinoma«/bu» - 1.25 mg/kg (up to 125 mg) IV on Days 1, 8 and 15 of a 28-day cycle - Continue until disease progression or unacceptable toxicity «b»Weight ≥100kg«/b» - Maximum Dose: 125 mg/dose «b»Contraception«/b» «bi»Females of Reproductive Potential«/bi» - Use effective contraception during treatment and for 2 months after the last dose «bi»Males with Female Partners of Reproductive Potential«/bi» - Use effective contraception during treatment and for 4 months after the last dose «b»Infertility«/b» «bi»Males«/bi» - Based on findings from animal studies, may impair male fertility «b»Recommended Dose Reduction Schedule«/b» First Dose Reduction - 1 mg/kg up to 100 mg Second Dose Reduction - 0.75 mg/kg up to 75 mg Third Dose Reduction - 0.5 mg/kg up to 50 mg «b»Hyperglycemia«/b» «bi»Blood glucose >250 mg/dL«/bi» - Withhold until blood glucose improves to ≤250 mg/dL, then resume at the same dose level «b»Peripheral Neuropathy«/b» «bi»Grade 2«/bi» - Withhold until Grade ≤1, then resume at same dose level (if first occurrence) - For recurrence, withhold until Grade ≤1 then, resume at reduced dose by 1 level «bi»Grade ≥3«/bi» - Permanently discontinue «b»Skin Reactions«/b» «bi»Grade 3 (Severe)«/bi» - Withhold until Grade ≤1, then, - Resume at same dose level, or consider dose reduction by 1 dose level «bi»Grade 4 or Recurrent Grade 3«/bi» - Permanently discontinue «b»Other Non-hematologic Toxicity«/b» «bi»Grade 3«/bi» - Withhold until Grade ≤1, then, - Resume at the same dose level or consider dose reduction by 1 dose level «bi»Grade 4«/bi» - Permanently discontinue «b»Hematologic Toxicity«/b» «bi»Grade 3, or Grade 2 Thrombocytopenia«/bi» - Withhold until Grade ≤1, then, - Resume at the same dose level or consider reduction by 1 dose level «bi»Grade 4«/bi» - Withhold until Grade ≤1, then, - Reduce by 1 dose level or discontinue treatment

Enfuvirtide

Fuzeon

Enoxaparin

Lovenox

- One mg of enoxaparin is equal to 100 units of anti-Xa activity «bu»DVT Prophylaxis«/bu» «b»Obesity«/b» - In morbidly-obese patients (BMI ≥40 kg/m2), increasing the prophylactic dose by 30% may be appropriate for some indications - For bariatric surgery, dose increases may be >30% based on clinical trial data. «b»Abdominal Surgery«/b» - 40 mg SC once daily, with initial dose given 2 hours prior to surgery - Continue until risk of DVT has diminished (usually 7 to 10 days). «b»Hip Replacement Surgery«/b» - 30 mg SC every 12 hours with initial dose within 12 to 24 hours after surgery, and every 12 hours for at least 10 days or until risk of DVT has diminished or the patient is adequately anticoagulated on warfarin. - 40 mg SC once daily, with initial dose within 9 to 15 hours before surgery, and daily for at least 10 days (or up to 35 days postoperatively) or until risk of DVT has diminished or the patient is adequately anticoagulated on warfarin «b»Knee Replacement Surgery«/b» - 30 mg SC every 12 hours, with initial dose within 12 to 24 hours after surgery, and every 12 hours for at least 10 days or until risk of DVT has diminished or the patient is adequately anticoagulated on warfarin «b»Medical Patients with Severely Restricted Mobility During Acute Illness«/b» - 40 mg SC once daily - Continue until risk of DVT has diminished (usually 6 to 11 days) - In hospitalized cancer patients, the recommended duration of therapy is length of hospital stay or until fully ambulatory «b»Major Surgery in Cancer Patients«/b» - 30 mg SC 2 to 4 hours prior to surgery, then, - 40 mg once daily thereafter - 40 mg 10 to 12 hours prior to surgery, then, - 40 mg once daily thereafter «b»Treatment Duration«/b» - Treatment duration should be at least 7 to 10 days - Prolonged treatment up to 4 weeks should be considered in patients undergoing major abdominal or pelvic surgery for cancer with high-risk features: limited mobility, obesity, VTE history, comorbid conditions «bu»Bariatric Surgery«/bu» «b»Roux-en-Y gastric Bypass«/b» «bi»BMI ≤50 kg/m2«/bi» - 40 mg every 12 hours «bi»BMI >50 kg/m2«/bi» - 60 mg every 12 hours «bu»Prevention of Recurrent Venous Thromboembolism in Pregnancy«/bu» - 40 mg SC once daily - Therapy should continue for 6 weeks postpartum in high-risk women «bu»DVT or Pulmonary Embolism (PE) Treatment«/bu» - 1 mg/kg/dose SC every 12 hours OR - 1.5 mg/kg SC once daily - In patients transitioning to warfarin, start warfarin on the first or second treatment day and continue enoxaparin until INR is ≥2 for at least 24 hours (usually 5 to 7 days) «b»Obesity«/b» - Use actual body weight to calculate dose - A fixed upper dose limit is not recommended, however, increased monitoring and dosage adjustment based on anti-Xa levels may be warranted - Use of twice daily dosing preferred «b»Pregnant Women«/b» - 1 mg/kg/dose every 12 hours - Discontinue ≥24 hours prior to the induction of labor or cesarean section - Continue anticoagulation therapy for ≥6 weeks postpartum (minimum duration of therapy: 3 months) - LMWH or heparin therapy is preferred over warfarin during pregnancy «bi»Duration of Therapy«/bi» - Based on the cause of VTE, risk of recurrence and risk of bleeding «bu»Percutaneous Coronary Intervention (PCI)«/bu» «b»Adjunctive Therapy«/b» - If patient undergoing PCI has been treated with multiple doses of enoxaparin and PCI occurs within 8 hours after the last SC enoxaparin dose: No additional enoxaparin is needed. - If PCI occurs 8 to 12 hours after the last SC enoxaparin dose or the patient received only 1 therapeutic SC dose (eg, 1 mg/kg): Administer a single IV dose of 0.3 mg/kg. - If PCI occurs >12 hours after the last SC dose: May use an established anticoagulation regimen (full-dose unfractionated heparin or bivalirudin). - If patient has not received prior anticoagulant therapy: 0.5 to 0.75 mg/kg IV bolus dose «bu»ST-elevation MI (STEMI)«/bu» «b»Patients <75 years«/b» - Initial Dose: 30 mg IV single bolus plus 1 mg/kg SC every 12 hours - Maximum Dose: 100 mg for the first 2 doses only - The first SC dose should be administered with the IV bolus - Maintenance Dose: After first 2 doses, administer 1 mg/kg SC every 12 hours. «b»Patients ≥75 years«/b» - Initial Dose: 0.75 mg/kg SC every 12 hours - No IV bolus is administered in this population - Maximum dose of 75 mg is recommended for the first 2 doses - Maintenance Dose: After first 2 doses, administer 0.75 mg/kg SC every 12 hours «b»Obesity«/b» - Use weight-based dosing - Maximum dose of 100 mg is recommended for the first 2 doses - Therapy may be continued for up to 8 days or until revascularization «bu»Mechanical Heart Valve to Bridge Anticoagulation«/bu» - 1 mg/kg SC every 12 hours - If used in pregnant patients, target anti-Xa level of 0.8 to 1.2 units/mL, 4 to 6 hours post-dose «bu»Unstable Angina or Non-ST-Elevation MI (NSTEMI)«/bu» - 1 mg/kg every 12 hours in conjunction with oral aspirin therapy - Continue for the duration of hospitalization or until PCI is performed «b»Obesity«/b» - Use actual body weight to calculate dose - A fixed upper dose limit is not recommended «b»Conversion from UFH IV infusion to SC Enoxaparin«/b» - Calculate specific dose for enoxaparin based on indication - Discontinue UFH and begin enoxaparin within 1 hour. «b»Conversion from Enoxaparin SC to UFH IV Infusion«/b» «bi»Converting from a Prophylactic Enoxaparin SC 30 mg bid to a therapeutic UFH IV Infusion«/bi» - There should not be any delay in starting the UFH IV infusion - May include an UFH bolus/loading dose, when indicated - Discontinue enoxaparin, calculate specific dose for UFH IV infusion based on indication, omit UFH bolus/loading dose «bi»Converting from Enoxaparin SC dosed every 12 hours«/bi» - Start UFH IV infusion 10 to 11 hours after last dose of enoxaparin «bi»Converting from Enoxaparin SC dosed every 24 hours«/bi» - Start UFH IV infusion 22 to 23 hours after last dose of enoxaparin «bu»Venous Thromboembolism Extended Treatment in Cancer Patients«/bu» «b»Months 1 to 6«/b» - Initial Dose: 1 mg/kg/dose SC every 12 hours or - 1.5 mg/kg once daily for 5 to 10 days - Continue for up to 6 months for maintenance therapy - Warfarin may be used for maintenance therapy; however, meta-analyses and randomized control trials have validated the superiority of LMWH over warfarin - If warfarin is to be used for maintenance therapy, overlap enoxaparin with warfarin for a minimum of 5 to 7 days and continue until INR in therapeutic range for at least 48 hours «b»Maintenance Beyond 6 months«/b» - ACCP and ASCO guidelines for VTE prophylaxis/treatment recommend considering continuing anticoagulation beyond 6 months in selected patients due to the persistent high risk of recurrence in those with active cancer; consider risk vs. benefit of bleeding and recurrence

Entacapone

Comtan

Entecavir

Baraclude

Entrectinib

Rozlytrek

Enzalutamide

Xtandi

ePHEDrine

Akovaz, Corphedra, Emerphed, Rezipres

ePHEDrine-GuaiFENesin

Primatene Asthma, Bronkaid

Epinastine

Elestat

EPINEPHrine

EpiPen, Adyphren, Adrenaline, Auvi-Q, Allerject, Symjepi, Twinject

EPINEPHrine (Nasal)

Adrenalin

EPINEPHrine Bitartrate (Oral Inhalation)

Asthmanefrin, Micronefrin, Racepinephrine

EpiRUBicin

Ellence, Pidorubicin, Epidoxorubicin

Eplerenone

Inspra

Epoetin Alfa

Epogen, Eprex, Erythropoietin, Procrit, EPO, Retacrit,

Epoprostenol

Flolan, Veletri, Prostacyclin

«bu»Pulmonary Arterial Hypertension (PAH)«/bu» «b»Initial Dose«/b» - 2 ng/kg/minute - A lower initial dose may be used if patient is intolerant of starting dose «b»Maintenance Dose«/b» - Increase dose in increments of 1 to 2 ng/kg/minute at intervals of ≥15 minutes until dose-limiting side effects (flushing, jaw pain, headache, hypotension, nausea) are noted or response to epoprostenol plateaus - The dose may also be lowered by 1 to 2 ng/kg/minute every 15 minutes to a dose that is tolerated. «b»Usual Optimal Monotherapy Dose«/b» - 25 to 40 ng/kg/minute - Significant patient variability in optimal dose exists - Maximum dose with chronic therapy has not been defined; however, doses as high as 195 ng/kg/minute have been described in children «b»Dose Adjustment During Chronic Phase of Treatment«/b» - If PAH symptoms persist or recur following improvement, increase dose in 1 to 2 ng/kg/minute increments at intervals of ≥15 minutes - May also increase dose at intervals of 24 to 48 hours or longer (every 1 to 2 weeks) - The need for increased doses should be expected with chronic use; incremental increases occur more frequently during the first few months after the drug is initiated. - In case of dose-limiting pharmacologic events (hypotension, severe nausea, vomiting), decrease dose in 2 ng/kg/minute decrements at intervals of ≥15 minutes until dose-limiting effects resolve. Avoid abrupt withdrawal or sudden large dose reductions. Note: Adverse event may resolve without dosage adjustment. «bi»Lung Transplant«/bi» - In patients receiving lung transplants, epoprostenol may be tapered after sequential lung transplantation once the allografts have been reperfused. If cardiopulmonary bypass utilized, epoprostenol may be tapered after pump perfusion has been initiated. «bu»Acute Vasodilator Testing in Patients with PAH«/bu» - Acute vasodilator testing should only be done in patients who might be considered candidates for calcium channel blocker therapy. «b»Initial Dose«/b» - 2 ng/kg/minute - Increase dose in increments of 2 ng/kg/min every 10 to 15 minutes - Dosing Range During Testing: 2 to 12 ng/kg/minute «bu»Hypoxia Secondary to Acute Respiratory Distress Syndrome«/bu» «b»Initial Dose«/b» - 0.01 to 0.05 mcg/kg/minute inhalation - Increase dose in stepwise fashion based on efficacy and tolerability - Wean by reducing dose by 0.01 mcg/kg/minute every 1 to 2 hours as tolerated «bu»Flolan IV Preparation«/bu» «b»3000 ng/mL«/b» - 0.5 mg vial/5 mL mfr supplied sterile diluent - Withdraw 3 mL; and add sufficient diluent to make 100 mL «b»5000 ng/mL«/b» - 0.5 mg vial/5 mL mfr supplied sterile diluent - Withdraw entire vial; and add sufficient diluent to make 100 mL «b»10,000 ng/mL«/b» - two 0.5 mg vials each in 5 mL mfr supplied sterile diluent - Withdraw entire vial; and add sufficient diluent to make 100 mL «b»15,000 ng/mL«/b» - 1.5 mg vial/5 mL mfr supplied sterile diluent - Withdraw entire vial; and add sufficient diluent to make 100 mL - Do not use preparation and administration materials containing polyethylene terephthalate (PET) or polyethylene terephthalate glycol (PETG); PET/PETG products may become damaged when used with Flolan’s mfr supplied with sterile diluent which is alkaline (pH 12) «bu»Veletri IV Preparation«/bu» - Reconstituted in vial with only 5 mL of either sterile water for injection or 0.9% NaCl - Further dilute reconstituted product with same diluent used for reconstitution - Solutions of 15,000 ng/mL or above may be used for up to 25 hr at room temperature - Lower concentrations may be used with pump reservoir changed q12hr at room temperature «bu»IV Administration«/bu» - For IV use via an infusion pump. - Use infusion sets with an in-line 0.22 micron filter. - When administered on an ongoing basis, must be infused through a central venous catheter. - Peripheral infusion may be used temporarily until central line is established. - Do not administer as a bolus injection. - Avoid abrupt withdrawal (including interruptions in delivery) or sudden large reductions in dosing. - The ambulatory infusion pump should be small and lightweight, be able to adjust infusion rates in 2 ng/kg/minute increments, have occlusion, end of infusion, and low battery alarms, have ± 6% accuracy of the programmed rate, and have positive continuous or pulsatile pressure with intervals ≤3 minutes between pulses. - The reservoir should be made of polyvinyl chloride, polypropylene, or glass. - Immediate access to back up pump, infusion sets and medication is essential to prevent treatment interruptions. Consult manufacturer’s labeling for infusion rate example calculations. «b»Inhalation Administration: Intraoperative Administration«/b» - Administer via jet nebulizer connected to the inspiratory limb of the ventilator near the endotracheal tube with a bypass oxygen flow of 8 L/minute to achieve administration of a high proportion of small particles «bu»Post-cardiothoracic Surgery«/bu» - May also be administered via jet nebulizer connected to the inspiratory limb of the ventilator near the endotracheal tube or via face mask with a Venturi attachment for aerosolization with a bypass oxygen flow of 2 to 3 L/minute. - Glycine buffer diluent may cause ventilator valve malfunction; it has been recommended that filters be changed on the ventilator every 2 hours; may also use a ventilator heating coil. «b»Administration after Induction of Anesthesia before Incision«/b» - 60 mcg (4 mL of 15,000 ng/mL concentration) via jet nebulizer - Effect persists for ~25 minutes «b»Intraoperative Administration«/b» - Nebulization via ventilator circuit - Using a 15,000 ng/mL concentration and an oxygen flow of 8 L/minute - Begin administration via jet nebulizer 5 minutes prior to weaning from CPB - Discontinue at least 60 minutes after CPB weaned «bu»Post-cardiothoracic Surgery Pulmonary Hypertension, Right Ventricular Dysfunction, or Refractory Hypoxemia«/bu» «b»Inhalation«/b» - Study utilized Flolan brand; however, formulary status of epoprostenol formulations may vary with some institutions utilizing Veletri, the more thermostable formulation - If using Flolan, may need to change ventilator filter every 2 hours due to glycine buffer diluent ; may cause ventilator valve malfunction - Tidal volume delivered by ventilator may require adjustment. «b»Nebulization via Ventilator Circuit«/b» - Using a 20,000 ng/mL concentration; prime nebulizer chamber with 15 mL - Administer remainder at a constant rate of 8 mL/hour - Delivers ~38 ng/kg/minute (based on a 70 kg patient) - Set oxygen flow at 2 to 3 L/min - Wean as tolerated - Although not achieved with this regimen, in general, doses >50 ng/kg/minute do not provide additional benefit, may increase the risk of hypotension, and should be avoided. «b»Nebulization via Facemask with Venturi Attachment«/b» - Using a 20,000 ng/mL concentration, prime nebulizer chamber with 15 mL - Set oxygen flow at 2 to 3 L/minute - 8 mL/hour will be nebulized - Wean as tolerated. «b»Weaning Procedure«/b» - Reduce dose by 50% every 2 to 4 hours (20,000 ng/mL to 10,000 ng/mL to 5,000 ng/mL) until a concentration of 2,500 ng/mL is reached - Carefully discontinue once patient remains stable on this concentration for at least 4 hours.

Eprosartan

Teveten

Eprosartan-Hydrochlorothiazide

Teveten HCT

Eptifibatide

Integrilin

Eptinezumab

Vyepti

Eravacycline

Xerava

Erdafitinib

Balversa

«bu»Urothelial Carcinoma«/bu» - Initial Dose: 8 mg PO daily - Increase to 9 mg PO daily based on serum phosphate (PO4) levels and tolerability at 14-21 days - Increase dose to 9 mg PO daily if serum phosphate level <5.5 mg/dL and there are no ocular disorders or ≥Grade 2 adverse reactions - Continue until disease progression or unacceptable toxicity «b»Vomited Dose«/b» - If vomiting occur any time after taking erdafitinib, the next dose should be taken the next day «b»Missed Dose«/b» - Take missed dose as soon as possible on the same day - Resume regular daily dose schedule the next day - Extra tablets should not be taken to make up for the missed dose «b»Infertility«/b» - Based on findings in animal studies, may impair fertility in females of reproductive potential «b»Contraception«/b» «bi»Females«/bi» - Advise females of reproductive potential to use effective contraception during treatment and for 1 month after last dose «bi»Males«/bi» - Advise male patients with female partners of reproductive potential to use effective contraception during treatment and for 1 month after last dose «b»Dose Reduction Schedule«/b» 9 mg/day reduction schedule - First: 8 mg/day - Second: 6 mg/day - Third: 5 mg/day - Fourth: 4 mg/day - Fifth: Stop drug if fifth reduction needed 8 mg/day reduction schedule - First: 6 mg/day - Second: 5 mg/day - Third: 4 mg/day - Fourth: Stop drug if fourth reduction needed «b»Hyperphosphatemia«/b» - In all patients, restrict phosphate intake to 600-800 mg/day; if serum phosphate >7 mg/dL, consider adding oral phosphate binder until serum phosphate level returns to <5.5 mg/dL «bi»Phosphate Levels and Dosage«/bi» 5.6-6.9 mg/dL (1.8-2.3 mmol/L) - Continue at current dose 7-9 mg/dL (2.3-2.9 mmol/L) - Withhold drug; reassess weekly until phosphate <5.5 mg/dL (or baseline), then, - Resume drug at same dose level - Implement dose reduction if hyperphosphatemia lasts >1 week >9 mg/dL (>2.9 mmol/L) - Withhold drug - Reassess weekly until phosphate <5.5 mg/dL (or baseline), then, - Restart drug at 1 dose level lower >10 mg/dL (>3.2 mmol/L) or significantly altered baseline renal function or Grade 3 hypercalcemia - Withhold drug - Reassess weekly until phosphate <5.5 mg/dL (or baseline), then, - Restart drug at 2 dose levels lower «b»Central Serous Retinopathy or Retinal Pigment Epithelial Detachment (CSR/RPED)«/b» «bi»Grade 1«/bi» - Asymptomatic; clinical or diagnostic observations only - Withhold drug until resolution - If resolves within 4 weeks, resume at the next lower dose level; then, if no recurrence for a month, consider reescalation - If stable for 2 consecutive eye examinations, but not resolved, resume at the next lower dose level «bi»Grade 2«/bi» - Visual acuity 20/40 or better or ≤3 lines of decreased vision from baseline - Withhold until resolution - If resolves within 4 weeks, may resume at the next lower dose level «bi»Grade 3«/bi» - Visual acuity worse than 20/40 or >3 lines of decreased vision from baseline - Withhold until resolution - If resolves within 4 weeks, may resume 2 dose levels lower - If recurs, consider permanent discontinuation «bi»Grade 4«/bi» - Visual acuity 20/200 or worse in affected eye - Permanently discontinue «b»Other Adverse Reactions«/b» «bi»Grade 3«/bi» - Withhold drug until resolves to Grade 1 or baseline, then may resume dose 1 level lower «bi»Grade 4«/bi» - Permanently discontinue

Erenumab

Aimovig

Ergocalciferol

Drisdol, Calcidol, Calciferol, Drisdol, Vitamin D2

Ergoloid Mesylates

Hydergine

Ergotamine

Ergomar

Ergotamine-Caffeine

Ercaf, Migergot, Cafergot

EriBULin

Halaven

Erlotinib

Tarceva

«bu»Non-Small Cell Lung Cancer (NSCLC)«/bu» «b»Metastatic«/b» - In patients with EGFR exon 19 deletions or exon 21 (L858R) substitution mutations - 150 mg PO once daily until disease progression or unacceptable toxicity «bu»Pancreatic Cancer«/bu» - 100 mg PO once daily in combination with gemcitabine - Continue until disease progression or unacceptable toxicity «b»Limitations of Use«/b» - Use in combination with platinum-based chemotherapy is not recommended. Safety and efficacy of treatment for metastatic NSCLC with EGFR mutations other than exon 19 deletion or exon 21 (L858R) substitution have not been established. «b»Strong CYP3A4 Inhibitors«/b» - Avoid concurrent use if possible - Reduce erlotinib dose for severe adverse reactions if erlotinib is administered concomitantly with strong CYP3A4 inhibitors - Dose reduction should be done in decrements of 50 mg (after toxicity has resolved to baseline or ≤ grade 1). «b»Concomitant CYP3A4 and CYP1A2 Inhibitor«/b» - Avoid concurrent use if possible - If concomitant use cannot be avoided, reduce dose in decrements of 50 mg if severe adverse reactions occur (after toxicity has resolved to baseline or ≤ grade 1). «b»CYP3A4 Inducers«/b» - Avoid concurrent use if possible - If concomitant administration with CYP3A4 inducers cannot be avoided, increase erlotinib dose in 50 mg increments at 2-week intervals to a maximum of 450 mg - Reduce erlotinib dose to recommended starting dose when CYP3A4 inducer is discontinued. «b»CYP1A2 Inducers«/b» - Avoid concurrent moderate CYP1A2 inducers if possible - If unavoidable, increase dose at 2-week intervals in 50 mg increments to a maximum dose of 300 mg (with careful monitoring); immediately reduce erlotinib dose to recommended starting dose (based on indication) upon discontinuation of the moderate CYP1A2 inducer. «b»Dosage Adjustment for Concomitant Smoking«/b» - Avoid tobacco smoking if possible - If unavoidable, increase dose at 2-week intervals in 50 mg increments to a maximum dose of 300 mg (with careful monitoring); immediately reduce erlotinib dose to recommended starting dose (based on indication) upon smoking cessation. «b»Dermatologic Toxicity«/b» «bi»Bullous, Blistering, or Exfoliative Skin Toxicity (Severe)«/bi» - Discontinue treatment. «bi»Severe Rash (Unresponsive to Medical Management)«/bi» - Withhold treatment - May reinitiate with a 50 mg dose reduction after toxicity has resolved to baseline or ≤ grade 1. «b»Gastrointestinal Toxicity«/b» «bi»Diarrhea«/bi» - Manage with loperamide - In persistent, severe diarrhea (unresponsive to loperamide) or dehydration due to diarrhea, withhold treatment - May reinitiate with a 50 mg dose reduction after toxicity has resolved to baseline or ≤ grade 1. «bi»Gastrointestinal Perforation«/bi» - Discontinue treatment «b»Ocular Toxicities«/b» «bi»Acute or Worsening Ocular Toxicities (Eye Pain)«/bi» - Interrupt and consider discontinuing treatment - If therapy is resumed, reinitiate with a 50 mg dose reduction after toxicity has resolved to baseline or ≤ grade 1. «bi»Corneal Perforation or Severe Ulceration«/bi» - Discontinue treatment. «bi»Keratitis (Grade 3 or 4 or Grade 2 Persisting >2 weeks)«/bi» - Withhold treatment - May reinitiate with a 50 mg dose reduction after toxicity has resolved to baseline or ≤ grade 1. «b»Pulmonary Symptoms«/b» «bi»Acute Onset (or worsening) of Pulmonary Symptoms (Dyspnea, Cough, Fever)«/bi» - Withhold treatment while evaluating for drug-induced interstitial lung disease - If resuming treatment, reinitiate with a 50 mg dose reduction after symptoms resolve to grade 1 or lower - Discontinue permanently with development of interstitial lung disease

Ertapenem

INVanz

- IV therapy may be administered for up to 14 days - IM for up to 7 days «bu»Community-Acquired Pneumonia (CAP)«/bu» - 1 g IM/IV once daily x 10 to 14 days - Duration includes possible switch to appropriate oral therapy after at least 3 days of parenteral treatment, once clinical improvement demonstrated «bu»Complicated Urinary Tract Infections«/bu» «b»Pyelonephritis«/b» - 1 g IM/IV once daily x 10 to 14 days - Duration includes possible switch to appropriate oral therapy after at least 3 days of parenteral treatment, once clinical improvement demonstrated «bu»Intra-abdominal Infection«/bu» - 1 g IM/IV once daily x 5 to 14 days - Treatment duration of 4 to 7 days (provided source controlled) for community-acquired, mild to moderate intra-abdominal infections «bu»Osteomyelitis«/bu» «b»Native Vertebral due to Enterobacteriaceae«/b» - 1 g IV once daily x 6 weeks «bu»Acute Pelvic Infections«/bu» - 1 g IV/IM once daily x 3-10 days «bu»Surgical Site Infection Following Colorectal Surgery«/bu» «b»Prophylaxis«/b» - 1 g as a single dose given 1 hour pre-operatively «bu»Skin and Skin Structure Infections«/bu» - 1 g IV/IM once daily for 7 to 14 days - For diabetic foot infections, recommended treatment duration is up to 4 weeks depending on severity of infection and response to therapy «bu»IV Catheter-related Bloodstream Infection«/bu» - 1 g IV once daily - Carbapenems, including ertapenem, are preferred agents for extended-spectrum β-lactamase [ESBL]-positive Escherichia coli and Klebsiella, Enterobacter, and Serratia «bu»Prosthetic Joint Infection«/bu» - 1 g IV every 24 hours for 4 to 6 weeks «bu»Skin and Soft Tissue Necrotizing Infections«/bu» - 1 g IV once daily in combination with an agent effective against MRSA (vancomycin, linezolid, daptomycin) for empiric therapy of polymicrobial (mixed) infections - Continue until further debridement is not necessary, patient has clinically improved, and patient is afebrile for 48 to 72 hours «bu»Surgical Site Infection«/bu» «b»Intestinal or Genitourinary Tract Surgery«/b» - 1 g IV once daily

Ertugliflozin

Steglatro

Ertugliflozin-Metformin

Segluromet

Ertugliflozin-Sitagliptin

Steglujan

Erythromycin

Erythro-Rx, Erythrocin, E.E.S, Ery-Tab

- Due to differences in absorption, 400 mg erythromycin ethylsuccinate produces the same serum levels as 250 mg erythromycin base or stearate. «bu»Usual Dosage Range«/bu» «b»Erythromycin Base«/b» - 250 to 500 mg PO every 6 to 12 hours - Maximum PO Dose 4 g PO daily «b»Erythromycin Ethylsuccinate«/b» - 400 to 800 mg PO every 6 to 12 hours - Maximum PO Dose: 4 g PO daily «b»Erythromycin Lactobionate«/b» - 15 to 20 mg/kg/day IV divided every 6 hours - 500 mg to 1 g IV every 6 hours - Maximum IV Dose: 4 g daily «bu»Acne Vulgaris«/bu» «b»Alternative Therapy«/b» - Initial Dose: 250 to 500 mg (base) PO bid, then, - 250 to 500 mg (base) PO once daily - The shortest possible duration should be used to minimize development of bacterial resistance; re-evaluate at 3 to 4 months «bu»Bartonella Infections«/bu» - 500 mg (base) PO qid x 3 to 4 months «b»Bartonella Infections in HIV-infected Patients«/b» - Duration of therapy is at least 3 months - Continuation of therapy depends on relapse occurrence and clinical condition «bu»Bacillary Angiomatosis«/bu» - 500 mg IV/PO every 6 hours «bu»Peliosis Hepatitis«/bu» - 500 mg IV/PO every 6 hours «bu»Bacteremia«/bu» - 500 mg IV/PO every 6 hours «bu»Osteomyelitis«/bu» - 500 mg IV/PO every 6 hours «bu»Chancroid«/bu» - 500 mg (base) PO 3 times daily for 7 days «bu»Chlamydia Trachomatis Infection«/bu» «b»Uncomplicated«/b» - 500 mg (base) PO tid x 7 days «bu»Urogenital Infections«/bu» - 500 mg (base) PO four times daily - 800 mg (ethylsuccinate) qid x 7 days «bu»Lymphogranuloma Venereum«/bu» - Alternative therapy to doxycycline - 500 mg (base) PO qid x 21 days «bu»Gastroparesis«/bu» - 3 mg/kg IV administered over 45 minutes every 8 hours - 250 to 500 mg (base) PO tid before meals - Limit duration of therapy, tachyphylaxis may occur after 4 weeks - Patients refractory/intolerant to other prokinetic agents: metoclopramide, domperidone «bu»Granuloma Inguinale«/bu» (off-label use) - 500 mg (base) PO qid at least 21 days and resolution of lesions - If symptoms do not improve within the first few days of therapy, the addition of gentamicin may be considered «bu»Impetigo«/bu» - Erythromycin Base: 250 mg PO qid x 7 days - Erythromycin Ethylsuccinate: 400 mg PO qid x 7 days «bu»Legionnaire Disease«/bu» - 1.6 to 4 g (ethylsuccinate) PO daily - 1 to 4 g (base) PO daily in divided doses x 21 days «bu»Nongonococcal Urethritis«/bu» - 500 mg (base) PO 4 times daily - Two 333 mg (base) tablets PO every 8 hours for at least 7 days - 800 mg (ethylsuccinate) PO tid x 7 days «bu»Pertussis«/bu» - 500 mg (base) PO every 6 hours x 14 days «bu»Surgical Preoperative Prophylaxis«/bu» «b»Colorectal«/b» - 1 g erythromycin base per dose at 1 PM, 2 PM, and 11 PM on the day before 8 AM surgery combined with mechanical cleansing of the large intestine, oral neomycin. - Perioperative IV antibiotics are also given on the day of surgery - Due to differences in absorption, 400 mg erythromycin ethylsuccinate produces the same serum levels as 250 mg erythromycin base or stearate. «b»Usual Dosage Range«/b» «b»Infants and Children«/b» Erythromycin Base - 30 to 50 mg/kg/day in 2 to 4 divided doses - Maximum Dose: 2 g daily Erythromycin Ethylsuccinate - 30 to 50 mg/kg/day in 2 to 4 divided doses - Dose may be increased 60 to 100 mg/kg/day in severe infections - Maximum Dose: 4 g/day Erythromycin Stearate - 30 to 50 mg/kg/day in 2 to 4 divided doses - Maximum Dose: 2 g daily Erythromycin Lactobionate - 15 to 20 mg/kg/day divided every 6 hours - Maximum Dose: 4 g daily «bu»Bartonella Infections«/bu» (off-label use) «b»Non–HIV-exposed/-positive Patients«/b» Infants, Children, and Adolescents - 40 mg/kg/day (ethylsuccinate) in 4 divided doses (maximum: 2 g daily) for 3 to 4 months «b»HIV-infected Patients«/b» - Adolescents: Refer to adult dosing. «bu»Chlamydia Trachomatis Infection, Uncomplicated«/bu» (off-label) «b»Conjunctivitis or Pneumonia«/b» (preferred therapy) - 50 mg/kg/day (base or ethylsuccinate) in 4 divided doses for 14 days «bu»Urogenital Infection«/bu» «b»Children and Adolescents <45 kg«/b» - 50 mg/kg/day (base or ethylsuccinate) in 4 divided doses x 14 days «b»Adolescents ≥45 kg«/b» - 500 mg (base) four times daily or 800 mg (ethylsuccinate) four times daily for 7 days «bu»Community-Acquired Pneumonia (CAP)«/bu» «b»Infants >3 months and Children«/b» - A beta-lactam antibiotic should be added if typical bacterial pneumonia cannot be ruled out. «b»Mild Atypical CAP«/b» - M. pneumoniae, Chlamydophila (Chlamydia) pneumoniae, C. trachomatis) infection - Alternative to azithromycin - 10 mg/kg/dose PO every 6 hours «b»Moderate to Severe Atypical Infection«/b» - Alternative to azithromycin - 5 mg/kg/dose IV every 6 hours «bu»Impetigo«/bu» - 40 mg/kg/day PO in 3 to 4 divided doses for 7 days «b»Mild to Moderate Infection«/b» - 30 to 50 mg/kg/day PO in divided doses every 6 to 12 hours «bu»Pertussis«/bu» - 40 to 50 mg/kg/day PO in 4 divided doses for 14 days - Maximum Dose: 2 g daily (not preferred agent for infants <1 month due to IHPS) «bu»Pharyngitis, Tonsillitis (Streptococcal)«/bu» - 20 mg (base)/kg/day PO x 10 days - 40 mg (ethylsuccinate)/kg/day PO in 2 divided doses x10 days «bu»Surgical Prophylaxis (Colorectal)«/bu»(off-label use) «b»Children ≥1 year«/b» - 20 mg (base)/kg PO (maximum dose: 1000 mg) at 1 PM, 2 PM, and 11 PM on the day before 8 AM surgery combined with mechanical cleansing of the large intestine, oral neomycin - Perioperative IV antibiotics are also given on the day of surgery

Erythromycin (Ophthalmic)

Ilotycin, Romycin

Erythromycin (Topical)

Del-Mycin, Erygel, Akne-Mycin, Erysol

Erythromycin-Sulfisoxazole

Eryzole, Pediazole, E.S.P

Escitalopram

Lexapro, S-Citalopram

«bu»Major Depressive Disorder (MDD)«/bu» Initial Dose - 10 mg once daily Maintenance Dose - Dose may be increased to a maximum of 20 mg once daily after at least 1 week «bu»Generalized Anxiety Disorder (GAD)«/bu» Initial Dose - 10 mg once daily Maintenance Dose - Dose may be increased to a maximum of 20 mg once daily after at least 1 week «bu»Hot Flashes«/bu» Initial Dose - 10 mg once daily Maintenance Dose - May increase to 20 mg once daily after 4 weeks if symptoms not adequately controlled «bu»Obsessive Compulsive Disorder (OCD)«/bu» Initial Dose - 10 mg once daily Usual Dosage Range - 10 mg to 20 mg once daily «bu»Panic Disorder«/bu» Initial Dose - 5 mg once daily for 7 days Maintenance Dose - May increase dose to 10 mg once daily - Consider further dosage adjustments based on response and tolerability up to 20 mg once daily «bu»Post Traumatic Stress Disorder (PTSD)«/bu» Initial Dose - 10 mg once daily Maintenance Dose - After 4 weeks increase to 20 mg once daily «b»Discontinuation of Therapy«/b» - Upon discontinuation of antidepressant therapy, gradually taper the dose to minimize the incidence of withdrawal symptoms and allow for the detection of re-emerging symptoms. - Evidence supporting ideal taper rates is limited - APA and NICE guidelines suggest tapering therapy over at least several weeks with consideration to the half-life of the antidepressant; antidepressants with a shorter half-life may need to be tapered more conservatively - In addition for long-term treated patients, WFSBP guidelines recommend tapering over 4 to 6 months - If intolerable withdrawal symptoms occur following a dose reduction, consider resuming the previously prescribed dose and/or decrease dose at a more gradual rate «b»MAO Inhibitor Recommendations«/b» - Allow 14 days to elapse between discontinuing an MAO inhibitor intended to treat psychiatric disorders and initiation of escitalopram. - Allow 14 days to elapse between discontinuing escitalopram and initiation of an MAO inhibitor intended to treat psychiatric disorders.

Esketamine

Spravato

Eslicarbazepine

Aptiom

Esmolol

Brevibloc

«bu»Hypertensive Emergency«/bu» «b»Loading Dose«/b» - 0.25-0.5 mg/kg IVP over 1 min THEN, - 0.05-0.1 mg/kg/min IV for 4 min «b»Maintenance Dose«/b» - May repeat loading dose OR - Increase infusion up to 0.3 mg/kg/min prn «bu»Hypertension«/bu» - 2.5 mg PO daily - May increase dose gradually «bu»Intraoperative and Postoperative Tachycardia and/or Hypertension«/bu» «b»Immediate Control«/b» Initial Bolus - 1,000 mcg/kg over 30 seconds THEN, - Followed by a 150 mcg/kg/minute infusion prn Maintenance Dose - Adjust infusion rate as needed to maintain desired heart rate and/or blood pressure (up to 300 mcg/kg/minute) «b»Gradual Control«/b» Initial Bolus - 500 mcg/kg over 1 minute THEN, - Followed by a 50 mcg/kg/minute infusion for 4 minutes Maintenance Dose - Infusion may be continued at 50 mcg/kg/minute - May be titrated upward in 50 mcg/kg/minute increments (increased no more frequently than every 4 minutes) to a maximum of 300 mcg/kg/minute - May administer an optional loading dose equal to the initial bolus (500 mcg/kg over 1 minute) prior to each increase in infusion rate. - For control of tachycardia, doses >200 mcg/kg/minute provide minimal additional effect - For control of postoperative hypertension, as many as one-third of patients may require higher doses (250 to 300 mcg/kg/minute) to control blood pressure; the safety of doses >300 mcg/kg/minute has not been studied. «bu»Supraventricular Tachycardia (SVT) or Non-compensatory Sinus Tachycardia«/bu» - Loading Dose (optional): 500 mcg/kg over 1 minute; then, - Follow with a 50 mcg/kg/minute infusion for 4 minutes - Response to this initial infusion rate may be a rough indication of the responsiveness of the ventricular rate. - Infusion may be continued at 50 mcg/kg/minute - May be titrated upward in 50 mcg/kg/minute increments (increased no more frequently than every 4 minutes) to a maximum of 200 mcg/kg/minute. «b»Rapid Response«/b» - To achieve more rapid response, following the initial loading dose and 50 mcg/kg/minute infusion, re-bolus with a second 500 mcg/kg loading dose over 1 minute, and increase the maintenance infusion to 100 mcg/kg/minute for 4 minutes. - If necessary, a third (and final) 500 mcg/kg loading dose may be administered, prior to increasing to an infusion rate of 150 mcg/kg/minute - After 4 minutes of the 150 mcg/kg/minute infusion, the infusion rate may be increased to a maximum rate of 200 mcg/kg/minute (without a bolus dose). The ACC/AHA/HRS supraventricular tachycardia guidelines recommend a maximum dose of 300 mcg/kg/minut «b»No Loading Dose«/b» - If a loading dose is not administered, a continuous infusion at a fixed dose reaches steady-state in ~30 minutes. In general, the usual effective dose is 50 to 200 mcg/kg/minute; doses as low as 25 mcg/kg/minute may be adequate. Maintenance infusions may be continued for up to 48 hours. «bu»Acute Coronary Syndrome (ACS)«/bu» - 500 mcg/kg over 1 minute - Follow with a 50 mcg/kg/minute infusion - May be titrate upward in 50 mcg/kg/minute increments every 5 to 15 minutes to a maximum of 300 mcg/kg/minute - An additional bolus (500 mcg/kg over 1 minute) may be administered prior to each increase in infusion rate «bu»Electroconvulsive Therapy«/bu» - 1,000 mcg/kg IV administered 1 minute prior to induction of anesthesia «bu»Intubation«/bu» - 1,000 to 2,000 mcg/kg IV given 1.5 to 3 minutes prior to intubation «bu»Thyrotoxicosis or Thyroid Storm«/bu» - 50 to 100 IV mcg/kg/minute «b»Switch from IV Infusion to PO Therapy«/b» «bi»Beta-blocker, Calcium Channel Blocker«/bi» - Infusion should be reduced by 50% thirty minutes following the first dose of the alternative agent - Manufacturer suggests following the second dose of the alternative drug, patient's response should be monitored and if control is adequate for the first hour, esmolol may be discontinued.

Esomeprazole

NexIUM

«bu»Erosive Esophagitis (Healing)«/bu» Initial Dose - 20 to 40 mg PO once daily x 4 to 8 weeks - If incomplete healing, may continue for an additional 4 to 8 weeks Maintenance Dose - 20 mg once daily «bu»Heartburn«/bu» Initial Dose - 20 mg once daily x 14 days Maximum Daily Dose - 20 mg/day Maintenance Dose - Treatment may be repeated after 4 months prn «bu»Symptomatic Gastroesophageal Reflux«/bu» Initial Dose - 20 mg PO once daily x 4 weeks Maintenance Dose - May consider an additional 4 weeks of treatment if symptoms do not resolve «b»Short-term Treatment«/b» - 20 mg or 40 mg IV once daily - Indicated only in cases where oral therapy is inappropriate or not possible; safety/efficacy ≥10 days has not been established. «bu»Recurrent Gastric Ulcer Bleeding Post-endoscopy«/bu» «b»Prevention«/b» Loading Dose - 80 mg IV over 30 minutes x 1 dose Maintenance Dose - 8 mg/hour continuous infusion for a total of 72 hours THEN, - 40 mg PO once daily for 27 additional days - May follow continuous infusion with any single daily-dose oral proton pump inhibitor (PPI) for a duration dictated by the underlying etiology «bu»Recurrent Duodenal Ulcer Bleeding Post-endoscopy«/bu» «b»Prevention«/b» Loading Dose - 80 mg IV over 30 minutes x 1 dose Maintenance Dose - 8 mg/hour continuous infusion for a total of 72 hours THEN, - 40 mg PO once daily for 27 additional days - May follow continuous infusion with any single daily-dose oral proton pump inhibitor (PPI) for a duration dictated by the underlying etiology «bu»Helicobacter Pylori Eradication«/bu» - 40 mg once daily administered with amoxicillin 1,000 mg and clarithromycin 500 mg «b»Clarithromycin Triple Regimen«/b» - 20 to 40 mg PO bid in combination with clarithromycin 500 mg PO bid and either amoxicillin 1 g PO bid or metronidazole 500 mg PO tid - Continue regimen for 14 days - Avoid use of clarithromycin triple therapy in patients with risk factors for macrolide resistance (prior macrolide exposure, local clarithromycin resistance rates ≥15%, eradication rates with clarithromycin-based regimens ≤85%) «b»Bismuth Quadruple Regimen«/b» - 20 mg PO bid in combination with tetracycline 500 mg PO qid, metronidazole 250 mg PO qid or 500 mg PO tid or qid, and either bismuth subcitrate 120 to 300 mg PO qid or bismuth subsalicylate 300 mg qid - Continue regimen for 10 to 14 days. «b»Concomitant Regimen«/b» - 20 mg PO bid in combination with amoxicillin 1 g PO bid, clarithromycin 500 mg PO bid, and either metronidazole or tinidazole 500 mg PO bid - Continue regimen x 10 to 14 days. «b»Sequential Regimen«/b» - 20 mg PO bid plus amoxicillin 1 g PO bid x 5 to 7 days; then, - Continue esomeprazole along with clarithromycin 500 mg PO bid, and either metronidazole or tinidazole 500 mg PO bid x 5 to 7 days. «b»Hybrid Regimen«/b» - 20 mg PO bid plus amoxicillin 1 g PO bid x 7 days; then, - Continue esomeprazole and amoxicillin along with clarithromycin 500 mg PO bid, and either metronidazole or tinidazole 500 mg PO bid x 7 days. «b»Levofloxacin Triple Regimen«/b» - 20 mg PO bid in combination with amoxicillin 1 g bid and levofloxacin 500 mg once daily - Continue regimen x 10 to 14 days. «bu»NSAID-Induced Gastric Ulcers«/bu» «b»Prevention«/b» - 20 to 40 mg PO once daily for up to 6 months - 40 mg daily did not show additional benefit over 20 mg daily in clinical trials. «b»Treatment«/b» - 20 mg PO once daily for 8 weeks «bu»Zollinger-Ellison Syndrome«/bu» - 40 mg PO bid - Doses up to 240 mg daily have been administered «bu»Oral Administration«/bu» «b»Capsule«/b» - Swallow whole and take at least 1 hour before eating (best if taken before breakfast) - Capsule can be opened and contents mixed with 1 tablespoon of applesauce - Swallow immediately; mixture should not be chewed or warmed - For patients with difficulty swallowing, use of granules may be more appropriate. «b»Granules«/b» - Empty the 2.5 mg or 5 mg packet into a container with 5 mL of water or the 10 mg, 20 mg, or 40 mg packet into a container with 15 mL of water and stir; leave 2 to 3 minutes to thicken - Stir and drink within 30 minutes - If any medicine remains after drinking, add more water, stir and drink immediately. «b»Tablet«/b» - Swallow whole; do not crush or chew; administer with a full glass of water before breakfast in the morning. «bu»IV Administration«/bu» - Flush line prior to and after administration with NS, LR, or D5W. «b»Children«/b» - Administer by intermittent infusion (10 to 30 minutes); the manufacturer recommends that children receive intravenous esomeprazole by intermittent infusion only. «b»Adults«/b» - Treatment of GERD: May be administered by injection (≥3 minutes), or intermittent infusion (10 to 30 minutes) - Prevention of recurrent gastric or duodenal ulcer bleeding postendoscopy: Administer the loading dose over 30 minutes, followed by the continuous infusion at a rate of 8 mg/hour over 71.5 hours (adjust rate of continuous infusion in patients with hepatic dysfunction) «bu»Nasogastric Tube«/bu» «b»Capsule«/b» - Open capsule and place intact granules into a 60 mL catheter-tip syringe; mix with 50 mL of water - Replace plunger and shake vigorously for 15 seconds - Ensure that no granules remain in syringe tip. Do not administer if pellets dissolve or disintegrate - Use immediately after preparation - After administration, flush nasogastric tube with additional water. «b»Granules«/b» - Delayed release oral suspension granules can also be given by nasogastric or gastric tube - If using a 2.5 mg or 5 mg packet, first add 5 mL of water to a catheter-tipped syringe, then add granules from packet - If using a 10 mg, 20 mg, or 40 mg packet, first add 15 mL of water to a catheter-tipped syringe, then add granules from packet - Shake the syringe, leave 2 to 3 minutes to thicken - Shake the syringe and administer through nasogastric or gastric tube (size 6 French or greater) within 30 minutes - Refill the syringe with equal amount (5 mL or 15 mL) of water, shake and flush nasogastric/gastric tube. «bu»Granules for Oral Administration«/bu» - Empty the 2.5 mg or 5 mg packet into a container with 5 mL of water or empty the 10 mg, 20 mg, or 40 mg packet into a container with 15 mL of water and stir; leave 2-3 minutes to thicken. «bu»IV Injection Reconstitution«/bu» - For IV injection (≥3 minutes) - Adults: Reconstitute powder with 5 mL NS. «bu»Intermittent IV Infusion Preparation«/bu» «b»Children«/b» - Initially reconstitute powder (20 mg or 40 mg) with 5 mL of NS, LR, or D5W, then further dilute to a final volume of 50 mL; withdraw the appropriate amount of the final solution to administer the intended dose. «b»Adults«/b» - Initially reconstitute powder with 5 mL of NS, LR, or D5W, then further dilute to a final volume of 50 mL. «bu»Continuous IV Infusion Preparation«/bu» - Loading dose and continuous infusion - Prepare the 80 mg loading dose by reconstituting two 40 mg vials with NS (5 mL each) - The contents of the two vials should then be further diluted in NS 100 mL - To prepare the continuous infusion, also reconstitute two 40 mg vials with NS (5 mL each); the contents of the two vials should then be further diluted in NS 100 mL.

Estazolam

ProSom

Esterified Estrogens

Menest

«bu»Prostate Cancer«/bu» «b»Advanced«/b» - 1.25 to 2.5 mg PO tid «bu»Female Hypoestrogenism«/bu» «b»Due to Hypogonadism«/b» - 2.5 to 7.5 mg/day in divided doses for 20 days - Followed by a 10-day rest period - Administer cyclically (3 weeks on and 1 week off) - If bleeding does not occur by the end of the 10-day period, repeat the same dosing schedule; the number of courses to produce bleeding is dependent upon the responsiveness of the endometrium - If bleeding occurs before the end of the 10-day period, begin an estrogen-progestin cyclic regimen of 2.5 to 7.5 mg/day in divided doses for 20 days; during the last 5 days of estrogen therapy, give an oral progestin - If bleeding occurs before regimen is concluded, discontinue therapy and resume on the fifth day of bleeding. «bu»Female Hypoestrogenism«/bu» «b»Due to Castration and Primary Ovarian Failure«/b» - 1.25 mg/day, cyclically - Adjust dosage upward or downward, according to the severity of symptoms and patient response - For maintenance, adjust dosage to lowest level that will provide effective control. «bu»Vasomotor Symptoms Associated with Menopause«/bu» - 1.25 mg/day administered cyclically (3 weeks on and 1 week off) - If patient has not menstruated within the last 2 months or more, cyclic administration is started arbitrary - If the patient is menstruating, cyclical administration is started on day 5 of the bleeding - For short-term use only and should be discontinued as soon as possible - Re-evaluate at 3- to 6-month intervals for tapering or discontinuation of therapy. «bu»Vulvar and Vaginal Atrophy Associated with Menopause«/bu» - 0.3 to ≥1.25 mg/day, depending on the tissue response of the individual patient - Administer cyclically - For short-term use only and should be discontinued as soon as possible - Re-evaluate at 3- to 6-month intervals for tapering or discontinuation of therapy. «bu»Breast Cancer«/bu» «b»Metastatic«/b» - Appropriately selected patients «b»Males and Postmenopausal Females«/b» - 10 mg PO tid x at least 3 months

Esterified Estrogens-Methyltestosterone

Covaryx, EEMT, Estratest

Estetrol

Estetrol-Drospirenone

Nextstellis

«bu»Contraception«/bu» «b»Days 1-24«/b» - 1 active tablet PO daily «b»Days 25-28«/b» -1 inert tablet PO daily «b»Initiating with No Current Use of Hormonal Contraception«/b» Females with Irregular Menstrual Cycles - Consider pregnancy testing before initiation Days 1-24 - Take 1 pink active tablet once daily starting on first day of menses Days 25-28 - Take 1 white inert tablet daily Each Subsequent 28-day pack - Begin on same day of week as first cycle pack (eg, on day after taking the last tablet) - If not starting on first day of menses, use nonhormonal contraceptive (eg, condoms and/or spermicide) as backup until 1 active tablet has been taken daily for 7 days in a row «b»Switching from Another Contraceptive Method«/b» Combined PO Contraceptive (COC) - Start when new pack of previous COC would have started - Transdermal system, vaginal insert, or injection: Start when next administration would have been scheduled Intrauterine System (IUS) or Implant - Start after removal Progestin-only Pill - Start after last tablet was taken «b»Initiating After Delivery (>20 weeks gestation)«/b» - Do not start <4 weeks after delivery Menstrual Cycles Have Resumed - Follow instructions for “starting estetrol/drospirenone in females with no current use of hormonal contraception” Menstrual Cycles Have NOT Resumed - Consider possibility of ovulation and pregnancy - If not pregnant, use additional nonhormonal contraception for first 7 days of use «b»Starting DRSP/E4 After Delivery (>20 weeks gestation)«/b» ≤14 Weeks Gestation - Starting ≤7 days of complete first trimester abortion or miscarriage: Use additional contraception for next 7 days - Starting >7 days: Follow instructions for “starting DRSP/E4 in females with no current use of hormonal contraception” >14 Weeks to ≤20 Weeks Gestation - Start after 4 weeks following second trimester abortion or miscarriage; consider duration of pregnancy and increased risk of thromboembolism - Menstrual cycles have resumed: Follow instructions for “starting DRSP/E4 in females with no current use of hormonal contraception” - Menstrual cycles have not resumed: Consider possibility of ovulation and pregnancy; if not pregnant, use additional nonhormonal contraception for first 7 days of use «b»Limitation of Use«/b» - May be less effective in females with a body mass index (BMI) ≥30 kg/m2; decreased effectiveness may be associated with increased BMI

Estradiol

Femring, Estrasorb, Estrace, Vivelle-Dot, Alora, Elestrin, Divigel, Minivelle, Estrogel, Delestrogen, Evamist, Menostar, Climara, Delestrogen, Depo-Estradiol

Estradiol (Topical)

Estrace, Estring, Vagifem, Yuvafem

Estradiol Valerate

Estradiol Valerate-Dienogest

Natazia

«bu»Contraception or Treatment of Heavy Menstrual Bleeding«/bu» - Take 1 tablet daily in the order presented in the blister pack - Initial Dosing: Start on day 1 of menstrual period (first day of bleeding) - A nonhormonal contraceptive should be used for the first 9 days «b»Limitations of Use«/b» - Efficacy has not been evaluated in women with a BMI >30 kg/m2 «b»Switching from Another Combination Contraceptive (PO)«/b» - Take the first dark yellow tablet on the first day of withdrawal bleeding; do not continue taking tablets from previous contraceptive pack - If withdrawal bleeding does not occur, rule-out pregnancy before starting therapy - A nonhormonal contraceptive should be used for the first 9 days «b»Switching from a Vaginal Ring or Patch«/b» - Take the first dark yellow tablet on the day the ring or patch is removed - A nonhormonal contraceptive should be used for the first 9 days. «b»Switching from a Progestin-only Contraceptive«/b» - Take the first dark yellow tablet on the day of the next progestin-only tablet would have been given, or the day the progestin implant or IUD is removed, or on the day the next injection would have been given - A non-hormonal contraceptive should be used for the first 9 days. «b»Missed Doses«/b» - If ≤12 hours late, take tablet as soon as remembering and take the next tablet at the usual time - If >12 hours late, instructions vary by day of cycle and number of tablets missed: If missed ONE dose: «bi»Days 1-17«/bi» - Take missed tablet immediately - Take next tablet at usual time - Use back-up (nonhormonal) contraception for the next 9 days - Continue taking 1 tablet each day for the rest of the cycle «bi»Days 18-24«/bi» - Do not continue using current blister pack (throw away) - Take day 1 of new blister pack - Use back-up (nonhormonal) contraception for the next 9 days - Continue taking 1 tablet each day for the rest of the cycle «bi»Days 25-28«/bi» - Take missed tablet immediately - Take next tablet at usual time - Continue taking 1 tablet each day for the rest of the cycle - No backup method of contraception is needed «b»Missed TWO Doses in a Row«/b» «bi»Days 1-17«/bi» - Do not take missed tablets - Start by taking the tablet for the day it was first noticed that the tablet was missed - Use back-up (nonhormonal) contraception for the next 9 days - Continue taking 1 tablet each day for the rest of the cycle - If tablets were missed on days 17 and 18, follow directions for missed tablets on days 17-25. «bi»Days 17-25«/bi» - Do not continue using current blister pack (throw away) - Take day 3 of new blister pack - Use back-up (nonhormonal) contraception for the next 9 days - Continue taking 1 tablet each day for the rest of the cycle - If tablets were missed on days 25 and 26, follow directions for missed tablets on days 25-28. «bi»Days 25-28«/bi» - Do not continue using current blister pack (throw away) - Start a new pack on the same day, or start a new pack the day it would normally be started - Continue taking 1 tablet each day for the rest of the cycle - No backup method of contraception is needed.

Estradiol-Levonorgestrel

ClimaraPro

Estradiol-Norethindrone

CombiPatch, Activella, Amabelz, Lopreeza, Mimvey

Estradiol-Norgestimate

Prefest, Ortho Prefest

- General dosing guidelines: For use in women with a uterus. When treating postmenopausal women, use estrogens for the shortest duration possible at the lowest effective dose consistent with treatment goals. Reevaluate patients as clinically appropriate to determine if treatment is still necessary. Consider use of an estrogen with a progestin in postmenopausal women with a uterus. Women who have had a hysterectomy generally do not need a progestin; however one may be needed if there is a history of endometriosis. Dosage needs to be adjusted based upon the patient's response «bu»Osteoporosis Prevention«/bu» - Treatment is cyclical - One tablet of estradiol 1 mg (peach tablet) once daily for 3 days - Followed by 1 tablet of estradiol 1 mg and norgestimate 0.09 mg (white tablet) once daily for 3 days - Repeat sequence continuously - This dose may not be the lowest effective combination for these indications. In case of a missed tablet, restart therapy with next available tablet in sequence (taking only 1 tablet each day) «bu»Vasomotor Symptoms Associated with Menopause«/bu» - Treatment is cyclical - One tablet of estradiol 1 mg (peach tablet) once daily for 3 days - Followed by 1 tablet of estradiol 1 mg and norgestimate 0.09 mg (white tablet) once daily for 3 days - Repeat sequence continuously - This dose may not be the lowest effective combination for these indications. In case of a missed tablet, restart therapy with next available tablet in sequence (taking only 1 tablet each day) «bu»Vulvar and Vaginal Atrophy Associated with Menopause«/bu» - Treatment is cyclical - One tablet of estradiol 1 mg (peach tablet) once daily for 3 days - Followed by 1 tablet of estradiol 1 mg and norgestimate 0.09 mg (white tablet) once daily for 3 days - Repeat sequence continuously - This dose may not be the lowest effective combination for these indications. In case of a missed tablet, restart therapy with next available tablet in sequence (taking only 1 tablet each day) «b»Limitations of Use«/b» - For use in women with a uterus - When used solely for the treatment of vulvar and vaginal atrophy, topical vaginal products should be considered. When used for the prevention of osteoporosis, use only in women at significant risk; consider use of nonestrogen medications

Estramustine

Emcyt

Estrogens, Conjugated

Premarin, C.E.S.

«bu»Abnormal Uterine Bleeding«/bu» «b»Acute/Heavy Bleeding«/b» - 25 mg IV/IM x 1 dose - May repeat in 6-12 hours prn - 25 mg IV repeated every 4 to 6 hours for 24 hours «b»Limitations of Use«/b» - For short term use only to provide a rapid and temporary increase in estrogen levels «bu»Breast Cancer«/bu» «b»Metastatic«/b» «bi»Males and Postmenopausal Females«/bi» - 10 mg PO tid for at least 3 months «bu»Hypoestrogenism (Female)«/bu» «b»Castration or Primary Ovarian Failure«/b» - 1.25 mg/day given cyclically (Either 3 weeks on, 1 week off or 25 days on, 5 days off) - Adjust according to severity of symptoms and patient response - For maintenance, adjust to the lowest effective dose. «b»Hypogonadism«/b» - 0.3 or 0.625 mg/day PO given cyclically (Either 3 weeks on, 1 week off or 25 days on, 5 days off) - Dose may be titrated in 6- to 12-month intervals - Progestin treatment should be added to maintain bone mineral density once skeletal maturity is achieved. «bu»Osteoporosis (Females)«/bu» «b»Prevention«/b» - Initial Dose: 0.3 mg/day cyclically (Either 3 weeks on, 1 week off or 25 days on, 5 days off) or daily, depending on medical assessment of patient - Dose may be adjusted based on bone mineral density and clinical response - The lowest effective dose should be used «b»Limitations of Use«/b» - For use only in women at significant risk of osteoporosis; consider use of non-estrogen medications. «bu»Prostate Cancer«/bu» «b»Advanced«/b» - 1.25 to 2.5 mg PO 3 times/day «bu»Uremic Bleeding«/bu» - 0.6 mg/kg/day IV for 5 days «bu»Vasomotor Symptoms Associated with Menopause«/bu» - Initial Dose: 0.3 mg/day. May be given cyclically (Either 3 weeks on, 1 week off or 25 days on, 5 days off) or daily, depending on medical assessment of patient - Adjust dose based on patient’s response - The lowest dose that will control symptoms should be used. «bu»Vulvar and Vaginal Atrophy Associated with Menopause«/bu» - Initial Dose: 0.3 mg/day - The lowest dose that will control symptoms should be used - May be given cyclically or daily, depending on medical assessment of patient. Adjust dose based on patient’s response «b»Limitations of Use«/b» - When used solely for the treatment of vulvar and vaginal atrophy, topical vaginal products should be considered. «b»Postmeopausal Women«/b» - When treating postmenopausal women, use estrogens for the shortest duration possible at the lowest effective dose consistent with treatment goals - Reevaluate patients as clinically appropriate to determine if treatment is still necessary - Consider use of an estrogen with a progestin in postmenopausal women with a uterus - Women who have had a hysterectomy generally do not need a progestin; however one may be needed if there is a history of endometriosis - Dosage needs to be adjusted based upon the patient's response

Estrogens, Conjugated (Topical)

Premarin

Estrogens, Conjugated-Bazedoxifene

Duavee

Estrogens, Conjugated-Medroxyprogesterone

Premphase, Prempro

Estropipate

Ortho-Est, Piperazine Estrone Sulfate

«bu»Hypoestrogenism«/bu» «b»Castration or Primary Ovarian Failure«/b» - 1.5 to 9 mg PO daily for the first 3 weeks of a theoretical cycle - Followed by a rest period of 8 to 10 days «b»Hypogonadism«/b» - 1.5 to 9 mg PO daily for the first 3 weeks of a theoretical cycle - Followed by a rest period of 8 to 10 days - Repeat if bleeding does not occur by the end of the rest period - The duration of therapy necessary to product the withdrawal bleeding will vary according to the responsiveness of the endometrium - If satisfactory withdrawal bleeding does not occur, give an oral progestin in addition to estrogen during the third week of the cycle. «bu»Osteoporosis (Females)«/bu» «b»OPrevention«/b» - 0.75 mg PO daily for 25 days of a 31-day cycle «bu»Vasomotor Symptoms Associated with Menopause«/bu» - 0.75 to 6 mg PO daily - If a patient with vasomotor symptoms has not menstruated within the last ≥2 months, start the cyclic administration arbitrarily - If the patient has menstruated, start cyclic administration on day 5 of bleeding. «bu»Vulvar and Vaginal Atrophy Associated with Menopause«/bu» - 0.75 to 6 mg PO daily - Administer cyclically «b»Limitations of Use«/b» - When used solely for the treatment of vulvar and vaginal atrophy, topical vaginal products should be considered - When used for osteoporosis prevention, use only in women at significant risk of postmenopausal osteoporosis; consider use of nonestrogen medications «b»Postmenopausal Women«/b» - When treating postmenopausal women, use estrogens for the shortest duration possible at the lowest effective dose consistent with treatment goals - Reevaluate patients as clinically appropriate to determine if treatment is still necessary - Consider use of an estrogen with a progestin in postmenopausal women with a uterus. - Women who have had a hysterectomy generally do not need a progestin; however one may be needed if there is a history of endometriosis - Dosage needs to be adjusted based upon the patient's response

Eszopiclone

Lunesta

Etanercept

Enbrel, Erelzi, Eticovo

Etelcalcetide

Parsabiv

Eteplirsen

Exondys 51

Etesevimab

LY-CoV016

Ethacrynic Acid

Edecrin

Ethambutol

Myambutol

Ethinyl Estradiol

Ethinyl Estradiol-Drospirenone-Levomefolate

Beyaz, Rajani, Safyral

«bu»Acne Vulgaris«/bu» «b»Beyaz, Rajani«/b» - One tablet once daily «bu»Premenstrual Dysphoric Disorder (PMDD)«/bu» «b»Beyaz, Rajani«/b» - One tablet once daily «b»Limitations of Use«/b» - The effectiveness of use for more than 3 menstrual cycles has not been evaluated - Has not been evaluated for the treatment of premenstrual syndrome (PMS) «bu»Dysmenorrhea«/bu» «b»Beyaz, Rajani«/b» - One tablet once daily «bu»Endometriosis«/bu» «b»Beyaz, Rajani«/b» - One tablet once daily «bu»Polycystic Ovary Syndrome«/bu» «b»Beyaz, Rajani«/b» - One tablet once daily «bu»Contraception«/bu» «b»Beyaz, Rajani, Safyral«/b» - One tablet once daily «b»Day 1 Starter«/b» - Dose starts on first day of menstrual cycle taking 1 tablet daily - If first dose is taken later than the first day of the menstrual cycle, an additional method of contraception should be used until after the first 7 days of consecutive administration. «b»Sunday Starter«/b» - Dose begins on first Sunday after onset of menstruation; if the menstrual period starts on Sunday, take first tablet that very same day - With a Sunday start, an additional method of contraception should be used until after the first 7 days of consecutive administration. «b»Missed or Late Doses«/b» - If one dose is late (<24 hours since dose should have been taken) or if one dose is missed (24 to <48 hours since dose should have been taken): Take dose as soon as possible. Continue remaining doses at the usual time (even if that means 2 doses on the same day). - If ≥2 consecutive doses are missed (≥48 hours since dose should have been taken): Take the most recently missed dose as soon as possible, discard any other missed doses. Continue remaining doses at the usual time (even if that means taking 2 doses on the same day); use back-up contraception until hormonal pills have been taken for 7 consecutive days. If doses were missed during the last week of hormonal (active) tablets (eg, days 15 to 21 of a 28-day pack), omit the hormone-free interval by finishing the current pack and starting a new pack. If unable to start a new pack immediately, back up contraception is needed until hormonal pills from a new pack have been taken for 7 consecutive days. Consider use of emergency contraception in some situations (refer to guidelines for details). - Also refer to prescribing information for product specific information. «b»Switching from a Different Contraceptive«/b» «bi»Oral Contraceptive«/bi» - Start on the same day that a new pack of the previous oral contraceptive would have been taken «bi»Transdermal Patch, Vaginal Ring, Injection«/bi» - Start on the day the next dose would have been due «bi»IUD or Implant«/bi» - Start on the day of removal «b»Use After Childbirth (in women who are not breast-feeding) or After Second Trimester Abortion«/b» - Therapy may be started ≥4 weeks postpartum. Pregnancy should be ruled out prior to treatment if menstrual periods have not restarted and an additional method of contraception (nonhormonal) should be used until after the first 7 days of consecutive administration.

Ethinyl Estradiol-Ethynodiol Diacetate

Kelnor 1/35, Zovia 1/35E, Zovia 1/50E, Demulen

Ethinyl Estradiol-Norelgestromin

Ortho-Evra, Xulane

«bu»Contraception«/bu» - Apply one patch each week for 3 weeks (21 total days); followed by one week that is patch-free - Each patch should be applied on the same day each week (“patch change day”) and only one patch should be worn at a time - No more than 7 days should pass during the patch-free interval «b»Limitations of Use«/b» - The topical patch may be less effective in patients weighing ≥90 kg. «b»Sunday Starter«/b» - Dose begins on first Sunday after onset of menstruation; if the menstrual period starts on Sunday, apply one patch that very same day - With a Sunday start, an additional method of contraception (nonhormonal) must be used until after the first 7 days of consecutive administration unless the menstrual period starts on Sunday - Each patch change will then occur on Sunday. «b»Day 1 Starter«/b» - Dose starts on first day of menstrual cycle, applying one patch during the first 24 hours of menstrual cycle - Each patch change will then occur on that same day of the week. «b»Switching from PO Contraceptives or Vaginal Ring«/b» - Complete current cycle and apply the first patch on the day the next pill cycle would be started or ring would be inserted. - If there is no menstrual bleeding within 7 days of taking the last active tablet or removing the last vaginal ring, the patient can initiate the first patch application; however, assess pregnancy status. - If patch is applied later than 7 days after the last active pill or removal of the vaginal ring, an additional method of contraception (nonhormonal) should be used until after the first 7 days of consecutive administration «b»Use after Childbirth«/b» - Therapy should not be started <4 weeks after childbirth. - Pregnancy should be ruled out prior to treatment if menstrual periods have not restarted. - An additional method of contraception (nonhormonal) should be used until after the first 7 days of consecutive administration. «b»Use after Abortion or Miscarriage«/b» - Therapy may be started immediately if abortion/miscarriage occurs within the first trimester. - If therapy is not started within 5 days, follow instructions for first time use; an additional method of contraception (nonhormonal) should be used until after the first 7 days of consecutive administration. - If abortion/miscarriage occurs during the second trimester, therapy should not be started for at least 4 weeks. - Follow directions for use after childbirth. - New patches should be applied on the same day each week - Apply to clean, dry, intact, healthy skin on the buttock, abdomen, upper outer arm, or back - Avoid areas that will be rubbed by tight clothing - Do not apply to the breasts or to skin that is red, irritated, or cut - Alternate application sites; do not apply to the same place as the previous patch. - Do not apply make-up, creams, lotions, powders, or other topical products to the skin where the patch will be placed - Remove the patch and the plastic liner from the foil pouch, being careful not to remove the clear liner when removing the patch - Apply patch by first peeling back half of the clear protective liner - Avoid touching surface of patch. Apply patch to skin and remove the rest of the liner - Press patch down firmly onto skin using palm of the hand; apply pressure for 10 seconds - Run fingers over entire surface area to smooth out any wrinkles in the patch - The patch should be checked daily to ensure all edges are sticking - When changing the patch each week, the new patch may be applied in the same anatomic area but should be applied to a new spot in that area - Do not use supplemental adhesives or wraps to hold patch into place - Do not cut, damage or alter the size of the patch; contraceptive efficacy may be impaired. «b»Partially or Completely Detached Patch«/b» «bi»<24 hours«/bi» - Try to reapply to same place or replace with a new patch immediately - Do not reapply if patch is no longer sticky, if it is sticking to itself or another surface, or if it has material sticking to it. «bi»>24 hours«/bi» - Apply a new patch and use this day of the week as the new “patch change day” from this point on - An additional method of contraception (nonhormonal) must be used until after the first 7 days of consecutive administration. «b»Missed Doses«/b» «bi»Start of Cycle (Week 1/day 1)«/bi» - Forgetting to apply the patch at the start of cycle (week 1/day 1): Apply first patch as soon as remembering, using this day of the week as the new “patch change day” from this point on. An additional method of contraception (nonhormonal) must be used until after the first 7 days of consecutive administration. «bi»Middle of Cycle (Weeks 2-3/Days 8-15)«/bi» - Forgetting to change patch in the middle of the cycle (week 2/day 8 or week 3/day 15): If <48 hours from normal “patch change day,” apply new patch immediately. No back-up contraception is needed. If >48 hours from normal “patch change day,” apply a new patch and use this day of the week as the new “patch change day” from this point on. An additional method of contraception (nonhormonal) must be used until after the first 7 days of consecutive administration. «bi»End of Cycle (Week 4/Day 22)«/bi» - Forgetting to remove patch at end of cycle (week 4/day 22): Take off as soon as remembering, start new cycle on usual “patch change day.” «b»Changing the “Patch Change Day”«/b» - The “patch change day” can be changed to an earlier day in the week by first completing the current cycle. Then, during the “patch-free interval”, select an earlier day to start the new cycle. Shortening the patch free interval may increase the incidence of spotting or breakthrough bleeding. Do not allow >7 consecutive patch-free days. «b»Skin Irritation«/b» - If patch is in an uncomfortable location, it can be removed and a new patch applied to a different location until the next “patch change day.” «b»Patch Disposal«/b» - To dispose of patch, fold the sticky sides together and dispose in the trash within a child-resistant container - Do not flush down the toilet.

Ethinyl Estradiol-Norethindrone

Genora, Taytulla, Femhrt, Jevantique Lo, Jinteli, Fyavolv, Alyacen 1/35, Balziva, Blisovi 24 Fe, Blisovi Fe 1/20, Blisovi Fe 1/20, Brevicon, Briellyn, Cyclafem 1/35, Dasetta 1/35

«bu»Acne Vulgaris«/bu» «b»Adolescents ≥15 years and Adults«/b» Estrostep Fe, Tilia Fe, Tri-Legest Fe - Refer to dosing for contraception «b»Limitations of Use«/b» - When used for acne, use only in females ≥15 years who have achieved menarche, who also desire combination hormonal contraceptive therapy, are unresponsive to topical treatments, have no contraindications to combination hormonal contraceptive use, and plan to stay on therapy for ≥6 months. «bu»Contraception«/bu» - One tablet once daily «b»Limitations of Use«/b» - The efficacy of some products has not been established in women with a BMI >35 kg/m2. «b»Schedule 1 (Sunday Starter)«/b» - Dose begins on first Sunday after onset of menstruation; if the menstrual period starts on Sunday, take first tablet that very same day. (This schedule is not preferred for all products [eg, Generess Fe, Lo Loestrin Fe, Lo Minastrin Fe]). With a Sunday start, an additional method of contraception should be used until after the first 7 days of consecutive administration (all products). «b»Schedule 2 (Day 1 Starter)«/b» - Dose starts on first day of menstrual cycle taking 1 tablet daily. - Additional contraceptive dosing considerations: «b»Switching from a Different Contraceptive«/b» «i»Oral Contraceptive«/bi» - Start on the same day that a new pack of the previous oral contraceptive would have been taken. «bi»Transdermal Patch, Vaginal Ring, Injection«/bi» - Start on the day the next dose would have been due. «bi»IUD or Implant«/bi» - Start on the day of removal. A backup method of contraception should be used for the first 7 days if IUD is not removed on the first day of the menstrual cycle. «b»Use after First Trimester Abortion or Miscarriage«/b» - Therapy may be started immediately. If not started within 5 days, a back-up method of contraception should be used for the first 7 days. «b»Use after Childbirth (in women who are not breastfeeding) or After Second Trimester Abortion or Miscarriage«/b» - Therapy may be started ≥4 weeks postpartum - Pregnancy should be ruled out prior to treatment if menstrual periods have not restarted. An additional method of contraception (nonhormonal) should be used until after the first 7 days of consecutive administration. «b»Missed or Late Doses«/b» - If one dose is late (<24 hours since dose should have been taken) or if one dose is missed (24 to <48 hours since dose should have been taken): Take dose as soon as possible. Continue remaining doses at the usual time (even if that means 2 doses on the same day). - If ≥2 consecutive doses are missed (≥48 hours since dose should have been taken): Take the most recently missed dose as soon as possible, discard any other missed doses. Continue remaining doses at the usual time (even if that means taking 2 doses on the same day); use back-up contraception until hormonal pills have been taken for 7 consecutive days. If doses were missed during the last week of hormonal (active) tablets (eg, days 15 to 21 of a 28 day pack), omit the hormone free interval by finishing the current pack and starting a new pack. If unable to start a new pack immediately, back up contraception is needed until hormonal pills from a new pack have been taken for 7 consecutive days. Consider use of emergency contraception in some situations (refer to guidelines for details). - Also refer to prescribing information for product specific information. «bu»Osteoporosis Prevention«/bu» Femhrt, Jevantique Lo, Jinteli - One tablet daily «b»Limitations of Use«/b» - For use only in women at significant risk of postmenopausal osteoporosis; consider use of nonestrogen medications. «bu»Vasomotor Symptoms associated with Menopause«/bu» Femhrt, Jevantique Lo, Jinteli - Initial Dose: One tablet daily; patient should be re-evaluated at 3- to 6-month intervals to determine if treatment is still necessary.

Ethionamide

Trecator

Ethosuximide

Zarontin

Ethotoin

Peganone

Ethynodiol Diacetate

Etidronate Disodium

Didronel, EHDP

Etodolac

Lodine

Etomidate

Amidate

Etonogestrel

Implanon, Nexplanon, 3-Keto-desogestrel

«bu»Contraception«/bu» «b»Subdermal«/b» - Insert 1 implant in the inner side of the upper, nondominant arm - Remove no later than 3 years after the date of insertion; may be replaced with a new implant at the time of removal if continued contraceptive protection is desired - After ruling out pregnancy, timing of insertion is based on the patient's contraceptive history: - No hormonal contraceptives within the past month: Insert between days 1 through 5 of menstruation, even if woman is still bleeding «b»Switching from Combination Hormonal Contraceptive«/b» «bi»Oral Tablet«/bi» - Insert on the day after the last active tablet (at the latest, insert on the day following the usual tablet-free or placebo interval) «bi»Transdermal System or Vaginal Ring«/bi» - Insert on the day of the removal of the transdermal system or vaginal ring (at the latest, insert on the day following the transdermal-free or ring-free interval) «b»Switching from a Progestin-only Contraceptive«/b» «bi»Oral Tablet«/bi» - Any day during the month; do not skip days between the last tablet and implant insertion «bi»Implant or IUD«/bi» - Insert on same day as removal of implant or IUD «bi»Injection«/bi» - Insert on day next injection is due First Trimester Abortion or Miscarriage - Insert within first 5 days following first trimester abortion or miscarriage. Second Trimester Abortion or Miscarriage - Insert between 21 and 28 days following second trimester abortion or miscarriage. Postpartum - If not breastfeeding, insert between 21 to 28 days postpartum. If breast-feeding, insert after the fourth postpartum week and use a second nonhormonal form of contraception for the first 7 days of insertion. - If following any of the above insertion schedules, no back-up contraception needed (except in postpartum women who are breastfeeding). If deviating, use a back-up nonhormonal contraceptive method for 7 days postinsertion. If intercourse has already occurred, pregnancy should be excluded. «b»Additional Dosing Considerations«/b» «bi»Initiation of Therapy«/bi» - May be started at any time in the menstrual cycle once it is determined that the woman is not pregnant. Back-up contraception is not needed if started within 5 days of onset of menstruation. If started >5 days after the onset of menstruation or at any time in a woman experiencing amenorrhea (not postpartum), back-up contraception should be used for 7 days. «b»Switching from a Different Contraceptive to an Implant«/b» - May be started at any time if it is determined that the woman is not pregnant. Unless the woman abstains from sexual intercourse, a back-up method of contraception is needed if it has been >5 days since menstrual bleeding has begun. When an additional method of contraception is needed, consider continuing the woman’s previous method for 7 days after inserting the implant. «b»Switching from an IUD to an Implant«/b» - Continue the IUD for at least 7 days after the implant is inserted or advise the woman to abstain from sexual intercourse or use a barrier contraceptive for 7 days before removing the IUD - Alternately, an emergency contraceptive may be used at the time of IUD removal.

3 continuous hours during weeks 1 and 2, the ring should be reinserted as soon as the woman remembers and a spermicide or barrier method of contraception should be used until the ring has been in place for 7 consecutive days.* If the ring is accidently removed from the vagina for >3 hours during week 3, the ring should be discarded. A new ring may be inserted immediately, restarting a new 3-week cycle, OR a new ring may be inserted ≤7 days from the time the previous ring was removed or expelled (the second option should only be done if a vaginal ring was in continuous use for ≥7 days prior to the inadvertent expulsion/removal). With either option, a spermicide or barrier method of contraception should be used until the ring has been in place for 7 consecutive days - If the ring has been removed for longer than 1 week or for an unknown period of time, pregnancy must be ruled out prior to restarting therapy. A spermicide or barrier method of contraception should be used for the following 7 days «b»Prolonged Use«/b» - If the ring has been left in place for up to 1 extra week (up to 4 weeks total); a new ring should be inserted following a 1-week (ring-free) interval. Protection continues during week 4, however, if the ring is left in place >4 weeks, pregnancy must be ruled out prior to insertion and a spermicide or barrier method of contraception should be used for the following 7 days «b»Disconnected Ring«/b» - In the event the ring disconnects at the weld joint, discard and replace with a new ring. - Certain female barrier methods (eg, diaphragm, female condom) may interfere with proper ring placement, and therefore, are not recommended for use as an additional form of contraception.,«bu»Contraception«/bu» «b»Females: Children and Adolescents«/b» «bi»Vaginal«/bi» - Refer to adult dosing - Not to be used prior to menarche." class="list-group-item active pb-0 drug">

Etonogestrel-Ethinyl Estradiol

NuvaRing, EluRyng

«bu»Contraception«/bu» «b»Vaginal«/b» - One ring, inserted vaginally and left in place continuously for 3 consecutive weeks, then removed for 1 week. - A new ring is inserted 7 days after the last was removed (even if bleeding is not complete) and should be inserted at approximately the same time of day the ring was removed the previous week. «bi»Initial Treatment«/bi» - No hormonal contraceptive use in the past month: Insert ring on the first day of menstrual cycle ("Day 1"). May also insert on days 2 to 5 even if bleeding is not complete, however, a spermicide or barrier method of contraception should be used for the following 7 days. «b»Switching from Combination Hormonal Contraceptive«/b» - Ring can be inserted on any day but at the latest on the day following the usual hormone free interval, if she is using the hormonal method consistently and correctly, or if it is reasonably sure she is not pregnant. «b»Switching from Progestin-only Contraceptive«/b» - A spermicide or barrier method of contraception should be used for the following 7 days with any of the following.* - If previously using a progestin-only mini-pill, insert the ring on any day of the month; insert the vaginal ring on the day after the last mini-pill; do not skip days between the last pill and insertion of the ring. - If previously using an implant, insert the ring on the same day of implant removal. - If previously using a progestin-containing IUD, insert the ring on day of IUD removal. - If previously using a progestin injection, insert the ring on the day the next injection would be given. «b»Following Complete 1st Trimester Abortion or Miscarriage«/b» - Insert ring within the first 5 days of abortion or miscarriage. If not inserted within 5 days, follow instructions for "No hormonal contraceptive use within the past month" and instruct patient to use a nonhormonal contraceptive in the interim. «b»Following Delivery or 2nd Trimester Abortion or Miscarriage«/b» - Insert ring 4 weeks postpartum (in women who are not breast-feeding) or following 2nd trimester abortion or miscarriage. A spermicide or barrier method of contraception should be used for the following 7 days «b»Additional Contraceptive Considerations«/b» - Inadvertent removal or expulsion: If the ring is accidentally removed from the vagina at any time during the 3-week period of use, it may be rinsed with cool or lukewarm water (not hot) and reinserted as soon as possible. If the ring is not reinserted within 3 hours, contraceptive effectiveness will be decreased. If the ring is accidently removed from the vagina for >3 continuous hours during weeks 1 and 2, the ring should be reinserted as soon as the woman remembers and a spermicide or barrier method of contraception should be used until the ring has been in place for 7 consecutive days.* If the ring is accidently removed from the vagina for >3 hours during week 3, the ring should be discarded. A new ring may be inserted immediately, restarting a new 3-week cycle, OR a new ring may be inserted ≤7 days from the time the previous ring was removed or expelled (the second option should only be done if a vaginal ring was in continuous use for ≥7 days prior to the inadvertent expulsion/removal). With either option, a spermicide or barrier method of contraception should be used until the ring has been in place for 7 consecutive days - If the ring has been removed for longer than 1 week or for an unknown period of time, pregnancy must be ruled out prior to restarting therapy. A spermicide or barrier method of contraception should be used for the following 7 days «b»Prolonged Use«/b» - If the ring has been left in place for up to 1 extra week (up to 4 weeks total); a new ring should be inserted following a 1-week (ring-free) interval. Protection continues during week 4, however, if the ring is left in place >4 weeks, pregnancy must be ruled out prior to insertion and a spermicide or barrier method of contraception should be used for the following 7 days «b»Disconnected Ring«/b» - In the event the ring disconnects at the weld joint, discard and replace with a new ring. - Certain female barrier methods (eg, diaphragm, female condom) may interfere with proper ring placement, and therefore, are not recommended for use as an additional form of contraception.

Etoposide

Toposar, VePesid, Etopophos

«b»Oral Administration«/b» - Oral etoposide is associated with a low (adults) or moderate (children) emetic potential; antiemetics may be recommended to prevent nausea and vomiting - Doses ≤200 mg/day as a single once daily dose - Doses >200 mg should be given in 2 divided doses - If necessary, the injection may be used for oral administration (see Extemporaneously Prepared). «b»IV Administration«/b» - Administer standard doses over at least 30 to 60 minutes to minimize the risk of hypotension - Higher (off-label) doses used in transplantation may be infused over longer time periods depending on the protocol - Etoposide injection contains polysorbate 80 which may cause leaching of diethylhexyl phthalate (DEHP), a plasticizer contained in polyvinyl chloride (PVC) tubing - Administration through non-PVC (low sorbing) tubing will minimize patient exposure to DEHP - Etoposide is an irritant; tissue irritation and inflammation have occurred following extravasation; avoid extravasation. - Concentrations >0.4 mg/mL are very unstable and may precipitate within a few minutes - For large doses, where dilution to ≤0.4 mg/mL is not feasible, consideration should be given to slow infusion of the undiluted drug through a running normal saline, dextrose or saline/dextrose infusion; or use of etoposide phosphate. - Due to the risk for precipitation, an inline filter may be used; etoposide solutions of 0.1 to 0.4 mg/mL may be filtered through a 0.22 micron filter without damage to the filter; etoposide solutions of 0.2 mg/mL may be filtered through a 0.22 micron filter without significant loss of drug. «b»Etoposide IV Solution Preparation«/b» - Etoposide should be diluted to a concentration of 0.2 to 0.4 mg/mL in D5W or NS for administration - Diluted solutions have concentration-dependent stability - More concentrated solutions have shorter stability times - Precipitation may occur with concentrations >0.4 mg/mL. «b»Etoposide (10 mg/mL) PO Solution Preparation«/b» - Dilute etoposide for injection 1:1 with normal saline to a concentration of 10 mg/mL - This solution is stable in plastic oral syringes for 22 days at room temperature - Prior to oral administration, further mix with fruit juice (orange or apple NOT grapefruit juice) or lemonade to a concentration of <0.4 mg/mL; once mixed with fruit juice, use within 3 hours «b»Infusion (Hypersensitivity) Reactions«/b» - Interrupt infusion. «b»ANC <500/mm3 or Platelets <50,000/mm3«/b» - Withhold treatment until recovery «b»Severe Adverse Reactions (Non-hematologic)«/b» - Reduce dose or discontinue treatment

Etravirine

Intelence

Everolimus

Afinitor, Disperz, Zortress

Evinacumab

Evkeeza

Evolocumab

Repatha, Repatha SureClick, Repatha Pushtronex System

Exemestane

Aromasin

Exenatide

Bydureon, Byetta

Ezetimibe

Zetia

Ezetimibe-Simvastatin

Vytorin

«bu»Homozygous Familial Hypercholesterolemia«/bu» - Ezetimibe 10 mg and Simvastatin 40 mg once daily in the evening. «bu»Primary Hyperlipidemia«/bu» - Initial Dose: Ezetimibe 10 mg and Simvastatin 10 to 20 mg once daily in the evening - Start patients who require >55% reduction in LDL-C at ezetimibe 10 mg and simvastatin 40 mg once daily in the evening - Dosing Range: Ezetimibe 10 mg and simvastatin 10 to 40 mg once daily «b»Dosing Limitation«/b» - Simvastatin 80 mg is limited to patients that have been taking this dose for >12 consecutive months without evidence of myopathy and are not currently taking or beginning a simvastatin dose-limiting or contraindicated interacting medication - If patient is unable to achieve low-density lipoprotein-cholesterol (LDL-C) goal using the 40 mg dose of simvastatin, increasing to 80 mg dose is not recommended - Instead, switch patient to an alternative LDL-C-lowering treatment providing greater LDL-C reduction. After initiation or titration, monitor lipid response after ≥2 weeks and adjust dose as necessary. «b»Dosage Adjustment with Concomitant Medications«/b» - Patients currently tolerating and requiring a dose of simvastatin 80 mg who require initiation of an interacting drug with a dose cap for simvastatin should be switched to an alternative statin with less potential for drug-drug interaction. «bi»Amiodarone, Amlodipine, or Ranolazine«/bi» - Simvastatin dose should not exceed 20 mg once daily. «bi»Diltiazem, Dronedarone, or Verapamil«/bi» - Simvastatin dose should not exceed 10 mg once daily. «bi»Lomitapide«/bi» - Reduce simvastatin dose by 50% when initiating lomitapide - Simvastatin dose should not exceed 20 mg once daily (or 40 mg once daily for those who previously tolerated simvastatin 80 mg daily for ≥1 year without evidence of muscle toxicity). «b»Dosage Adjustment in Chinese Patients on Niacin doses ≥1 g daily«/b» - Use caution with simvastatin doses exceeding 20 mg daily; because of an increased risk of myopathy, do not administer simvastatin 80 mg «b»Limitations of Use«/b» - No incremental benefit of ezetimibe/simvastatin on cardiovascular morbidity and mortality over and above that demonstrated for simvastatin has been established. - Ezetimibe/simvastatin has not been studied in Fredrickson type I, III, IV, and V dyslipidemias.

Ezogabine

Potiga, Retigabine

Factor IX Complex (Human) [(Factors II, IX, X)]

Bebulin, Profilnine, 3 Factor PCC

- Factor IX complex (Human) [Factors II, IX, X] (Bebulin, Profilnine) contains low or nontherapeutic levels of factor VII component and should not be confused with Prothrombin Complex Concentrate (Human) [(Factors II, VII, IX, X), Protein C, Protein S] (Kcentra, Octaplex) which contains therapeutic levels of factor VII. «bu»Hemophilia B«/bu» - Dosage is expressed in units of factor IX activity and must be individualized based on severity of factor IX deficiency, extent and location of bleeding, and clinical status of patient - Close laboratory monitoring of the factor IX level is required to determine proper dosage, particularly with severe hemorrhage and major surgery - Larger doses than those derived from the formula below may be required, especially if treatment is delayed. When multiple doses are required, administer at 24-hour intervals unless otherwise specified. «b»Formula: Units Required to Raise Blood Level %«/b» - Bebulin: In general, factor IX 1 unit/kg will increase the plasma factor IX level by 0.8% - Number of Factor IX units required = body weight (kg) x desired factor IX increase (as % of normal) x 1.2 units/kg Profilnine: In general, factor IX 1 unit/kg will increase the plasma factor IX level by 1%: - Number of factor IX units required = bodyweight (kg) x desired factor IX increase (as % of normal) x 1 unit/kg «b»Limitations of Use«/b» - Not indicated for the treatment of other factor deficiencies (eg, factor II, VII, VIII, X), treatment of hemophilia A patients with inhibitors to factor VIII, or treatment of bleeding caused by low levels of liver-dependent coagulation factors. - As a general rule, the level of factor IX required for treatment of different conditions is listed below: «bu»Hemorrhage«/bu» «b»Minor Bleeding«/b» - Early hemarthrosis, minor epistaxis, gingival bleeding, mild hematuria «bi»Bebulin«/bi» - Raise factor IX level to 20% of normal (typical initial dose: 25 to 35 units/kg); average duration of treatment is 1 day. A single dose is usually sufficient or a second dose may be given after 24 hours. «bi»Profilnine«/bi» - Raise factor IX level to 20% to 30% of normal (initial dose: 20 to 30 units/kg) every 16 to 24 hours for 1 to 2 days for minor hemorrhage or until hemorrhage stops and healing has been achieved. «b»Moderate Bleeding«/b» - Severe joint bleeding, early hematoma, major open bleeding, minor trauma, minor hemoptysis, hematemesis, melena, major hematuria «bi»Bebulin«/bi» - Raise factor IX level to 40% of normal (typical initial dose: 50 to 65 units/kg); average duration of treatment is 2 days or until adequate wound healing. «bi»Profilnine«/bi» - Raise factor IX level to 20% to 30% of normal (initial dose: 20 to 30 units/kg) every 16 to 24 hours for 2 to 7 days for moderate hemorrhage or until hemorrhage stops and healing has been achieved. «b»Major Bleeding«/b» - Severe hematoma, major trauma, severe hemoptysis, hematemesis, melena «bi»Bebulin«/bi» - Raise factor IX level to ≥60% of normal (typical initial dose: 75 to 90 units/kg); average duration of treatment is 2 to 3 days or until adequate wound healing. «bi»Profilnine«/bi» - Raise factor IX level to 30% to 50% of normal (initial dose: 30 to 50 units/kg) every 16 to 24 hours; following this treatment period, maintain factor IX levels at 20% of normal (maintenance dose: 20 units/kg) for 3 to 10 days or until healing has been achieved. «bu»Surgical Procedures«/bu» «b»Dental Surgery«/b» «bi»Bebulin«/bi» - Raise factor IX level to 40% to 60% of normal on day of surgery (typical dose: 50 to 75 units/kg). One infusion, administered 1 hour prior to surgery, is generally sufficient for the extraction of one tooth; for the extraction of multiple teeth, replacement therapy may be required for up to 1 week «bi»Profilnine«/bi» - Raise factor IX level to 50% of normal immediately prior to procedure; maintain factor IX levels at 30% to 50% of normal (maintenance dose: 30 to 50 units/kg) every 16 to 24 hours for 7 to 10 days following surgery or until healing has been achieved. «b»Minor Surgery«/b» «bi»Bebulin«/bi» - Raise factor IX level to 40% to 60% of normal on day of surgery (typical initial dose: 50 to 75 units/kg). Decrease factor IX level from 40% to 60% of normal to 20% to 40% of normal during initial postoperative period (1 to 2 weeks or until adequate wound healing) [typical dose: 26 to 65 units/kg]. The preoperative dose should be given 1 hour prior to surgery. The average dosing interval may be every 12 hours initially, then every 24 hours later in the postoperative period. «bi»Profilnine«/bi» - Raise factor IX level to 30% to 50% of normal (initial dose: 30 to 50 units/kg) prior to surgery (Note: Surgery type not specified by the manufacturer); maintain factor IX levels at 30% to 50% of normal (maintenance dose: 30 to 50 units/kg) every 16 to 24 hours for 7 to 10 days following surgery or until healing is achieved. «b»Major Surgery«/b» «bi»Bebulin«/bi» - Raise factor IX level to ≥60% of normal on day of surgery (typical initial dose: 75 to 90 units/kg). Decrease factor IX level from ≥60% of normal to 20% to 60% of normal during initial postoperative period (1 to 2 weeks) [typical dose: 25 to 75 units/kg]; further decrease to maintain a factor IX level of 20% of normal during late postoperative period (≥3 weeks) and continuing until adequate wound healing is achieved [typical dose: 25 to 35 units/kg]. The preoperative dose should be given 1 hour prior to surgery. The average dosing interval may be every 12 hours initially, then every 24 hours later in the postoperative period. «bi»Profilnine«/bi» - Raise Factor IX level to 30% to 50% of normal (initial dose: 30 to 50 units/kg) prior to surgery (Note: Surgery type not specified by the manufacturer); maintain factor IX levels at 30% to 50% of normal (maintenance dose: 30 to 50 units/kg) every 16 to 24 hours for 7 to 10 days following surgery or until healing is achieved. «bu»Life-threatening Hemorrhage associated with Warfarin«/bu» - Products contain low or nontherapeutic levels of factor VII component; therefore, additional fresh frozen plasma (FFP) or factor VIIa may be considered. When immediate INR reversal is required, concomitant use of 1 to 2 units of FFP should be considered to ensure acute INR reversal. Coadminister vitamin K (phytonadione) 5 to 10 mg by slow IV infusion; vitamin K may be repeated every 12 hours if INR is persistently elevated. Factor IX complex (human) dosing has not been established in this setting; the following regimens have been used with some success. «b»Adjusted-dose Regimen, Weight-based«/b» - INR <2: 20 units/kg - INR 2 to 4: 30 units/kg - INR >4: 50 units/kg - If after administration, INR remains >1.5 consider repeating dose appropriate for INR. - May also determine dose based on presenting INR and estimated functional prothrombin complex (PC) expressed as percentage of normal plasma levels - Units needed to be infused = (target % of functional PC to be reached – current estimated % of functional PC) x kg of body weight «bu»Intracranial Hemorrhage associated with Warfarin«/bu» - Factor IX complex (human) products contain low or nontherapeutic levels of factor VII component (ie, considered a 3-factor PCC). Four-factor PCC is preferred. Administer with vitamin K IV «b»Fixed-dose Regimen, Weight-based«/b» - INR ≥1.4: 50 units/kg; repeat INR within 15 to 60 minutes and serially every 6 to 8 hours for the next 24 to 48 hours - If INR remains ≥1.4 within the first 24 to 48 hours after initial dose, use FFP (alone) for further correction. For initial reversal, it is suggested to administer factor IX complex (PCC) alone rather than combined with FFP or recombinant factor VIIa

Factor XIII Concentrate (Human)

Corifact, Factor 13, FXIII

Famciclovir

Famvir

Famotidine

Pepcid

Famotidine-Calcium Carbonate-Magnesium Hydroxide

Pepcid Complete

Faricimab

Vabysmo

«b»Intravitreal Administration«/b» - Must be administered by qualified physician - Use aseptic conditions for intravitreal injection, including use of surgical hand disinfection, sterile gloves, a sterile drape, a sterile eyelid speculum (or equivalent), and availability of sterile paracentesis equipment (if required) - Administer adequate anesthesia and a broad-spectrum microbicide before injecting - Slowly inject until rubber stopper reaches end of syringe to deliver 0.05 mL; confirm full dose was delivered by checking that the rubber stopper has reached end of syringe barrel; discard any unused medicinal product or waste materials in accordance with local regulations - Monitor for elevated intraocular pressure immediately following intravitreal injection - Appropriate monitoring may consist of a check for perfusion of optic nerve head or tonometry; if required, a sterile paracentesis needle should be available - Following intravitreal injection, instruct patients to report any symptoms suggestive of endophthalmitis or retinal detachment (eg, vision loss, eye pain, eye redness, photophobia, blurred vision) without delay - Each syringe should only be used for treatment of a single eye - If contralateral eye requires treatment, use a new syringe, and change sterile field, syringe, gloves, drapes, eyelid speculum, filter, and injection needles before administering to other eye «b»Intravitreal Preparation«/b» - Remove vial from refrigerator and allow it to reach room temperature (20-25ºC [68-77ºF]) before administering; may keep vial at room temperature for up to 24 hr; keep vial in original carton to protect from light - Visually inspect vial for particulate matter and discoloration before administering; solution is clear to opalescent and colorless to brownish-yellow; discard if particulates, cloudiness, or discoloration are visible; do not use if packaging, vial, and/or transfer filter needle are expired, damaged, or have been tampered with - Use aseptic technique to prepare intravitreal injection - Gather 1 vial of faricimab, 1 sterile 5-micron transfer filter needle 18-gauge x 1.5 inch, a 1-mL Luer lock syringe with a 0.05 mL dose mark, and 1 sterile 30-gauge x 0.5 inch injection needle - Place vial upright on a flat surface (for ~1 minute) after removal from packaging; gently tap vial with finger, as liquid may stick to top of vial - Remove cap from vial and wipe vial septum with alcohol swab - Aseptically and firmly attach 18-gauge x 1.5 inch transfer filter needle onto 1-mL Luer lock syringe - Push filter needle into center of vial septum, then tilt vial slightly so that needle touches bottom edge of vial - Hold vial slightly inclined and slowly withdraw all liquid from vial; keep bevel of filter needle submerged in liquid, to avoid introduction of air - Ensure that plunger rod is drawn sufficiently back when emptying vial, to completely empty filter needle - Disconnect transfer filter needle from syringe and discard in accordance with local regulations - Aseptically and firmly attach a 30-gauge x 0.5-inch injection needle onto Luer lock syringe - Hold syringe with needle pointing up; if there are any air bubbles, gently tap syringe with finger until bubbles rise to the top; carefully expel air from syringe and needle, and slowly depress plunger to align rubber stopper tip to 0.05 mL-dose mark - Use injection immediately after preparation

Fat Emulsion (Fish Oil Based)

Smoflipid

Fat Emulsion (Plant Based)

Intralipid, Liposyn III, Nutrilipid, Clinolipid

«b»IV Administration«/b» - Administer by IV infusion only via peripheral line or by central venous infusion. - All fat emulsion infusions should be filtered whether part of an admixture or infused separately using a 1.2-micron in-line filter only - At the onset of therapy, the patient should be observed for any immediate allergic reactions such as dyspnea, cyanosis, and fever. - Change tubing after each infusion. May be simultaneously infused with carbohydrate/amino acid solutions by means of Y-connector located near infusion site or administered in total nutrient mixtures (3-in-1) with amino acids, dextrose, and other nutrients. - Fat emulsions of 30% should only be administered in total nutrient mixtures (3-in-1) with amino acids, dextrose, and other nutrients. Hang fat emulsion higher than other fluids (has low specific gravity and could run up into other lines). «b»Clinolipid Administration«/b» - Prior to opening the overwrap of Clinolipid, check the color of the oxygen indicator and compare to the reference color next to the OK symbol - If the color of the oxygen absorber/indicator does not correspond to the reference color, do not use - After opening the bag, use the contents immediately and do not store for a subsequent infusion - Do not connect flexible bags in series to avoid air embolism due to possible residual gas contained in the primary bag. When preparing total parenteral nutrition admixture, do not use the EXACTAMIX Inlet H938173 with an EXACTAMIX compounder to transfer Clinolipid injection; EXACTAMIX Inlet H938174 is recommended. «b»Intralipid Administration«/b» - Prior to opening the overwrap, the integrity indicator should be inspected - If the indicator is black, the overwrap is damaged; do not use. «b»Nutrilipid Administration«/b» - To avoid air embolism, use a nonvented infusion set or close the air vent on a vented set and use a dedicated line without any connections. - Prior to opening the overwrap, the oxygen indicator should be inspected; if the indicator is pink or dark pink, do not use. May be infused concurrently into the same vein as carbohydrate-amino acid solutions by means of a Y-connector located near the infusion site; flow rates of each solution should be controlled separately by infusion pumps. - Do not use administration sets and lines that contain di-2-ethylhexyl phthalate (DEHP). See prescribing information for detailed administration information. «bu»Caloric Source EFAD«/bu» «b»Children«/b» - Initiate infusions of 10% emulsions at ≤0.1 mL/minute for 10 to 15 minutes; if no untoward effects occur, the infusion rate may be increased to 1 mL/kg/hour (maximum rate: 100 mL/hour) - Initiate infusions of 20% emulsions at ≤0.05 mL/minute for 10 to 15 minutes; if no untoward effects occur, the infusion rate may be increased to 0.5 mL/kg/hour. Note: Premature and/or septic infants may require reduced infusion rates. Do not exceed 1 g fat/kg in 4 hours in this population. «b»Adults«/b» - Initiate infusions of 10% emulsions at 1 mL/minute for 15 to 30 minutes; if no untoward effects occur, the infusion rate may be increased to 2 mL/minute - Initiate infusions of 20% emulsions at 0.5 mL/minute for 15 to 30 minutes; if no untoward effects occur, the infusion rate may be increased to 1 mL/minute. «bu»Hemodynamic Instability Secondary to Highly Lipid Soluble Substances«/bu» - Administer initial bolus over 1 to 3 minutes followed by a continuous infusion. - Chest compressions should continue during administration if patient is in cardiac arrest. - Some experts recommend a decreased infusion rate in patients who respond favorably to the initial bolus and infusion; repeat bolus or an increase in the infusion rate may be considered if instability persists or recurs.

Fe Bisglycinate

Febuxostat

Uloric

Fedratinib

Inrebic

«bu»Myelofibrosis«/bu» «b»Baseline Platelet Count ≥50 x 109/L«/b» - 400 mg PO daily - Conduct baseline testing of thiamine (Vitamin B1) levels prior to initiation «b»Discontinue Treatment«/b» - If unable to tolerate 200 mg PO daily «b»Management of Thiamine Levels and Wernicke Encephalopathy«/b» - Assess thiamine levels and nutritional status before starting treatment, periodically during treatment, and as clinically indicated - Do not start in patients with thiamine deficiency; replete thiamine before initiating and during treatment if thiamine levels are low - If Wernicke encephalopathy is suspected, immediately discontinue treatment and initiate parenteral thiamine treatment - Monitor until symptoms resolve or improve and thiamine levels normalize «b»Missed Dose«/b» - Take the next scheduled dose the following day «b»Dosing Considerations«/b» - Patients treated with ruxolitinib before initiating fedratinib must taper and discontinue according to the ruxolitinib prescribing information «b»Hematologic Adverse Reactions«/b» Grade 4 Thrombocytopenia, Grade 3 Thrombocytopenia with Bleeding, or Grade 4 Neutropenia - Interrupt dose until resolved to Grade ≤2 or baseline - Restart at 100 mg qDay below the last given dose - Consider dose reduction in patients who become transfusion-dependent during treatment «b»Nausea, Vomiting, Diarrhea«/b» «bi»Grade ≥3 Nausea, Vomiting, Diarrhea Nonresponsive to Supportive Measure After 48 hr«/bi» - Interrupt dose until resolved to Grade ≤1 or baseline - Restart at 100 mg qDay below the last given dose «b»Hepatoxicity«/b» «bi»Grade ≥3 ALT, AST, Bilirubin«/bi» - Interrupt dose until resolved to Grade ≤1 or baseline - Restart at 100 mg qDay below the last given dose - Closely monitor ALT, AST, and bilirubin after dose reduction - If Grade ≥3 recurs, discontinue treatment «b»Other Non-hematologic Toxicities«/b» «bi»Grade ≥3«/bi» - Interrupt dose until resolved to Grade ≤2 or baseline - Restart at 100 mg daily below the last given dose

Felbamate

Felbatol

Felodipine ER

Plendil

Fenfluramine

Fintepla

Fenofibrate Micronized

Antara, Lofibra, Trilipix, Fenoglide, Tricor, Lipofen, Triglide, Fibricor

Fenoldopam

Corlopam

Fenoprofen

Fenortho, Nalfon, ProFeno

FentaNYL

Actiq, Duragesic, Onsolis, Sublimaze, Subsys

Ferric Carboxymaltose

Injectafer, Iron Dextri-Maltose, Ferinject

Ferric Citrate

Auryxia, Tetraferric Tricitrate Decahydrate

Ferric Hexacyanoferrate

Prussian Blue Insoluble, Radiogardase

Ferric Maltol

Accrufer

Ferric Pyrophosphate Citrate

Triferic, Soluble Ferric Pyrophosphate

Ferrous Fumarate

Ferretts, Ferrocite, Hemocyte, Iron Fumarate

Ferrous Gluconate

Fergon, Ferate, Iron Gluconate

Ferrous Sulfate

FE-Caps, FeroSul, Fer-In-Sol, Fer-Iron, Slow Iron, Slow Fe,

Ferumoxytol

Feraheme

Fesoterodine ER

Toviaz, FESO

Fexinidazole

Fexofenadine

Allegra

Fexofenadine-Pseudoephedrine

Allegra-D

Fezolinetant

Veozah

Fibrin Sealant Component

Artiss, Tisseel, Evicel, Evarrest, TachoSil

Fibrinogen Concentrate (Human)

Fibryga, RiaSTAP, Coagulation Factor I

Fidaxomicin

Dificid, Difimicin, Lipiarrmycin, Tiacumicin B

Filgrastim

G-CSF, Granix, Grastofil, Neupogen, Nivestym, Releuko, Zarxio

«bu»Myelosuppressive Chemotherapy Recipients with Non-myeloid Malignancies«/bu» - 5 mcg/kg IV/SC daily - Doses may be increased by 5 mcg/kg (for each chemotherapy cycle) according to the duration and severity of the neutropenia - Continue for up to 14 days until the absolute neutrophil count (ANC) reaches 10,000/mm3 - Discontinue if the ANC surpasses 10,000/mm3 after the expected chemotherapy-induced neutrophil nadir. «bu»Acute Myeloid Leukemia (AML) following Induction or Consolidation Chemotherapy«/bu» - 5 mcg/kg IV/SC - Doses may be increased by 5 mcg/kg (for each chemotherapy cycle) according to the duration and severity of the neutropenia - Continue for up to 14 days until the ANC reaches 10,000/mm3 - Discontinue if the ANC surpasses 10,000/mm3 after the expected chemotherapy-induced neutrophil nadir. «bu»Bone Marrow Transplantation«/bu» - 10 mcg/kg IV daily - Administer ≥24 hours after chemotherapy and ≥24 hours after bone marrow infusion - Adjust the dose according to the duration and severity of neutropenia; recommended steps based on neutrophil response: «b»ANC >1,000/mm3 x 3 Consecutive Days«/b» - Reduce dose to 5 mcg/kg/day «b»ANC Remains >1,000/mm3 x 3 more Consecutive Days«/b» - Discontinue «b»ANC Decreases to <1,000/mm3«/b» - Resume at 5 mcg/kg/day. «b»ANC Decreases to <1,000/mm3 During the 5 mcg/kg/day dose«/b» - Increase dose to 10 mcg/kg/day and follow the above steps «bu»Hematopoietic Radiation Injury Syndrome«/bu» «b»Acute«/b» - 10 mcg/kg SC once daily - Begin as soon as possible after suspected or confirmed radiation doses >2 gray (Gy) and continue filgrastim until ANC remains >1,000/mm3 for 3 consecutive CBCs or ANC exceeds 10,000/mm3 after the radiation-induced nadir «bu»Peripheral Blood Progenitor (PBPC) Cell Collection and Therapy«/bu» - 10 mcg/kg SC daily sually x 6 to 7 days (with apheresis occurring on days 5, 6, and 7) - Begin at least 4 days before the first apheresis and continue until the last apheresis; discontinue for WBC >100,000/mm3 «bu»Severe Chronic Neutropenia«/bu» «b»Congenital«/b» Initial Dose - 6 mcg/kg/day SC in 2 divided doses Maintenance Dose - Adjust the dose based on ANC and clinical response - Mean Dose: 6 mcg/kg/day «b»Idiopathic«/b» Initial Dose - 5 mcg/kg SC once daily Maintenance Dose - Adjust the dose based on ANC and clinical response - Total daily dose may be administered in 1 or 2 divided doses - Mean Dose: 1.2 mcg/kg/day «b»Cyclic«/b» Initial Dose - 5 mcg/kg SC once daily Maintenance Dose - Adjust the dose based on ANC and clinical response - Total daily dose may be administered in 1 or 2 divided doses - Mean dose: 2.1 mcg/kg/day «bu»Anemia in Myelodysplastic Syndrome«/bu» - In combination with epoetin - 300 mcg SC weekly in 2 to 3 divided doses OR - 1 mcg/kg SC once daily OR - 75 mcg, 150 mcg, or 300 mcg per dose 3 times weekly «bu»Neutropenia«/bu» «bu»Hepatitis C Treatment-associated«/bu» Initial Dose - 150 mcg SC once weekly to 300 mcg 3 times weekly Maintenance Dose - Titrate to maintain ANC between 750 and 10,000/mm3 «bu»Advanced HIV Infection«/bu» Initial Dose - 1 mcg/kg SC once daily OR - 300 mcg SC one to three times per week Maintenance Dose - Titrate to maintain ANC 2,000 to 10,000/mm3 - Doses up to 10 mcg/kg/day or 600 mcg daily were studied - Do not administer in the period 24 hours before to 24 hours after cytotoxic chemotherapy «bu»Myelosuppressive Chemotherapy Recipients with Non-myeloid Malignancies«/bu» - 5 mcg/kg SC/IV daily - Doses may be increased by 5 mcg/kg (for each chemotherapy cycle) according to the duration and severity of the neutropenia - Continue for up to 14 days until the absolute neutrophil count (ANC) reaches 10,000/mm3 - Discontinue if the ANC surpasses 10,000/mm3 after the expected chemotherapy-induced neutrophil nadir. «bu»Bone Marrow Transplantation«/bu» - 10 mcg/kg IV daily - Administer ≥24 hours after chemotherapy and ≥24 hours after bone marrow infusion) - Adjust the dose according to the duration and severity of neutropenia; recommended steps based on neutrophil response: «b»ANC >1,000/mm3 x 3 Consecutive Days«/b» - Reduce dose to 5 mcg/kg/day «b»ANC Remains >1,000/mm3 x 3 More Consecutive Days«/bi» - Discontinue «b»ANC Decreases to <1,000/mm3«/b» - Resume at 5 mcg/kg/day «b»ANC Decreases to <1,000/mm3 During the 5 mcg/kg/day Dose«/b» - Increase dose to 10 mcg/kg/day and follow the above steps «bu»Hematopoietic Radiation Injury Syndrome«/bu» «b»Acute«/b» - 10 mcg/kg SC once daily - Begin as soon as possible after suspected or confirmed radiation doses >2 gray (Gy) and continue filgrastim until ANC remains >1,000/mm3 for 3 consecutive CBCs or ANC exceeds 10,000/mm3 after the radiation-induced nadir «bu»Peripheral Blood Progenitor Cell Collection and Therapy«/bu» - 10 mcg/kg SC daily usually for 6 to 7 days (with apheresis occurring on days 5, 6, and 7) - Begin at least 4 days before the first apheresis and continue until the last apheresis; discontinue for WBC >100,000/mm3 «bu»Severe Chronic Neutropenia«/bu» «b»Infants ≥1 month, Children, and Adolescents«/b» «bi»Congenital«/bi» - Initial: 6 mcg/kg/day SC in 2 divided doses - Adjust the dose based on ANC and clinical response - Mean dose: 6 mcg/kg/day. «b»Idiopathic«/bi» - Initial: 5 mcg/kg once SC daily - Adjust the dose based on ANC and clinical response - Total daily dose may be administered in 1 or 2 divided doses - Mean dose: 1.2 mcg/kg/day «bi»Cyclic«/bi» - Initial: 5 mcg/kg SC once daily - Adjust the dose based on ANC and clinical response - Total daily dose may be administered in 1 or 2 divided doses - Mean dose: 2.1 mcg/kg/day «bu»Neutropenia in Advanced HIV infection«/bu» «b»Adolescents >13 years«/b» - Refer to adult dosing. - Do not administer earlier than 24 hours after or in the 24 hours prior to cytotoxic chemotherapy. «b»IV Administration«/b» - May be administered IV as a short infusion over 15 to 30 minutes (chemotherapy-induced neutropenia) or by continuous infusion (chemotherapy-induced neutropenia) or as an infusion of no longer than 24 hours (bone marrow transplantation). «b»SC Administration«/b» - May be administered SC (chemotherapy-induced neutropenia, peripheral blood progenitor cell collection, severe chronic neutropenia, hematopoietic radiation injury syndrome) - Administer into the outer upper arm, abdomen (except within 2 inches of navel), front middle thigh, or the upper outer buttocks area - Rotate injection site; do not inject into areas that are tender, red, bruised, hardened, or scarred, or sites with stretch marks. - Some patients (or caregivers) may be appropriate candidates for SC self-administration with proper training; patients/caregivers should follow the manufacturer instructions for preparation and administration - Do not skip doses, change schedule, or discontinue without consulting with health care provider. - Granix is available in prefilled syringes with and without a needle guard; the prefilled syringe without a safety needle guard is intended for patient/caregiver self-administration. - If filgrastim comes in contact with the skin, wash area thoroughly with soap and water; if eye contact occurs, flush exposed eye(s) with water. «b»Reconstitution«/b» - Visually inspect prior to use; discard if discolored or if particulates are present. - Do not dilute with saline at any time; product may precipitate. - Filgrastim (vial only; do not use prefilled syringe for IV preparation) may be diluted with D5W to a concentration of 5 to 15 mcg/mL for IV infusion administration (minimum concentration: 5 mcg/mL). - Concentrations of 5 to 15 mcg/mL require addition of albumin (final albumin concentration of 2 mg/mL) to prevent adsorption to plastics. - Dilution to <5 mcg/mL is not recommended - Do not shake - May be prepared in glass bottles, polyvinyl chloride (PVC) or polyolefin bags, and polypropylene syringes. Discard unused portion of vial. «bi»Granix«/bi» - Remove needle shield and expel extra volume if needed (depending on dose) - Prefilled syringe is for single use only; discard unused portion. «bi»Grastofil«/bi» - Do not dilute with saline at any time; product may precipitate - May be diluted with D5W to a concentration of 5 to 15 mcg/mL for IV infusion administration - Concentrations of 5 to 15 mcg/mL require addition of albumin (final albumin concentration of 2 mg/mL) to prevent adsorption to plastics. Dilution to <5 mcg/mL is not recommended - Do not shake. May be prepared in glass if diluted with D5W or in PVC or polyolefin IV bags if diluted in D5W plus albumin - Discard unused portion of syringe. «bi»Zarxio«/bi» - Do not dilute with saline at any time; product may precipitate. - Filgrastim-sndz may be diluted with D5W to a concentration of 5 to 15 mcg/mL for IV infusion administration. - Concentrations of 5 to 15 mcg/mL require addition of albumin (final albumin concentration of 2 mg/mL) to prevent adsorption to plastics. - Do not shake. - May be prepared in glass, PVC, polyolefin, and polypropylene - Discard unused portion of syringe.

Finasteride

Propecia, Proscar

Finasteride-Tadalafil

Entadfi

Finerenone

Kerendia

Fingolimod

Gilenya

Fish Oil Triglycerides

Omegaven

«bu»Nutrition-associated Cholestasis«/bu» - Recommended Dose: 1 g/kg/day IV (maximum daily dose) - Initial Rate: Not exceed 0.05 mL/minute for the first 15-30 minutes of infusion, then, if tolerated, gradually increase until reaching the required rate after 30 minutes - Maximum Infusion Rate: Not exceed 1.5 mL/kg/hr, corresponding to 0.15 g/kg/hr «b»Hypertriglyceridemia«/b» - If hypertriglyceridemia (triglycerides >250 mg/dL for neonates and infants or >400 mg/dL for older children) develops once fish oil triglycerides has been initiated at the recommended dosage, consider stopping the administration for 4 hr and obtain a repeat serum triglyceride level - Resume based on new result as indicated In patients with elevated triglyceride levels, consider other reasons for hypertriglyceridemia (eg, renal disease, other drugs) - If triglycerides remain at elevated levels, consider a reduced dose of 0.5-0.75 g/kg/day with an incremental increase to 1 g/kg/day; monitor triglyceride levels during treatment - Recommended duration for infusion is between 8-24 hr, depending on the clinical situation - Administer until direct bilirubin levels are <2 mg/dL or until the patient no longer requires PN «b»Dosing Considerations«/b» - Prior to administration, correct severe fluid and electrolyte disorders and measure serum triglycerides to establish a baseline level - Initiate dosing as soon as direct or conjugated bilirubin (DBil) levels are ≥2 mg/dL in pediatric patients who are expected to be PN-dependent for at least 2 weeks - Dosing depends on each patient’s energy requirements, which may be influenced by age, body weight, tolerance, clinical status, and ability to metabolize and eliminate lipids - When determining dose, take into account the energy supplied by dextrose and amino acids from PN, as well as energy from oral or enteral nutrition - Energy provided from lipid-based medications must also be taken into account (eg, propofol); contains 0.15-0.30 mg/mL of dl-alpha-tocopherol - Take into account the amount of alpha-tocopherol in fish oil triglyceride when determining the need for additional supplementation of vitamin E «b»Limitations of Use«/b» - Not indicated for the prevention of PNAC; it is not been demonstrated that fish oil triglycerides prevents PNAC in parenteral nutrition (PN)-dependent patients - It has not been demonstrated that the clinical outcomes observed in patients treated with fish oil triglycerides are a result of the omega-6:omega-3 fatty acid ratio of the product

Flavocoxid

Limbrel, Flavan

FlavoxATE

Urispas

Flecainide

Tambocor

«bu»Ventricular Arrhythmias Prevention«/bu» «b»Initial Dose«/b» - 100 mg PO every 12 hours «b»Maintenance Dose«/b» - May increase by 50 mg PO bid at 4-day intervals «b»Maximum Dose«/b» - 400 mg per day - Some patients inadequately controlled with or intolerant to dosing every 12 hours may require dosing every 8 hours. - Initiate therapy in a hospital setting in patients with sustained ventricular tachycardia. Use of higher initial doses and more rapid dosage adjustments have resulted in an increased incidence of proarrhythmic events and congestive heart failure, particularly during the first few days - Do not use a loading dose. Use very cautiously in patients with history of congestive heart failure or myocardial infarction. «bu»Paroxysmal Atrial Fibrillation/Flutter Prevention«/bu» «b»Initial Dose«/b» - 50 mg PO every 12 hours «b»Maintenance Dose«/b» - Increase by 50 mg PO bid at 4-day intervals «b»Maximum Total Dose«/b» - 300 mg «bu»Paroxysmal Supraventricular Tachycardias Prevention«/bu» «b»Initial Dose«/b» - 50 mg PO every 12 hours «b»Maintenance Dose«/b» - Increase by 50 mg PO bid at 4-day intervals «b»Maximum Total Dose«/b» - 300 mg «bu»Atrial Fibrillation or Flutter«/bu» - Pharmacological cardioversion - May be used on an outpatient basis «b»(“Pill-in-the-Pocket”)«/b» - An initial «b»inpatient«/b» cardioversion trial should have been successful before sending patient home on this approach - Patient must be taking an AV nodal-blocking agent (beta-blocker, non-dihydropyridine calcium channel blocker) prior to initiation of antiarrhythmic «b»<70 kg«/b» - 200 mg PO x 1 dose - May not repeat in ≤24 hours «b»≥70 kg«/b» - 300 mg PO x 1 dose - May not repeat in ≤24 hours «b»Conversion from Another Antiarrhythmic Agent«/b» - Allow for 2 to 4 half-lives of the other agent after discontinuation to pass before initiating flecainide therapy «b»Dosage Adjustment for Concomitant Therapy«/b» «bi»Amiodarone«/bi» - Reduce the flecainide dose by 50% and monitor the patient closely for adverse effects - Monitoring of plasma concentrations is strongly recommended to guide dosage

Flibanserin

Addyi

Flortaucipir F 18

Tauvid

Flotufolastat F 18 Injection

Posluma Injection

«b»Patient Preparation«/b» - Instruct to drink water before administration to ensure adequate hydration - Continue drinking and voiding frequently for first few hours after administration to reduce radiation exposure «b»IV Preparation«/b» - Handle radioactive drug with appropriate safety measures to minimize radiation exposure during administration - Use waterproof gloves and effective shielding, including syringe shields, when handling and administering - Inspect solution visually for particulate matter and discoloration before administration; discard if solution contains particulate matter or is discolored - Use aseptic technique and radiation shielding when withdrawing and administering - Calculate necessary volume to administer based on calibration time and date; assay dose using a suitably calibrated instrument - Recommended maximum volume of injection of undiluted drug is 5 mL; may be diluted with NS «b»IV Administration«/b» - After IV bolus injection, administer IV flush of sterile NS to ensure full delivery of the dose - Dispose of any unused drug in a safe manner in compliance with applicable regulations «b»Image Acquisition Guidelines«/b» - Have patient void immediately before imaging - Position patient supine with arms above head - Begin PET scanning ~60 minutes after injection - Image acquisition should start from mid-thigh and proceed to base of skull - Scan duration ~20 minutes depending on number of bed positions and acquisition time per bed position (typically 3 minutes) - Adapt imaging technique according to equipment used and patient characteristics to obtain the best image quality possible «b»Image Display and Interpretation«/b» - Localization of prostate cancer recurrence in sites typical for prostate cancer recurrence is based on flotufolastat F 18 uptake in comparison with tissue background - Lesions should be considered suspicious if uptake is greater than physiologic uptake in that tissue or greater than adjacent background if no physiologic uptake is expected; tumors that do not express PSMA will not be visualized; increased uptake in tumors is not specific for prostate cancer

Floxuridine

5-FUDR, Fluorodeoxyuridine

Fluconazole

Diflucan

«b»Usual Dosage Range«/b» - 150 mg IV/PO x 1 dose «b»Loading Dose«/b» - 200 to 800 mg IV/PO x 1 dose «b»Maintenance Dose«/b» - 200 to 800 mg IV/PO once daily - Duration and dosage depend on location and severity of infection «bu»Blastomycosis«/bu» - 800 mg PO daily for ≥12 months and until resolution of CSF abnormalities «bu»Candidemia«/bu» «b»Loading Dose«/b» - 800 mg (12 mg/kg) IV/PO on day 1 «b»Maintenance Dose«/b» - 400 mg IV/PO daily (6 mg/kg/day) for 14 days after first negative blood culture and resolution of signs/symptoms. - Not recommended as first-line therapy in patients with previous azole exposure, critical illness, or if at high risk of C. glabrata infection (elderly, diabetic, malignancy) «bu»Oropharyngeal Candidiasis«/bu» «b»Loading Dose«/b» - 200 mg PO on Day 1 «b»Maintenance Dose«/b» - 100 mg PO daily «b»Dosing Considerations«/b» - Treatment should be continued for at least 2 weeks to decrease likelihood of relapse «bu»Esophageal Candidiasis«/bu» «b»Loading Dose«/b» - 200 mg PO on Day 1 -«b»Maintenance Dose«/b» 100 mg PO daily - Doses up to 400 mg/day may be used based on patient’s response «b»Dosing Considerations«/b» - Treat for a minimum of 3 weeks and for at least 2 weeks following resolution of symptoms «bu»Cryptococcal Meningitis«/bu» Loading Dose - 400 mg PO on Day 1 Maintenance Dose - 200 mg PO daily - Dosage of up to 400 mg daily may be used based on patient’s response «bu»Suppression of Relapse in Patients with AIDS«/bu» - 200 mg PO daily «b»Dosing Considerations«/b» - Recommended duration of therapy is 10-12 weeks after cerebrospinal fluid becomes culture negative «bu»Prophylaxis of Candidiasis with BMT«/bu» - 400 mg PO daily «b»Dosing Considerations«/b» - Patients who are anticipated to have severe granulocytopenia should start prophylaxis several days before anticipated onset of neutropenia and continue for 7 days after neutrophil count rises >1000 cells per mm³ «bu»Vaginal Candidiasis«/bu» «b»Uncomplicated«/b» - 150 mg PO x 1 dose «b»Complicated«/b» - 150 mg PO every 72hr x 3 doses «b»Recurrent«/b» - 150 mg PO daily x 10-14 days THEN, - 150 mg PO once weekly x 6 months «bu»Candida UTI/Peritonitis«/bu» - 50-200 mg PO daily

Flucytosine

Ancobon, 5-Fluorocytosine, 5-FC

Fludarabine

Fludara

Fludrocortisone

Florinef

Flumazenil

Romazicon

Flunisolide (Nasal)

Nasalide, Rhinalar

Fluocinolone (Topical)

Synalar, Xilapak, Capex, Derma-Smoothe/FS Scalp

Fluocinolone Acetonide (Ophthalmic)

Iluvien, Retisert, Yutiq

Fluocinolone Acetonide (Otic)

DermOtic

Fluocinonide

Vanos, Lidex

Fluorescein

BioGlo, Fluorets, Ful-Glo (Ophthalmic)

Fluorescein-Proparacaine

Flucaine

Fluoride

Altaflor, PreviDent, Fluoridex, Sodium Fluoride, Phos-Flur Rinse, Phos-Flur Gel

Fluorometholone

Flarex, FML, FML Forte (Ophthalmic)

Fluorouracil

Adrucil, 5-FU, 5FU

Fluorouracil (Topical)

Carac, Efudex, Fluoroplex, Tolak

FLUoxetine

PROzac, Sarafem

«bu»Borderline Personality Disorder«/bu» - 20 mg daily - Adjust dose based on response and tolerability up to 80 mg/day «bu»Bulimia Nervosa«/bu» - 60 mg/day - May titrate dose to 60 mg over several days «bu»Depression«/bu» - Initial Dose: 20 mg/day - May increase after several weeks if inadequate response - Maximum: 80 mg/day - Patients maintained on Prozac 20 mg/day may be changed to Prozac Weekly 90 mg/week, starting dose 7 days after the last 20 mg/day dose «bu»Depression associated with Bipolar I Disorder«/bu» «b»In Combination with Olanzapine«/b» - Initial Dose: 20 mg in the evening - Adjust as tolerated to usual range of 20 to 50 mg/day. «bu»Fibromyalgia«/bu» - Initial Dose: 20 mg daily - May adjust dose based on response and tolerability in 10 to 20 mg increments at 2 week intervals up to 80 mg/day - Mean dose in clinical trials was 45 mg (range: 20 to 80 mg/day) «bu»Obsessive-Compulsive Disorder (OCD)«/bu» - Initial Dose: 20 mg/day - May increase after several weeks if inadequate response - Recommended range: 20 to 60 mg/day - Maximum: 80 mg/day «bu»Panic Disorder«/bu» - Initial Dose: 10 mg/day; after 1 week, increase to 20 mg/day - May increase after several weeks - Doses >60 mg/day have not been evaluated «bu»Post-Traumatic Stress Disorder (PTSD)«/bu» - 20 to 40 mg/day «bu»Premenstrual Dysphoric Disorder (PMDD)«/bu» «b»Sarafem«/b» - 20 mg/day continuously OR - 20 mg/day starting 14 days prior to menstruation and through first full day of menses (repeat with each cycle) «bu»Raynaud Phenomenon«/bu» - 20 mg/day «bu»Social Anxiety Disorder«/bu» - Initial Dose: 10 mg/day for 7 days - May increase the dose based on response and tolerability in 10 mg increments at intervals of at least 7 days to a target dose of 40 mg/day; typical range in clinical trial was 30 to 60 mg/day «bu»Treatment-resistant Depression«/bu» «b»Combination with Olanzapine«/b» - Initial Dose: 20 mg in the evening - Adjust as tolerated to usual range of 20 to 50 mg/day. When using individual components of fluoxetine with olanzapine rather than fixed-dose combination product (Symbyax), approximate dosage correspondence is as follows: - Olanzapine 2.5 mg + fluoxetine 20 mg = Symbyax 3/25 - Olanzapine 5 mg + fluoxetine 20 mg = Symbyax 6/25 - Olanzapine 12.5 mg + fluoxetine 20 mg = Symbyax 12/25 - Olanzapine 5 mg + fluoxetine 50 mg = Symbyax 6/50 - Olanzapine 12.5 mg + fluoxetine 50 mg = Symbyax 12/50 «b»Discontinuation of Therapy«/b» - Upon discontinuation of antidepressant therapy, gradually taper the dose to minimize the incidence of withdrawal symptoms and allow for the detection of re-emerging symptoms. Evidence supporting ideal taper rates is limited. APA and NICE guidelines suggest tapering therapy over at least several weeks with consideration to the half-life of the antidepressant; antidepressants with a shorter half-life may need to be tapered more conservatively. In addition for long-term treated patients, WFSBP guidelines recommend tapering over 4 to 6 months. If intolerable withdrawal symptoms occur following a dose reduction, consider resuming the previously prescribed dose and/or decrease dose at a more gradual rate «b»Switching to or from an MAO Inhibitor«/b» - Allow 14 days to elapse between discontinuing an MAO inhibitor intended to treat psychiatric disorders and initiation of fluoxetine. - Allow 5 weeks to elapse between discontinuing fluoxetine and initiation of an MAO inhibitor intended to treat psychiatric disorders. «b»Use with other MAO Inhibitors (Linezolid or IV Methylene Blue)«/b» - Do not initiate fluoxetine in patients receiving linezolid or IV methylene blue; consider other interventions for psychiatric condition. - If urgent treatment with linezolid or IV methylene blue is required in a patient already receiving fluoxetine and potential benefits outweigh potential risks, discontinue fluoxetine promptly and administer linezolid or IV methylene blue. - Monitor for serotonin syndrome for 5 weeks or until 24 hours after the last dose of linezolid or IV methylene blue, whichever comes first. May resume fluoxetine 24 hours after the last dose of linezolid or IV methylene blue. «bu»Depression«/bu» «b»Children ≥8 years«/b» - 10 to 20 mg/day - Lower-weight children can be started at 10 mg/day - May increase to 20 mg/day after 1 week if needed «bu»Depression associated with Bipolar I Disorder«/bu» «b»Children ≥10 years«/b» - In combination with olanzapine - Initial Dose: 20 mg in the evening - Adjust dose, if needed, as tolerated; safety of fluoxetine doses >50 mg in combination with doses >12 mg of olanzapine has not been studied in pediatrics. «bu»Obsessive Compulsive Disorder«/bu» «b»Children ≥7 years«/b» - Initial Dose: 10 mg/day - May increase after 2 weeks if inadequate clinical response to 20 mg/day - Further increases may be considered after several weeks to recommended range of 20 to 30 mg/day (lower weight children) or 20 to 60 mg/day (adolescents and higher weight children) «bu»Selective Mutism«/bu» «b»Children ≥5 years«/b» - Initial Dose: 5 mg once daily for 7 days - May increase to 10 mg once daily for 7 days, and 20 mg once daily - May further titrate in 20 mg/day increments if needed every 2 weeks; maximum daily dose: 60 mg/day «bi»Weight-based Dosing«/bi» - 0.2 mg/kg/day for 1 week, then, - 0.4 mg/kg/day for 1 week, then, - 0.6 mg/kg/day for 10 weeks - Mean final dose in clinical trials: 21.4 mg/day - To fully assess therapeutic response, a therapeutic trial of at least 9 to 12 weeks or longer has been suggested. When using individual components of fluoxetine with olanzapine rather than fixed-dose combination product (Symbyax), approximate dosage correspondence is as follows: - Olanzapine 2.5 mg + fluoxetine 20 mg = Symbyax 3/25 - Olanzapine 5 mg + fluoxetine 20 mg = Symbyax 6/25 - Olanzapine 12.5 mg + fluoxetine 20 mg = Symbyax 12/25 - Olanzapine 5 mg + fluoxetine 50 mg = Symbyax 6/50 - Olanzapine 12.5 mg + fluoxetine 50 mg = Symbyax 12/50 - Discontinuation of therapy: Refer to adult dosing «b»Children Pharmacokinetics«/b» - Average steady-state fluoxetine serum concentrations in children (n=10; 6 to <13 years of age) were 2-fold higher than in adolescents (n=11; 13 to <18 years of age); all patients received 20 mg/day; average steady-state norfluoxetine serum concentrations were 1.5-fold higher in the children compared with adolescents; differences in weight almost entirely explained the differences in serum concentrations.

Fluoxymesterone

Androxy, Halotestin

FluPHENAZine

Prolixin

«bu»Psychosis«/bu» - Initial Dose: 2.5 to 10 mg/day in 3 or 4 divided doses - Maintenance Dose: 1 to 5 mg/day (may be given as a daily dose) - Some patients may require up to 40 mg/day for symptom control «b»Limitations of Use«/b» - Fluphenazine has not been shown to be effective in the management of behavioral complications in patients with mental retardation. «b»PORT Guidelines«/b» «bi»Acute Therapy«/bi» - 6 to 20 mg/day for up to 6 weeks «bi»Maintenance Dose«/bi» - 6 to 12 mg/day «b»IM (Hydrochloride)«/b» - Initial Dose: 1.25 mg as a single dose - Depending on severity and duration, may need 2.5 to 10 mg/day in divided doses at 6- to 8-hour intervals (IM fluphenazine HCl is approximately equivalent to 33% to 50% of the oral fluphenazine HCl dose) - Use caution with doses >10 mg/day; once symptoms stabilized, transition to oral maintenance therapy «b»Long-acting Maintenance Injections (Decanoate)«/b» - Prior to initiation consider establishing response, the appropriate dose and tolerability with a short-acting form of fluphenazine. «bi»IM, SC (Decanoate)«/bi» - Initial Dose: 12.5 to 25 mg every 3 to 4 weeks - Response may last up to 6 weeks in some patients - Titrate dose cautiously - If doses >50 mg are needed, increase in 12.5 mg increments - Maximum dose: 100 mg «bi»Conversion from Hydrochloride to Decanoate IM«/bi» - 12.5 mg of decanoate every 3 weeks is approximately equivalent to 10 mg of oral hydrochloride/day «bi»PORT Guidelines«/bi» - 6.25 to 25 mg IM/SC every 2 weeks - Decrease the oral fluphenazine (or current antipsychotic) dose by half after the initial injection - Consider discontinuation of oral therapy after second injection «bu»Chorea of Huntington Disease«/bu» - Initial Dose: 2 mg PO daily - Increase dose gradually based on response and tolerability - Doses as high as 7 mg/day have been reported «b»IM (Decanoate)«/b» - Initial Dose: 25 mg IM x 1 dose - After initial injection, dose can be increased based on response and tolerability in increments of 12.5 to 25 mg IM up to 75 mg every 3 weeks. «bu»Chronic Tic Disorders«/bu» - Initial Dose: 0.5 to 1 mg PO once daily - Increase in 0.5 mg to 1 mg increments every week based on response and tolerability. - Doses up to 24 mg divided 1 to 3 times daily have been studied - Usual Dose Range: 2.5 to 10 mg/day «b»Discontinuation of Therapy«/b» - The American Psychiatric Association (APA), Canadian Psychiatric Association (CPA), and World Federation of Societies of Biological Psychiatry (WFSBP) guidelines recommend gradually tapering antipsychotics to avoid withdrawal symptoms and minimize the risk of relapse; risk for withdrawal symptoms may be highest with highly anti-cholinergic or dopaminergic antipsychotics. When stopping antipsychotic therapy in patients with schizophrenia, the CPA guidelines recommend a gradual taper over 6 to 24 months, and the APA guidelines recommend reducing the dose by 10% each month. Continuing anti-parkinsonism agents for a brief period after discontinuation may prevent withdrawal symptoms. When switching antipsychotics, 3 strategies have been suggested: cross-titration (gradually discontinuing the first antipsychotic while gradually increasing the new antipsychotic), overlap and taper (maintaining the dose of the first antipsychotic while gradually increasing the new antipsychotic, then tapering the first antipsychotic), and abrupt change (abruptly discontinuing the first antipsychotic and either increasing the new antipsychotic gradually or starting it at a treatment dose). Evidence supporting ideal switch strategies and taper rates is limited, and results are conflicting

Flurazepam

Dalmane, Dalmadorm

Flurbiprofen

Ansaid

Flurbiprofen (Ophthalmic)

Ocufen

Flutamide

Eulexin, Flucinom, Flugerel, Niftolid

Fluticasone

ArmonAir Respiclick, Arnuity Ellipta, Flovent (Oral Inhalations)

«b»Dry Powder Inhaler Inhalation«/b» «bi»ArmonAir Respiclick«/bi» - Administer the dose at approximately the same time every day. - Does not require priming and do not use with a spacer or volume holding chamber. - Following administration, rinse mouth with water after use (do not swallow). - Do not wash or place any part of inhaler in water; if mouthpiece needs cleaning, gently wipe with a dry cloth or tissue. - Discard inhaler 30 days after opening the foil pouch or when the counter reads "0" (whichever comes first). «bi»Arnuity Ellipta«/bi» - Administer the dose at the same time every day. - Do not shake inhaler. - When ready to use, open and prepare mouthpiece of the inhaler and slide the cover down to activate the first dose. - Exhale fully (not into mouthpiece), take one deep breath through mouth without blocking air vents and hold breath for about 3 to 4 seconds. - If the cover is opened and closed without inhaling the medicine, the dose will be lost. - The lost dose will be held in the inhaler, but it will no longer be available to be inhaled. - It is not possible to accidentally take a double dose or an extra dose in one inhalation. - Following administration, rinse mouth with water after use (do not swallow). - Routine cleaning of the inhaler is not required; may clean the mouthpiece if needed, using a dry tissue, before the cover is closed. - Discard inhaler 6 weeks after opening the foil tray or when the counter reads "0" (device is not reusable). «bi»Flovent Diskus«/bi» - Do not use with a spacer device. - Do not exhale into Diskus. - Do not wash or take apart. Use in horizontal position; do not tilt. - Rinse mouth with water (without swallowing) after each use. - Discard after 6 weeks (50 mcg diskus) or after 2 months (100 mcg and 250 mcg diskus) once removed from protective pouch or when the dose counter reads "0", whichever comes first (device is not reusable). «b»Metered Dose Inhaler Administration«/b» «bi»Flovent HFA«/bi» - Shake container thoroughly for 5 seconds before each inhalation. - Use inhaler on inspiration. - Allow 30 seconds between inhalations. - Rinse mouth with water (without swallowing) after each use. - Inhaler must be primed before first use, when not used for 7 days, or if dropped. - To prime the first time, release 4 sprays into air; shake well for 5 seconds before each spray and spray away from face. - The counter should now read "120". - If dropped or not used for 7 days, prime by shaking well for 5 seconds and releasing a single test spray. - Patient should contact pharmacy for refill when the dose counter reads "020". - Discard device when the dose counter reads "000". - Do not use "float" test to determine contents. - Clean the inhaler at least once weekly; use a cotton swab dampened with water to clean circular opening of the metal canister and wipe the inside of the mouthpiece with a tissue dampened with water. «b»Oral Administration«/b» - For the treatment of eosinophilic esophagitis (off-label use), fluticasone is administered orally with a metered-dose inhaler without the use of a spacer. - Administer as a spray into the mouth and swallow (do not inhale). - Patients may not rinse, eat, or drink for 30 minutes after administration

Fluticasone (Nasal)

Avamys, Xhance, Flonase, Ticaspray, Flonase Sensimist, Veramyst, ClariSpray

Fluticasone (Topical)

Cutivate

Fluticasone-Salmeterol

Advair, AirDuo RespiClick, Wixela Inhub

Fluticasone-Vilanterol

Breo Ellipta

Fluvastatin

Lescol

FluvoxaMINE

Luvox

«bu»Obsessive Compulsive Disorder (OCD)«/bu» «b»Immediate Release«/b» Initial Dose - 50 mg once daily at bedtime Maintenance Dose - May be increased in 50 mg increments at 4- to 7-day intervals, as tolerated Usual Dose Range - 100 to 300 mg daily Maximum Dose - 300 mg/day - Manufacturer's labeling recommends that daily doses >100 mg be given in 2 divided doses, with the larger dose administered at bedtime. «b»Extended Release«/b» Initial Dose - 100 mg once daily at bedtime Maintanace Dose - May be increased in 50 mg increments at intervals of at least 1 week Usual Dosage Range - 100 to 300 mg daily Maximum Dose - 300 mg/day «bu»Bulimia Nervosa«/bu» «b»Immediate Release«/b» Initial Dose - 50 mg daily Maintenance Dose - May increase dose based on response and tolerability up to 300 mg/day given in 1 or 2 divided doses «bu»Major Depressive Disorder«/bu» «b»Immediate Release«/b» Initial Dose - 50 mg/day Maintenance Dose - May increase dose based on response and tolerability to usual dosage range of 100 to 200 mg/day - Doses as high as 300 mg/day have been studied «bu»Panic Disorder«/bu» «b»Immediate Release«/b» Initial Dose - 25 to 50 mg daily Maintenance Dose - Titrate gradually based on response and tolerability Usual Dosage Range - 100 to 200 mg daily «bu»Post Traumatic Stress Disorder (PTSD)«/bu» «b»Immediate Release«/b» - 75 mg PO bid «bu»Social Anxiety Disorder«/bu» «b»Immediate Release«/b» Initial Dose - 50 mg PO once daily Maintenance Dose - May increase in 50 mg increments at intervals of at least 1 week Usual Dosage Range - 100 to 300 mg daily «b»Extended Release«/b» Initial Dose - 100 mg once daily at bedtime Maintenance Dose - May be increased in 50 mg increments at intervals of at least 1 week Usual Dosage Range - 100 to 300 mg daily Maximum Dose - 300 mg/day «b»Discontinuation of Therapy«/b» - Upon discontinuation of antidepressant therapy, gradually taper the dose to minimize the incidence of withdrawal symptoms and allow for the detection of re-emerging symptoms. Evidence supporting ideal taper rates is limited. APA and NICE guidelines suggest tapering therapy over at least several weeks with consideration to the half-life of the antidepressant; antidepressants with a shorter half-life may need to be tapered more conservatively. In addition for long-term treated patients, WFSBP guidelines recommend tapering over 4 to 6 months. If intolerable withdrawal symptoms occur following a dose reduction, consider resuming the previously prescribed dose and/or decrease dose at a more gradual rate «b»Switching to or from an MAO Inhibitor«/b» - Allow 14 days to elapse between discontinuing an MAO inhibitor intended to treat psychiatric disorders and initiation of fluvoxamine. - Allow 14 days to elapse between discontinuing fluvoxamine and initiation of an MAO inhibitor intended to treat psychiatric disorders.

Folic Acid

Folacin, Folate, Pteroylglutamic Acid, Vitamin B9

Folic Acid-Cyanocobalamin-Pyridoxine

Homocysteine Formula, Airavite, Folbee, Folgard RX, Av-VITE FB, CenFol, FaBB, Folbic, Folplex 2.2, Foltabs 800, Niva-Fol, NuFol, Virt-Gard, Virt-Vite, Virt-Vite Forte,Vita-Respa

Follitropin Alfa

Gonal-f RFF, Gonal-f, rFSH-alpha, rhFSH-alpha

Follitropin Beta

Follistim, rhFSH-beta, rFSH-beta

«bu»Ovulation Induction«/bu» «b»Follistim AQ«/b» «bi»Stepwise Approach«/bi» - Initiate therapy with 75 units/day IM/SC for at least the first 7 days. - Increase dose by 25 or 50 units at weekly intervals until follicular growth or serum estradiol levels indicate an adequate response - Maximum Daily Dose: 300 units - If response to follitropin is appropriate, hCG is given 1 day following the last dose to induce final oocyte maturation and ovulation - Withhold hCG if the ovaries are abnormally enlarged, or if abdominal pain occurs. «b»Follistim AQ Cartridge«/b» «bi»Stepwise Approach«/bi» - Initiate therapy with 50 units/day SC for at least the first 7 days - Increase dose by 25 or 50 units at weekly intervals until follicular growth and/or serum estradiol levels indicate an adequate response. - Maximum Daily Dose: 250 units. - If response to follitropin is appropriate, hCG is given 1 day following the last dose to induce final oocyte maturation and ovulation. - Withhold hCG if the ovaries are abnormally enlarged, or if abdominal pain occurs. «bu»Assisted Reproductive Technologies (ART)«/bu» «b»Follistim AQ«/b» «bi»Stepwise Approach«/bi» - A starting dose of 150 to 225 units IM/SC is recommended for at least the first 4 days of treatment. - The dose may be adjusted for the individual patient based upon their ovarian response - Maximum Daily Dose: 600 units. - When a sufficient number of follicles of adequate size are present, the final maturation of the follicles is induced by administering hCG. - Oocyte retrieval is performed 34 to 36 hours later. - Withhold hCG in cases where the ovaries are abnormally enlarged on the last day of follitropin beta therapy. «b»Follistim AQ Cartridge«/b» «bi»Stepwise Approach«/bi» - A starting dose of 200 SC units is recommended for at least the first 7 days of treatment. - The dose may be adjusted for the individual patient based upon their ovarian response. - Maximum Daily Dose: 500 units - When a sufficient number of follicles of adequate size are present, the final maturation of the follicles is induced by administering hCG. - Oocyte retrieval is performed 34 to 36 hours later. - Withhold hCG in cases where the ovaries are abnormally enlarged on the last day of follitropin beta therapy. See "Note" for dosage adjustment for this product. «bu»Spermatogenesis Induction«/bu» «b»Follistim AQ, Follistim AQ Cartridge«/b» - Pretreatment with hCG monotherapy is required prior to concomitant therapy with follitropin beta and hCG. - Follitropin beta therapy may be initiated after normal serum testosterone levels have been reached - 450 units/week (administered as 225 units SC twice weekly or 150 units SC 3 times/weekly) - A lower dose of Follistim AQ Cartridge may be considered. «b»Dose Adjustment for Follistim AQ Cartridge«/b» - When administered using the Follistim Pen, the Follistim AQ Cartridge delivers on average 18% more follitropin beta when compared to dissolved lyophilized follitropin beta administered by a conventional syringe. - If the above starting doses were previously used when administering a recombinant lyophilized gonadotropin product via a conventional syringe, lower starting and maintenance doses should be considered when switching to Follistim AQ Cartridge.

Fomepizole

Antizol, 4-Methylpyrazole, 4-MP

Fondaparinux

Arixtra

«bu»DVT Prophylaxis«/bu» «b»Adults ≥50 kg«/b» - 2.5 mg SC once daily - Prophylactic use contraindicated in patients <50 kg. - Initiate dose after hemostasis has been established, no earlier than 6 to 8 hours postoperatively. «b»DVT Prophylaxis with History of HIT«/b» - 2.5 mg SC once daily «b»Usual Duration«/b» - 5 to 9 days (up to 10 days following abdominal surgery or up to 11 days following hip fracture, hip replacement, or knee replacement was administered in clinical trials). - The American College of Chest Physicians recommends a minimum of 10 to 14 days for patients undergoing total hip arthroplasty, total knee arthroplasty, or hip fracture surgery; extended duration of up to 35 days suggested «bu»Acute DVT/PE Treatment«/bu» «b»<50 kg«/b» - 5 mg once daily «b»50 to 100 kg«/b» - 7.5 mg once daily «b»>100 kg«/b» - 10 mg once daily «b»Usual Duration«/b» - 5 to 9 days (administered up to 26 days in clinical trials) - Start warfarin on the first or second treatment day and continue fondaparinux until INR is ≥2 for at least 24 hours (usually 5 to 7 days) «bu»Unstable Angina (UA)/NSTEMI«/bu» - 2.5 mg SC once daily - Treat for the duration of hospitalization or until PCI performed «bu»STEMI«/bu» - 2.5 mg IV x 1 dose, then, - Subsequent doses (starting the following day) 2.5 mg SC once daily - Treat for the duration of the hospitalization, up to 8 days, or until revascularization «bu»Acute Symptomatic Superficial Vein Thrombosis«/bu» - ≥5 cm in length of the legs - 2.5 mg SC once daily for 45 days «bu»Acute Thrombosis«/bu» «b»<50 kg«/b» - 5 mg SC once daily «b»50 to 100 kg«/b» - 7.5 mg SC once daily «b»>100 kg«/b» - 10 mg SC once daily «bu»Venous Thromboembolism (VTE) Prophylaxis«/bu» «b»Hospitalized Cancer Patients«/b» - 2.5 mg SC once daily - Recommended duration of therapy is length of hospital stay or until fully ambulatory «b»Undergoing Major Surgery for Cancer«/b» - 2.5 mg SC once daily beginning 6 to 8 hours postoperative - Treatment duration should be at least 7 to 10 days - Prolonged treatment up to 4 weeks should be considered in patients undergoing major abdominal or pelvic surgery for cancer with high-risk features (limited mobility, obesity, VTE history, comorbid conditions)

Formoterol

Foradil, Perforomist, Eformoterol

Fosamprenavir

Lexiva, Telzir

Fosaprepitant Dimeglumine (IV)

Emend (IV)

Foscarnet

Foscavir, Phosphonoformate

Fosdenpoterin

Nulibry

Fosfomycin

Monurol

Fosinopril

Monopril

Fosinopril-Hydrochlorothiazide

Monopril-HCT

Fosphenytoin

Cerebyx, Sesquient

Fostamatinib

Tavalisse

«bu»Immune Thrombocytopenia (ITP)«/bu» - Initial Dose: 100 mg PO bid - After a month, if platelet count has not increased to at least 50 x 10^9/L, increase dose to 150 mg PO bid - Use the lowest dose to achieve and maintain a platelet count at least 50 x 10^9/L as necessary to reduce the risk of bleeding «b»Missed Dose«/b» - Instruct patients to take their next dose at its regularly scheduled time «b»Fertility«/b» - There are no data on the effect of fostamatinib on human fertility - Based on the finding of reduced pregnancy rates in animal studies, fostamatinib may affect female fertility «b»Contraception«/b» Females - Use effective contraception during treatment and for at least 1 month after the last dose «b»Adverse Reaction Dose Reduction Schedule«/b» - If a patient is on the maximum dose at the time of an adverse reaction, the first dose reduction would be from 300 mg/day to 200 mg/day 300 mg/day: (150-mg tablet AM and PM) 200 mg/day: (100-mg tablet AM and PM) 150 mg/day: (150-mg tablet AM) 100 mg/day: (100-mg tablet AM) If further dose reduction <100 mg/day is required, discontinue treatment «b»Hypertension«/b» «bi»Stage 1 Systolic (130-139 mmHg) or Diastolic (80-89 mmHg)«/bi» - Initiate or increase dose of antihypertensive medication; adjust as needed until BP is controlled - If BP target is not met after 8 weeks, reduce to next lower daily dose «bi»Stage 2 Systolic (140 to ≤180 mmHg) or Diastolic (90 to ≤120 mmHg)«/bi» - Initiate or increase dosage of antihypertensive medication, and adjust as needed until BP is controlled - If BP remains ≥140/90 mmHg for >8 weeks, reduce to next lower daily - If BP remains ≥160/100 mmHg for >4 weeks despite aggressive antihypertensive therapy, interrupt or discontinue fostamatinib «bi»Hypertensive Crisis Systolic >180 mmHg and/or Diastolic >120 mmHg«/bi» - Interrupt or discontinue fostamatinib - Initiate or increase dosage of antihypertensive medication; adjust as needed until BP is controlled - If BP returns to less than the target BP, resume at same daily dose - If repeat BP is ≥160/100 mmHg for >4 weeks despite aggressive antihypertensive treatment, discontinue fostamatinib «b»Hepatoxicity«/b» «bi»AST/ALT (≥3x to <5x upper limit of normal ULN)«/bi» Symptomatic - Interrupt fostamatinib; recheck liver function tests (LFTs) q72hr until ALT/AST are below 1.5x ULN and total bilirubin (BL) remains <2x ULN; resume at next lower daily dose Asymptomatic - Recheck LFTs q72hr until ALT/AST are <1.5x ULN and total BL remains <2x ULN; consider interrupting or reducing dose if ALT/AST and total BL remain at AST/ALT 3-5x ULN and total BL remains <2x ULN; if interrupted, resume at next lower daily dose; when ALT/AST are no longer elevated (<1.5x ULN) and total BL remains <2x ULN «bi»AST/ALT (≥5x ULN) and total BL (<2x ULN)«/bi» - Interrupt fostamatinib - Recheck LFTs q72hr: If AST/ALT decrease, recheck until ALT/AST are no longer elevated (<1.5x ULN) and total BL remains <2x ULN; resume at next lower daily dose - If AST/ALT persist at ≥5x ULN for ≥2 weeks, discontinue fostamatinib «bi»AST/ALT (≥3x ULN) and total BL (>2x ULN)«/bi» - Discontinue fostamatinib «bi»Elevated Unconjugated (indirect) BL in Absence of other LFT Abnormalities«/bi» - Continue fostamatinib; monitor frequently since isolated increase in unconjugated (indirect) BL may be due to UGT1A1 inhibition «b»Diarrhea«/b» - Use supportive measures (eg, dietary changes, hydration, and/or antidiarrheal medication) early after the onset until symptoms have resolved - If symptoms become severe (≥Grade 3), temporarily interrupt fostamatinib - If diarrhea improves to mild (Grade 1), resume at the next lower daily dose «b»Neutropenia«/b» «bi»ANC (<1 x 10^9/L) and Remains Low After 72 hr«/bi» - Temporarily interrupt fostamatinib until resolved (ANC >1.5 x 10^9/L); resume at the next lower daily dose thereafter «b»Strong CYP3A4 Inhibitor«/b» - Coadministration with a strong CYP3A4 inhibitor increases exposure to the major active metabolite (R406); monitor for toxicities that may require fostamatinib dose reduction «b»Discontinuation«/b» - Discontinue after 12 weeks of treatment if platelet count does not increase to a level sufficient to avoid clinically important bleeding

Fostemsavir

Rukobia

Fremanezumab

Ajovy

Frovatriptan

Frova, Migard

Fulvestrant

Faslodex

Furosemide

Lasix, Furoscix

-Furosemide 40 mg = Bumetanide 1 mg = Ethacrynic Acid 50 mg = Torsemide 20 mg «bu»Acute Pulmonary Edema«/bu» - Initial Dose: 40 mg IV/IM x 1 dose - If response not adequate within 1 hour, may increase to 80 mg/dose - Minimal additional response is gained by single doses over 160 to 200 mg - Maximum Dose: 200 mg/dose «bu»Edema«/bu» - Initial Dose: 20 to 80 mg PO x 1 dose - If response is not adequate, may repeat the same dose or increase dose in increments of 20 to 40 mg/dose PO at intervals of 6 to 8 hours - May titrate up to 600 mg/day with severe edematous states - Usual maintenance dose interval is once or twice daily. «bu»Congestive Heart Failure (CHF)«/bu» - Initial Dose: 20 to 40 mg IM/IV once or twice daily - Maximum Dose: 600 mg/day, 200 mg/dose - If response is not adequate, may repeat the same dose or increase dose in increments of 20 mg/dose IV/IM and administer 1 to 2 hours after previous dose - Individually determined dose should then be given once or twice daily although some patients may initially require dosing as frequent as every 6 hours «b»Continuous IV Infusion«/b» - Initial Bolus Dose: 40 to 100 mg IV over 1 to 2 minutes - Followed by continuous IV infusion rate of 10 to 40 mg/hour - Repeat loading dose before increasing infusion rate - In clinical trials evaluating dosing strategies in acute decompensated heart failure, median and maximum doses were ≤ 20 mg/hour - With lower baseline CrCl (CrCl <25 mL/minute), the upper end of the initial infusion dosage range should be considered - If urine output is <1 mL/kg/hour, double as necessary to a maximum of 80 to 160 mg/hour. The risk associated with higher infusion rates (80 to 160 mg/hour) must be weighed against alternative strategies «b»Furoscix (SC)«/b» - 30mg SC over the first hour THEN, - 12.5mg/hr for the subsequent 4 hours via on-body Infusor - Not for chronic use and should be replaced with oral diuretics as soon as practical «bu»Hypertension«/bu» - Initial Dose: 40 mg PO twice daily - If response inadequate, may add another antihypertensive «bu»Ascites, due to Cirrhosis«/bu» - Initial Dose: 40 mg PO once daily - Titrate every 3 to 5 days as clinically indicated - Maximum Dose: 160 mg once daily - Furosemide:Spironolactone dosing ratio of 40 mg:100 mg should be maintained «b»IV Administration«/b» - May administer IM or IV - In adults, undiluted direct IV injections may be administered at a rate of 20 to 40 mg per minute; maximum rate of administration for short-term intermittent infusion is 4 mg/minute; exceeding this rate increases the risk of ototoxicity. - In children, a maximum rate of 0.5 mg/kg/minute has been recommended. «b»PO Administration«/b» - Administer on an empty stomach - May administer with food or milk if GI distress occurs; however, this may reduce diuretic efficacy. «b»SL Administration«/b» - When IV or oral administration is not possible, the sublingual route may be used. - Place 1 tablet under tongue for at least 5 minutes to allow for maximal absorption. - Patients should be advised not to swallow during disintegration time «b»IV Infusion Solution Preparation«/b» - IV infusion solution may be mixed in NS or D5W solution - May also be diluted for infusion to 1 to 2 mg/mL - Maximum: 10 mg/mL «b»Furoscix (SC) On-Body Infusor Instructions for Use«/b» «u»www.furoscix.com/wp-content/uploads/2022/10/instructions-for-use.pdf«/u» «b»Furoscix (SC) Administration«/b» - Intended for use in a setting where the patient can limit their activity for the duration of administration. - Not compatible with use in an MRI setting - Inspect prefilled cartridge prior to administration; it is a clear to slightly yellow solution - Do not use if solution is discolored or cloudy. - Load the prefilled cartridge of into the on-body infusor and close the cartridge holder - Peel away the adhesive liner on the on-body infusor and apply onto a clean, dry area of the abdomen between the top of the beltline and the bottom of the ribcage that is not tender, bruised, red or indurated. - The distance from the top of the beltline to the bottom of the ribcage should be at least 2 ½ inches. -Start the injection by firmly pressing and releasing the blue start button. - Do not remove until the injection is complete (signaled by the solid green status light, beeping sound, and the white plunger rod filling the cartridge window). - Rotate the site of each subcutaneous administration.

Futibatinib

Lytgobi

Ga 68 PSMA-11 Injection

Gallium 68 PSMA-11 Injection, Illuccix

«b»Patient Preparation«/b» - Instruct patients to drink water to ensure adequate hydration before administration - Continue to drink water and void frequently during first hours following administration to reduce radiation exposure «b»IV Administration«/b» - Administer by IV bolus - After injection, flush line with NS to ensure full delivery of dose - Dispose of any unused drug in a safe manner in compliance with applicable regulations - Unless contraindicated, consider administering a diuretic expected to act within the uptake time period at time of radiotracer injection to potentially decrease artifact from radiotracer accumulation in the urinary bladder and ureters «bi»Image Acquisition«/bi» - Position patient supine with arms above head - Begin PET scanning 50-100 minutes after IV bolus - Patients should void immediately before image acquisition and that image acquisition should begin at the proximal thighs and proceed cranially to skull base or skull vertex - Adapt imaging technique according to equipment used and patient characteristics in order to obtain the best image quality possible «b»IV Preparation«/b» «bi»Gallium Ga 68 PSMA-11«/bi» - Use aseptic technique and radiation shielding when withdrawing or administering dose - Calculate necessary volume to administer based on calibration time and required dose - Visually inspect for particulate matter and discoloration before administration; do not use if solution contains particulate matter or is discolored - May dilute with 0.9% NaCl injection - Assay final dose immediately before administration in a dose calibrator «bi»Illuccix«/bi» - If Ga 68 is generator produced, test Ga 68 chloride eluate for Ge 68 breakthrough weekly by a suitable method according to manufacturer recommendations; if Ga 68 is cyclotron produced, test for Ga 66 and Ga 67 (with specification of ≤2% combined total) when a new Zn 68 is introduced for manufacturing - Place a “radioactive” label on Vial 3 (sterile vacuumed reaction vial) with product name, lot number and date. - Remove vial cap and swab with alcohol each of the 3 vials - Minimize any potential metallic contamination by using shortest possible needle for transfer of gallium solution from generator; needle should be clean and dilute acid resistant - Use only plastic syringes for preparation and administration; do not use syringes with rubber plungers - Before using any vial, confirm the correct vial is being used by a visual check of vial label - Refer to prescribing information for specific reconstitution procedure depending on Ga 68 source

Gabapentin

Neurontin, Neuraptine, Gralise, Fanatrex FusePaq

Gabapentin Enacarbil ER

Horizant, Solzira

Gadobenate Dimeglumine

MultiHance

Gadobutrol

Gadavist

Gadofosveset Trisodium

Ablavar

Galantamine

Razadyne

Galcanezumab

Emgality

Gallium Ga 68 Gozetotide

Locametz

Galsulfase

Naglazyme

Ganaxolone

Ztalmy

Ganciclovir

Cytovene, GCV Sodium

Ganciclovir (Ophthalmic)

Zirgan

Ganirelix

Antagon, Orgalutran

Gatifloxacin (Ophthalmic)

Zymaxid, Zymar

Gefitinib

Iressa

Gemcitabine

Gemzar

Gemfibrozil

Lopid

Gemifloxacin

Factive

Gemtuzumab

Mylotarg

«bu»Acute Myeloid Leukemia«/bu» «b»Newly Diagnosed CD33-positive AML«/b» «bi»Combination Regimen«/bi» Induction Cycle - 3 mg/m2 IV on Days 1, 4, and 7 in combination with daunorubicin and cytarabine - Maximum Dose: 4.5 mg - For patients requiring a second induction cycle, do not administer gemtuzumab during second induction cycle Consolidation - 3 mg/m2 IV on Day 1 in combination with daunorubicin and cytarabine - Maximum Dose: 4.5 mg «bi»Monotherapy«/bi» Induction Cycle - 6 mg/m2 IV on Day 1, and 3 mg/m2 on Day 8 Continuation Therapy - 2 mg/m2 IV on Day 1 every 4 weeks Treatment Duration - One cycle of induction and up to 8 cycles of continuation therapy «b»Relapsed or Refractory CD33-Positive AML«/b» - 3 mg/m2 on Days 1, 4, and 7 for 1 cycle «b»Contraception«/b» - Advise females of reproductive potential to avoid becoming pregnant while receiving gemtuzumab - Advise females of reproductive potential to use effective contraception during treatment and for at least 6 months after last dose - Advise males with female partners of reproductive potential to use effective contraception during treatment and for at least 3 months after last dose «b»Dosing Modifications«/b» «bi»Veno-occlusive Disease (VOD)«/bi» - Discontinue treatment «bi»Total Bilirubin >2 x ULN, or AST and/or ALT >2.5 x ULN«/bi» - Hold treatment until total bilirubin to ≤2x ULN and AST/ALT to ≤2.5x ULN prior to each dose - Omit scheduled dose if delayed >2 days between sequential infusions «bi»Infusion-related Reactions«/bi» - Interrupt infusion and institute appropriate medical management - Administer acetaminophen, diphenhydramine, and/or methylprednisolone, if needed - Provide supportive care measures as needed - Consider resuming the infusion at less than or half the rate at which the reaction occurred once symptoms resolve - Repeat the procedure above in the event of recurrence of symptoms - Permanently discontinue gemtuzumab if a severe infusion reaction occurs or for any life-threatening infusion reaction «bi»Other Severe/Life-threatening Non-hematologic Toxicities«/bi» - Hold treatment until reaction severity is no more than mild - Omit scheduled dose if delayed more than 2 days between sequential infusions «bi»Combination Therapy Only«/bi» - Persistent Thrombocytopenia - If platelet count does not recover to >100 Gi/L within14 days following the planned start date of the consolidation cycle (14 days after hematologic recovery following previous cycle), discontinue gemtuzumab - Do not administer gemtuzumab in the consolidation cycle Persistent Neutropenia - If neutrophil count does not recover to >0.5 Gi/L within14 days following the planned start date of the consolidation cycle (14 days after hematologic recovery following previous cycle), discontinue gemtuzumab - Do not administer gemtuzumab in the consolidation cycle «b»Dosing Considerations«/b» - Use appropriate measures to prevent tumor lysis syndrome - Patients with hyperleukocytosis (leukocyte count ≥30 Gi/L): Cytoreduction is recommended prior to gemtuzumab administration - Monitor blood cell counts frequently through resolution of cytopenias - Monitor blood cell counts and chemistries <3X/week through recovery from treatment-related toxicitie «bu»Acute Myeloid Leukemia«/bu» «b»Newly Diagnosed CD33-positive AML«/b» «bi»<1 month«/bi» - Safety and efficacy not established «bi»≥1 month«/bi» - BSA <0.6 m2: 0.1 mg/kg IV - BSA ≥0.6 m2: 3 mg/m2 IV First Induction Cycle - Give once in combination with standard chemotherapy Second Induction Cycle - No gemtuzumab given First Intensification Cycle - No gemtuzumab given Second Intensification Cycle - Give once in combination with standard chemotherapy - Consider risks and potential benefits before giving gemtuzumab Third Intensification Cycle - No gemtuzumab given «b»Relapse or Refractory AML«/b» - CD33-positive AML in adults and pediatric patients ≥2 years - 3 mg/m2 (up to one 4.5-mg vial) on Days 1, 4, and 7 for 1 cycle «b»Dosing Modifications«/b» «bi»Veno-occlusive Disease (VOD)«/bi» - Discontinue treatment «bi»Combination Therapy Only«/bi» Persistent Thrombocytopenia - Platelet count should be at least 75 Gi/L before the next cycle (induction or intensification) Persistent Neutropenia - Neutrophil count should be at least 1 Gi/L before the next cycle (induction or intensification) «bi»Total Bilirubin > 2x ULN, or AST and/or ALT >2.5 x ULN«/bi» - Hold treatment until total bilirubin improves to ≤2x ULN and AST/ALT to ≤2.5x ULN prior to each dose - Omit scheduled dose if delayed >2 days between sequential infusions «bi»Infusion-related Reactions«/bi» - Interrupt infusion and institute appropriate medical management - Administer acetaminophen, diphenhydramine, and/or methylprednisolone, if needed - Provide supportive care measures as needed - Consider resuming the infusion at less than or half the rate at which the reaction occurred once symptoms resolve - Repeat the procedure above in the event of recurrence of symptoms - Permanently discontinue gemtuzumab if a severe infusion reaction occurs or for any life-threatening infusion reaction «bi»Other Severe/Life-threatening Non-hematologic Toxicities«/bi» - Hold treatment until reaction severity is no more than mild - Omit scheduled dose if delayed more than 2 days between sequential infusions «bi»Dosing Considerations«/bi» - Use appropriate measures to prevent tumor lysis syndrome - Patients with hyperleukocytosis (leukocyte count ≥30 Gi/L): Cytoreduction is recommended prior to gemtuzumab administration - Monitor blood cell counts frequently through resolution of cytopenias - Monitor blood cell counts and chemistries <3X/week through recovery from treatment-related toxicities «b»Premedication«/b» «bi»Children and Adolescents«/bi» - Premediate 1 hr before with acetaminophen and diphenhydramine, then 30 min before with methylprednisolone - Acetaminophen 15 mg/kg (not to exceed 650 mg/dose) PO AND - Diphenhydramine 1 mg/kg (not to exceed 50 mg/dose) PO/IV AND - Methylprednisolone 1 mg/kg PO/IV - Additional doses of acetaminophen and diphenhydramine may be administered q4hr after the initial pretreatment dose - Repeat with the same dose of methylprednisolone or an equivalent corticosteroid for any sign of an infusion reaction (fever, chills, hypotension, or dyspnea) during the infusion or within 4 hr afterwards «bi»Adults«/bi» - Premediate 1 hr before with acetaminophen and diphenhydramine, then 30 min before with methylprednisolone - Acetaminophen 650 mg PO AND - Diphenhydramine 50 mg PO/IV AND - Methylprednisolone 1 mg/kg IV or an equivalent dose of an alternative corticosteroid - Additional doses of acetaminophen and diphenhydramine may be administered q4hr after the initial pretreatment dose - Repeat with the same dose of methylprednisolone or an equivalent corticosteroid for any sign of an infusion reaction (fever, chills, hypotension, or dyspnea) during the infusion or within 4 hr afterward «b»IV Administration«b» - Must use an in-line 0.2 micron polyethersulfone (PES) filter for infusion - Protect IV bag from light using a light-blocking cover during infusion; the infusion line does not need to be protected from light - Infuse diluted solution IV over 2 hr - Do not mix or infuse gemtuzumab with other medicinal products - Cytotoxic drug; follow applicable special handling and disposal procedures «b»IV Preparation«/b» - Cytotoxic Drug; follow applicable special handling and disposal procedures «bi»Reconstitution«/bi» - Calculate dose in mg and determine number of vials required - Allow vials to reach ambient temperature for ~5 minutes - Reconstitute each vial with 5 mL sterile water for injection to obtain a concentration of 1 mg/mL - Do not shake; gently swirl vial to aid dissolution - Inspect reconstituted solution for particulates and discoloration - Reconstituted solution may contain small white to off-white, opaque-to-translucent, and amorphous to fiber like particles - Contains no bacteriostatic preservatives - Use solution immediately to further dilute or refrigerate (see Storage) «bi»IV Infusion Solutions«/bi» - Calculate the required volume of the reconstituted solution needed to obtain the appropriate dose according to patient body surface area - Withdraw this amount from the vial(s) using a syringe; discard unused reconstituted solution - Remove a volume of 0.9% NaCl from the prefilled bag equal to the volume of product (mL) calculated above - Add reconstituted solution to infusion container with 0.9% NaCl to make a total volume of 50 mL or 100 mL, depending on dose - Do not shake; gently invert infusion container to mix diluted solution

Gentamicin

G-Mycin, Garamycin

«b»Conventional Dosing«/b» - 3 to 5 mg/kg/day IM/IV in divided doses every 8 hours «b»Extended-Interval Dosing (EID) Once Daily Dosing«/b» - 5 to 7 mg/kg/day IM/IV once daily - Not recommended in patients with ascites, burns covering >20% of the total body surface area, cystic fibrosis, end-stage renal disease (requiring hemodialysis), endocarditis, infants, mycobacterial infections, or pregnancy «bu»Brucellosis«/bu» - 5 mg/kg IV once daily for 7 days - Treatment Range: 5 to 14 days - Administered in combination with 6 weeks of doxycycline «bu»Cerebrospinal Fluid (CSF) Shunt Infection«/bu» «b»Intraventricular«/b» - Use a preservative-free preparation - 4 to 8 mg/day «bu»Endocarditis Treatment«/bu» «b»Enterococcus (Native or Prosthetic Valve)«/b» - 3 mg/kg/day IV/IM in 2 or 3 divided doses in combination with a beta-lactam or vancomycin (choice of concomitant antibiotic and treatment duration are dependent on organism sensitivity testing and source of infection) «b»Staph Aureus (Prosthetic Valve; MSSA, MRSA)«/b» - 3 mg/kg/day IV/IM in 2 or 3 divided doses for 2 weeks - Use in combination with other antibiotics (choice of concomitant antibiotic dependent on organism sensitivity testing) «b»Viridans Group Streptococcus (VGS) and S bovis (native or prosthetic valve)«/b» - 3 mg/kg/day IV/IM once daily (preferred) or in 3 divided doses (alternative) in combination with other antibiotics (choice of concomitant antibiotic and treatment duration are dependent on organism sensitivity testing and source of infection) «bu»Gonococcal Infection, Uncomplicated«/bu» - Patients with severe cephalosporin allergy - 240 mg IM x 1 dose in combination with oral azithromycin «bu»Granuloma Inguinale (Donovanosis)«/bu» - 1 mg/kg/dose IM/IV every 8 hours - Gentamicin must be used in addition to the recommended antibiotic agent and only if improvement is not evident within the first days of therapy «bu»Meningitis«/bu» - Due to Enterococcus spp (off-label use), Listeria monocytogenes (off-label use), Streptococcus agalactiae (off-label use), or Pseudomonas aeruginosa - 5 mg/kg/day IV in divided doses every 8 hours (administered with other antimicrobials «bu»Intra-abdominal Infections«/bu» - 5 to 7 mg/kg once daily for 4 to 7 days «bu»Pelvic Inflammatory Disease«/bu» - Loading Dose: 2 mg/kg IV/IM, then, - 1.5 mg/kg IV every 8 hours or 3 to 5 mg/kg IV once daily in combination with clindamycin IV - Transition from parenteral to oral therapy can usually be initiated within 24 to 48 hours of clinical improvement for a total treatment duration of 14 days «bu»Peritoneal Dialysis-associated Peritonitis«/bu» «b»Intraperitoneal«/b» - Intermittent Dosing: 0.6 mg/kg per exchange once daily; allow to dwell ≥6 hours - Continuous dosing (all exchanges): Loading dose: 8 mg/L; maintenance dose: 4 mg/L «bu»Plague (Yersinia pestis)«/bu» - 5 mg/kg/dose once daily - 2 mg/kg loading dose, then, - 1.7 mg/kg/dose every 8 hours - Duration of therapy is 10 to 14 days, or until 2 days after patient is afebrile «bu»Hospital Acquired Pneumonia (HAP), Ventilator-associated Pneumonia (VAP)«/bu» - 5 to 7 mg/kg/day IV once daily for 7 days - May consider shorter or longer duration depending on rate of clinical improvement. - When used as empiric therapy, use in combination with an agent active against S. aureus and an additional antipseudomonal agent. - Aminoglycosides are not recommended as monotherapy in patients with hospital-acquired or ventilator-associated pneumonia due to P. aeruginosa «bu»Sepsis/Septic Shock«/bu» - Empiric or targeted therapy - 5 to 7 mg/kg IV once daily - First dose administered as soon as possible and within 1 hour of identifying sepsis/septic shock - Duration of therapy of 7 to 10 days is generally adequate for serious infections «bu»Surgical (Preoperative) Prophylaxis«/bu» - 5 mg/kg within 60 minutes prior to surgical incision with or without other antibiotics (procedure dependent) «bu»Synergy for Gram-positive Infections«/bu» - 3 mg/kg/day IV in 1-3 divided doses (with ampicillin) «bu»Tularemia«/bu» - 5 mg/kg/dose IV once daily for 10 days - 5 mg/kg/day IV in 2 divided doses for ≥10 days

Gentamicin (Ophthalmic)

Gentafair, Gentak, Garamycin

Gentamicin (Topical)

Garamycin

Gentamicin-Prednisolone (Ophthalmic)

Pred-G

Gilteritinib

Xospata

Givosiran

Givlaari

Glasdegib

Daurismo

«bu»Acute Myeloid Leukemia (AML)«/bu» - 100 mg PO daily on days 1-28 of each 28-day cycle - Administer in combination with cytarabine 20 mg SC bid on days 1-10 - For patients without unacceptable toxicity, treat for a minimum of 6 cycles to allow time for clinical response «b»Missed or Vomited Dose«/b» «bi»Vomited Dose«/bi» - Do not replace dose - Wait until the next scheduled dose is due «bi»Missed Dose or Not Taken at Usual Time«/bi» - Administer dose as soon as possible and at least 12 hour before the next scheduled dose; return to normal schedule the following day - Do not administer 2 doses within 12 hour «b»Pregnancy Testing«/b» - Conduct pregnancy testing in females of reproductive potential before initiating «b»QTc >480 to 500 ms (≥2 separate ECGs)«/b» - Assess electrolyte levels and supplement as clinically indicated - Review and adjust concomitant medications with known QTc interval-prolonging effects - Monitor ECGs at least weekly for 2 weeks following QTc prolongation resolution to ≤480 ms «b»QT >500 ms (≥2 separate ECGs)«/b» - Assess electrolyte levels and supplement as clinically indicated - Review and adjust concomitant medications with known QTc interval-prolonging effects - Interrupt glasdegib dosing; resume at reduced dose of 50 mg qDay when QTc interval returns to within 30 ms of baseline or ≤480 ms - Monitor ECGs at least weekly for 2 weeks following QTc prolongation resolution - Consider re-escalating glasdegib dose to 100 mg daily if other etiology identified for QTc prolongation «b»QTc Prolongation with Life-threatening Arrhythmia«/b» - Discontinue permanently «b»Hematologic Toxicity«/b» - Platelets <10 Gi/L or neutrophil count <0.5 Gi/L for >42 days in absence of disease: Discontinue glasdegib and cytarabine permanently «b»Nonhematologic Toxicity«/b» «bi»Grade 3«/bi» - Interrupt glasdegib and/or cytarabine until symptoms reduce to mild or return to baseline - Resume glasdegib at the same dose level, or reduce dose to 50 mg - Resume cytarabine at the same dose level, or reduce dose to 15 mg or 10 mg - If toxicity recurs, discontinue glasdegib and cytarabine - If toxicity attributed only to glasdegib, cytarabine may be continued «bi»Grade 4«/bi» - Discontinue glasdegib and cytarabine permanently

Glatiramer

Copaxone, Glatopa, Copolymer-1

Glecaprevir

Glecaprevir-Pibrentasvir

Mavyret

«bu»Chronic Hepatitis C Virus (HCV)«/bu» - Treatment-naïve adolescents aged 12-17 yr, or weighing at least 45 kg (99 lb) with chronic hepatitis C virus (HCV) genotypes 1-6 without cirrhosis or with compensated cirrhosis - Treatment-experienced adolescents with HCV genotype 1 who have been previously treated with a regimen containing either an NS5A inhibitor or an NS3/4A protease inhibitor, but not both «b»≥12 years or weight ≥45 kg (99 lb)«/b» - 3 tablets (ie, 300 mg/120 mg total dose) PO once daily with food «b»Recommended Duration for Treatment-naïve Patients«/b» «bi»Genotypes 1-6, No Cirrhosis«/bi» - 8 week «bi»Genotypes 1-6, Compensated Cirrhosis (Child-Pugh A)«/bi» - 12 week «b»Recommended duration for treatment-experienced patients«/b» «bi»No Cirrhosis«/bi» Genotype 1 and NS5A inhibitor prior treatment: 16 week Genotype 1 and NS3/4A protease inhibitor prior treatment: 12 week Genotypes 1, 2, 4, 5, or 6 (prior treatment with simeprevir and sofosbuvir, or simeprevir, boceprevir, or telaprevir with pegylated interferon and ribavirin): 8 wk Genotype 3 (prior treatment with simeprevir and sofosbuvir, or simeprevir, boceprevir, or telaprevir with pegylated interferon and ribavirin): 16 wk «bi»Compensated Cirrhosis (Child-Pugh A)«/bi» Genotype 1 and NS5A inhibitor prior treatment: 16 wk Genotype 1 and NS3/4A protease inhibitor prior treatment: 12 wk Genotypes 1, 2, 4, 5, or 6 (prior treatment with simeprevir and sofosbuvir, or simeprevir, boceprevir, or telaprevir with pegylated interferon and ribavirin): 12 wk Genotype 3 (prior treatment with simeprevir and sofosbuvir, or simeprevir, boceprevir, or telaprevir with pegylated interferon and ribavirin): 16 wk «bi»Liver or Kidney Transplant Recipients«/bi» - Treatment duration is 12 weeks - 16-week treatment duration recommended Genotype 1-infected patients who are NS5A inhibitor-experienced without prior treatment with an NS3/4A protease inhibitor Genotype 3-infected patients who are treatment experience with regimens containing (peg)interferon, ribavirin, and/or sofosbuvir, but no prior treatment experience with an HCV NS3/4A PI or NS5A inhibitor

Glimepiride

Amaryl

GlipiZIDE

Glucotrol, GlipiZIDE

GlipiZIDE-MetFORMIN

Metaglip

Glucagon

GlucaGen

Glucagon Intranasal

Baqsimi

Glucarpidase

Voraxaze, Carboxypeptidase-G2

Glucosamine Sulfate

G6S, Glucose6 Phosphate

GlyBURIDE

Glynase, Diabeta, Glibenclamide, Micronase

GlyBURIDE-MetFORMIN

Glucovance

Glycerin

Fleet Liquid Glycerin Supp, Glycerol, Pedia-Lax

Glycopyrrolate

Cuvposa, Dartisla ODT, Glycate, Robinul

«b»IM Administration«/b» - May administer undiluted «b»IV Administration«/b» - May be administered IV without dilution or may dilute in a compatible solution. - In perioperative setting, usually administered over 1 to 2 minutes (in adults: 0.2 mg over 1 to 2 minutes) - May also be administered via the tubing of a running IV infusion of a NS - May be administered IV in the same syringe with neostigmine or pyridostigmine for reversal of neuromuscular blockade - For chronic pediatric uses, consider further dilution and infusing over 20 to 30 minutes «b»Oral Administration«/b» - Administer oral solution 1 hour before or 2 hours after meals - Measure oral solution with an accurate measuring device (dosing cup or oral syringe) «b»ODT Administration«/b» - Using dry hands, place ODT on top of tongue; allow tablet to disintegrate and swallow without water - Do not break or cut tablet «b»IV Reconstitution«/b» - May further dilute in a compatible solution. «b»Oral Suspension (0.5 mg/mL) Preparation«/b» - A 0.5 mg/mL oral suspension may be made with 1 mg tablets and a 1:1 mixture of Ora-Plus and either Ora-Sweet or Ora-Sweet SF - Crush thirty 1 mg tablets in a mortar and reduce to a fine powder - Prepare diluent by mixing 30 mL of Ora-Plus with 30 mL of either Ora-Sweet or Ora-Sweet SF and stir vigorously - Add 30 mL of diluent (via geometric dilution) to powder until smooth suspension is obtained - Transfer suspension to 60 mL amber bottle - Rinse contents of mortar into bottle with sufficient quantity of remaining diluent to obtain 60 mL (final volume) - Label “shake well”. Stable at room temperature for 90 days - Due to bitter aftertaste, chocolate syrup may be administered prior to or mixed (1:1 v/v) with suspension immediately before administration «b»Oral Solution (0.5 mg/mL) Preparation«/b» - A 0.5 mg/mL oral solution can be made from tablets - Crush fifty 1 mg tablets in a mortar and reduce to a fine powder - Add enough distilled water to make about 90 mL, mix well - Transfer to a bottle, rinse mortar with water, and add a quantity of water sufficient to make 100 mL - Label “shake well” and “protect from light” - Stable at room temperature for 25 days «b»Oral Solution (0.1 mg/mL) Preparation«/b» - A 0.1 mg/mL oral solution may be made using glycopyrrolate 0.2 mg/mL injection without preservatives - Withdraw 50 mL from vials with a needle and syringe, add to 50 mL of a 1:1 mixture of Ora-Sweet and Ora-Plus in a bottle - Label “shake well”, “protect from light,” and “refrigerate” - Stable refrigerated for 35 days

Glycopyrrolate (INH)

Seebri Neohaler, Lonhala Magnair

Glycopyrrolate-Formoterol

Bevespi Aerosphere

Glycopyrronium (Topical )

Qbrexza

Gold Sodium Thiomalate

Myochrysine, Sodium Aurothiomalate

Golimumab

Simponi, Simponi Aria

- Intact solution should be colorless to light yellow; solution may develop a few fine, translucent particles. - The safety and efficacy of switching between the IV and SC formulations and routes have not been studied. «b»IV Administration«/b» - Dilute prior to use. Infuse over 30 minutes, using an infusion set with an in-line low protein-binding 0.22 micron filter. - Do not infuse in the same line with other medications. «b»SC Administration«/b» «bi»Prefilled Syringe«/bi» - Warm by sitting at room temperature for 30 min; do NOT heat or microwave - If multiple injections required, administer at different site on the body - Injection sites: Front of thighs (recommended), lower abdomen (except for a 2-inch area right around the navel); back of the upper arms (only if someone else is administering it) - Rotate injection sites for each administration - Do not administer in area where the skin is tender, bruised, red, or hard «bi»Autoinjector«/bi» - Hold autoinjector firmly against skin and inject subcutaneously into thigh, lower abdomen (below navel), or upper arm. - A loud click is heard when injection has begun. - Continue to hold autoinjector against skin until second click is heard (may take 3 to 15 seconds). - Following second click, lift autoinjector from injection site. Rotate injection sites and avoid injecting into tender, red, scaly, hard, or bruised skin, or areas with scars or stretch marks. - If multiple injections are required for a single dose, administer at different sites on body. «b»IV Preparation«/b» - Do not use if solution is discolored, or contains opaque or foreign particles. Dilute for infusion by slowly adding calculated dose/volume to NS or 1/2 NS to a total volume of 100 mL. Gently mix. - Discard unused portion of vial/syringe/autoinjector. «b»SC Preparation«/b» - Bring to room temperature by allowing syringe/autoinjector to sit at room temperature outside the carton for 30 minutes prior to administration (do not warm in any other way). - Do not use if discolored, cloudy, or if foreign particles are present.

Golodirsen

Vyondys 53

Goserelin

Zoladex,Zoladex LA, ZDX

Gramicidin

Granisetron

Kytril, Granisol, Sancuso, Sustol

Grass Mix Pollens Allergen Extract

Oralair

Grass Pollen Allergen Extract

Grastek, Timothy Grass

Grazoprevir

Griseofulvin Microsize

Gris-PEG,

GuaiFENesin

Altarussin, Robitussin, Mucinex, Tussin, Organidin

Guaifenesin-Codeine

Cheratussin AC, Coditussin AC, Robitussin AC

Guaifenesin-Phenylephrine

Robitussin PE

Guaifenesin-Pseudoephedrine-Dextromethorphan

Anatuss DM, Capmist DM, Entre-Cough, Poly-Vent DM

GuanFACINE

Tenex, Intuniv

«bu»Hypertension«/bu» «b»Immediate Release«/b» - 1 mg PO once daily at bedtime - May increase if needed after 3 to 4 weeks of therapy to 2 mg daily at bedtime - Adverse reactions increase significantly with doses above 3 mg/day. «bu»Heroin Withdrawal«/bu» - 0.03-1.75 mg/day PO for 5-15 days «bu»Migraine Prophylaxis«/bu» - Initial Dose: 1 mg/day - Maximum Dose: 3 mg/day «b»Discontinuation of Therapy«/b» - To minimize risk of rebound hypertension upon discontinuation, taper total daily dose in decrements of no more than 1 mg every 3 to 7 days; blood pressure and heart rate should be monitored when reducing dose or discontinuing therapy; follow patients closely for rebound hypertension if abrupt discontinuation occurs (especially with concomitant stimulant use) «b»Strong or Moderate CYP3A4 Inhibitors«/b» - Strong or moderate CYP3A4 inhibitors significantly increase guanfacine plasma concentrations - FDA-labeling for extended-release (ER) guanfacine recommends that, if coadministered, the guanfacine dosage should be decreased to half of the reommended dose; specific recommendations for immediate-release (IR) guanfacine are not available - Starting therapy while currently taking CYP3A4 inhibitor: Decrease dose to half the recommended level - Continuing therapy while adding CYP3A4 inhibitor: Decrease dose to half the recommended level - Continuing therapy while stopping CYP3A4 inhibitor: Increase dose to recommended level «b»Strong or Moderate CYP3A4 Inducers«/b» - CYP3A4 inducers significantly reduce guanfacine plasma concentrations and elimination half-life - If coadministered, more frequent dosing of the IR product may be required to achieve or maintain the desired hypotensive response - For patients with ADHD, FDA-approved labeling for ER guanfacine recommends that, if coadministered, doubling the recommended dose of guanfacine should be considered - Starting therapy while currently taking CYP3A4 inducer: Increase dose up to double the recommended level - Continuing therapy while adding CYP3A4 inducer: Increase dose up to double the recommended level over 1-2 weeks - Continuing therapy while stopping CYP3A4 inducer: Increase dose to recommended level

Guanidine

Guanidin

Guselkumab

Tremfya

Haemophilus B Conjugate-Hepatitis B Vaccine

Comvax, Hib-HepB, HepB-Hib

Haemophilus B Polysac Conj Vaccine

ActHIB, Hiberix, PedvaxHIB

«b»IM Adminstration«/b» - For IM administration; do not inject IV, intradermally, or subcutaneously - Shake well prior to use - Administer into the anterolateral thigh or deltoid - Do not administer into buttocks due to potential risk of injury to sciatic nerve - Do not mix with other vaccines or injections; separate needles and syringes should be used for each injection - To prevent syncope related injuries, adolescents and adults should be vaccinated while seated or lying down - US law requires that the date of administration, the vaccine manufacturer, lot number of vaccine, and the administering person's name, title, and address be entered into the patient's permanent medical record. «bi»ActHIB, PedvaxHIB«/bi» - If the primary series is delayed or interrupted, there is no need to start the series over, regardless of the interval between doses. «bi» Hiberix«/bi» - If Hiberix is inadvertently administered during the primary vaccination series, the dose can be counted as a valid PRP-T dose that does not need to be repeated if administered according to schedule. In this case, a total of 3 doses completes the primary series. - For patients at risk of hemorrhage following intramuscular injection, the vaccine should be administered intramuscularly if, in the opinion of the physician familiar with the patient's bleeding risk, the vaccine can be administered by this route with reasonable safety - If the patient receives antihemophilia or other similar therapy, intramuscular vaccination can be scheduled shortly after such therapy is administered - A fine needle (23 gauge or smaller) can be used for the vaccination and firm pressure applied to the site (without rubbing) for at least 2 minutes - The patient should be instructed concerning the risk of hematoma from the injection - Patients on anticoagulant therapy should be considered to have the same bleeding risks and treated as those with clotting factor disorders «b»Reconstitution«/b» «bi»ActHIB«/bi» - Dilute with 0.6 mL of provided saline diluent (sodium chloride 0.4%); agitate to form a clear, colorless solution. Withdraw 0.5 mL of reconstituted vaccine for administration - Shake well prior to use «bi»Hiberix«/bi» - Dilute with provided saline diluent only - Transfer entire contents of prefilled syringe containing diluent into the vial; with needle still inserted, shake vigorously until it becomes a clear, colorless solution - Withdraw entire contents of vial (~0.5 mL) for administration - Shake well prior to use. «bi»PedvaxHIB«/bi» - Used as supplied; no reconstitution is necessary - Shake well; thorough agitation is necessary to maintain suspension of the vaccine.

Halcinonide

Halog

Halobetasol

Ultravate, Halonate

Haloperidol

Haldol

«bu»Psychosis«/bu» - 0.5 to 5 mg PO 2 to 3 times daily - Adjust dose based on response and tolerability - Recommended Dose Range: 5 to 20 mg/day - Daily dosages up to 100 mg may be necessary in some cases to achieve an optimal response; infrequently, doses >100 mg have been used in severely treatment resistant patients. «bu»Schizophrenia«/bu» - 2 to 5 mg IM (lactate) x 1 dose - Subsequent doses may be administered as often as every 60 minutes, although 4- to 8-hour intervals may be satisfactory. «b»IM (Decanoate) Dosing Regimen«/b» - Establish tolerance to oral haloperidol prior to changing to IM decanoate injection. - Initial Dose: 10 to 20 times the daily oral dose. - The initial dose should not exceed 100 mg regardless of previous antipsychotic requirements. - If the initial dose conversion requires >100 mg, administer the dose in 2 injections (maximum of 100 mg for first injection) separated by 3 to 7 days. - Oral haloperidol ≤10 mg/day, elderly, or debilitated: Initiate dose at 10 to 15 times the daily oral dose - Oral haloperidol >10 mg/day or high risk of relapse: Initiate dose at 20 times the daily oral dose - Maintenance Dose: 10 to 15 times the previous daily oral dose or 50 to 200 mg administer doses at 4-week intervals - Oral Overlap: Following initial dose, taper the oral dose and discontinue following the subsequent 2 or 3 injections (60 to 90 days) «b»Alternative Dosing Regimen«/b» «bi»Loading Dose Regimen«/bi» - Initial Dose: 20 times the previous daily oral dose, divide total dose and give every 3 to 7 days, do not exceed 250 mg per injection - Discontinue oral haloperidol prior to first injection - Reduce the dose by 25% each month, depending on clinical response, in months 2 to 4, and establish the maintenance dose. «bi»Usual Maintenance Dose«/bi» - 200 mg per month «bu»Tourette Syndrome«/bu» - 0.5 to 5 mg PO bid to tid - Adjust dose based on response and tolerability - According to the manufacturer, daily dosages up to 100 mg may be necessary in some cases to achieve an optimal response; infrequently doses >100 mg have been used in severely treatment resistant patients. «bu»Chemotherapy-Induced Nausea and Vomiting«/bu» «b»Breakthrough Nausea/Vomiting«/b» - 0.5 to 1 mg PO/IV every 6 hours as needed «bu»Chorea of Huntington Disease«/bu» - Initial Dose: 0.5 to 2 mg PO day - Adjust dose based on response and tolerability up to a maximum dose of 10 mg/day «bu»Delirium in the Intensive Care Unit«/bu» «b»Treatment«/b» - Initial Dose: 0.5 to 10 mg IV depending on degree of agitation - Continuous infusions have also been used with doses in the range of 0.5 to 2 mg/hour with an optional loading dose of 2.5 mg - If inadequate response, may repeat bolus dose (with sequential doubling of initial bolus dose) every 15 to 30 minutes until calm achieved, then administer 25% of the last bolus dose every 6 hours; monitor ECG and QTc interval. - After the patient is controlled, haloperidol therapy should be tapered over several days. This strategy is based upon expert opinion; efficacy and safety have not been formally evaluated «b»Prevention«/b» - Initial Dose: 0.5 mg IV followed by a continuous infusion of 0.1 mg/hour for 12 hours or 0.5 to 1 mg every 8 hours «bu»Nausea and Vomiting in Advanced or Terminal Illness«/bu» - Initial Dose: 1.5 to 3 mg PO/SC daily - Titrate daily based on response and tolerability up to a maximum of 6 mg per 24 hours. «bu»Nausea and Vomiting in Advanced Cancer«/bu» - 1.5 to 2.5 mg PO once or twice daily - 1 to 2 mg SC 2 to 3 times a day or as a continuous subcutaneous infusion at 1 to 5 mg per 24 hours «bu»Obsessive Compulsive Disorder (OCD)«/bu» - Initial Dose: 2 mg PO daily - Adjust dose based on response and tolerability by 2 mg every 3 days up to a maximum dose of 10 mg/day - Average dose in clinical trial was 6 mg/day «bu»Postoperative Nausea and Vomiting (PONV) Prevention«/bu» - 0.5 to 2 mg IV/IM «bu»Rapid Tranquilization«/bu» - Agitation/aggression/violent behavior - 2.5 to 10 mg IM «b»Discontinuation of Therapy«/b» - The manufacturer and the American Psychiatric Association (APA), Canadian Psychiatric Association (CPA), and World Federation of Societies of Biological Psychiatry (WFSBP) guidelines recommend gradually tapering antipsychotics to avoid withdrawal symptoms and minimize the risk of relapse; risk for withdrawal symptoms may be highest with highly anti-cholinergic or dopaminergic antipsychotics - When stopping antipsychotic therapy in patients with schizophrenia, the CPA guidelines recommend a gradual taper over 6 to 24 months, and the APA guidelines recommend reducing the dose by 10% each month - Continuing anti-parkinsonism agents for a brief period after discontinuation may prevent withdrawal symptoms - When switching antipsychotics, 3 strategies have been suggested: cross-titration (gradually discontinuing the first antipsychotic while gradually increasing the new antipsychotic), overlap and taper (maintaining the dose of the first antipsychotic while gradually increasing the new antipsychotic, then tapering the first antipsychotic), and abrupt change (abruptly discontinuing the first antipsychotic and either increasing the new antipsychotic gradually or starting it at a treatment dose) - Evidence supporting ideal switch strategies and taper rates is limited, and results are conflicting. «bu»Behavior Disorders, Nonpsychotic«/bu» «b»Children 3 to 12 years weighing 15 to 40 kg«/b» - Initial Dose: 0.5 mg/day PO in 2 to 3 divided doses - May increase by 0.5 mg every 5 to 7 days to usual maintenance range of 0.05 to 0.075 mg/kg/day in 2 to 3 divided doses - Maximum dose not established; children with severe, nonpsychotic disturbance may require higher doses; however, no improvement has been shown with doses >6 mg/day. «b»Children >40 kg and Adolescents«/b» (off-label dose) - 0.5 to 15 mg/day PO in 2 to 3 divided doses - Begin at lower end of the range and may increase as needed (no more frequently than every 5 to 7 days) - Maximum Daily Dose: 15 mg/day - Higher doses may be necessary in severe or refractory cases «bu»Psychosis«/bu» «b»Children 3 to 12 years weighing 15 to 40 kg«/b» - Initial: 0.5 mg/day PO in 2 to 3 divided doses - Increase by 0.5 mg every 5 to 7 days to usual maintenance range of 0.05 to 0.15 mg/kg/day in 2 to 3 divided doses - Higher doses may be necessary in severe or refractory cases - Maximum dose not established; in adolescents, the maximum daily dose is 15 mg/day «b»Children >40 kg and Adolescents«/b» (off-label dose) - 0.5 to 15 mg/day PO in 2 to 3 divided doses - Begin at lower end of the range and may increase as needed (no more frequently than every 5 to 7 days) - Maximum Daily Dose: 15 mg/day - Higher doses may be necessary in severe or refractory cases «bu»Tourette Syndrome«/bu» «b»Children 3 to 12 years weighing 15 to 40 kg«/b» - Initial Dose: 0.5 mg/day PO in 2 to 3 divided doses - Increase by 0.5 mg every 5 to 7 days to usual maintenance of 0.05 to 0.075 mg/kg/day in 2 to 3 divided doses - Maximum dose not established; however, no improvement has been shown with doses >6 mg/day in patients with nonpsychotic disturbances «b»Children >40 kg and Adolescents«/b» (off-label dose) - 0.25 to 15 mg/day PO in 2 to 3 divided doses - Begin at lower end of the range and may increase as needed (no more frequently than every 5 to 7 days) - Usual Dose Range: 1 to 4 mg/day - Maximum dose not established; however, no improvement has been shown with doses >6 mg/day in patients with nonpsychotic disturbances

Heparin

«bu»DVT & PE Prophylaxis«/bu» «b»Prophylaxis«/b» - 5000 units SC every 8-12 hr - 7500 units SC every 12 hr «b»Treatment«/b» - 80 units/kg IV x 1 dose THEN, - 18 units/kg/hr continuous IV infusion - 5000 units IV x 1 dose THEN, - 1300 units/hr continuous IV infusion - 250 units/kg (or 17,500 units) SC x 1 dose THEN, - 250 units/kg every 12hr «b»Dosing Considerations«/b» - Numerous concentrations available; extreme caution is required to avoid medication error «bu»Acute Coronary Syndrome (ACS)«/bu» «b»PCI Without GPIIb/IIIa Inhibitor«/b» - Initial IV bolus of 70-100 units/kg - Target ACT 250-300 sec «b»PCI With GPIIb/IIIa Inhibitor«/b» - Initial IV bolus of 50-70 units/kg - Target ACT >200 sec «b»STEMI on Fibrinolytics«/b» - IV bolus of 60 units/kg (max: 4000 units) THEN, - 12 units/kg/hr (max 1000 units/hr) as continuous IV infusion - Dose should be adjusted to maintain aPTT of 50-70 sec «b»Unstable Angina/NSTEMI«/b» - Initial IV bolus of 60-70 units/kg (max: 5000 units) THEN, - Initial IV infusion of 12-15 units/kg/hr (max: 1000 units/hr) - Dose should be adjusted to maintain aPTT of 50-70 sec Dosing Considerations - Numerous concentrations available; extreme caution is required to avoid medication error «bu»Anticoagulation«/bu» Intermittent IV Injection - 8000-10,000 units IV initially THEN, - 50-70 units/kg (5000-10,000 units) every 4-6hr «b»Continuous IV Infusion«/b» - 5000 units IV injection THEN, - Continuous IV infusion of 20,000-40,000 units/24 hr «b»Dosing Considerations«/b» - Numerous concentrations available; extreme caution is required to avoid medication error - Heparin sodium may prolong one-stage prothrombin time; when heparin sodium is given with dicumarol or warfarin sodium, a period of at least 5 hr after last intravenous dose or 24 hr after last subcutaneous dose should elapse before blood is drawn if a valid prothrombin time is to be obtained «bu»Catheter Patency«/bu» - Prevention of clot formation within venous and arterial catheters - Use 100 units/mL; instill enough volume to fill lumen of catheter «b»Dosing Considerations«/b» - Numerous concentrations available; extreme caution is required to avoid medication error - Amount and frequency depends on catheter volume and type - Peripheral heparin locks typically are flushed q6-8hr

Hepatitis A Vaccine

Avaxim, HepA, Vaccine, Havrix, VAQTA

Hepatitis A-Hep B Recombinant Vaccine

Twinrix

Hepatitis B Immune Globulin (Human)

HepaGam B, HyperHEP B, Nabi-HB, HBIG

Hepatitis B Vaccine (Recombinant)

Engerix-B, Heplisav-B, PreHevbrio, Recombivax HB

«b»IM Administration«/b» - IM injection (preferred); do not administer IV or intradermally; in adults, the deltoid muscle is the preferred site; the anterolateral thigh is the recommended site in infants and young children. - Not for gluteal administration - Shake well prior to withdrawal and use - For patients at risk of hemorrhage following intramuscular injection, hepatitis B vaccine may be administered subcutaneously although lower titers and/or increased incidence of local reactions may result. - Obese patients may require an adjustment of needle length - Do not mix with other vaccines or injections; separate needles and syringes should be used for each injection - To prevent syncope related injuries, adolescents and adults should be vaccinated while seated or lying down. «b»SC Administration«/b» - Engerix B or Recombivax HB may be administered SC to persons at risk for hemorrhage following IM injections (eg, hemophiliacs) - SC administration known to result in lower antibody response - Increased incidence of local reactions, including SC nodules, observed when other aluminum-adsorbed vaccines have been administered SC - Do not mix with other vaccines or injections; separate needles and syringes should be used for each injection. - To prevent syncope related injuries, adolescents and adults should be vaccinated while seated or lying down. - Pediatric/adolescent formulations of hepatitis B vaccine products differ by concentration (mcg/mL). - However, when dosed in terms of volume (mL), the dose of Engerix-B and Recombivax HB are the same (both 0.5 mL). - Adult formulations of hepatitis B vaccine products also differ by concentration (mcg/mL), but when dosed in terms of volume (mL), the dose of Engerix-B and Recombivax HB are the same (both 1 mL). - It is possible to interchange the vaccines for completion of a series or for booster doses; the antibody produced in response to each type of vaccine is comparable, however, the quantity of the vaccine will vary. «b»Vaccination at the Time of HBsAg Testing«/b» - For persons in whom vaccination is recommended, the first dose of hepatitis B vaccine can be given after blood is drawn to test for HBsAg.

Hetastarch

Hespan, Hextend, Hydroxyethyl Starch, HES

Hexachlorocyclohexane

Kwell, Lindane, Benzene Hexachloride

Hexaminolevulinate

Cysview

Histrelin

Vantas, Supprelin LA

Homatropine (Ophthalmic)

Homatropaire, Isopto Homatropine

Hyaluronidase

Amphadase, Hylenex, Vitrase, Wydase

«bu»Skin Test«/bu» «b»Intradermal«/b» - 0.02 mL (Amphadase 3 units, Hylenex 3 units, or Vitrase 4 units) of a 150 units/mL (Amphadase, Hylenex) or 200 units/mL (Vitrase) solution. - Positive reaction consists of a wheal with pseudopods appearing within 5 minutes and persisting for 20-30 minutes with localized itching (transient erythema is not considered a positive reaction). - Skin testing is not necessary prior to use for extravasation management. «bu»Dehydration: Hypodermoclysis«/bu» - 150 or 200 units SC followed by subcutaneous isotonic fluid administration ≥1000 mL or may be added to small volumes (≤200 mL) of subcutaneous replacement fluid. - Rate and volume of a single clysis should not exceed those used for infusion of IV fluids. «bu»Dispersion/Absorption Enhancement of Injected Drugs«/bu» - 50-300 units (usual dose: 150 units) SC either injected prior to drug administration or added to injection solution (consult compatibility reference prior to mixing) «bu»Extravasation Management«/bu» - To make a 15 units/mL concentration, mix 0.1 mL (of 150 units/mL) with 0.9 mL NS - Administer as soon as extravasation is recognized. - Do NOT use for extravasation of vasoconstrictors (dopamine, norepinephrine) - For extravasation management, skin testing is not necessary prior to use. - The concentration of doses used to manage extravasation ranges from 15 units/mL to 150 units/mL; refer to specific vesicant (below) for a description of doses/concentrations used in published case reports and/or reviews: «b»Aminophylline, Calcium Solutions, Dextrose 10%, Nafcillin«/b» «bi»Intradermal or SC Administration«/bi» - Inject a total of 1 mL (15 units/mL) as five separate 0.2 mL injections (using a 25-gauge needle) into area of extravasation at the leading edge in a clockwise manner «b»Contrast Media«/b» - The injection of a total of 5 mL (150 units/mL) as five separate 1 mL injections around the extravasation site has been also used successfully «b»Dextrose 50%«/b» - Injection of a total of 1 mL (150 units/mL) as five separate 0.2 mL injections administered along the leading edge of erythema has also been used successfully for dextrose 50% extravasation «b»Mannitol«/b» - Administer SC multiple injections of 0.5-1 mL (15 units/mL) around the periphery of the extravasation «b»Paclitaxel«/b» - Administer 1-6 mL (150 units/mL) into existing IV line, and/or, if needle/cannula has been removed, inject subcutaneously in a clockwise manner around area of extravasation; usual dose is 1 mL hyaluronidase for each 1 mL of extravasated drug; may repeat several times over the next 3-4 hours «b»Sodium Bicarbonate«/b» - Administer SC 4-5 separate 0.2 mL injections (15 units/mL) around area of extravasation «b»Vinblastine, Vincristine, Vindesine, Vinorelbine«/b» «bi»Needle/Cannula Still in Place (IV)«/bi» - After gently aspirating to remove extravasated vesicant, administer 1-6 mL hyaluronidase (150 units/mL) into existing IV line; the usual dose is 1 mL hyaluronidase for each 1 mL of extravasated drug «bi»Needle/Cannula Has Been Removed (SC)«/bi» - Inject 1-6 mL (150 units/mL) in a clock wise manner using 1 mL for every 1 mL of drug extravasated or administer 1 mL (150 units/mL) as 5 separate 0.2 mL injections (using a 25-gauge needle) into the extravasation site «b»Parenteral Nutrition, Potassium Solutions, Radiocontrast Media«/b» «bi»Intradermal or SC Administration«/bi» - Inject a total of 1 mL (15 units/mL) as five separate 0.2 mL injections (using a 25-gauge needle) into area of extravasation at the leading edge in a clockwise manner «b»Retrobulbar/Peribulbar Block (Adjuvant in Bupivacaine-Lidocaine Mixture)«/b» - 3.75 units (150 units/mL concentration) or 7.5 units (150 units/mL concentration) for every 1 mL of a 1:1 mixture of bupivacaine 0.75% and lidocaine 2% - Administer a total of 6-8 mL of mixture divided evenly between retrobulbar and peribulbar injections

HydrALAZINE

Apresoline

Hydrochlorothiazide

Microzide, Carozide, Hydrodiuril, HCTZ

HYDROcodone Bitartrate ER

Hydrocodone, Zohydro ER, Hysingla ER, Vantrela ER

«bu»Chronic Pain«/bu» «b»Initial Dosing«/b» - Should be prescribed only by healthcare professionals who are knowledgeable in the use of potent opioids for the management of chronic pain - Initiate the dosing regimen for each patient individually, taking into account the patient's prior analgesic treatment experience and risk factors for addiction, abuse, and misuse - Monitor patients closely for respiratory depression, especially within the first 24-72 hr of initiating therapy «b»Opioid Naïve or First Opioid Analgesic«/b» - Use of higher starting doses in patients who are not opioid tolerant may cause fatal respiratory depression «bi»Zohydro ER«/bi» - 10 mg PO every 12hr initially - A single dose of Zohydro ER >40 mg, Zohydro ER 50 mg capsules, or a total daily dose greater than 80 mg are only for patients in whom tolerance to an opioid of comparable potency is established «bi»Hysingla ER«/bi» - Administer once daily as 20 mg PO every 24h initially - Daily doses of Hysingla ER ≥80 mg/day are only for use in opioid tolerant patients «bi»Vantrela ER«/bi» - 15 mg PO every 12hr initially - 90-mg tablets, a single dose >60 mg, or a total daily dose >120 mg are only for use in opioid tolerant patients «b»Opioid Tolerant«/b» - See prescribing information for conversion table from existing opioid analgesic to hydrocodone extended-release - Opioid tolerance definition - Defined as patients who are receiving the following opioids (or an equianalgesic dose of another opioid) for 1 week or longer - Morphine 60 mg/day PO - Transdermal fentanyl 25 mcg/hr - Oxycodone 30 mg/day - Hydromorphone 8 mg/day PO - Oxymorphone 25 mg/day PO «b»Titration, Maintenance, Discontinuation«/b» «bi»Zohydro ER«/bi» - Increase by increments of 10 mg every 12hr q3-7d as needed to achieve adequate analgesia «bi»Hysingla ER«/bi» - Increase by increments of 10-20 mg/day every 3-5d as needed to achieve adequate analgesia «bi»Vantrela ER«/bi» - May increase to the next higher dose every 3-7d as needed to achieve adequate analgesia - Assess pain frequently for toxicity, breakthrough pain, or need for short-acting rescue analgesia - Discontinue by a gradual downward titration every 2-4 days; do not withdraw abruptly «b»Limitations of Use«/b» - Reserve hydrocodone ER for use in patients for whom alternative treatment options (nonopioid analgesics, immediate-release opioids) are ineffective, not tolerated, or would be otherwise inadequate to provide sufficient management of pain. Hydrocodone ER is not indicated as an as-needed analgesic.

Hydrocodone-Acetaminophen

Vicodin, Lortab, Lorcet, Norco, Hycet, Zamicet, Stagesic, Zolvit, Verdrocet, Xodol, Zydone

Hydrocodone-Chlorpheniramine

TussiCaps, Vituz, Tussionex Pennkinetic ER

Hydrocodone-Guaifenesin

Fentuss Expectorant, Flowtuss, Obredon

Hydrocodone-Homatropine

Hydromet, Tussigon, Hycodan

Hydrocodone-Ibuprofen

Ibudone, Reprexain, Vicoprofen, Xylon

Hydrocortisone

A-Hydrocort, Solu-CORTEF, Cortef, Compound F

«bu»Anti-inflammatory«/bu» - Initial Dose: 100 to 500 mg/dose IM/IV at intervals of 2, 4, or 6 hours. - Initial Dose: 20 to 240 mg PO daily «bu»Immunosuppressive«/bu» - Initial Dose: 100 to 500 mg/dose IM/IV at intervals of 2, 4, or 6 hours. - Initial Dose: 20 to 240 mg PO daily «bu»Status Asthmaticus«/bu» - Initial Dose: 1-2 mg/kg IV every 6hr for 24 hours - Maintenance Dose: 0.5-1 mg/kg IV every 6 hour «bu»Multiple Sclerosis«/bu» «b»Acute Exacerbations«/b» - 800 mg/day IM/IV for 1 week, then, - 320 mg IM/IV every other day for 1 month - 200 mg/day PO for 1 week, then, - 80 mg PO every other day for 1 month «bu»Adrenal Insufficiency«/bu» «b»Acute (Adrenal Crisis)«/b» - 100 mg IV bolus x1 dose, then immediately followed by, - 200 mg over 24 hours as a continuous IV infusion or in divided doses (IM or IV) every 6 hours, then, - 100 mg IV over 24 hours the following day «b»Chronic (Primary), Physiologic Replacement«/b» - 15 to 25 mg PO daily in 2 to 3 divided doses - Administer the largest dose in the morning upon awakening, followed by next dose 2 hours after lunch (two-dose regimen) or next dose at lunch, followed by smallest dose in the afternoon no later than 4 to 6 hours before bedtime (three-dose regimen) «b»Temporary«/b» - Physiologic replacement following resection of an ACTH-producing tumor or unilateral adrenalectomy (off-label dose) - 10 to 12 mg/m2/day PO in 2 to 3 divided doses, with the first dose taken as soon as possible after waking; continue hydrocortisone until HPA axis recovers, generally 6 to 12 months following resection of ACTH-producing tumors or 18 months following unilateral adrenalectomy «bu»Congenital Adrenal Hyperplasia«/bu» - 15 to 25 mg/day PO in 2 to 3 divided doses «bu»Illness with Fever«/bu» - Double the routine oral hydrocortisone dose until recovery for fever >38°C [100.4°F] or triple the routine oral hydrocortisone dose until recovery for fever >39°C [102.2°F]; return to standard dose within 1 to 2 days «bu»Gastroenteritis with Vomiting and/or Diarrhea«/bu» - 100 mg IM/SC dose given early in course of illness - Repeat after 6 to 12 hours «bu»Severe Infection«/bu» «b»Pneumonia with Altered Cognition«/b» - 100 mg IM/SC dose given early in course of illness - Repeat after 6 to 12 hours until recovery «bu»Surgery Stress«/bu» «b»Minor Stress, Inguinal Herniorrhaphy«/b» - 25 mg/day IV for 1 day «bu»Moderate Stress«/bu» «b»Joint Replacement, Cholecystectomy«/b» - 50 to 75 mg/day (25 mg every 8 to 12 hours) IV for 1 to 2 days «bu»Major Stress«/bu» «b»Pancreatoduodenectomy, Esophagogastrectomy, Cardiac Surgery«/b» - 100 to 150 mg/day (50 mg every 8 to 12 hours) IV for 2 to 3 days «bu»Septic Shock«/bu» - 200 mg/day IV as a continuous infusion or 50 mg IV bolus every 6 hours - Taper slowly (over several days) when vasopressors are no longer required; do not stop abruptly. Note: Low-dose hydrocortisone in septic shock patients may cause a significant increase in hyperglycemia and hypernatremia. A small study demonstrated that repetitive bolus doses of hydrocortisone caused significant hyperglycemia that was not seen during continuous infusion; practice guidelines recommend strategies for avoidance and/or detection of these side effects (the use of continuous infusion) «bu»Thyroid Storm«/bu» - 300 mg IV x 1 dose, then, - 100 mg IV every 8 hours «b»Oral Administration«/b» - Administer with food or milk to decrease GI upset. «b»IM or IV Administration«/b» - Dermal and/or subdermal skin depression may occur at injection site. «bi»IM Administration«/bi» - Avoid injection into deltoid muscle (high incidence of subcutaneous atrophy). «bi»IV Bolus Administration«/bi» - Administer undiluted over at least 30 seconds; for large doses (≥500 mg), administer over 10 minutes. «bi»IV Intermittent Infusion Administration«/bi» - Further dilute in a compatible fluid and administer over 20 to 30 minutes. «b»IV Bolus or IM Reconstitution«/b» - Reconstitute 100 mg vials with bacteriostatic water or bacteriostatic sodium chloride (not >2 mL). «b»IV Infusion Reconstitution«/b» - Add reconstituted solutions to an appropriate volume of D5W, NS, or D5NS (100 to 1,000 mL for a 100 mg solution; 250 to 1,000 mL for a 250 mg solution; 500 to 1,000 mL for a 500 mg solution; 1,000 mL for a 1,000 mg solution) - In cases where administration of a small volume of fluid is desirable, 100 to 3,000 mg of hydrocortisone may be added to 50 mL of D5W or NS. «b»Act-O-Vial Activator«/b» - Press the activator to force diluent into the powder compartment. - Following gentle agitation, solution may be withdrawn via syringe through a needle inserted into the center of the stopper. «b»Oral Suspension (2 mg/mL) Preparation«/b» - A 2 mg/mL oral suspension may be made with 10 mg tablets and a 1:1 mixture of Ora-Sweet and Ora-Plus. Crush ten 10 mg hydrocortisone tablets in a mortar and reduce to a fine powder. Add a small amount of vehicle and mix to a uniform paste; mix while adding the vehicle in incremental proportions to almost 50 mL; transfer to a calibrated amber bottle, rinse mortar with vehicle, and add sufficient quantity of vehicle to make 50 mL. Label “shake well.” Stable under refrigeration or at room temperature for 90 days. «b»Oral Suspension (2.5 mg/mL) Preparation«/b» - A 2.5 mg/mL oral suspension may be made with either tablets or powder and a vehicle containing sodium carboxymethylcellulose (1 g), syrup BP (10 mL), hydroxybenzoate 0.1% preservatives (0.1 g), polysorbate 80 (0.5 mL), citric acid (0.6 g), and water - To make the vehicle, dissolve the hydroxybenzoate, citric acid, and syrup BP in hot water - Cool solution and add the carboxymethylcellulose; leave overnight - Crush twelve-and-one-half 20 mg hydrocortisone tablets (or use 250 mg of powder) in a mortar and reduce to a fine powder while adding polysorbate 80 - Add small portions of vehicle and mix to a uniform paste; mix while adding the vehicle in incremental proportions to almost 100 mL; transfer to a calibrated bottle, rinse mortar with vehicle, and add sufficient quantity of vehicle to make 100 mL - Label “shake well” and “refrigerate.” - Stable for 90 days

Hydrocortisone (Topical, Rectal)

MiCort-HC, Westcort, Anucort-HC, Cortisol

Hydrocortisone-Urea

Carmol-HC, U-Cort

Hydrogen Peroxide

Peroxyl Spot Treatment, Eskata, H2O2, Peroxide

HYDROmorphone

Dilaudid, Exalgo, Palladone

«bu»Pain Management«/bu» - These are a guide and do not represent the maximum doses that may be required in all patients. Doses should be titrated to provide adequate pain relief «b»Immediate Release (PO)«/b» «bi»Initial Dose«/bi» - 2 to 4 mg PO every 4 to 6 hours as needed (tablets) or - 2.5 mg to 10 mg every 3 to 6 hours as needed (oral solution) - Patients with prior opioid exposure may require higher initial doses. - An initial dose of 4 to 8 mg is recommended for severe pain «b»Discontinuation of Therapy«/b» - For patients on long-term opioid therapy, decrease dose by 25% to 50% every 2 to 4 days; monitor carefully for signs/symptoms of withdrawal - If patient displays withdrawal symptoms, increase dose to previous level and then reduce dose more slowly by increasing interval between dose reductions, decreasing amount of daily dose reduction, or both. «b»IV Push«/b» «bi»Opioid Naive«/bi» - Initial Dose: 0.2 to 1 mg IV every 2 to 3 hours as needed - Hydromorphone HP should NOT be used in opioid-naive patients «bi»Opioid-tolerant Definition«/bi» - Use of higher starting doses in patients who are not opioid tolerant may cause fatal respiratory depression - Patients who are opioid tolerant are those receiving, for 1 week or longer, at least 60 mg/day PO morphine, 25 mcg/hr transdermal fentanyl, 30 mg/day PO oxycodone, 8 mg/day PO hydromorphone, 25 mg/day PO oxymorphone, or an equianalgesic dose of another opioid «bi»Critically ill Patients«/bi» - 0.2 to 0.6 mg IV every 1 to 2 hours as needed or - 0.5 mg IV every 3 hours as needed «b»Continuous IV Infusion«/b» - Usual Dosage Range: 0.5 to 3 mg/hour «b»Patient-Controlled Analgesia (PCA)«/b» «bi»Opioid Naive«/bi» - Consider lower end of dosing range - A continuous (basal) infusion is not recommended in opioid-naive patients - Usual concentration: 0.2 mg/mL - Demand dose: Usual initial dose: 0.2 mg; range: 0.05 to 0.4 mg - Lockout interval: 5 to 10 minutes «b»Epidural PCA«/b» - Usual concentration: 0.01 mg/mL - Bolus dose: 0.4 to 1 mg - Infusion rate: 0.03 to 0.3 mg/hour - Demand dose: 0.02 to 0.05 mg - Lockout interval: 10 to 15 minutes «b»IM, SC«/b» - IM use may result in variable absorption and lag time to peak effect - IM route not recommended for use - Initial Dose: 1 to 2 mg IM/SC every 2 to 3 hours as needed - Lower initial doses may be used in opioid-naive patients - Patients with prior opioid exposure may require higher initial doses - Hydromorphone HP should NOT be used in opioid-naive patients. «b»Rectal«/b» - US labeling: 3 mg (1 suppository) every 6 to 8 hours as needed. - Canadian labeling: 3 mg (1 suppository) at bedtime as needed. Discontinuation of Therapy - For patients on long-term opioid therapy, decrease dose by 25% to 50% every 2 to 4 days; monitor carefully for signs/symptoms of withdrawal - If patient displays withdrawal symptoms, increase dose to previous level and then reduce dose more slowly by increasing interval between dose reductions, decreasing amount of daily dose reduction, or both. «bu»Chronic Pain«/bu» - Patients taking opioids chronically may become tolerant and require doses higher than the usual dosage range to maintain the desired effect. - Tolerance can be managed by appropriate dose titration. - There is no optimal or maximal dose for hydromorphone in chronic pain. - The appropriate dose is one that relieves pain throughout its dosing interval without causing unmanageable side effects. «b»Long-acting (Exalgo)«/b» - Indicated for the management of pain in opioid tolerant patients severe enough to require daily, around-the-clock, long-term opioid treatment and for which alternative treatment options are inadequate «bi»Opioid Tolerant Patients Only«/bi» - 8-64 mg ER PO daily - May administer a starting dose equivalent to patient's total daily oral hydromorphone dose administered once daily with or without food - Should address pain relief and adverse events frequently; increase dose no more frequently than q3-4days; may titrate with increases of 25-50% of current daily dose; consider increasing dose if more than 2 doses of rescue medications are needed within 24hr within 2 consecutive days - Extented-release tablets should be swallowed whole; crushing, dividing, or dissolving will release opioid content all at once and increase risk of respiratory depression and death «bi»Converting to Exalgo«/bi» - Conversion from other oral hydromorphone formulations: Start with equivalent total daily dose of immediate release formulation and administer once daily; may titrate q3-4days until adequate pain relief with tolerable adverse effects achieved «bi»Conversion from Other Opioids«/bi» - Start Exalgo dose at 50% of calculated daily dose q24hr; titrate until adequate pain relief with tolerable adverse effects achieved «bi»Conversion from Transdermal Fentanyl to Exalgo«/bi» - Start Exalgo 18 hr after removal of transdermal fentanyl patch at 50% of calculated total daily dose given over 24hr; for a 25 mcg/hr fentanyl patch the equianalgesic dose is 12 mg PO q24hr «bi»Discontinuation of Exalgo Therapy«/bi» - Taper gradually by decreasing dose by 25-50% q2-3days to a dose of 8 mg PO q24hr before discontinuing Opioid-tolerant Definition - Use of higher starting doses in patients who are not opioid tolerant may cause fatal respiratory depression Patients who are opioid tolerant are those receiving, for 1 week or longer, at least 60 mg/day PO morphine, 25 mcg/hr transdermal fentanyl, 30 mg/day PO oxycodone, 8 mg/day PO hydromorphone, 25 mg/day PO oxymorphone, or an equianalgesic dose of another opioid «b»Limitations of Use«/b» - Because of the risks of addiction, abuse, and misuse with opioids, even at recommended doses, and because of the greater risks of overdose and death with extended-release opioid formulations, reserve for patients whom alternative treatment options (eg, nonopioid analgesics or immediate-release opioids) are ineffective, not tolerated, or would be otherwise inadequate to provide sufficient management of pain - Not indicated for acute pain or as a PRN analgesic «bu»Cough«/bu» - 1 mg PO every 3-4 hour prn

Hydroquinone

Melquin, Alphaquin HP, AMBI Fade, Lustra, Nuquin, Quinol, Solaquin, Esoterica, Melanex, Melpaque, Claripel, Clarite, Eldopaque, Eldoquin, Epiquin Micro,

Hydroxocobalamin

Cyanokit, Vitamin B12a

Hydroxyamphetamine-Tropicamide

Paremyd

Hydroxychloroquine

Plaquenil

Hydroxyprogesterone Caproate

Delta-Lutin, Makena, Delautin

«b»FDA removed all Hydroxyprogesterone Caproate (Makena) from the US market in October 2020«/b» «bu»Preterm Labor«/bu» «b»Pregnant Females ≥16 years«/b» - 250 mg IM once weekly (every 7 days) - Treatment may begin between 16 weeks 0 days and 20 weeks 6 days of gestation. - Continue weekly administration until 37 weeks gestation or until delivery, whichever comes first. «bu»Amenorrhea (Primary and Secondary) or Abnormal Uterine Bleeding due to Hormonal Imbalance«/bu» «b»Single Dose Therapy«/b» - 375 mg IM x 1 dose - Begin at any time «b»Cyclic Therapy Schedule«/b» - 250 mg IM on day 15 of each 28-day cycle for 4 cycles (in combination with estradiol valerate) - Begin cyclic therapy schedule after 4 days of desquamation - If there is no bleeding, begin cyclic therapy schedule 21 days after the 375 mg single dose schedule. «bu»Production of Secretory Endometrium and Desquamation«/bu» «b»Patients NOT on Estrogen Therapy«/b» «bi»Cyclic Therapy Schedule«/bi» - 250 mg IM on day 15 of each 28-day cycle (in combination with estradiol valerate) - May begin at any time; continue until cyclic therapy is no longer required. «b»Patients Currently on Estrogen Therapy«/b» «bi»Single Dose Therapy«/bi» - 375 mg IM as a single dose; begin at any time or «bi»Cyclic Therapy Schedule«/bi» - 250 mg IM on day 15 of each 28-day cycle (in combination with estradiol valerate) - Begin cyclic therapy schedule after 4 days of desquamation. - If there is no bleeding, begin cyclic therapy schedule 21 days after the 375 mg single dose schedule. - Continue until cyclic therapy is no longer required. «bu»Test for Endogenous Estrogen Production«/bu» - 250 mg IM as a single dose (bleeding 7 to 14 days after administration indicates endogenous estrogen) - May repeat once 4 weeks after initial dose. «bu»Uterine Adenocarcinoma«/bu» - 1,000 mg IM one or more times a week (1,000 to 7,000 mg/week) - Discontinue upon relapse. - While approved for the treatment of advanced adenocarcinoma (stage III or IV) of the uterine corpus, chemotherapy may be preferable to progestin therapy in the management of advanced disease. Based on a systematic review, response to hormonal therapy is inversely proportional to tumor grade

Hydroxyurea

Droxia, Hydrea, Siklos

«bu»Chronic Myeloid Leukemia (CML)«/bu» «b»Hydrea«/b» - Initial Dose: 40 mg/kg PO daily (reduce initial dose for thrombocytopenia) - Reduce dose to 20 mg/kg PO daily, if WBC count <2,000/mm3 «bu»Head and Neck Cancer«/bu» «b»Hydrea«/b» - 1,000 mg PO every 12 hours for 11 doses per cycle, in combination with continuous infusion fluorouracil and radiation therapy «bu»Sickle Cell Anemia«/bu» «b»Droxia«/b» - Initial Dose: 15 mg/kg PO daily - Monitor blood counts every 2 weeks - If blood counts are in an acceptable range, may increase by 5 mg/kg/day every 12 weeks until the maximum tolerated dose of 35 mg/kg/day is achieved or the dose that does not produce toxic effects over 24 consecutive weeks - If toxicity occurs, withhold treatment until the bone marrow recovers, then restart with a dose reduction of 2.5 mg/kg/day.If no toxicity occurs over the next 12 weeks, then the subsequent dose may be increased by 2.5 mg/kg/day every 12 weeks to a maximum tolerated dose (dose that does not produce hematologic toxicity for 24 consecutive weeks). - If hematologic toxicity recurs a second time at a specific dose, discontinue treatment. «b»Acceptable Hematologic Ranges«/b» - Neutrophils ≥2,500/mm3 - Platelets ≥95,000/mm3 - Hemoglobin >5.3 g/dL - Reticulocytes ≥95,000/mm3 if hemoglobin is <9 g/dL «b»Toxic Hematologic Ranges«/b» - Neutrophils <2,000/mm3 - Platelets <80,000/mm3 - Hemoglobin <4.5 g/dL - Reticulocytes <80,000/mm3 if hemoglobin is <9 g/dL «b»Siklos«/b» - Initial Dose: 20 mg/kg PO daily - Monitor blood counts every 2 weeks - If blood counts are in an acceptable range, may increase by 5 mg/kg/day every 8 weeks or if a painful crisis occurs until mild myelosuppression (ANC 2,000 to 4,000/mm3) is achieved, or up to a maximum dose of 35 mg/kg/day - If blood counts are in a toxic range, discontinue until hematologic recovery. Following hematologic recovery, restart with the dose reduced by 5 mg/kg/day; may titrate dose up or down every 8 weeks in 5 mg/kg/day increments, seeking a stable dose with no hematologic toxicity for 24 weeks - Discontinue permanently if hematologic toxicity develops twice. «b»Acceptable Hematologic Ranges«/b» - Neutrophils ≥2,000/mm3 - Platelets ≥80,000/mm3 - Hemoglobin >5.3 g/dL - Reticulocytes ≥80,000/mm3 if hemoglobin is <9 g/dL «b»Toxic Hematologic Ranges«/b» - Neutrophils <2,000/mm3 (neutrophil limit of 1,250/mm3 may be acceptable in younger patients with lower baseline counts) - Platelets <80,000/mm3 - Hemoglobin <4.5 g/dL - Reticulocytes <80,000/mm3 if hemoglobin is <9 g/dL - Calculate rounded doses to the nearest 50 or 100 mg strength. «bu»Acute Myeloid Leukemia (AML), Cytoreduction«/bu» (off-label use) - 50 to 100 mg/kg PO daily until WBC <100,000/mm3 - 50 to 60 mg/kg/day PO until WBC <10,000 to 20,000/mm3 «bu»Essential Thrombocythemia, High-Risk«/bu» (off-label use) - 500 to 1000 mg PO daily - Adjust dose to maintain platelets <400,000/mm3 «bu»Hypereosinophilic Syndrome«/bu» (off-label use) - 1,000 to 3,000 mg PO daily «bu»Meningioma«/bu» (off-label use) - 20 mg/kg PO once daily «bu»Polycythemia Vera, High-Risk«/bu» (off-label use) - 15 to 20 mg/kg PO daily - Cutaneous vasculitic ulcerations: Discontinue - Pancreatitis: Discontinue permanently «b»Hematologic Toxicity«/b» - CML, Head and Neck cancer - Do not initiate therapy if bone marrow function is markedly reduced «bu»Sickle Cell Anemia«/bu» «b»Infants ≥6 months and Children <2 years«/b» - 20 mg/kg/dose PO once daily - Increase by 5 mg/kg/day PO every 8 weeks until mild myelosuppression (target ANC 2,000 to 4,000/mm3 [a lower ANC limit of 1,500/mm3 has been used in some studies]) is achieved - Maximum Dose: 35 mg/kg/day - If myelosuppression occurs (platelets <80,000/mm3, neutrophils <2,000/mm3; younger patients with lower baseline counts may safely tolerate ANC down to 1,250/mm3), hold therapy until counts recover (monitor weekly); reinitiate at a dose 5 mg/kg/day lower than the dose given prior to onset of cytopenias; some have recommended reinitiating at a dose 2.5 mg/kg/day lower - A clinical response to treatment may take 3 to 6 months; a 6-month trial of the maximum tolerated dose is recommended prior to considering discontinuation due to treatment failure. Effectiveness of hydroxyurea depends upon daily dosing adherence. For patients who have a clinical response, long-term hydroxyurea therapy is indicated «b»Children ≥2 years and Adolescents (Siklos)«/b» «bi»Initial Dose«/bi» - 20 mg/kg/day as a single daily dose. - Monitor blood counts every 2 weeks; if blood counts are in an acceptable range, may increase by 5 mg/kg/day every 8 weeks or if a painful crisis occurs until mild myelosuppression (ANC 2,000 to 4,000/mm3) is achieved, or up to a maximum dose of 35 mg/kg/day. - If blood counts are in a toxic range, discontinue until hematologic recovery. Following hematologic recovery, restart with the dose reduced by 5 mg/kg/day; may titrate dose up or down every 8 weeks in 5 mg/kg/day increments, seeking a stable dose with no hematologic toxicity for 24 weeks. - Discontinue permanently if hematologic toxicity develops twice. An initial starting dose of 15 mg/kg/dose once daily has also been studied «bi»Acceptable Hematologic Ranges«/bi» - Neutrophils ≥2,000/mm3; platelets ≥80,000/mm3; hemoglobin >5.3 g/dL; and reticulocytes ≥80,000/mm3 if hemoglobin is <9 g/dL «bi»Toxic Hematologic Ranges«/bi» - Neutrophils <2,000/mm3 (neutrophil limit of 1,250/mm3 may be acceptable in younger patients with lower baseline counts); platelets <80,000/mm3; hemoglobin <4.5 g/dL; and reticulocytes <80,000/mm3 if hemoglobin is <9 g/dL - Calculate rounded doses to the nearest 50 or 100 mg strength. - A clinical response to treatment may take 3 to 6 months; a 6-month trial of the maximum tolerated dose is recommended prior to considering discontinuation due to treatment failure. Effectiveness of hydroxyurea depends upon daily dosing adherence. For patients who have a clinical response, long-term hydroxyurea therapy is indicated. «b»Oral Administration«/b» - Administer at the same time each day - Swallow whole, do not open capsules. «bi»Siklos«/bi» - Administer with water. - If unable to swallow tablets whole, may disperse immediately before use in a small amount of water in a teaspoon (add tablet to spoon, add water; tablet dissolves in ~1 minute; administer immediately); drink an additional glass of water after administering the dose. - The 1,000 mg tablets are scored with 3 lines to enable splitting into 4 parts; wear gloves and use a damp paper towel surface to break scored tablets (properly dispose of used gloves and paper towel) - Do not split the 100 mg tablet into smaller parts. - Impervious gloves should be worn when handling bottles containing hydroxyurea or when handling/administering intact capsules/tablets. - Wash hands with soap and water before and after contact with hydroxyurea - Avoid exposure to crushed capsules/tablets or open capsules. - If skin contact occurs, immediately wash the affected area thoroughly with soap and water. - If eye(s) contact occurs, the affected area should be flushed thoroughly with water or isotonic eyewash designated for that purpose for at least 15 minutes. - If powder from the capsules or tablets is spilled, immediately wipe it up with a damp disposable towel and discard (along with the empty capsules) in a closed container, such as a plastic bag - The spill areas should then be cleaned using a detergent solution followed by clean water «b»Oral Solution (100 mg/mL) Preparation«/b» - A 100 mg/mL oral solution may be prepared with capsules - Mix the contents of twenty 500 mg capsules with enough room temperature sterile water (~50 mL) to initially result in a 200 mg/mL concentration - Stir vigorously using a magnetic stirrer for several hours, then filter to remove insoluble contents - Add 50 mL Syrpalta (flavored syrup without color, HUMCO) to filtered solution, resulting in 100 mL of a 100 mg/mL hydroxyurea solution - Stable for 1 month at room temperature in amber plastic bottle

HydrOXYzine

Vistaril, Atazine, Atarax

Hyoscyamine

Hyosyne, Levsin, Oscimin, Anaspaz, Levbid, Ed-Spaz, NuLev, Symax FasTabs, Symax Duotab, Levbid, HyoMax-SL

Hyoscyamine-Atropine-Scopolamine-Phenobarbital

Anti-Spas, Donnatal, Donnatal Extentabs, Phenohytro

Hyoscyamine-Methenamine-Methylene Blue-Na Phos

Indiomin MB, UTA, Urogesic-Blue, Urolet MB

Ibalizumab

Trogarzo

Ibandronate

Boniva, Bondronate

Ibrexafungerp

Brexafemme

Ibritumomab Tiuxetan

Zevalin Y-90

«bu»Non-Hodgkin Lymphoma (NHL)«/bu» - Ibritumomab is administered only as part of the Zevalin therapeutic regimen (a combined treatment regimen with rituximab) «b»The Regimen Consists of Two Steps«/b» «bi»Day 1 Treatment«/bi» Rituximab - 250 mg/m2 IV at an initial rate of 50 mg/hour - If hypersensitivity or infusion-related events do not occur, increase infusion in increments of 50 mg/hour every 30 minutes, to a maximum of 400 mg/hour - Stop rituximab and discontinue regimen for severe infusion reaction - For less severe infusion reactions, temporarily slow or interrupt; the infusion may be resumed at one-half the previous rate upon improvement of symptoms. «bi»Day 7, 8, or 9 of Treatment«/bi» Rituximab - 250 mg/m2 IV at an initial rate of 100 mg/hour (50 mg/hour if infusion-related events occurred with the day 1 infusion) - If hypersensitivity or infusion-related events do not occur, increase infusion in increments of 100 mg/hour every 30 minutes, to a maximum of 400 mg/hour, as tolerated (increase in 50 mg/hour increments every 30 minutes if initial infusion rate was 50 mg/hour). «bi»Y-90 Ibritumomab«/bi» - Within 4 hours after completion of the rituximab infusion - Platelet count ≥150,000 cells/mm3: 0.4 mCi/kg (14.8 MBq/kg) actual body weight over 10 minutes; maximum dose: 32 mCi (1184 MBq) - Platelet count between 100,000 to 149,000 cells/mm3 (in relapsed or refractory patients): 0.3 mCi/kg (11.1 MBq/kg) actual body weight over 10 minutes; maximum dose: 32 mCi (1184 MBq) - Platelet count <100,000 cells/mm3: Do not administer - Maximum Dose: The prescribed, measured, and administered dose of Y-90 ibritumomab must not exceed 32 mCi (1184 MBq), regardless of the patient's body weight - Radiopharmaceutical; use appropriate precautions for handling and disposal. To prepare radiolabeled injection and determine radiochemical purity, follow detailed preparation guidelines provided by manufacturer. Use appropriate shielding during and after radiolabeling «b»Pre-medication«/b» - Premedicate with oral acetaminophen 650 mg and oral diphenhydramine 50 mg prior to each rituximab infusion - Allow at least 6 weeks, but no more than 12 weeks following first-line chemotherapy before treatment initiation - Platelets should recover to ≥150,000/mm3 prior to initiation of treatment regimen.

Ibrutinib

Imbruvica

«bu»Chronic Graft-Versus-Host Disease (cGVHD)«/bu» «b»Refractory«/b» - 420 mg PO once daily - Continue until cGVHD disease progression, recurrence of underlying malignancy, or unacceptable toxicity - When cGVHD treatment is no longer required, discontinue ibrutinib based on medical assessment of patient. «bu»Chronic Lymphocytic Leukemia/Small Lymphocytic Lymphoma (CLL/SLL)«/bu» - 420 mg PO once daily - Either as monotherapy or in combination with bendamustine and rituximab - Continue until disease progression or unacceptable toxicity «b»CLL/SLL with 17p Deletion«/b» - 420 mg PO once daily - Continue until disease progression or unacceptable toxicity «bu»Mantle Cell Lymphoma (MCL)«/bu» «b»Previously Treated«/b» - 560 mg PO once daily - Continue until disease progression or unacceptable toxicity «bu»Marginal Zone Lymphoma (MZL)«/bu» «b»Relapsed/Refractory«/b» - 560 mg PO once daily - Continue until disease progression or unacceptable toxicity «bu»Waldenström Macroglobulinemia (WM)«/bu» - 420 mg PO once daily - Continue until disease progression or unacceptable toxicity «b»Missed Doses«/b» - Administer as soon as the missed dose is remembered on the same day - Return to normal scheduling the following day - Do not take extra capsules to make up for the missed dose. «b»Moderate CYP3A Inhibitors«/b» «bi»Voriconazole«/bi» - 200 mg PO bid «bi»Posaconazole Suspension«/bi» - 100 mg PO once daily OR - 100 mg PO bid OR - 200 mg PO Bid - Reduce ibrutinib dose to 140 mg once daily - Monitor closely and interrupt ibrutinib treatment as recommended for toxicities. «bi»Other Strong CYP3A Inhibitors«/bi» - Avoid concurrent use - If these inhibitors will be used short-term (anti-infectives for ≤7 days), interrupt ibrutinib treatment. «b»Strong CYP3A Inhibitors«/b» - Avoid concurrent use - If these inhibitors will be used short-term (anti-infectives for ≤7 days), interrupt ibrutinib treatment. «b»Hematologic Toxicity«/b» «bi»≥Grade 3 Neutropenia with Infection, Fever, or Grade 4 Toxicity«/bi» - Interrupt therapy - Upon improvement to grade 1 toxicity or baseline, resume dosing at the starting dose. - If toxicity recurs, reduce daily dose by 140 mg - If toxicity recurs after first dose reduction, reduce daily dose by an additional 140 mg. - If toxicity persists following 2 dose reductions, discontinue therapy «b»Non-hematologic Toxicity«/b» «bi»≥ Grade 3 Toxicity«/bi» - Interrupt therapy - Upon improvement to grade 1 toxicity or baseline, resume dosing at the starting dose - If toxicity recurs, reduce daily dose by 140 mg - If toxicity recurs after first dose reduction, reduce daily dose by an additional 140 mg - If toxicity persists following 2 dose reductions, discontinue therapy. «b»Recommend Dose Reductions for Toxicity (following recovery)«/b» «bi»Chronic Lymphocytic Leukemia/small Lymphocytic Lymphoma, Chronic GVHD and Waldenström Macroglobulinemia«/bi» First Occurrence - Restart at 420 mg once daily Second Occurrence - Restart at 280 mg once daily Third Occurrence - Restart at 140 mg once daily Fourth Occurrence - Discontinue «bi»Mantle Cell Lymphoma and Marginal Zone Lymphoma«/bi» First Occurrence - Restart at 560 mg once daily Second Occurrence - Restart at 420 mg once daily Third Occurrence - Restart at 280 mg once daily Fourth Occurrence - Discontinue

Ibuprofen

Advil, Motrin, Caldolor, NeoProfen, Provil, Dyspel, EnovaRX-Ibuprofen, Genpril

«bu»Analgesia«/bu» «b»Caldolor (IV)«/b» - Patients should be well hydrated prior to administration. «bi»Infants ≥6 months and Children <12 years«/bi» - 10 mg/kg (maximum dose: 400 mg) every 4 to 6 hours as needed - Maximum Daily Dose: 40 mg/kg/day or 2,400 mg/day, whichever is less. «bi»Children and Adolescents 12 to 17 years«/bi» - 400 mg every 4 to 6 hours as needed - Maximum Daily Dose: 2,400 mg/day «b»Ibuprofen PO«/b» «bi»Infants and Children <50 kg«/bi» - Limited data available in infants <6 months - 4 to 10 mg/kg/dose every 6 to 8 hours - Maximum Single Dose: 400 mg - Maximum Daily Dose: 40 mg/kg/day «bu»Antipyretic«/bu» «b»Caldolor (IV)«/b» - Patients should be well hydrated prior to administration. «bi»Infants ≥6 months and Children <12 years«/bi» - 10 mg/kg (maximum dose: 400 mg) every 4 to 6 hours as needed - Maximum Daily Dose: 40 mg/kg/day or 2,400 mg/day, whichever is less. «bi»Children and Adolescents 12 to 17 years«/bi» - 400 mg every 4 to 6 hours as needed - Maximum Daily Dose: 2,400 mg/day «b»Ibuprofen PO«/b» «bi»Infants ≥6 months, Children, and Adolescents«/bi» - 5 to 10 mg/kg/dose every 6 to 8 hours - Maximum Single Dose: 400 mg - Maximum Daily Dose: 40 mg/kg/day up to 1,200 mg, unless directed by physician (under physician supervision, not to exceed maximum of 2,400 mg daily «bu»Juvenile Idiopathic Arthritis (JIA)«/bu» «b»Ibuprofen PO«/b» «bi»Children and Adolescents«/bi» - 30 to 40 mg/kg/day in 3 to 4 divided doses - Start at lower end of dosing range and titrate - Patients with milder disease may be treated with 20 mg/kg/day - Patients with more severe disease may require up to 50 mg/kg/day - Maximum Single Dose: 800 mg - Maximum Daily Dose: 2,400 mg «bu»Patent Ductus Arteriosus«/bu» «b»Ibuprofen Lysine (NeoProfen)«/b» «bi»Infants weighing between 500 to 1,500 g and ≤32 weeks' GA«/bi» - Initial Dose: Ibuprofen 10 mg/kg, followed by two doses of 5 mg/kg at 24 and 48 hours. - Dose should be based on birth weight.

Ibuprofen-Famotidine

Duexis

Ibutilide

Corvert

Icatibant

Firazyr

IDArubicin

Idamycin

IdaruCIZUmab

Praxbind, aDabi-Fab

Idecabtagene Vicleucel

Abecma

Idelalisib

Zydelig

«bu»Chronic Lymphocytic Leukemia«/bu» «b»Relapsed«/b» - 150 mg PO bid (in combination with rituximab) - Continue until disease progression or unacceptable toxicity «bu»Follicular B-cell Non-Hodgkin Lymphoma«/bu» «b»Relapsed«/b» - 150 mg PO bid - Continue until disease progression or unacceptable toxicity «bu»Small Lymphocytic Lymphoma«/bu» «b»Relapsed«/b» - 150 mg PO bid - Continue until disease progression or unacceptable toxicity «b»Missed Doses«/b» - May administer a missed dose if within 6 hours of usual dosing time - If >6 hours, skip the missed dose and resume therapy with the next scheduled dose. «b»Limitations of Use«/b» - Idelalisib is not indicated or recommended for first-line treatment of CLL, follicular B-cell non-Hodgkin lymphoma, or SLL «b»Anaphylaxis or Other Serious Allergic Reactions«/b» - Permanently discontinue. «b»Dermatologic Toxicity«/b» Severe Cutaneous Reactions - Discontinue. Suspected Stevens-Johnson Syndrome (SJS) or Toxic Epidermal Necrolysis (TEN) - Interrupt therapy - Discontinue permanently if SJS or TEN are confirmed «b»Hematologic Toxicity«/b» «bi» Neutropenia«/bi» ANC 1,000 to <1,500 cells/mm3 - Continue current dose. ANC 500 to <1,000 cells/mm3 - Continue current dose - Monitor blood counts at least weekly ANC <500 cells/mm3 - Temporarily interrupt therapy - Monitor blood counts at least weekly until ANC ≥500 cells/mm3, then may reinitiate therapy at 100 mg twice daily. «bi»Thrombocytopenia«/bi» Platelets 50,000 to <75,000 cells/mm3 - Continue current dose. Platelets 25,000 to <50,000 cells/mm3 - Continue current dose; monitor platelet counts at least weekly. Platelets <25,000 cells/mm3 - Temporarily interrupt therapy - Monitor platelet counts at least weekly, may reinitiate therapy at 100 mg twice daily when platelets recover to ≥25,000 cells/mm3. «b»Gastrointestinal Toxicity«/b» «bi»Diarrhea«/bi» Moderate Diarrhea (increase of 4 to 6 stools/day over baseline) - Continue current dose - Monitor at least weekly until resolved Severe Diarrhea (increase of ≥7 stools/day over baseline) or Hospitalization - Temporarily interrupt therapy - Monitor at least weekly until resolved, then may reinitiate therapy at 100 mg twice daily. Life-threatening Diarrhea - Discontinue permanently. «b»Infection«/b» «bi» Sepsis, Pneumonia, or Other Infection«/bi» Grade 3 or Higher - Interrupt therapy until infection has resolved «bi»Cytomegalovirus (CMV) Infection or Viremia«/bi» - Interrupt therapy for evidence of CMV infection of any grade or viremia (positive PCR or antigen test) until infection has resolved - If idelalisib is reinitiated, monitor for CMV reactivation by PCR or antigen test at least monthly. «bi»Pneumocystis Jirovecii Pneumonia (PCP) Infection«/bi» - Interrupt therapy for suspected PCP infection of any grade - Permanently discontinue if PCP infection is confirmed «b»Pulmonary Toxicity«/b» - If pneumonitis is suspected, interrupt therapy and evaluate; discontinue for symptomatic pneumonitis of any severity thought to be associated with therapy (may also require corticosteroids). «b»Other Toxicity«/b» - If severe or life-threatening toxicities occur, interrupt therapy until toxicity is resolved - If the decision is made to resume therapy, reduce the dose to 100 mg twice daily. - Discontinue permanently if severe or life-threatening toxicities recur upon rechallenge.

Idursulfase

Elaprase

Ifosfamide

Ifex, Isophosphamide

Iloperidone

Fanapt

Iloprost

Ventavis, Prostacyclin PGI2

Imatinib

Gleevec

«bu»Acute Lymphoblastic Leukemia (ALL)«/bu» «b»Relapsed or Refractory Philadelphia Chromosome Positive (Ph+)«/b» - 600 mg PO daily «bu»Myelodysplastic/Myeloproliferative Diseases«/bu» - 400 mg PO daily «bu»Hypereosinophilic Syndrome (HES) and/or /Chronic Eosinophilic Leukemia«/bu» - 400 mg PO daily «b»HES/CEL with F1P1L1-PDGFR-alpha Fusion Kinase«/b» - 100 mg PO daily - May increase to 400 mg PO daily in absence of adverse drug reactions if assessments demonstrate insufficient response to therapy «bu»Chronic Myeloid Leukemia Philadelphia-Chromosome-positive«/bu» «b»Chronic Phase«/b» Newly diagnosed adult and pediatric patients - 400 mg PO daily «b»Chronic Phase After Failure of Interferon-alpha Therapy«/b» - May increase to 600 mg/day in absence of severe adverse drug reaction and severe nonleukemia related neutropenia or thrombocytopenia - There is disease progression (at any time) - Failure to achieve a satisfactory hematologic response after at least 3 months of treatment - Failure to achieve a cytogenetic response after 6-12 months of treatment - Loss of a previously achieved hematologic or cytogenetic response «b»Accelerated Phase or Blast Crisis«/b» - 600 mg PO daily - May increase to 400 mg PO q12hr in absence of severe adverse drug reaction and severe nonleukemia related neutropenia or thrombocytopenia - There is disease progression (at any time) - Failure to achieve a satisfactory hematologic response after at least 3 months of treatment - Failure to achieve a cytogenetic response after 6-12 months of treatment - Loss of a previously achieved hematologic or cytogenetic response «bu»Dermatofibrosarcoma Protuberans«/bu» - Indicated for adults with unresectable, recurrent and/or metastatic dermatofibrosarcoma protuberans - 400 mg PO every 12hr «bu»Mastocytosis«/bu» - Indicated for adults with aggressive systemic mastocytosis without the D816V c-Kit mutation as determined with an FDA-approved test or with c-Kit mutational status unknown «b»Without D816V c-Kit Mutation«/b» - 100 mg PO daily «b»c-Kit Mutational Status Unknown«/b» - 400 mg PO daily if not responding to other therapies «b»ASM Associated with Eosinophilia«/b» - A clonal hematological disease related to the fusion kinase FIP1L1-PDGFR-alpha) - 100 mg PO qDay initially - May increase to 400 mg/day in absence of adverse effects if response to therapy is insufficient «bu»Gastrointestinal Stromal Tumors«/bu» «b»Unresectable and/or Metastatic Malignant GIST«/b» - 400 mg PO daily - May increase to 400 mg BID in patients showing clear signs or symptoms of disease progression at a lower dose and in the absence of severe adverse drug reactions «b»Adjuvant Treatment following Complete Cross Resection of GIST«/b» - 400 mg PO qDay x3 years «b»Dosage Modifications«/b» - Withhold treatment if fluid retention «b»Hematologic Toxicity«/b» - Generally, discontinue if ANC <1000/mm³ and/or Plts <50,000/mm³ - Resume when ANC >1500/mm³ and Plts >75,000/mm³ See Mfr's PI for specifics «b»Hepatotoxicity«/b» - Withhold if bilirubin >3x ULN or ALT/AST >5x ULN - Resume after bilirubin <1.5x ULN and ALT/AST <2.5x ULN at a reduced dose (ie, 400 mg to 300 mg; 600 mg to 400 mg; 800 mg to 600 mg) - Withhold if severe hepatotoxicity; once resolved, reduce dose by 25% «b»Oral Administration«/b» - Imatinib is associated with a moderate emetic potential; antiemetics may be recommended to prevent nausea and vomiting - Should be administered with a meal and a large glass of water. - For daily dosing ≥800 mg, the 400 mg tablets should be used in order to reduce iron exposure. - Do not crush tablets. - Tablets may be dispersed in water or apple juice (using ~50 mL for 100 mg tablet, ~200 mL for 400 mg tablet); stir until dissolved and administer immediately - If necessary, an oral suspension may be prepared (see Extemporaneously Prepared). Avoid skin or mucous membrane contact with crushed tablets; if contact occurs, wash thoroughly - Avoid exposure to crushed tablets. «bi»Adults«/bi» - Doses ≤600 mg may be given once daily - 800 mg dose should be administered as 400 mg twice daily. «bi»Children«/bi» - Dosing may be once or twice daily for chronic myeloid leukemia (CML) and once daily for Philadelphia chromosome-positive (Ph+) acute lymphoblastic leukemia (ALL). «b»Oral Suspension (40 mg/mL) Preparation«/b» - An oral suspension may be prepared by placing tablets (whole, do not crush) in a glass of water or apple juice - Use ~50 mL for 100 mg tablet, or ~200 mL for 400 mg tablet - Stir until tablets are disintegrated, then administer immediately - To ensure the full dose is administered, rinse the glass and administer residue. - A 40 mg/mL oral suspension may be prepared using imatinib 400 mg tablets and Ora-Sweet - Determine necessary quantity of imatinib 400 mg tablets; crush the tablets in a glass mortar and triturate to a fine powder (estimated powder volume for each imatinib 400 mg tablet is 0.4 mL) - Measure the necessary volume of Ora-Sweet (to make a 40 mg/mL suspension) and add to the powder by geometric dilution until a smooth suspension is created - Transfer to an amber plastic bottle and label “Shake Well Before Use” and “Use by (date)” - Suspension is stable for up to 14 days at both room temperature and 4°C (39.2°F).

Imdevimab

Imiglucerase

Cerezyme

Imipenem

Imipenem-Cilastatin

Primaxin, Imipemide

«b»Susceptible Bacterial Species«/b» - 500 mg IV every 6 hours or 1,000 mg every 8 hours - Maximum Dose: 4,000 mg/day «b»Intermediate Susceptibility Bacterial Species«/b» - 1,000 mg IV every 6 hours - Maximum Dose: 4,000 mg/day «bu»Burkholderia Pseudomallei (Melioidosis)«/bu» - Initial Dose: 20 mg/kg IV every 8 hours for at least 10 days - 25 mg/kg (up to 1 g) IV every 6 hours for at least 10 days - Continue parenteral therapy until clinical improvement then switch to oral therapy if tolerated and/or appropriate. «bu»Intra-abdominal Infections«/bu» «b»Complicated«/b» - 500 mg IV every 6 hours x 4 to 7 days - 1 g IV every 8 hours x 4 to 7 days (provided source controlled) - Not recommended for mild to moderate, community-acquired intra-abdominal infections due to risk of toxicity and the development of resistant organisms «bu»Neutropenic Fever«/bu» - 500 mg IV every 6 hours «bu»Nontuberculous Mycobacterial Disease«/bu» - M. abscessus skin, soft tissue, or bone infections - 500 mg IV every 6 to 12 hours - Use in combination with other antibacterial agents «bu»Hospital Acquired Pneumonia (HAP) or Ventilator Associated Pneumonia (VAP)«/bu» - 500 mg IV every 6 hours for 7 days - May consider shorter or longer duration depending on rate of clinical improvement - When used as empiric therapy, use in combination with an agent active against MRSA (unless coverage of MSSA only is appropriate) with or without an additional antipseudomonal agent (dependent on patient and institution-specific risk factors) - May need to decrease dose in patients weighing less than 70 kg to prevent seizures «bu»Skin and Soft Tissue Necrotizing Infections«/bu» - 1 g IV every 6 to 8 hours in combination with an agent effective against MRSA (eg, vancomycin, linezolid, daptomycin) for empiric therapy of polymicrobial [mixed] infections - Continue until further debridement is not necessary, patient has clinically improved, and patient is afebrile for 48 to 72 hours «bu»Surgical-Site Infection«/bu» - Intestinal or genitourinary tract surger - 500 mg IV every 6 hours

Imipenem-Cilastatin-Relebactam

Recarbrio

Imipramine

Tofranil

«bu»Depression«/bu» «b»Outpatients«/b» - Initial Dose: 75 mg/day - May increase gradually to 150 mg/day - May be given in divided doses or as a single bedtime dose - Maintenance 50 to 150 mg/day - Maximum Dose: 200 mg/day «b»Inpatients«/b» - Initial Dose: 100 to 150 mg/day - May increase gradually to 200 mg/day - If no response after 2 weeks, may further increase to 250 to 300 mg/day - May be given in divided doses or as a single bedtime dose - Maximum: 300 mg/day. «bu»Bulimia Nervosa«/bu» - Initial Dose: 50 mg at bedtime - Increase gradually based on response and tolerability up to 300 mg at bedtime «bu»Neuropathic Pain«/bu» - Initial Dose: 50 mg once daily or in divided doses twice daily - Increase gradually up to 150 mg daily or to a dosage sufficient to achieve an imipramine plus desipramine plasma concentration of 113-170 ng/mL (SI: 400-600 nmol/L) «bu»Panic Disorder«/bu» - Initial Dose: 10 mg/day - Increase gradually over 3 to 5 weeks to a target dose of 100 to 300 mg/day; mean doses in studies ranged from 155 to 239 mg/day «bu»Post-Traumatic Stress Disorder (PTSD)«/bu» - Initial Dose: 50 mg once daily - Increase gradually to 200-300 mg once daily to achieve blood levels in the therapeutic range (>150 ng/mL) «b»Discontinuation of Therapy«/b» - Upon discontinuation of antidepressant therapy, gradually taper the dose to minimize the incidence of withdrawal symptoms and allow for the detection of re-emerging symptoms - Evidence supporting ideal taper rates is limited. APA and NICE guidelines suggest tapering therapy over at least several weeks with consideration to the half-life of the antidepressant; antidepressants with a shorter half-life may need to be tapered more conservatively. In addition for long-term treated patients, WFSBP guidelines recommend tapering over 4 to 6 months. If intolerable withdrawal symptoms occur following a dose reduction, consider resuming the previously prescribed dose and/or decrease dose at a more gradual rate «b»Switching to or from an MAO Inhibitors Intended to Treat Psychiatric Disorders«/b» - Allow 14 days to elapse between discontinuing an MAO inhibitor intended to treat psychiatric disorders and initiation of imipramine. - Allow 14 days to elapse between discontinuing imipramine and initiation of an MAO inhibitor intended to treat psychiatric disorders.

Imiquimod

Aldara, Zyclara, Vyloma

«bu»Actinic Keratosis«/bu» «b»2.5% and 3.75% Cream«/b» - Apply thin film (using up to 2 packets or 2 full pump actuations) once daily before bedtime for 2 weeks to the skin of the affected area (either the entire face or balding scalp, but not both concurrently) - Leave on for ~8 hours, then remove with mild soap and water - After a 2-week period of no treatment, repeat with a second 2-week treatment (do not extend treatment cycles because of missed doses or rest periods) Maximum to be Prescribed - 56 packets or 2 x 7.5 g pumps per 2 cycles of treatment - Treatment should continue for the full treatment course even if all actinic keratoses appear to be gone (do not extend the treatment period because of missed doses or rest periods). «b»5% Cream«/b» - Apply 2 times per week (using up to 1 packet per application), prior to normal sleeping hours, to a defined treatment area(s) on the face or scalp (but not both concurrently; treatment should be limited to areas ≤25 cm2) - Leave on for ~8 hours, then remove with mild soap and water Maximum to be Prescribed - 36 packets per 16-week treatment period - Treatment should continue for 16 weeks (do not extend the treatment period beyond 16 weeks because of missed doses or rest periods). «bu»Genital and Perianal Warts«/bu» «b»3.75% Cream«/b» - Apply a thin layer once daily (using up to 1 packet or 1 full actuation of pump) prior to bedtime - Leave on skin for ~8 hours, then remove with mild soap and water - Continue treatment until there is total clearance of the warts or for a maximum duration of therapy of 8 weeks Maximum to be Prescribed - 56 packets or 2 x 7.5 g pumps per course of treatment. «b»5% Cream«/b» - Apply a thin layer 3 times per week (on alternate days) prior to bedtime - Leave on skin for 6 to 10 hours, then remove with mild soap and water - Continue until there is total clearance of the genital/perianal warts or for a maximum duration of therapy of 16 weeks. «bu»Superficial Basal Cell Carcinoma«/bu» «b»Aldara 5% Cream«/b» - Apply once daily 5 days per week, prior to normal sleeping hours, for 6 weeks - Leave on skin for ~8 hours, then remove with mild soap and water - Apply enough cream to cover the treatment area, including 1 cm of skin surrounding the tumor - Tumor treatment area should not exceed 3 cm (maximum of 2 cm tumor diameter plus a 1 cm margin of skin around the tumor) - The diameter of cream droplet applied should range from 4 mm to 7 mm for tumor areas of 0.5 cm to 2 cm, respectively Maximum To Be Prescribed - 36 packets during the 6-week treatment period. «bu»Cutaneous Flat Warts«/bu» «b»Topical (5% Cream)«/b» - Apply once daily at bedtime until warts completely disappear up to a maximum of 12 weeks «bu»Herpes Simplex Virus (HSV) Infection«/bu» «b»Acyclovir-Resistant«/b» - Apply to lesions once daily for 5 consecutive days «b»Local Skin Reactions«/b» - Erythema, edema, skin erosion/weeping, scabbing - Temporarily interrupt treatment for up to several days for severe or intolerable reactions - May consider resuming therapy once reaction subsides. «b»Systemic/flu-like Reactions«/b» - Malaise, fever, rigors - Consider temporary interruption of therapy. «b»Vulvar Swelling«/b» - Interrupt or discontinue therapy for severe vulvar swelling.

Immune Globulin (IVIG)

Gamunex-C , GamaSTAN, Hyqvia, Gammagard, Gammaked, Bivigam, Flebogamma DIF, Gammaplex, Octagam, Privigen,Cuvitru, Hizentra, Carimune, Panzyga

Inclisiran

Leqvio

IncobotulinumtoxinA

Xeomin, Botulinum Toxin Type A

Indacaterol

Arcapta Neohaler

Indacaterol-Glycopyrrolate (INH)

Utibron Neohaler

Indapamide

Lozol

Indinavir

Crixivan, IDV

Indomethacin

Indoflex, Tivorbex, Indocin

Inebilizumab

Uplizna

Infigratinib

Truseltiq

«bu»Cholangiocarcinoma«/bu» - Each cycle is 28 days for adults with previously treated, unresectable locally advanced or metastatic cholangiocarcinoma with a fibroblast growth factor receptor 2 (FGFR2) fusion or other rearrangement - 125 mg PO daily for 21 consecutive days followed by 7 days off therapy - Continue until disease progression or unacceptable toxicity «b»Missed or Vomited Dose«/b» Missed dose ≥4 hr or vomited dose - Resume regular daily dose schedule the next day «b»Contraception«/b» «bi»Females of Reproductive Potential«/bi» - Use effective contraception during treatment and for 1 month after final dose «bi»Males with Female Partners of Reproductive Potential«/bi» - Use effective contraception during treatment and for 1 month after final dose «b»Dose Reductions for Adverse Reactions«/b» First Dose Reduction - 100 mg PO daily Second Dose Reduction - 75 mg PO daily Third Dose Reduction - 50 mg PO daily «b»Retinal Pigment Epithelial Detachment (RPED)«/b» - Continue at current dose and periodic ophthalmic evaluation - If resolving within 14 days, continue current dose - If not resolving within 14 days, withhold until resolving; then resume at previous or a lower dose «b»Hyperphosphatemia«/b» «bi»Serum Phosphate >5.5 to ≤7.5 mg/dL«/bi» - Continue at the current dose and initiate or dose adjust phosphate binder accordingly - Monitor serum phosphate weekly - Hold phosphate binder dosing during the week off in each cycle (Days 22-28) and during dose interruptions for nonhyperphosphatemia adverse events «bi»Serum Phosphate >7.5 mg/dL or Single Serum phosphate >9 mg/dL«/bi» - Regardless of duration or dose of phosphate-lowering therapy - Withhold until level returns to serum phosphate ≤5.5 mg/dL «bi»Resume as Below, with Maximal Phosphate Binder Dosing«/bi» Serum Phosphate >7.5 mg/dL Occurred for <7 days - Restart at the same dose Serum Phosphate >7.5 mg/dL for >7 days or if patient had a one-time serum phosphate of >9 mg/dL - Resume at the next lower dose level «bi»Serum Phosphate with Life-threatening Consequences«/bi» - Urgent interventions indication (dialysis) - Permanently discontinue «b»Other Adverse Reactions«/b» «bi»Grade 3«/bi» - Withhold dose until resolved to Grade ≤1, then, - Resume at the next lower dose level - If not resolved within ≤14 days, permanently discontinue «bi»Grade 4«/bi» - Permanently discontinue «b»Coadministration with Gastric acid-reducing Agents«/b» - Avoid coadministration with proton pump inhibitors (PPIs), a H2-receptor antagonist, or a locallyacting antacid «bi»If use is unavoidable«/bi» H2-antagonists - Separate administration by at least 2 hr before or 10 hr after - Locally acting antacids: Separate administration by at least 2 hr before or after «b»Dosing Considerations«/b» - Verify pregnancy status of females of reproductive potential before initiating «b»Patient Selection«/b» - Select patients based on presence of an FGFR2 fusion or rearrangement - Information on FDA-approved tests is available at: https://www.fda.gov/CompanionDiagnostics

InFLIXimab

Avakine, Avsola, Inflectra, Ixifi, Remicade, Remsima, Renflexis, Zymfentra

«bu»Ankylosing Spondylitis«/bu» «b»Initial Dose«/b» - 5 mg/kg IV at 0, 2, and 6 weeks «b»Maintenance Dose«/b» - 5 mg/kg IV every 6 weeks thereafter «bu»Crohn Disease«/bu» «b»Initial Dose«/b» - 5 mg/kg IV at 0, 2, and 6 weeks «b»Maintenance Dose«/b» - 5 mg/kg IV every 8 weeks thereafter - Dose may be increased to 10 mg/kg in patients who respond but then lose their response - If no response by week 14, consider discontinuing therapy. «bu»Plaque Psoriasis«/bu» «b»Initial Dose«/b» - 5 mg/kg IV at 0, 2, and 6 weeks «b»Maintenance Dose«/b» - 5 mg/kg IV every 8 weeks thereafter «bu»Psoriatic Arthritis«/bu» «b»Initial Dose«/b» - 5 mg/kg IV at 0, 2, and 6 weeks, with or without methotrexate «b»Maintenance Dose«/b» - 5 mg/kg IV every 8 weeks thereafter «bu»Rheumatoid Arthritis«/bu» «b»Initial Dose«/b» - 3 mg/kg IV at 0, 2, and 6 weeks, in combination with methotrexate therapy «b»Maintenance Dose«/b» - 3 mg/kg IV every 8 weeks thereafter - Remicade doses have ranged from 3 to 10 mg/kg repeated at 4- to 8-week intervals «bu»Ulcerative Colitis«/bu» «b»Initial Dose«/b» - 5 mg/kg IV at 0, 2, and 6 weeks «b»Maintenance Dose«/b» - 5 mg/kg IV every 8 weeks thereafter - Doses up to 10 mg/kg IV were studied in clinical trials with similar efficacy observed with both doses - 120 mg SC Every 2 Weeks; Start at Week 10 or thereafter «bu»Pustular Psoriasis«/bu» «b»Initial Dose«/b» - 5 mg/kg IV at week 0, 2, and 6 «b»Maintenance Dose«/b» - 5 mg/kg IV every 8 weeks for up to 46 weeks «b»Switching from IV to SC«/b» To switch patients who are responding to maintenance therapy with an IV infliximab product, administer first SC dose in place of the next scheduled IV infusion, and then every 2 Weeks thereafter «b»Congestive Heart Failure (CHF)«/b» «bi»NYHA Class I/II«/bi» - No dosage adjustment necessary - Use with caution and monitor closely for worsening of HF «bi»NYHA Class III or IV«/bi» - ≤5 mg/kg/dose (Not to exceed 5 mg/kg/dose) «bu»SC Administration (Zymfentra)«/bu» - Intended for use under guidance and supervision of a healthcare professional - If a healthcare professional determines that it is appropriate, patients may self-inject or caregivers may inject - Inject SC into front of thighs, abdomen (except for 2 inches around the navel), or the outer area of upper arms (caregiver only) - Rotate injection site at each administration - Allow at least 1.2 inches between the new injection site and the previous injection site - Do not into areas where skin is red, bruised, tender, or indurated - Do not use syringe or pen if it has been dropped or is visibly damaged (may not function properly) - Do not reuse or shake the syringe or pen at any time «bu»IV Adminstration Premedications«/bu» «b»Diphenhydramine«/b» - 1 mg/kg IV/PO x 1 dose - 90 minutes prior to infusion - Maximum Dose: 50 mg «b»Acetaminophen«/b» - 15 mg/kg (Maximum: 650mg) PO every 6 hour - 90 minutes prior to infusion - Maximum Dose: 3000 mg/day «b»Prednisone «/b» - 50 mg PO every 12 hours x 3 doses prior to infusion OR «b»Hydrocortison«/b» - 100 mg IV 20 minutes prior to the infusion OR «b»Methylprednisolone«/b» - 20 to 40 mg IV 20 minutes prior to the infusion «b»IV Administration«/b» - The infusion should begin within 3 hours of reconstitution and dilution - Infuse over at least 2 hours; do not infuse with other agents; use in-line low protein binding filter (≤1.2 micron) - Temporarily discontinue or decrease infusion rate with infusion-related reactions. - Antihistamines (H1-antagonist +/- H2-antagonist), acetaminophen and/or corticosteroids may be used to manage reactions. Infusion may be reinitiated at a lower rate upon resolution of mild to moderate symptoms. «b»Guidelines for the Treatment and Prophylaxis of Infusion Reactions«/b» - Limited to adult patients and dosages used in Crohn disease; prospective data for other populations [pediatrics, other indications/dosing] are not available). - A protocol for the treatment of infusion reactions, as well as prophylactic therapy for repeat infusions, has been published. «b»Treatment of Infusion Reactions«/b» - Medications for the treatment of hypersensitivity reactions should be available for immediate use. - For mild reactions, the rate of infusion should be decreased to 10 mL/hour. Initiate a normal saline infusion (500 to 1,000 mL/hour) and appropriate symptomatic treatment (eg, acetaminophen and diphenhydramine); monitor vital signs every 10 minutes until normal. After 20 minutes, the infusion may be increased at 15-minute intervals, as tolerated, to completion (initial increase to 20 mL/hour, then 40 mL/hour, then 80 mL/hour, etc [maximum of 125 mL/hour]) - For moderate reactions, the infusion should be stopped or slowed. Initiate a normal saline infusion (500 to 1,000 mL/hour) and appropriate symptomatic treatment - Monitor vital signs every 5 minutes until normal - After 20 minutes, the infusion may be reinstituted at 10 mL/hour; then increased at 15-minute intervals, as tolerated, to completion (initial increase 20 mL/hour, then 40 mL/hour, then 80 mL/hour, etc [maximum of 125 mL/hour]) - For severe reactions, the infusion should be stopped with administration of appropriate symptomatic treatment (hydrocortisone/methylprednisolone, diphenhydramine and epinephrine) and frequent monitoring of vitals (consult institutional policies, if available) - Re-treatment after a severe reaction should only be done if the benefits outweigh the risks and with appropriate prophylaxis - Delayed infusion reactions typically occur 1 to 7 days after an infusion - Treatment should consist of appropriate symptomatic treatment (eg, acetaminophen, antihistamine, methylprednisolone). «b»Prophylaxis of Infusion Reactions«/b» - Premedication with acetaminophen and diphenhydramine 90 minutes prior to infusion may be considered in all patients with prior infusion reactions, and in patients with severe reactions corticosteroid administration is recommended - Steroid dosing may be oral (prednisone 50 mg orally every 12 hours for 3 doses prior to infusion) or intravenous (a single dose of hydrocortisone 100 mg or methylprednisolone 20 to 40 mg administered 20 minutes prior to the infusion) - On initiation of the infusion, begin with a test dose at 10 mL/hour for 15 minutes. - Thereafter, the infusion may be increased at 15-minute intervals, as tolerated, to completion (initial increase 20 mL/hour, then 40 mL/hour, then 80 mL/hour, etc) - A maximum rate of 125 mL/hour is recommended in patients who experienced prior mild to moderate reactions and 100 mL/hour is recommended in patients who experienced prior severe reactions. - In patients with cutaneous flushing, aspirin may be considered - For delayed infusion reactions, premedicate with acetaminophen and diphenhydramine 90 minutes prior to infusion. On initiation of the infusion, begin with a test dose at 10 mL/hour for 15 minutes - Thereafter, the infusion may be increased to infuse over 3 hours - Post-infusion therapy with acetaminophen for 3 days and an antihistamine for 7 days is recommended. «b»IV Reconstitution«/b» - Reconstitute vials with 10 mL sterile water for injection (SWFI) with a 21-gauge or smaller needle, directing the SWFI towards the wall of the vial - Swirl vial gently to dissolve powder; do not shake - Allow solution to stand for 5 minutes - Total dose of reconstituted product should be further diluted to 250 mL of NS injection (add reconstituted infliximab slowly) to a final concentration of 0.4 to 4 mg/mL - Do not dilute reconstituted infliximab solution with any other diluent - Infusion should begin within 3 hours of preparation

Influenza A (H5N1) Vaccine

Audenz

Influenza Virus Quadrivalent Vaccine (Live)

FluMist Quadrivalent, H1N1 Influenza Vaccine

Influenza Virus Vaccine (Inactivated)

Afluria, Flucelvax, FluLaval, Fluvirin, Fluzone, Fluad, Fluarix

«b»Fluzone Intradermal Quadrivalent Administration«/b» - For intradermal administration, preferably into the skin over the deltoid muscle only. Gently shake gently prior to use. Hold system using the thumb and middle finger (do not place fingers on windows). Insert needle perpendicular to the skin; inject using index finger to push on plunger. Do not aspirate. «b»Afluria, Afluria Quadrivalent, Fluad, Fluarix Quadrivalent, Flucelvax Quadrivalent, FluLaval Quadrivalent, Fluvirin, Fluzone High-Dose, Fluzone Quadrivalent, Agriflu, Fluad, Fluad Pediatric, FluLaval Tetra, Fluviral Administration«/b» - For IM administration only. Suspensions should be shaken well prior to use. Inspect for particulate matter and discoloration prior to administration. Some manufacturers recommend avoiding use if visible particles or discoloration are present in the suspension after shaking. See manufacturer labeling for specific recommendations. Adults and older children should be vaccinated in the deltoid muscle. Infants and young children should be vaccinated in the anterolateral aspect of the thigh. Children ≥1 years with adequate deltoid muscle mass may be vaccinated in the deltoid. Do not inject into the gluteal region or areas where there may be a major nerve trunk. - www.pharmajet.com «b»Influvac Administration«/b» - May be administered by IM or deep subcutaneous injection. Shake well prior to use. Allow to warm to room temperature prior to use. - Unless otherwise indicated in product labeling, jet injectors should not be used to administer inactivated influenza vaccines. Currently, Afluria and Afluria Quadrivalent are the only influenza vaccines licensed in the United States with data about use with a jet-injector device. - Do not mix with other vaccines or injections; separate needles and syringes should be used for each injection. To prevent syncope related injuries, adolescents and adults should be vaccinated while seated or lying down (ACIP [Kroger 2017]). US law requires that the date of administration, the vaccine manufacturer, lot number of vaccine, and the administering person's name, title, and address be entered into the patient's permanent medical record. - If a pediatric vaccine (0.25 mL) is inadvertently administered to an adult, an additional 0.25 mL should be administered to provide the full adult dose (0.5 mL). If the error is discovered after the patient has left, an adult dose should be given as soon as the patient can return. If an adult vaccine (0.5 mL) is inadvertently given to a child, no action needs to be taken. «b»Agriflu«/b» - If 0.25 mL dose is to be given, discard half the contained syringe volume prior to administration. - For patients at risk of hemorrhage following intramuscular injection, the vaccine should be administered intramuscularly if, in the opinion of the physician familiar with the patient's bleeding risk, the vaccine can be administered by this route with reasonable safety. If the patient receives antihemophilia or other similar therapy, intramuscular vaccination can be scheduled shortly after such therapy is administered. A fine needle (23 gauge or smaller) can be used for the vaccination and firm pressure applied to the site (without rubbing) for at least 2 minutes. The patient should be instructed concerning the risk of hematoma from the injection. Patients on anticoagulant therapy should be considered to have the same bleeding risks and treated as those with clotting factor disorders

Influenza Virus Vaccine (Recombinant)

Flublok, RIV3

Ingenol Mebutate

Picato

Inotersen

Tegsedi

«bu»Hereditary Transthyretin Amyloidosis«/bu» - 284 mg SC once weekly - Administer on the same day each week «b»Missed Dose«/b» - Instruct patient to take missed dose as soon as possible, unless next scheduled dose is within 2 days - If next dose within 2 days, direct patient to skip the missed dose and take the next scheduled dose on the scheduled day «b»Platelets«/b» - Do not initiate if <100x 10^9/L - If signs or symptoms of thrombocytopenia develop, obtain platelet count as soon as possible, and hold dosing until platelet count is confirmed; recheck platelet count as soon as possible if a platelet measurement is uninterpretable «bi»Platelet count ≥100x 10^9/L«/bi» - Monitor weekly - Continue to dose weekly «bi»Platelet count ≥75 to <100 x 10^9/L«/bi» - Monitor weekly - Stop treatment - May resume if platelet count >100 «bi»Platelet count ≥50 to <75x 10^9/L«/bi» - Monitor twice weekly until 3 successive values >75, then weekly - Stop treatment - May resume after 3 successive values >100 and the benefit of inotersen outweighs thrombocytopenia risk «bi»Platelet count ≥25 to <50x 10^9/L«/bi» - Monitor twice weekly until 3 successive values >75, then weekly - Stop treatment - May resume after 3 successive values >100 and the benefit of inotersen outweighs thrombocytopenia risk - Corticosteroids recommended - Consider discontinuation of any antiplatelet agents or anticoagulants «bi»Platelet count <25x 10^9/L«/bi» - Monitor daily until 2 successive values >25, then twice weekly until 3 successive values >75, then weekly until stable - Stop treatment - Corticosteroids recommended - Consider discontinuation of any antiplatelet agents or anticoagulants «b»UPCR or eGFR«/b» - Urine protein to creatinine ratio (UPCR) ≥1000 mg/g or eGFR <45 mL/min/1.73 m²: Hold dosing pending further evaluation - Once eGFR ≥45 mL/minute/1.73 m², UPCR <1000 mg/g, or the underlying cause of the decline in renal function is corrected, may resume weekly dosing - UPCR ≥2000 mg/g: Perform further evaluation for acute glomerulonephritis, as clinically indicated - If acute glomerulonephritis confirmed, permanently discontinue

Inotuzumab

Besponsa

«bu»Acute Lymphoblastic Leukemia (ALL)«/bu» «b»Cycle 1«/b» - 0.8 mg/m2 on day 1 and 0.5 mg/m2 on days 8 and 15 of a 21-day treatment cycle (total dose/cycle 1: 1.8 mg/m2) - Treatment cycle may be extended to 4 weeks if complete remission (CR) is achieved, or CR with incomplete hematologic recovery (CRi) and/or to allow for recovery from toxicity. «b»Subsequent Cycles«/b» «bi»Patients Who Achieve CR or CRi«/bi» - 0.5 mg/m2 on days 1, 8 and 15 of a 28-day treatment cycle (total dose/cycle: 1.5 mg/m2) «bi»Patients Who Do NOT Achieve CR or CRi«/bi» - 0.8 mg/m2 on day 1 and 0.5 mg/m2 on days 8 and 15 of a 28-day treatment cycle (total dose/cycle: 1.8 mg/m2) - If CR or CRi is not achieved within 3 cycles, discontinue treatment. «b»Treatment Duration«/b» - The recommended duration of treatment is 2 cycles for patients proceeding to hematopoietic stem cell transplant (HSCT) - May consider a third cycle in patients who do not achieve CR or CRi and minimal residual disease (MRD) negativity after 2 cycles - For patients not proceeding to HSCT, may continue treatment for a maximum of up to 6 cycles. «b»Premedication«/b» - A corticosteroid, an antipyretic, and an antihistamine are recommended prior to dosing (observe for symptoms of infusion reaction during and for at least 1 hour after the end of the infusion). - Doses on days 8 and 15 may be varied by ±2 days (maintain a minimum of 6 days between doses). CR is defined as <5% blasts in bone marrow and the absence of peripheral blood leukemic blasts, full recovery of peripheral blood counts (platelets ≥100,000/mm3 and ANC ≥1,000/mm3) and resolution of any extramedullary disease. CRi is defined as <5% blasts in bone marrow and the absence of peripheral blood leukemic blasts, incomplete recovery of peripheral blood counts (platelets <100,000/mm3 and/or ANC <1,000/mm3) and resolution of any extramedullary disease. - Modify the inotuzumab ozogamicin dose for toxicities; doses within a treatment cycle (eg, day 8 and/or day 15 doses) do not need to be interrupted due to neutropenia or thrombocytopenia; however, dosing interruptions within a cycle are recommended for nonhematologic toxicities. If a dose is reduced due to toxicity, do not re-escalate the dose. «b»Infusion Reaction«/b» - Interrupt infusion and institute appropriate medical management - Depending on the severity of the reaction, consider discontinuing the infusion or administer steroids and antihistamines - For severe or life-threatening infusion reactions, discontinue permanently.

180 mg/dL and to target an upper blood glucose ≤180 mg/dL «b»Diabetic Ketoacidosis, Mild to Moderate«/b» «bi»1-hour Interval Dosing Subcutaneous Injection«/bi» - Initial Dose: 0.3 units/kg, followed by 0.1 units/kg every hour until blood glucose <250 mg/dL, then decrease to 0.05 units/kg every hour until resolution of ketoacidosis «bi»2-hour Interval Dosing Subcutaneous Injection«/bi» - Initial: 0.3 units/kg, followed by 0.2 units/kg 1 hour later and then every 2 hours thereafter until blood glucose <250 mg/dL, then decrease to 0.1 units/kg every 2 hours until resolution of ketoacidosis,«bu»Diabetes Mellitus, Type 1«/bu» «b»Children and Adolescents«/b» «bi»Initial Total Insulin Dose«/bi» - 0.2 to 0.6 units/kg/day SC in divided doses. - Conservative Initial Doses of 0.2 to 0.4 units/kg/day are often recommended to avoid the potential for hypoglycemia. «bi»Usual Maintenance Range«/bi» - 0.5 to 1 unit/kg/day SC in divided doses. - An estimate of anticipated needs may be based on body weight and/or activity factors as follows: «bi»Non-obese Dose«/bi» - 0.4 to 0.6 units/kg/day «bi»Obese Dose«/bi» - 0.8 to 1.2 units/kg/day «bi»Pubescent Children and Adolescents«/bi» - During puberty, requirements may substantially increase to >1 unit/kg/day and in some cases up to 2 units/kg/day «b»Dose Adjustment«/b» - Dosage must be titrated to achieve glucose control and avoid hypoglycemia - Adjust dose to maintain premeal and bedtime glucose in target range - Since combinations of agents are frequently used, dosage adjustment must address the individual component of the insulin regimen which most directly influences the blood glucose value in question, based on the known onset and duration of the insulin component. «b»Continuous SC Insulin Infusion (Insulin Pump)«/b» - A combination of a "basal" continuous insulin infusion rate with pre-programmed, premeal bolus doses which are patient controlled - When converting from multiple daily SC doses of maintenance insulin, it is advisable to reduce the basal rate to less than the equivalent of the total daily units of longer acting insulin (NPH); divide the total number of units by 24 to get the basal rate in units/hour - Do not include the total units of regular insulin or other rapid-acting insulin formulations in this calculation - The same prandial insulin dosage may be used empirically." class="list-group-item active pb-0 drug">

Insulin Aspart

NovoLOG, Fiasp

«bu»Diabetes Mellitus, Type 1«/bu» «b»Initial Total Insulin Dose«/b» - 0.2 to 0.6 units/kg/day in divided doses. - Conservative initial doses of 0.2 to 0.4 units/kg/day are often recommended to avoid the potential for hypoglycemia. «b»Usual Maintenance Range«/b» - 0.5 to 1 units/kg/day in divided doses - An estimate of anticipated needs may be based on body weight and/or activity factors as follows: «bi»Non-obese Dose«/bi» - 0.4 to 0.6 units/kg/day «bi»Obese«/bi» - 0.8 to 1.2 units/kg/day «b»Division of Daily Insulin Requirement (“Conventional Therapy”)«/b» - Generally, 50% to 75% of the total daily dose (TDD) is given as an intermediate- or long-acting form of insulin (in 1 to 2 daily injections) - The remaining portion of the TDD is then divided and administered before or at mealtimes (depending on the formulation) as a rapid-acting (eg, lispro, aspart, glulisine) or short-acting (regular) form of insulin - Some patients may benefit from the use of CSII which delivers rapid-acting insulin as a continuous infusion throughout the day and as boluses at mealtimes via an external pump device. «b»Division of Daily Insulin Requirement (“Intensive Therapy”)«/b» - Basal insulin delivery with 1 or 2 doses of intermediate- or long-acting insulin formulations superimposed with doses of short-acting (regular) or rapid-acting insulin (lispro, aspart, glulisine) formulations 3 or more times daily. «b»Dosage Adjustment«/b» - Dosage must be titrated to achieve glucose control and avoid hypoglycemia - Since combinations of agents are frequently used, dosage adjustment must address the individual component of the insulin regimen which most directly influences the blood glucose value in question, based on the known onset and duration of the insulin component - Treatment and monitoring regimens must be individualized. «b»Continuous SC Insulin Infusion (Insulin Pump)«/b» - A combination of a "basal" continuous insulin infusion rate with preprogrammed, premeal bolus doses which are patient controlled - When converting from multiple daily SC doses of maintenance insulin, it is advisable to reduce the basal rate to less than the equivalent of the total daily units of the longer acting insulin (eg, NPH); divide the total number of units by 24 to get the basal rate in units/hour - Do not include the total units of regular insulin or other rapid-acting insulin formulations in this calculation - The same prandial insulin dosage may be used empirically. «bu»Diabetes Mellitus, Type 2«/bu» - Initial Dose: 4 units or 0.1 unit/kg or 10% of the basal insulin dose - Insulin aspart (a rapid acting insulin) is administered before the largest meal of the day and is usually given in addition to a regimen that includes basal insulin (a long-acting insulin such as glargine, degludec, or detemir) and metformin +/- other noninsulin agents. - If HbA1c is still not controlled despite titrations to reach glycemic targets, one option is to advance to 'basal-bolus' (ie, insulin aspart administered before ≥2 meals per day) in addition to basal insulin and usually given in addition to metformin +/- other noninsulin agent «b»Dosage Adjustment«/b» - To reach self-monitoring glucose target: Adjust dose by 10% to 15% or 1 to 2 units; may adjust at weekly or twice weekly intervals - For hypoglycemia: If no clear reason for hypoglycemia, decrease dose by 2 to 4 units or by 10 to 20% «b»General Considerations for Insulin Use in Type 2 Diabetes«/b» «bi»Timing of Initiation«/bi» - Dual therapy (metformin + a second antihyperglycemic agent) and then triple therapy (metformin + two antihyperglycemic agents) is recommended in patients who fail to achieve glycemic goals after ~3 months with lifestyle intervention and metformin monotherapy or dual therapy, respectively (unless contraindications to metformin exist). Preference is not given for which agent(s) should be added to metformin (drug choice should be individualized based on patient characteristics). If HbA1c target not achieved after ~3 months of triple therapy, consider initiating basal insulin (usually with metformin +/- other noninsulin agent) or if patient already receiving an optimally titrated basal insulin (ie, a long-acting insulin such as glargine, degludec, or detemir) as part of their regimen, consider combination injectable therapy. «bi»Combination Injectable Therapy«/bi» - If HbA1c target has not been met with basal insulin (ie, long-acting insulin such as glargine, degludec or detemir) (usually combined with metformin +/- other noninsulin agent), despite titrating basal insulin to provide acceptable fasting blood glucose concentrations, combination injectable therapy should be considered. Options include: adding a rapid-acting insulin (lispro, aspart, glulisine) prior to largest meal or adding a GLP-1 receptor agonist or changing from basal insulin to a twice daily premixed insulin. If HbA1c still not adequately controlled, consider advancing from one rapid-acting insulin prior to largest meal to ‘basal-bolus’ regimen (ie, rapid-acting insulin administered before ≥2 meals) or consider advancing from a twice daily premixed insulin to a 3 times daily premixed insulin. «bi»Patients with Elevated HbA1C at Therapy Initiation«/bi» - If HbA1c is ≥9% at initiation of therapy, dual therapy (metformin + a second antihyperglycemic agent) should be considered - If HbA1c ≥10%, blood glucose is ≥300 mg/dL or if patient is symptomatic (polyuria, polydipsia), insulin therapy (with or without additional agents) should be considered «b»Hyperglycemia, Critically Ill«/b» «bi»IV Continuous Infusion«/bi» - Insulin therapy should be implemented when blood glucose ≥150 mg/dL with a goal to maintain blood glucose <150 mg/dL (with values absolutely <180 mg/dL) using a protocol that achieves a low rate of hypoglycemia (ie, ≤70 mg/dL). Before discontinuation, stable ICU patients should be transitioned to a protocol-driven basal/bolus insulin regimen, based on insulin infusion history and carbohydrate intake, to avoid loss of glycemic control. Subcutaneous insulin therapy may be considered for selected clinically stable ICU patients. - The Surviving Sepsis Campaign guidelines recommend initiating insulin dosing in patients with severe sepsis when 2 consecutive blood glucose concentrations are >180 mg/dL and to target an upper blood glucose ≤180 mg/dL «b»Diabetic Ketoacidosis, Mild to Moderate«/b» «bi»1-hour Interval Dosing Subcutaneous Injection«/bi» - Initial Dose: 0.3 units/kg, followed by 0.1 units/kg every hour until blood glucose <250 mg/dL, then decrease to 0.05 units/kg every hour until resolution of ketoacidosis «bi»2-hour Interval Dosing Subcutaneous Injection«/bi» - Initial: 0.3 units/kg, followed by 0.2 units/kg 1 hour later and then every 2 hours thereafter until blood glucose <250 mg/dL, then decrease to 0.1 units/kg every 2 hours until resolution of ketoacidosis «b»SC Administration«/b» - Do not use if solution is viscous or cloudy; use only if clear and colorless - Cold injections should be avoided - SC administration is usually made into the thighs, arms, or abdomen; Novolog may also be administered in the buttocks - Rotate injection sites within the same region to avoid lipodystrophy. «bi»Fiasp«/bi» - Inject at the beginning of or within 20 minutes after starting a meal - Do not mix with any other insulin products or solutions. «bi»Novolog«/bi» - Administer immediately (within 5 to 10 minutes) before a meal - Novolog from a vial may be mixed with insulin NPH only (do not mix with other types of insulin) but should be drawn into syringe first - Do not dilute or mix other insulin formulations with Novolog contained in a cartridge or prefilled pen. «b»CSII Administration (Novolog)«/b» - Do not use if solution is viscous or cloudy; use only if clear and colorless - Patients should be trained in the proper use of their external insulin pump and in intensive insulin therapy - Infusion sets and infusion set insertion sites should be changed at least every 3 days; rotate infusion sites - Insulin in reservoir should be changed at least every 6 days - Do not dilute or mix other insulin formulations with insulin aspart that is to be used in an external insulin pump. «b»IV Administration«/b» - Do not use if solution is viscous or cloudy; use only if clear and colorless - May be administered IV with close monitoring of blood glucose and serum potassium; appropriate medical supervision is required - Do not administer insulin mixtures intravenously. «b»IV Infusions«/b» - To minimize insulin adsorption to plastic IV tubing: Although data is lacking regarding adsorption with insulin aspart, insulin regular loss has been shown to occur by adsorption to plastic (PVC, polyethylene, polyolefin, polypropylene) IV containers and tubing - Therefore, flush the IV tubing with a priming infusion of 20 mL from the insulin infusion, whenever a new IV tubing set is added to the insulin infusion container - Because of insulin adsorption to plastic IV tubing or infusion bags, the actual amount of insulin being administered via IV infusion could be substantially less than the apparent amount - Therefore, adjustment of the IV infusion rate should be based on effect and not solely on the apparent insulin dose - The apparent dose may be used as a starting point for determining the subsequent SC dosing regimen; however, the transition to SC administration requires continuous medical supervision, frequent monitoring of blood glucose, and careful adjustment of therapy - In addition, SC insulin should be given 1 to 4 hours prior to the discontinuation of IV insulin to prevent hyperglycemia «b»SC Administration«/b» «bi»Fiasp«/bi» - Do not dilute or mix with any other insulin products or solutions. «bi»NovoLog«/bi» - Vials may be diluted with Insulin Diluting Medium for NovoLog to a concentration of 10 units/mL (U-10) or 50 units/mL (U-50). Do not dilute insulin contained in a cartridge, prefilled pen, or if using in an external insulin pump. «b»IV Infusion Preparation«/b» - May be diluted in compatible fluid (eg, NS) to concentrations of 0.05 to 1 unit/mL

Insulin Aspart Protamine and Insulin Aspart

NovoLOG Mix 70/30

Insulin Degludec

Tresiba

Insulin Degludec-Liraglutide

Xultophy

Insulin Detemir

Levemir

Insulin Glargine

Basaglar KwikPen, Lantus, Semglee, Toujeo SoloStar

«bu»Diabetes Mellitus, Type 1«/bu» - Long-acting basal insulin indicated to improve glycemic control in adults with type 1 diabetes mellitus «b»Initial Dose«/b» «bi»Insulin-naïve«/bi» - Start ~1/3 of total daily insulin dose - Use remaining 2/3 of daily insulin dose on short-acting, premeal insulin «b»Usual Initial Dose Range«/b» - 0.2-0.4 units/kg - Optimal glucose lowering effect may take 5 days to fully manifest and the first insulin glargine dose may be insufficient to cover metabolic needs in the first 24 hour of use - Titrate insulin glargine per instructions, and adjust coadministered glucose-lowering therapies per standard of care «bu»Diabetes Mellitus, Type 2«/bu» - Long-acting basal insulin indicated to improve glycemic control in adults with type 2 diabetes mellitus «b»Initial Dose«/b» «bi»Insulin-naïve«/bi» - Start 0.2 units/kg SC daily - If necessary, adjust dosage of other antidiabetic drugs when starting insulin glargine to minimize the risk of hypoglycemia «b»Converting from Other Insulins«/b» - If changing from a treatment regimen with an intermediate- or long-acting insulin to a regimen with insulin glargine, the amount and timing of shorter-acting insulins and doses of any oral antidiabetic drugs may need to be adjusted - For patients controlled on Lantus expect that a higher daily dose of Toujeo will be needed to maintain the same level of glycemic control «bi»NPH Insulin Once-daily to Glargine Once-daily«/bi» - Initial dose is the same as the dose of NPH that is being discontinued «bi»NPH Insulin bid to Glargine Once-daily«/bi» - Initial dose is 80% of the total daily NPH dose that is being discontinued - This dose reduction will lower the likelihood of hypoglycemia «b»Converting from Intermediate-to-long Acting Insulins to Toujeo«/b» - To minimize the risk of hypoglycemia when changing patients from a once daily long-acting or intermediate-acting insulin product to Toujeo, the starting dose of Toujeo can be the same as the once daily long-acting dose - For patients controlled on Lantus (insulin glargine, 100 units/mL) expect that a higher daily dose of Toujeo will be needed to maintain the same level of glycemic control «b»Converting from Intermediate-to-long-acting Insulins to Lantus«/b» - If changing from a treatment regimen with an intermediate- or long-acting insulin to Lantus or Basaglar, a change in the dose of the basal insulin may be required and the amount and timing of the shorter-acting insulins and doses of any oral antidiabetic drugs may be needed to be adjusted - If changing patients from once daily Toujeo (300 units/mL) to once daily Lantus or Basaglar (100 units/mL), the recommended initial Lantus or Basaglar dose is 80% of the Toujeo dose that is being discontinued; this dose reduction will lower the likelihood of hypoglycemia «b»Limitation of Use«/b» - Not recommended for treating diabetic ketoacidosis «bu»Diabetes Mellitus, Type 1«/bu» «b»Children ≥6 years and Adolescents«/b» «bi»Initial Dose«/bi» - Approximately one-third of the total daily insulin requirement; a rapid-acting or short-acting insulin should also be used. «b»Children <6 years«/b» - 40% of the established total daily insulin requirement; this resulted in a reduction in hypoglycemic episodes in 35 nonobese preschool-aged children (age range: 2.6-6.3 years) when used in conjunction with a rapid-acting insulin prior to meals «b»Children ≥6 years«/b» «bi»Converting from Once-daily NPH Insulin«/bi» - May be substituted on an equivalent unit-per-unit basis «bi»Converting from Twice-daily NPH Insulin«/bi» - Initial dose: Use 80% of the total daily dose of NPH (20% reduction); administer once daily - Adjust dosage according to patient response «b»Children and Adolescents«/b» - Multiple daily doses are utilized and guided by blood glucose monitoring - Combinations of insulin formulations are commonly used. - The daily doses presented below are expressed as the total units/kg/day of all insulin formulations used. - Insulin glargine must be used in combination with a short-acting insulin. «b»Usual Maintenance Range«/b» - 0.5-1 unit/kg/day SC in divided doses - An estimate of anticipated needs may be based on body weight and/or activity factors as follows «bi»Nonobese«/bi» - 0.4 to 0.6 units/kg/day «bi»Obese«/bi» - 0.8 to 1.2 units/kg/day «bi»Pubescent Children and Adolescents«/bi» - During puberty, requirements may substantially increase to >1 unit/kg/day and in some cases up to 2 units/kg/day «b»Dosage Adjustment«/b» - Dosage must be titrated to achieve glucose control and avoid hypoglycemia - Adjust dose to maintain premeal and bedtime glucose in target range - Since combinations of agents are frequently used, dosage adjustment must address the individual component of the insulin regimen which most directly influences the blood glucose value in question, based on the known onset and duration of the insulin component.

Insulin Glargine-Lixisenatide

Soliqua

1 unit/kg/day and in some cases up to 2 units/kg/day «b»Dose Adjustment«/b» - Dosage must be titrated to achieve glucose control and avoid hypoglycemia. Adjust dose to maintain pre-meal and bedtime glucose in target range - Since combinations of agents are frequently used, dosage adjustment must address the individual component of the insulin regimen which most directly influences the blood glucose value in question, based on the known onset and duration of the insulin component. «b»Continuous SC Insulin Infusion (Insulin Pump)«/b» - A combination of a "basal" continuous insulin infusion rate with pre-programmed pre-meal bolus doses which are patient controlled - When converting from multiple daily SC doses of maintenance insulin, it is advisable to reduce the basal rate to less than the equivalent of the total daily units of longer-acting insulin (NPH); divide the total number of units by 24 to get the basal rate in units/hour - Do not include the total units of regular insulin or other rapid-acting insulin formulations in this calculation - The same pre-meal regular insulin dosage may be used." class="list-group-item active pb-0 drug">

Insulin Glulisine

Apidra

«bu»Diabetes Mellitus, Type 1«/bu» «b»Initial Total Insulin Dose«/b» - 0.2 to 0.6 units/kg/day in divided doses - Conservative initial doses of 0.2 to 0.4 units/kg/day are often recommended to avoid the potential for hypoglycemia - A rapid-acting insulin may be the only insulin formulation used initially. «b»Usual Maintenance Range«/b» - 0.5 to 1 units/kg/day in divided doses - An estimate of anticipated needs may be based on body weight and/or activity factors as follows: «bi»Non-obese«/bi» - 0.4 to 0.6 units/kg/day «bi»Obese«/bi» - 0.8 to 1.2 units/kg/day «b»Division of Daily Insulin Requirement ("Conventional Therapy")«/b» - Generally, 50% to 75% of the total daily dose (TDD) is given as an intermediate- or long-acting form of insulin (in 1 to 2 daily injections) - The remaining portion of the TDD is then divided and administered before or at mealtimes (depending on the formulation) as a rapid-acting insulin (lispro, aspart, glulisine) or short-acting (regular) form of insulin. - Some patients may benefit from the use of CSII which delivers rapid-acting insulin as a continuous infusion throughout the day and as boluses at mealtimes via an external pump device. «b»Division of Daily Insulin Requirement ("Intensive Therapy")«/b» - Basal insulin delivery with 1 or 2 doses of intermediate- or long-acting insulin formulations superimposed with doses of short-acting (regular) or rapid-acting insulin (lispro, aspart, glulisine) formulations 3 or more times daily. «b»Dose Adjustment«/b» - Dosage must be titrated to achieve glucose control and avoid hypoglycemia - Since combinations of agents are frequently used, dosage adjustment must address the individual component of the insulin regimen which most directly influences the blood glucose value in question, based on the known onset and duration of the insulin component. Treatment and monitoring regimens must be individualized. «b»Continuous SC Insulin Infusion (Insulin Pump)«/b» - A combination of a "basal" continuous insulin infusion rate with preprogrammed, premeal bolus doses which are patient controlled. - When converting from multiple daily SC doses of maintenance insulin, it is advisable to reduce the basal rate to less than the equivalent of the total daily units of the longer-acting insulin (NPH); divide the total number of units by 24 to get the basal rate in units/hour - Do not include the total units of regular insulin or other rapid-acting insulin formulations in this calculation - The same premeal regular insulin dosage may be used. «bu»Diabetes Mellitus, Type 2«/bu» «b»Initial Dose«/b» - 4 units or 0.1 unit/kg or 10% of the basal insulin dose - Insulin glulisine (a rapid acting insulin) is administered before the largest meal of the day and is usually given in addition to a regimen that includes basal insulin (a long-acting insulin such as glargine, degludec, or detemir) and metformin +/- other noninsulin agents - If HbA1c is still not controlled despite titrations to reach glycemic targets, one option is to advance to ‘basal-bolus’ (insulin glulisine administered before ≥2 meals per day) in addition to basal insulin and usually given in addition to metformin +/- other noninsulin agent «b»Dosage Adjustment«/b» - To reach self-monitoring glucose target: Adjust dose by 10% to 15% or 1 to 2 units - May adjust at weekly or twice weekly intervals - For hypoglycemia: If no clear reason for hypoglycemia, decrease dose by 2 to 4 units or by 10% to 20% «b»General Considerations for Insulin Use in Type 2 Diabetes«/b» «bi»Timing of Initiation«/bi» - Dual therapy (metformin + a second antihyperglycemic agent) and then triple therapy (metformin + two antihyperglycemic agents) is recommended in patients who fail to achieve glycemic goals after ~3 months with lifestyle intervention and metformin monotherapy or dual therapy, respectively (unless contraindications to metformin exist). Preference is not given for which agent(s) should be added to metformin (drug choice should be individualized based on patient characteristics). If HbA1c target not achieved after ~3 months of triple therapy, consider initiating basal insulin (usually with metformin +/- other noninsulin agent) or if patient already receiving an optimally titrated basal insulin (a long-acting insulin such as glargine, degludec, or detemir) as part of their regimen, consider combination injectable therapy «b»Combination Injectable Therapy«/b» - If HbA1c target has not been met with basal insulin (long-acting insulin such as glargine, degludec or detemir) (usually combined with metformin +/- other noninsulin agent), despite titrating basal insulin to provide acceptable fasting blood glucose concentrations, combination injectable therapy should be considered. Options include: adding a rapid-acting insulin (lispro, aspart, glulisine) prior to largest meal or adding a GLP-1 receptor agonist or changing from basal insulin to a twice daily premixed insulin. If HbA1c still not adequately controlled, consider advancing from one rapid-acting insulin prior to largest meal to ‘basal-bolus’ regimen (rapid-acting insulin administered before ≥2 meals) or consider advancing from a twice daily premixed insulin to a three times daily premixed insulin «b»Patients with Elevated HbA1C at Therapy Initiation«/b» - If HbA1c is ≥9% at initiation of therapy, dual therapy (metformin + a second antihyperglycemic agent) should be considered. If HbA1c ≥10%, blood glucose is ≥300 mg/dL or if patient is symptomatic (polyuria, polydipsia), insulin therapy (with or without additional agents) should be considered «bu»Hyperglycemia Critically Ill«/bu» «b»IV Continuous Infusion«/b» - Insulin therapy should be implemented when blood glucose ≥150 mg/dL with a goal to maintain blood glucose <150 mg/dL (with values absolutely <180 mg/dL) using a protocol that achieves a low rate of hypoglycemia (≤70 mg/dL) - Before discontinuation, stable ICU patients should be transitioned to a protocol-driven basal/bolus insulin regimen, based on insulin infusion history and carbohydrate intake, to avoid loss of glycemic control «bu»Diabetic Ketoacidosis«/bu» - 0.1 unit/kg IV bolus - Followed by a continuous infusion of 0.1 unit/kg/hour until blood glucose <250 mg/dL, then, - Decrease to 0.05 unit/kg/hour until resolution of ketoacidosis - Discontinue IV infusion 2 hours after administration of subcutaneous insulin - Insulin glulisine is a rapid-acting insulin analog which is normally administered SC as a premeal component of the insulin regimen or as a continuous SC infusion and should be used with an intermediate- or long-acting insulin - When compared to insulin regular, insulin glulisine has a more rapid onset and shorter duration of activity. - In carefully controlled clinical settings with close medical supervision and monitoring of blood glucose and potassium, insulin glulisine may be administered IV. - Insulin requirements vary dramatically between patients and dictate frequent monitoring and close medical supervision. «b»SC Administration«/b» - Do not use if solution is viscous or cloudy; use only if clear and colorless - Insulin glulisine should be administered within 15 minutes before or within 20 minutes after starting a meal - Cold injections should be avoided - SC administration is usually made into the thighs, arms, buttocks, or abdomen; rotate injection sites within the same region to avoid lipodystrophy - Insulin glulisine from a vial may be mixed with insulin NPH only (do not mix with other types of insulin); insulin glulisine should be drawn into syringe first - Do not mix other insulin formulations with insulin glulisine contained in a cartridge or prefilled pen. «b»CSII Administration«/b» - Do not use if solution is viscous or cloudy; use only if clear and colorless. - Patients should be trained in the proper use of their external insulin pump and in intensive insulin therapy - Infusion sets, reservoirs, infusion set insertion sites, and the insulin in the reservoir should be changed every 48 hours; rotate infusion sites - Do not dilute or mix other insulin formulations with insulin glulisine that is to be used in an external insulin pump. «b»IV Administration«/b» - Do not use if solution is viscous or cloudy; use only if clear and colorless - May be administered IV with close monitoring of blood glucose and serum potassium; appropriate medical supervision is required - Do not administer insulin mixtures intravenously. «b»IV Infusions«/b» - To minimize insulin adsorption to plastic IV tubing: Although data is lacking regarding adsorption with insulin glulisine, insulin regular loss has been shown to occur by adsorption to plastic (PVC, polyethylene, polyolefin, polypropylene) IV containers and tubing. Therefore, flush the IV tubing with a priming infusion of 20 mL from the insulin infusion, whenever a new IV tubing set is added to the insulin infusion container. - Because of insulin adsorption to plastic IV tubing or infusion bags, the actual amount of insulin being administered via IV infusion could be substantially less than the apparent amount. Therefore, adjustment of the IV infusion rate should be based on effect and not solely on the apparent insulin dose. The apparent dose may be used as a starting point for determining the subsequent SC dosing regimen; however, the transition to SC administration requires continuous medical supervision, frequent monitoring of blood glucose, and careful adjustment of therapy. In addition, SC insulin should be given 1 to 4 hours prior to the discontinuation of IV insulin to prevent hyperglycemia «b»IV Preparation«/b» - May be diluted in NS to concentrations of 0.05-1 unit/mL

1 unit/kg/day and in some cases up to 2 units/kg/day «b»Dosage Adjustment«/b» - Dosage must be titrated to achieve glucose control and avoid hypoglycemia - Since combinations of agents are frequently used, dosage adjustment must address the individual component of the insulin regimen that most directly influences the blood glucose value in question, based on the known onset and duration of the insulin component. «b»Continuous SC Insulin Infusion (Insulin pump)«/b» - A combination of a "basal" continuous insulin infusion rate with preprogrammed, premeal bolus doses which are patient controlled - When converting from multiple daily SC doses of maintenance insulin, it is advisable to reduce the basal rate to less than the equivalent of the total daily units of longer-acting insulin (NPH); divide the total number of units by 24 to get the basal rate in units/hour. - Do not include the total units of regular insulin or other rapid-acting insulin formulations in this calculation - The same prandial insulin dosage may be used empirically." class="list-group-item active pb-0 drug">

Insulin Lispro

Admelog, Admelog Solostar, HumaLOG, HumaLOG Kwikpen, HumaLOG Junior KwikPen, Lyumjev

«bu»Diabetes Mellitus, Type 1«/bu» - Multiple daily doses or continuous subcutaneous infusions guided by blood glucose monitoring are the standard of diabetes care. Combinations of insulin formulations are commonly used. The daily doses presented below are expressed as the total units/kg/day of all insulin formulations combined. «b»Initial Total Insulin Dose«/b» - 0.2 to 0.6 units/kg/day in divided doses - Conservative initial doses of 0.2 to 0.4 units/kg/day are often recommended to avoid the potential for hypoglycemia. «b»Usual Maintenance Range«/b» - 0.5 to 1 units/kg/day in divided doses - An estimate of anticipated needs may be based on body weight and/or activity factors as follows: «bi»Nonobese«/bi» - 0.4 to 0.6 units/kg/day «bi»Obese«/bi» - 0.8 to 1.2 units/kg/day «b»Division of Daily Insulin Requirement (“Conventional Therapy”)«/b» - Generally, 50% to 75% of the total daily dose (TDD) is given as an intermediate- or long-acting form of insulin (in 1 to 2 daily injections) - The remaining portion of the TDD is then divided and administered before or at mealtimes (depending on the formulation) as a rapid-acting (eg, lispro, aspart, glulisine) or short-acting (regular) form of insulin - Some patients may benefit from the use of CSII which delivers rapid-acting insulin as a continuous infusion throughout the day and as boluses at mealtimes via an external pump device. «b»Division of Daily Insulin Requirement (“Intensive Therapy”)«/b» - Basal insulin delivery with 1 or 2 doses of intermediate- or long-acting insulin formulations superimposed with doses of short-acting (regular) or rapid-acting insulin (lispro, aspart, glulisine) formulations 3 or more times daily. «b»Dosage Adjustment«/b» - Dosage must be titrated to achieve glucose control and avoid hypoglycemia - Since combinations of agents are frequently used, dosage adjustment must address the individual component of the insulin regimen which most directly influences the blood glucose value in question, based on the known onset and duration of the insulin component - Treatment and monitoring regimens must be individualized. «b»Continuous SC Insulin Infusion (Insulin Pump)«/b» - A combination of a "basal" continuous insulin infusion rate with preprogrammed, premeal bolus doses which are patient controlled - When converting from multiple daily SC doses of maintenance insulin, it is advisable to reduce the basal rate to less than the equivalent of the total daily units of the longer acting insulin (NPH); divide the total number of units by 24 to get the basal rate in units/hour - Do not include the total units of regular insulin or other rapid-acting insulin formulations in this calculation. The same prandial insulin dosage may be used empirically. «bu»Diabetes Mellitus, Type 2«/bu» «b»Initial Dose«/b» - 4 units or 0.1 unit/kg or 10% of the basal insulin dose; insulin lispro (a rapid acting insulin) is administered before the largest meal of the day and is usually given in addition to a regimen that includes basal insulin (a long-acting insulin such as glargine, degludec, or detemir) and metformin +/- other noninsulin agents. If HbA1c is still not controlled despite titrations to reach glycemic targets, one option is to advance to ‘basal-bolus’ (insulin lispro administered before ≥2 meals per day) in addition to basal insulin and usually given in addition to metformin +/- other noninsulin agent «b»Dosage Adjustment«/b» - To reach self-monitoring glucose target: Adjust dose by 10% to 15% or 1 to 2 units; may adjust at weekly or twice weekly intervals «bi»Hypoglycemia«/bi» - If no clear reason for hypoglycemia, decrease dose by 2 to 4 units or by 10% to 20% «bi»Surgical Patients«/bi» - On the morning of surgery or procedure, give 60% to 80% of the usual dose of long-acting analogs (eg, detemir, glargine, or degludec) or pump “basal” insulin (rapid-or short-acting insulins) «b»General Considerations for Insulin Use in Type 2 Diabetes«/b» «bi»Timing of Initiation«/bi» - Dual therapy (metformin + a second antihyperglycemic agent) and then triple therapy (metformin + two antihyperglycemic agents) is recommended in patients who fail to achieve glycemic goals after ~3 months with lifestyle intervention and metformin monotherapy or dual therapy, respectively (unless contraindications to metformin exist) - Preference is not given for which agent(s) should be added to metformin (drug choice should be individualized based on patient characteristics) - If HbA1c target not achieved after ~3 months of triple therapy, consider initiating basal insulin (usually with metformin +/- other noninsulin agent) or if patient already receiving an optimally titrated basal insulin (ie, a long-acting insulin such as glargine, degludec, or detemir) as part of their regimen, consider combination injectable therapy «bi»Combination Injectable Therapy«/bi» - If HbA1c target has not been met with basal insulin (long-acting insulin such as glargine, degludec or detemir) (usually combined with metformin +/- other noninsulin agent), despite titrating basal insulin to provide acceptable fasting blood glucose concentrations, combination injectable therapy should be considered. Options include: adding a rapid-acting insulin (eg, lispro, aspart, glulisine) prior to largest meal or adding a GLP-1 receptor agonist or changing from basal insulin to a twice daily premixed insulin. If HbA1c still not adequately controlled, consider advancing from one rapid-acting insulin prior to largest meal to ‘basal-bolus’ regimen (rapid-acting insulin administered before ≥2 meals) or consider advancing from a twice daily premixed insulin to a three times daily premixed insulin - Patients with elevated HbA1C at therapy initiation: If HbA1c is ≥9% at initiation of therapy, dual therapy (metformin + a second antihyperglycemic agent) should be considered. If HbA1c ≥10%, blood glucose is ≥300 mg/dL or if patient is symptomatic (polyuria, polydipsia), insulin therapy (with or without additional agents) should be considered. «b»Diabetic Ketoacidosis, Mild-to-Moderate«/b» - Initial Dose: 0.3 units/kg SC x 1 dose - Followed by 0.1 units/kg every hour until blood glucose <250 mg/dL, then, decrease to 0.05 units/kg/hour until resolution of ketoacidosis «bu»Diabetes Mellitus, Type 1«/bu» «b»Children and Adolescents«/b» - Multiple daily doses or continuous subcutaneous infusions guided by blood glucose monitoring are the standard of diabetes care - Combinations of insulin formulations are commonly used - The daily doses presented below are expressed as the total units/kg/day of all insulin formulations combined. «bi»Initial Dose«/bi» - 0.2 to 0.6 units/kg/day SC in divided doses. - Conservative initial doses of 0.2 to 0.4 units/kg/day are often recommended to avoid the potential for hypoglycemia. «bi»Usual Maintenance Range«/bi» - 0.5 to 1 unit/kg/day SC in divided doses - An estimate of anticipated needs may be based on body weight and/or activity factors as follows: «bi»Nonobese«/bi» - 0.4 to 0.6 units/kg/day «bi»Obese«/bi» - 0.8 to 1.2 units/kg/day «bi»Pubescent Children and Adolescents«/bi» - During puberty, requirements may substantially increase to >1 unit/kg/day and in some cases up to 2 units/kg/day «b»Dosage Adjustment«/b» - Dosage must be titrated to achieve glucose control and avoid hypoglycemia - Since combinations of agents are frequently used, dosage adjustment must address the individual component of the insulin regimen that most directly influences the blood glucose value in question, based on the known onset and duration of the insulin component. «b»Continuous SC Insulin Infusion (Insulin pump)«/b» - A combination of a "basal" continuous insulin infusion rate with preprogrammed, premeal bolus doses which are patient controlled - When converting from multiple daily SC doses of maintenance insulin, it is advisable to reduce the basal rate to less than the equivalent of the total daily units of longer-acting insulin (NPH); divide the total number of units by 24 to get the basal rate in units/hour. - Do not include the total units of regular insulin or other rapid-acting insulin formulations in this calculation - The same prandial insulin dosage may be used empirically. - Use only if solution is clear and colorless; do not use if solution is viscous, cloudy, colored, or if it has lumps or particles in it. «b»SC Administration«/b» - Insulin lispro should be administered within 15 minutes before or immediately after a meal. Cold injections should be avoided - SC administration is usually made into the thighs, arms, buttocks, or abdomen; rotate injection sites within the same region to avoid lipodystrophy. «bi»Humalog«/bi» - Do not dilute or mix other insulins with insulin lispro contained in a cartridge or prefilled pen - Do not mix insulin lispro U 200 with any other insulin. May mix insulin lispro U 100 (100 units/mL) from a vial only with insulin NPH (do not mix with other types of insulin); insulin lispro should be drawn into syringe first; perform injection immediately - Kwikpens are designed to dial doses in 1-unit increments (U-100 or U-200 pens) or in 0.5-unit increment - Do not perform dose conversion when using Humalog KwikPen devices; the dose window shows the number of units to be delivered and no conversion is needed - Do not transfer insulin lispro U 200 KwikPen to a syringe for administration. «bi»Admelog«/bi» - Do not mix with any other insulin. «b»CSII Administration«/b» - Only administer insulin lispro U 100 (eg, 100 units/mL) via CSII; do not administer insulin lispro U 200 (200 units/mL) in a CSII pump - Patients should be trained in the proper use of their external insulin pump and in intensive insulin therapy - Infusion sets and infusion set insertion sites should be changed every 3 days; rotate infusion sites - Insulin in reservoir should be changed at least every 7 days - Do not dilute or mix other insulins with insulin lispro U 100 (100 units/mL) contained in an external insulin pump. «b»IV Administration«/b» - May be administered IV with close monitoring of blood glucose and serum potassium; appropriate medical supervision is required - Do not administer insulin lispro U 200 (200 units/mL) IV - Do not administer insulin mixtures IV. «b»IV Infusions«/b» «bi»To Minimize Adsorption to IV Tubing«/bi» - At low concentrations and flow rates, insulin lispro has been shown to adsorb to PVC IV bags and tubing - Therefore, flush the IV tubing with a priming infusion of 20 mL from the insulin infusion, whenever a new IV tubing set is added to the insulin infusion container - Because of insulin adsorption to IV tubing or infusion bags, the actual amount of insulin being administered via IV infusion could be substantially less than the apparent amount - Therefore, adjustment of the IV infusion rate should be based on effect and not solely on the apparent insulin dose. The apparent dose may be used as a starting point for determining the subsequent SC dosing regimen; however, the transition to SC administration requires continuous medical supervision, frequent monitoring of blood glucose, and careful adjustment of therapy. Transition to a protocol-driven basal/bolus insulin regimen should begin prior to stopping the IV infusion in order to avoid significant loss of glucose control «b»SC Administration«/b» - Do not dilute insulin contained in a cartridge, prefilled pen, or external insulin pump. «bi»Humalog Vials«/bi» - May be diluted with the universal diluent, Sterile Diluent for Humalog U 100, Humulin N, Humulin R, Humulin 70/30, and Humulin R U-500, to a concentration of 10 units/mL (U-10) or 50 units/mL (U-50). «bi»Admelog Vials«/bi» - May be diluted with sterile normal saline in equal parts to yield a concentration of 50 units/mL (U-50). «b»IV Infusion Reconstitution«/b» - Insulin lispro U 100 may be diluted in NS to concentrations of 0.1 to 1 units/mL. - Humalog U 200 may not be administered intravenously.

1 unit/kg/day and in some cases up to 2 units/kg/day «b»Dosage Adjustment«/b» - Dosage must be titrated to achieve glucose control and avoid hypoglycemia - Adjust dose to maintain premeal and bedtime glucose in target range - Since combinations of agents are frequently used, dosage adjustment must address the individual component of the insulin regimen which most directly influences the blood glucose value in question, based on the known onset and duration of the insulin component." class="list-group-item active pb-0 drug">

Insulin Lispro Protamine and Insulin Lispro

HumaLOG Mix 50/50, HumaLOG Mix 75/25,

«bu»Diabetes Mellitus, Type 1«/bu» «b»Usual Maintenance Range«/b» - 0.5 to 1 units/kg/day in divided doses - An estimate of anticipated needs may be based on body weight and/or activity factors as follows: «bi»Non-obese«/bi» - 0.4 to 0.6 units/kg/day «bi»Obese«/bi» - 0.8 to 1.2 units/kg/day «b»Division of Daily Insulin Requirement ("Conventional Therapy")«/b» - Generally, 50% to 75% of the total daily dose (TDD) is given as an intermediate-acting (eg, NPH) or a long-acting form of insulin (in 1 to 2 daily injections) - The remaining portion of the TDD is then divided and administered before or at mealtimes (depending on the formulation) as a rapid-acting (lispro, aspart, glulisine) or short-acting (regular) form of insulin. «b»Division of Daily Insulin Requirement (“Intensive Therapy”)«/b» - Basal insulin delivery with 1 or 2 doses of intermediate- or long-acting insulin formulations superimposed with doses of short-acting (regular) insulin or rapid-acting insulin (lispro, aspart, glulisine) formulations 3 or more times daily. «b»Dosage Adjustment«/b» - Dosage must be titrated to achieve glucose control and avoid hypoglycemia - Since combinations of agents are frequently used, dosage adjustment must address the individual component of the insulin regimen which most directly influences the blood glucose value in question, based on the known onset and duration of the insulin component - Treatment and monitoring regimens must be individualized «bu»Diabetes Mellitus, Type 2«/bu» - Insulin lispro protamine and insulin lispro combination product is not intended for initial therapy; basal insulin requirements should be established first to direct dosing of combination insulin products. Dosage must be carefully adjusted. «b»Initial Dose«/b» - Insulin lispro protamine and insulin lispro premix dose is obtained by dividing the current total daily basal insulin dose into 2 doses administered either as two-thirds of the dose before the morning meal and one-third of the dose before the evening meal or as one-half of the dose before the morning and evening meals «b»Dosage Adjustment«/b» - To reach self-monitoring glucose target: Adjust dose by 10% to 15% or 1 to 2 units; may adjust at weekly or twice weekly intervals - If HbA1c not controlled: May add a third mealtime dose (before lunch) for a total of 3 daily mealtime injections - For hypoglycemia: If no clear reason for hypoglycemia, decrease dose by 2 to 4 units or by 10% to 20% «b»General Considerations for Insulin Use in Type 2 Diabetes«/b» «bi»Timing of Initiation«/bi» - Dual therapy (metformin + a second antihyperglycemic agent) and then triple therapy (metformin + two antihyperglycemic agents) is recommended in patients who fail to achieve glycemic goals after ~3 months with lifestyle intervention and metformin monotherapy or dual therapy, respectively (unless contraindications to metformin exist) - Preference is not given for which agent(s) should be added to metformin (drug choice should be individualized based on patient characteristics) - If HbA1c target not achieved after ~3 months of triple therapy, consider initiating basal insulin (usually with metformin +/- other noninsulin agent) or if patient already receiving an optimally titrated basal insulin (a long-acting insulin such as glargine, degludec, or detemir) as part of their regimen, consider combination injectable therapy «bi»Combination Injectable Therapy«/bi» - If HbA1c target has not been met with basal insulin (long-acting insulin such as glargine, degludec or detemir) (usually combined with metformin +/- other noninsulin agent), despite titrating basal insulin to provide acceptable fasting blood glucose concentrations, combination injectable therapy should be considered. - Options include: adding a rapid-acting insulin (lispro, aspart, glulisine) prior to largest meal or adding a GLP-1 receptor agonist or changing from basal insulin to a twice daily premixed insulin - If HbA1c still not adequately controlled, consider advancing from one rapid-acting insulin prior to largest meal to ‘basal-bolus’ regimen (rapid-acting insulin administered before ≥2 meals) or consider advancing from a twice daily premixed insulin to a three times daily premixed insulin «bi»Patients with Elevated HbA1C at Therapy Initiation«/bi» - If HbA1c is ≥9% at initiation of therapy, dual therapy (metformin + a second antihyperglycemic agent) should be considered. If HbA1c ≥10%, blood glucose is ≥300 mg/dL or if patient is symptomatic (eg, polyuria, polydipsia), insulin therapy (with or without additional agents) should be considered

1 unit/kg/day and in some cases up to 2 units/kg/day «b»Dosage Adjustment«/b» - Dosage must be titrated to achieve glucose control and avoid hypoglycemia - Since combinations of agents are frequently used, dosage adjustment must address the individual component of the insulin regimen that most directly influences the blood glucose value in question, based on the known onset and duration of the insulin component." class="list-group-item active pb-0 drug">

Insulin NPH (Human)

HumuLIN N, Isophane Insulin

«bu»Diabetes Mellitus, Type 1«/bu» «b»Initial Total Insulin Dose«/b» - 0.2 to 0.6 units/kg/day SC in divided doses - Conservative initial doses of 0.2 to 0.4 units/kg/day are often recommended to avoid the potential for hypoglycemia. - A rapid-acting insulin may be the only insulin formulation used initially. «b»Usual Maintenance Range«/b» - 0.5 to 1 units/kg/day SC in divided doses - An estimate of anticipated needs may be based on body weight and/or activity factors as follows: «bi»Non-obese«/bi» - 0.4 to 0.6 units/kg/day «bi»Obese«/bi» - 0.8 to 1.2 units/kg/day «b»Division of Daily Insulin Requirement ("Conventional Therapy")«/b» - Generally, 50% to 75% of the total daily dose (TDD) is given as an intermediate-acting (eg, NPH) or a long-acting form of insulin (in 1 to 2 daily injections) - The remaining portion of the TDD is then divided and administered before or at mealtimes (depending on the formulation) as a rapid-acting (lispro, aspart, glulisine) or short-acting (regular) form of insulin. «b»Division of Daily Insulin Requirement (“Intensive Therapy”)«/b» - Basal insulin delivery with 1 or 2 doses of intermediate- or long-acting insulin formulations superimposed with doses of short-acting (regular) insulin or rapid-acting insulin (lispro, aspart, glulisine) formulations 3 or more times daily. «b»Dosage Adjustment«/b» - Dosage must be titrated to achieve glucose control and avoid hypoglycemia - Since combinations of agents are frequently used, dosage adjustment must address the individual component of the insulin regimen which most directly influences the blood glucose value in question, based on the known onset and duration of the insulin component. Treatment and monitoring regimens must be individualized. «bu»Diabetes Mellitus, Type 2«/bu» «b»Initial Dose«/b» - 0.1 to 0.2 units/kg/day SC or 10 units/day. - Longer acting basal insulin analogs are generally preferred to reduce hypoglycemia risk; however NPH insulin may be considered in patients without a history of hypoglycemia «b»Dosage Adjustment«/b» - To reach self-monitoring glucose target: Adjust dose by 10% to 15% or 2 to 4 units; may adjust at weekly or twice weekly intervals «bi»Hypoglycemia«/bi» - If no clear reason for hypoglycemia, decrease dose by 4 units or by 10% to 20% «bi»Surgical Patients«/bi» - On the morning of surgery or procedure, give 60% to 80% of the usual dose of long-acting analogs (eg, detemir, glargine, or degludec) or pump “basal” insulin (rapid-or short-acting insulins) «b»Timing of Initiation«/b» - Dual therapy (metformin + a second antihyperglycemic agent) and then triple therapy (metformin + two antihyperglycemic agents) is recommended in patients who fail to achieve glycemic goals after ~3 months with lifestyle intervention and metformin monotherapy or dual therapy, respectively (unless contraindications to metformin exist). Preference is not given for which agent(s) should be added to metformin (drug choice should be individualized based on patient characteristics). If HbA1c target not achieved after ~3 months of triple therapy, consider initiating basal insulin (usually with metformin +/- other noninsulin agent) or if patient already receiving an optimally titrated basal insulin (a long-acting insulin such as glargine, degludec, or detemir) as part of their regimen, consider combination injectable therapy «b»Combination Injectable Therapy«/b» - If HbA1c target has not been met with basal insulin (ie, long-acting insulin such as glargine, degludec or detemir) (usually combined with metformin +/- other noninsulin agent), despite titrating basal insulin to provide acceptable fasting blood glucose concentrations, combination injectable therapy should be considered. Options include: adding a rapid-acting insulin (lispro, aspart, glulisine) prior to largest meal or adding a GLP-1 receptor agonist or changing from basal insulin to a twice daily premixed insulin. If HbA1c still not adequately controlled, consider advancing from one rapid-acting insulin prior to largest meal to ‘basal-bolus’ regimen (ie, rapid-acting insulin administered before ≥2 meals) or consider advancing from a twice daily premixed insulin to a three times daily premixed insulin. «b»Patients with Elevated HbA1C at Therapy Initiation«/b» - If HbA1c is ≥9% at initiation of therapy, dual therapy (metformin + a second antihyperglycemic agent) should be considered. If HbA1c ≥10%, blood glucose is ≥300 mg/dL or if patient is symptomatic (polyuria, polydipsia), insulin therapy (with or without additional agents) should be considered. - Refer to indication-specific dosing for obesity-related information (may not be available for all indications). «b»SC Administration«/b» «bi»Humulin N Vials«/bi» - May be diluted with the universal diluent, Sterile Diluent for Humalog, Humulin N, Humulin R, Humulin 70/30, and Humulin R U-500. - Do not dilute insulin contained in a cartridge or prefilled pen. «bi»Novolin N«/bi» - Insulin Diluting Medium for NovoLog is not intended for use with Novolin N or any insulin product other than insulin aspart.

1 unit/kg/day and in some cases up to 2 units/kg/day «b»Dosage Adjustment«/b» - Dosage must be titrated to achieve glucose control and avoid hypoglycemia - Adjust dose to maintain premeal and bedtime glucose in target range - Since combinations of agents are frequently used, dosage adjustment must address the individual component of the insulin regimen which most directly influences the blood glucose value in question, based on the known onset and duration of the insulin component." class="list-group-item active pb-0 drug">

Insulin NPH and Insulin Regular

HumuLIN 70/30, NovoLIN 70/30

«bu»Diabetes Mellitus, Type 1«/bu» «b»Usual Maintenance Range«/b» - 0.5 to 1 units/kg/day in divided doses - An estimate of anticipated needs may be based on body weight and/or activity factors as follows: «bi»Non-obese«/bi» - 0.4 to 0.6 units/kg/day «bi»Obese«/bi» - 0.8 to 1.2 units/kg/day «b»Division of Daily Insulin Requirement ("Conventional Therapy")«/b» - Generally, 50% to 75% of the total daily dose (TDD) is given as an intermediate-acting (eg, NPH) or a long-acting form of insulin (in 1 to 2 daily injections) - The remaining portion of the TDD is then divided and administered before or at mealtimes (depending on the formulation) as a rapid-acting (lispro, aspart, glulisine) or short-acting (regular) form of insulin. «b»Division of Daily Insulin Requirement (“Intensive Therapy”)«/b» - Basal insulin delivery with 1 or 2 doses of intermediate- or long-acting insulin formulations superimposed with doses of short-acting (regular) insulin or rapid-acting insulin (lispro, aspart, glulisine) formulations 3 or more times daily. «b»Dosage Adjustment«/b» - Dosage must be titrated to achieve glucose control and avoid hypoglycemia - Since combinations of agents are frequently used, dosage adjustment must address the individual component of the insulin regimen which most directly influences the blood glucose value in question, based on the known onset and duration of the insulin component. Treatment and monitoring regimens must be individualized. «bu»Diabetes Mellitus, Type 2«/bu» «b»Initial Dose«/b» - Insulin NPH and insulin regular premix dose is obtained by dividing the current total daily basal insulin dose into 2 doses administered either as two-thirds of the dose before the morning meal and one-third of the dose before the evening meal or as one-half of the dose before the morning and evening meals «b»Dosage Adjustment«/b» «bi»To Reach Self-monitoring Glucose Target«/bi» - Adjust dose by 10% to 15% or 1 to 2 units; may adjust at weekly or twice weekly intervals «bi»Hypoglycemia«/bi» - If no clear reason for hypoglycemia, decrease dose by 2 to 4 units or by 10% to 20% «b»Timing of Initiation«/b» - Dual therapy (metformin + a second antihyperglycemic agent) and then triple therapy (metformin + two antihyperglycemic agents) is recommended in patients who fail to achieve glycemic goals after ~3 months with lifestyle intervention and metformin monotherapy or dual therapy, respectively (unless contraindications to metformin exist) - Preference is not given for which agent(s) should be added to metformin (drug choice should be individualized based on patient characteristics) - If HbA1c target not achieved after ~3 months of triple therapy, consider initiating basal insulin (usually with metformin +/- other noninsulin agent) or if patient already receiving an optimally titrated basal insulin (ie, a long-acting insulin such as glargine, degludec, or detemir) as part of their regimen, consider combination injectable therapy «b»Combination Injectable Therapy«/b» - If HbA1c target has not been met with basal insulin (ie, long-acting insulin such as glargine, degludec or detemir) (usually combined with metformin +/- other noninsulin agent), despite titrating basal insulin to provide acceptable fasting blood glucose concentrations, combination injectable therapy should be considered. Options include: adding a rapid-acting insulin (eg, lispro, aspart, glulisine) prior to largest meal or adding a GLP-1 receptor agonist or changing from basal insulin to a twice daily premixed insulin. If HbA1c still not adequately controlled, consider advancing from one rapid-acting insulin prior to largest meal to ‘basal-bolus’ regimen (ie, rapid-acting insulin administered before ≥2 meals) or consider advancing from a twice daily premixed insulin to a three times daily premixed insulin «b»Patients with Elevated HbA1C at Therapy Initiation«/b» - If HbA1c is ≥9% at initiation of therapy, dual therapy (metformin + a second antihyperglycemic agent) should be considered. - If HbA1c ≥10%, blood glucose is ≥300 mg/dL or if patient is symptomatic (eg, polyuria, polydipsia), insulin therapy (with or without additional agents) should be considered

180 mg/dL and to target an upper blood glucose ≤180 mg/dL «bu»Moderate-to-Severe Hyperkalemia«/bu» - 10 units IV regular insulin mixed with 25 g dextrose (50 mL D50W) given over 15 to 30 minutes, alternatively, - 50 mL D50W over 5 minutes followed by 10 units regular insulin IV push over seconds may be administered in the setting of imminent cardiac arrest - In patients with ongoing cardiac arrest (PEA with presumed hyperkalemia), administration of D50W over <5 minutes is routine. Effects on potassium are temporary. As appropriate, consider methods of enhancing potassium removal/excretion. «bu»Hyperosmolar Hyperglycemic State (HHS)«/bu» - Only regular injectable insulin should be used - Infusion should continue until reversal of mental status changes and hyperosmolality - Serum glucose is not a direct indicator of these abnormalities, and may decrease more rapidly than correction of the metabolic abnormalities. «b»Adults <20 years«/b» «bi»IV Infusion«/bi» - 0.1 units/kg/hour «bi»IV Infusion Adjustment«/bi» - If serum glucose does not fall by 50 mg/dL in the first hour, check hydration status; if acceptable, double insulin dose hourly until glucose levels fall at rate of 50 to 75 mg/dL per hour. Once serum glucose reaches 300 mg/dL, decrease dose to 0.05 to 0.1 units/kg/hour; dextrose-containing IV fluids should be administered to maintain serum glucose between 250 to 300 mg/dL until hyperosmolality clears and mental status returns to normal. After resolution of HHS, supplement IV insulin with SC insulin as needed until the patient is able to eat and transition fully to a SC insulin regimen. An overlap of ~1 to 2 hours between discontinuation of IV insulin and administration of SC insulin is recommended to ensure adequate plasma insulin levels. «bi»SC, IM (If IV Infusion Access is Unavailable)«/bi» - 0.1 to 0.3 units/kg SC bolus, followed by 0.1 units/kg given every hour SC or IM or 0.15 to 0.2 units/kg every 2 hours SC; continue until resolution of hyperosmolality, then decrease to 0.05 units/kg given every hour until SC replacement dosing can be initiated «b»Adults ≥20 years«/b» «bi»IV Bolus«/bi» - 0.1 units/kg bolus (optional) «bi»IV Infusion«/bi» - 0.1 to 0.14 units/kg/hour - If no IV bolus was administered, patients should receive a continuous infusion of 0.14 units/kg/hour. «bi»Dose Adjustment«/bi» - If serum glucose does not fall by at least 10% in the first hour, give an IV bolus of 0.14 units/kg and continue previous regimen. In addition, if serum glucose does not fall by 50 to 70 mg/dL in the first hour, the insulin infusion dose should be increased hourly until a steady glucose decline is achieved. Once serum glucose reaches 300 mg/dL, decrease dose to 0.02 to 0.05 units/kg/hour; dextrose-containing IV fluids should be administered to maintain serum glucose between 200 to 300 mg/dL until the patient is mentally alert. After resolution of HHS, supplement IV insulin with SC insulin as needed until the patient is able to eat and transition fully to a SC insulin regimen. An overlap of ~1 to 2 hours between discontinuation of IV insulin and administration of SC insulin is recommended to ensure adequate plasma insulin levels.,«bu»Diabetes Mellitus, Type 1«/bu» «b»Infants, Children, and Adolescents«/b» «bi»Initial Dose«/bi» - 0.2 to 0.6 units/kg/day SC in divided doses - Conservative initial doses of 0.2 to 0.4 units/kg/day SC are often recommended to avoid the potential for hypoglycemia. «bi»Usual Maintenance Range«/bi» - 0.5 to 1 unit/kg/day SC in divided doses; doses must be individualized; however an estimate can be determined based on phase of diabetes and level of maturity Partial Remission Phase (Honeymoon Phase) - <0.5 units/kg/day Prepubertal Children (not in partial remission) - 0.7 to 1 units/kg/day «b»Pubescent Children and Adolescents«/b» - During puberty, requirements may substantially increase to >1.2 unit/kg/day and in some cases up to 2 units/kg/day «b»Division of Daily Insulin Requirement ("Conventional Therapy")«/b» - Generally, 50% to 75% of the daily insulin dose is given as an intermediate- or long-acting form of insulin (in 1 to 2 daily injections) - The remaining portion of the 24-hour insulin requirement is divided and administered as either regular insulin or a rapid-acting form of insulin at the same time before breakfast and dinner. «b»Division of Daily Insulin Requirement ("Intensive Therapy")«/b» - Basal insulin delivery with 1 or 2 doses of intermediate- or long-acting insulin formulations superimposed with doses of rapid- or very rapid-acting insulin formulations 3 or more times daily. «bi»Dosage Adjustment«/bi» - Dosage must be titrated to achieve glucose control and avoid hypoglycemia - Since combinations of agents are frequently used, dosage adjustment must address the individual component of the insulin regimen which most directly influences the blood glucose value in question, based on the known onset and duration of the insulin component. «b»Continuous SC Insulin Infusion (Insulin Pump)«/b» - Using an appropriate rapid-acting insulin formulation, consists of a combination of a "basal" continuous insulin infusion rate with preprogrammed, premeal bolus doses which are patient controlled. - When converting from multiple daily SC doses of maintenance insulin, it is advisable to reduce the basal rate to less than the equivalent of the total daily units of longer acting insulin (NPH) - Divide the total number of units by 24 to get the basal rate in units/hour - Do not include the total units of regular insulin or other rapid-acting insulin formulations in this calculation. The same premeal regular insulin dosage may be used. «bu»Diabetes Mellitus, Type 2«/bu» «b»Children ≥10 years and Adolescents«/b» - The goal of therapy is to achieve an HbA1c <6.5% as quickly as possible using the safe titration of medications. Initial therapy in metabolically unstable patients (eg, plasma glucose ≥ 250 mg/dL, HbA1c >9% and symptoms excluding acidosis) may include once daily intermediate-acting insulin or basal insulin in combination with lifestyle changes and metformin - In patients who fail to achieve glycemic goals with metformin and basal insulin, may consider initiating prandial insulin (regular insulin or rapid acting insulin) and titrate to achieve goals - Once initial goal reached, insulin should be slowly tapered and the patient transitioned to lowest effective doses or metformin monotherapy if able - Patients who are ketotic or present with ketoacidosis require aggressive management as indicated. «bu»Diabetic ketoacidosis (DKA)«/bu» «b»Infants, Children, and Adolescents«/b» - Only IV regular insulin should be used for treatment of DKA; the rare exception where the use of SC rapid-acting insulin analogs (eg, aspart, lispro) may be appropriate is for patients with uncomplicated DKA in whom peripheral circulation is adequate and continuous IV regular insulin administration is not possible. Treatment should continue until resolution of acid-base abnormalities (eg, pH >7.3, serum HCO3 >15 mEq/L, and/or closure of anion gap); serum glucose is not a direct indicator of these abnormalities, and may decrease more rapidly than correction of the metabolic abnormalities. As part of overall DKA management, dextrose should be added to IV fluids to prevent hypoglycemia, usually once serum glucose is between 250 to 300 mg/dL but it may be required sooner if serum glucose has decreased precipitously. Generally, only dextrose 5% is necessary and is added to NS or 1/2NS; however, dextrose 10% or 12.5% may be necessary in some cases «bi»Continuous IV Infusion«/bi» - Initial: 0.05 to 0.1 units/kg/hour; continue the rate at 0.05 to 0.1 units/kg/hour if tolerated until resolution of ketoacidosis (pH >7.3; bicarbonate >15 mEq/L and/or closure of anion gap); Note: Some patients (eg, some young children with DKA, or older children with established diabetes) may have marked sensitivity to insulin requiring lower infusion rates; these lower infusion rates should only be used provided that resolution of the acidosis continues - After resolution of DKA: Once ketoacidosis has resolved and oral intake is tolerated, transition to a SC insulin regimen. An overlap between discontinuation of IV insulin and administration of SC insulin is recommended to ensure adequate plasma insulin levels; timing of SC insulin administration prior to infusion discontinuation is dependent on type of insulin used; for SC regular insulin: 1 to 2 hours, or for rapid-acting insulin: 15 to 30 minutes «bu»Hyperkalemia«/bu» «b»Infants, Children, and Adolescents«/b» - 0.1 unit/kg with 400 mg/kg of glucose; usual ratio of combination therapy of insulin to glucose is 1 unit of insulin for every 4 g of glucose - An alternate approach is glucose 1 g/kg followed by 0.2 units of insulin/g of glucose administered over 15 to 30 minutes then infused continuously as a similar amount per hour. - In adults, the usual dose is 10 units of insulin mixed with 25 g of dextrose (50 mL of D50W) administered over 15 to 30 minutes «bu»Hyperosmolar Hyperglycemic State (HHS)«/bu» «b»Children and Adolescents«/b» - Only regular IV insulin should be used. Insulin administration should be initiated when serum glucose concentration is no longer declining at a rate ≥50 mg/dL per hour with fluid administration alone; earlier initiation may be required in patients with severe ketosis and acidosis. Infusion should continue until reversal of mental status changes and hyperosmolality. Serum glucose is not a direct indicator of these abnormalities, and may decrease more rapidly than correction of the metabolic abnormalities. Refer to institution-specific protocols where appropriate. «bi»Continuous IV Infusion«/bi» - Initial Dose: 0.025 to 0.05 units/kg/hour; titrate dose to achieve a decrease in serum glucose concentration at a rate of 50 to 75 mg/dL per hour; higher rates of decline may be required in some patients; however, if rate of decline exceeds 100 mg/dL per hour discontinue infusion" class="list-group-item active pb-0 drug">

Insulin Regular Human

HumuLIN R, NovoLIN R

«bu»Diabetes Mellitus, Type 1«/bu» «b»Initial Total Insulin Dose«/b» - 0.2 to 0.6 units/kg/day SC in divided doses - Conservative initial doses of 0.2 to 0.4 units/kg/day SC are often recommended to avoid the potential for hypoglycemia. - A rapid-acting insulin may be the only insulin formulation used initially. «b»Usual Maintenance Range«/b» - 0.5 to 1 units/kg/day in divided doses - An estimate of anticipated needs may be based on body weight and/or activity factors as follows: «bi»Non-obese«/bi» - 0.4 to 0.6 units/kg/day «bi»Obese«/bi» - 0.8 to 1.2 units/kg/day «b»Division of Daily Insulin Requirement (“Conventional Therapy”)«/b» - Generally, 50% to 75% of the total daily dose (TDD) is given as an intermediate- or long-acting form of insulin (in 1 to 2 daily injections) - The remaining portion of the TDD is then divided and administered before or at mealtimes (depending on the formulation) as a rapid-acting (lispro, aspart, glulisine) or short-acting (regular) form of insulin - Some patients may benefit from the use of CSII which delivers rapid-acting insulin as a continuous infusion throughout the day and as boluses at mealtimes via an external pump device. «b»Division of Daily Insulin Requirement (“Intensive Therapy”)«/b» - Basal insulin delivery with 1 or 2 doses of intermediate- or long-acting insulin formulations superimposed with doses of short-acting (regular) insulin or rapid-acting insulin (lispro, aspart, glulisine) formulations 3 or more times daily. «b»Dosage Adjustment«/b» - Dosage must be titrated to achieve glucose control and avoid hypoglycemia - Since combinations of agents are frequently used, dosage adjustment must address the individual component of the insulin regimen which most directly influences the blood glucose value in question, based on the known onset and duration of the insulin component. Treatment and monitoring regimens must be individualized. «b»Continuous SC Insulin Infusion (Insulin Pump)«/b» - Using an appropriate rapid-acting insulin formulation, consists of a combination of a "basal" continuous insulin infusion rate with preprogrammed, premeal bolus doses that are patient controlled - When converting from multiple daily SC doses of maintenance insulin, it is advisable to reduce the basal rate to less than the equivalent of the total daily units of the longer acting insulin (eg, NPH); divide the total number of units by 24 to get the basal rate in units/hour - Do not include the total units of regular insulin or other rapid-acting insulin formulations in this calculation. The same premeal regular insulin dosage may be used. «bu»Diabetes Mellitus, Type 2«/bu» «b»Timing of Initiation«/b» - Dual therapy (metformin + a second antihyperglycemic agent) and then triple therapy (metformin + two antihyperglycemic agents) is recommended in patients who fail to achieve glycemic goals after ~3 months with lifestyle intervention and metformin monotherapy or dual therapy, respectively (unless contraindications to metformin exist). Preference is not given for which agent(s) should be added to metformin (drug choice should be individualized based on patient characteristics) - If HbA1c target not achieved after ~3 months of triple therapy, consider initiating basal insulin (usually with metformin +/- other noninsulin agent) or if patient already receiving an optimally titrated basal insulin (a long-acting insulin such as glargine, degludec, or detemir) as part of their regimen, consider combination injectable therapy «b»Combination Injectable Therapy«/b» - If HbA1c target has not been met with basal insulin (long-acting insulin such as glargine, degludec or detemir) (usually combined with metformin +/- other noninsulin agent), despite titrating basal insulin to provide acceptable fasting blood glucose concentrations, combination injectable therapy should be considered. Options include: adding a rapid-acting insulin (lispro, aspart, glulisine) prior to largest meal or adding a GLP-1 receptor agonist or changing from basal insulin to a twice daily premixed insulin. If HbA1c still not adequately controlled, consider advancing from one rapid-acting insulin prior to largest meal to ‘basal-bolus’ regimen (rapid-acting insulin administered before ≥2 meals) or consider advancing from a twice daily premixed insulin to a three times daily premixed insulin «b»Patients with Elevated HbA1C at Therapy Initiation«/b» - If HbA1c is ≥9% at initiation of therapy, dual therapy (metformin + a second antihyperglycemic agent) should be considered. If HbA1c ≥10%, blood glucose is ≥300 mg/dL or if patient is symptomatic (eg, polyuria, polydipsia), insulin therapy (with or without additional agents) should be considered «bu»Cadaveric Organ Recovery (Hormonal Resuscitation)«/bu» - Continuous infusion of 1 unit/hour (minimum dose) to maintain blood glucose of 120 to 180 mg/dL or 20 units as a bolus dose (after an IV bolus of dextrose 25 g) administered to the brain-dead donor who is hemodynamically unstable requiring significant vasopressor support; give concomitantly with levothyroxine or liothyronine (preferred), vasopressin, and methylprednisolone «bu»Diabetic Ketoacidosis (DKA)«/bu» - Only IV regular insulin should be used for severe DKA - Treatment should continue until reversal of acid-base derangement/ketonemia - Serum glucose is not a direct indicator of these abnormalities, and may decrease more rapidly than correction of the metabolic abnormalities «b»Adults <20 years«/b» «bi»IV Infusion«/bi» - 0.1 units/kg/hour «bi»Adjustment Dose«/bi» - If serum glucose does not fall by 50 mg/dL in the first hour, check hydration status; if acceptable, double insulin dose hourly until glucose levels fall at rate of 50 to 75 mg/dL per hour. - Once serum glucose reaches 250 mg/dL, decrease dose to 0.05 to 0.1 units/kg/hour; dextrose-containing IV fluids should be administered to maintain serum glucose between 150 to 250 mg/dL until the acidosis clears. After resolution of DKA, supplement IV insulin with SC insulin as needed until the patient is able to eat and transition fully to a SC insulin regimen. - An overlap of ~1 to 2 hours between discontinuation of IV insulin and administration of SC insulin is recommended to ensure adequate plasma insulin levels. «b»SC, IM (If IV Infusion Access Unavailable)«/bi» - 0.1 to 0.3 units/kg SC bolus, followed by, - 0.1 units/kg given every hour SC or IM or 0.15 to 0.2 units/kg every 2 hours SC - Continue until acidosis clears, then decrease to 0.05 units/kg given every hour until SC replacement dosing can be initiated «b»Adults ≥20 years«/b» «bi»IV Bolus«/bi» - 0.1 units/kg (optional) «bi»IV Infusion«/bi» - 0.1 to 0.14 units/kg/hour. Note: If no IV bolus was administered, patients should receive a continuous infusion of 0.14 units/kg/hour; lower doses may not achieve adequate insulin concentrations to suppress hepatic ketone body production. «bi»Adjustment«/bi» - If serum glucose does not fall by at least 10% in the first hour, give an IV bolus of 0.14 units/kg and continue previous regimen. In addition, if serum glucose does not fall by 50 to 70 mg/dL in the first hour, the insulin infusion dose should be increased hourly until a steady glucose decline is achieved Once serum glucose reaches 200 mg/dL, decrease infusion dose to 0.02 to 0.05 units/kg/hour or switch to SC rapid-acting insulin (aspart, lispro) at 0.1 units/kg every 2 hours; dextrose-containing IV fluids should be administered to maintain serum glucose between 150 to 250 mg/dL until the acidosis clears. After resolution of DKA, supplement IV insulin with SC insulin as needed until the patient is able to eat and transition fully to a SC insulin regimen. An overlap of ~1 to 2 hours between discontinuation of IV insulin and administration of SC insulin is recommended to ensure adequate plasma insulin levels. «bi»SC, IM Bolus«/bi» - Give half of the dose (0.2 units/kg) as an IV bolus and half of the dose (0.2 units/kg) as SC or IM «bi»SC, IM Intermittent«/bi» - 0.1 units/kg given every hour SC or IM «bi»SC IM Dose Adjustment«/bi» - If serum glucose does not fall by 50 to 70 mg/dL in the first hour, administer 10 units hourly by IV bolus until glucose levels fall at a rate of 50 to 70 mg/dL per hour. Once serum glucose reaches 250 mg/dL, decrease dose to 5 to 10 units SC every 2 hours; dextrose-containing IV fluids should be administered to maintain serum glucose between 150 to 250 mg/dL until the acidosis clears. «b»Hyperglycemia, Critically Ill«/b» «bi»Adults IV Continuous Infusion«/bi» - Insulin therapy should be implemented when blood glucose ≥150 mg/dL with a goal to maintain blood glucose <150 mg/dL (with values absolutely <180 mg/dL) using a protocol that achieves a low rate of hypoglycemia (ie, ≤70 mg/dL). Alternatively, other rapid acting insulin analogues (insulin aspart or insulin glulisine) may also be used as a continuous infusion to maintain glycemic control (in place of regular insulin). Before discontinuation, stable ICU patients should be transitioned to a protocol-driven basal/bolus insulin regimen, based on insulin infusion history and carbohydrate intake, to avoid loss of glycemic control. Subcutaneous insulin therapy may be considered for selected clinically stable ICU patients - The Surviving Sepsis Campaign guidelines recommend initiating insulin dosing in patients with severe sepsis when 2 consecutive blood glucose concentrations are >180 mg/dL and to target an upper blood glucose ≤180 mg/dL «bu»Moderate-to-Severe Hyperkalemia«/bu» - 10 units IV regular insulin mixed with 25 g dextrose (50 mL D50W) given over 15 to 30 minutes, alternatively, - 50 mL D50W over 5 minutes followed by 10 units regular insulin IV push over seconds may be administered in the setting of imminent cardiac arrest - In patients with ongoing cardiac arrest (PEA with presumed hyperkalemia), administration of D50W over <5 minutes is routine. Effects on potassium are temporary. As appropriate, consider methods of enhancing potassium removal/excretion. «bu»Hyperosmolar Hyperglycemic State (HHS)«/bu» - Only regular injectable insulin should be used - Infusion should continue until reversal of mental status changes and hyperosmolality - Serum glucose is not a direct indicator of these abnormalities, and may decrease more rapidly than correction of the metabolic abnormalities. «b»Adults <20 years«/b» «bi»IV Infusion«/bi» - 0.1 units/kg/hour «bi»IV Infusion Adjustment«/bi» - If serum glucose does not fall by 50 mg/dL in the first hour, check hydration status; if acceptable, double insulin dose hourly until glucose levels fall at rate of 50 to 75 mg/dL per hour. Once serum glucose reaches 300 mg/dL, decrease dose to 0.05 to 0.1 units/kg/hour; dextrose-containing IV fluids should be administered to maintain serum glucose between 250 to 300 mg/dL until hyperosmolality clears and mental status returns to normal. After resolution of HHS, supplement IV insulin with SC insulin as needed until the patient is able to eat and transition fully to a SC insulin regimen. An overlap of ~1 to 2 hours between discontinuation of IV insulin and administration of SC insulin is recommended to ensure adequate plasma insulin levels. «bi»SC, IM (If IV Infusion Access is Unavailable)«/bi» - 0.1 to 0.3 units/kg SC bolus, followed by 0.1 units/kg given every hour SC or IM or 0.15 to 0.2 units/kg every 2 hours SC; continue until resolution of hyperosmolality, then decrease to 0.05 units/kg given every hour until SC replacement dosing can be initiated «b»Adults ≥20 years«/b» «bi»IV Bolus«/bi» - 0.1 units/kg bolus (optional) «bi»IV Infusion«/bi» - 0.1 to 0.14 units/kg/hour - If no IV bolus was administered, patients should receive a continuous infusion of 0.14 units/kg/hour. «bi»Dose Adjustment«/bi» - If serum glucose does not fall by at least 10% in the first hour, give an IV bolus of 0.14 units/kg and continue previous regimen. In addition, if serum glucose does not fall by 50 to 70 mg/dL in the first hour, the insulin infusion dose should be increased hourly until a steady glucose decline is achieved. Once serum glucose reaches 300 mg/dL, decrease dose to 0.02 to 0.05 units/kg/hour; dextrose-containing IV fluids should be administered to maintain serum glucose between 200 to 300 mg/dL until the patient is mentally alert. After resolution of HHS, supplement IV insulin with SC insulin as needed until the patient is able to eat and transition fully to a SC insulin regimen. An overlap of ~1 to 2 hours between discontinuation of IV insulin and administration of SC insulin is recommended to ensure adequate plasma insulin levels. «bu»Diabetes Mellitus, Type 1«/bu» «b»Infants, Children, and Adolescents«/b» «bi»Initial Dose«/bi» - 0.2 to 0.6 units/kg/day SC in divided doses - Conservative initial doses of 0.2 to 0.4 units/kg/day SC are often recommended to avoid the potential for hypoglycemia. «bi»Usual Maintenance Range«/bi» - 0.5 to 1 unit/kg/day SC in divided doses; doses must be individualized; however an estimate can be determined based on phase of diabetes and level of maturity Partial Remission Phase (Honeymoon Phase) - <0.5 units/kg/day Prepubertal Children (not in partial remission) - 0.7 to 1 units/kg/day «b»Pubescent Children and Adolescents«/b» - During puberty, requirements may substantially increase to >1.2 unit/kg/day and in some cases up to 2 units/kg/day «b»Division of Daily Insulin Requirement ("Conventional Therapy")«/b» - Generally, 50% to 75% of the daily insulin dose is given as an intermediate- or long-acting form of insulin (in 1 to 2 daily injections) - The remaining portion of the 24-hour insulin requirement is divided and administered as either regular insulin or a rapid-acting form of insulin at the same time before breakfast and dinner. «b»Division of Daily Insulin Requirement ("Intensive Therapy")«/b» - Basal insulin delivery with 1 or 2 doses of intermediate- or long-acting insulin formulations superimposed with doses of rapid- or very rapid-acting insulin formulations 3 or more times daily. «bi»Dosage Adjustment«/bi» - Dosage must be titrated to achieve glucose control and avoid hypoglycemia - Since combinations of agents are frequently used, dosage adjustment must address the individual component of the insulin regimen which most directly influences the blood glucose value in question, based on the known onset and duration of the insulin component. «b»Continuous SC Insulin Infusion (Insulin Pump)«/b» - Using an appropriate rapid-acting insulin formulation, consists of a combination of a "basal" continuous insulin infusion rate with preprogrammed, premeal bolus doses which are patient controlled. - When converting from multiple daily SC doses of maintenance insulin, it is advisable to reduce the basal rate to less than the equivalent of the total daily units of longer acting insulin (NPH) - Divide the total number of units by 24 to get the basal rate in units/hour - Do not include the total units of regular insulin or other rapid-acting insulin formulations in this calculation. The same premeal regular insulin dosage may be used. «bu»Diabetes Mellitus, Type 2«/bu» «b»Children ≥10 years and Adolescents«/b» - The goal of therapy is to achieve an HbA1c <6.5% as quickly as possible using the safe titration of medications. Initial therapy in metabolically unstable patients (eg, plasma glucose ≥ 250 mg/dL, HbA1c >9% and symptoms excluding acidosis) may include once daily intermediate-acting insulin or basal insulin in combination with lifestyle changes and metformin - In patients who fail to achieve glycemic goals with metformin and basal insulin, may consider initiating prandial insulin (regular insulin or rapid acting insulin) and titrate to achieve goals - Once initial goal reached, insulin should be slowly tapered and the patient transitioned to lowest effective doses or metformin monotherapy if able - Patients who are ketotic or present with ketoacidosis require aggressive management as indicated. «bu»Diabetic ketoacidosis (DKA)«/bu» «b»Infants, Children, and Adolescents«/b» - Only IV regular insulin should be used for treatment of DKA; the rare exception where the use of SC rapid-acting insulin analogs (eg, aspart, lispro) may be appropriate is for patients with uncomplicated DKA in whom peripheral circulation is adequate and continuous IV regular insulin administration is not possible. Treatment should continue until resolution of acid-base abnormalities (eg, pH >7.3, serum HCO3 >15 mEq/L, and/or closure of anion gap); serum glucose is not a direct indicator of these abnormalities, and may decrease more rapidly than correction of the metabolic abnormalities. As part of overall DKA management, dextrose should be added to IV fluids to prevent hypoglycemia, usually once serum glucose is between 250 to 300 mg/dL but it may be required sooner if serum glucose has decreased precipitously. Generally, only dextrose 5% is necessary and is added to NS or 1/2NS; however, dextrose 10% or 12.5% may be necessary in some cases «bi»Continuous IV Infusion«/bi» - Initial: 0.05 to 0.1 units/kg/hour; continue the rate at 0.05 to 0.1 units/kg/hour if tolerated until resolution of ketoacidosis (pH >7.3; bicarbonate >15 mEq/L and/or closure of anion gap); Note: Some patients (eg, some young children with DKA, or older children with established diabetes) may have marked sensitivity to insulin requiring lower infusion rates; these lower infusion rates should only be used provided that resolution of the acidosis continues - After resolution of DKA: Once ketoacidosis has resolved and oral intake is tolerated, transition to a SC insulin regimen. An overlap between discontinuation of IV insulin and administration of SC insulin is recommended to ensure adequate plasma insulin levels; timing of SC insulin administration prior to infusion discontinuation is dependent on type of insulin used; for SC regular insulin: 1 to 2 hours, or for rapid-acting insulin: 15 to 30 minutes «bu»Hyperkalemia«/bu» «b»Infants, Children, and Adolescents«/b» - 0.1 unit/kg with 400 mg/kg of glucose; usual ratio of combination therapy of insulin to glucose is 1 unit of insulin for every 4 g of glucose - An alternate approach is glucose 1 g/kg followed by 0.2 units of insulin/g of glucose administered over 15 to 30 minutes then infused continuously as a similar amount per hour. - In adults, the usual dose is 10 units of insulin mixed with 25 g of dextrose (50 mL of D50W) administered over 15 to 30 minutes «bu»Hyperosmolar Hyperglycemic State (HHS)«/bu» «b»Children and Adolescents«/b» - Only regular IV insulin should be used. Insulin administration should be initiated when serum glucose concentration is no longer declining at a rate ≥50 mg/dL per hour with fluid administration alone; earlier initiation may be required in patients with severe ketosis and acidosis. Infusion should continue until reversal of mental status changes and hyperosmolality. Serum glucose is not a direct indicator of these abnormalities, and may decrease more rapidly than correction of the metabolic abnormalities. Refer to institution-specific protocols where appropriate. «bi»Continuous IV Infusion«/bi» - Initial Dose: 0.025 to 0.05 units/kg/hour; titrate dose to achieve a decrease in serum glucose concentration at a rate of 50 to 75 mg/dL per hour; higher rates of decline may be required in some patients; however, if rate of decline exceeds 100 mg/dL per hour discontinue infusion «b»SC Administration«/b» - Do not use if solution is viscous or cloudy; use only if clear and colorless - Regular insulin should be administered approximately 30 minutes before a meal - Cold injections should be avoided. - SC administration is usually made into the thighs, arms, buttocks, or abdomen; rotate injection sites within the same region to avoid lipodystrophy - Regular insulin is not recommended for use in external SubQ insulin infusion pump. «bi»U-100 Regular Insulin«/bi» - When mixing U-100 regular insulin with other preparations of insulin, regular insulin should be drawn into syringe first. «bi»U-500 Regular Insulin (Concentrated)«/bi» - Do not dilute or mix U-500 regular insulin - U-500 regular insulin vials are to be used only in conjunction with a dedicated U-500 insulin syringe; dosage conversion is not required with the U-500 syringe - Only in cases where the U-500 insulin syringe is not available, a U-100 insulin syringe or a tuberculin syringe may be necessary - When using a U-100 syringe or a tuberculin syringe to deliver Humulin R U-500 (from vial), a conversion step is required to ensure the correct amount of Humulin R U-500 is drawn up in the syringe - To avoid dosing errors when using a U-100 insulin syringe, the prescribed dose should be written in actual insulin units and as unit markings on the U-100 insulin syringe (Humulin R U-500 50 units = 10 units on a U-100 insulin syringe) - To avoid dosing errors when using a tuberculin syringe, the prescribed dose should be written in actual insulin units and as a volume (Humulin R U-500 50 units = 0.1 mL on a tuberculin syringe) - Do not perform dose conversions when using the KwikPen; the dose window shows the number of units to be injected. Do not transfer KwikPen insulin into a syringe for administration. «b»IM Administration«/b» - Do not administer U-500 regular insulin IM - Do not use if solution is viscous or cloudy; use only if clear and colorless - May be administered IM in selected clinical situations; close monitoring of blood glucose and serum potassium as well as medical supervision is required. «b»IV Administration«/b» - Do not administer U-500 regular insulin or mixtures of insulin formulations IV - Do not use if solution is viscous or cloudy; use only if clear and colorless - May be administered IV with close monitoring of blood glucose and serum potassium; appropriate medical supervision is required - If possible, avoid IV bolus administration in pediatric patients with DKA; may increase risk of cerebral edema. «b»IV Infusions«/b» «bi»To Minimize Insulin Adsorption to Plastic IV Tubing«/bi» - Insulin loss will occur by adsorption to plastic (PVC, polyethylene, polyolefin, polypropylene) IV containers and tubing - Therefore, flush the IV tubing with a priming infusion of 20 mL from the insulin infusion, whenever a new IV tubing set is added to the insulin infusion container - If insulin is required prior to the availability of the insulin drip, regular insulin should be administered by IV push injection. - Because of insulin adsorption to plastic IV tubing or infusion bags, the actual amount of insulin being administered via IV infusion could be substantially less than the apparent amount. - Therefore, adjustment of the IV infusion rate should be based on effect and not solely on the apparent insulin dose. - The apparent dose may be used as a starting point for determining the subsequent SC dosing regimen; however, the transition to SC administration requires continuous medical supervision, frequent monitoring of blood glucose, and careful adjustment of therapy - In addition, SC insulin should be given 1 to 4 hours prior to the discontinuation of IV insulin to prevent hyperglycemia

Insulin Regular Human (Oral Inhalation)

Afrezza, Technosphere Insulin (TI)

Interferon Alfa 2B

Intron A, INF-alpha 2, rLFN-α2, α-2-interferon

«b»Premedication«/b» - Consider premedication with acetaminophen prior to administration to reduce the incidence of some adverse reactions - Not all dosage forms and strengths are appropriate for all indications - Interferon alfa-2b at doses ≥10 million units/m2 is associated with a moderate emetic potential - Antiemetics may be recommended to prevent nausea and vomiting. «bu»Hairy Cell Leukemia«/bu» - 2 million units/m2 SC/IM 3 times weekly for up to 6 months - May continue treatment with sustained treatment response - Discontinue for disease progression or failure to respond after 6 months «b»Dose Adjustment«/b» «bi»Platelet count <50,000/mm3«/bi» - Do not administer intramuscularly - Administer SC instead «bi»Severe Toxicity«/bi» - Reduce dose by 50% or temporarily withhold and resume with 50% dose reduction - Permanently discontinue if persistent or recurrent severe toxicity is noted. «bu»Lymphoma (Follicular)«/bu» - 5 million units SC 3 times weekly for up to 18 months «b»Dose Adjustment«/b» «bi»Neutrophils >1000/mm3 to <1,500/mm3«/bi» - Reduce dose by 50%; may re-escalate to starting dose when neutrophils return to >1,500/mm3 «bi»Severe Toxicity«/bi» - Neutrophils <1000/mm3 or Platelets <50,000/mm3 - Temporarily withhold. «bi»AST >5 times ULN or Serum Creatinine >2 mg/dL«/bi» - Permanently discontinue «bu»Malignant Melanoma«/bu» «b»Induction«/b» - 20 million units/m2 IV for 5 consecutive days per week for 4 weeks «b»Maintenance Dose«/b» - 10 million units/m2 SC 3 times weekly for 48 weeks «b»Dose Adjustment«/b» «bi»Severe Toxicity«/bi» - Neutrophils >250/mm3 to <500/mm3 or ALT/AST >5 to 10 times ULN - Temporarily withhold; resume with a 50% dose reduction when adverse reaction abates. «bi»Neutrophils <250/mm3, ALT/AST >10 Times ULN, or Severe/Persistent Adverse Reactions«/bi» - Permanently discontinue. «bu»AIDS-related Kaposi Sarcoma«/bu» - 30 million units/m2 SC/IM 3 times weekly - Continue until disease progression or until maximal response has been achieved after 16 weeks «b»Dose Adjustment«/b» «bi»Severe Toxicity«/bi» - Reduce dose by 50% or temporarily withhold - May resume at reduced dose with toxicity resolution - Permanently discontinue for persistent/recurrent toxicities. «bu»Chronic Hepatitis B«/bu» - 5 million units daily or 10 million units IM/SC 3 times weekly for 16 weeks «b»Dose Adjustment«/b» «bi»WBC <1,500/mm3, Granulocytes <750/mm3, or Platelet Count <50,000/mm3, or Other Laboratory Abnormality or Severe Adverse Reaction«/bi» - Reduce dose by 50%; may re-escalate to starting dose upon resolution of hematologic toxicity - Discontinue for persistent intolerance. «bi»WBC <1,000/mm3, Granulocytes <500/mm3, or Platelet Count <25,000/mm3«/bi» - Permanently discontinue «bu»Chronic Hepatitis C«/bu» - 3 million units IM/SC 3 times weekly - In patients with normalization of ALT at 16 weeks, continue treatment (if tolerated) for 18-24 months; consider discontinuation if normalization does not occur at 16 weeks - May be used in combination therapy with ribavirin in previously untreated patients or in patients who relapse following alpha interferon therapy «b»Dose Adjustment«/b» «bi»Severe Toxicity«/bi» - Reduce dose by 50% or temporarily withhold until subsides - Permanently discontinue for persistent toxicities after dosage reduction «bu»Condyloma Acuminata«/bu» - 1 million units/lesion (maximum: 5 lesions per treatment) intralesionally 3 times weekly (on alternate days) for 3 weeks - May administer a second course at 12-16 weeks. «b»Hematologic Toxicity«/b» «bi»ANC <500/mm3 or platelets <25,000/mm3«/bi» - Discontinue treatment. «bi»Hypersensitivity reaction (acute, serious), ophthalmic disorders (new or worsening), thyroid abnormality development (which cannot be normalized with medication), signs or symptoms of liver failure«/bi» - Discontinue treatment. «bi»Liver function abnormality, pulmonary infiltrate development, evidence of pulmonary function impairment, or autoimmune disorder development, triglycerides >1,000 mg/dL«/bi» - Monitor closely and discontinue if appropriate. Permanently discontinue for severe (grade 3) hepatic injury or hepatic decompensation (Child-Pugh class B and C [score >6]). «b»Neuropsychiatric Disorders During Treatment«/b» - Clinical depression or other psychiatric problem: Monitor closely during and for 6 months after treatment. - Severe depression or other psychiatric disorder: Discontinue treatment. - Persistent or worsening psychiatric symptoms, suicidal ideation, aggression towards others: Discontinue treatment and follow with appropriate psychiatric intervention. - Administer dose in the evening (if possible) to enhance tolerability - Not all dosage forms are recommended for all administration routes; refer to manufacturer’s labeling. - Interferon alfa-2b at doses ≥10 million units/m2 is associated with a moderate emetic potential; antiemetics may be recommended to prevent nausea and vomiting. «b»IM Administration«/b» - Rotate injection sites; preferred sites for injection are anterior thigh, deltoid, and superolateral buttock. - Some patients may be appropriate for self-administration with appropriate training. - Allow to reach room temperature prior to injection. In hairy cell leukemia treatment, if platelets are <50,000/mm3, do not administer intramuscularly (administer SubQ instead). «b»IV Administration«/b» - Infuse over ~20 minutes «b»SC Administration«/b» - Suggested for those who are at risk for bleeding or are thrombocytopenic. - Rotate SC injection site; preferred sites for injection are abdomen (except around the navel), anterior thigh, and outer upper arm. - Patient should be well hydrated. - Some patients may be appropriate for self-administration with appropriate training. Allow to reach room temperature prior to injection. «b»Intralesional Administration«/b» - Inject at an angle nearly parallel to the plane of the skin, directing the needle to center of the base of the wart to infiltrate the lesion core and cause a small wheal. - Only infiltrate the keratinized layer; avoid administration which is too deep or shallow - Allow to reach room temperature prior to injection. «b»Reconstitution«/b» «bi»Powder for Injection«/bi» - The manufacturer recommends reconstituting vial with the diluent provided (SWFI) - When reconstituted with SWFI 1 mL, the 10 million unit vial concentration is 10 million units/mL, the 18 million unit vial concentration is 18 million units/mL, and the 50 million unit vial concentration is 50 million units/mL. Swirl gently - To prepare solution for infusion, further dilute appropriate dose in NS 100 mL - Final concentration should be ≥10 million units/100 mL.

Interferon Alfa n3

Alferon N

Interferon Beta 1a

Avonex, Rebif, rIFN beta-1a

Interferon Beta 1b

Betaseron, Extavia, rIFN beta-1b

Interferon Gamma 1B

Actimmune

Iodine

Iodoflex, Iodosorb

Ioflupane I 123

DaTscan

Iopromide

Ultravist

- Maximum recommended total dose of iodine is 86 g. Individualize dose taking into account patient's age, body weight, size of the vessel, and the rate of blood flow within the vessel. Consideration should also be made for the extent of opacification required, structure or area to be examined, disease processes, and equipment and technique used. «bu»Aortography and Visceral Angiography«/bu» «b»Intra-arterial (370 mg iodine/mL)«/b» - Volume and rate of administration based on blood flow and specific characteristics of vessels being studied - Maximum Dose for Procedure: 225 mL «bu»Cerebral Arteriography«/bu» - Intra-arterial (300 mg iodine/mL) - Maximum Dose for Procedure: 150 mL - Carotid Artery Visualization: 3 to 12 mL - Vertebral Artery Visualization: 4 to 12 mL - Aortic Arch Injection: 20 to 50 mL «bu»Coronary Arteriography and Left Ventriculography«/bu» «b»Intra-arterial (370 mg iodine/mL)«/b» - Maximum Dose for Procedure: 225 mL - Left Coronary: 3 to 14 mL - Right Coronary: 3 to 14 mL - Left Ventricle: 30 to 60 mL «bu»Peripheral Arteriography«/bu» «b»Intra-arterial (300 mg iodine/mL)«/b» - Maximum Dose for Procedure: 250 mL - Subclavian or Femoral Artery: 5 to 40 mL - Aortic Bifurcation for Distal Runoff: 25 to 50 mL «bu»Contrast-enhanced CT«/bu» «b»300 mg Iodine/mL«/b» «bi»Head«/bi» - 50 to 200 mL - Maximum Dose for Procedure: 200 mL «bi»Body«/bi» Bolus Injection - 50 to 200 mL - Maximum Dose for Procedure: 200 mL Rapid Infusion - 100 to 200 mL - Maximum Dose for Procedure: 200 mL «b»370 mg Iodine/mL«/b» «bi»Head«/bi» - 41 to 162 mL - Maximum Dose for Procedure: 162 mL «bi»Body«/bi» Bolus Injection - 41 to 162 mL - Maximum Dose for Procedure: 162 mL Rapid Infusion - 81 to 162 mL - Maximum Dose for Procedure: 162 mL «bu»Excretory Urography«/bu» «b»IV (300 mg iodine/mL)«/b» - 1 mL/kg in patients with normal renal function - Maximum Dose for Procedure: 100 mL «bu»Peripheral Venography«/bu» IV (240 mg iodine/mL): Minimum amount to clearly visualize the structure under examination - Maximum Dose for Procedure: 250 mL

Ipilimumab

Yervoy

«bu»Melanoma«/bu» «b»Unresectable or Metastatic«/b» - 3 mg/kg IV every 3 weeks - Maximum of 4 doses - Doses may be delayed due to toxicity, but all doses must be administered within 16 weeks of the initial dose. «bi»First Line Combination Therapy«/bi» - 3 mg/kg IV every 3 weeks x 4 doses (in combination with nivolumab; with nivolumab continued until disease progression or unacceptable toxicity) «bi»Adjuvant Treatment«/bi» - 10 mg/kg IV every 3 weeks x 4 doses THEN, - 10 mg/kg IV every 12 weeks for up to 3 years unless disease progression or unacceptable toxicity occur - If toxicity occurs, doses are omitted (not delayed) «bu»Small Cell Lung Cancer«/bu» «b»Progressive«/b» - 3 mg/kg IV every 3 weeks (in combination with nivolumab) x 4 doses THEN, - Nivolumab monotherapy «bu»Renal Cell Carcinoma«/bu» - In combination with nivolumab for patients with intermediate or poor risk, previously untreated advanced renal cell carcinoma - 1 mg/kg IV infused over 30 min immediately following nivolumab on the same day THEN, - Repeat every 3 Weeks for up to 4 doses or until intolerable toxicity or disease progression «b»Dermatologic Toxicity«/b» - Treat symptomatically for mild to moderate dermatitis (localized rash and pruritus); topical or systemic corticosteroids should be administered if not resolved within 1 week - Withhold ipilimumab for moderate to severe dermatologic symptoms - Permanently discontinue for Stevens-Johnson syndrome, toxic epidermal necrolysis, or rash complicated by dermal ulceration (full thickness) or necrotic, bullous, or hemorrhagic manifestations; also initiate systemic corticosteroids (prednisone 1 to 2 mg/kg/day or equivalent) - When dermatitis is controlled, taper corticosteroid over at least 1 month. «b»Endocrinopathy«/b» - Temporarily withhold ipilimumab for symptomatic endocrinopathy - Initiate systemic corticosteroids (prednisone at 1 to 2 mg/kg/day or equivalent), and begin appropriate hormone replacement therapy - Resume treatment in patients with complete or partial resolution of toxicity (≤ grade 1) and who are receiving prednisone <7.5 mg daily (or equivalent) - Permanently discontinue ipilimumab for symptomatic endocrinopathy lasting 6 weeks or longer, or if unable to reduce corticosteroid dose to prednisone ≤7.5 mg daily (or equivalent) «b»Gastrointestinal Toxicity«/b» «bi»Moderate Enterocolitis«/bi» - Withhold ipilimumab and administer antidiarrheal treatment - If moderate enterocolitis persists for >1 week, initiate systemic corticosteroids (prednisone at 0.5 mg/kg/day or equivalent) - May resume treatment in patients with complete or partial resolution of toxicity (≤ grade 1) and who are receiving prednisone <7.5 mg daily (or equivalent). «bi»Severe Enterocolitis«/bi» - Permanently discontinue - Initiate systemic corticosteroids (prednisone 1 to 2 mg/kg/day or equivalent). Upon improvement to ≤ grade 1, taper corticosteroids slowly over ≥1 month (rapid tapering may cause recurrence or worsen symptoms) - May consider adding anti-tumor necrosis factor (TNF) or other immunosuppressive therapy for management of immune-mediated enterocolitis unresponsive to 3 to 5 days of systemic corticosteroids or recurring after symptomatic improvement. «b»Neuropathy«/b» - Withhold therapy for moderate neuropathy (not interfering with daily activities). - Permanently discontinue for severe neuropathy which interferes with daily activities, such as Guillain-Barré-like syndromes - Consider initiating systemic corticosteroids (prednisone 1 to 2 mg/kg/day or equivalent) for severe neuropathies. «b»Ophthalmologic Toxicity«/b» - Administer corticosteroid eye drops for uveitis, iritis, or episcleritis. - Permanently discontinue for grade 2 through 4 immune-mediated reactions which do not improve to ≤ grade 1 within 2 weeks while receiving topical therapy or which require systemic treatment - Uveitis in combination with other immune-mediated adverse reactions may require systemic corticosteroids to reduce the risk of permanent visions loss. «b»Pancreatitis, Immune-mediated«/b» - Permanent discontinuation is recommended for grades 3 or 4 amylase or lipase increases «b»Other Toxicity«/b» - Temporarily withhold ipilimumab for grade 2 adverse reactions - May resume treatment in patients (with grade 2 toxicity) with complete or partial resolution of toxicity (≤ grade 1) and who are receiving prednisone <7.5 mg daily (or equivalent) - Initiate systemic corticosteroids (prednisone 1 to 2 mg/kg/day or equivalent) for severe immune-mediated adverse reactions - Permanently discontinue for clinically significant or severe immune-mediated adverse reactions, grade 2 reactions lasting 6 weeks or longer, grade 3 or 4 toxicity, or if unable to reduce corticosteroid dose to prednisone ≤7.5 mg daily (or equivalent)

Ipratropium Bromide (Nasal)

Atrovent

Ipratropium Bromide (Oral Inhalation)

Atrovent,

Ipratropium-Albuterol

DuoNeb, Combivent Respimat

Irbesartan

Avapro

Irbesartan-Hydrochlorothiazide

Avalide

Irinotecan (Conventional)

Camptosar, Camptothecin-11

Irinotecan (Liposomal)

Onivyde

«b»Premedication«/b» - Irinotecan (liposomal) is associated with a moderate emetic potential. - Premedicate with a corticosteroid and an antiemetic 30 minutes prior to infusion. Irinotecan (liposomal) and irinotecan (conventional) are NOT interchangeable. - Dosing differs between formulations; verify intended product and dose prior to preparation and administration. «bu»Pancreatic Adenocarcinoma«/bu» «b»Metastatic«/b» - 70 mg/m2 IV once every 2 weeks (in combination with fluorouracil and leucovorin) - Reduce initial starting dose to 50 mg/m2 IV in patients known to be homozygous for the UGT1A1*28 allele; the dose may be increased to 70 mg/m2 as tolerated in subsequent cycles. - Fluorouracil and leucovorin may also require dosage adjustment «b»Limitations of Use«/b» - Irinotecan (liposomal) is not indicated as a single agent for the treatment of metastatic adenocarcinoma of the pancreas. «b»Hematologic Toxicity«/b» «bi»ANC <1,500/mm3 or Neutropenic Fever«/bi» - Withhold treatment - Resume therapy when ANC ≥1,500/mm3 with a reduced dose for grade 3 or 4 neutropenia or neutropenic fever in subsequent cycles First Occurrence - Reduce dose to 50 mg/m2 (in patients receiving 70 mg/m2) - Reduce dose to 43 mg/m2 in patients homozygous for UGT1A1*28 without previous increase to 70 mg/m2 Second Occurrence - Reduce dose to 43 mg/m2 (in patients receiving 50 mg/m2) - Reduce dose to 35 mg/m2 in patients homozygous for UGT1A1*28 previously receiving 43 mg/m2 Third Occurrence - Discontinue «b»Non-hematologic Toxicity«/b» «bi»Anaphylactic Reaction«/bi» - Discontinue permanently «bi»Diarrhea«/bi» - Withhold therapy for grade 2 to 4 diarrhea - Administer IV or SubQ atropine 0.25 to 1 mg (unless clinically contraindicated) for early-onset diarrhea of any severity - Administer loperamide for late-onset diarrhea of any severity. Following recovery to ≤ grade 1 diarrhea, resume treatment at a reduced dose First Occurrence - Reduce dose to 50 mg/m2 (in patients receiving 70 mg/m2) - Reduce dose to 43 mg/m2 in patients homozygous for UGT1A1*28 without previous increase to 70 mg/m2 Second Occurrence - Reduce dose to 43 mg/m2 (in patients receiving 50 mg/m2); reduce dose to 35 mg/m2 in patients homozygous for UGT1A1*28 previously receiving 43 mg/m2 Third Occurrence - Discontinue «b»Interstitial lung disease (ILD)«/b» - Discontinue «b»Other Grade 3 or 4 Adverse Reactions«/b» - Withhold therapy - Upon recovery to ≤ grade 1 toxicity, resume treatment at a reduced dose First Occurrence - Reduce dose to 50 mg/m2 (in patients receiving 70 mg/m2) - Reduce dose to 43 mg/m2 in patients homozygous for UGT1A1*28 without previous increase to 70 mg/m2 Second Occurrence - Reduce dose to 43 mg/m2 (in patients receiving 50 mg/m2) - Reduce dose to 35 mg/m2 in patients homozygous for UGT1A1*28 previously receiving 43 mg/m2 Third Occurrence - Discontinue

Iron Dextran

Dexferrum, INFeD, Imferon

Iron Sucrose

Venofer, Ferric Saccharate

Isatuximab

Sarclisa

Isavuconazonium

Cresemba, Isavuconazole

Isocarboxazid

Marplan

«bu»Depression«/bu» - Initial Dose: 10 mg PO bid - May increase by 10 mg/day every 2 to 4 days to 40 mg/day by the end of the first week (divided into 2 to 4 doses) - After first week, may increase by up to 20 mg/week to a maximum of 60 mg/day. - May take 3 to 6 weeks to see effects - Dose should be reduced once maximum clinical effect is seen - If no response obtained within 6 weeks, additional titration is unlikely to be beneficial. - Use caution in patients on >40 mg/day; experience is limited. «b»Discontinuation of Therapy«/b» - Upon discontinuation of antidepressant therapy, gradually taper the dose to minimize the incidence of withdrawal symptoms and allow for the detection of re-emerging symptoms - Evidence supporting ideal taper rates is limited - APA and NICE guidelines suggest tapering therapy over at least several weeks with consideration to the half-life of the antidepressant; antidepressants with a shorter half-life and MAO inhibitors may need to be tapered more conservatively. In addition for long-term treated patients, WFSBP guidelines recommend tapering over 4-6 months. If intolerable withdrawal symptoms occur following a dose reduction, consider resuming the previously prescribed dose and/or decrease dose at a more gradual rate «b»Switching to or from an MAO Inhibitor Intended to Treat Psychiatric Disorders«/b» - Allow 14 days to elapse between discontinuing an alternative antidepressant without long half-life metabolites (eg, TCAs, paroxetine, fluvoxamine, venlafaxine) or MAO inhibitor intended to treat psychiatric disorders and initiation of isocarboxazid. - Allow 5 weeks to elapse between discontinuing fluoxetine (long half-life metabolites) intended to treat psychiatric disorders and initiation of isocarboxazid. - Allow at least 7 to 14 days to elapse between discontinuing isocarboxazid and initiation of an alternative antidepressant or MAO inhibitor intended to treat psychiatric disorders. «b»Use with Other MAO Inhibitors«/b» - Such as linezolid or IV methylene blue - Do not initiate isocarboxazid in patients receiving linezolid or IV methylene blue; consider other interventions for psychiatric condition. - If urgent treatment with linezolid or IV methylene blue is required in a patient already receiving isocarboxazid and potential benefits outweigh potential risks, discontinue isocarboxazid promptly and administer linezolid or IV methylene blue. Monitor for serotonin syndrome for 2 weeks or until 24 hours after the last dose of linezolid or IV methylene blue, whichever comes first - May resume isocarboxazid 24 hours after the last dose of linezolid or IV methylene blue.

Isometheptene

Isoniazid

Isonicotinic Acid Hydrazide, INH

«bu»Active Tuberculosis«/bu» - Drug susceptible «b»Once Daily Therapy«/b» - 5 mg/kg/dose (usual dose: 300 mg) once daily - The preferred frequency of administration is once daily during the intensive and continuation phases; however, 5-days per week administration by directly observed therapy (DOT) is an acceptable alternative. «b»Three-Times-Weekly DOT«/b» - 15 mg/kg/dose (usual dose: 900 mg) administered 3 times weekly «b»Twice-weekly DOT«/b» - 15 mg/kg/dose (usual dose: 900 mg) administered twice weekly «b»Once-weekly DOT«/b» - 15 mg/kg/dose (usual dose: 900 mg) administered once weekly «b»Regimens«/b» - Treatment regimens for pulmonary tuberculosis and tuberculous meningitis consist of an initial 2-month phase of a 4-drug regimen, followed by a continuation phase of an additional 4 to 7 months of isoniazid and rifampin for pulmonary tuberculosis and a continuation phase of an additional 7 to 10 months of isoniazid and rifampin for tuberculous meningitis (optimal duration is not defined although continuation phase must continue for a minimum of 7 additional months) - Adjunctive corticosteroid therapy (dexamethasone, prednisolone) tapered over 6 to 8 weeks is also recommended for tuberculous meningitis - Isoniazid frequency and dosing differs depending on treatment regimen selected; consult current Drug-sensitive TB guidelines «bu»Latent Infection Tuberculosis (LTBI)«/bu» - Concomitant administration of pyridoxine 10 to 50 mg daily is recommended in malnourished patients or those prone to neuropathy (eg, patients with HIV-infection, diabetes or chronic alcohol abusers). «b»Non-HIV Exposed/Infected«/b» - 5 mg/kg (maximum: 300 mg per dose) once daily for 6 or 9 months or 15 mg/kg (maximum: 900 mg per dose) twice weekly for 6 or 9 months. - 9 months is optimal; 6 months may be considered to reduce costs of therapy and improve adherence. «b»HIV-Exposed/-Infected on Antiretroviral Therapy«/b» - 5 mg/kg (maximum: 300 mg per dose) once daily for 9 months or 15 mg/kg (maximum: 900 mg per dose) twice weekly for 9 months. - LTBI treatment is recommended in HIV-infected patients testing positive for LTBI (but have no evidence of TB disease and no history of treatment for active or LTBI) or in HIV-infected close contacts of anyone who has infectious TB (regardless of screening tests for LTBI). - LTBI treatment is not associated with clinical benefit or recommended in HIV infected patients who are anergic and who have not had recent contact with anyone with infectious TB «bi»Alternate Regimen«/bi» - 15 mg/kg/dose (maximum 900 mg) once weekly in combination with rifapentine for 12 weeks. - The rifapentine-containing regimen may only be used in patients who are not pregnant and/or not expecting to become pregnant; if used in HIV-infected patients, it may only be used in otherwise healthy HIV-infected patients not receiving antiretroviral therapy (ART) (high risk of drug-drug interactions with rifapentine) «bu»Nontuberculous Mycobacterium«/bu» «bi»M. Kansasii«/bi» - 5 mg/kg/day (maximum: 300 mg daily) for duration to include 12 months of culture-negative sputum; typically used in combination with ethambutol and rifampin «bu»Tuberculosis, Active«/bu» - Excludes meningitis «b»Once Daily Therapy«/b» - The preferred frequency of administration is once daily during the intensive and continuation phases; however, 5-days-per-week administration by directly observed therapy (DOT) is an acceptable alternative. «bi»Infants, Children <15 years and ≤40 kg«/bi» - 10 to 15 mg/kg/dose once daily - Maximum Dose: 300 mg/dose «bi»Children <15 years and >40 kg and Adolescents ≥15 years«/bi» - 5 mg/kg/dose once daily - Typical Dose: 300 mg «b»Three-Times-Weekly DOT«/b» - Although suggested dosing based on experience with twice-weekly regimen; experts suggest 3-times-weekly regimens are more effective than twice-weekly DOT regimens; 3-times-weekly DOT may be used as part of an intensive phase and/or continuation phase dosing regimen; consult guidelines for specific information. «bi»Infants, Children and Adolescents <15 years, weighing ≤40 kg«/bi» - 20 to 30 mg/kg/dose 3 times weekly - Maximum Dose: 900 mg/dose; in adolescents, some experts would use 15 mg/kg/dose (maximum dose: 900 mg/dose) «bi»Children <15 years weighing >40 kg or Adolescents ≥15 years«/bi» - 15 mg/kg/dose 3 times weekly - Typical Dose: 900 mg «bu»Latent Tuberculosis Infection (LTBI)«/bu» «b»Preferred Regimen«/b» «bi»Infants and Children <12 years«/bi» - 10 to 20 mg/kg/day once daily - Maximum Dose: 300 mg per dose «bi»Children ≥12 years and Adolescents«/bi» - 10 to 20 mg/kg/day once daily - Maximum Dose: 300 mg per dose «b»Alternate Recommendations«/b» «bi»Infants and Children <12 years«/bi» - 20 to 40 mg/kg (maximum: 900 mg per dose) twice weekly for 9 months. - Once weekly regimen of isoniazid and rifapentine may also be considered in children ≥2 or <12 years if completion of 9 month regimen (preferred) is unlikely and the hazard of tuberculosis is great - 10 to 15 mg/kg/day once daily (maximum: 300 mg per dose) for 9 months «bi»Children ≥12 years«/bi» - 20 to 40 mg/kg (maximum: 900 mg per dose) twice weekly for 9 months - 15 mg/kg/dose (maximum: 900 mg per dose) once weekly in combination with rifapentine for 12 weeks - The rifapentine-containing regimen may be used in otherwise healthy HIV-infected patients, but only in patents not receiving antiretroviral therapy - 10 to 15 mg/kg/day once daily (maximum: 300 mg per dose) for 9 months

Isoproterenol

Isuprel, Isoprenaline

Isosorbide Dinitrate

Dilatrate-SR, Isordil, ISD, ISDN

Isosorbide Dinitrate-Hydralazine

BiDil

Isosorbide Mononitrate

Imdur, ISMN

ISOtretinoin

Absorica, Amnesteem, Claravis, Myorisan, Accutane

Isradipine

Dynacirc

Istradefylline

Nourianz

Itraconazole

Sporanox, Onmel, Tolsura

«bu»Life-threatening Fungal Infections«/bu» «b»Sporanox«/b» - Loading Dose: 200 mg (2 capsules) PO tid (600 mg/day) for the first 3 days, followed by recommended dosing based on indication «b»Tolsura«/b» - Loading Dose: 130 mg (2 x 65 mg capsules) PO tid (390 mg/day) for the first 3 days, followed by recommended dosing based on indication - Continue for a minimum of 3 months and until active fungal infection has subsided; an inadequate period of treatment may lead to recurrence of active infection «bu»Blastomycosis«/bu» - Treatment of blastomycosis, including pulmonary and extrapulmonary infections in immunocompromised and nonimmunocompromised adults «b»Sporanox«/b» - 200 mg PO daily - If no improvement, or evidence of progressive fungal disease, increase dose in 100-mg increments to a maximum of 400 mg/day - Divide doses >200 mg/day into 2 doses «b»Tolsura«/b» - 130 mg PO daily - If no improvement, or evidence of progressive fungal disease, increase dose in 65 mg increments to a maximum of 260 mg/day - Divide doses >130 mg/day into 2 doses «bu»Aspergillosis«/bu» - Treatment of pulmonary and extrapulmonary aspergillosis in immunocompromised and nonimmunocompromised adults who are intolerant of or refractory to amphotericin B therapy «b»Sporanox«/b» - 200-400 mg/day PO; may be used in combination with corticosteroids «b»Tolsura«/b» - 130 mg PO daily or BID «bu»Histoplasmosis«/bu» - Treatment of histoplasmosis, including chronic cavitary pulmonary disease and disseminated, nonmeningeal histoplasmosis in immunocompromised and nonimmunocompromised adults «b»Sporanox«/b» - 200 mg PO daily - If no improvement, or evidence of progressive fungal disease, increase dose in 100-mg increments to a maximum of 400 mg/day - Divide doses >200 mg/day into 2 doses «b»Tolsura«/b» - 130 mg PO daily - If no improvement, or evidence of progressive fungal disease, increase dose in 65 mg increments to a maximum of 260 mg/day (130 mg BID) - Divide doses >130 mg/day into 2 doses «bu»Onychomycosis«/bu» - Treatment of onychomycosis of the toenail due to Trichophyton rubrum or T. mentagrophytes in nonimmunocompromised patients «b»Fingernails«/b» «bi»Sporanox«/bi» - 2 treatment pulses, each consisting of 200 mg q12hr for 1 week - Pulses are separated by a 3-week period without Sporanox «b»Toenails, with or without Fingernail Involvement«/b» «bi»Sporanox, Onmel«/bi» - 200 mg/day PO for 12 weeks «bu»Esophageal Candidiasis«/bu» - Treatment of oropharyngeal and esophageal candidiasis - 100 mg (10 mL) PO daily for a minimum of 3 weeks - Continue treatment for 2 weeks following resolution of symptoms - Doses ≤200 mg/day (20 mL) may be used based on medical judgment of the patient’s response to therapy «bu»Oropharyngeal Candidiasis«/bu» «b»Oral Solution«/b» - 200 mg (20 mL) PO qDay for 1-2 weeks - Signs and symptoms of oropharyngeal candidiasis generally resolve within several days «b»Unresponsive/Refractory to Fluconazole«/b» - 100 mg (10 mL) PO bid - Clinical response will be seen in 2-4 weeks - May be expected to relapse shortly after discontinuing therapy - Limited data on safety of long-term use (>6 months) of oral solution are available at this time

Ivabradine

Corlanor

«bu»Congestive Heart Failure (CHF)«/bu» «b»Initial Dose«/b» - 5 mg PO bid - 2.5 mg PO bid in patients with a history of conduction defects or who may experience hemodynamic compromise due to bradycardia «b»Maintenance Dose«/b» - After 2 weeks, adjust dose to achieve a resting heart rate between 50 and 60 beats per minute (bpm) - Thereafter, adjust dose as needed based on resting heart rate and tolerability «b»Maximum Dose«/b» - 7.5 mg PO bid «b»Adjustment Based on Resting HR«/b» «bi»HR >60 bpm«/bi» - Increase dose by 2.5 mg PO bid - Maximum Dose: 7.5 mg PO bid «bi»HR: 50 to 60 bpm«/bi» - Maintenance Dose «bi»HR <50 bpm or Signs and Symptoms of Bradycardia«/bi» - Decrease dose by 2.5 mg PO bid - If current dose is 2.5 mg PO bid, discontinue therapy «bu»Inappropriate Sinus Tachycardia«/bu» «b»Initial Dose«/b» - 5 mg PO bid «b»Maintenance Dose«/b» - 7.5 mg PO bid - May also use in combination with a beta-blocker (metoprolol) in patients who are refractory to monotherapy «bu»Stable Angina«/bu» «b»Adults <75 years«/b» Initial Dose - 2.5 to 5 mg PO bid Maintenance Dose - Titrate up in increments of 2.5 mg after 3 to 4 weeks if symptoms persist and heart rate is greater than 60 bpm to a maximum dose of 7.5 mg twice daily - Discontinue therapy if angina symptoms do not improve within 3 months of initiation - Also consider discontinuation if improvement of angina symptoms is limited and no clinically significant heart rate reduction occurs in the first 3 months - If heart rate is lower than 50 bpm at rest or patient experiences symptomatic bradycardia (dizziness, fatigue, hypotension) during therapy, decrease dose by 2.5 mg per dose, or discontinue if already at the minimum dose of 2.5 mg twice daily. - Monitor heart rate carefully after dosage reduction - If heart rate continues to be lower than 50 bpm or symptoms of bradycardia persist, discontinue ivabradine - If symptoms are not controlled on beta-blocker or calcium channel blocker monotherapy, addition of ivabradine can be considered. If combined with a calcium channel blocker, use of a dihydropyridine (such as slow-release nifedipine, amlodipine, or felodipine) is suggested

Ivacaftor

Kalydeco

Ivermectin

Stromectol

Ivermectin (Topical)

Soolantra, Sklice

Ivosidenib

Tibsovo

«bu»Acute Myeloid Leukemia (AML)«/bu» «b»Newly Diagnosed AML«/b» - Treatment of newly-diagnosed AML with a susceptible isocitrate dehydrogenase-1 (IDH1) mutation as detected by an FDA-approved test in adults who are ≥75 years old or who have comorbidities that preclude use of intensive induction chemotherapy - 500 mg PO daily - Continue until disease progression or unacceptable toxicity; treat for a minimum of 6 months to allow time for clinical response «b»Relapsed or Refractory AML«/b» - 500 mg PO daily - Continue until disease progression or unacceptable toxicity; treat for a minimum of 6 months to allow time for clinical response «b»Missed Dose«/b» - If a dose is missed or not taken at the usual time, administer dose as soon as possible and at least 12 hr prior to the next scheduled dose - Return to normal schedule the following day; do not administer 2 doses within 12 hr «bi»Vomited Dose«/bi» - Do not administer replacement dose; wait to administer until next scheduled dose «b»Discontinue Permanently«/b» - Guillain-Barre syndrome - Life-threatening arrhythmia signs or symptoms «b»Differentiation Syndrome«/b» «bi»Suspected Differentiation Syndrome«/bi» - Administer systemic corticosteroids and initiate hemodynamic monitoring until symptom resolution and for a minimum of 3 days - Interrupt treatment if severe signs and/or symptoms persist for >48 hr after initiation of systemic corticosteroids - Resume treatment when signs and symptoms improve to ≤Grade 2 «b»Non-infectious Leukocytosis«/b» - WBC >25 x 10^9/L or an absolute increase in total WBC of >15 x 10^9/L from baseline - Initiate treatment with hydroxyurea, as per standard institutional practices, and leukapheresis if clinically indicated -Taper hydroxyurea only after leukocytosis improves or resolves - Interrupt treatment if leukocytosis unimproved with hydroxyurea; when leukocytosis resolved, resume treatment at 500 mg/day «b»QTc Interval Prolongation«/b» «bi»>480 to 500 msec«/bi» - Monitor and supplement electrolyte levels as clinically indicated - Review and adjust concomitant medications with known QTc interval-prolonging effects - Interrupt treatment - Restart at 500 mg qDay after the QTc interval returns to ≤480 msec - Monitor ECGs at least weekly for 2 weeks following resolution of QTc prolongation «bi»>500 msec«/bi» - Monitor and supplement electrolyte levels as clinically indicated - Review and adjust concomitant medications with known QTc interval-prolonging effects - Interrupt treatment - Restart at a reduced dose of 250 mg qDay after the QTc interval returns to ≤480 msec - Monitor ECGs at least weekly for 2 weeks following resolution of QTc prolongation - Consider re-escalating the dose to 500 mg qDay if an alternative etiology for QTc prolongation can be identified «b»Other Grade 3 or Higher Dose-related Toxicity«/b» - Interrupt treatment until toxicity resolves to ≤Grade 2 - Resume at 250 mg daily - May increase to 500 mg qDay if toxicities resolve to ≤Grade 1 - If Grade 3 or higher toxicity recurs, discontinue treatment «b»Strong CYP3A4«/b» - If strong CYP3A4 inhibitor must be coadministered, reduce dose to 250 mg/day - If strong CYP3A4 inhibitor discontinued, wait at least 5 half-lives of the strong CYP3A4 inhibitor, and then increase to recommended dose of 500 mg/day

Ixabepilone

Ixempra, Azaepothilone B, Epothilone B Lactam

Ixazomib

Ninlaro

Ixekizumab

Taltz

Japanese Encephalitis Virus Vaccine (Inactivated)

Ixiaro

«b»IM Administration«/b» - For IM injection - Do not inject IV, SC, or intradermally - Shake well prior to use to form a homogeneous suspension - Do not use if discolored or if particulate matter remains - Do not mix with other vaccines or injections; separate needles and syringes should be used for each injection. - When administering to children 2 to 11 months of age, the preferred site for administration is the anterolateral aspect of the thigh; for children 1 to <3 years of age, the anterolateral aspect of the thigh or deltoid muscle may be used (if mass is adequate); the deltoid muscle is the preferred site in children ≥3 years, adolescents, and adults. To prevent syncope related injuries, adolescents and adults should be vaccinated while seated or lying down. - Ixiaro is available only in a prefilled syringe containing 0.5 mL. In order to administer a 0.25 mL dose in children 2 months to <3 years, first shake the syringe to form a homogenous suspension. Attach a sterile needle to the prefilled syringe and while holding the syringe upright, discard 0.25 mL of the suspension. Attach a new sterile needle prior to administration. - Avoid IM administration in patients with bleeding disorders (eg, thrombocytopenia, hemophilia) and suggests that SC administration may be considered in these patients. Clinical efficacy data regarding this route is lacking and the U.S. labeling does not recommend SC administration. For patients at risk of hemorrhage following intramuscular injection, the vaccine should be administered intramuscularly if, in the opinion of the physician familiar with the patient's bleeding risk, the vaccine can be administered by this route with reasonable safety. If the patient receives antihemophilia or other similar therapy, intramuscular vaccination can be scheduled shortly after such therapy is administered. A fine needle (23 gauge or smaller) can be used for the vaccination and firm pressure applied to the site (without rubbing) for at least 2 minutes. The patient should be instructed concerning the risk of hematoma from the injection. Patients on anticoagulant therapy should be considered to have the same bleeding risks and treated as those with clotting factor disorders

Kanamycin

Kantrex

Ketamine

Ketalar

- May administer atropine, scopolamine, or another drying agent prior to induction and at appropriate intervals to decrease hypersalivation - Titrate dose for desired effect. «bu»Anesthesia«/bu» «b»Induction Dose«/b» - 6.5 to 13 mg/kg IM x 1 dose - 1 to 4.5 mg/kg IV x 1 dose «bi»Alternate Recommendations«/bi» - Lower doses may be used if adjuvant drugs (midazolam) are administered - 4 to 10 mg/kg IM x 1 dose - 0.5 to 2 mg/kg IV x 1 dose «b»Maintenance of Anesthesia«/b» - May administer supplemental doses of one-half to the full induction dose or a continuous infusion of 0.1 to 0.5 mg/minute (per manufacturer) - To maintain an adequate concentration of ketamine for maintenance of anesthesia, 1 to 2 mg/minute has been recommended - Doses in the range of 15 to 90 mcg/kg/minute (~1 to 6 mg/minute in a 70-kg patient) have also been suggested «bu»Analgesia«/bu» «b»Sub-anesthetic Dosing«/b» «bi»Acute Pain«/bi» - 0.5 to 1 mg/kg intranasal x 1 dose - May repeat 0.25 to 0.5 mg/kg, if necessary, in 10 to 15 minutes «bi»Chronic Pain«/bi» - 10 mg intranasal every 90 seconds as needed until a maximum total dose of 50 mg is reached or pain relieved «bi»IV Infusion«/bi» Initial Dose - 0.5 mg/kg IV over 6 hours Titrate Dose - If pain improved by 50% or more after completion of initial dose, then, continue infusion at 1.5 mg/kg/24 hours for 48 hours. - If pain not improved after completion of initial dose, increase to 2 mg/kg over 12 hours - If pain recurs after initial improvement, titrate upwards by 50% to 100% every 24 hours as needed. Discontinue infusion if pulse >110 bpm, SBP increases >25% of baseline, sustained respiratory rate <7, agitation or severe psychotomimetic effects «bi»Oral«/bi» Initial Dose - 0.5 mg/kg PO x 1 dose to evaluate effect on pain and duration of effect Titer Dose - May increase dose in increments of 0.5 mg/kg as appropriate - For a continuous analgesic effect, may administer 3 to 4 times daily «bu»Severe Neuropathic Pain«/bu» - 2.3 to 6.7 mcg/kg/minute continuous IV or SC Infusion (equivalent to 0.14 to 0.4 mg/kg/hour) «bu»Postoperative Opioid Sparing«/bu» - 2 to 4 mg/kg IM x 1 dose - May follow with a continuous infusion if necessary. - 0.2 to 0.8 mg/kg IV x 1 dose - Maximum Bolus Dose: of 50 mg - May follow bolus dose with a continuous infusion if necessary. - 2 mcg/kg/minute continuous IV infusion (equivalent to 0.12 mg/kg/hour) «b»Critically ill Patients«/b» - As an adjunct to an opioid analgesic for non-neuropathic pain - Initial Dose: 0.1 to 0.5 mg/kg IV bolus; followed by, - 0.83 to 6.7 mcg/kg/minute continuous IV infusion (equivalent to 0.05 to 0.4 mg/kg/hour) «bu»Procedural Sedation/Analgesia«/bu» «b»IM Route«/b» - The IV route is preferred; however if IV route unavailable, may administer 4 to 5 mg/kg IM as a single dose - May give a repeat dose (range: 2 to 5 mg/kg) if sedation inadequate after 5 to 10 minutes or if additional doses are required - May consider prophylactic use of a benzodiazepine (eg, midazolam) before ketamine administration to reduce the risk of emergence reactions «b»IV Route«/b» - 1 to 2 mg/kg (usual adult dose: 100 mg) over 1 to 2 minutes - May consider prophylactic use of a benzodiazepine (midazolam) before ketamine administration to reduce the risk of emergence reactions - If initial sedation inadequate or repeated doses are necessary to accomplish a longer procedure, may administer incremental doses of 0.5 to 1 mg/kg every 5 to 15 minutes as needed «bu»Status Epilepticus«/bu» «b»Loading Dose«/b» - 1.5 mg/kg IV bolus x 1 dose «b»Maintenance Dose«/b» - 0.05 to 0.1 mg/kg/hr IV infusion «bu»Alcohol Withdrawal«/bu» «b»Loading Dose«/b» - 3 mg/kg IV bolus x 1 dose «b»Maintenance Dose«/b» - 0.15 to 0.3 mg/kg/hr IV infusion «bu»Acute Agitation«/bu» «b»Loading Dose«/b» - 0.25 to 0.5 mg/kg IV bolus x 1 dose «b»Maintenance Dose«/b» - 1 to 2 mg/kg/hr IV infusion OR - 3 to 5 mg/kg IM «bu»Status Asthmaticus«/bu» «b»Loading Dose«/b» - 0.1 mg/kg IV x 1 dose over 5 minutes «b»Maintenance Dose«/b» - 0.5 mg/kg/hr IV infusion - May administer atropine, scopolamine, or another drying agent prior to induction and at appropriate intervals to decrease hypersalivation. «bu»Anesthesia«/bu» «b»Pre-anesthetic Sedation«/b» «bi»Infants ≥6 months«/bi» - 3 mg/kg/dose (half dose per nostril) intranasal administered at least 15 minutes prior to mask induction «bi»Children <2 years«/bi» - 3 to 5 mg/kg/dose (half dose per nostril) intranasal administered at least 15 minutes prior to mask induction «bi»Children 2 to 7 years«/bi» - 3 to 6 mg/kg/dose (half dose per nostril) intranasal administered 15 to 40 minutes prior to induction «bi»Children ≤8 years«/bi» - 6 to 8 mg/kg/dose PO 20 to 30 minutes prior to surgery «bi»Infants 2 to 6 months«/bi» - 8 mg/kg/dose PR x 1 dose «bi»Infants ≥7 months and Children«/bi» - 8 to 10 mg/kg/dose PR x 1 dose administer 15 to 45 minutes prior to surgery as a single agent - When used in combination with midazolam, a lower rectal dose of 3 mg/kg/dose has been effective «b»Induction of Anesthesia«/b» «bi»Infants ≥3 months, Children <16 years«/bi» - 5 to 10 mg/kg IM x 1 dose - 1 to 3 mg/kg IV x 1 dose «bi»Adolescents ≥16 years«/bi» - 6.5 to 13 mg/kg IM x 1 dose - 1 to 4.5 mg/kg IV x 1 dose «b»Maintenance of Anesthesia«/b» «bi»Adolescents ≥16 years«/bi» - May administer supplemental doses of one-half to the full induction dose as needed. «bu»Endotracheal Intubation«/bu» «b»Infants, Children, and Adolescents«/b» - 1 to 2 mg/kg IV as part of rapid sequence sedation «bu»Procedural Sedation/Analgesia«/bu» «b»Infants, Children, and Adolescents«/b» - Due to risk of airway obstruction, laryngospasm, and apnea, ACEP only recommends use in patients ≥3 months of age «b»Ketamine without Propofol«/b» - 4 to 5 mg/kg IM x 1 dose - May give a repeat dose (range: 2 to 5 mg/kg) if sedation inadequate after 5 to 10 minutes or if additional doses are required - Some have recommended smaller doses (2 to 2.5 mg/kg) for minor procedures (eg, wound suture with local anesthetic) - 1 to 2 mg/kg IV over 30 to 60 seconds. - If initial sedation inadequate or repeated doses are necessary to accomplish a longer procedure, may administer additional doses of 0.5 to 1 mg/kg every 5 to 15 minutes as needed «bi»Infants ≥3 months and Children«/bi» - 3 to 6 mg/kg (half dose per nostril) intranasal x 1 dose «bi»Children and Adolescents«/bi» - 3 to 5 mg/kg PO with midazolam 30 to 45 minutes before procedure - A higher dose (10 mg/kg) has been used successfully as monotherapy prior to procedures «bi»Children 1 to 8 years«/bi» - 1.5 to 3 mg/kg PR with midazolam as a single dose 20 minutes prior to painful procedure «b»Ketamine without Propofol«/b» «bi»Infants ≥3 months, Children, Adolescents«/bi» - 0.5 to 0.75 mg/kg IV of each agent - This combination has been used to decrease the dose of each agent required

Ketoconazole

Nizoral

Ketoconazole (Topical)

Extina, Ketodan, Xolegel, Nizoral

Ketoprofen

Orudis KT, Oruvail, Frotek, Ketophene Rapidpaq

Ketorolac

Toradol

Ketorolac (Nasal)

Sprix

Ketorolac (Ophthalmic)

Acular, Acular LS, Acuvail

Ketotifen (Ophthalmic)

Zaditor, ZyrTEC Itchy Eye, Claritin Eye, TheraTear

Labetalol

Trandate, Normodyne

«bu»Hypertension«/bu» «b»Initial PO Dose«/b» - 100 mg PO bid «b»Maintenance PO Dose«/b» - May increase as needed every 2 to 3 days by 100 mg PO bid - Titration increments not to exceed 200 mg twice daily until desired response is obtained «b»Usual Dosage PO Range«/b» - 100 to 300 mg PO bid - May require up to 2,400 mg daily «bu»Hypertensive Emergency/Urgency«/bu» «b»Initial IVP Dose«/b» - 10 to 20 mg IV push over 2 minutes - May administer additional injections using double the dose at 10-min intervals until target SBP is reached «b»Maximum IVP Dose«/b» - 80 mg/dose «b»Total Maximum IVP Dose«/b» - 300 mg «b»Initial IV Infusion Dose«/b» - 0.5 to 2 mg/minute - Some patients may require doses within the range of 2 to 10 mg/minute «bu»Arterial Hypertension in Intracranial Hemorrhage«/bu» «b»Initial IVP Dose«/b» - 5 to 20 mg IV push over 2 minutes - May administer additional doses every 15 minutes until target SBP is reached «b»Total Maximum IVP Dose«/b» - 300 mg «b»Initial IV Infusion Dose«/b» - 0.5 to 2 mg/minute «bu»Hypertensive Emergency in Pregnancy«/bu» - SBP ≥160 mm Hg or DBP≥110 mm Hg «b»Initial IVP Dose«/b» - 20 mg IV push over 2 minutes - May increase dose every 10 minutes in increments of 20 to 40 mg to a maximum single dose of 80 mg «b»Maximum Total Cumulative Dose«/b» - 300 mg is recommended - After the initial dose, may initiate a continuous infusion of 1 to 2 mg/minute instead of intermittent dosing «bu»Subarachnoid Hemorrhage«/bu» «b»Initial IVP Dose«/b» - 5 to 40 mg IV push - May increase to 20 to 80 mg every 10 minutes up to a maximum of 300 mg followed by a continuous IV infusion «b»Continuous IV Infusion«/b» - 0.5 to 2 mg/minute; based on very limited information «b»IV to Oral Conversion«/b» - Upon discontinuation of IV infusion, may initiate oral dose of 200 mg followed in 6 to 12 hours with an additional dose of 200 to 400 mg - Thereafter, dose patients with 400 to 2,400 mg/day in divided doses depending on blood pressure response.

Lacosamide

Vimpat

Lactase

Lactrase, Lac-Dose, Lactaid, Surelac

Lactulose

Kristalose, Constulose, Enulose, Generlac

LamiVUDine

Epivir, Epivir HBV, 3TC

«bu»HIV-1 Infection«/bu» «b»Combination with Other Antiretroviral Agent«/b» - 150 mg PO bid - 300 mg PO once daily - Lamivudine is a component of recommended initial regimens for any ART-naive patient (when coadministered with tenofovir plus dolutegravir or with tenofovir plus raltegravir) or for ART-naive patients who are HLA-B*5701 negative (when coadministered with abacavir plus dolutegravir) «bu»HIV-1 Nonoccupational Postexposure Prophylaxis (nPEP)«/bu» - Initiate therapy within 72 hours of exposure and continue for 28 days; use in combination with other antiretroviral agents. «b»CrCl ≥60 mL/minute«/b» - Lamivudine is not a component of the recommended antiretroviral regimens for these patients. «b»CrCl <60 mL/minute«/b» - Dose should be adjusted based on renal function «bu»Hepatitis B Treatment«/bu» - 100 mg PO once daily - Treatment duration for nucleos(t)ide analog-based therapy (lamivudine) is variable and influenced by HBeAg status, duration of HBV suppression, and presence of cirrhosis/decompensation «b»Patients without Cirrhosis«/b» «bi»Hepatitis B e Antigen (HBeAg) Positive Immune-active Chronic Hepatitis«/bi» - Treat until HBeAg seroconversion; after seroconversion, prolonged duration of therapy is often required in patients treated with nucleos(t)ide analogues. Optimal duration is unknown; however, consolidation therapy is generally a minimum of 12 months of persistently normal ALT and undetectable serum HBV DNA levels after HBeAg seroconversion «bi»HBeAg-negative Immune-active Chronic Hepatitis«/bi» - Indefinite antiviral therapy is suggested unless there is competing rationale for discontinuation (risk/benefit decision); treatment discontinuation may be considered in patients with loss of HBsAg; however, there is insufficient evidence to guide decisions in these patients. «b»Patients with Cirrhosis«/b» «bi»HBeAg-positive Immune-active Chronic Hepatitis«/bi» - In patients who seroconvert on therapy, continue antiviral therapy indefinitely due to concerns with decompensation and death, unless there is a strong competing rationale for discontinuation. «bi»HBeAg-negative Immune-active Chronic Hepatitis«/bi» - Treatment discontinuation is not recommended due to potential for decompensation and death (limited data). «b»Viral Breakthrough«/b» - Patients with confirmed viral breakthrough (HBV DNA ≥100 units/mL with previously undetectable levels [<10 units/mL] or >1 log increase in HBV DNA) should either be switched to an alternative antiviral monotherapy agent with a high genetic barrier to resistance or receive a second antiviral agent with a complementary resistance profile; consult current clinical practice guidelines for recommended agents «bu»Treatment of Hepatitis B/HIV Coinfection«/bu» - 150 mg twice daily or 300 mg once daily, in combination with other antiretrovirals in an antiretroviral (ARV) regimen

Lamivudine-Zidovudine

Combivir, AZT + 3TC

LamoTRIgine

LaMICtal

Lanadelumab

Takhzyro

Lanolin

Lan-O-Soothe

Lanreotide

Somatuline

Lansoprazole

Prevacid

«bu»Symptomatic GERD«/bu» «b»Short-term Treatment«/b» - 15 mg PO once daily for up to 8 weeks «bu»Erosive Esophagitis«/bu» «b»Short-term Treatment«/b» - 30 mg PO once daily for up to 8 weeks - Continued treatment for an additional 8 weeks may be considered for recurrence or for patients who do not heal after the first 8 weeks of therapy - Maintenance Therapy: 15 mg PO once daily «bu»Hypersecretory Conditions«/bu» - Initial Dose: 60 mg PO once daily - Adjust dose based upon patient response and to reduce acid secretion to <10 mEq/hour (5 mEq/hour in patients with prior gastric surgery) - Doses of 90 mg twice daily have been used - Administer doses >120 mg/day in divided doses «bu»Peptic Ulcer Disease (PUD)«/bu» «b»Duodenal Ulcer«/b» - 15 mg once daily for 4 weeks - Maintenance therapy: 15 mg once daily «b»Gastric Ulcer«/b» - 30 mg PO once daily for up to 8 weeks - Some clinical trial data suggests a dose of 15 mg once daily for up to 8 weeks may also be effective. «bu»Helicobacter Pylori (H. Pylori) Eradication«/bu» - 30 mg PO 3 times daily administered with amoxicillin 1,000 mg 3 times daily for 14 days - 30 mg twice daily administered with amoxicillin 1,000 mg and clarithromycin 500 mg twice daily for 10 to 14 days «b»Clarithromycin Triple Regimen«/b» - 30 to 60 mg twice daily in combination with clarithromycin 500 mg twice daily and either amoxicillin 1 g twice daily or metronidazole 500 mg 3 times per day for 14 days. «b»Sequential Regimen«b» - 30 mg twice daily plus amoxicillin 1 g twice daily for 5 to 7 days; then, - Clarithromycin 500 mg twice daily, either metronidazole or tinidazole 500 mg twice daily, and lansoprazole 30 mg twice daily for 5 to 7 days «b»Levofloxacin Triple Regimen«/b» - 30 mg twice daily in combination with amoxicillin 1 g twice daily and levofloxacin 500 mg once daily for 10 to 14 days «b»Bismuth Quadruple Regimen«/b» - 30 mg twice daily in combination with tetracycline 500 mg 4 times daily, metronidazole 250 mg 4 times daily or 500 mg 3 or 4 times daily, and either bismuth subcitrate 120 to 300 mg 4 times daily or bismuth subsalicylate 300 mg 4 times daily for 10 to 14 days «b»Concomitant Regimen«/b» - 30 mg twice daily in combination with amoxicillin 1 g twice daily, clarithromycin 500 mg twice daily, and either metronidazole or tinidazole 500 mg twice daily for 10 to 14 days «b»Hybrid Regimen«/b» - 30 mg twice daily plus amoxicillin 1 g twice daily for 7 days; then follow with amoxicillin 1 g twice daily, clarithromycin 500 mg twice daily, either metronidazole or tinidazole 500 mg twice daily, and lansoprazole 30 mg twice daily for 7 days «bu»NSAID Associated Gastric Ulcer«/bu» «b»Healing«/b» - 30 mg once daily for 8 weeks «b»Reduce Risk«/b» - 15 mg once daily for up to 12 weeks «bu»Heartburn«/bu» - 15 mg PO once daily for 14 days - May repeat 14 days of therapy every 4 months - Do not take for >14 days or more often than every 4 months «bu»Stress Ulcer Prophylaxis in Critically-Ill Patients«/bu» - 30 mg PO once daily - Intended for patients with associated risk factors (eg, coagulopathy, mechanical ventilation for >48 hours, sepsis/septic shock); discontinue use once risk factors have resolved - Administer before food; best if taken before breakfast - The intact granules should not be chewed or crushed; however, several options are available for those patients unable to swallow capsules - Capsules may be opened and the intact granules sprinkled on 1 tablespoon of applesauce, Ensure pudding, cottage cheese, yogurt, or strained pears. The granules should then be swallowed immediately. - Capsules may be opened and emptied into ~60 mL orange juice, apple juice, or tomato juice; mix and swallow immediately. Rinse the glass with 2 or more volumes of juice and swallow immediately to assure complete delivery of the dose. «b»Orally Disintegrating Tablets (ODT) Administration«/b» - Should not be swallowed whole, broken, cut, or chewed. Place tablet on tongue; allow to dissolve (with or without water) until particles can be swallowed. Orally-disintegrating tablets may also be administered via an oral syringe: Place the 15 mg tablet in an oral syringe and draw up ~4 mL water, or place the 30 mg tablet in an oral syringe and draw up ~10 mL water. After tablet has dispersed, administer within 15 minutes. Refill the syringe with water (2 mL for the 15 mg tablet; 5 mL for the 30 mg tablet), shake gently, then administer any remaining contents. «b»Nasogastric Tube Administration«/b» - Capsule can be opened, the granules mixed (not crushed) with 40 mL of apple juice and then administered through the NG tube into the stomach, then flush tube with additional apple juice. Do not mix with other liquids. Thirty milligrams has also been suspended in 10 mL of 8.4% sodium bicarbonate solution (or apple juice) or divided into 4 equal parts and flushed with water and administered via NG tube - Nasogastric tube ≥8 French: Place a 15 mg tablet in a syringe and draw up ~4 mL water, or place the 30 mg tablet in a syringe and draw up ~10 mL water. After tablet has dispersed, administer within 15 minutes (gently shake syringe immediately prior to administration). Refill the syringe with ~5 mL water, shake gently, and then flush the nasogastric tube. «b»Oral Suspension (3 mg/mL) Preparation«/b» - A 3 mg/mL oral solution may be made with capsules and sodium bicarbonate. Empty the contents of ten lansoprazole 30 mg capsules into a beaker. Add 100 mL sodium bicarbonate 8.4% and gently stir until dissolved (about 15 minutes). Transfer solution to an amber-colored syringe or bottle. A prior study showed that SLS was stable for 8 hours at room temperature or for 14 days refrigerated. However, a more recent study, demonstrated SLS to be stable for 48 hours at room temperature in oral syringes and for only 7 days when refrigerated

Lanthanum Carbonate

Fosrenol

Lapatinib

Tykerb

Laronidase

Aldurazyme

«bu»IV Administration«/bu» - Administer using an infusion set with low protein-binding and 0.2 micrometer in-line filter - Antipyretics and/or antihistamines should be administered 60 minutes prior to infusion. - Volume and infusion rate are based on body weight; deliver infusion over ~3 to 4 hours. - An initial 10 mcg/kg/hour infusion rate may be incrementally increased every 15 minutes during the first hour if tolerated. - Increase to a maximum infusion rate of 200 mcg/kg/hour which is maintained for the remainder of the infusion (~3 hours) - Vital signs should be monitored every 15 minutes, if stable; in case of infusion-related reaction in any patient, decrease the rate of infusion, temporarily discontinue the infusion, and/or administer additional antipyretics/antihistamines. «b»IV Infusion Rate«/b» «bi»≤20 kg: Total Infusion Volume: 100 mL«/bi» - 2 mL/hour for 15 minutes - 4 mL/hour for 15 minutes - 8 mL/hour for 15 minutes - 16 mL/hour for 15 minutes - 32 mL/hour for remainder of infusion (~3 hours) «bi»>20 kg: Total Infusion Volume: 250 mL«/bi» - 5 mL/hour for 15 minutes - 10 mL/hour for 15 minutes - 20 mL/hour for 15 minutes - 40 mL/hour for 15 minutes - 80 mL/hour for remainder of infusion (~3 hours) - A total infusion volume of 100 mL NS and slower infusion rate may be considered for patients with cardiac or respiratory compromise who weigh up to 30 kg. «bu»IV Preparation«/bu» - Determine the number of vials to dilute by calculating the required dose and rounding up to the nearest whole vial. - Allow vials to come to room temperature prior to admixture. - Do not use if the solution is discolored or contains particulate matter. - Prepare the infusion using a low protein-binding container (there is no compatibility information of diluted laronidase in glass containers). - Total volume of infusion is determined by body weight. - For patients weighing ≤20 kg (or weighing up to 30 kg and with cardiac or respiratory compromise), dilute the required dose in 100 mL NS; for patients weighing >20 kg, dilute required dose in 250 mL NS. - Remove and discard a volume of NS from the infusion bag equal to the volume of the calculated dose of laronidase. - Slowly withdraw from vial(s) and slowly add laronidase to the NS; avoid excessive agitation; do not use filter needle. - Gently rotate infusion bag to mix (do not shake).

Larotrectinib

Vitrakvi

Lasmiditan

Reyvow

Latanoprost

Xalatan

Latanoprost-Netarsudil

Rocklatan

Latanoprostene Bunod (Ophthalmic)

Vyzulta

Latrodectus Antivenom

Antivenin Black Widow Spider

«bu»Latrodectus Mactans (Black Widow Spider) Envenomation Treatment«/bu» - Reconstitute one IV vial with NS or D5W (50-100 mL) infuse over 20-30 minutes - The initial dose of antivenin should be administered as soon as possible for prompt relief of symptoms - IM administered in anterolateral thigh: 1 vial reconstituted with 2.5 mL of sterile water - May require 2nd dose if there is no response within 1 hour or patient weighs >40 kg - Delayed antivenin administration may still be effective in treating patients with prolonged or refractory symptoms resulting from black widow spider bites (case report of antivenin administration up to 90 hours after bite) «b»Positive Reaction and Premedication«/b» - If a positive reaction to a skin or conjunctival test occurs and antivenin therapy is necessary, pretreat the patient with intravenous diphenhydramine and an H2-blocker while having a syringe of epinephrine (1 mg/mL) at the bedside «b»Sensitivity Testing«/b» - Skin testing may identify allergic individuals, but the lack of an initial reaction does not eliminate the possibility of a hypersensitivity reaction; therefore, always be prepared to treat an unanticipated hypersensitivity reaction - Intradermal skin test or conjunctival test may be performed prior to antivenin administration: «bi»Skin Test«/bi» - Intradermal: Up to 0.02 mL of a 1:10 dilution of normal horse serum in NS - Evaluate after 10 minutes against a control test (intradermal injection of NS) - A positive reaction is an urticarial wheal surrounded by a zone of erythema. «bi»Conjunctival Test«/bi» - Instill 1 drop of a 1:10 dilution of normal horse serum into the conjunctival sac - Itching of the eye and/or reddening of conjunctiva indicates a positive reaction, usually occurring within 10 minutes. «b»Desensitization«/b» - In separate vials or syringes, prepare 1:10 and 1:100 dilutions of antivenin in NS. «bi»SC Route«/bi» - Inject 0.1 mL, 0.2 mL, and 0.5 mL of the 1:100 dilution at 15- to 30- minute intervals - During this procedure, proceed with the next dose only if a reaction has NOT occurred following the previous dose - Repeat procedure using the 1:10 dilution and then undiluted antivenin - If no reaction has occurred following administration of 0.5 mL of undiluted antivenin, continue the dose at 15-minute intervals until the entire dose has been administered. - If a reaction occurs, apply a tourniquet proximal to the injection site and administer epinephrine (1 mg/mL) SC or IV proximal to the tourniquet or into another extremity. Wait at least 30 minutes; then administer another antivenin injection at the previous dilution which did not evoke a reaction.

Lecanemab-irmb

Leqembi

«b»IV Administration«/b» - Visually inspect the diluted solution for particles or discoloration prior to administration - Do NOT use if it is discolored, or opaque or foreign particles are seen - Prior to infusion, allow the LEQEMBI diluted solution to warm to room temperature. - Infuse the entire volume of the diluted solution IV over approximately one hour through an IV line containing a terminal low-protein binding 0.2 micron in-line filter. - Flush infusion line to ensure all is administered - Monitor for any signs or symptoms of an infusion-related reaction - The infusion rate may be reduced, or the infusion may be discontinued, and appropriate therapy administered as clinically indicated - Consider pre-medication at subsequent dosing with antihistamines, non-steroidal anti-inflammatory drugs, or corticosteroids «b»IV Preparation«/b» - Must be diluted in 250 mL of NS prior to administration - Use aseptic technique when preparing the diluted solution for IV infusion. - Calculate the dose (mg), the total volume (mL) and the number of vials needed based on the patient’s actual body weight and the recommended dose of 10 mg/kg - Parenteral drug products should be inspected visually for particulate matter and discoloration prior to administration, whenever solution and container permit - Check that the solution is clear to opalescent and colorless to pale yellow - Do not use if opaque particles, discoloration, or other foreign particles are present. - Remove the flip-off cap from the vial - Insert the sterile syringe needle into the vial through the center of the rubber stopper. - Withdraw the required volume from the vial(s) and add to an infusion bag containing 250 mL of 0.9% NS - Each vial is for one time-use only. Discard any unused portion. - Gently invert the infusion bag containing the diluted solution to mix completely. Do not shake. - After dilution, immediate use is recommended - If not administered immediately, store refrigerated at 2°C to 8°C (36°F to 46°F) for up to 4 hours, or at room temperature up to 30°C (86°F) for up to 4 hours. Do not freeze.

Ledipasvir

Ledipasvir-Sofosbuvir

Harvoni

Lefamulin

Xenleta

Leflunomide

Arava

Lemborexant

Dayvigo

Lenalidomide

Revlimid

Leniolisib

Joenja

Lenvatinib

Lenvima

«b»Premedication«/b» - Lenvatinib is associated with a moderate emetic potential - Antiemetics are recommended to prevent nausea and vomiting «bu»Renal Cell Carcinoma«/bu» «b»Advanced«/b» - 18 mg PO once daily (in combination with everolimus) - Continue until disease progression or unacceptable toxicity «bu»Thyroid Cancer«/bu» «b»Differentiated«/b» - 24 mg PO once daily until disease progression or unacceptable toxicity «bu»Hepatocellular Carcinoma«/bu» «b»Advanced«/b» «bi»Weight ≥60 kg«/bi» - 12 mg PO once daily «bi»Weight <60 kg«/bi» -8 mg PO once daily «b»Missed Doses«/b» - Do not take a missed dose within 12 hours of the next dose (if within 12 hours, skip the missed dose and return to regular administration time). «b»Dose Modifications«/b» - Persistent and intolerable grade 2 or grade 3 adverse reactions or grade 4 laboratory abnormalities «b»Renal Cell Cancer, Advanced«/b» «bi»First Occurrence«/bi» - Interrupt therapy until resolved to ≤ grade 1 or baseline, then, - Resume dosing at 14 mg once daily «bi»Second Occurrence (same or different toxicity)«/bi» - Interrupt therapy until resolved to ≤ grade 1 or baseline, then, - Resume dosing at 10 mg once daily. «b»Third Occurrence (same or different toxicity)«/bi» - Interrupt therapy until resolved to ≤ grade 1 or baseline, then resume dosing at 8 mg once daily. - For toxicities related only to everolimus, reduce frequency to every other day or interrupt or discontinue everolimus (refer to everolimus monograph for dosage adjustment for toxicity).For toxicities related to both lenvatinib and everolimus, first reduce lenvatinib, and then everolimus. «b»Thyroid Cancer, Differentiated«/b» «bi»First Occurrence«/bi» - Interrupt therapy until resolved to ≤ grade 1 or baseline, then, - Resume dosing at 20 mg once daily «bi»Second Occurrence (same or different toxicity)«/bi» - Interrupt therapy until resolved to ≤ grade 1 or baseline, then, - Resume dosing at 14 mg once daily «bi»Third Occurrence (same or different toxicity)«/bi» - Interrupt therapy until resolved to ≤ grade 1 or baseline, then, - Resume dosing at 10 mg once daily «b»Arterial Thrombotic Event«/b» - Discontinue therapy - Do not resume «b»Cardiac«/b» «bi»Cardiac Dysfunction«/bi» - Temporarily interrupt therapy for a grade 3 event until improved to ≤ grade 1 or baseline - Depending on severity and persistence of toxicity, may either resume therapy at a reduced dose or discontinue treatment - Discontinue for a grade 4 event - Do not resume. «bi»Hypertension«/bi» - Monitor blood pressure prior to and throughout therapy - Initiate or adjust antihypertensive medication to control blood pressure - Temporarily interrupt therapy for grade 3 hypertension that persists despite optimal medical management - When hypertension is ≤ grade 2, resume therapy at a reduced dose - Discontinue therapy for life-threatening hypertension - Do not resume. «bi»QT Prolongation«/bi» - Temporarily interrupt therapy for ≥ grade 3 QT prolongation (>500 msec) - When improved to ≤ grade 1 (<480 msec) or baseline, resume therapy at a reduced dose. «b»Gastrointestinal Toxicity«/b» «bi»Nausea, Vomiting, or Diarrhea«/bi» Grade 3 - Initiate prompt medical management prior to interrupting therapy (or reducing dose) until resolves to ≤ grade 1 or baseline; then resume (for diarrhea, resume at a reduced dose). Grade 4 vomiting or diarrhea despite optimal medical management - Discontinue therapy - Do not resume. «bi»Perforation (Any Grade) or Fistula Formation (Grade 3 or 4; Life-threatening)«/bi» - Discontinue therapy - Do not resume «b»Hemorrhage«/b» - Temporarily interrupt therapy for a grade 3 event until improved to ≤ grade 1 - Depending on severity and persistence of toxicity, may either resume therapy at a reduced dose or discontinue treatment - Discontinue for a grade 4 event - Do not resume «b»Hypocalcemia«/b» - Administer calcium replacement therapy as necessary - May require treatment interruption or dose reduction depending on the severity, presence of ECG changes, and persistence of hypocalcemia. «b»Nephrotic Syndrome«/b» - Discontinue therapy - Do not resume «b»Proteinuria«/b» - Temporarily interrupt therapy for ≥2 g proteinuria/24 hours - Resume therapy at a reduced dose when improved to <2 g proteinuria/24 hours. «b»Reversible Posterior Leukoencephalopathy Syndrome (RPLS)«/b» - Interrupt or discontinue therapy until fully resolved - Consider resuming at a reduced dose if resolves to ≤ grade 1, depending on severity and persistence of neurologic symptoms.

Letermovir

Prevymis

Letrozole

Femara

Leucovorin

Calcium Folinate, Folinic Acid, Citrovorum Factor

- Due to calcium content, do not administer IV solutions at a rate >160 mg/minute; not intended for intrathecal use. - Refer to individual protocols. - Should be administered IM, IV push, or IV infusion (15 minutes to 2 hours). Leucovorin should not be administered concurrently with methotrexate. - It is commonly initiated 24 hours after the start of methotrexate. Toxicity to normal tissues may be irreversible if leucovorin is not initiated by ~40 hours after the start of methotrexate. «b»Folate Antagonists Administration«/b» - As a rescue after folate antagonists - Administer by IV bolus, IM, or orally. - Do not administer orally in the presence of nausea or vomiting. - Because oral absorption is saturable at doses above 25 mg, administering oral doses >25 mg is not recommended (convert to parenteral therapy). «b»Combination Therapy with Fluorouracil Administration«/b» - Fluorouracil is usually given after, or at the midpoint, of the leucovorin infusion. - Leucovorin is usually administered by IV bolus injection or short (10 to 120 minutes) IV infusion. - Other administration schedules have been used; refer to individual protocols. «b»Methanol Toxicity Administration«/b» - For the treatment of methanol toxicity, infuse over 30 to 60 minutes «b»Oral Suspension (5 mg/mL) Preparation«/b» - A 5 mg/mL oral suspension may be prepared with tablets, Cologel, and a 2:1 mixture of simple syrup and wild cherry syrup. - Crush twenty-four 25 mg tablets in a glass mortar and reduce to a fine powder; transfer powder to amber bottle. - Add 30 mL Cologel and shake mixture thoroughly. - Add a quantity of syrup mixture sufficient to make 120 mL. - Label “shake well” and “refrigerate”. - Stable for 28 days refrigerated «b»IV Reconstitution«/b» «bi»Powder for Injection«/bi» - Reconstitute with SWFI or BWFI - Dilute in D5W or NS for infusion. When doses >10 mg/m2 are required - Reconstitute using sterile water for injection, not a solution containing benzyl alcohol. - For methanol toxicity, dilute in D5W

Leuprolide

Camcevi, Fensolvi, Eligard, Lupron Depot, Lupron Depot-Ped

- Do not use concurrently a fractional dose of the 3-, 4-, or 6-month depot formulation, or a combination of doses of the monthly depot formulation or any depot formulation due to different release characteristics. - Do not use a combination of syringes to achieve a particular dose. «b»IM Administration«/b» «bi»Lupron Depot, Lupron Depot-Ped«/bi» - Administer as a single injection into the gluteal area, anterior thigh, or deltoid. Vary injection site periodically. «b»SC Administration«/b» «bi»Eligard«/bi» - Vary/rotate injection site; choose site with adequate subcutaneous tissue (upper or mid-abdomen, upper buttocks) that does not have excessive pigment, nodules, lesions, or hair - Avoid areas with brawny or fibrous tissues or areas that may be compressed or rubbed (belt or waistband). Administer within 30 minutes of preparation. «bi»Leuprolide Acetate 5 mg/mL Solution«/bi» - Vary injection site; if an alternate syringe from the syringe provided is required, insulin syringes should be used «bi»Camcevi«/bi» - Choose an injection site on the upper- or mid-abdominal area with sufficient soft or loose SC tissue that has not recently been used - Clean injection site with alcohol swab - Do NOT inject in areas with brawny or fibrous SC tissue or locations that can be rubbed or compressed (eg, with a belt or clothing waistband) - Avoid applying heat directly to injection site - Grab and bunch skin around injection site with one hand, then insert needle at 90° angle to skin surface, and then release the bunched skin - Inject the full contents of syringe with a slow and steady push on the plunger, and then withdraw the needle at the same 90° angle used for insertion «b»Reconstitution«/b» «bi»Eligard«/bi» - Packaged in two syringes; one contains the Atrigel polymer system and the second contains leuprolide acetate powder; follow package instructions for mixing «bi»Lupron Depot, Lupron Depot-Ped«/bi» - Reconstitute only with diluent provided «bi»Camcevi«/bi» - Allow prefilled syringe to sit at room temperature for 30 minutes before SC injection On a clean, dry surface, remove prefilled syringe (A) and needle cartridge (B) from the blister carton - Remove the gray cap from the syringe - Twist the clear cap off the bottom of the needle cartridge - Attach the needle to the end of the syringe by pushing and turning the needle until firmly connected to the syringe - Do not over twist the needle and strip the threading

Leuprolide-Norethindrone

Lupaneta Pack

Levalbuterol

Xopenex, Levosalbutamol

Levamlodipine

Conjupri

LevETIRAcetam

Keppra, Roweepra, Spritam

Levobunolol

Betagan

Levocarnitine

Carnitor, Carnitine

Levocetirizine

Xyzal

Levodopa

Inbrija

LevoFLOXacin

Levaquin

LevoFLOXacin (Ophthalmic)

Iquix, Quixin

Levoketoconazole

Recorlev

«bu»Cushing Syndrome«/bu» «b»Initial Dose«/b» - 150 mg PO bid «b»Dose Titration«/b» - Titrate by 150 mg daily, no more frequently than every 2-3 weeks based on 24-hr urine free cortisol levels and patient tolerability - Monitor cortisol levels from at least two 24-hr urine free cortisol collections every 2-3 weeks until an adequate clinical response achieved - May reduce to 150 mg once daily if needed for reasons of tolerability «b»Maximum Recommended Dosage«/b» - 600 mg PO bid «b»Missed Dose«/b» - Take next dose at regularly scheduled time «b»Dose Monitoring for Efficacy«/b» - Once maintenance dose achieved, monitor cortisol levels from at least two 24-hr urine free cortisol collections at least every 1-2 months or as indicated - If 24-hr urine free cortisol levels remain above ULN after treatment with maximum recommended dose (1200 mg/day) or patient cannot tolerate treatment, consider discontinuing and switching to another therapy «b»Hepatoxicity«/b» ALT/AST ≥5x ULN and any TB - Permanently discontinue ALT/AST ≥3x ULN and TB >2x ULN - Permanently discontinue ALT/AST ≥3 to <5x ULN and TB ≤2x ULN - Temporarily discontinue - Monitor liver tests every 3 days until levels are stable, and then at least q7-10 days until tests return to baseline levels - May restart at lower dosage and titrate more slowly once liver tests normalize and other possible contributing factors addressed - Before considering dosage increase, monitor liver tests weekly for 1 month and then routinely thereafter - Permanently discontinue if recurs after restarting ALT/AST >ULN to <3x ULN and any TB - If liver tests increase above baseline, monitor liver tests at least q7-10 days until tests have returned to baseline levels; consider temporarily discontinuing levoketoconazole during this time - If discontinued, restart at lower dosage and titrate more slowly once liver tests return to baseline and other possible contributing factors addressed - Before considering dosage increase, monitor liver tests weekly for 1 month to ensure stability of liver tests «b»QT Prolongation«/b» - Temporarily discontinue if QTcF interval >500 msec - After correcting other possible contributing factors (eg, hypokalemia, hypomagnesemia, use of concomitant drugs), may resume at lower dosage when QTcF interval returns to ≤500 msec - If QT interval prolongation recurs after restarting, permanently discontinue «b»Hypocortisolism «/b» - Decrease dose or temporarily discontinue if urine free cortisol or morning serum or plasma cortisol levels fall below target range, rapid decrease in cortisol levels, or if signs and/or symptoms consistent with hypocortisolism reported - Stop therapy and administer exogenous glucocorticoid replacement therapy if morning serum or plasma cortisol levels are below target range and signs and/or symptoms of adrenal insufficiency or hypocortisolism are present - Reinitiate at lower dose when cortisol levels are within target ranges and signs and/or symptoms of hypocortisolism have resolved - May titrate to previous dose associated with hypocortisolism if reduced dose tolerated, but does not achieve an adequate clinical response

LEVOleucovorin Calcium

Levo-folinic Acid, Fusilev, L-leucovorin, Khapzory

«bu»High-dose Methotrexate Rescue«/bu» - Indicated for rescue after high-dose methotrexate therapy in osteosarcoma - Recommended initial dose of 7.5 mg every 6 hours based on methotrexate IV dose of 12 g/m² - Monitor serum creatinine and methotrexate levels at least once daily; continue levoleucovorin, hydration, and urinary alkalinization (pH ≥7) until methotrexate level <5 x 10-8 M (0.05 micromolar) «b»Normal Methotrexate Elimination«/b» - Serum methotrexate level ~10 micromolar at 24 hour, 1 micromolar at 48 hour, and <0.2 micromolar at 96 hour post methotrexate infusion - Initiate at 7.5 mg (~5 mg/m²) every 6 hour; 24 hour after beginning methotrexate infusion for 60 hour (10 doses) «b»Delayed Late Methotrexate Elimination«/b» - Serum methotrexate levels >0.2 micromolar at 72 hr and >0.05 micromolar at 96 hr post methotrexate infusion - Continue 7.5 mg IV every 6 hour until methotrexate level <0.05 micromolar «b»Delayed Early Methotrexate Elimination and/or Evidence of Acute Renal Injury«/b» - Serum methotrexate level ≥50 micromolar at 24 hour, ≥5 micromolar at 48 hour, or serum creatinine level increased ≥100% at 24 hour post methotrexate infusion - 75 mg IV q3hr until methotrexate level is <1 micromolar, followed by 7.5 mg IV q3hr until methotrexate level is <0.05 micromolar - Extend levoleucovorin treatment for an additional 24 hr (total of 14 doses) in subsequent cycles if there is significant clinical toxicity in the presence of impaired methotrexate elimination or renal impairment «b»Delayed Methotrexate Elimination Due to Third Space Fluid Accumulation, Renal Insufficiency, or Inadequate Hydration«/b» - May require higher levoleucovorin doses or prolonged administration «bu»Folic Acid Antagonists Overdose or Impaired Elimination«/bu» - Indicated for diminishing toxicity and counteracting effects of impaired methotrexate elimination and of inadvertent overdosage of folic acid antagonists - 7.5 mg (~5 mg/m²) every 6 hours until methotrexate level is <0.05 micromolar - Start as soon as possible after methotrexate overdosage or 24 hr of delayed elimination «b»Increase Dose 50 mg/m² every 3hr until Methotrexate Level <0.05 Micromolar for the Following«/b» - If serum creatinine at 24 hr increases ≥50% compared to baseline - If methotrexate level at 24 hr >5 x 10^6 M - If methotrexate level at 48 hr >9 x 10^7 M - Continue hydration (3 L/day) and urinary alkalinization with sodium bicarbonate Adjust bicarbonate dose to maintain urine pH at ≥7 «bu»Metastatic Colorectal Cancer«/bu» - Indicated, in combination with 5-fluorouracil (5-FU), for palliative treatment in patients with advanced metastatic colorectal cancer «b»Regimens for Treatment of Colorectal Cancer«/b» - Levoleucovorin 100 mg/m² IV over a minimum of 3 min, followed by 5-FU 370 mg/m² daily for 5 consecutive days - Levoleucovorin 10 mg/m² IV followed by 5-FU 425 mg/m2 qDay for 5 consecutive days Repeat q4Weeks for 2 courses, then q4-5Weeks, if patient recovered from toxicity from the prior course - Do not adjust levoleucovorin dosage for toxicity - Refer to fluorouracil prescribing information for information on dosage and dosage modifications for adverse reactions «b»Dosing Considerations«/b» - Fusilev is dosed at one-half the usual dose of racemic d,l-leucovorin «b»Limitations of Use«/b» - Not indicated for pernicious anemia and megaloblastic anemia secondary to lack of vitamin B12

Levomefolate

Levomilnacipran ER

Fetzima

Levonorgestrel

Aftera, EContra EZ, Fallback Solo, My Way, Plan B, Plan B One-Step, Next Choice One Dose, Opcicon One-Step, React, Take Action

Levonorgestrel (IUD)

Kyleena, Liletta, Mirena, Skyla, Jaydess

«bu»Contraception«/bu» «b»Intrauterine Device«/b» - To be inserted into uterine cavity «bu»Heavy Menstrual Bleeding«/bu» «b»Intrauterine Device«/b» «bi»Mirena«/bi» - Refer to dosing for contraception «bi»Kyleena«/bi» - Initially releases levonorgestrel ~17.5 mcg/day, then, - Rate subsequently decreases - The average release rate over 5 years is levonorgestrel ~9 mcg/day - Do not leave device in place for >5 years. «bi»Liletta«/bi» - Initially releases levonorgestrel 19.5 mcg/day, then, - Rate subsequently decreases - The average release rate over 4 years is levonorgestrel ~15.4 mcg/day - Do not leave in place for >4 years «bi»Mirena«/bi» - Initially releases levonorgestrel 20 mcg/day, then, - Rate subsequently decreases to half of that after 5 years - Do not leave device in place for >5 years. «bi»Skyla, Jaydess«/bi» - Initially releases levonorgestrel ~14 mcg/day after 24 days, then, - Rate subsequently decreases; mean release rate over 3 years is levonorgestrel ~6 mcg/day - Do not leave device in place for >3 years «b»Initiation of Therapy«/b» - The device may be inserted at any time in the menstrual cycle once it is determined that the woman is not pregnant; immediately postpartum; or immediately after first or second trimester spontaneous or induced abortion. Back-up contraception is not needed if insertion is within 7 days of onset of menstruation. If insertion occurs >7 days after menstrual bleeding started, an additional form of contraception must be used for 7 days unless the woman abstains from sexual intercourse. Additional contraception is not needed if IUD is placed at the time of surgical abortion. Do not administer immediately following a septic abortion. «bi»Manufacturer Recommendations«/bi» - Following pregnancy or a second trimester abortion or miscarriage, insertion of the device should not take place for at least 6 weeks or until involution of the uterus is complete. «b»Continuation of Contraception«/b» - When it is time to replace, device may be removed and replaced with a new device immediately, and at any time during menstrual cycle as long as the woman is not pregnant. «b»Switching from a Different Contraceptive to Levonorgestrel IUD«/b» - The device may be inserted immediately if it is determined that the woman is not pregnant. Unless the woman abstains from sexual intercourse, a backup method of contraception is needed if it has been >7 days since menstrual bleeding has begun. When an additional method of contraception is needed, consider continuing the woman's previous method for 7 days after insertion «b»Switching from a Copper IUD«/b» - If sexual intercourse occurred after the start of the current cycle, and it has been >5 days since bleeding began, consider administering an emergency contraceptive «b»Switching to Liletta or Mirena from an Injectable Progestin Contraceptive«/b» - May be inserted at any time. If inserted >13 weeks after the last injection, a barrier method of contraception should be used for 7 days. «b»Switching to Liletta or Mirena from a Contraceptive Implant or Another Intrauterine System«/b» - May insert on the same day the implant or device is removed, any time during the menstrual cycle. «b»Switching to Liletta or Mirena from a Hormonal Contraceptive (PO, Transdermal, Vaginal)«/b» - May be inserted anytime, including hormone free interval of the previous method. If inserted during active use of the previous method, continue previous method for 7 days after insertion or until the end of the current treatment cycle. «b»Switching from Levonorgestrel IUD to a Different Contraceptive«/b» - If the patient wishes to change to a different method of birth control, may remove the device during the first 7 days of menstrual cycle and begin the new therapy. If the device is not removed during the first 7 days of menstruation (or if the patient has irregular menstrual cycles or amenorrhea) and wants to start a different method of birth control, start the new method at least 7 days prior to device removal, otherwise, a back-up barrier contraceptive should be used for 7 days after the device is removed unless the woman abstains from vaginal intercourse.

Levonorgestrel-Ethinyl Estradiol

Altavera, Aubra, Aviane, Chateal, Delyla, FaLessa, Falmina, Kurvelo, Larissia, Lessina, Levora, Lutera, Orsythia, Sronyx, Vienva, Lillow, Marlissa, Portia 28, Amethia,Amethia Lo, Ashlyna, Camrese

«bu»Contraception«/bu» - One tablet once daily. «b»Schedule 1 (Sunday Starter)«/b» - Dose begins on first Sunday after onset of menstruation - If the menstrual period starts on Sunday, take first tablet that very same day - With a Sunday start, an additional method of contraception should be used until after the first 7 days of consecutive administration. «b»Schedule 2 (Day 1 Starter)«/b» - Dose starts on first day of menstrual cycle taking 1 tablet daily. «b»Missed or Late Doses«/b» «bi»One Dose Missed or Late«/bi» - If one dose is late (<24 hours since dose should have been taken) or if one dose is missed (24 to <48 hours since dose should have been taken) - Take dose as soon as possible - Continue remaining doses at the usual time (even if that means 2 doses on the same day). «bi»≥2 Consecutive Dose Missed or Late«/bi» - If ≥2 consecutive doses are missed (≥48 hours since dose should have been taken): - Take the most recently missed dose as soon as possible, discard any other missed doses - Continue remaining doses at the usual time (even if that means taking 2 doses on the same day); use back-up contraception until hormonal pills have been taken for 7 consecutive days - If doses were missed during the last week of hormonal (active) tablets (days 15 to 21 of a 28-day pack), omit the hormone-free interval by finishing the current pack and starting a new pack - If unable to start a new pack immediately, back up contraception is needed until hormonal pills from a new pack have been taken for 7 consecutive days - Consider use of emergency contraception in some situations (refer to guidelines for details). «bu»Emergency Contraception«/bu» - One dose followed by a second dose 12 hours later - Each dose should contain a minimum of ethinyl estradiol 100 mcg and levonorgestrel 0.5 mg. - Although no longer available in a dedicated dosage form, available combination oral contraceptive pills can be used to achieve this dose. - Treatment for emergency contraception should begin as soon as possible; however, treatment is still moderately effective if used within 5 days after unprotected or inadequately protected intercourse - Although routine use of antiemetics is not recommended, pretreatment may be considered for specific women

Levonorgestrel-Ethinyl Estradiol-Fe Bisglycinate

Balcoltra

«bu»Contraception«/bu» - One active tab PO daily x 21 days, then, - One Fe tab PO qDay on Days 22-28 - Take tablets in the order directed on the blister pack «b»Missed Dose«/b» «bi»One Orange Tablet Missed in Weeks 1, 2, or 3«/bi» - Take orange tablet as soon as possible; continue taking 1 tablet daily until the pack is finished «bi»Two Orange Tablets Missed in Week 1 or 2«/bi» - Take 2 missed tablets as soon as possible and the next 2 orange tablets the next day; continue taking 1 tablet daily until the pack is finished - Additional nonhormonal contraception (condoms or spermicide) should be used as backup if the patient has sex within 7 days after missing tablets «bi»Two Orange Tablets Missed in Week 3 or ≥3 Orange Tablets Missed in a Row in Weeks 1, 2, or 3«/bi» Day 1 Start - Throw out remaining pack and start a new pack that same day Sunday Start - Continue taking 1 tablet daily until Sunday, then throw out the remaining pack and start a new pack that same day; additional nonhormonal contraception (such as condoms or spermicide) should be used as backup if the patient has sex within 7 days after missing tablets «bi»Gastrointestinal Disturbances«/bi» - In case of severe vomiting or diarrhea, absorption may not be complete and additional contraceptive measures should be taken - If vomiting or diarrhea occurs within 3-4 hour after taking an orange tablet, handle this as a missed dose «b»Switching to Levonorgestrel-Ethinyl Estradiol-Ferrous Bisglycinate from Another Contraceptive Method«/b» «bi»Transdermal Patch«/bi» - Start levonorgestrel-Ethinyl Estradiol-Ferrous Bisglycinate on the next scheduled application «bi»Vaginal Ring«/bi» - Start Levonorgestrel-Ethinyl Estradiol-Ferrous Bisglycinate on the day when next insertion would have been scheduled «bi»Injection«/bi» - Start Levonorgestrel-Ethinyl Estradiol-Ferrous Bisglycinate on the day when next injection would have been scheduled «bi»Intrauterine Contraceptive (IUD)«/bi» - Start Levonorgestrel-Ethinyl Estradiol-Ferrous Bisglycinate on the day of removal; if IUD is not removed on first day of the patient’s menstrual cycle, additional nonhormonal contraceptive (eg, condoms, spermicide) is needed for the first 7 days of the first cycle pack «bi»Implant«/bi» - Start Levonorgestrel-Ethinyl Estradiol-Ferrous Bisglycinate on the day of removal «b»After Abortion or Miscarriage During First Trimester«/b» - After a first-trimester abortion or miscarriage, start Levonorgestrel-Ethinyl Estradiol/Ferrous Bisglycinate immediately - Initiating within 5 days after pregnancy termination: No additional method of contraception is needed - Initiating >5 days after termination of pregnancy: Additional nonhormonal contraception (eg, condoms, spermicide) required for the first 7 days of first cycle pack - Do not start until 4 weeks after a second-trimester abortion or miscarriage, due to increased risk of thromboembolic disease; start therapy following instructions for Day 1 or Sunday start, as desired; if using Sunday start, use additional non-hormonal contraception (such as condoms or spermicide) for first seven days of patient’s first cycle pack of contraceptive therapy «b»After Childbirth«/b» - Do not start until 4 weeks after delivery owing to increased risk of thromboembolic disease - Start contraceptive therapy following instructions for women not currently using hormonal contraception - If woman has not yet had a period postpartum, consider possibility of ovulation and conception occurring prior to use of contraceptive therapy - CDC guidelines recommend waiting 3 weeks after delivery in postpartum women with no venous thromboembolism (VTE) risks and 3-6 weeks in postpartum women with additional VTE risks «b»Discontinue If These ADR Occurs«/b» - Arterial thrombotic event or venous thromboembolic event occurs - Unexplained loss of vision, proptosis, diplopia, papilledema, or retinal vascular lesions occurs - Jaundice develops «b»Drug Interactions«/b» «bi»Drugs or herbal products that may decrease the effectiveness of hormonal contraceptives«/bi» - Phenytoin, barbiturates, carbamazepine, bosentan, felbamate, griseofulvin, oxcarbazepine, rifampicin, topiramate, rifabutin, rufinamide, aprepitant, products containing St. John’s wort - Use an alternative method of contraception or a back-up method and continue backup contraception for 28 days after discontinuing the enzyme inducer to ensure contraceptive reliability «bi»Coadministration with Colesevelam«/bi» - Separate doses by 4 hour «bi»Combination Drug Regimen Ombitasvir/Paritaprevir/Ritonavir«/bi» Discontinue Levonorgestrel-Ethinyl Estradiol-Ferrous Bisglycinate prior to starting therapy with the combination drug regimen ombitasvir/paritaprevir/ritonavir, with or without dasabuvir; restart therapy ~2 weeks following completion of hepatitis C treatment «b»Tablet Color«/b» - Active Tablets: Orange (Day 1-21) - Placebo Tablet: Blue (Day 22-28) «b»Day 1 Start«/b» - Administer 1 tablet daily at the same time each day - Take 1 orange tablet on the first day of period; take subsequent orange tablets once daily for a total of 21 days - Take 1 blue tablet daily for 7 days - Begin each subsequent pack on the same day of the week as the first cycle pack (on the day after taking the last blue placebo tablet) «b»Sunday Start«/b» - Administer 1 tablet daily at the same time each day - Take first orange tablet on the first Sunday after the onset of menses - Due to the potential risk of becoming pregnant, use additional nonhormonal contraception (condoms or spermicide) for the first 7 days of the patient’s first cycle pack - Take subsequent orange tablets once daily for a total of 21 days - Take 1 blue tablet daily for the following 7 days - Begin each subsequent pack on the same day of the week as the first cycle pack «b»Missed Dose«/b» «bi»One Orange Tablet Missed in Weeks 1, 2, or 3«/bi» - Take orange tablet as soon as possible; continue taking 1 tablet daily until the pack is finished «bi»Two Orange Tablets Missed in Week 1 or 2«/bi» - Take 2 missed tablets as soon as possible and the next 2 orange tablets the next day; continue taking 1 tablet daily until the pack is finished - Additional nonhormonal contraception (condoms or spermicide) should be used as backup if the patient has sex within 7 days after missing tablets «bi»Two Orange Tablets Missed in Week 3 or ≥3 Orange Tablets Missed in a Row in Weeks 1, 2, or 3«/bi» Day 1 Start - Throw out remaining pack and start a new pack that same day Sunday Start - Continue taking 1 tablet daily until Sunday, then throw out the remaining pack and start a new pack that same day; additional nonhormonal contraception (such as condoms or spermicide) should be used as backup if the patient has sex within 7 days after missing tablets «bi»Gastrointestinal Disturbances«/bi» - In case of severe vomiting or diarrhea, absorption may not be complete and additional contraceptive measures should be taken - If vomiting or diarrhea occurs within 3-4 hour after taking an orange tablet, handle this as a missed dose

Levorphanol

Levo-Dromoran

Levothyroxine

L-Thyroxine Sodium, Levoxyl, Synthroid, Unithroid, Tirosint

«bu»Hypothyroidism«/bu» «b»Adults (Healthy)«/b» «bi»Hypothyroid for Only a Few Months«/bi» Initial Dose - 1.6 mcg/kg/day Maintenance Dose - Adjust Dose by 12.5 to 25 mcg/day every 4 to 6 weeks as needed Usual Dose Range - ≤200 mcg/day (Range: 100 to 125 mcg/day [70 kg adult]) - Doses ≥300 mcg/day are rare (consider poor compliance, malabsorption, and/or drug interactions). «b»Adults >50 years Without Evidence of CAD«/b» - Lower starting doses (50 mcg/day) may be preferred «b»Adults with Cardiac Disease«/b» Initial Dose - 12.5 to 25 mcg/day Maintenance Dose - Adjust dose by 12.5 to 25 mcg increments at 6- to 8-week intervals prn «b»Adults with Severe Longstanding Hypothyroidism«/b» Initial Dose - 12.5 to 25 mcg/day Maintenance Dose - Adjust dose by 12.5 to 25 mcg/day every 2 to 4 weeks as appropriate «b»Pregnant Patients«/b» - Dosage requirements may increase during pregnancy in patients with preexisting disease - If new onset hypothyroidism occurs initiate therapy with 1.6 mcg/kg/day (for severe hypothyroidism) or 1 mcg/kg/day (for mild hypothyroidism [TSH <10 milliunits/L]) followed by appropriate dosage adjustments every 4 weeks. «b»IV Route«/b» - ~75% of the oral dose by IV administration - Bioavailability of the oral formulation is highly variable, but absorption has been measured to be ~80%, when the oral tablet formulation was administered in the recommended fasting state «bu»Well-differentiated Thyroid Cancer«/bu» «b»Papillary and Follicular«/b» - Highly individualized; Doses >2 mcg/kg/day may be needed to suppress TSH to <0.1 milliunits/L in high-risk tumors - For intermediate-risk tumors, initial TSH suppression to 0.1 to 0.5 milliunits/L is recommended; for low-risk tumors, TSH may be maintained at or slightly below the lower limit of normal (0.1 to 0.5 milliunits/L [if low serum thyroglobulin levels]) or at 0.5 to 2 milliunits/L [if undetectable serum thyroglobulin levels or post-lobectomy] «bu»Benign Nodules and Nontoxic Multinodular Goiter«/bu» - Routine use of T4 for TSH suppression is not recommended in patients with benign thyroid nodules. In patients deemed appropriate candidates, treatment should never be fully suppressive (TSH <0.1 milliunits/L) «bu»Myxedema Coma or Stupor«/bu» Initial Dose - 300 to 500 mcg IV x 1 dose Maintenance Dose - 50 to 100 mcg IV once daily until patient is able to tolerate oral administration - Smaller doses should be considered in patients with cardiovascular disease «bu»Cadaveric Organ Recovery«/bu» «b»Hormonal Resuscitation«/b» Initial Dose - 20 mcg IV bolus x 1 dose Maintenance Dose - 10 mcg/hour continuous IV infusion administered to the brain-dead donor who is hemodynamically unstable requiring significant vasopressor support - Give concomitantly with methylprednisolone, dextrose, and regular insulin «bu»Subclinical Hypothyroidism«/bu» Initial Dose - 25 to 75 mcg/day PO, with higher doses usually required for those presenting with higher TSH values or - 1.5 mcg/kg/day (for patients without heart disease) OR - 25 or 50 mcg/day (for patients with cardiac disease) «b»Cardiac Symptoms Onset or Worsening«/b» - Manufacturer labeling recommends reducing dosage or withholding therapy for 7 days and then resuming therapy at reduced dosage - Specific dosing recommendations are not provided.

Levothyroxine-Liothyronine

Thyrolar, Liotrix (T3-T4), Levothyroxine Sodium-Liothyronine

Lidocaine

Xylocaine, Adult Lumbar Puncture Tray,

«bu»Antiarrhythmic«/bu» - VF or Pulseless VT (after defibrillation attempts, CPR, and vasopressor administration), alternative to amiodarone: IV, intraosseous (IO) - Initial Dose: 1 to 1.5 mg/kg - If refractory VF or pulseless VT, repeat 0.5 to 0.75 mg/kg bolus every 5 to 10 minutes (maximum cumulative dose: 3 mg/kg) - Follow with continuous infusion (1 to 4 mg/minute) after return of perfusion. - Reappearance of arrhythmia during constant infusion: 0.5 mg/kg bolus and reassessment of infusion «bu»Endotracheal«/bu» - Loading dose only: 2 to 3.75 mg/kg (2 to 2.5 times the recommended IV dose) - Dilute in 5 to 10 mL NS or sterile water - Absorption is greater with sterile water and results in less impairment of PaO2. «bu»Hemodynamically Stable Monomorphic VT«/bu» - 1 to 1.5 mg/kg - Repeat with 0.5 to 0.75 mg/kg every 5 to 10 minutes as necessary - Maximum Cumulative Dose: 3 mg/kg - Follow with continuous infusion of 1 to 4 mg/minute (or 14 to 57 mcg/kg/minute). - Reduce maintenance infusion in patients with CHF, shock, or hepatic disease; initiate infusion at 10 mcg/kg/minute - Maximum Dose: 1.5 mg/minute or 20 mcg/kg/minute «bu»Anesthesia, Local Injectable«/bu» - Varies with procedure, degree of anesthesia needed, vascularity of tissue, duration of anesthesia required, and physical condition of patient. «b»Cutaneous Infiltration«/b» - Maximum: 4.5 mg/kg/dose not to exceed 300 mg - Do not repeat within 2 hours. «b»Intraosseous Line or Infusion Pain«/b» «bi»Lidocaine 1% or 2% Preservative-free Solution«/bi» - Intraosseous Initial dose: 40 mg over 1 to 2 minutes; usual adult dose range and maximum: 20 to 50 mg/dose; after allowing lidocaine to dwell for up to 1 minute, follow with NS flush; immediately following the NS flush, some centers administer a second lower (50% dose reduction) lidocaine dose over 30 to 60 seconds (usual adult maximum repeat dose: 20 mg/dose); if discomfort reoccurs, may repeat doses at a maximum frequency of every 45 minutes during intraosseous access; maximum total dose not established - Intraosseous access devices have a minimum weight and age for a particular device in addition to specific instruction for insertion and validation; consult product specific information for more detail. «bu»Interstitial Cystitis (Bladder Pain Syndrome)«/bu» «b»Intravesical«/b» - Various dosage regimens of alkalinized lidocaine alone or with heparin (20,000 to 50,000 units) have been used. There is a risk of precipitation if proper alkalinization does not occur. Lidocaine stability and pH should be determined after the components have been mixed, prior to administration «b»Single Instillation«/b» - Single intravesical administration of lidocaine (200 mg)/heparin (50,000 units)/sodium bicarbonate (420 mg) in 15 mL of sterile water, instilled into the bladder via catheter and allowed to dwell for 30 minutes before drainage «b»Weekly Instillation«/b» - Weekly bladder instillations for 12 consecutive weeks with lidocaine 4% (5 mL)/heparin (20,000 units)/sodium bicarbonate 7% (25 mL), instilled into an empty bladder via catheter and allowed to dwell for 30 minutes before drainage «b»Daily Instillation«/b» - Daily bladder instillations for 5 days with lidocaine (200 mg)/sodium bicarbonate 8.4% solution (final volume of 10 mL), instilled into an empty bladder and allowed to dwell for 1 hour before drainage «b»Local Infiltration«/b» - Buffered lidocaine for injectable local anesthetic may be prepared: Add 2 mL of sodium bicarbonate 8.4% to 18 mL of lidocaine 1%

Lidocaine (Ophthalmic)

Akten

Lidocaine (Topical)

AneCream, Xylocaine, Glydo, Zingo, Xryliderm

«bu»Anesthetic Lubricant for Intubation«/bu» - Indicated as an anesthetic lubricant for oral or nasal endotracheal intubation «b»Jelly (2%)«/b» - Apply moderate amount to external surface of endotracheal tube shortly before use «b»Ointment«/b» - Apply to tube prior to intubation - Not to exceed 600 mg/12 hr «bu»Urethral Surface Anesthesia«/bu» - When using Xylocaine 2% Jelly 30 mL tubes for urologic procedures, sterilize the plastic cone for 5 minutes in boiling water, cool, and attach to the tube «b»Females«/b» - Instill 2-5 mL jelly (60-100 mg) into urethra - Some jelly may also be deposited on a cotton swab and introduced into urethra - Allow several minutes following instillation prior to performing urological procedure «b»Males«/b» - Slowly instill 15 mL (300 mg lidocaine) into urethra or until patient experiences tension - Apply a penile clamp for several minutes at the corona - An additional dose of not more than 15 mL (300 mg) can be instilled for adequate anesthesia - Prior to sounding or cystoscopy, a penile clamp should be applied for 5-10 minutes to obtain adequate anesthesia - A total dose of 30 mL (600 mg) is usually required to fill and dilate the male urethra - Prior to catheterization, smaller volumes of 5-10 mL (100-200 mg) are usually adequate for lubrication «bu»Premature Ejaculation«/bu» - Temporarily reduces sensitivity of the penis, which helps to delay ejaculation - Epic, Premject, Promescent: Apply 3 or more sprays (10 mg/spray), not to exceed 10 sprays, to the head and shaft of the penis before intercourse - Wash product off after intercourse - Correct quantity and time of application will be determined by individual requirements; use the minimum effective quantity - Do not exceed 24 sprays/24 hr «bu»Skin Irritation«/bu» - Indicated for temporary relief of pain and itching caused by minor skin irritations (eg, sunburn, minor burns, minor cuts, scrapes, insect bites, minor skin irritations) - Apply topically to affected area tid/qid «b»Gel (Topicaine) Administration«/b» - Apply a moderately thick layer to affected area (~1/8 inch thick) - Allow time for numbness to develop (~20 to 60 minutes after application) - When used prior to laser surgery, avoid mucous membranes and remove prior to laser treatment. «b»Intradermal Injection Administration«/b» - Refer to manufacturer’s labeling for administration technique - Apply intradermal lidocaine 1 to 3 minutes prior to needle insertion; perform procedure within 10 minutes following application - Application of one additional intradermal lidocaine at a new location is acceptable after a failed attempt at venous access; multiple administrations of intradermal lidocaine at the same location are not recommended - Only use on intact skin and on skin locations where an adequate seal can be maintained - Do not use on body orifices, mucous membranes, around the eyes, or on areas with a compromised skin barrier - When removing the device from the pouch, be careful not to touch the purple outlet (open end) to avoid contamination; do not use if the device has been dropped or if the pouch is damaged or torn. «b»Ointment Administration«/b» - Use of a sterile gauze is suggested for application to broken skin; apply to tube prior to intubation - In dentistry, apply to previously dried oral mucosa; subsequent removal of excess saliva with cotton rolls or saliva ejector minimizes dilution of ointment, permits maximum penetration, and minimizes possibility of swallowing the ointment - For use with the insertion of new dentures, apply to all denture surfaces contacting mucosa. «b»Oral Topical Solution (2% Viscous) Administration«/b» «bi»Mouth irritation or inflammation«/bi» - Have patient swish medication around mouth and then spit it out - In children <3 years, apply to affected area with cotton-tipped applicator (do not use to relieve teething pain) - Do not eat or chew gum for 60 minutes following use. «b»Pharyngeal Anesthesia Administration«/b» - Patient should gargle and may swallow medication - In children <3 years, apply to affected area with cotton-tipped applicator - Do not eat or chew gum for 60 minutes following use. «b»Oral Topical Endotracheal Solution Administration«/b» «bi»Metered-dose Spray (10 mg/actuation)«/bi» - Attach nozzle and prime pump 5 to 10 times prior to first use; prime ~2 times (to remove air) when switching to a new nozzle - Product should be in upright position while spraying - Do not modify manufacturer supplied nozzle. Discard nozzle after use (do not reuse) - Do not use on cuffs or endotracheal tubes made of plastic (may damage cuff). «b»Patch Administration«/b» «bi»Lidoderm«/bi» - Apply to most painful area of skin immediately after removal from protective envelope. Do not apply to non-intact skin - May be cut (with scissors, prior to removal of release liner) to appropriate size. - Clothing may be worn over application area. After removal from skin, fold used patches so the adhesive side sticks to itself; avoid contact with eyes. Remove immediately if irritation or a burning sensation occurs - Wash hands after application. Avoid contact with water (bathing, swimming, showering) - Avoid exposing application site to external heat sources (heating pad, electric blanket, heat lamp, hot tub) - Discard any used or unused patches by folding adhesive sides together and dispose of in trash away from children and pets. «bi»LidoPatch«/bi» - Remove protective film and apply to painful area - Avoid contact with eyes or mucous membranes - Wash hands after application. Avoid exposing application site to external heat sources (heating pad, electric blanket, heat lamp, hot tub) - Discard any used or unused patches by folding adhesive sides together and dispose of in trash away from children and pets.

Lidocaine-Epinephrine (Caudal Tray)

Caudal Tray, Xylocaine with Epinephrine

Lidocaine-Glycerin

Preparation H (Rectal Cream)

Lidocaine-Menthol

AvaDERM, Mentho-Caine, LevigoLT, Veltrix, Synvexia TC, LidoPatch, LenzaGel, Mentholix, Prolida, Aflexeryl-LC, Atendia, AvaLin,ELenzaPatch, Endoxcin, K2K Pain Relieving, LenzaPatch, Lidenza,

Lidocaine-Prilocaine

AgonEaze, EMLA, Oraqix, Anodyne LPT, DermacinRx, Prilolid, Priloxx

«bu»Topical Anesthetic«/bu» «b»Cream (Intact Skin)«/b» - Apply a thick layer to intact skin and cover with an occlusive dressing - Dermal analgesia can be expected to increase for up to 3 hours under occlusive dressing and persist for 1 to 2 hours after removal of the cream. «b»Minor Dermal Orocedures«/b» «bi»IV Cannulation or Venipuncture«/bi» - Apply 2.5 g (1/2 of the 5 g tube) over 20 to 25 cm2 of skin surface area) for at least 1 hour «b»Major Dermal Procedures«/b» - More painful dermatological procedures involving a larger skin area such as split thickness skin graft harvesting - Apply 2 g per 10 cm2 of skin and allow to remain in contact with the skin for at least 2 hours. «b»Adult Male Genital Skin«/b» - Pretreatment prior to local anesthetic infiltration - Apply 1 g per 10 cm2 to the skin surface for 15 minutes - Local anesthetic infiltration should be performed immediately after removal of cream. «b»Adult Female Genital Mucous Membranes«/b» «bi»Minor Procedures«/bi» - Removal of condylomata acuminata, pretreatment for local anesthetic infiltration - Apply 5 to 10 g for 5 to 10 minutes - The local anesthetic infiltration or procedure should be performed immediately after removal of cream. «b»Minor Dermal Procedures«/b» IV Cannulation, Venipuncture, Surgical or Laser Treatment - Apply 2 g (~1/2 of the 5 g tube) over ~13.5 cm2 for at least 1 hour but no longer than 5 hours «b»Major Dermal Procedures«/b» «bi»Split-skin Grafting«/bi» - 1.5 to 2 g per 10 cm2 (maximum: 60 g per 400 cm2) for at least 2 hours but no longer than 5 hours «b»Genital Mucosa«/b» - Surgical procedures ≤10 minutes such as localized wart removal, and prior to local anesthetic infiltration - Apply 2 g (~1/2 of 5 g tube) per lesion (maximum: 10 g) for 5 to 10 minutes. - Initiate procedure immediately after removing cream. «b»Leg Ulcers«/b» «bi»Mechanical Cleansing/Surgical Debridement«/b» - Apply ~1 to 2 g per 10 cm2 (maximum: 10 g) for at least 30 minutes and up to 60 minutes for necrotic tissue that is more difficult to penetrate. - Initiate procedure immediately after removing cream. «b»Periodontal Gel (Oraqix)«/b» - Apply on gingival margin around selected teeth using the blunt-tipped applicator included in package. - Wait 30 seconds, then fill the periodontal pockets using the blunt-tipped applicator until gel becomes visible at the gingival margin. - Wait another 30 seconds before starting treatment. - May reapply; maximum recommended dose: One treatment session: 5 cartridges (8.5 g) «b»Transdermal Patch«/b» - Minor procedures (needle insertion) - Apply 1 or more patches to intact skin surface area <10 cm2 for at least 1 hour (maximum application time: 5 hours) - Although the incidence of systemic adverse effects is very low, caution should be exercised, particularly when applying over large areas and leaving on for >2 hours «bu»Topical Anesthetic«/bu» «b»Infants and Children (Intact Skin)«/b» - If a patient >3 months of age does not meet the minimum weight requirement, the maximum total dose should be restricted to the corresponding maximum based on patient weight. «bi»Cream«/bi» - Should not be used in neonates with a gestation age <37 weeks nor in infants <12 months of age who are receiving treatment with methemoglobin-inducing agents «b»Dosing Based on Child's Age and Weight«/b» «bi»Age 0 to 3 months or <5 kg«/bi» - Apply a maximum of 1 g over no more than 10 cm2 of skin - Leave on for no longer than 1 hour «bi»Age 3 months to 12 months and >5 kg«/bi» - Apply no more than a maximum 2 g total over no more than 20 cm2 of skin - Leave on for no longer than 4 hours «bi»Age 1 to 6 years and >10 kg«/bi» - Apply no more than a maximum of 10 g total over no more than 100 cm2 of skin - US labeling recommends leaving on for no longer than 4 hours - Canadian labeling recommends leaving on for no longer than 5 hours «bi»Age 7 to 12 years and >20 kg«/bi» - Apply no more than a maximum 20 g total over no more than 200 cm2 of skin - US labeling recommends leaving on for no longer than 4 hours. - Canadian labeling recommends leaving on for no longer than 5 hours. «b»Transdermal Patch«/b» - Should not be used in neonates with a gestation age <37 weeks nor in infants <12 months of age who are receiving treatment with methemoglobin-inducing agents «bi»Dosing Based on Child's Age and Weight«/bi» - Apply patch(es) to skin area(s) <10 cm2 Age 0 to 3 months or <5 kg - Apply 1 patch and leave on for ~1 hour (do not exceed 1-hour application time); do not apply more than 1 patch at same time; safety of repeated dosing not established Age 3 months to 12 months and >5 kg - Apply 1 to 2 patches for ~1 hour (maximum application time: 4 hours); do not apply more than 2 patches at the same time Age 1 to 6 years and >10 kg - Apply 1 or more patches for minimum of 1 hour (maximum application time: 5 hours); maximum dose: 10 patches Age 7 to 12 years and >20 kg - Apply 1 or more patches for a minimum of 1 hour (maximum application time: 5 hours); maximum dose: 20 patches

Lifitegrast

Xiidra

Linaclotide

Linzess

- Administer at least 30 minutes before the first meal of the day on an empty stomach; loose stools and greater stool frequency may occur after administration with a high-fat breakfast. Swallow capsule whole; do not break, crush, or chew capsules or capsule contents. - For patients with swallowing difficulties, capsules may be opened and administered orally either in applesauce or with water or administered with water via a nasogastric or gastric feeding tube. Mixing beads from capsules in other soft foods or in other liquids has not been tested. «b»Administration in Applesauce«/b» - Open capsule and sprinkle entire contents (beads) onto 1 teaspoonful (5 mL) of room temperature applesauce. Swallow entire contents immediately; do not chew the beads. Do not store mixture for future use. «b»Administration in Water«/b» - Open capsule and sprinkle entire contents (beads) into a cup with ~30 mL of room temperature bottled water. Gently swirl for at least 20 seconds and swallow immediately; add another 30 mL of water to any remaining beads in cup, swirl for at least 20 seconds, and swallow immediately. Do not store the water-bead mixture for future use. Note: The drug is coated on surface of beads and will dissolve off the beads in water; beads will remain visible and will not dissolve; therefore, it is not necessary to consume all the beads to deliver complete dose. «b»Nasogastric or Gastric Feeding Tube Administration«/b» - Open capsule and empty entire contents (beads) into a clean container with 30 mL of room temperature bottled water. Gently swirl for at least 20 seconds; draw up bead and water mixture with catheter syringe and apply rapid and steady pressure (10 mL per 10 seconds) to dispense the bead-water mixture into the tube; add another 30 mL of water to any remaining beads and repeat process. Flush nasogastric/gastric tube with at least 10 mL of water after administration. Note: Not necessary to flush all the beads through tube to deliver complete dose.

Linagliptin

Tradjenta

Linagliptin-Metformin

Jentadueto

Lincomycin

Lincocin

Linezolid

Zyvox

Liothyronine

Triostat, Cytomel

«bu»Hypothyroidism«/bu» «b»Initial Dose«/b» - 25 mcg PO once daily «b»Maintenance Dose«/b» - May increase by up to 25 mcg/day PO every 1 to 2 weeks «b»Usual Maintenance Dose«/b» - 25 to 75 mcg PO once daily «b»Cardiovascular Disease«/b» Initial Dose - 5 mcg once daily Maintenance Dose - May increase by 5 mcg/day every 2 weeks. «b»Myxedema«/b» Initial Dose - 5 mcg once daily Maintenance Dose - Increase in increments of 5 to 10 mcg/day every 1 to 2 weeks - When 25 mcg/day is reached, dosage may be increased at intervals of 5 to 25 mcg/day every 1 to 2 weeks Usual Maintenance Dose - 50 to 100 mcg once daily «bu»Nontoxic Goiter«/bu» Initial Dose - 5 mcg PO daily Maintenance Dose - May increase by 5-10 mcg every 1-2 weeks (5 mcg in elderly) - When reach 25 mcg PO daily, may increase by 12.5 mcg or 25 mcg every 1 to 2 weeks Maintenance Dose - 75 mcg PO daily «b»Conversion to Liothyronine from Thyroid (desiccated) or Levothyroxine«/b» - Discontinue the other medication, initiate a low dose of liothyronine, and increase gradually according to response - Liothyronine has a rapid onset of action; residual effects of other thyroid preparation may persist for the first several weeks into therapy. «bu»Myxedema Coma«/bu» «b»Initial Dose«/b» - 25 to 50 mcg IV x 1 Dose «b»Cardiovascular Disease«/b» - 10 to 20 mcg; initial and maintenance dosing is based on clinical condition and response to therapy. «b»Conversion to Liothyronine Tablets from Injectable Liothyronine«/b» - Discontinue the injectable, initiate oral therapy at a low dosage, and increase gradually according to response. «bu»Antidepressant Augmentation«/bu» «b»Initial Dose«/b» - 25 mcg/day «b»Maintenance Dose«/b» - May be increased to 50 mcg/day after ~1 week based on response and tolerability - Dose ranges of 20 to 62.5 mcg/day have been studied in clinical trials «bu»Prevention of Memory Deficit with ECT«/bu» - 50 mcg once daily administered from the day before beginning of ECT and every morning until the last session

Liraglutide

Saxenda, Victoza

Lisdexamfetamine

Vyvanse

Lisinopril

Prinivil, Zestril, Qbrelis

- Administer as a single daily dose and without regard to meals. «b»Oral Suspension (1 mg/mL) Preparation«/b» - A 1 mg/mL lisinopril oral suspension may be made with tablets and a 1:1 mixture of Ora-Plus and Ora-Sweet - Crush ten 10 mg tablets in a mortar and reduce to a fine powder - Add small portions of the vehicle and mix to a uniform paste; mix while adding the vehicle in incremental proportions to almost 100 mL; transfer to a graduated cylinder; rinse mortar with vehicle, and add quantity of vehicle sufficient to make 100 mL - Store in amber plastic prescription bottles; label "shake well." - Stable for 13 weeks at room temperature or refrigerated «b»Oral Suspension (1 mg/mL) Preparation«/b» - A 1 mg/mL lisinopril oral suspension may be made with tablets and a mixture of sodium citrate/citric acid oral solution or Cytra-2 diluent and Ora-Sweet SF - Place ten 20 mg tablets into an 8 ounce amber polyethylene terephthalate (PET) bottle and then add 10 mL purified water and shake for at least 1 minute - Gradually add 30 mL of sodium citrate/citric acid oral solution or Cytra-2 diluent and 160 mL of Ora-Sweet SF to the bottle and gently shake after each addition to disperse the contents - Store resulting suspension at ≤25°C (77°F) for up to 4 weeks - Label bottle “shake well. - A 1 mg/mL lisinopril oral suspension also be made with tablets, methylcellulose 1% with parabens, and simple syrup NF - Crush ten 10 mg tablets in a mortar and reduce to a fine powder - Add 7.7 mL of methylcellulose gel and mix to a uniform paste; mix while adding the simple syrup in incremental proportions to almost 100 mL; transfer to a graduated cylinder; rinse mortar with vehicle, and add quantity of vehicle sufficient to make 100 mL - Store in amber plastic prescription bottles; label "shake well." - Stable for 13 weeks refrigerated or 8 weeks at room temperature. «b»Oral Syrup (2 mg/mL) Preparation«/b» - A 2 mg/mL lisinopril syrup may be made with powder and simple syrup - Dissolve 1 g of lisinopril powder in 30 mL of distilled water - Mix while adding simple syrup in incremental proportions in a quantity sufficient to make 500 mL - Label "shake well" and "refrigerate." - Stable for 30 days when stored in amber plastic prescription bottles at room temperature or refrigerated - Although no visual evidence of microbial growth was observed, the authors recommend refrigeration to inhibit microbial growth

Lisinopril-Hydrochlorothiazide

Zestoretic

Lisocabtagene Maraleucel

Breyanzi

«bu»Diffuse Large B-Cell Lymphoma«/bu» «b»Lymphodepleting Chemotherapy«/b» - 3 doses of Fludarabine and Cyclophosphamide infused IV on the 5th, 4th, and 3rd day «bi»BEFORE«/bi» infusion of «bi»Lisocabtagene Maraleucel«/bi» «bi»Fludarabine«/bi» - 30 mg/m2 IV daily x 3 days «bi»Cyclophosphamide«/bi» - 500 mg/m2 IV daily x 3 days starting with the first dose of Fludarabine «b»Premedication«/b» «bi»Acetaminophen«/bi» - 650 mg PO 30-60 minutes before Lisocabtagene Maraleucel infusion «bi»Diphenhydramine«/bi» - 25 to 50 mg IV/PO ~30-60 minutes before Lisocabtagene Maraleucel infusion - Avoid prophylactic use of systemic corticosteroids at all times «b»Lisocabtagene Maraleucel«/bi» - For autologous use only - Administer 2-7 days after completing lymphodepleting chemotherapy - Dose based on the number of CAR-positive viable T-cells per vial - A single dose contains 50-110 x 106 CAR-positive viable T-cells (consisting of 1:1 CAR-positive viable T-cells of the CD8 and CD4 components) - Each component supplied separately in 1-4 single-dose vials «b»Cytokine Release Syndrome (CRS) Management«b» «bi»Grade 1«/bi» Symptoms: Fever <72 hr after CAR T-cell Infusion - Tocilizumab 8 mg/kg IV over 1 hr - Not to exceed 800 mg - May consider dexamethasone 10 mg IV every 24 hourr Symptoms: Fever ≥72 hr - Treat symptomatically «bi»Grade 2«/bi» Symptoms Require Moderate Intervention - Oxygen requirement <40% FiO2 or hypotension responsive to fluids or low dose of one vasopressor or Grade 2 organ toxicity Tocilizumab - 8 mg/kg IV infused over 1 hour - Maximum Dose: 800 mg - Repeat tocilizumab every 8 hours prn if not responsive to IV fluids or increasing supplemental oxygen - Not to exceed 3 doses in a 24-hr period or 4 doses in total - If improving, discontinue tocilizumab - If no improvement after 24 hr of starting tocilizumab, administer methylprednisolone (1 mg/kg IV bid or dexamethasone 10 mg IV every 6 hour) until Grade 1, then taper corticosteroids If <72 hr - Dexamethasone 10 mg IV every 12-24hr If ≥72 hr - Consider dexamethasone at above dose No improvement within 24 hr or rapid progression - Repeat tocilizumab and escalate dose and frequency of dexamethasone (10-20 mg IV every 6-12 hr) - If no improvement on maximized dexamethasone, switch to high-dose methylprednisolone 2 mg/kg if needed «bi»Grade 3«/bi» Symptoms require aggressive intervention: - Oxygen requirement ≥40% FiO2 or hypotension requiring high-dose or multiple vasopressors or Grade 3 organ toxicity or Grade 4 transaminitis Tocilizumab - Administration per Grade 2 - If improving, discontinue Corticosteroid - Dose as for Grade 2 - Taper if improving or manage as Grade 4 if not improving «bi»Grade 4«/bi» - Life-threatening symptoms; requires ventilator support, continuous venovenous hemodialysis, or Grade 4 organ toxicity (excluding transaminitis) Tocilizumab - Administration per Grade 2 - If improving, discontinue Methylprednisolone - 1000 mg IV daily for 3 days - Taper if improving or consider alternate immunosuppressants if not improving «b»Neurologic Toxicity Grading and Management«/b» «bi»Grades 2, 3, or 4«/bi» - Consider nonsedating, antiseizure medicines (levetiracetam) for seizure prophylaxis «bi»Grade 1 with Concurrent CRS«/bi» - Administer tocilizumab as described for Grade 1 CRS «bi»Grade 1 with No Concurrent CRS«/bi» - Supportive care «bi»Grade 2 with concurrent CRS«/bi» - Administer tocilizumab (see doses in CRS Grade 2) - If no improvement within 24 hr after starting tocilizumab, administer dexamethasone 10 mg IV everu 6 hours if not already taking other corticosteroids - Continue dexamethasone use until the event is ≤Grade 1, then taper over 3 days «bi»Grade 2 or 3 with NO Concurrent CRS«/bi» - Administer dexamethasone 10 mg IV every 6 hours if not already taking other corticosteroids - Continue until event is ≤Grade 1, then taper over 3 days - If Grade 3 and not improving, manage as Grade 4 (IV methylprednisolone) «bi»Grade 3 with Concurrent CRS«/bi» - Administer tocilizumab (see doses in CRS Grade 2) AND - Administer dexamethasone 10 mg IV every 6 hours if not already taking other corticosteroids; continue dexamethasone until event is ≤Grade 1, then taper over 3 days «bi»Grade 4 with Concurrent CRS«/bi» - Administer tocilizumab (see doses in CRS Grade 2) - Administer methylprednisolone 1000 mg/day IV for 3 days with first dose of tocilizumab; if improvement, then manage as above «bi»Grade 4 with NO Concurrent CRS«/bi» - Administer methylprednisolone 1000 mg/day IV for 3 days; if improvement, then manage as above - If not improving, consider alternate immunosuppressants «b»Contraception«/b» - See the prescribing information for fludarabine and cyclophosphamide for information on the need for effective contraception in patients who receive the lymphodepleting chemotherapy - Limited exposure data available concerning the duration of contraception following treatment «b»IV Administration«/b» - For autologous use only - Do NOT use leukodepleting filter - Ensure tocilizumab and emergency equipment are available before infusion and during the recovery period - Confirm patient identity matches identifiers on syringe label - Proceed with administration as soon as possible after preparation - Total time from removal from frozen storage to patient administration should not exceed 2 hr as indicated by the time entered on the syringe label - Use IV 0.9% NaCl to flush all infusion tubing before and after each CD8 or CD4 component administration - Administer entire volume of CD8 component IV at infusion rate of ~0.5 mL/minute, using the closest port or Y-arm - Infusion time will vary, but usually <15 minutes for each component - If >1 syringe required for full cell dose of CD8 component, administer volume in each syringe consecutively without any time between administering the contents of the syringes (unless there is a clinical reason [eg, infusion reaction] to hold the dose) - After CD8 component administered, flush tubing with 0.9% NaCl, using enough volume to clear tubing and length of IV catheter - Administer CD4 component second, immediately after administration of CD8 component completed, using steps described for the CD8 component, then flush tubing as described - Follow universal precautions and local biosafety guidelines applicable for handling and disposal, to avoid potential transmission of infectious disease «b»IV Preparation«/b» «bi»Thawing«/bi» - Carefully remove vials from cartons and place on protective barrier pad - Thaw at room temperature until there is no visible ice in vials - Thaw all vials at the same time - Keep CD8 and CD4 components separate «bi»Preparing Syringes«/bi» - Based on concentration of CAR-positive viable T cells for each component, >1 vial of each of the CD8 and CD4 components may be required to complete a dose - Prepare separate syringes for each CD8 or CD4 component vial received - Volume drawn up and infused may differ for each component as indicated on the RFI Certificate; do NOT draw up excess volume into syringe - Each vial contains 5 mL with a total extractable volume of 4.6 mL of CD8 or CD4 component T cells; RFI Certificate for each component indicates the volume (mL) of cells to be drawn up into each syringe - Use the smallest Luer-lock tip syringe necessary (1, 3, or 5 mL) to draw up specified volume from each vial - Use 5-mL syringe for volumes <3 mL - Draw up CD8 component first; affix CD8 syringe labels to syringe(s) beforehand - See specific instructions and diagrams in prescribing information for needle gauge, length, and angle when puncturing port septum - Repeat process for CD4 component

Lithium

Lithobid, Eskalith

Lixisenatide

Adlyxin

Lodoxamide (Ophthalmic)

Alomide

Lofexidine

Lucemyra

Lomitapide

Juxtapid

«bu»Homozygous Familial Hypercholesterolemia (HoFH)«/bu» - Initial Dose: 5 mg once daily - After ≥2 weeks of therapy, may increase to 10 mg once daily, as tolerated; then, - At ≥4-week intervals, may increase to 20 mg once daily, then to 40 mg once daily, and finally to a maximum dose of 60 mg/day as tolerated. - Measure transaminases (ALT, AST), alkaline phosphatase, and total bilirubin prior to initiation and prior to any dose increase; obtain a negative pregnancy test in female patients of reproductive potential prior to beginning treatment - Maintenance dose should be individualized, taking into account patient characteristics such as goal of therapy and response to treatment - To reduce development of fat-soluble nutrient deficiency, administer daily supplements containing vitamin E 400 units, linoleic acid ≥200 mg, alpha-linolenic acid (ALA) ≥210 mg, eicosapentaenoic acid (EPA) ≥110 mg, and docosahexaenoic acid (DHA) ≥80 mg - Initiate and maintain a low-fat diet supplying <20% of energy from fat. «b»Weak CYP3A Inhibitors«/b» - Initial Dose: Decrease lomitapide dose by half to a minimum of 5 mg once daily when initiating a weak CYP3A inhibitor in a patient already receiving lomitapide - Titrate based on response and tolerability - Maximum Dose: 30 mg/day «b»Oral Contraceptives«/b» - Initial Dose: Decrease lomitapide dose by half to a minimum of 5 mg once daily when initiating an oral contraceptive in a patient already receiving lomitapide - Titrate based on response and tolerability - Maximum Dose: 40 mg/day. «b»Hepatotoxicity«/b» - If transaminases are abnormal, reduce or withhold dose; monitor as recommended - If transaminase elevations are accompanied by clinical symptoms of liver injury (nausea, vomiting, abdominal pain, fever, jaundice, lethargy, flu-like symptoms), increases in bilirubin ≥2 times ULN, or active liver disease, discontinue use and investigate for probable cause. «bi»AST or ALT ≥ 3 to <5 times ULN«/bi» - Confirm measurement (within 1 week) - Once confirmed, reduce dose and obtain additional liver function tests (LFTs) (alkaline phosphatase, total bilirubin, and INR) - Repeat tests weekly and withhold subsequent doses if signs of abnormal liver function (increased bilirubin or INR), if transaminases rise to >5 times ULN, or if they do not fall to <3 times ULN within ~4 weeks; investigate for probable cause - If resuming after transaminase resolution to <3 times ULN, consider reducing dose and monitor LFTs more frequently. «bi»AST or ALT ≥ 5 times ULN«/bi» - Withhold doses, obtain additional LFTs (alkaline phosphatase, total bilirubin, and INR); investigate for probable cause - If resuming after transaminase resolution to <3 times ULN, reduce dose and monitor LFTs more frequently. «b»Persistent or Clinically Significant Transaminase Elevations«/b» - Discontinue use

Lomustine

Gleostine, CCNU, CeeNU

- Dispense only enough capsules for a single dose; do not dispense more than one dose at a time - Repeat courses should only be administered after adequate recovery of leukocytes to >4,000/mm3 and platelets to >100,000/mm3 - Doses should be rounded to the nearest 5 mg - Lomustine is associated with a moderate emetic potential; antiemetics are recommended to prevent nausea and vomiting. «bu»Brain Tumors«/bu» - 130 mg/m2 as a single dose once every 6 weeks - Reduce dose to 100 mg/m2 as a single dose once every 6 weeks in patients with compromised bone marrow function «bu»Anaplastic Oligodendroglioma«/bu» «b»PCV Regimen«/b» - 130 mg/m2 on day 1 every 6 weeks for up to 4 cycles prior to radiation therapy (in combination with procarbazine and vincristine) «bu»Astrocytoma, High Grade«/bu» «b»POC Regimen«/b» «bi»Adults ≤21 years«/bi» - 100 mg/m2 PO on day 1 every 6 weeks for 8 cycles (in combination with vincristine and prednisone) «bu»Glioblastoma, Recurrent«/bu» «b»PCV Regimen«/b» - 110 mg/m2 on day 1 every 6 weeks for 7 cycles (in combination with procarbazine and vincristine) «b»Single Agent Therapy«/b» - 100 to 130 mg/m2 every 6 weeks until disease progression or unacceptable toxicity «bu»Medulloblastoma«/bu» «b»Adults ≤21 years«/b» - 75 mg/m2 once every 6 weeks for 8 cycles (in combination with cisplatin and vincristin) «bu»Hodgkin Lymphoma«/bu» - 130 mg/m2 as a single dose once every 6 weeks - Reduce dose to 100 mg/m2 as a single dose once every 6 weeks in patients with compromised bone marrow function (dosage reductions may be recommended for combination chemotherapy regimens) «b»Hematologic Toxicity«/b» «bi»Dosing Adjustment (based on nadir) for Subsequent Cycles«/bi» - Leukocytes ≥3,000/mm3, platelets ≥75,000/mm3: No dosage adjustment required - Leukocytes 2,000 to 2,999/mm3, platelets 25,000 to 74,999/mm3: Reduce dose to 70% of prior dose - Leukocytes <2,000/mm3, platelets <25,000/mm3: Reduce dose to 50% of prior dose «b»Nonhematologic Toxicity«/b» «bi»Pulmonary Fibrosis«/bi» - Discontinue permanently.

Lonafarnib

Zokinvy

Lonapegsomatropin

Skytrofa

«b»SC Administration«/b» - Administer SC into abdomen, buttock, or thighs; rotate injection sites between and within regions to reduce the risk of lipoatrophy - Refer to Instructions for Use [www.Skytrofa.com/IFU] for complete administration instructions with illustrations - Diluted solution appears clear and colorless to opalescent and may occasionally contain air bubbles; do NOT inject if solution is cloudy or contains particulate matter - Use cartridges within 4 hr after reconstitution; discard reconstituted cartridges after 4 hours when stored at room temperature up to 86ºF (30ºC) «b»SC Preparation«/b» - Selection of appropriate cartridge is based on prescribed dose (mg/kg) and patient’s body weight (kg) For a prescribed dose of 0.24 mg/kg/week and patient’s weight is 11.5-100 kg, follow the recommended dosing «b»11.5-13.9 kg«/b» - 3 mg/week «b»14-16.4 kg«/b» - 3.6 mg/week «b»16.5-19.9 kg«/b» - 4.3 mg/week «b»20-23.9 kg«/b» - 5.2 mg/week «b»24-28.9 kg«/b» - 6.3 mg/week «b»29-34.9 kg«/b» - 7.6 mg/week «b»35- 41.9 kg«/b» - 9.1 mg/week «b»42-50.9 kg«/b» - 11 mg/week «b»51-60.4 kg«/b» - 13.3 mg/week «b»60.5-69.9 kg«/b» - 15.2 mg/week (use 2 cartridges of 7.6 mg each) «b»70- 84.9 kg«/b» - 18.2 mg/week (use 2 cartridges of 9.1 mg each) «b»85-100 kg«/b» - 22 mg/week (use 2 cartridges of 11 mg each) - For a prescribed dose other than 0.24 mg/kg/week, calculate total weekly dose (in mg) and select appropriate cartridge as follows: «b»Total weekly dose (mg) = Prescribed weekly dose (mg/kg) x patient’s body weight (kg)«/b» - Round total weekly dose (mg) to closest cartridge dose while also considering treatment goals and clinical response - Cartridge has been designed for use only with autoinjector - If refrigerated, calibrate cartridge to room temperature for 15 minutes before use - Autoinjector provides a fully automated reconstitution of the lyophilized drug product, which is followed by a manual mixing step controlled by the device - Insert injection needle into skin; the device automatically delivers the drug - Built-in electronics and software assist the user during drug preparation and administration, and confirm dose delivery

Loncastuximab

Zynlonta

Loperamide

Anti-Diarrheal, Imodium A-D, Loperamide A-D, Diamode, Anti-Diarrheal

Lopinavir

40 kg: Lopinavir 400 mg PO bid Fixed dosing for patients weighing ≥15 kg and able to swallow tablets: Dosing approximates lopinavir 230 mg/m2/dose - ≥15 to 25 kg: Lopinavir 200 mg PO bid - >25 to 35 kg: Lopinavir 300 mg PO bid - >35 kg: Lopinavir 400 mg PO bid Antiretroviral-experienced or suspected decreased sensitivity to lopinavir - BSA-directed dosing: Children and Adolescents: Lopinavir 300 mg/m2/dose (maximum dose: 400 mg/dose) twice daily Weight-directed dosing: Children and Adolescents: Dosing approximates lopinavir 300 mg/m2/dose: - <15 kg: Lopinavir 13 mg/kg/dose twice daily - 15 to 45 kg: Lopinavir 11 mg/kg/dose twice daily - >45 kg: Lopinavir 400 mg twice daily Weight band dosing for patients weighing ≥15 kg and able to swallow tablets: Dosing approximates lopinavir 300 mg/m2/dose: - 15 to 20 kg: 200 mg twice daily - >20 to 30 kg: 300 mg twice daily - >30 kg: 400 mg twice daily Patients receiving concomitant antiretroviral therapy with efavirenz, nelfinavir, or nevirapine (or treatment-experienced patients not receiving these agents who have suspected decreased susceptibility to lopinavir): - BSA-directed dosing: Children and Adolescents: Lopinavir 300 mg/m2/dose twice daily; maximum dose: Oral solution: 520 mg/dose; Tablet: 500 mg/dose Alternate fixed dosing for patients who are able to swallow tablets: - BSA ≥0.6 to <0.8 m2: Lopinavir 200 mg twice daily - BSA ≥0.8 to <1.2 m2: Lopinavir 300 mg twice daily - BSA ≥1.2 to <1.7 m2: Lopinavir 400 mg twice daily - BSA ≥1.7 m2: Lopinavir 500 mg twice daily Weight-directed dosing: Children and Adolescents: Dosing approximates lopinavir ~300 mg/m2/dose: - <15 kg: Lopinavir 13 mg/kg/dose twice daily - ≥15 to 45 kg: Lopinavir 11 mg/kg/dose twice daily >45 kg: - Oral solution: Lopinavir 520 mg (6.5 mL) twice daily - Tablets: Lopinavir 500 mg twice daily «b»Fixed Dosing Weighing ≥15 kg who are able to swallow tablets«/b» ≥15 to 20 kg - Lopinavir 200 mg PO bid >20 to 30 kg - Lopinavir 300 mg PO bid >30 to 45 kg - Lopinavir 400 mg PO bid >45 kg - Lopinavir 500 mg PO bid Lopinavir 600 mg twice daily (3 tablets of the 200/50 mg lopinavir/ritonavir) can be used for ease of dosing «bu»HIV-1 Nonoccupational Postexposure Prophylaxis (nPEP)«/bu» - Initiate therapy within 72 hours of exposure and continue for 28 days - Use in combination with other antiretroviral agents «b»Infants (At Least 42 Weeks Postmenstrual)«/b» «bi»Oral Solution«/bi» - 300 mg/m2/dose or 16 mg/kg/dose twice daily «b»Children«/b» «bi»Oral Solution«/bi» <15 kg - Lopinavir 12 mg/kg/dose PO bid 15 to 40 kg - Lopinavir 10 mg/kg/dose PO bid >40 kg - Lopinavir 400 mg PO bid «bi»Fixed Dosing«/bi» - Patients weighing ≥15 kg and able to swallow tablets ≥15 to 25 kg - Lopinavir 200 mg PO bid >25 to 35 kg - Lopinavir 300 mg PO bid >35 kg - Lopinavir 400 mg PO bid «b»Adolescents«/b» - Not recommended; other antiretroviral agents should be used" class="list-group-item active pb-0 drug">

Lopinavir-Ritonavir

Kaletra

«bu»HIV-1 Infection Treatment«/bu» - Pediatric dosage is based on patient body weight or surface area and is presented here based on lopinavir component - Do not exceed recommended adult dose - Use of tablets in patients <15 kg or <0.6 m2 is not recommended (use oral solution) - Once-daily dosing in pediatric patients is not recommended; in a study of treatment experienced children, once-daily dosing resulted in a lower trough concentration and less virological control «b»Infants ≥42 Weeks Postmenstrual Age«/b» «bi»Combination Therapy without Efavirenz, Nelfinavir, or Nevirapine«/bi» - Lopinavir 16 mg/kg or 300 mg/m2 PO bid - Infants who receive 300 mg/m2/dose twice daily may have lower trough concentrations compared to adults - Evaluate infants and adjust dose for incremental growth at frequent intervals. «bi»Combination Therapy with Efavirenz, Fosamprenavir, Nelfinavir, or Nevirapine«/bi» - Dosage information does not exist - Lopinavir/Ritonavir is not recommended in infants who are receiving these agents «b»Children and Adolescents«/b» «bi»Combination Therapy without Efavirenz, Nelfinavir, or Nevirapine«/bi» Antiretroviral Naive - Higher dose (see below) recommended in antiretroviral-experienced patients who may have decreased sensitivity to lopinavir; some clinicians choose to initiate therapy with the higher dose in all patients due to lower trough concentrations observed with the lower dose «b»BSA-directed Dosing: Children and Adolescents«/b» - Lopinavir 230 mg/m2/dose (maximum dose: 400 mg/dose) PO bid - Others have suggested 300 mg/m2/dose PO bid if the oral solution is used - For patients already receiving lopinavir and ritonavir, an immediate dosage reduction at 12 months is not recommended; patients are allowed to "grow into" the 230 mg/m2/dose dosage as they gain weight over time. «bi»Fixed Dosing Weighing ≥15 kg«/bi» Dosing Approximates Lopinavir 230 mg/m2/dose - BSA ≥0.6 to <0.9 m2: Lopinavir 200 mg PO bid - BSA ≥0.9 to <1.4 m2: Lopinavir 300 mg PO bid - BSA ≥1.4 m2: Lopinavir 400 mg PO bid «b»Weight-directed Dosing: Children and Adolescents«/b» Dosing Approximates Lopinavir 230 mg/m2/dose - <15 kg: Lopinavir 12 mg/kg/dose PO bid - 15 to 40 kg: Lopinavir 10 mg/kg/dose PO bid - >40 kg: Lopinavir 400 mg PO bid Fixed dosing for patients weighing ≥15 kg and able to swallow tablets: Dosing approximates lopinavir 230 mg/m2/dose - ≥15 to 25 kg: Lopinavir 200 mg PO bid - >25 to 35 kg: Lopinavir 300 mg PO bid - >35 kg: Lopinavir 400 mg PO bid Antiretroviral-experienced or suspected decreased sensitivity to lopinavir - BSA-directed dosing: Children and Adolescents: Lopinavir 300 mg/m2/dose (maximum dose: 400 mg/dose) twice daily Weight-directed dosing: Children and Adolescents: Dosing approximates lopinavir 300 mg/m2/dose: - <15 kg: Lopinavir 13 mg/kg/dose twice daily - 15 to 45 kg: Lopinavir 11 mg/kg/dose twice daily - >45 kg: Lopinavir 400 mg twice daily Weight band dosing for patients weighing ≥15 kg and able to swallow tablets: Dosing approximates lopinavir 300 mg/m2/dose: - 15 to 20 kg: 200 mg twice daily - >20 to 30 kg: 300 mg twice daily - >30 kg: 400 mg twice daily Patients receiving concomitant antiretroviral therapy with efavirenz, nelfinavir, or nevirapine (or treatment-experienced patients not receiving these agents who have suspected decreased susceptibility to lopinavir): - BSA-directed dosing: Children and Adolescents: Lopinavir 300 mg/m2/dose twice daily; maximum dose: Oral solution: 520 mg/dose; Tablet: 500 mg/dose Alternate fixed dosing for patients who are able to swallow tablets: - BSA ≥0.6 to <0.8 m2: Lopinavir 200 mg twice daily - BSA ≥0.8 to <1.2 m2: Lopinavir 300 mg twice daily - BSA ≥1.2 to <1.7 m2: Lopinavir 400 mg twice daily - BSA ≥1.7 m2: Lopinavir 500 mg twice daily Weight-directed dosing: Children and Adolescents: Dosing approximates lopinavir ~300 mg/m2/dose: - <15 kg: Lopinavir 13 mg/kg/dose twice daily - ≥15 to 45 kg: Lopinavir 11 mg/kg/dose twice daily >45 kg: - Oral solution: Lopinavir 520 mg (6.5 mL) twice daily - Tablets: Lopinavir 500 mg twice daily «b»Fixed Dosing Weighing ≥15 kg who are able to swallow tablets«/b» ≥15 to 20 kg - Lopinavir 200 mg PO bid >20 to 30 kg - Lopinavir 300 mg PO bid >30 to 45 kg - Lopinavir 400 mg PO bid >45 kg - Lopinavir 500 mg PO bid Lopinavir 600 mg twice daily (3 tablets of the 200/50 mg lopinavir/ritonavir) can be used for ease of dosing «bu»HIV-1 Nonoccupational Postexposure Prophylaxis (nPEP)«/bu» - Initiate therapy within 72 hours of exposure and continue for 28 days - Use in combination with other antiretroviral agents «b»Infants (At Least 42 Weeks Postmenstrual)«/b» «bi»Oral Solution«/bi» - 300 mg/m2/dose or 16 mg/kg/dose twice daily «b»Children«/b» «bi»Oral Solution«/bi» <15 kg - Lopinavir 12 mg/kg/dose PO bid 15 to 40 kg - Lopinavir 10 mg/kg/dose PO bid >40 kg - Lopinavir 400 mg PO bid «bi»Fixed Dosing«/bi» - Patients weighing ≥15 kg and able to swallow tablets ≥15 to 25 kg - Lopinavir 200 mg PO bid >25 to 35 kg - Lopinavir 300 mg PO bid >35 kg - Lopinavir 400 mg PO bid «b»Adolescents«/b» - Not recommended; other antiretroviral agents should be used

Loratadine

Claritin, Alavert, Loradamed, Triaminic Allerchews, Loradamed, QlearQuil 24 Hour Relief

Loratadine-Pseudoephedrine

Claritin-D, Loratadine-D, Alavert Allergy & Sinus

LORazepam

Ativan

«bu»Anxiety Disorder«/bu» Initial Dose - 2 to 3 mg daily in 2 to 3 divided doses Usual Dose - 2 to 6 mg daily in divided doses; however, daily dose may vary from 1 to 10 mg/day «bu»Insomnia due to Anxiety or Stress«/bu» «b»<65 years«/b» - 0.5 to 2 mg at bedtime «b»≥65 years«/b» - 0.5 to 1 mg at bedtime - The manufacturer recommends higher dosing (2 to 4 mg at bedtime); however, generally, it is a safer approach to employ the above recommended doses. «bu»Premedication for Anesthesia«/bu» «b»IM Route«/b» - 0.05 mg/kg administered 2 hours before surgery - Maximum Dose: 4 mg «b»IV Route«/b» - 0.044 mg/kg administered 15 to 20 minutes before surgery - Usual Dose: 2 mg - Maximum Dose: 4 mg - Doses >2 mg should generally not be exceeded in patients >50 years «b»Sublingual Tablet«/b» - 0.05 mg/kg 1 to 2 hours before surgery - Maximum Dose: 4 mg «bu»Status Epilepticus«/bu» - 0.1 mg/kg (maximum dose: 4 mg) IV/IM given at a maximum rate of 2 mg/minute - May repeat in 5 to 10 minutes - Dilute dose 1:1 with saline. «bu»Agitation in the ICU«/bu» - Loading Dose: 0.02 to 0.04 mg/kg IV x 1 dose - Maximum Single IV Dose: 2 mg - Maintenance Dose : 0.02 to 0.06 mg/kg IV every 2 to 6 hours as needed or 0.01 to 0.1 mg/kg/hour - Maximum Dose: ≤10 mg/hour «bu»Alcohol Withdrawal Delirium«/bu» - 1 to 4 mg IV every 5 to 15 minutes until calm, then, - Every hour as needed to maintain light somnolence - 1 to 4 mg IM every 30 to 60 minutes until calm, then, - Every hour as needed to maintain light somnolence «bu»Alcohol Withdrawal Syndrome«/bu» «b»Fixed-dose Regimen (Oral, IM, IV)«/b» - 2 mg every 6 hours for 4 doses, then 1 mg every 6 hours for 8 additional doses «b»Symptom-triggered Regimen (Oral, IM, IV)«/b» - 2 to 4 mg every 1 hour as needed; dose determined by a validated severity assessment scale «bu»Chemotherapy Associated Nausea and Vomiting«/bu» - Breakthrough nausea/vomiting or as adjunct to standard antiemetics - 0.5 to 2 mg IV/IM/PO every 6 hours as needed «bu»Partial Complex Seizures, Refractory«/bu» - 1 mg PO twice daily - Increase biweekly in increments of 1 mg twice daily until seizures stop or side effects occur - Additional data may be necessary to further define the role of lorazepam in this condition «bu»Psychogenic Catatonia«/bu» - 1 to 2 mg IM/SL x 1 dose - Repeat dose in 3 hours then again in another 3 hours if initial and subsequent doses, respectively, are ineffective - Initial Dose: 1 mg IV/IM/PO x 1 dose, - May repeat in 5 minutes if necessary - If initial challenge is unsuccessful, may increase dose up to 4 to 8 mg per day; may continue treatment for up to 5 days «bu»Rapid Tranquilization of the Agitated«/bu» - 1 to 3 mg IV/IM/PO administered every 30 to 60 minutes - May be administered with an antipsychotic (haloperidol) - When administering IM, may consider a lower initial dose (0.5 mg) «b»Dosage Adjustment«/b» «bi»Probenecid or Valproic Acid«/bi» - Reduce lorazepam dose by 50% «b»IM Administration«/b» - Should be administered (undiluted) deep into the muscle mass. «b»IV Injection Administration«/b» - Dilute prior to use (according to the manufacturer) - Do not exceed 2 mg/minute or 0.05 mg/kg over 2 to 5 minutes - Monitor IV site during administration - Avoid intra-arterial administration - Avoid extravasation «b»Continuous IV Infusion Administration«/b» - Solutions should have an in-line filter and the solution should be checked frequently for possible precipitation «b»Oral Administration«/b» «bi»Lorazepam Oral Concentrate«/bi» - Use only the provided calibrated dropper to withdraw the prescribed dose - Mix the dose with liquid (water, juice, soda, soda-like beverage) or semisolid food (applesauce, pudding), and stir for a few seconds to blend completely - The prepared mixture should be administered immediately. «bi»Sublingual Tablet«/bi» - Place under tongue - Patient should not swallow for at least 2 minutes «b»IV Reconstitution«/b» - According to the manufacturer, dilute IV dose prior to use with an equal volume of compatible diluent (D5W, NS, SWFI). «b»Infusion Reconstitution«/b» - Precipitation may occur upon dilution when preparing an infusion. - Use 2 mg/mL injectable vial to prepare; there may be decreased stability when using 4 mg/mL vial. - Dilute to ≤1 mg/mL with a compatible diluent in a non-PVC (polyolefin, glass) container (consult parenteral admixture resource for additional detailed recommendations). - Can also be administered undiluted (up to 4 mg/mL) via infusion into a central vein or into a peripheral vein with a running compatible maintenance IV solution «b»Oral Suspension (1 mg/mL) Preparation«/b» - Two different 1 mg/mL oral suspensions may be made from different generic lorazepam tablets, sterile water, Ora-Sweet, and Ora-Plus. - Place one-hundred-eighty 2 mg tablets in a 12-ounce amber glass bottle; add 48 mL sterile water to disperse the tablets; shake until slurry is formed - Add 156 mL of Ora-Plus in incremental proportions; then add a quantity of Ora-Sweet sufficient to make 360 mL - Label "shake well" and "refrigerate" - Store in amber glass prescription bottles - Stable for 63 days at room temperature or 91 days refrigerated.

Lorcaserin

Belviq

Lorlatinib

Lorbrena

«bu»Non-small Cell Lung Cancer (NSCLC)«/bu» - Anaplastic lymphoma kinase (ALK)-positive metastatic NSCLC whose disease has progressed on the following: - Crizotinib and at least 1 other ALK inhibitor or - Alectinib or ceritinib as first ALK inhibitor therapy - 100 mg PO daily with or without food - Continue until disease progression or unacceptable toxicity «b»Missed Dose«/b» - If a dose is missed, then administer dose unless next dose is due within 4 hr - Do not take 2 doses at the same time - Do not take an additional dose if vomiting occurs after administration; continue with next scheduled dose «b»Dosage Modifications for Adverse Reactions«/b» - First Dose Reduction: 75 mg PO daily - Second Dose Reduction: 50 mg PO daily - Unable to tolerate 50 mg Daily: Permanently discontinue «b»Central Nervous System (CNS) Effects«/b» «bi»Grade 1«/bi» - Continue at same dose or withhold dose until recovery to baseline - Resume at same or reduced dose «bi»Grades 2 or 3«/bi» - Withhold dose until Grade <1 - Resume at reduced dose «bi»Grade 4«/bi» - Permanently discontinue «b»Grade 4 Hypercholesterolemia or Hypertriglyceridemia«/b» - Withhold until recovery of hypercholesterolemia and/or hypertriglyceridemia to Grade ≤2; resume at same dose - If severe hypercholesterolemia and/or hypertriglyceridemia recurs, resume at reduced dose «b»Atrioventricular (AV) Block«/b» - Second-degree AV block: Withhold until PR interval <200 msec; resume at reduced dose - First occurrence of complete AV block: Withhold until pacemaker placed or PR interval <200 msec - If pacemaker is placed, resume at same dose - If no pacemaker is placed, resume at reduced dose - Recurrent complete AV block: Place pacemaker or permanently discontinue «b»Interstitial Lung Disease (ILD)/Pneumonitis«/b» - Any grade treatment-related ILD/pneumonitis: Permanently discontinue «b»Other Adverse Reactions«/b» «bi»Grades 1 or 2«/bi» - Continue at same or reduced dose «bi»Grades 3 or 4«/bi» - Withhold until symptoms resolve to Grade ≤2 or baseline; resume at reduced dose «b»Moderate CYP3A Inducers«/b» - Avoid use «b»Strong CYP3A Inducers«/b» - Coadministration with Strong CYP3A inducers is contraindicated - Discontinue strong CYP3A inducers for 3 plasma half-lives before initiating lorlatinib «b»Strong CYP3A Inhibitors«/b» - Avoid use with strong CYP3A inhibitors; if coadministration unavoidable, reduce starting lorlatinib dose to 75 mg daily - If dosed reduced to 75 mg daily because of adverse reactions and are initiating a strong CYP3A inhibitor, reduce dose to 50 mg daily - If strong CYP3A inhibitor is discontinued, increase dose (after 3 plasma half-lives of the strong CYP3A inhibitor) to dose used before starting the strong inhibitor «b»Contraception«/b» «bi»Female Patients of Reproductive Potential«/bi» - Use effective nonhormonal contraception during treatment and for at least 6 months after final dose, because lorlatinib can render hormonal contraceptives ineffective «bi»Males«/bi» - Based on genotoxicity findings, advise males with female partners of reproductive potential to use effective contraception during treatment and for at least 3 months after final dose «b»Infertility«/b» - Based on animal studies, male fertility may transiently be impaired

Losartan

Cozaar

Losartan-Hydrochlorothiazide

Hyzaar

Loteprednol (Ophthalmic)

Alrex, Inveltys, Eysuvis, Lotemax, Lotemax SM

Lovastatin

Mevacor, Altoprev, Mevinolin

Loxapine

Loxitane, Adasuve

Lubiprostone

Amitiza

Luliconazole

Luzu

Lumacaftor

Lumacaftor-Ivacaftor

Orkambi

Lumasiran

Oxlumo

Lumateperone

Caplyta

Lumefantrine

Lurasidone

Latuda

Lurbinectedin

Zepzelca

Luspatercept

Reblozyl

Lusutrombopag

Mulpleta

Lutetium Lu 177 dota tate

Lutathera

Lutetium Lu 177 Vipivotide Tetraxetan

Pluvicto

Lymphocyte AntiThymocyte Immune Globulin

Atgam, ATG, Antithymocyte Immunoglobulin

«b»Test Dose«/b» - While a skin test is recommended prior to administration of the initial dose, anaphylaxis may still occur in patients who display negative skin tests - Consider testing initially with an epicutaneous prick of undiluted antithymocyte globulin (ATG); if no wheal in 10 minutes, then use 0.02 mL intradermally of a 1:1000 dilution of ATG in normal saline along with a separate saline control of 0.02 mL; observe in 10 minutes - A positive skin reaction consists of a wheal with the initial prick test (undiluted) or ≥3 mm in diameter larger than the saline control with the diluted intradermal test - Alternatively, a 0.1 mL test dose (5 mg/mL concentration) may be administered intradermally along with a separate saline control; erythema larger than 5 mm in diameter (compared to the control) is considered a positive test - A positive skin test is suggestive of an increased risk for systemic allergic reactions with an infusion - If ATG treatment is deemed appropriate following a positive skin test, the first infusion should be administered in a controlled environment with intensive life support immediately available - A systemic reaction precludes further administration. «b»Premedication«/b» - Antihistamine - Corticosteroids, and/or - Antipyretic «bu»Aplastic Anemia«/bu» - 10 to 20 mg/kg IV once daily for 8 to 14 days, then, - if needed, may administer every other day for 7 more doses for a total of 21 doses in 28 days or - 40 mg/kg once daily for 4 days in combination with cyclosporine «bu»Acute Graft-versus-Host Disease (GVHD) Treatment«/bu» - 30 mg/kg every other day for 6 doses - 15 mg/kg twice daily for 10 doses «bu»Lung Transplant«/bu» «b»Induction Therapy«/b» - 5 to 15 mg/kg daily IV for the first 3 days after transplant «bu»Myelodysplastic Syndromes«/bu» «b»Refractory, Lower-risk Disease«/b» - 40 mg/kg IV once daily for 4 days - An intradermal test dose was administered prior to treatment «b»Anaphylaxis«/b» - Discontinue infusion immediately; administer epinephrine - May require corticosteroids, respiration assistance, and/or other resuscitative measures. Do not resume infusion. «b»Hemolysis (Severe and Unremitting)«/b» - May require discontinuation of treatment.

Macimorelin

Macrilen

Macitentan

Opsumit

Mafenide

Sulfamylon

Maftivimab

Magnesium Carbonate

Magonate, Magnesite

Magnesium Chloride

Mag-Delay, Chloromag, Slow-Mag

Magnesium Citrate

Citrate of Magnesia, Citroma

Magnesium Gluconate

Almora, Magonate, Mag-G,

Magnesium Hydroxide

Dulcolax Milk of Magnesia, Milk of Magnesia Concentrate, Pedia-Lax, MOM, Magnesia Magma

Magnesium Oxide

Uro-Mag, MaOx, Mag Oxide, Mag-200

Magnesium Salicylate

Backaid Pills, Doans Pills

Magnesium Sulfate

MagSulfate, Epsom Salt

«b»IM Administration«/b» - Must be diluted prior to administration for children (Adults: 25% or 50% concentration; Children: ≤20% diluted solution) «b»IV Administration«/b» - Must be diluted to a ≤20% solution for IV infusion and may be administered IV push, IVPB, or continuous IV infusion - When giving IV push, must dilute first and should generally not be given any faster than 150 mg/minute; may administer over 1 to 2 minutes in patients with persistent pulseless VT or VF with known hypomagnesemia. ACLS guidelines recommend administration over 15 minutes in patients with torsade de pointes. In patients not in cardiac arrest, hypotension and asystole may occur with rapid administration. In patients with asthma (acute severe exacerbation) (off-label use), may administer single dose over 20 minutes to 60 minutes. - Maximal rate of infusion: Up to 50% of an IV dose may be eliminated in the urine, therefore, slower administration may improve retention (maximum rate: 1 g/hour in asymptomatic patients). For doses <6 g, infuse over 8 to 12 hours and for larger doses infuse over 24 hours if patient is asymptomatic. If patient is severely symptomatic (or has conditions such as preeclampsia or eclampsia) more aggressive therapy (≤4 g over 4 to 5 minutes) may be required; patients should be closely monitored. «b»Oral Administration«/b» - When used as a laxative, dissolve dose in 8 ounces of water prior to ingesting. Lemon juice may be added to the solution to improve the taste. «b»Topical Administration«/b» - May dissolve granules to prepare a solution for use as a soaking aid or as a compress. To make a compress, use a towel to apply as a wet dressing. «b»IV Preparation«/b» - Dilute to ≤20% in a compatible solution (D5W, NS) for IV infusion. «b»IM Preparation«/b» - A 25% or 50% concentration may be used for adults and dilution to a ≤20% solution is recommended for children. «b»Oral Preparation«/b» - Dissolve granules in 8 ounces of water prior to administration - May add lemon juice to improve taste. «b»Topical Preparation«/b» - Dissolve 2 cups of granules per gallon of warm water to use as a soaking aid.

Malathion

Ovide

Manganese

MN-50, Mangimin

Mannitol

Osmitrol, Resectisol, D-Mannitol

Mannitol (Oral Inhalation)

Aridol, Bronchitol

Maprotiline

Ludiomil

Maralixibat

Livmarli

Maraviroc

Selzentry

Margetuximab

Margenza

Maribavir

Livtencity

Mavacamten

Camzyos

Measles Mumps Rubella (MMR) Virus Vaccine

M-M-R II, MMR Vaccine, Priorix

«bu»Immunization Against Measles, Mumps & Rubella«/bu» - Routine vaccination: First dose of 0.5 mL SC between age 12-15 months; administer second dose between 4-6 yr - Minimum age for 1st dose is 12 months «b»International Travel«/b» «bi»6-12 months«/bi» - Administer 1 dose of MMR before departure from the United States for international travel; revaccinate with 2 doses of MMR, the first at age 12-15 months (12 months if the child remains in an area where disease risk is high), and the second dose at least 4 weeks later «bi»>12 months«/bi» - Administer 2 doses of MMR before departure from the United States for international travel; the first dose should be administered on or after age 12 months and the second dose at least 4 weeks later «b»Catch-up Vaccination«/b» - Ensure all school-aged children and adolescents received 2 doses (0.5 mL SC each) - Minimum time between 1st and 2nd dose is 4 wk «b»Perinatal HIV Infection«/b» - Revaccinate persons who were vaccinated before establishment of effective antiretroviral therapy with 2 appropriately spaced doses of MMR vaccine once effective ART has been established «b»12 months or older with HIV infection«/b» - Vaccinate all persons with HIV infection who do not have evidence of current severe immunosuppression «b»Additional dose during mumps outbreak«/b» - Increased risk for acquiring mumps are individuals who are more likely to have prolonged or intense exposure to droplets or saliva from a person infected with mumps, (close contact or sharing of drinks or utensils) - During an outbreak, persons identified as being at increased risk who have received ≤2 doses of mumps virus-containing vaccine or have unknown vaccination status should receive 1 dose Infants aged 6-12 months - Local health authorities may recommend measles vaccination of infants in outbreak situations - This population may fail to respond to the components of the vaccine; safety and effectiveness of mumps and rubella vaccine in infants aged <12 months have not been established - The younger the infant, the lower the likelihood of seroconversion - Such infants should receive a second dose of MMR between aged 12-15 months followed by revaccination at elementary school entry

Measles Mumps Rubella Varicella (MMRV) Vaccine

ProQuad, MMRV

Mebendazole

Emverm, Vermox

Mecamylamine

Vecamyl

Mecasermin

Increlex, rhIGF-1

Mechlorethamine

Mustargen, Chlorethazine, Nitrogen Mustard

Mechlorethamine (Topical)

Valchlor

Meclizine

Meclicot, Dramamine, Travel Sickness, Antivert, Vertin-32, Motion-Time

Meclofenamate

Meclomen

MedroxyPROGESTERone

Depo-Provera, Provera, MPA

«bu»Abnormal Uterine Bleeding«/bu» - 5 or 10 mg daily for 5 to 10 days starting on day 16 or 21 of menstrual cycle. - A suggested dose of 10 mg daily for 10 days starting on day 16 of the cycle induces optimum secretory transformation of the endometrium when adequately primed with endogenous or exogenous estrogen. - Withdrawal bleeding may be expected within 3 to 7 days after discontinuing medroxyprogesterone. - Planned menstrual cycling may benefit patients with a history of recurrent episodes of abnormal uterine bleeding. «bu»Amenorrhea, Secondary«/bu» - 5 or 10 mg daily for 5 to 10 days - Therapy may be started at any time - A dose of 10 mg daily for 10 days induces optimum secretory transformation of the endometrium when adequately primed with endogenous or exogenous estrogen - Withdrawal bleeding may be expected within 3 to 7 days after discontinuing «bu»Contraception«/bu» «b»Depo-Provera Contraceptive«/b» - 150 mg IM every 3 months (every 13 weeks) «b»Depo-SC Provera 104«/b» - 104 mg SC every 3 months (every 12 to 14 weeks) «bu»Endometrial Carcinoma«/bu» «b»Recurrent or Metastatic«/b» «bi»Adjunctive/Palliative Treatment«/bi» «b»Depo-Provera«/b» - Initial Dose: 400 to 1,000 mg IM weekly «bu»Endometrial Hyperplasia Prevention«/bu» «b»Postmenopausal Receiving Daily Conjugated Estrogen«/b» - 5 or 10 mg daily for 12 to 14 consecutive days each month, starting on day 1 or day 16 of the cycle - When treating postmenopausal persons, use for the shortest duration possible at the lowest effective dose consistent with treatment goals - Reevaluate patients as clinically appropriate to determine if treatment is still necessary. - Treatment is indicated for postmenopausal persons with a uterus to decrease the risk of endometrial cancer; persons who have had a hysterectomy generally do not need a progestin. «bu»Endometriosis«/bu» «b»Depo-SC Provera 104«/b» - 104 mg SC every 3 months (every 12 to 14 weeks) «bu»Hot Flashes«/bu» - 400 mg IM x 1 dose «bu»Paraphilia/Hypersexuality«/bu» «b»Males«/b» - Avoid use if active pituitary pathology, hepatic failure, or thromboembolic disease Depo-Provera - 100 to 600 mg IM weekly - 100 to 500 mg PO daily «b»IM Administration«/b» «bi»Depo-Provera Contraceptive«/bi» - Administer first dose during the first 5 days of menstrual period, or within the first 5 days postpartum if not breastfeeding, or at the sixth week postpartum if breastfeeding exclusively - Shake vigorously prior to administration - Administer by deep IM injection in the gluteal or deltoid muscle - Rotate administration site with each injection. - When switching from combined hormonal contraceptives (estrogen plus progestin), the first injection should be on the day after the last active tablet or (at the latest) the day after the final inactive tablet - When switching from other contraceptive methods, ensure continuous contraceptive coverage. «b»SC Administration«/b» «bi»Depo-SC Provera 104«/bi» - Administer first dose during the first 5 days of menstrual period, or at the sixth week postpartum if breastfeeding. Shake vigorously for at least 1 minute prior to administration. Administer by SC injection in the anterior thigh or abdomen; avoid boney areas and the umbilicus. Administer slowly over 5 to 7 seconds. Do not rub the injection area. Rotate administration site with each injection. - When switching from combined hormonal contraceptives (estrogen plus progestin), the first injection should be within 7 days after the last active pill, or removal of patch or ring. If switching from the IM to SC formulation, the next dose should be given within the prescribed dosing period for the IM injection to ensure continuous coverage. «bi»IM, SC: Additional Contraceptive Considerations«/bi» - Available guidelines note the first injection may be given at any time in the menstrual cycle once it is determined that the woman is not pregnant. Back-up contraception is not needed if given within 7 days of onset of menstruation, immediately postpartum, or immediately after a spontaneous or induced abortion. Additional contraception is needed for 7 days unless the injection is given at the time of a surgical abortion. If the injection is given >7 days after menstrual bleeding started, an additional form of contraception must be used for 7 days unless the woman abstains from sexual intercourse. When switching from an IUD to the injection in women who have had sexual intercourse since the start of their last menstrual cycle, consider postponing removal of the IUD for 7 days after the initial injection, instruct the woman to use barrier contraception or abstain from intercourse for 7 days before the first injection, or consider emergency contraception at the time of IUD removal. When contraception will be continued, repeat injections should be given every 13 weeks but may be given early if needed. Injections may be given up to 2 weeks late, however pregnancy should be ruled out and additional contraceptive measures are required for 7 days if the repeat dose is >15 weeks from the last injection

Mefenamic Acid

Ponstel

Mefloquine

Lariam

Megestrol

Megace, Megace ES

Melatonin

Pineal Hormone Melatonin

Meloxicam

Vivlodex, Mobic

Melphalan

Alkeran, Evomela, L-PAM, L-Phenylalanine Mustard

«b»Melphalan«/b» - Associated with a moderate emetic potential (depending on dose and/or administration route); antiemetics may be recommended to prevent nausea and vomiting «bi»IV Administration«/bi» - Available in different formulations - Indications for use, product preparation, storage, and dosing differ between formulations - Use caution when selecting melphalan formulations for preparation and administration - Do not mix or combine the formulations - Irritant; local reactions may occur «bi»Extravasation«/bi» - May cause local tissue damage - Administration by slow injection into a fast running IV solution into an injection port or via a central line is recommended - Do not administer by direct injection into a peripheral vein «bi»Oral Administration«/bi» - Administer on an empty stomach «b»Alkeran«/b» «bi»IV Administration«/bi» - Due to limited stability, complete administration of IV dose should occur within 60 minutes of reconstitution - Infuse over 15 to 20 minutes. «b»Evomela«/b» «bi»IV Administration«/bi» - Infuse over 15 to 20 minutes (palliative treatment for multiple myeloma) or 30 minutes (conditioning regimen for autologous stem cell transplantation). «b»IV Reconstitution«/b» «bi»Alkeran Injection«/bi» - Stability is limited; must be prepared fresh - The time between reconstitution/dilution and administration of parenteral melphalan (Alkeran) must be kept to a minimum (manufacturer recommends <60 minutes) because reconstituted and diluted solutions are unstable - Dissolve powder initially with 10 mL of supplied diluent to a concentration of 5 mg/mL; shake immediately and vigorously to dissolve. - Immediately dilute dose in NS to a concentration of ≤0.45 mg/mL - Do not refrigerate solution; precipitation occurs if stored at 5°C. - The manufacturer recommends administration within 60 minutes of reconstitution. «bi»Evomela Injection«/bi» - Reconstitute each vial with 8.6 mL of NS to a 5 mg/mL concentration - Further dilute the appropriate dose in NS to a concentration of 0.45 mg/mL.

Melphalan Flufenamide

Pepaxto

«bu»Multiple Myeloma«/bu» «bi»Melphalan Flufenamide«/bi» - 40 mg IV on Day 1 - Repeat cycle every 28 days AND «bi»Dexamethasone«/bi» - 40 mg PO/IV on Days 1, 8, 15, and 22 - Reduce dose to 20 mg in patients aged ≥75 yr - Repeat cycle every 28 days - Continue until disease progression or until unacceptable toxicity «b»Dose Reductions for Adverse Reactions«/b» - Administered IV on Day 1 of each 28-day cycle «bi»First Dose Reduction«/bi» - Reduce to 30 mg «bi»Second Dose Reduction«/bi» - Reduce to 20 mg - Unable to tolerate 20-mg dose: Permanently discontinue «b»Myelosuppression«/b» - Platelet count <50 x 109/L or absolute neutrophil count (ANC) <1 x 109/L on intended dosing day - Withhold and monitor platelet count weekly until ≥50 x 109/L and ANC weekly until ≥1 x 109/L - Resume at same dose if delay ≤2 weeks or at 1 dose level lower if delay >2 weeks - Grade 4 hematological adverse reaction on an intended dosing day in 2 consecutive cycles: Resume at 1 dose level lower «b»Nonhematologic Adverse Reactions«/b» «bi»Grade 2«/bi» - Consider withholding until resolved to Grade ≤1 or baseline - Consider resuming at 1 dose level «bi»Grade 3 or 4«/bi» - Withhold until resolved to Grade ≤1 or baseline - Resume at 1 dose level as clinically appropriate «b»Limitation of Use«/b» - Not indicated or recommended for use as conditioning regimen for transplantation outside of controlled clinical trials «b»Contraception«/b» «bi»Females of Reproductive Potential«/bi» - Use effective contraception during treatment and for 6 months after last dose «bi»Males with Female Partners of Reproductive Potential«/bi» - Use effective contraception during treatment and for 3 months after last dose «b»Infertility«/b» «bi»Females«/bi» - May cause amenorrhea in premenopausal women and result in infertility «bi»Males«/bi» - Based on animal data, male fertility may be impaired - Alkylating drugs can also cause irreversible testicular suppression «b»IV Administration«/b» - Premedicate with a serotonin-3 (5-HT3) receptor antagonist or other antiemetics before and during treatment - Visually inspect diluted solution; do not use if visibly opaque particles, discoloration, or foreign particles are observed - Infuse over 30 min via central venous access device (ediport, peripherally inserted central catheter, tunneled central venous catheter) - If infusion bag was stored in a refrigerator, allow to reach to room temperature (20-25ºC [68-77ºF]); start infusion within 30 min of removing diluted solution from refrigerator - Once completed, flush central catheter per individual institutional guidelines «b»IV Preparation«/b» - Determine dose, total volume of reconstituted solution required, and number of vials needed - Remove vial(s) from refrigerator and place at room temperature for at least 30 min - Shake vial(s) vigorously or vortex to disintegrate lyophilized powder cake into loose powder «bi»Reconstitution«/bi» - Reconstitute each vial with 40 mL of room temperature (20-25ºC/68-77ºF) D5W to obtain a final concentration of 0.5 mg/mL - Shake vial(s) vigorously until solution is clear; allow vials to stand to dissipate any air bubbles to confirm a clear solution «bi»Dilution«/bi» - Withdraw and discard 80 mL from a cold (2-8ºC [36-46ºF]) 250-mL infusion bag of NS - Withdraw required volume of reconstituted solution and transfer into an IV bag containing NS to obtain a final concentration of 0.1-0.16 mg/mL; discard any product remaining in vial(s) - Gently invert bag to mix solution; NOT shake - Visually inspect solution (clear/colorless to pale yellow) and discard if solution is discolored or particles are present - Must begin infusion within 60 min of initial reconstitution; if not immediately used, refrigerate at 2-8C (36-46F), within 30 min after initial reconstitution, for up to 6 hr Degrades in solution, especially at room temperature; do not exceed storage timelines for diluted solution

Memantine

Namenda

Memantine-Donepezil

Namzaric

Meningococcal A/C /Y&W135 Diphtheria Conj Vaccine

Menactra, Menveo, MCV4

«bu»Meningococcal Vaccination«/bu» - Dose: 0.5 mL IM x 1 dose - Indicated active immunization to prevent invasive meningococcal disease caused by Neisseria meningitidis serogroups A, C, Y, and W-135 in high risk adults «b»Immunization for High-Risk Conditions«/b» - MenACWY is preferred for adults with any of the following indications who are aged ≤55 yr as well as for adults aged ≥56 years who a) were vaccinated previously with MenACWY and are recommended for revaccination, or b) for whom multiple doses are anticipated - Meningococcal polysaccharide vaccine (MPSV4 [Menomune]) is preferred for adults aged ≥56 years who have not received MenACWY previously and who require a single dose only (eg, travelers) «b»Asplenia or Complement Deficiencies«/b» - Indicated in adults of all ages with functional asplenia or persistent complement component deficiencies Menactra or Menveo - Administer 2 doses at least 2 months apart to adults of all ages with functional asplenia or persistent complement component deficiencies - Booster dose: Every 5 years «b»HIV Infection«/b» - ACIP recommends routine immunization for persons aged ≥2 months with HIV infection Menactra or Menveo - Not previously vaccinated: Give 2-dose primary series - Previously vaccinated with 1 dose of conjugate vaccine: Give a booster dose at the earliest opportunity, provided at least 8 wk have elapsed since the previous dose, and then continue to receive boosters at the appropriate interval throughout life «b»Microbiologists«/b» - Administer a single dose of meningococcal vaccine to microbiologists routinely exposed to isolates of Neisseria meningitidis - Booster dose: Every 5 years «b»Military Recruits«/b» - Administer a single dose «b»First-year College Students«/b» - Administer a single dose for first-year college students (up through age 21 years) who are living in residence halls should be vaccinated if they have not received a dose on or after their 16th birthday «b»Community Outbreak«/b» Administer a single dose for persons at risk during an outbreak attributable to a vaccine serogroup «b»Travel/Reside in Hyperendemic/Epidemic Countries«/b» - Administer a single dose for adults who travel to or reside in countries in which meningococcal disease is hyperendemic or epidemic, including countries in the African meningitis belt or the Hajj - International travelers should receive a booster dose of MenACWY if the last dose was administered >4 years previously - Vaccination in the 3 years before the date of travel is required by the government of Saudi Arabia for all travelers to Mecca during the annual Hajj «bu»Primary Immunization (Adolescent)«/bu» - Routine primary vaccination of adolescents recommended at age 11 or 12 years unless high risk or outbreak requires earlier vaccination at younger age «bi»11-12 years«/bi» - 0.5 mL IM once; CDC recommends booster dose at age 16 yr «bi»11-12 years (HIV Infection)«/bi» - 2-dose primary series of 0.5 mL IM with at least 8 wk between doses «b»Catch-up Schedule (Adolescent)«/b» - Administer vaccine at age 13 through 18 years if not previously vaccinated - If first dose is administered at age 13 through 15 years, a booster dose should be given at age 16 through 18 years; minimum interval between doses is 8 weeks - If first dose administered at age 16 or older, a booster dose is not needed «b»First-year College Students«/b» - First-year college students (up to age 21 yr) living in residence halls should receive at least 1 dose of MenACWY before college entry; the preferred timing of the most recent dose is on or after their 16th birthday - If only 1 dose of vaccine was administered before the 16th birthday, a booster dose should be administered before enrollment «b»Immunization for High-Risk Conditions«/b» «bi»Asplenia«/bi» - Indicated for children with anatomic or functional asplenia (including sickle cell disease) Menveo for children aged <19 months - 4-dose infant series given at 2, 4, 6, and 12 through 15 months For children aged 19 through 23 months who have not completed a series of MenHibrix or - Menveo, administer 2 primary doses of Menveo at least 3 months apart For children aged ≥24 months who have not received a complete series of MenHibrix or Menveo or Menactra, administer 2 primary doses of either Menactra or Menveo at least 2 months apart - Booster dose: Every 5 years «b»HIV Infection«/b» - ACIP recommends routine immunization for persons aged ≥2 months with HIV infection Menactra or Menveo - Not previously vaccinated: Give 2-dose primary series - Previously vaccinated with 1 dose of conjugate vaccine: Give a booster dose at the earliest opportunity, provided at least 8 wk have elapsed since the previous dose, and then continue to receive boosters at the appropriate interval throughout life «b»Complement Deficiency«/b» - For children with persistent complement component deficiency - For children younger than 19 months of age, administer a 4-dose infant series of Menveo at 2, 4, 6, and 12 through 15 months of age - For children 7 through 23 months who have not initiated vaccination, 2 options exist depending on age and vaccine brand: -a. For children who initiate vaccination with Menveo at 7 months through 23 months of age, a 2-dose series should be administered with the 2nd dose after 12 months of age and at least 3 months after the first dos -b. For children who initiate vaccination with Menactra at 9 months through 23 months of age, a 2-dose series of Menactra should be administered at least 3 months apart - For children ≥24 months who have not received a complete series of any meningococcal vaccine, administer 2 primary doses of either Menactra or Menveo at least 2 months apart - Booster dose: Every 5 years «b»Travel/reside in hyperendemic/epidemic countries«/b» - For children who travel to or reside in countries in which meningococcal disease is hyperendemic or epidemic, including countries in the African meningitis belt or the Hajj - Administer an age-appropriate formulation and series of Menactra (minimum age 9 months) or Menveo (minimum age 2 months) for protection against serogroups A and W meningococcal disease - Note: Prior receipt of MenHibrix is not sufficient for children traveling to the meningitis belt or the Hajj because it does not contain serogroups A or W International travelers should receive a booster dose of MenACWY if the last dose was administered >4 years previously - Vaccination in the 3 years before the date of travel is required by the government of Saudi Arabia for all travelers to Mecca during the annual Hajj «b»Community Outbreak«/b» - For children at risk during a community outbreak attributable to a vaccine serogroup, administer or complete an age- and formulation-appropriate series of MenHibrix, Menactra, or Menveo «b»Dosing Considerations«/b» - Indicated for routine prophylaxis initiated during adolescence CDC guidelines provide guidance for high risk infants/children (eg, sickle cell, asplenia, persistent complement deficiencies, traveling to endemic areas, outbreaks) «b»Schedule for initiating vaccine at a particular age (product specific)«/b» - Menveo (age 2 months): FDA approved for 4-dose series given at 2, 4, 6, and 12 months of age - Meveo (age 7-23 months): FDA approved for 2-dose series with 2nd dose being given in 2nd year of life at least 3 months after the first dose - Menveo (age 2-10 years): Single dose; for children aged 2 yr through 5 yr at continued high risk of meningococcal disease, a 2nd dose may be administered 2 months after the 1st dose - Menveo (adolescents and adults aged 11 through 55 years): FDA approved as a single dose - Menactra: (age 9-23 months): FDA approved for 2-dose series given 3 months apart - Menactra: (age 2-55 years): FDA approved as single dose with a booster dose (if at least 4 yr have elapsed) in high risk individuals aged 15 yr through 55 yr «b»IM Administration«/b» - Administer by IM route, preferably into the anterolateral aspect of the thigh (infants) or upper deltoid region (toddlers, adolescents, and adults) - Do not administer via IV, SC or intradermal route - Do not mix with other vaccines or injections; separate needles and syringes should be used for each injection - To prevent syncope related injuries, adolescents and adults should be vaccinated while seated or lying down - US law requires that the date of administration, the vaccine manufacturer, lot number of vaccine, and the administering person's name, title, and address be entered into the patient's permanent medical record. - For patients at risk of hemorrhage, the vaccine should be administered intramuscularly if, in the opinion of a physician familiar with the patient's bleeding risk, the vaccine can be administered by this route with reasonable safety. - If the patient receives antihemophilia or other similar therapy, intramuscular vaccination can be scheduled shortly after such therapy is administered. - A fine needle (23 gauge or smaller) can be used for the vaccination and firm pressure applied to the site (without rubbing) for at least 2 minutes. - The patient or family should be instructed concerning the risk of hematoma from the injection. - Patients on anticoagulant therapy should be considered to have the same bleeding risks and treated as those with clotting factor disorders - For IM administration only. Based on limited data, inadvertent SubQ administration provides a lower serologic response, however, the response is still considered to be protective. If inadvertently administered by the SubQ route, revaccination is not necessary «b»Reconstitution«/b» Menveo - Prior to use, remove entire contents from vial of MenCYW-135 and inject into vial containing MenA powder - Invert and shake well until dissolved - The resulting solution should be clear and colorless - A small amount of liquid will remain in the vial after withdrawing the 0.5 mL dose.

Meningococcal Group B Vaccine

Bexsero, Trumenba

«bu»Meningococcal Serogroup B Immunization«/bu» «b»Bexsero«/b» «bi»Children ≥10 years and Adolescents«/bi» - 0.5 mL/dose IM given as a 2-dose series at least 1 month apart «b»Trumenba«/b» «bi»Children ≥10 years and Adolescents«/bi» - Consider risk of exposure and patient’s susceptibility to the disease when choosing a schedule. «b»2-dose Schedule«/b» - 0.5 mL per dose IM given as a 2-dose series according to a 0- and 6-month schedule - If the interval between the first and second dose is ≤6 months, administer a third dose ≥4 months after the second dose. «b»3-dose Schedule«/b» - 0.5 mL per dose IM given as a 3-dose series according to a 0-, 1- to 2-, and 6-month schedule. «b»ACIP Recommendations for Trumenba«/b» - Children and adolescents ≥10 years of age at increased risk for serogroup B meningococcal disease and during serogroup B meningococcal disease outbreak: Administer 3-dose series at 0, 1 to 2 months, and 6 months. If the interval between the first and second dose is ≥6 months, then the third dose is not needed. - Adolescents ≥16 years of age who are not at increased risk for meningococcal disease: Administer a 2-dose series at 0 and 6 months. If the interval between the first and second dose is ≤6 months, then a third dose ≥4 months later should be administered. «bi»Infants 2 to 5 months«/bi» - IM: Total of 4 doses (0.5 mL each); a primary infant series is administered at 2, 4, and 6 months of age followed by a booster dose between 12 to 23 months of age; alternatively, may give first 3 doses at 2, 3, and 4 months of age, however, the immune response to 1 component (NHBA) of the vaccine is reduced with this regimen «bi»Infants 6 months to <12 months (unvaccinated)«/bi» - IM: Total of 3 doses (0.5 mL each) with first and second dose administered at least 2 months apart; third dose is administered during second year of life at least 2 months after the second dose. The necessity of a booster dose has not been determined. «bi»Children ≥1 year to <2 years (unvaccinated)«/bi» -IM: Total of 2 doses (0.5 mL each) administered at least 2 months apart. The necessity of a booster dose has not been determined. «bi»Children ≥2 years to <11 years«/bi» - IM: Total of 2 doses (0.5 mL each) administered at least 2 months apart. The necessity for subsequent dosing has not been determined. «bi»Children ≥11 years to Adolescents ≤17 years«/bi» - IM: Total of 2 doses (0.5 mL each) administered at least 1 month apart. The necessity for subsequent dosing has not been determined.

Meningococcal Polysaccharide Vaccine A/C/Y & W 135

Menomune-A/C/Y/W 135

Menotropins

Menopur, Repronex, hMG

«bu»Ovulation Induction (Females)«/bu» «b»Repronex«/b» «bi»Initial Dose«/bi» - 150 units IM/SC once daily for the first 5 days of treatment - Adjustments should not be made more frequently than once every 2 days and should not exceed 75-150 units per adjustment based on ultrasound monitoring of ovarian response and/or measurement of serum estradiol levels «bi»Maximum Daily Dose«/bi» - 450 units IM/SC - Treatment >12 days is not recommended - If patient's response is appropriate, administer hCG one day following the last dose of Repronex - Hold dose if serum estradiol is >2000 pg/mL, if the ovaries are abnormally enlarged, or if abdominal pain occurs; the patient should also be advised to refrain from intercourse. - May repeat process if follicular development is inadequate or if pregnancy does not occur. «bu»Assisted Reproductive Technologies (ART) (Females)«/bu» «b»Menopur«/b» «bi»Initial Dose«/bi» - 225 units SC once daily beginning on cycle day 2 or 3 - Menotropins may be administered together with urofollitropin and the total initial dose of both products combined should not exceed 225 units (menotropins 150 units and urofollitropin 75 units; or menotropins 75 units and urofollitropin 150 units) - Dose should be adjusted after 5 days based on ultrasound monitoring of ovarian response and/or measurement of serum estradiol levels - Do not make additional adjustments more frequently than once every 2 days or by >150 units «bi»Maximum Daily Dose«/bi» - 450 units (of menotropins, or menotropins plus urofollitropin) - Treatment >20 days is not recommended - Once adequate follicular development is evident, hCG should be administered - Withhold the hCG dose if ovarian monitoring suggests an increased risk of ovarian hyperstimulation syndrome «b»Repronex«/b» «bi»Initial Dose«/bi» - 225 units IM/SC once daily - Adjustments in dose based on ultrasound monitoring of ovarian response and/or measurement of serum estradiol levels should not be made more frequently than once every 2 days and should not exceed more than 75-150 units per adjustment «bi»Maximum Daily Dose«/bi» - 450 units - Treatment >12 days is not recommended. - Once adequate follicular development is evident, hCG should be administered to induce final follicular maturation in preparation for oocyte retrieval. - Withhold the hCG dose if ovarian monitoring suggests an increased risk of OHSS. «bu»Spermatogenesis (Males)«/bu» - Following pretreatment with hCG: 75 units IM 3 times per week with hCG twice weekly until sperm is detected in the ejaculate (4-6 months); if response is inadequate after 6 months, may increase menotropins dosage to 150 units 3 times per week for another 6 months «b»Limitations of Use«/b» - Prior to therapy, preform a complete gynecologic exam and endocrinologic evaluation to diagnose the cause of infertility; exclude the possibility of pregnancy; evaluate the fertility status of the male partner; exclude a diagnosis of primary ovarian failure.

Menthol

Menthol (Topical), Bengay Cold Therapy, Icy Hot Advanced Relief Patch, Salonsip Gel Patch, Aspercreme Heat Pain Relieving Gel, Mentholatum Sports

Meperidine

Demerol

Mepivacaine

Carbocaine, Polocaine, Scandonest

Mepolizumab

Nucala

Meprobamate

MB-Tab, Equanil

Mercaptopurine

Purixan, Purinethol, 6-MP

Meropenem

Merrem

«b»Usual Dosage Range«/b» - 1.5 to 6 g IV daily divided every 8 hours «bu»Bacterial Meningitis«/bu» - 2 g IV every 8 hours - Duration of therapy dependent upon pathogen: N. meningitidis, H. influenza: 7 days; S. pneumoniae: 10 to 14 days; Listeria monocytogenes, aerobic gram-negative bacilli: 21 days «bu»Catheter-related Bloodstream Infections«/bu» - 1 g IV every 8 hours «bu»Cholangitis, Intra-abdominal Infections«/bu» «b»Complicated«/b» - 1 g IV every 8 hours - Recommend treatment duration of 4 to 7 days (provided source controlled) - Not recommended for mild-to-moderate, community-acquired intra-abdominal infections due to risk of toxicity and the development of resistant organisms «bu»Cystic Fibrosis, Pulmonary Exacerbation«/bu» - 2 g IV every 8 hours «bu»Febrile Neutropenia«/bu» - 1 g IV every 8 hours «bu»Gynecologic and Pelvic Infections«/bu» - 500 mg IV every 8 hours «bu»Melioidosis«/bu» «b»Burkholderia Pseudomallei«/b» - Initial treatment (intensive-phase): 1 g every 8 hours - Meropenem is an alternative treatment to ceftazidime for melioidosis; continued treatment with oral antibiotics is recommended after intensive-phase is completed «bu»Hospital Acquired Pneumonia«/bu» - 1 g IV every 8 hours «bu»Prosthetic Joint Infection«/bu» «b»Pseudomonas Aeruginosa«/b» - 1 g IV every 8 hours for 4 to 6 weeks - Consider addition of aminoglycoside «bu»Skin and Skin Structure Infections«/bu» «b»Pseudomonas Aaeruginosa-Suspected/Confirmed«/b» - 1 g every 8 hours «b»Pseudomonas Aeruginosa Not Suspected«/b» - 500 mg every 8 hours «bu»Skin and Soft Tissue Necrotizing Infections«/bu» - 1 g every 8 hours in combination with an agent effective against MRSA (vancomycin, linezolid, daptomycin) for empiric therapy of polymicrobial (mixed) infections - Continue until further debridement is not necessary, patient has clinically improved, and patient is afebrile for 48 to 72 hours «bu»Surgical Site Infection«/bu» «b»Intestinal or Genitourinary Tract Surgery«/b» - 1 g IV every 8 hours «bu»Urinary Tract Infections«/bu» «b»Complicated«/b» - 500 mg to 1 g every 8 hours «b»Usual Dosage Range«/b» «bi»Infants <3 months«/bi» Gestational age <32 weeks - Postnatal age <14 days: 20 mg/kg/dose every 12 hours - Postnatal age ≥14 days: 20 mg/kg/dose every 8 hours Gestational age ≥32 weeks - Postnatal age <14 days: 20 mg/kg/dose every 8 hours - Postnatal age ≥14 days: 30 mg/kg/dose every 8 hours «b»Infants ≥3 months, Children (≤50 kg)«/b» - 30 to 120 mg/kg/day IV divided every 8 hours - Maximum Dose: 6 g daily «b»Children (>50 kg)«/b» - 1.5 to 6 g IV daily divided every 8 hours «bu»Catheter-related Blood Stream Infections«/bu» «b»Infants ≥3 months, Children, Adolescents (≤50 kg)«/b» - 20 mg/kg every 8 hours - Maximum single dose: 1,000 mg «b»Children and Adolescents (>50 kg)«/b» - Refer to adult dosing «bu»Cholangitis, Intra-abdominal Infections«/bu» «b»Children and Adolescents (>50 kg)«/b» - Refer to adult dosing «bu»Cystic Fibrosis, Pulmonary Exacerbation«/bu» «b»Infants ≥3 months, Children, Adolescents (≤50 kg)«/b» - 40 mg/kg every 8 hours - Maximum Single Dose: 2,000 mg «b»Children and Adolescents (>50 kg)«/b» - Refer to adult dosing «bu»Febrile Neutropenia«/bu» «b»Infants ≥3 months, Children, Adolescents (≤50 kg)«/b» - 20 mg/kg every 8 hours - Maximum Dose: 1,000 mg every 8 hours «b»Children and Adolescents (>50 kg)«/b» - Refer to adult dosing «bu»Intra-abdominal Infections«/bu» «b»Infants <3 months«/b» - Administer as an IV infusion over 30 minutes - Do not administer as an IV bolus «bi»Gestational age <32 weeks«/bi» - Postnatal age <14 days: 20 mg/kg/dose every 12 hours - Postnatal age ≥14 days: 20 mg/kg/dose every 8 hours «bi»Gestational age ≥32 weeks«/bi» - Postnatal age <14 days: 20 mg/kg/dose every 8 hours - Postnatal age ≥14 days: 30 mg/kg/dose every 8 hours «b»Infants ≥3 months, Children, Adolescents«/b» - 20 mg/kg every 8 hours - Maximum dose: 1,000 mg every 8 hours) for 4 to 7 days «bu»Melioidosis (Burkholderia Pseudomallei)«/bu» «b»Infants ≥6 months, Children, and Adolescents (≤40 kg)«/b» - Initial treatment (intensive-phase): 25 mg/kg (up to 1 g) every 8 hours - Meropenem is an alternative treatment to ceftazidime for melioidosis; continued treatment with oral antibiotics is recommended after intensive-phase is completed «b»Children and Adolescents (>50 kg)«/b» - Refer to adult dosing. «bu»Meningitis«/bu» «b»Infants ≥3 months, Children, Adolescents (≤50 kg)«/b» - 40 mg/kg every 8 hours - Maximum Dose: 2,000 mg every 8 hours «b»Children and Adolescents (>50 kg)«/b» - 2 g every 8 hours «bu»Prosthetic Joint Infection, Pseudomonas Aeruginosa«/bu» «b»Children and Adolescents (>50 kg)«/b» - Refer to adult dosing. «bu»Skin and Skin Structure Infections, Complicated«/bu» «b»Infants ≥3 months, Children, and Adolescents (≤50 kg)«/b» «bi»Pseudomonas Aeruginosa-Suspected/Confirmed«/bi» - 20 mg/kg every 8 hours - Maximum Dose: 1,000 mg every 8 hours «bi»Pseudomonas Aeruginosa not Suspected«/bi» - 10 mg/kg every 8 hours - Maximum Dose: 500 mg every 8 hours «b»Children and Adolescents (>50 kg)«/b» - Refer to adult dosing. «bu»Skin and Soft Tissue Necrotizing Infections«/bu» - 20 mg/kg IV every 8 hours in combination with an agent effective against MRSA (vancomycin, linezolid, daptomycin) for empiric therapy of polymicrobial (mixed) infections - Continue until further debridement is not necessary, patient has clinically improved, and patient is afebrile for 48 to 72 hours «bu»Urinary Tract Infection«/bu» «b»Children and Adolescents (>50 kg)«/b» - Refer to adult dosing

Meropenem-Vaborbactam

Vabomere

Mesalamine

Lialda, Pentasa, Apriso, Rowasa, Canasa, Asacol

«b»Capsules«/b» - Administer with or without food. «bi»Apriso«/bi» - Do not administer with antacids - Opening the capsule and placing the contents (delayed-release granules) on food with a pH <6 is not expected to affect the release of mesalamine once ingested (data on file, Salix Pharmaceuticals Medical Information) - There is no safety/efficacy information regarding this practice. «bi»Delzicol«/bi» - Swallow capsule whole with water; do not break, chew, crush, or cut - If a patient is unable to swallow the capsule, may open capsule and swallow capsule contents whole (do not cut, chew, break, or crush, or cut the contents). «bi»Pentasa«/bi» - Swallow capsule whole; do not crush or chew; if a patient is unable to swallow the capsule, may open capsule and sprinkle the entire contents (controlled-release beads) onto yogurt or applesauce. «b»Tablets«/b» - Swallow whole; do not break, chew, or crush. «bi»Asacol«/bi» - Administer with or without food. «bi»Asacol HD«/bi» - Product formulated without dibutyl phthalate [DBP]) - Administer on an empty stomach (at least 1 hour before or 2 hours after a meal) «bi»Asacol HD«/bi» - Product formulated with DBP - Administer with or without food «bi»Lialda«/bi» - Administer with a meal. «bi»Mesasal«/bi» - Administer before meals. «bi»Mezavant«/bi» - Administer with a meal. «bi»Pentasa«/bi» - Administer with meals. «b»Rectal Enema«/b» - Shake bottle well - Instruct patient to lie on left side with left leg extended and right leg flexed forward for balance, or in “knee-chest” position - Insert lubricated applicator tip into the rectum and point slightly toward the navel - Grasp bottle firmly and tilt so nozzle is aimed toward the back; squeeze slowly to instill medication - After administration, withdraw and discard bottle - Retain enemas for 8 hours or as long as practical «b»Suppository«/b» - Remove foil wrapper; avoid excessive handling - Insert into rectum. Retain suppository for 1 to 3 hours or longer - Do not cut or break suppository.

Mesna

Mesnex, Mercaptoethane Sulfonate

Mestranol

Metaproterenol

Alupent, Orciprenaline Sulfate

Metaxalone

Metaxall, Skelaxin

MetFORMIN

Glucophage, Fortamet, Glumetza, Riomet

«bu»Diabetes Mellitus, Type 2«/bu» - Allow 1 to 2 weeks between dose titrations - Clinically significant responses may not be seen at doses <1,500 mg/day; however, a lower recommended starting dose and gradual increased dosage is recommended to minimize gastrointestinal symptoms. «b»Immediate-release Tablet or Solution«/b» «bi»Adults ≥17 years«/bi» Initial Dose - 500 mg PO bid OR - 850 mg PO once daily Maintenance Dose - Titrate in increments of 500 mg weekly OR - 850 mg every other week - May also titrate from 500 mg twice a day to 850 mg twice a day after 2 weeks - Usual effective dose is 850 to 1,000 mg twice daily; modest additional benefit may be observed with doses up to ~2,500 mg/day but their use may be limited by adverse GI effects. - If a dose >2,000 mg/day is considered, it may be better tolerated in 3 divided doses Maximum Recommended Dose - 2,550 mg/day. «b»Extended-release Tablet«/b» - If glycemic control is not achieved at maximum dose, may divide dose and administer PO bid - Initial Dose: 500 to 1000 mg once daily - Dosage may be increased by 500 mg weekly up to a maximum of 2,000 mg/day (Glucophage XR, Glumetza) or 2,500 mg/day (Fortamet) «b»Conversion from IR to ER Tablets«/b» - Patients receiving metformin immediate release may be switched to metformin ER once daily at the same total daily dose, up to 2,000 mg once daily (2,500 mg for Fortamet) «b»Transfer from Other Antidiabetic Agents«/b» - No transition period is generally necessary except when transferring from chlorpropamide. When transferring from chlorpropamide, care should be exercised during the first 2 weeks because of the prolonged retention of chlorpropamide in the body, leading to overlapping drug effects and possible hypoglycemia. «b»Concomitant Use with Insulin or Insulin Secretagogues«/b» - Reduced dose of insulin or insulin secretagogues (eg, sulfonylureas) may be needed. «b»Patients Not Meeting Glycemic Goals«/b» - Advance to dual therapy (metformin + a second antihyperglycemic agent) and then triple therapy (metformin + two antihyperglycemic agents) in patients who fail to achieve glycemic goals after ~3 months with lifestyle intervention and monotherapy or dual therapy, respectively. Preference is not given for which agent(s) should be added to metformin (drug choice should be individualized based on patient characteristics). If HbA1c target not achieved after ~3 months of triple therapy, consider initiating basal insulin (usually with metformin +/- other noninsulin agent) or if patient already receiving an optimally titrated basal insulin as part of their regimen, consider combination injectable therapy (adding a GLP-1 receptor agonist or adding mealtime insulin or changing from basal insulin to a more complex insulin regimen). «b»Patients with Elevated HbA1C at Therapy Initiation«/b» - If HbA1c is ≥9% at initiation of therapy, dual therapy (metformin + a second antihyperglycemic agent) should be considered. If HbA1c ≥10%, blood glucose is ≥300 mg/dL, or if patient is symptomatic (eg, polyuria, polydipsia), insulin therapy (with or without additional agents) should be considered. «bu»Antipsychotic-induced Weight Gain«/bu» «b»Immediate-release Tablet«/b» - Initial Dose: 250 to 500 mg twice daily - May increase after 3 to 7 days to 500 mg two or three times daily based on tolerability. - Doses as high as 2,550 mg/day have been studied «b»Extended-release Tablet«/b» - Initial Dose: 500 mg once daily for 2 to 6 weeks, then, - May increase to 1,000 mg once daily - May continue dosage increases in 500 mg increments every 6 weeks based on tolerability up to 2,000 mg/day «bu»Diabetes Mellitus, Type 2, Prevention«/bu» «b»Immediate-release Tablet or Solution«/b» - Initial Dose: 850 mg once daily - Target Dose: 850 mg PO bid «bu»Polycystic Ovary Syndrome with Anovulatory Infertility«/bu» «b»Immediate-release Tablet«/b» - 1,500 to 2,000 mg/day in 2 or 3 divided doses «b»Extended-release Tablet«/b» - 1,000 mg twice daily - Metformin should be initiated at lower doses (500 mg daily) and increased gradually over 1 to 2 weeks to the target dose to minimize adverse effects (GI intolerance) «bu»Polycystic Ovary Syndrome with Menstrual Irregularities«/bu» «b»Immediate-release Tablet«/b» - 500 mg 2 or 3 times daily, up to 1,000 mg twice daily - The dose of metformin should be increased gradually to minimize GI adverse effects - When metformin is used, cyclic progestin therapy may be added for the first 6 months of metformin treatment, until regular cycles are established. «bu»Prevention of Ovarian Hyperstimulation Syndrome with Polycystic Ovary Syndrome«/bu» «b»Immediate-release Tablet«/b» - 1,000 mg to 2,550 mg per day as 500 mg 2 or 3 times per day or 850 mg 2 or 3 times per day. - The dose of metformin should be increased gradually to minimize GI adverse effects. - Pretreatment with metformin may be started as early as 16 weeks prior (but typically 4 to 5 weeks prior) to as late as the first day of gonadotropin-releasing hormone (GnRH) agonist administration; some studies continued metformin therapy during gonadotropin ovarian stimulation

Meth/Meblue/Sod Phos/Psal/Hyos

Azuphen MB, Uramit MB, Uribel, Ustell, Vilevev MB

Methadone

Methadose, Dolophine

Methamphetamine

Desoxyn, Desoxyephedrine

MethazolAMIDE

Neptazane

Methenamine

Hiprex, Urex

MethIMAzole

Tapazole

«bu»Thyrotoxicosis, Type 1 Amiodarone-induced«/bu» - 40 mg PO once daily to restore euthyroidism (generally 3 to 6 months) - If high doses continue to be required, dividing the dose may be more effective - Use in combination with a corticosteroid if etiology of thyrotoxicosis (eg, type 1 or type 2) cannot be unequivocally determined or if patient is too clinically unstable to allow a trial of monotherapy «bu»Hyperthyroidism«/bu» «b»Initial Dose«/b» - 15 to 60 mg/day depending on severity of disease «b»Usual Maintenance Dose«/b» - 5 to 15 mg/day - Adjust dosage as required to achieve and maintain serum T3, T4, and TSH levels in the normal range. An elevated T3 may be the sole indicator of inadequate treatment. An elevated TSH indicates excessive antithyroid treatment. «bu»Hyperthyroidism Associated with Graves disease«/bu» (off label) - Individualize dose based on serum free T4 and T3 levels and clinical status to restore euthyroidism and minimize adverse effects - Adjunctive therapy with potassium iodide may be beneficial in controlling hyperthyroidism and may allow lower initial dosages of methimazole to be used «b»Initial Dose«/b» - 10 to 30 mg once daily; based on free T4 levels, lower doses (eg, 5 mg/day) or higher doses (eg, 40 mg/day) may be considered however initial doses >30 mg/day are associated with increased adverse effects - In patients with severe disease, administering the daily dose in 2 divided doses (eg, 15 to 20 mg twice daily) may increase efficacy (methimazole duration of action may be less than 24 hours). - The following recommendations may be considered to guide initial dosing based on free T4 levels: - 1 to 1.5 times ULN: 5 to 10 mg/day - >1.5 to 2 times ULN: 10 to 20 mg/day - >2 times ULN: 30 to 40 mg/day «b»Usual Maintenance Dose«/b» - 5 to 10 mg once daily for a total of 12 to 18 months, then discontinue if thyroid function tests (eg, TSH, thyrotropin receptor antibody [TRAb]) are normal at that time. «bu»Iodine-induced Thyrotoxicosis«/bu» - 20 to 40 mg daily given either once or twice daily «bu»Thyrotoxicosis or Thyroid Storm«/bu» - Recommendations vary - Use in combination with other specific agents - Dosages of 20 to 25 mg every 6 hours have been used; once stable, dosing frequency may be reduced to once or twice daily - The American Thyroid Association recommends 60 to 80 mg/day

Methocarbamol

Carbacot, Robaxin

Methotrexate

Otrexup, Rasuvo, Rheumatrex, Trexall, MTX, RediTrex

«bu»Neoplasms«/bu» «b»Antineoplastic Dosage Range«/b» - 30-40 mg/m²/week to 100-12,000 mg/m² with leucovorin rescue «b»Trophoblastic Neoplasms«/b» - 15-30 mg/day PO/IM for 5 days - May be repeated «bu»Burkitt Lymphoma, Stage I/II«/bu» - 10-25 mg/day PO for 4-8 days «bu»Meningeal Leukemia«/bu» - 12 mg intrathecally - Not to exceed 15 mg/dose every 2-7 days - Administer 1 additional dose after cell count on CSF returns to normal «b»Dosing Considerations«/b» - Administration at intervals less than 1 week may result in increased subacute toxicity - Use preservative-free methotrexate only; dilute to 1 mg/mL in preservative-free NS «bu»Osteosarcoma«/bu» - 12 g/m² IV over 4 hours on weeks 4, 5, 6, 7, 11, 12, 15, 16, 29, 30, 44, and 45 after surgery in combination with other chemotherapy; leucovorin rescue - If peak serum methotrexate <454 mcg/mL at end of initial infusion, dose may be increased to 15 g/m² in subsequent treatments «b»Dosing Considerations«/b» - High-dose therapy requires adequate hydration and urine alkalinization - Delay methotrexate if severe myelosuppression, hepatotoxicity, mucositis, or pleural effusion present «bu»Rheumatoid Arthritis«/bu» «b»Initial Dose«/b» - 7.5 mg PO as a single weekly dose OR - 2.5 mg PO every 12 hr for 3 sequential doses per week - Increase PO dose to optimum response - Single dose not to exceed 20 mg/week PO (increased risk of bone marrow suppression) - Reduce to lowest possible effective dose «b»Otrexup (SC)«/b» - If used as initial therapy, start at lowest available dose (10 mg SC every week) «b»Rasuvo (SC)«/b» Initial Dose - 7.5 mg as a single SC dose once weekly Maintenance Dose - Adjust autoinjector dose by 2.5 mg increments as clinically required «bu»Psoriasis«/bu» «b»Initial Dose«/b» - 10-25 mg weekly in single PO/SC/IM/IV dose - Not to exceed 30 mg/week - Gradually adjust dose to achieve to optimal clinical response; use lowest dose and longest rest period possible with return to conventional topical therapy encouraged «b»Trexall«/b» - May give weekly dose divided as 2.5 mg PO every 12 hr for 3 sequential doses «b»Otrexup (SC)«/b» - If used as initial therapy, start a lowest available dose (10 mg SC every week) «b»Rasuvo (SC)«/b» - 10-25 mg SC once weekly «bu»Breast Cancer«/bu» - 40 mg/m² IV; days 1 and 8 every 4 weeks in combination with cyclophosphamide and fluoracil for 6-12 cycles «bu»Head and Neck Cancer«/bu» - 40 mg/m² IV once weekly until disease progression or unacceptable toxicity «bu»Mycosis Fungoides (Cutaneous T-cell Lymphoma)«/bu» - 5-50 mg PO/IM once weekly or 15-37.5 mg twice weekly for who have responded poorly to weekly therapy «b»Switching from PO to SC (Otrexup, Rasuvo)«/b» - Consider higher bioavailability with SC compared with PO «bu»Ectopic Pregnancy«/bu» - 50 mg/m² IM x 1 dose - Measure serum hCG levels on days 4 and 7 - May repeat dose on day 7 if necessary - If hCG levels decrease <15% between days 4 and 7, administer methotrexate 50 mg/m² IM - If hCG ≥15% between days 4 and 7, discontinue treatment and measure hCG weekly until reaching nonpregnant levels «b»Dosing Consideration«/b» - Methotrexate doses between 100 to 500 mg/m2 may require leucovorin calcium rescue. - Doses >500 mg/m2 require leucovorin calcium rescue - Doses ≥250 mg/m2 (IV) are associated with moderate emetic potential. - Antiemetics may be recommended to prevent nausea and vomiting. - In children, doses ≥12 g/m2 are associated with a high emetic potential; doses ≥250 mg/m2 (IV) in adults and children are associated with moderate emetic potential. - Antiemetics may be recommended to prevent nausea and vomiting - Methotrexate may be administered orally, IM, IV, intrathecally, or SC - IV administration may be as slow push (10 mg/minute), bolus infusion, or 24-hour continuous infusion (route and rate of administration depend on indication and/or protocol) - Must use preservative-free formulation for intrathecal or high-dose methotrexate administration. - Specific dosing schemes vary, but high doses should be followed by leucovorin calcium rescue to prevent toxicity. «b»Oral Solution Administration«/b» - Ensure accuracy when dispensing and administering to prevent dosing errors - A calibrated oral syringe/dosing cup that can measure and deliver the prescribed dose accurately should be used; do not use a household teaspoon or tablespoon to measure dose. «b»SC Administration«/b» - Otrexup and Rasuvo are autoinjectors for once weekly subcutaneous use in the abdomen or thigh; patient may self-administer after appropriate training. - All schedules should be continually tailored to the individual patient - An initial test dose may be given prior to the regular dosing schedule to detect any extreme sensitivity to adverse effects. «b»IV Preparation«/b» - Dilute powder with D5W or NS to a concentration of ≤25 mg/mL (20 mg and 50 mg vials) and 50 mg/mL (1 g vial) - May further dilute in D5W or NS. «b»Intrathecal Preparation«/b» - Prepare intrathecal solutions with preservative-free NS, lactated Ringer’s, or Elliot’s B solution to a final volume of up to 12 mL (volume generally based on institution or practitioner preference) - Intrathecal methotrexate concentrations may be institution specific or based on practitioner preference, generally ranging from a final concentration of 1 mg/mL up to ~2 to 4 mg/mL - For triple intrathecal therapy (methotrexate 12 mg/hydrocortisone 24 mg/cytarabine 36 mg), preparation to final volume of 12 mL is reported - Intrathecal medications should NOT be prepared during the preparation of any other agents.

Methoxsalen

Oxsoralen Ultra, 8-Mop, Uvadex

- Refer to treatment protocols for UVA exposure guidelines. «bu»Psoriasis«/bu» «b»Initial Dose«/b» - 10 to 70 mg PO 1.5 to 2 hours (Oxsoralen Ultra) or 2 hours (8-MOP) before exposure to UVA light - Dose may be repeated 2-3 times per week, based on UVA exposure - Doses must be given at least 48 hours apart «bi»Dosage Based Upon Body Weight and Skin Type«/bi» - <30 kg: 10 mg - 30 to 50 kg: 20 mg - 51 to 65 kg: 30 mg - 66 to 80 kg: 40 mg - 81 to 90 kg: 50 mg - 91 to 115 kg: 60 mg - >115 kg: 70 mg - Dosage may be increased (one time) by 10 mg after 15th treatment if minimal or no response. «b»Maintenance Dose«/b» - When 95% psoriasis clearing achieved, may begin 1 treatment every week for at least 2 treatments; followed by 1 treatment every 2 weeks for at least 2 treatments; then every 3 weeks for at least 2 treatments then as needed to maintain response while minimizing UVA exposure. «bu»Vitiligo«/bu» «b»Oral (8-MOP)«/b» - 20 mg 2 to 4 hours before exposure to UVA light - Dose may be repeated based on erythema and tenderness of skin - Do not give on 2 consecutive days «bu»Cutaneous T-cell Lymphoma (CTCL)«/bu» «b»Extracorporeal (Uvadex)«/b» - Dose is determined by treatment volume; amount of Uvadex needed for each treatment may be calculated using the following equation: Treatment volume x 0.017 = mL of Uvadex needed. - Inject this amount into the recirculation bag prior to the photoactivation phase using the UVAR XTS or CELLEX photopheresis system (consult user's guide). «b»Treatment Schedule«/b» - Two consecutive days every 4 weeks for a minimum of 7 treatment cycles (6 months), may accelerate to 2 consecutive days every 2 weeks if skin score worsens (eg, increases from baseline) after assessment during the fourth treatment cycle (~3 months) - If skin score improves by 25% after 4 consecutive weeks of accelerated therapy, may resume regular treatment schedule - Patients maintained on accelerated therapy may receive a maximum of 20 accelerated therapy cycles - There is no clinical evidence to show that treatment with methoxsalen for more than 6 months or using a different schedule provides additional benefit.

Methoxy Polyethylene Glycol Epoetin Beta

Mircera, CERA, MPG-EPO

- Evaluate iron status before and during treatment and maintain iron repletion. Anemia associated with chronic kidney disease (CKD): Individualize dosing and use the lowest dose necessary to reduce the need for RBC transfusions: Patients not currently taking an ESA: «bu»Anemia Associated with Chronic Kidney Disease on Dialysis«/bu» - IV route is preferred for hemodialysis patients - Initiate treatment when hemoglobin <10 g/dL «b»Initial Dose«/b» - 0.6 mcg/kg IV/SC once every 2 weeks - Reduce dose or interrupt treatment if hemoglobin approaches or exceeds 11 g/dL - After hemoglobin stabilizes, may administer once monthly with a dose that is double the dose administered every 2 weeks; titrate as necessary. «bu»Anemia Associated with Chronic Kidney Disease NOT on Dialysis«/bu» - Consider initiating treatment when hemoglobin <10 g/dL and the rate of hemoglobin decline would likely result in RBC transfusion and goal is to reduce risk of alloimmunization or other RBC transfusion-related risks «b»Initial Dose«/b» - 0.6 mcg/kg IV/SC once every 2 weeks - Reduce dose or interrupt treatment if hemoglobin exceeds 10 g/dL - After hemoglobin stabilizes, may administer once monthly with a dose that is double the dose administered every 2 weeks; titrate as necessary. «b»Conversion from Epoetin Alfa or Darbepoetin Alfa«/b» - Based on total weekly ESA dose at the time of conversion (if hemoglobin is stabilized) - For epoetin alfa dose <8,000 units/week or darbepoetin alfa dose <40 mcg/week: Administer methoxy polyethylene glycol-epoetin beta 120 mcg once monthly or 60 mcg every 2 weeks. - For epoetin alfa dose 8,000 to 16,000 units/week or darbepoetin alfa dose 40 to 80 mcg/week: Administer methoxy polyethylene glycol-epoetin beta 200 mcg once monthly or 100 mcg every 2 weeks. - For epoetin alfa dose >16,000 units/week or darbepoetin alfa dose >80 mcg/week: Administer methoxy polyethylene glycol-epoetin beta 360 mcg once monthly or 180 mcg every 2 weeks. «b»Dosage Adjustments for All CKD Patients«/b» - Do not increase dose more frequently than every 4 weeks (dose decreases may occur more often) - Avoid frequent dosage adjustments. - If hemoglobin increases >1 g/dL in any 2-week period: Decrease dose by ≥25% as needed to reduce rapid responses. - If hemoglobin does not increase by >1 g/dL after 4 weeks of therapy: Increase dose by 25%. - Inadequate or lack of response over 12 weeks of therapy: If adequate response is not achieved after 12 weeks of therapy, further increases are unlikely to be of benefit and may increase the risk for adverse events; use the minimum effective dose that will maintain a hemoglobin level sufficient to avoid red blood cell transfusions and evaluate patient for other causes of anemia. Discontinue treatment if responsiveness does not improve. «b»Serious Allergic/Anaphylactic Reactions«/b» - Discontinue immediately (and permanently). «b»Hypertension (difficult to control)«/b» - Reduce dose or withhold treatment (use is contraindicated in uncontrolled hypertension). «b»Pure Red Cell Aplasia (PRCA)«/b» - Permanently discontinue treatment. «b»Limitations of Use«/b» - Not indicated and is not recommended in the treatment of anemia due to cancer chemotherapy or as a substitute for red blood cell (RBC) transfusions in patients who require immediate correction of anemia; has not been shown to improve symptoms, physical functioning or health-related quality of life.

Methscopolamine

Pamine, Pamine Forte

Methsuximide

Celontin

Methyldopa

L-Dopres, Aldomet

Methyldopa-Hydrochlorothiazide

Aldoril

Methylene Blue

ProvayBlue, Methylthionine Chloride

«b»IV Administration«/b» «bi»Generic«/bi» - Administer undiluted by direct IV injection slowly over several minutes. «bi»ProvayBlue«/bi» - Administer IV over 5 to 30 minutes - Do not administer subcutaneously - May be diluted (in D5W only) prior to administration to avoid pain on injection. «bi»Vesicant«/bi» - Ensure proper needle or catheter placement prior to and during infusion; avoid extravasation. «b»Extravasation Management«/b» - If extravasation occurs, stop infusion immediately and disconnect (leave cannula/needle in place) - Gently aspirate extravasated solution (do NOT flush the line) - Remove needle/cannula; elevate extremity - Apply dry warm compresses (based on mechanism of extravasation injury) proximal to the injection site «bi»Nitroglycerin 2% Ointment«/bi» - Based on mechanism of extravasation injury - Apply a 1-inch strip of topical nitroglycerin 2% ointment to the site of ischemia - May repeat every 8 hours as necessary - If a prolonged or continuous infusion is employed, administration via central line is recommended due to the risk of extravasation injury «b»Ifosfamide-Induced Encephalopathy«/b» «bi»IV«/bi» - Methylene blue may be administered either undiluted as a slow IV push over at least 5 minutes or diluted and infused over 5 to 30 minutes - Consider concomitant dextrose administration, especially in patients who are hypoglycemic, to ensure efficacy of methylene blue «b»Oral Administration«/b» - Administer mixed in fruit juice to mask the taste «b»Topical Administration«/b» - When used as a diagnostic aid (off-label), spray or directly apply solution to the affected mucosa; methylene blue is used in conjunction with other preparatory methods (procedure-dependent) «b»Treatment of Onychomycosis Administration«/b» - Apply to affected area and wait 3 minutes for the solution to soak in followed by photodynamic therapy «b»Intraparenchymal Administration«/b» - Administer as an injection directly into nodal tissue - Do NOT administer subcutaneously or intrathecally. «b»IV Preparation«/b» «bi»ProvayBlue«/bi» - Dilution not required - In order to avoid local pain (especially in pediatric patients), may be diluted in 50 mL of D5W - Do not dilute in NS (the solubility of methylene blue is reduced). «bi»Generic«/bi» - Dilution not required. «b»Treatment of Ifosfamide-induced Encephalopathy Preparation«/b» - Administer the dose undiluted, diluted in 50 mL NS or D5W, or diluted in 250 mL of D5W to allow for infusions over a longer duration - However, use caution if diluting in NS due to the potential for precipitation (refer to specific product labeling or a compatibility reference); the manufacturer’s labeling for Provayblue specifically states to avoid diluting in NS because of reduced solubility of methylene blue due to chloride.

Methylergonovine

Methergine

Methylfolate

Elfolate, Deplin, L-Methylfolate

Methylnaltrexone

Relistor

Methylphenidate

Metadate CD, Aptensio XR, Ritalin, Ritalin SR, Ritalin LA, Daytrana, Quillivant, Adhansia XR, Jornay PM, Methylin, Concerta

8 hours after the injury; not effective in penetrating trauma (eg, gunshot)" class="list-group-item active pb-0 drug">

MethylPREDNISolone

SOLU-medrol, A-Methapred, DEPO-Medrol

- The lowest possible dose should be used to control the condition; when dose reduction is possible, the dose should be reduced gradually. Only sodium succinate salt may be given IV. «bu»Allergic Conditions«/bu» «b»Tapered-dosage Schedule«/b» «bi»Dose-pack Containing 21 x 4 mg Tablets«/bi» Day 1 - 24 mg on day 1 administered as 8 mg (2 tablets) before breakfast, 4 mg (1 tablet) after lunch, 4 mg (1 tablet) after supper, and 8 mg (2 tablets) at bedtime OR 24 mg (6 tablets) as a single dose or divided into 2 or 3 doses upon initiation (regardless of time of day) Day 2 - 20 mg on day 2 administered as 4 mg (1 tablet) before breakfast, 4 mg (1 tablet) after lunch, 4 mg (1 tablet) after supper, and 8 mg (2 tablets) at bedtime Day 3 - 16 mg on day 3 administered as 4 mg (1 tablet) before breakfast, 4 mg (1 tablet) after lunch, 4 mg (1 tablet) after supper, and 4 mg (1 tablet) at bedtime Day 4 - 12 mg on day 4 administered as 4 mg (1 tablet) before breakfast, 4 mg (1 tablet) after lunch, and 4 mg (1 tablet) at bedtime Day 5 - 8 mg on day 5 administered as 4 mg (1 tablet) before breakfast and 4 mg (1 tablet) at bedtime Day 6 - 4 mg on day 6 administered as 4 mg (1 tablet) before breakfast «bu»Anti-inflammatory or Immunosuppressive«/bu» - Initial dosage depends upon condition being treated - Adjust subsequent doses based on patient response - Initial Dose: 4 to 48 mg/day PO in 1 to 4 divided doses initially - Followed by gradual reduction in dosage to the lowest possible level consistent with maintaining an adequate clinical response. «b»IM (Succinate)«/b» - 10 to 40 mg/day initially «b»IM (Acetate)«/b» - 4 to 120 mg single dose; repeated injections may be necessary for recurrent or chronic conditions. «b»IV (Succinate)«/b» - 10 to 40 mg over a period of several minutes and repeated IV or IM at intervals depending on clinical response; when high dosages are needed, administer 30 mg/kg over a period ≥30 minutes and may be repeated every 4 to 6 hours for 48 hours. «b»Intralesional (Acetate)«/b» - 20 to 60 mg; for large lesions, it may be necessary to distribute doses ranging from 20 to 40 mg by repeated local injections; 1 to 4 injections are usually employed with intervals between injections varying with the type of lesion being treated and clinical response. «b»Soft tissue (Acetate)«/b» - 4 to 30 mg; repeated injections may be necessary for recurrent or chronic conditions. «bu»Arthritis«/bu» «b»Intra-articular (Acetate)«/b» - Administer every 1 to 5 weeks. Large Joints (knee, ankle, shoulder) - 20 to 80 mg Medium Joints (elbow, wrist) - 10 to 40 mg Small Joints (metacarpophalangeal, interphalangeal, sternoclavicular, acromioclavicular) - 4 to 10 mg «bu»Asthma, Exacerbations«/bu» «b»Acute Short-course “Burst”«/b» - 40 to 60 mg PO daily in divided doses once or twice daily for 3 to 10 days - Burst should be continued until symptoms resolve and peak expiratory flow is at least 80% of personal best; usually requires 3 to 10 days of treatment - Longer treatment may be required IM (Acetate) - 240 mg as a one-time dose; Note: This may be given in place of short-course “burst” of oral steroids in patients who are vomiting or if compliance is a problem. Hospital/Emergency Medical Care Doses - 40 to 80 mg/day PO/IV in divided doses once or twice daily until peak expiratory flow is 70% of predicted or personal best. - Asthma, long-term (maintenance): Oral: 7.5 to 60 mg once daily in the morning or every other day as needed for asthma control «bu»Multiple Sclerosis, Acute Exacerbation«/bu» - Manufacturer’s labeling: Oral, IV (succinate only), IM (acetate or succinate): 160 mg daily for 1 week, followed by 64 mg every other day for 1 month. Off-label Dosing: - Oral: 500 mg daily for 5 days (NICE 2014). - IV (succinate only): 1,000 mg daily for 3 to 7 days «bu»Bronchiolitis Obliterans Syndrome, Prevention«/bu» «b»IV (Succinate)«/b» - 1000 mg daily for 3 days - Many centers use 10 to 15 mg/kg/day for smaller patients «bu»Cadaveric Organ Recovery«/bu» «b»Hormonal Resuscitation«/b» «b»IV (Succinate)«/b» - 15 mg/kg or 2,000 mg bolus administered to the brain-dead donor who is hemodynamically unstable requiring significant vasopressor support; give concomitantly with vasopressin, levothyroxine or liothyronine (preferred), dextrose (if bolus dose insulin used), and regular insulin (bolus dose or continuous infusion). If continuous infusion insulin is employed, maintain blood glucose 120 to 180 mg/dL «bu»Acute Cellular Rejection (treatment) or Antibody-mediated Rejection Treatment«/bu» «b»IV (Succinate)«/b» - 250 to 1,000 mg daily for 3 days «bu»COPD Exacerbation«/bu» - Dose, frequency, and duration of therapy not established. GOLD guidelines recommend the use of oral prednisone; however, methylprednisolone may be used as an alternative. - No comparative studies exist to examine safety and efficacy between low-, medium-, or high-dose regimens. While several clinical trials have examined the use of methylprednisolone in this setting, these trials included low numbers of patients, employed vastly different regimens, and/or examined different clinical outcomes. - Current dosing strategies are empiric and have not been established by clinical trials. Based on expert opinion, commonly used regimens ranging from 60 to 125 mg IV administered 1 to 4 times daily followed by oral therapy (eg, prednisone 40 mg once daily) for a total of 5 to 14 days of therapy may be employed; the shorter duration (ie, 5 days) may be preferred; however, comparative prospective data does not exist. IV administration with a higher dose (eg, ≥60 mg) may be preferred for those patients with impending or actual acute respiratory failure; outcome trials not available for this approach. «bu»Dermatomyositis/Polymyositis«/bu» «b»IV (Succinate)«/b» - 1,000 mg daily for 3 to 5 days for severe muscle weakness, followed by conversion to oral prednisone «bu»Gout, Acute«/bu» «b»IV (Succinate), IM«/b» - Initial Dose: 0.5 to 2 mg/kg; may be repeated as clinically indicated «bu»Lupus Nephritis«/bu» «b»High-dose “Pulse” Therapy: IV (Succinate)«/b» - 0.5 to 1 g/day for 3 days «bu»Pneumocystis Pneumonia in AIDS«/bu» «b»IV (Succinate)«/b» - 30 mg twice daily on days 1 to 5, then, - 30 mg once daily on days 6 to 10, then, - 15 mg once daily on days 11 to 21 «bu»Spinal Cord Injury, Acute«/bu» «b»IV (Succinate)«/b» - 30 mg/kg over 15 minutes followed in 45 minutes by a continuous infusion of 5.4 mg/kg/hour for 23 hours - Due to insufficient evidence of clinical efficacy (preserving or improving spinal cord function), the routine use of methylprednisolone in the treatment of acute spinal cord injury is no longer recommended. If used in this setting, methylprednisolone should not be initiated >8 hours after the injury; not effective in penetrating trauma (gunshot) - The lowest possible dose should be used to control the condition; when dose reduction is possible, the dose should be reduced gradually. Only sodium succinate salt may be given IV. «bu»Kawasaki Syndrome«/bu» Recrudescent fever after additional IVIG - 30 mg/kg IV/IM once daily x 1-3 days - Maximum Dose: 1 gram/dose AND «b»Aspirin«/b» - 20-25 mg/kg qid x 1 day or afibrile for 48-72 hour THEN, - 3–5 mg/kg PO every 24 hour x 6–8 weeks «bu»Anti-inflammatory or Immunosuppressive«/bu» - Initial dosage depends upon condition being treated; adjust subsequent doses based on patient response. «b»Infants, Children, and Adolescents«/b» Oral, IM (Acetate or Succinate), IV (Succinate) - Initial Dose: 0.11 to 1.6 mg/kg/day or 3.2 to 48 mg/m 2/day in 3 to 4 divided doses; usual range: 0.5 to 1.7 mg/kg/day; for oral, IM (succinate), and IV (succinate) may also administer in divided doses every 6 to 12 hours; for IM (acetate) administer as a single daily dose “Pulse” Therapy: IV (Succinate) - 30 mg/kg/dose once daily for 1 to 5 days; maximum: 1,000 mg/day Long-acting: IM (Acetate) - 4 to 80 mg every 1 to 2 weeks «bu»Asthma, Exacerbations«/bu» Acute Short-course “Burst” «b»Infants and Children <12 years«/b» Oral - 1 to 2 mg/kg/day in divided doses once or twice daily for 3 to 10 days; maximum daily dose: 60 mg/day; Note: Burst should be continued until symptoms resolve or patient achieves peak expiratory flow 80% of personal best; usually requires 3 to 10 days of treatment (~5 days on average); longer treatment may be required IM (Acetate) - This may be given in place of short-course “burst” of oral steroids in patients who are vomiting or if compliance is a problem. - Children ≤4 years: 7.5 mg/kg as a one-time dose; maximum dose: 240 mg - Children 5 to 11 years: 240 mg as a one-time dose - Children ≥12 years and Adolescents: Oral, IM (acetate): Refer to adult dosing. «bu»Hospital/Emergency Medical Care Doses«/bu» «b»Infants and Children <12 years«/b» - 1 to 2 mg/kg/day PO/IV in 2 divided doses - Maximum daily dose: 60 mg/day; continue until peak expiratory flow is 70% of predicted or personal best «b»Children ≥12 years and Adolescents«/b» Oral, IV: - Refer to adult dosing «bu»Status Asthmaticus«/bu» Loading Dose: 2 mg/kg/dose, then, 0.5 to 1 mg/kg/dose every 6 hours «b»Asthma, Long-term Treatment (Maintenance)«/b» Infants and Children <12 years - 0.25 to 2 mg/kg/day PO once daily in the morning or every other day as needed for asthma control - Maximum Daily Dose: 60 mg/day Children ≥12 years and Adolescents - Refer to adult dosing «bu»Lupus Nephritis«/bu» «b»Children and Adolescents«/b» IV (Succinate) - High-dose "pulse" therapy: 30 mg/kg/dose or 600 to 1,000 mg/m 2/dose once daily for 3 days - Maximum Dose: 1,000 mg/day «bu»Pneumocystis Pneumonia; Moderate or Severe Infection«/bu» - Initiate therapy within 72 hours of diagnosis, if possible. «b»Infants and Children: IV (Succinate)«/b» - 1 mg/kg/dose every 6 hours on days 1 to 7, then, - 1 mg/kg/dose twice daily on days 8 and 9, then, - 0.5 mg/kg/dose twice daily on days 10 and 11, and then, - 1 mg/kg/dose once daily on days 12 to 16 «b»Adolescents: IV (Succinate)«/b» - Refer to adult dosing «bu»Spinal Cord Injury, Acute«/bu» «b»IV (Succinate)«/b» - 30 mg/kg over 15 minutes, followed in 45 minutes by a continuous infusion of 5.4 mg/kg/hour for 23 hours. Note: Due to insufficient evidence of clinical efficacy (ie, preserving or improving spinal cord function), the routine use of methylprednisolone in the treatment of acute spinal cord injury is no longer recommended. If used in this setting, methylprednisolone should not be initiated >8 hours after the injury; not effective in penetrating trauma (eg, gunshot) «b»Oral Administration«/b» - Administer tablets after meals or with food or milk to decrease GI upset. If prescribed once daily, administer in the morning. «b»IM Administration«/b» «bi»IM (Acetate, Succinate)«/bi» - Avoid injection into the deltoid muscle due to a high incidence of subcutaneous atrophy. - Avoid injection or leakage into the dermis. - Do not inject into areas that have evidence of acute local infection. «b»IV Administration«/b» «bi»IV (Succinate)«/bi» - Rate dependent upon dose; typically, intermittent infusion is administered over 15 to 60 minutes. - Do not administer moderate- or high-dose IV push; severe adverse effects, including hypotension, cardiac arrhythmia, and sudden death, have been reported in patients receiving high-dose methylprednisolone IV push over <20 minutes - Do not give acetate form IV. «bi»Low Dose (≤1.8 mg/kg or ≤125 mg/dose)«/bi» - IV push over 3 to 15 minutes; maximum concentration: 125 mg/mL «bi»Moderate Dose (≥2 mg/kg or 250 mg/dose)«/bi» - Administer over 15 to 30 minutes «bi»High Dose (eg, ≥15 mg/kg or ≥500 mg/dose)«/bi» - Administer over 30 to 60 minutes - Doses ≥1,000 mg: Administer over 60 minutes. - In some of the adult spinal cord injury trials, bolus doses (30 mg/kg) have been administered over 15 minutes. «b»Intralesional Administration«/b» - Inject directly into the lesion. For large lesions, administer multiple small injections (20 to 40 mg) into the area of the lesion. Avoid injection of sufficient material to cause blanching because this may be followed by a small slough. «b»IV Reconstitution«/b» «bi»Methylprednisolone Sodium Succinate Injection«/bi» - Reconstitute vials only with provided diluent or bacteriostatic water with benzyl alcohol (see manufacturer's labeling for details) - For IV infusion, dilute reconstituted dose in D5W, NS, or D5NS. - Formulations containing benzyl alcohol should not be used in neonates - Neonates should only receive doses reconstituted with preservative free SWFI.

Methylsalicylate-Menthol-Camphor

Muscle Rub, Air Salonpas, Bengay Ultra Strength Cream, Salonpas Pain Relieving Patch, Flexall Ultra Plus

MethylTESTOSTERone

Android, Testred, Methitest

Metipranolol (Ophthalmic)

Optipranolol

Metoclopramide

Reglan, Metozolv ODT, Gimoti

«b»IV Administration«/b» «bi»Injection«/bi» - May be given IM, direct IV push, short infusion (at least 15 minutes), or continuous infusion - Lower doses (≤10 mg) of metoclopramide can be given IV push undiluted over 1 to 2 minutes - Higher doses (>10 mg) to be diluted in 50 mL of compatible solution (preferably NS) and given IVPB over at least 15 minutes - Rapid IV administration may be associated with a transient (but intense) feeling of anxiety and restlessness, followed by drowsiness. «b»Oral Administration«/b» «bi»Tablets and Oral Solution«/bi» - Administer 30 minutes prior to meals and at bedtime. «bi»Orally Disintegrating Tablets«/bi» - Administer on an empty stomach at least 30 minutes prior to food and at bedtime (do not repeat if inadvertently taken with food) - Do not remove from packaging until time of administration - If tablet breaks or crumbles while handling, discard and remove new tablet - Using dry hands, place tablet on tongue and allow to dissolve (disintegrates within ~1 minute [range: 10 seconds to 14 minutes]). - Swallow with saliva (formulation is designed to be taken without liquids). «b»SC Administration«/b» - Subcutaneous administration (off-label route) has been reported, either as an intermittent bolus injection or as continuous infusion «b»Intranasal Administration«/b» - Avoid treatment with metoclopramide (all dosage forms and routes of administration) for >12 weeks because of the increased risk of developing tardive dyskinesia with longer-term use - 1 spray in 1 nostril administers the appropriate dose - Before administering first dose, prime pump by releasing 10 sprays in the air - Place nozzle tip under 1 nostril and lean the head slightly forward - Close other nostril with the other index finger; move spray pump upwards so the tip of the nozzle is in the nostril - To ensure a full dose, hold bottle upright while pressing down firmly on finger flange and release while inhaling slowly through the open nostril - Remove nozzle tip from nostril and exhale slowly through the mouth - Wipe spray nozzle with a clean tissue «b»IV Preparation«/b» «bi»Lower Doses (≤10 mg)«/bi» - No dilution required «bi»Higher Doses (>10 mg)«/bi» - Dilute in 50 mL of compatible solution (preferably NS)

MetOLazone

Zaroxolyn

Metoprolol

Lopressor, Toprol XL, Kapspargo Sprinkles

«bu»Hypertension«/bu» «b»Lopressor«/b» - 100 mg/day PO initially in single dose or divided every 12 hr - May be increased at intervals of 1 week or longer - Maximum Dose: 450 mg/day «b»Toprol XL«/b» - 25-100 mg PO daily initially - May be increased at intervals of 1 week or longer - Usual Range: 50-100 mg/day - Maximum Dose: 400 mg/day «b»Kapspargo Sprinkles«/b» - Initial Dose: 25-100 mg PO daily - Adjust dosage at weekly (or longer) intervals until optimum blood pressure reduction is achieved - Maximum Dose: 400 mg/day «bu»Acute Myocardial Infarction«/bu» «b»Lopressor«/b» - 5 mg rapid IV every 2min, up to 3 doses; then, - 15 minutes after last IV, 50 mg PO every 6 hours for 48 hours; then, - 50-100 mg PO every 12 hr - If full IV dose not tolerated: 25-50 mg PO every 6 hr after last IV «bu»Congestive Heart Failure (CHF)«/bu» «b»Toprol XL«/b» - 25 mg PO daily initially - Increased every 2 weeks PRN - Target Dose: 200 mg/day - New York Heart Association (NYHA) class ≥II: Reduce dosage 12.5 mg/day «b»Kapspargo Sprinkle«/b» - Prior to initiation, stabilize dose of other heart failure drug therapy and ensure patient is not fluid overloaded - Initial Dose: 25 mg PO daily for 2 weeks - Not suitable for initial therapy in patients who are expected to require a starting dose less than 25 mg/day - Individualize dose and closely monitor during up-titration; double dose q2Weeks to the highest dosage level tolerated or up to 200 mg «bu»Angina«/bu» «b»Lopressor«/b» - 100 mg/day PO initially divided every 12 hr - May be increased at intervals of 1 week or longer - Maximum Dose: 400 mg/day «b»Toprol XL«/b» - 100 mg/day PO initially - May be increased at intervals of 1 week or longer - Maximum Dose: 400 mg/day «b»Kapspargo Sprinkle«/b» - Usual Initial Dose: 100 mg PO daily, given in a single dose - Gradually increase dose at weekly intervals until optimum clinical response is achieved or there is a pronounced slowing of the heart rate - Dosages above 400 mg/day have not been studied - If treatment is to be discontinued, gradually reduce dose over a period of 1-2 weeks «bu»Acute Tachyarrhythmia«/bu» - 5 mg IV over 1-2 minutes every 5 min - Total dose not to exceed 15 mg «bu»Migraine Prophylaxis«/bu» «b»Lopressor«/b» - 50-100 mg PO every 12 hour «bu»Atrial Fibrillation/Flutter or Supraventricular Tachycardia«/bu» «b»Lopressor«/b» - 2.5-5 mg IV every 2-5min - Not to exceed 15 mg over 10-15 minutes - Maintenance Dose 25-100 mg PO every 12 hr «bu»Thyrotoxicosis«/bu» «b»Lopressor«/b» - 25 to 50 mg every 8 to 12 hours - May also consider administering once-daily extended-release formulation «b»Toprol XL«/b» - When switching from immediate release (metoprolol tartrate) to extended release (metoprolol succinate), the same total daily dose of metoprolol should be used. Metoprolol tartrate is typically administered in 2 to 3 divided daily doses and metoprolol succinate is administered once daily. «b»Conversion from PO to IV«/b» - When switching between oral and intravenous dosage forms, in most cases, equivalent beta-blocking effect is achieved when doses in a 2.5:1 (Oral:IV) ratio is used

Metoprolol-Hydrochlorothiazide

Lopressor HCT, Dutoprol

MetroNIDAZOLE

Flagyl, Metro

MetroNIDAZOLE (Topical)

MetroCream, Noritate, Rosadan, Metrogel, Nuvessa, Vandazole

Mexiletine

Mexitil

Micafungin

Mycamine

Miconazole (Buccal)

Oravig

Miconazole (Topical)

Anti-Fungal, Desenex, Micatin, Podactin

Miconazole-Zinc Oxide (Topical)

Vusion

Microbiota Oral

Vowst, Fecal Microbiota Spores Live-brpk

Micrurus Fulvius Antivenom

Coral Snake Antivenom, Antivenin Micrurus Fulvius

Midazolam

Versed

- The dose of midazolam needs to be individualized based on the patient's age, underlying diseases, and concurrent medications. Consider reducing dose by 20% to 50% in elderly, chronically ill, or debilitated patients and those receiving opioids or other CNS depressants «bu»Anesthesia«/bu» «b»Induction: Adults <55 years«/b» «bi»Unpremedicated Patients«/bi» Initial Dose - 0.3 to 0.35 mg/kg over 20 to 30 seconds Maintenance Dose - After 2 minutes, may repeat if necessary at ~25% of initial dose every 2 minutes - Up to a total dose of 0.6 mg/kg in resistant cases «bi»Premedicated Patients«/bi» Usual Dosage Range - 0.05 to 0.2 mg/kg - Use of 0.2 mg/kg administered over 5 to 10 seconds has been shown to safely produce anesthesia within 30 seconds and is recommended for ASA physical status P1 and P2 patients - When used with other anesthetic drugs (co-induction), the dose is <0.1 mg/kg. - ASA physical status >P3 or debilitation: Reduce dose by at least 20% Maintenance Dose - 0.05 mg/kg as needed, or continuous infusion 0.015 to 0.06 mg/kg/hour (0.25 to 1 mcg/kg/minute) «bu»Sedation/Anxiolysis/Amnesia (Preoperative/Procedural)«/bu» «b»Healthy adults <60 years«/b» - 0.07 to 0.08 mg/kg IM 30 to 60 minutes prior to surgery/procedure Usual Dose Range - 5 mg «bi»Initial IV Dose«/bi» - Some patients respond to doses as low as 1 mg; no more than 2.5 mg should be administered over a period of at least 2 minutes - Additional doses of midazolam may be administered after at least a 2-minute waiting period and evaluation of sedation after each dose increment. A total dose >5 mg is generally not needed. «bi»Premedicated Patients«/bi» - Reduce initial dose by 30% Maintenance Dose - 25% of dose used to reach sedative effect - Adults ≥60 years, debilitated, or chronically ill: Refer to geriatric dosing. «bi»Intranasal«/bi» - Off-label route - 0.1 mg/kg; administer 15 minutes prior to surgery/procedure - Use 5 mg/mL injectable solution to deliver dose - Due to the low pH of the solution, burning upon administration is likely to occur «bi»Initial IV Dose«/bi» - 0.5 to 2 mg over at least 2 minutes - Slowly titrate to effect by repeating doses every 2 to 3 minutes if needed - Usual Total Dose: 2.5 to 5 mg «bu»Sedation in Mechanically-Ventilated Patients«/bu» - Nonbenzodiazepine sedation may be preferred «b»Initial Dose«/b» - 0.01 to 0.05 mg/kg IV (~0.5 to 4 mg) - May repeat at 10- to 15-minute intervals until adequate sedation achieved «b»Maintenance Infusion«/b» - 0.02 to 0.1 mg/kg/hour IV (0.3 to 1.7 mcg/kg/minute) - Titrate to reach desired level of sedation. Titration to maintain a light rather than a deep level of sedation is recommended unless clinically contraindicated - May consider a trial of daily awakening; if agitated after discontinuation of drip, then restart at 50% of the previous dose «bu»Palliative Sedation«/bu» - Use of midazolam in this setting should be done in close consult with or by an experienced palliative care provider - Ensure that flumazenil is readily available in the case of inadvertent overdose «b»Continuous Infusion«/b» - Initial Dose: 0.5 to 1 mg/hour IV/SC - May increase as needed - Usual Dosage Range: 1 to 20 mg/hour IV/SC; may also intermittently administer 1 to 5 mg during infusion as needed - Some have recommended an initial bolus dose of 5 to 10 mg (size of dose depending on patient weight, age, and degree of debility) «bu»Status Epilepticus«/bu» - 10 mg IM once or 0.2 mg/kg once - Maximum Dose: 10 mg - Midazolam IM is the preferred treatment in patients without IV access - Buccal and intranasal midazolam administration has also been used in patients without IV access, although these off-label routes are less well studied «b»Pre-hospital«/b» - 10 mg IM x 1 dose; has been administered by paramedics when convulsions last >5 minutes or if convulsions are occurring after having intermittent seizures without regaining consciousness for >5 minutes «bi»Intranasal«/bi» - 0.2 mg/kg x 1 dose - Use 5 mg/mL injectable concentrated solution to deliver dose. Due to the low pH of the solution, burning upon administration is likely to occur «bi»Buccal«/bi» - 0.5 mg/kg x 1 dose «b»Refractory«/b» - Mechanical Ventilation and cardiovascular monitoring required - Titrate dose to cessation of electrographic seizures or burst suppression - Loading dose: 0.2 mg/kg IV followed by a continuous infusion - Continuous infusion: 0.05 to 2 mg/kg/hour (0.83 to 33.2 mcg/kg/minute) IV titrated to cessation of electrographic seizures or burst suppression. - If patient experiences breakthrough status epilepticus while on the continuous infusion, administer a bolus of 0.1 to 0.2 mg/kg and increase infusion rate by 0.05 to 0.1 mg/kg/hour (0.83 to 1.66 mcg/kg/minute) every 3 to 4 hours. - Doses up to 2.9 mg/kg/hour have been described in the literature. - A period of at least 24 to 48 hours of electrographic control is recommended prior to withdrawing the continuous infusion; withdraw gradually to prevent recurrent status epilepticus. - The dose of midazolam needs to be individualized based on the patient's age, underlying diseases, and concurrent medications - Decrease dose (by ~30%) if opioids or other CNS depressants are administered concomitantly - Children <6 years may require higher doses and closer monitoring than older children; in children with obesity, calculate dose based on ideal body weight. «bu»Sedation/Anxiolysis/Amnesia«/bu» «b»Infants ≥6 months, Children, Adolescents ≤16 years«/b» «bi»Preoperative/Procedural)«/bi» - 0.25 to 0.5 mg/kg (maximum: 20 mg) PO as a single dose 20 to 30 minutes prior to procedure - Children <6 years or less cooperative patients may require as much as 1 mg/kg as a single dose; 0.25 mg/kg may suffice for children 6 to 16 years of age or for cooperative patients. Doses of 0.5 to 0.75 mg/kg administered 20 to 30 minutes prior to procedure have also been suggested; however, doses above 0.5 mg/kg typically do not improve the sedative and anxiolytic effects but increase side effects during recovery - 0.1 to 0.15 mg/kg IM 30 to 60 minutes before surgery or procedure - Dose Range: 0.05 to 0.15 mg/kg IM; doses up to 0.5 mg/kg have been used in more anxious patients - Maximum Total IM Dose: 10 mg «bi»Intranasal«/bi» - 0.2 to 0.5 mg/kg - Maximum Total Dose: 10 mg or 5 mg per nare - May be administered 10 to 20 minutes prior to procedure - Use 5 mg/mL injectable concentrated solution to deliver dose - Due to the low pH of the solution, burning upon administration is likely to occur. «b»Infants <6 months«/b» - Limited information is available in non-intubated infants - Dosing recommendations not clear - Infants <6 months are at higher risk for airway obstruction and hypoventilation; titrate dose in small increments to desired effect «b»Infants 6 months to Children 5 years«/b» - Initial: 0.05 to 0.1 mg/kg IV x 1 dose - Total Dose: 0.6 mg/kg may be required - Maximum Total Dose: 6 mg «b»Children 6 to 12 years«/b» - Initial: 0.025 to 0.05 mg/kg IV x 1 dose - Total Doses of 0.4 mg/kg may be required - Maximum Total Dose: 10 mg «b»Children 12 to 16 years«/b» - Refer to adult dosing - Maximum Total Dose: 10 mg «bi»Rectal«/bi» - 0.5 to 0.75 mg/kg PR (maximum: 20 mg) as a single dose 20 to 30 minutes prior to procedure «bu»Sedation in Mechanically-ventilated Patients«/bu» «b»Infants, Children, and Adolescents«/b» «bi»Loading IV Dose«/bi» - 0.05 to 0.2 mg/kg IV x 1 dose - Followed by initial continuous infusion: 0.06 to 0.12 mg/kg/hour IV (1 to 2 mcg/kg/minute) «bu»Seizures«/bu» «b»Children and Adolescents«/b» - 0.2 mg/kg IM x 1 dose - Maximum Dose: 6 mg - May repeat every 10 to 15 minutes «bu»Status Epilepticus«/bu» «b»Children and Adolescents«/b» «bi»<13 kg«/bi» - Not evaluated «bi»13 to 40 kg«/bi» - 5 mg IM x 1 dose «bi»>40 kg«/bi» - 10 mg IM x 1 dose - Midazolam IM is the preferred treatment in patients without IV access Buccal and intranasal midazolam administration have also been used in patients without IV access, although those off-label routes are less well studied - For prehospital status epilepticus, midazolam IM has been be administered by paramedics when convulsions last >5 minutes or if convulsions are occurring after having intermittent seizures without regaining consciousness for >5 minutes «bi»Intranasal«/bi» - 0.2 mg/kg x 1 dose - Use 5 mg/mL injectable concentrated solution to deliver dose - Due to the low pH of the solution, burning upon administration is likely to occur «bi»Buccal«/bi» - 0.5 mg/kg x 1 dose «bu»Status Epilepticus, Refractory«/bu» «b»Infants, Children, and Adolescents«/b» - Mechanical ventilation and cardiovascular monitoring required - Titrate dose to cessation of electrographic seizures or burst suppression «bi»Loading IV Dose«/bi» - 0.2 mg/kg followed by a continuous infusion. «bi»Continuous IV Infusion«/bi» - 0.05 to 2 mg/kg/hour (0.83 to 33.2 mcg/kg/minute) titrated to cessation of electrographic seizures or burst suppression - If patient experiences breakthrough status epilepticus while on the continuous infusion, administer a bolus of 0.1 to 0.2 mg/kg and increase infusion rate by 0.05 to 0.1 mg/kg/hour (0.83 to 1.66 mcg/kg/minute) every 3 to 4 hours - A period of at least 24 to 48 hours of electrographic control is recommended prior to withdrawing the continuous infusion; withdraw gradually to prevent recurrent status epilepticus. «bi»Loading Dose«/bi» - 0.15 to 0.2 mg/kg followed by a continuous infusion. «bi»Continuous Infusion«/bi» - 1 mcg/kg/minute titrated every 15 minutes by increments of 1 mcg/kg/minute until the cessation of seizures (maximum: 5 mcg/kg/minute)

Midodrine

ProAmatine

Midostaurin

Rydapt

- Administer prophylactic antiemetics prior to midostaurin therapy. «bu»Acute Myeloid Leukemia (AML), FLT3-positive«/bu» - 50 mg PO twice daily on days 8 to 21 of each induction cycle (in combination with daunorubicin and cytarabine) and on days 8 to 21 of each consolidation cycle (in combination with high-dose cytarabine) «bu»Mast Cell Leukemia«/bu» - 100 mg PO twice daily until disease progression or unacceptable toxicity «bu»Systemic Mastocytosis«/bu» «b»Aggressive Systemic Mastocytosis or Systemic Mastocytosis with Associated Hematological Neoplasm«/b» - 100 mg PO twice daily until disease progression or unacceptable toxicity «b»Missed Doses«/b» - If a dose is missed or vomited, do not make up the dose; take the next dose at the usually scheduled time. «b»Hematologic Toxicity«/b» «bi»ANC <1,000/mm3 (in patients without mast cell leukemia) or ANC <500/mm3 (in patients with baseline ANC of 500 to 1,500/mm3)«/bi» - Interrupt midostaurin - When ANC has improved to ≥1,000/mm3, resume therapy at a reduced dose of 50 mg twice daily and if tolerated - May increase dose to 100 mg PO bid «bi»Persistently low ANC for >21 days (associated with midostaurin)«/bi» - Discontinue midostaurin «bi»Platelets <50,000/mm3 (in patients without mast cell leukemia) or platelets <25,000/mm3 (in patients with baseline platelet count of 25,000 to 75,000/mm3)«/bi» - Interrupt midostaurin - When platelets have improved to ≥50,000/mm3, resume therapy at a reduced dose of 50 mg twice daily and if tolerated - May increase dose to 100 mg PO bid «bi»Persistently low platelet count for >21 days (associated with midostaurin)«/bi» - Discontinue midostaurin «bi»Hemoglobin <8 g/L (in patients without mast cell leukemia) or life-threatening anemia in patients with baseline hemoglobin of 8 to 10 g/L«/bi» - Interrupt midostaurin - When hemoglobin has improved to ≥8 g/L, resume therapy at a reduced dose of 50 mg twice daily and if tolerated - May increase dose to 100 mg twice daily. «bi»Persistently low hemoglobin for >21 days (associated with midostaurin)«/bi» - Discontinue midostaurin «b»Nonhematologic Toxicity«/b» «bi»Nausea/Vomiting, Grade 3 or 4 (Despite optimal antiemetic prophylaxis)«/bi» - Interrupt midostaurin for 3 days (6 doses) - Then resume therapy at a reduced dose of 50 mg twice daily - If tolerated, increase dose to 100 mg twice daily. «bi»Other Grade 3 or 4 Toxicities«/bi» - Interrupt midostaurin until improvement to ≤ grade 2 - Then resume therapy at a reduced dose of 50 mg twice daily - If tolerated, increase dose to 100 mg twice daily. «b»All Indications: Pulmonary Toxicity«/b» «bi»Signs/symptoms of interstitial lung disease or pneumonitis without infectious etiology)«/bi» - Discontinue midostaurin.

MiFEPRIStone

Korlym, Mifeprex, RU-486

«bu»Termination of Pregnancy«/bu» - Mifepristone 200 mg PO x 1 dose THEN, - Followed by misoprostol 800 mcg vaginally 24 to 48 hours later «b»Termination of Intrauterine Pregnancy«/b» «bi»Mifeprex«/bi» Treatment consists of 3 office visits by the patient Day 1 (mifepristone administration) - 200 mg taken as a single dose Day 2 or 3 (Misoprostol Administration) - Misoprostol 800 mcg buccally 24 to 48 hours after mifepristone administration - Dose is administered as two 200 mcg tablets in each cheek pouch, held in place for 30 minutes - Any remnants may be swallowed with water or other liquid - Note: Patient may need treatment for cramps or gastrointestinal symptoms at this time Day 7 to 14 (Post-treatment Exam) - Patient must return to the health care provider ~7 to 14 days after administration of mifepristone to confirm that complete termination of pregnancy has occurred and to evaluate the degree of bleeding. - If complete expulsion has not occurred, but the pregnancy is not ongoing, women may be treated with another dose of misoprostol 800 mcg buccally. - Women who choose to use a repeat dose of misoprostol should have another follow-up visit with their healthcare provider in approximately 7 days to assess for complete termination. - Surgical termination is recommended to manage treatment failures. «bu»Hyperglycemia in Cushing Syndrome«/bu» «b»Korlym«/b» Initial Dose - 300 mg once daily Maintenance Dose - Dose may be increased in 300 mg increments at intervals of ≥2 to 4 weeks based on tolerability and symptom control. Maximum Dose - 1,200 mg once daily, not to exceed 20 mg/kg/day - If treatment is interrupted, reinitiate at 300 mg daily or a dose lower than the dose that caused the treatment to be stopped if interruption due to adverse reactions «b»Already on Strong CYP3A Inhibitor«/b» Initial Dose - 300 mg once daily Maintenance Dose - May increase dose as clinically indicated Maximum Dose - 600 mg/day «b»Require Initiation of Strong CYP3A Inhibitor«/b» «bi»If current dose is 300 mg/day«/bi» - No dosage adjustment necessary «bi»If current dose is 600 mg/day«/bi» - Reduce dose to 300 mg once daily; if clinically indicated may increase dose to a maximum of 600 mg once daily. «bi»If current dose is 900 or 1200 mg/day«/bi» - Reduce dose to 600 mg once daily

Migalastat

Galafold

Miglitol

Glyset

Miglustat

Zavesca

Milnacipran

Savella

Milrinone

Primacor

Mineral Oil

Fleet Oil, Liqui-DOSS, White Mineral Oil, Kondremul

Minocycline

Minocin, Ximino, CoreMino, Solodyn

«b»Usual IV Dosage Range«/b» - Initial IV Dose: 200 mg IV x 1 dose - Maintenance IV Dose: 100 mg IV every 12 hours - Maximum IV Dose: 400 mg daily «b»Usual PO Dosage Range«/b» - Initial PO Dose: 200 mg PO x 1 dose - Maintenance PO Dose: 100 mg PO every 12 hours - More frequent dosing intervals may be used (100 to 200 mg initially, followed by 50 mg 4 times daily) «bu»Acne«/bu» - 50 to 100 mg IR PO bid - The shortest possible duration should be used to minimize development of bacterial resistance; re-evaluate at 3 at 4 months - Inflammatory, non-nodular, moderate to severe): Therapy should be continued for 12 weeks. Safety of use beyond 12 weeks has not been established. - 1 mg/kg ER Capsule (Ximino) PO once daily «b»Minolira«/b» «bi»45 to 59 kg«/bi» - 52.5 mg (one-half of the 105 mg tablet) once daily «bi»60 to 89 kg«/bi» - 67.5 mg (one-half of the 135 mg tablet) once daily «bi»90 to 125 kg«/bi» - 105 mg once daily «bi»126 to 136 kg«/bi» - 135 mg once daily «b»Solodyn«/b» «bi»45 to 49 kg«/bi» - 45 mg once daily «bi»50 to 59 kg«/bi» - 55 mg once daily «bi»60 to 71 kg«/bi» - 65 mg once daily «bi»72 to 84 kg«/bi» - 80 mg once daily «bi»85 to 96 kg«/bi» - 90 mg once daily «bi»97 to 110 kg«/bi» - 105 mg once daily «bi»111 to 125 kg«/bi» - 115 mg once daily «bi»126 to 136 kg«/bi» - 135 mg once daily «bu»Purulent Cellulitis«/bu» «b»Community Acquired MRSA«/b» - Initial Dose: 200 mg PO x 1 dose - Maintenance Dose: 100 mg PO bid x 5-10 days «bu»Chlamydial or Ureaplasma Urealyticum«/bu» «b»Uncomplicated Infection«/b» - 100 mg PO every 12 hours for at least 7 days «bu»Gonococcal Infection«/bu» «b»Uncomplicated Infection in Males«/b» - No anorectal infections or presence of urethritis - Initial Dose: 200 mg PO x 1 dose - Maintenance Dose: 100 mg PO twice daily for at least 4 days «bu»Uncomplicated Gonococcal Urethritis«/bu» - 100 mg PO every 12 hours for 5 days «bu»Meningococcal Carrier State«/bu» - 100 mg PO every 12 hr for 5 days «bu»Urethral, Endocervical, or Rectal Infections«/bu» «b»Caused by C. Trachomatis or U. Urealyticum Uncomplicated Infection«/b» - 100 mg PO every 12 hr for 7 days «bu»Mycobacterium Marinum«/bu» - 100 mg PO every 12 hr for 6-8 weeks «bu»Syphilis«/bu» - Initial Dose: 200 mg PO x 1 dose - Maintenance Dose: 100 mg every 12 hr for 10-15 days «bu»Rheumatoid Arthritis«/bu» - 100 mg PO bid «bu»Infective Endocarditis«/bu» - 100 mg IV bid for at least 5 weeks «bu»Infections, General Dosing«/bu» - Initial Dose: 200 mg PO/IV initially, then, - 100 mg PO/IV every 12 hours - Maximum Dose: 400 mg/day

Minocycline (Topical)

Amzeeq, Zilxi, FMX103

Minoxidil

Loniten

Minoxidil (Topical)

Rogaine

Mipomersen

Kynamro

Mirabegron ER

Myrbetriq

Mirtazapine

Remeron

Mirvetuximab Soravtansine

Elahere, Mirvetuximab Soravtansine-gynx

«b»IV Administration«/b» - Administer premedication - Administer as IV infusion only, using a 0.2 or 0.22 μm polyethersulfone (PES) in-line filter; do not substitute other membrane materials «bi»Initial Dose«/bi» - Initiate at rate of 1 mg/min; if well tolerated after 30 min, my increase to 3 mg/min; if 3 mg/min well tolerated after 30 min, may increase to 5 mg/min - If no infusion-related reactions occur with previous dose, subsequent infusions may be started at maximally tolerated rate and be increased up to maximum of 5 mg/min as tolerated - Flush IV line with D5W after infusion completed to ensure delivery of full dose - Do not use any other IV fluids for flushing «b»IV Preparation«/b» - Follow applicable special handling and disposal procedures - Calculate dose (mg) based on patient’s AIBW, total volume (mL) of solution required, and the number of vials needed for any dosage modifications - More than 1 vial will be needed for a full dose - Remove vials from refrigerator and allow to warm to room temperature - Inspect visually for particulate matter and discoloration before administering; solution should appear clear to slightly opalescent to colorless - Gently swirl and inspect each vial before withdrawing dose volume for subsequent further dilution - Do not shake vial - Using aseptic technique, withdraw dose volume for subsequent further dilution - Contains no preservatives and is intended for single-dose only; discard any unused drug remaining in vial «bi»IV Dilution«/bi» - Must dilute with D5W to final concentration of 1-2 mg/mL; incompatible with saline solutions - Do not mix with any other drugs or IV fluids - Determine D5W volume required to achieve final diluted concentration; either remove excess D5W from prefilled IV bag or add calculated volume to a sterile empty IV bag - Then add calculated dose volume to IV bag and gently mix by slowly inverting the bag several times to assure uniform mixing - Do not shake or agitate - If diluted solution if not used immediately, store appropriately

MiSOPROStol

Cytotec

Mitapivat

Pyrukynd

MitoMYcin

Mutamycin

«bu»Gastric Cancer«/bu» - 20 mg/m2 IV once every 6 to 8 weeks - 7 mg/m2 IV once every 6 weeks for 4 cycles (in combination with cisplatin and fluorouracil) - Maximum Dose: 14 mg/m2 «bu»Pancreatic Cancer«/bu» - 20 mg/m2 IV once every 6 to 8 weeks «bu»Anal Carcinoma«/bu» - 10 mg/m2 IV as an IV bolus on days 1 and 29 (maximum: 20 mg/dose) in combination with fluorouracil and radiation therapy or - 12 mg/m2 on day 1 only in combination with fluorouracil and radiation therapy or - 15 mg/m2 on day 1 only in combination with fluorouracil and radiation therapy or - 10 mg/m2 on day 1 (maximum dose: 15 mg) in combination with capecitabine and radiation therapy or - 12 mg/m2 on day 1 (maximum dose: 20 mg) in combination with capecitabine and radiation therapy «bu»Bladder Cancer«/bu» «b»Muscle Invasive«/b» - 12 mg/m2 IV on day 1 (in combination with fluorouracil and radiation) «b»Non-muscle Invasive«/b» «bi»Intravesicular Instillation«/bi» Low Risk of Recurrence (uncomplicated) - 40 mg as a single dose postoperatively; retain in bladder for 1 to 2 hours Increased Risk of Recurrence - 20 mg weekly for 6 weeks, followed by 20 mg monthly for 3 years - Retain in bladder for 1 to 2 hours or 40 mg weekly for 6 weeks (with urine alkalinization and decreased urine volume to increase drug concentration) - Retain in bladder for 2 hours «bu»Cervical Cancer, Recurrent or Metastatic«/bu» - 6 mg/m2 IV on day 1 once every 4 weeks (in combination with cisplatin) for a minimum of 2 cycles (preferably 9 cycles) «bu»Esophageal Cancer, Advanced«/bu» - 7 mg/m2 IV (maximum dose: 14 mg) once every 6 weeks for 4 cycles (in combination with cisplatin and fluorouracil) «bu»Vulvar Cancer, Advanced«/bu» - 15 mg/m2 IV on day 1 every 14 days for 2 cycles (in combination with concomitant radiation and fluorouracil) «bi»Leukocytes 2,000 to <3,000/mm3«/bi» - Hold therapy until leukocyte count ≥4,000/mm3 - Reduce to 70% of prior dose in subsequent cycles «bi»Leukocytes <2,000/mm3«/bi» - Hold therapy until leukocyte count ≥4,000/mm3 - Reduce to 50% of prior dose in subsequent cycles «bi»Platelets 25,000 to <75,000/mm3«/bi» - Hold therapy until platelets ≥100,000/mm3 - Reduce to 70% of prior dose in subsequent cycles «bi»Platelets <25,000/mm3«/bi» - Hold therapy until platelets ≥100,000 mm3 - Reduce to 50% of prior dose in subsequent cycles

MitoMYcin (Ophthalmic)

Mitosol

Mitomycin Pyelocalyceal

Jelmyto

Mitotane

Lysodren, Khloditan, Chloditan, Chlodithane

MitoXANTRONE

Novantrone

«b»IV Administration«/b» - For IV administration only - Do not administer intrathecally, subcutaneously, intramuscularly or intra-arterially. - Must be diluted prior to use. - Usually administered as a short IV infusion over 5-15 minutes - Do not infuse over <3-5 minutes. - High doses for bone marrow transplant (off-label use) are usually given as 3 divided doses over 1 hour each at 1-2 hour intervals on the same day - Irritant with vesicant-like properties; ensure proper needle or catheter placement prior to and during infusion; avoid extravasation. «b»Extravasation Management«/b» - If extravasation occurs, stop infusion immediately and disconnect (leave cannula/needle in place); gently aspirate extravasated solution (do NOT flush the line); remove needle/cannula; elevate extremity. Initiate antidote (dexrazoxane or dimethyl sulfate [DMSO]). Apply dry cold compresses for 20 minutes 4 times daily for 1-2 days; withhold cooling beginning 15 minutes before dexrazoxane infusion; continue withholding cooling until 15 minutes after infusion is completed. Topical DMSO should not be administered in combination with dexrazoxane; may lessen dexrazoxane efficacy. «bi»Dexrazoxane«/bi» - Adults: 1000 mg/m2 (maximum dose: 2000 mg) IV (administer in a large vein remote from site of extravasation) over 1-2 hours days 1 and 2, then 500 mg/m2 (maximum dose: 1000 mg) IV over 1-2 hours day 3; begin within 6 hours of extravasation. - Day 2 and day 3 doses should be administered at approximately the same time (± 3 hours) as the dose on day 1 - Reduce dexrazoxane dose by 50% in patients with moderate to severe renal impairment (CrCl <40 mL/minute). «bi»DMSO«/bi» Children and Adults - Apply topically to a region covering twice the affected area every 8 hours for 7 days - Begin within 10 minutes of extravasation - Do not cover with a dressing «b»IV Reconstitution«/b» - Dilute in at least 50 mL of NS or D5W. May further dilute in D5W, NS or D5NS - Use immediately after preparation.

Mobocertinib

Exkivity

Modafinil

Provigil

Moexipril

Univasc

Moexipril-Hydrochlorothiazide

Uniretic

Mogamulizumab

Poteligeo

Molindone

Moban

Molnupiravir

Lagevrio

Mometasone

Nasonex (Nasal)

Mometasone (Oral Inhalation)

Asmanex

Mometasone (Topical)

Elocon, Sinuva

Mometasone Furoate-Formoterol Fumarate

Dulera, Mometasone-Eformoterol

Montelukast

Singulair

Morphine

Duramorph, AVINza, Kadian, Roxanol, MS Contin, MorphaBond, Arymo ER

«bu»Acute Pain«/bu» «b»Immediate-release Tablet«/b» «bi»Opioid-naïve Patients«/bi» - 15-30 mg PO every 4 hr prn «b»Oral Solution«/b» «bi»Opioid-naïve Patients«/bi» - 10-20 mg PO every 4 hr prn «b»Suppository«/b» - 10-20 mg every 4 hr prn «b»Parenteral Solution«/b» «bi»Opioid-naïve Patients«/bi» - 5-10 mg IM/SC every 4hr prn - Dose Range: 5-20 mg - 2.5-5 mg IV every 3-4 hr prn - Infused IV over 4-5 minutes - Dose Range: 4-10 mg «b»Preservative-Free Parenteral Solution«/b» «bi»Epidural Injection«/bi» - Single Dose: 5-10 mg once daily in lumbar region - Continuous Infusion: 2-4 mg IV infused over 24 hr «bi»Intrathecal«/bi» Single Dose (Opioid Naive Patients) - 0.1-0.3 mg single dose, plus available infusion of naloxone - Dosage Range: 0.2-1 mg/day; because repeated IT injections are not recommended, alternative route should be used if pain recurs within 24 hours Continuous Infusion (Opioid Naive Patients) - 0.2-1 mg on lumbar region over 24 hr Opioid Tolerant - 1-10 mg over 24 hr micro-infusion on lumbar region - Not to exceed 20 mg over 24 hr «b»Extended-Release Liposomal Injection«/b» - DepoDur treatment of pain after major surgical procedures «bi»After Cesarean Section«/bi» - 10 mg as single lumbar epidural injection after umbilical cord is clamped «bi»Major Orthopedic Surgery of Lower Extremity«/bi» - 10-15 mg as single lumbar epidural injection before procedure «bi»Lower Abdominal or Pelvic Surgery«/bi» - 10-15 mg as single lumbar epidural injection before procedure - May benefit from 20 mg dose «b»Dosing Considerations«/b» - Injection formulation not for IV administration unless opioid antagonist immediately available - Usual dosage of IV morphine in adults, regardless of indication, is 2-10 mg/70 kg body weight - Consider lowest end of dosing range and monitor for side effects in elderly patients and those with renal or hepatic impairment «bi»Opioid-tolerant Patients«/bi» - May require higher initial doses - Patients are considered opioid-tolerant if they take at least 60 mg/day PO of morphine, 30 mg/day PO of oxycodone, 12 mg/day PO of hydromorphone, or equianalgesic dose of another opioid for >1 week «bi»PO Solution«/bi» - 100 mg/5 mL concentration is appropriate only for opioid-tolerant patients «bi»Parenteral Solution«/bi» - IM injection is painful and has variable onset of analgesia because of delayed onset of action and erratic absorption - Repeated SC administration may cause local tissue damage, as well as induration, irritation, and pain at injection site «bi»Preservative-Free Parenteral Solution«/bi» - American Pain Society describes "ceiling" for analgesic effect with dosages >0.3 mg/day and increase in adverse effects (respiratory depression); extreme caution is warranted with epidural or intrathecal administration in aged or debilitated patients, and lower dosages are usually adequate «bi»Extended-release Liposomal Injectable Suspension«/bi» - To be administered only in a single dose via lumbar epidural route; not recommended for administration into thoracic or higher epidural spaces; not to be administered IT, IV, or IM «bu»Chronic Severe Pain«/bu» - Extended-release (ER)/long-acting (LA) formulations are indicated for management of severe pain requiring daily, around-the-clock, long-term opioid treatment for which alternative options are inadequate «b»Immediate-release (IR)«/b» - May also be used for management of chronic pain but require more frequent dosing; may also be used in combination with ER/LA products for breakthrough pain «b»Extended-release Tablet (MS Contin)«/b» «bi»Opioid-naïve Patients (as first opioid dose)«/bi» - Initiate with 15 mg PO q8-12hr; use of higher starting doses in patients who are not opioid tolerant may cause fatal respiratory depression «bi»Opioid-tolerant Patients«/bi» - Dose depends on daily dose of previous opioid analgesic (individualization required for conversion) - MS Contin dose equivalent to one-half of patient's calculated 24-hr PO morphine requirement q12hr; alternatively, dose equivalent to one-third of patient's calculated 24-hr PO morphine requirement q8hr - Tablet must be swallowed whole and not broken, chewed, dissolved, or crushed; sudden release of morphine content increases risk of respiratory depression and death «b»Extended-release Capsule (Kadian)«/b» «bi»Opioid-naive Patients«/bi» - Not indicated for use as initial opioid analgesic - Initiate with IR formulation, then convert to Kadian - 30 mg PO daily «bi»Opioid-tolerant Patients«/bi» - Dose depends on daily dose of previous opioid analgesic (individualization required for conversion) - Kadian dose equivalent to one half of patient’s 24-hr PO morphine requirement every 12 hr; alternatively, dose equivalent to patient’s 24-hr PO morphine requirement once daily - Capsule must be swallowed whole, or contents must be sprinkled on applesauce and immediately swallowed; must not be chewed, crushed, or dissolved; sudden release of morphine content increases risk of respiratory depression and death «b»Extended-release Tablet, Abuse Deterrent (MorphaBond)«/b» «bi»Opioid-naïve Patients (as first opioid dose)«/bi» - 15 mg PO every 12 hr «bi»Opioid-tolerant Patients«/bi» - Dose depends on daily dose of previous opioid analgesic (individualization required for conversion) - MorphaBond dose equivalent to one-half of patient's calculated 24-hr PO morphine requirement administered q12hr - Tablet must be swallowed whole and not broken, chewed, dissolved, or crushed; sudden release of morphine content increases risk of respiratory depression and death «b»Extended-release Tablet, Abuse-deterrent (Arymo ER)«/b» «bi»Initial Dosing«/bi» - Opioid naïve patients and opioid non-tolerant patients: 15 mg PO every 8-12 hr «bi»Conversion to Arymo ER«/bi» Morphine Recipients - Administer one-half of 24-hr morphine requirement as Arymo ER PO q12hr, or one-third of 24-hr morphine requirement as Arymo ER PO q8hr -Patients receiving other opioids: Discontinue all around-the-clock opioid drugs, then initiate Arymo ER 15mg PO q8-12 hours - Arymo ER dose when converted from other opioids or parenteral morphine: Calculate 24-hr PO morphine equivalent requirement and administer one-half of that daily equivalent as Arymo ER q12hr; alternatively, may give one-third of patient's calculated 24-hour PO morphine requirement q8hr «bi»Methadone to Morphine ER Conversion«/bi» - Methadone has long-half-life and may accumulate in plasma; conversion dose may vary widely; judicious dosing and close monitoring is warranted «b»High-Potency Injectable Solution (Infumorph, Mitigo)«/b» - Treatment of intractable chronic pain - Starting dose for epidural or IT administration must be individualized on basis of in-hospital evaluation of response to serial single-dose bolus injections using lower concentration of preservative-free morphine solution, with close observation of analgesic efficacy and adverse effects before surgery involving continuous microinfusion device «bi»IT (Opioid-naïve Patients)«/bi» - 0.2-1 mg over 24 hr «bi»IT (Opioid-tolerant Patients)«/bi» - 1-10 mg over 24 hr - Caution warranted with dosages >20 mg/24 hr «bi»Epidural (Opioid-naïve Patients)«/bi» - 3.5-7.5 mg over 24 hr «bi»Epidural (Opioid-tolerant Patients)«/bi» - 4.5-10 mg over 24 hr «b»Opioid-tolerant Definition«/b» - Patients who are opioid tolerant are those receiving, for 1 week or longer, at least 60 mg/day PO morphine, 25 mcg/hr transdermal fentanyl, 30 mg/day PO oxycodone, 8 mg/day PO hydromorphone, 25 mg/day PO oxymorphone, or an equianalgesic dose of another opioid «b»Limitations of Use«/b» - Because of the risks of addiction, abuse, and misuse with opioids, even at recommended doses, and because of the greater risks of overdose and death with extended-release opioid formulations, reserve for patients whom alternative treatment options (nonopioid analgesics or immediate-release opioids) are ineffective, not tolerated, or would be otherwise inadequate to provide sufficient management of pain -Not indicated for acute pain or as a PRN analgesic «b»Oral Administration«/b» - Do not crush, chew, or dissolve extended release (ER) formulations; swallow whole. - Cutting, breaking, crushing, chewing, or dissolving ER formulations may result in uncontrolled delivery of morphine, leading to overdose and death. «bi»Avinza, Kadian«/bi» - Capsules may be opened and sprinkled on applesauce and eaten immediately without chewing; do not crush, dissolve, or chew the beads, as it can result in a rapid release of a potentially fatal dose of morphine - Ensure all pellets have been swallowed by rinsing mouth - Contents of Kadian capsules may be opened and sprinkled over 10 mL water and flushed through prewetted 16F gastrostomy tube; do not administer Kadian through gastric/nasogastric tubes. «bi»Arymo ER«/bi» - Swallow tablets whole, one tablet at a time, with enough water to ensure complete swallowing immediately after placing in the mouth; do not pre-soak, lick, or wet tablets prior to placing in the mouth. «b»IV Administration«/b» - Administer single-use prefilled syringes/cartridges via slow IV push over 4 to 5 minutes (rapid administration may result in chest wall rigidity) - Concentrated vials are available for preparation of continuous IV infusion or PCA; refer to indication-specific infusion rates in dosing for detailed recommendations. «b»Epidural, Intrathecal Administration«/b» Use only preservative-free solutions indicated for intrathecal or epidural use; refer to indication-specific infusion rates in dosing for detailed recommendations. «b»Parenteral Reconstitution«/b» «bi»IV push/Intermittent Infusion«/bi» - May dilute to a final concentration of 0.5 to 5 mg/mL «bi»Continuous IV Infusion«/bi» - Dilute in D5W, D10W, or NS to a usual final concentration of 0.1 to 1 mg/mL; more concentrated solutions may be used in patients requiring fluid restriction or high doses; concentrations >5 mg/mL are rarely needed - ISMP and Vermont Oxford Network recommend a standard concentration of 0.1 mg/mL for neonates «b»Epidural and Intrathecal Preparation«/b» - Use only preservative-free injections indicated for epidural/intrathecal use - Dilution may be required (preservative-free NS recommended); determined by the individual dosage requirements and the characteristics of the continuous microinfusion device; filter through ≤5 micron microfilter before injecting into microinfusion device. «b»Oral Preparation«/b» - A 0.4 mg/mL oral solution may be made using the 2 mg/mL oral morphine solution - Measure 10 mL (20 mg) of the 2 mg/mL oral morphine solution and transfer to a plastic amber bottle - Measure 40 mL of sterile water for irrigation and add to bottle containing the morphine - Shake to mix - Store at room temperature - Stable for 60 days.

Morphine Sulfate Liposome

DepoDur

Morphine-Naltrexone

Embeda

- These are guidelines and do not represent the doses that may be required in all patients. Individualize treatment based on patient’s prior analgesic treatment experience/tolerance and pain relief. Morphine 100 mg/naltrexone 4 mg; a single dose > morphine 60 mg/naltrexone 2.4 mg or a total daily dose > morphine 120 mg/naltrexone 5 mg are for use in opioid-tolerant patients only. «bu»Pain Management«/bu» «b»Opiate-Naive«/b» - Use as the first opioid analgesic or use in patients who are not opioid tolerant - Opioid tolerance is defined as: Patients already taking at least 60 mg of oral morphine daily, 25 mcg transdermal fentanyl per hour, 30 mg of oral oxycodone daily, 8 mg oral hydromorphone daily, 25 mg oral oxymorphone daily, 60 mg oral hydrocodone per day, or an equivalent dose of another opioid for at least 1 week. - Initial Dose: Morphine 20 mg/naltrexone 0.8 mg once daily. - Titration: Dosage adjustments may be made every 1 to 2 days - Breakthrough pain may require a rescue medication with an immediate release analgesic - If once-daily dosing is inadequate may switch to twice daily dosing. «b»Conversion«/b» - The first dose of morphine/naltrexone ER may be taken with the last dose of any immediate release opioid medication. «b»Conversion from Other Morphine PO to Morphine/Naltrexone ER«/b» - Administer 50% of the patient's total daily oral morphine dose as morphine/naltrexone ER every 12 hours or all of the patient's total daily oral morphine dose as morphine/naltrexone ER once daily. «b»Conversion from Other Opioids to Morphine/Naltrexone ER«/b» - Discontinue all other around-the-clock opioids when therapy is initiated - Initial Dose: Morphine 30 mg/naltrexone 1.2 mg once daily; there are no established conversion ratios from other opioids to morphine/naltrexone ER; consider the following general points when converting patients and provide breakthrough pain relief with rescue medication (immediate release morphine) «b»Conversion from IV to Morphine PO«/b» - It may take 2 to 6 mg of oral morphine to provide pain relief equivalent to 1 mg of parenteral morphine. An oral dose 3 times the daily parenteral dose may be sufficient. «b»Conversion from Other Non-morphine PO/Parenteral Opioids to Morphine PO«/b» - Specific recommendations are not available; refer to published relative potency data realizing that such ratios are only approximations. It is generally safest to give 50% the estimated daily morphine requirement as the initial dose and manage inadequate relief with immediate release morphine. «b»Conversion from Methadone to Morphine/Naltrexone ER«/b» - Close monitoring is required when converting methadone to another opioid - Ratio between methadone and other opioid agonists varies widely according to previous dose exposure - Methadone has a long half-life and can accumulate in the plasma. «b»Discontinuation of Therapy«/b» - Decrease dose by 25% to 50% every 2 to 4 days; monitor carefully for signs/symptoms of withdrawal. If patient displays withdrawal symptoms, increase dose to previous dose and then reduce dose more slowly by increasing interval between dose reductions, decreasing amount of daily dose reduction, or both. «b»Dosage Adjustment for Concomitant Therapy«/b» - Concomitant CNS depressants: Initiate morphine/naltrexone ER with 33% to 50% of the recommended initial dose «b»Limitations of Use«/b» - Reserve morphine/naltrexone ER for use in patients for whom alternative treatment options (eg, nonopioid analgesics, immediate-release opioids) are ineffective, not tolerated, or would be otherwise inadequate to provide sufficient management of pain. Morphine/naltrexone ER is not indicated as an as-needed analgesic.

Morrhuate Sodium

Scleromate

Moxetumomab Pasudotox

Lumoxiti

«b»IV Administration«/b» - Administer diluted solution IV over 30 minutes - Do not mix or administer with other medicinal products - Flush IV line with 0.9% NaCl after infusion at the same infusion rate to ensure the full dose is delivered «bi»Refrigerated Diluted Solution«/bi» - If the diluted solution is refrigerated, allow it to equilibrate to room temperature for no more than 4 hr before administration «b»IV Preparation«/b» - Calculate dose (mg) and number of vials (1 mg/vial) to be reconstituted - Final concentration of solution is 1 mg/kg - Do not round down for partial vials - Individualize dose based on patient’s actual body weight before first dose of first treatment cycle - Change dose between cycles if a weight gain >10% observed; do not change dose in the midst of a particular cycle - Reconstitute with 1.1 mL of sterile water for injection only; do not use IV solution stabilizer to reconstitute the vial - Direct the sterile water along the walls of the vial and not directly at the lyophilized cake or powder - Gently swirl the vial until completely dissolved; invert the vial to ensure all cake or powder is dissolved - Do not shake - Visually inspect reconstituted solution; it should appear clear to slightly opalescent, colorless to slightly yellow, and free from visible particles; do not use if cloudy, discolored, or contains any particles - Use reconstituted solution immediately; do not store reconstituted vials - Add 1 mL of IV solution stabilizer to 50 mL 0.9% NaCl infusion bag before adding the reconstituted solution to the infusion bag; vial of IV solution stabilizer is packaged separately - Only 1 vial of IV solution stabilizer should be used per administration; gently invert the bag to mix the solution - Withdraw the calculated dose from the reconstituted vial(s) and add to the 0.9% IV bag that contains the solution stabilize - Gently invert bag to mix; do not shake - Discard any partially used or empty vials of drug and IV solution stabilizer

Moxidectin

Moxifloxacin

Avelox

Moxifloxacin (Ophthalmic)

Moxeza, Vigamox

Multitrace-5 Concentrate

Peditrace, Addamel N, Multitrace-4, Multitrace-5

Mupirocin

Bactroban, Centany, Pseudomonic Acid A

Mycophenolate

CellCept, Myfortic, MMF

«b»Oral Administration«/b» - Oral dosage formulations (tablet, capsule, suspension) should be administered on an empty stomach (1 hour before or 2 hours after meals) to avoid variability in MPA absorption. The oral solution may be administered via a nasogastric tube (minimum 8 French, 1.7 mm interior diameter); oral suspension should not be mixed with other medications. Delayed release tablets should not be crushed, cut, or chewed. Cellcept may be administered with food in stable renal transplant patients when necessary. If a dose is missed, administer as soon as it is remembered. If it is close to the next scheduled dose, skip the missed dose and resume at next regularly scheduled time; do not double a dose to make up for a missed dose. «b»IV Administration«/b» - Intravenous solutions should be administered over at least 2 hours (either peripheral or central vein); do not administer intravenous solution by rapid or bolus injection «b»Oral Suspension Reconstitution«/b» - Should be constituted prior to dispensing to the patient and not mixed with any other medication. Add 47 mL of water to the bottle and shake well for ~1 minute. Add another 47 mL of water to the bottle and shake well for an additional minute. Final concentration is 200 mg/mL of mycophenolate mofetil. «b»IV Reconstitution«/b» - Reconstitute the contents of each vial with 14 mL of 5% dextrose injection; dilute the contents of a vial with 5% dextrose in water to a final concentration of 6 mg mycophenolate mofetil per mL. Note: Vial is vacuum-sealed; if a lack of vacuum is noted during preparation, the vial should not be used. «b»Oral Suspension (50 mg/mL) Preparation«/b» - A 50 mg/mL oral suspension may be made with mycophenolate mofetil capsules, Ora-Plus, and cherry syrup. In a vertical flow hood, empty six 250 mg capsules into a mortar; add 7.5 mL Ora-Plus and mix to a uniform paste. Mix while adding 15 mL of cherry syrup in incremental proportions; transfer to a calibrated bottle, rinse mortar with cherry syrup, and add sufficient quantity of cherry syrup to make 30 mL. Label "shake well". Stable for 210 days at 5°C, for 28 days at 25°C to 37°C, and for 11 days at 45°C.

Nabilone

Cesamet

Nabumetone

Relafen

Nadolol

Corgard

Nadolol-Bendroflumethiazide

Corzide

Nafarelin

Synarel

Nafcillin

Nallpen, Nafcil

Naftifine

Naftin

Nalbuphine

Nubain

Naldemedine

Symproic

Nalmefene

Revex Injection, Opvee Nasal Spray

«bu»Opioid Overdose (Revex IV)«/bu» «b»Non-opioid Dependent«/b» - 0.5 mg/70 kg IV x 1 dose - May administer a second dose of 1 mg/70 kg 2-5 min later prn «b»Opioid Dependent«/b» - 0.1 mg/70 kg IV x 1 dose (challenge dose) - If no evidence of withdrawal within 2 minutes, the recommended dosing should be followed - May cause acute withdrawal symptoms in individuals who have some degree of tolerance to and dependence on opioids - Closely observe for symptoms of withdrawal following administration - Administer subsequent doses with intervals of at least 2-5 minutes between doses to allow the full effect of each incremental dose of nalmefene to be reached «b»Dosage Limitations«/b» - If no clinical response after administering a total dose of 1.5 mg/70 kg, additional dose is unlikely to have an effect - Do not give more than is required to restore respiratory rate to normal, thus minimizing the likelihood of cardiovascular stress and precipitated withdrawal syndrome - If respiratory depression recurs, titrate dose again to clinical effect using incremental doses to avoid over-reversal «b»Loss of IV access«/b» - Single IM or SC 1-mg doses have been shown to effective within 5-15 min of administration «bu»Opioid Overdose (Opvee Nasal Spray)«/bu» - 1 spray (2.7 mg) intranasally into nose as soon as possible - Administer additional doses, using a new nasal spray with each dose, if patient is non-responsive or relapses into respiratory depression after response - May re-administer dose every 2-5 min until emergency medical assistance arrives - Consider additional supportive and/or resuscitation measures «b»Dosing Consideration«/b» - For immediate administration as emergency therapy in settings where opioids may be present. Emergency treatment of known or suspected opioid (natural or synthetic) overdose in adults as manifested by respiratory and/or central nervous system (CNS) depression - Not a substitute for emergency medical care - Seek emergency care immediately after use «b»Partial Agonists or Mixed Agonists/Antagonists«/b» - Reversal of respiratory depression by partial agonists or mixed agonist/antagonists (buprenorphine, pentazocine) may be incomplete and require repeated administration of nalmefene intranasal spary

Naloxegol

Movantik

Naloxone

Narcan, Evzio, Zimhi

- Available routes of administration include IV (preferred), IM, SC, and Intranasal; other available routes (off-label) include inhalation via nebulization (adults only), and intraosseous (IO) «bu»Opioid Overdose«/bu» «b»Narcan«/b» «bi»Initial Dose«/bi» - 0.4 to 2 mg IM/IV/SC x 1 dose «bi»Maintenance Dose«/bi» - May need to repeat doses every 2 to 3 minutes - A lower initial dose (0.1 to 0.2 mg) should be considered for patients with opioid dependence to avoid acute withdrawal or if there are concerns regarding concurrent stimulant overdose - After reversal, may need to re-administer dose(s) at a later interval (20 to 60 minutes) depending on type/duration of opioid - If no response is observed after 10 mg total, consider other causes of respiratory depression. - May be given endotracheally (off-label route) as 2 to 2.5 times the initial IV dose (0.8 to 5 mg) - Maximum Dose: 10 mg (0.01 mg/kg) «b»Zimhi High-Dose«/b» - 5 mg IM/SC into anterolateral aspect of the thigh (through clothing if necessary); if child is <1 yr, pinch the thigh muscle while administering the dose - Emergency treatment of known or suspected opioid overdose, as manifested by respiratory and/or central nervous system depression - Seek emergency medical care immediately after use - Additional doses may be administered every 2-3min until EMS arrives «b»Evzio«/b» - 0.4 mg or 2 mg IV/IM (contents of 1 auto-injector) x 1 dose - May repeat every 2 to 3 minutes until emergency medical assistance becomes available. «b»Continuous IV Infusion«/b» - For use with exposures to long-acting opioids (methadone), sustained release product, and symptomatic body packers after initial naloxone response. - Calculate dosage/hour based on effective intermittent dose used and duration of adequate response seen or use two-thirds (2/3) of the initial effective naloxone bolus on an hourly basis (typically 0.25 to 6.25 mg/hour); one-half (1/2) of the initial bolus dose should be re-administered 15 minutes after initiation of the continuous infusion to prevent a drop in naloxone levels; adjust infusion rate as needed to assure adequate ventilation and prevent withdrawal symptoms «b»Inhalation via Nebulization«/b» - 2 mg x 1 dose - May repeat - Switch to IV or IM administration when possible - This administration method is not included in the AHA recommendations for initial management of opioid-associated life-threatening emergency «b»Intranasal«/b» - Onset of action is slightly delayed compared to IM or IV routes - 4 mg (contents of 1 nasal spray) as a single dose in one nostril - May repeat every 2 to 3 minutes in alternating nostrils until medical assistance becomes available. «bi»Off Label Dosing«/bi» - 2 mg (1 mg per nostril) using generic injectable solution (with a mucosal atomization device) - May repeat in 3 to 5 minutes if respiratory depression persists «bu»Reversal of Respiratory Depression with Therapeutic Opioid Doses«/bu» - Initial Dose: 0.02 to 0.2 mg - Titrate to avoid profound withdrawal, seizures, arrhythmias, or severe pain - May be given endotracheally (off-label route) as 2 to 2.5 times the initial recommended IV dose (ie, 0.04 to 0.5 mg) «b»Continuous IV Infusion«/b» - For use with exposures to long-acting opioids (eg, methadone) or sustained release products. Calculate dosage/hour based on effective intermittent dose used and duration of adequate response seen or use two-thirds (2/3) of the initial effective naloxone bolus on an hourly basis (typically 0.2 to 0.6 mg/hour); one-half (1/2) of the initial bolus dose should be re-administered 15 minutes after initiation of the continuous infusion to prevent a drop in naloxone levels; adjust infusion rate as needed to assure adequate ventilation and prevent withdrawal symptoms «b»Opioid-dependent Patients Being Treated for Cancer Pain«/b» - May dilute 0.4 mg/mL (1 mL) ampule IV into 9 mL of normal saline for a total volume of 10 mL to achieve a 0.04 mg/mL (40 mcg/mL) concentration. - 0.02 mg (20 mcg) IV push - Administer every 2 minutes until improvement in symptoms - 0.04 to 0.08 mg (40 to 80 mcg) slow IV push - Administer every 30 to 60 seconds until improvement in symptoms; if no response is observed after total naloxone dose 1 mg, consider other causes of respiratory depression. If respiratory depression is due to long-acting opioids, may consider administering naloxone as a continuous infusion starting at 66% of the total bolus dose (or 0.2 mg per hour) to reverse the opioid toxicity. «bu»Postoperative Reversal«/bu» - 0.1 to 0.2 mg IV every 2 to 3 minutes until desired response (adequate ventilation and alertness without significant pain) - Repeat doses may be needed within 1 to 2 hour intervals depending on type, dose, and timing of the last dose of opioid administered. «bu»Opioid-Induced Pruritus«/bu» - 0.25 mcg/kg/hour IV infusion - Doses up to ~3 mcg/kg/hour have been employed - Doses >2 mcg/kg/hour are more likely to lead to reversal of analgesia and are not recommended - Monitor pain control and verify that the naloxone is not reversing analgesia «b»IV Push Administration«/b» - Administer over 30 seconds as undiluted preparation or administer as diluted preparation slow IV push by diluting 0.4 mg (1 mL) ampul with 9 mL of normal saline for a total volume of 10 mL to achieve a concentration of 0.04 mg/mL «b»IV Continuous Infusion Administration«/b» - Dilute to 4 mcg/mL in D5W or normal saline «b»IM, SC Administration«/b» - May administer IM or SC if unable to obtain IV access «b»Auto-Injector Administration«/b» - For IM or SC use only - Intended for buddy administration; the person administering the medication should follow the printed instructions on the device or the electronic voice instructions coming from the speaker on the device - If the voice instruction system does not operate properly, the device will still deliver the intended dose of naloxone when properly administered - Administer IM or SC into the anterolateral aspect of the thigh; may be injected through clothing. When being administered to infants <1 year of age, the thigh muscle should be pinched during administration - Following proper administration, a red indicator appears in the viewing window; the needle is not visible before, during, or after the injection - Patients who received naloxone in the out-of-hospital setting should seek immediate emergency medical assistance after the first dose due to the likelihood that respiratory and/or central nervous system depression will return - Repeat doses may be required until emergency medical assistance becomes available; a new device must be used as each device contains a single dose of naloxone. «b»Endotracheal Administration«/b» - There is only anecdotal support for this route of administration - May require a slightly higher dose than used in other routes - Dilute to 1 to 2 mL with normal saline; flush with 5 mL of saline and then administer 5 ventilations «b»Inhalation via Nebulization Administration«/b» - Dilute 2 mg of naloxone with 3 mL of normal saline and administer via nebulizer face mask «b»Intranasal Administration«/b» - Administer initial dose as soon as possible - Do not prime or test the device prior to administration - Administer in alternating nostrils with each dose - Place the patient in the supine position and provide support to the back of the neck to allow the head to tilt back - Following administration, turn the patient on their side - Each container contains a single intranasal spray, do not reuse; if repeat administration is necessary a new container must be used. - Alternate intranasal administration instructions using generic injectable solution: Administer total dose equally divided into each nostril using a mucosal atomization device (MAD) - If a MAD is not available, the solution may be sprayed into the nares without a MAD; however, a significant amount of drug may be lost likely due to swallowing and subsequent first-pass metabolism «b»IV Push Reconstitution«/b» - Dilute naloxone 0.4 mg (1 mL ampul) with 9 mL of NS for a total volume of 10 mL to achieve a concentration of 0.04 mg/mL «b»IM/SC Preparation«/b» - Before using, check to make sure the solution is not discolored - Replace if the solution is discolored or contains a precipitate «b»IV Infusion Preparation«/b» - Dilute naloxone 2 mg in 500 mL of NS or D5W to make a final concentration of 4 mcg/mL «b»Inhalation via Nebulization Preparation«/b» - Dilute 2 mg of naloxone with 3 mL of normal saline

Naloxone (Intranasal)

Kloxxado, Narcan Nasal Spray

Naltrexone

ReVia, Vivitrol, Depade

«b»Oral Administration«/b» - May be administered with or without food - Administration with food or after meals may minimize adverse gastrointestinal effects. - Advise patient not to self-administer opioids while receiving naltrexone therapy «b»IM Administration«/b» «bi»Vivitrol«/bi» - Prior to administration, replace the preparation needle with the appropriate size provided administration needle (use the 2-inch needle with the needle protection device for patients with a larger amount of subcutaneous tissue overlying the gluteal muscle; for very lean patients, the 1.5-inch needle may be appropriate; either needle may be used for patients with average body habitus) - Prior to injection, remove any air bubbles and push on the plunger until 4 mL of the suspension remains in the syringe - Following reconstitution of the suspension, administer immediately. - Administer IM into the upper outer quadrant of the gluteal area; must inject dose using one of the provided needles for administration - Use either the 1.5-inch needle (for very lean patients) or the 2-inch needle (for patients with a larger amount of subcutaneous tissue overlying the gluteal muscle) - Either needle may be used for patients with average body habitus - Avoid inadvertent injection into a blood vessel; do not administer IV, SC, or into fatty tissue (the risk of serious injection site reaction is increased if given incorrectly as a SC injection or into fatty tissue instead of the gluteal muscle) - Injection should alternate between the 2 buttocks - Do not substitute any components of the dose-pack «b»Injection Reconstitution«/b» - Prior to reconstitution, allow drug vial and provided diluent to reach room temperature (~45 minutes) - Using the provided 1-inch preparation needle, reconstitute with 3.4 mL of the diluent and allow to dissolve by vigorously shaking the vial for ~1 minute - Mixed suspension will be milky white, free of clumps, and will move freely down the walls of the vial - Immediately after suspension, withdraw 4.2 mL of the suspension using the same preparation needle.

Naltrexone-Bupropion

Contrave

Naphazoline (Ophthalmic)

Nafazair

Naproxen

Aleve, Naprosyn, Anaprox, Naprelan, Mediproxen

Naproxen-Esomeprazole

Vimovo

Naratriptan

Amerge

Natalizumab

Tysabri

Natamycin

Natacyn (Ophthalmic), Pimaricin

Nateglinide

Starlix

Naxitamab

Danyelza

Nebivolol

Bystolic

Nebivolol-Valsartan

Byvalson

Necitumumab

Portrazza

Nedocromil

Alocril

Nefazodone

Serzone

Nelarabine

Arranon

Nelfinavir

Viracept, NFV

Neomycin

Myciguent, Mycifradin, Neo-Fradin

Neomycin-Colistin-Hydrocortisone-Thonzonium

Coly-Mycin S, Cortisporin-TC

Neomycin-Polymyxin B (Irrigant)

Neosporin G.U. Irrigant

Neomycin-Polymyxin B-Bacitracin (Ophthalmic)

Triple Antibiotic, Neo-Polycin

Neomycin-Polymyxin B-Bacitracin (Topical)

Neosporin, Triple Antibiotic

Neomycin-Polymyxin B-Dexamethasone (Ophthalmic)

AK-Trol, Maxitrol

Neomycin-Polymyxin B-Gramicidin

AK-Spore, Neosporin

Neomycin-Polymyxin B-Hydrocortisone

Cortisporin (Topical)

Neostigmine

Bloxiverz, Prostigmin

«bu»Myasthenia Gravis«/bu» - Acute: 0.5-2.5 mg IV/IM/SC daily - Maintenance Dose: 15-375 mg/day PO divided every 6-8 hr - Use injectable with 0.6-1.2 mg atropine IV to counteract muscarinic effects «bu»Myasthenia Gravis Diagnosis«/bu» - 0.022 mg/kg IM x 1 dose - Discontinue all anticholinesterase agents for >8 hr - Give atropine 0.011 mg/kg IV (if IM give 30 minutes before) with neostigmine 0.022 mg/kg IM - If cholinergic response, stop test and give 0.4-0.6 mg atropine IV - If inconclusive, retest another day with neostigmine 0.031 mg/kg IM preceded by 0.016 mg/kg atropine «bu»Non-depolarizing Neuromuscular Blockade Reversal«/bu» - 0.03-0.07 mg/kg IV will generally achieve a TOF twitch ratio of 90% within 10-20 minutes of administration - Not to exceed 0.07 mg/kg or a cumulative total of 5 mg, whichever dose is less Inject by slow IV over at least 1 minute - Dose selection should be based on the extent of spontaneous recovery that has occurred at the time of administration, the half-life of the NMBA being reversed, and whether there is a need to rapidly reverse the NMBA - Administer an IV anticholinergic (atropine, glycopyrrolate) prior to, or concomitantly with neostigmine for NMB reversal; if bradycardia present, give anticholinergic before neostigmine «b»0.03 mg/kg«/b» - Use for reversal of NMBAs with shorter half-lives (eg, rocuronium), OR - When the first twitch response to the TOF stimulus is substantially >10% of baseline or when a second twitch is present «b»0.07 mg/kg«/b» - Use for NMBAs with longer half-lives (eg, vecuronium, pancuronium), OR When the first twitch response is relatively weak (not substantially >10% of baseline), OR - There is need for more rapid recovery «bu»Post-Op Distention or Urinary Retention«/bu» - Prevention: 0.25mg IM after surgery - Repeat every 4-6hr for 2-3 days - Treatment: 0.5-1 mg IM and up to q3hr PRN (for 5 doses for retention) «bu»Acute Colonic Pseudo-Obstruction«/bu» - 2 mg IV over 3 to 5 minutes - Administration over 60 minutes may reduce the incidence of bradycardia; however, efficacy may be reduced - Ensure atropine is available at the bedside to treat symptomatic neostigmine-induced bradycardia.

Nepafenac

Ilevro, Nevanac

Neratinib

Nerlynx

- Antidiarrheal prophylaxis is recommended during the first 2 cycles of therapy; initiate with the first neratinib dose «bu»Breast Cancer (HER2-positive)«/bu» «b»Extended Adjuvant Therapy«/b» - 240 mg once daily for 1 year «b»Missed Dose«/b» - If a dose is missed, resume therapy with the next scheduled daily dose; do not replace the missed dose. «b»Premedication«/b» - Antidiarrheal prophylaxis is recommended during the first 2 cycles of therapy; initiate with the first neratinib dose - Titrate to 1 to 2 bowel movements/day - Additional antidiarrheal medication may be required for loperamide-refractory diarrhea. - Days 1 to 14: Loperamide 4 mg orally 3 times daily - Days 15 to 56: Loperamide 4 mg orally twice daily - Days 57 to 365: Loperamide 4 mg as needed (maximum: 16 mg/day) - Discontinue neratinib if toxicity does not recover to ≤ grade 1, for toxicities that result in a treatment delay of more than 3 weeks, or in patients unable to tolerate the 120 mg once daily dose. «b»Recommended Neratinib Dose Reductions for Toxicity«/b» - First dose reduction: 200 mg once daily - Second dose reduction: 160 mg once daily - Third dose reduction: 120 mg once daily «bi»Diarrhea«/bi» Grade 1 - Increase of <4 stools/day over baseline Grade 2 - Increase of 4 to 6 stools/day over baseline Grade 3 - Increase of ≥7 stools/day over baseline; incontinence; hospitalization indicated; limiting self-care activities of daily living Grade 4 - Life-threatening consequences; urgent intervention necessary Grade 1, grade 2 (lasting <5 days), or grade 3 diarrhea (lasting <2 days) - Adjust antidiarrheal medication and diet; maintain fluid intake of ~2 L - When diarrhea has improved to ≤ grade 1 or baseline, initiate loperamide 4 mg with each subsequent neratinib dose. Grade 2 diarrhea lasting ≥5 days or grade 3 diarrhea lasting longer than 2 days (despite optimal antidiarrheal management), or any grade diarrhea with complicating features (eg, dehydration, fever, hypotension, renal failure, or grade 3/4 neutropenia) - Interrupt treatment. Modify diet; maintain fluid intake of ~2 L. If diarrhea improves to ≤ grade 1 in 1 week or less, resume neratinib at the same dose. If diarrhea improves to ≤ grade 1 in more than 1 week, resume neratinib at the next lower dose. When diarrhea has improved to ≤ grade 1 or baseline, initiate loperamide 4 mg with each subsequent neratinib dose. Recurrent ≥Grade 2 Diarrhea (occurring at 120 mg once daily dose) - Permanently discontinue neratinib. Grade 4 Diarrhea - Permanently discontinue neratinib. «bi»Other Toxicities«/bi» Grade 3 - Interrupt treatment until toxicity improves to ≤ grade 1 or baseline within 3 weeks of stopping neratinib - Upon recovery, resume neratinib at the next lower dose. Grade 4 - Permanently discontinue neratinib.

Nesiritide

Netarsudil

Rhopressa

Netupitant

Netupitant-Palonosetron

Akynzeo, NEPA, Fosnetupitant

Nevirapine

Viramune, NVP

«bu»HIV-1 Infection«/bu» - Indicated for treatment of HIV-1 infection in combination with other antiretrovirals «b»Immediate Release«/b» «bi»<15 days«/bi» - Safety and efficacy not established «bi»≥15 days to 16 years«/bi» - 150 mg/m² PO daily for 2 wk; if no rash, then increase to 150 mg/m² q12hr; not to exceed 200 mg/dose «bi»>16 years«/bi» - As adults - 200 mg PO qDay for 2 wk; if no rash or untoward effect occurs, then increase to 200 mg PO q12h «b»Extended Release«/b» «bi»<6 years«/bi» - Safety and efficacy not established «bi»6-18 years«/bi» - Switch from immediate-release tabs: If already taking immediate-release, may switch to extended- release without 14-day lead-in period of immediate-release nevirapine Initial therapy: Initiate with immediate-release 150 mg/m² PO daily for 14 days (not to exceed 200 mg/day), then, switch to extended release based on BSA «b»Extended-Release Dose Based on BSA«/b» 0.58-0.83 m² - 200 mg PO daily 0.84-1.16 m² - 300 mg PO daily ≥1.17 m² - 400 mg PO daily «b»Alternate Dosing Based on HIV Treatment Guidelines«/b» «bi»Immediate-release and Suspension Formulations«/bi» 34-37 Weeks Gestational Age - 4 mg/kg/dose PO BID for 1 week, then, - Increase to 6 mg/kg/dose bid thereafter ≥37 Weeks Gestational Age - 6 mg/kg/dose PO bid ≥1 month to <8 years - 200 mg/m² PO bid ≥8 years - 120-150 mg/m² PO bid - Not to exceed 200 mg bid «bu»Prevention of Maternal-Fetal HIV Transmission in Neonates«/bu» - Additional prophylaxis with nevirapine is needed for HIV-exposed infants of women who did not receive antepartum ART «b»Birth weight 1.5-2 kg«/b» - 8 mg/dose PO «b»Birth weight >2 kg«/b» - 12 mg/dose PO - Administer 3 doses in the first week of life; 1st dose 48 hr after birth, give 2nd dose 48 hr after 1st dose, and 3rd dose 96 hr after 2nd dose Recommended in combination with 6 weeks of zidovudine «b»Dosing Considerations«/b» - The 14-day lead-in period with immediate-release dosing must be strictly followed; it has been demonstrated to reduce the frequency of rash - If nevirapine extended-release interrupted >7 days, restart with lead-in dosing with immediate-release nevirapine - If mild-to-moderate rash (without constitutional symptoms) occurs during 14-day lead-in period, do not increase immediate-release dose or initiate extended-release regimen until the rash has resolved; duration of the lead-in dosing should not exceed 28 days, at which point an alternative regimen should be chosen

Niacin ER

Niacor, NiaSpan, Nicotinic Acid, Vitamin B3, Slo-Niacin

NiCARdipine

Cardene

«bu»Angina«/bu» «b»Immediate Release«/b» - 20 mg PO tid Usual Dosage Range - 20 to 40 mg PO tid (allow ≥3 days between dose increases) «bu»Hypertension«/bu» «b»Immediate Release«/b» Initial Dose - 20 mg PO tid Usual Dosage Range - 20 to 40 mg PO tid (allow ≥3 days between dose increases) «b»Sustained Release«/b» Initial Dose - 30 mg PO bid Usual Dosage Range - 30 to 60 mg PO bid «bu»Acute Hypertension«/bu» Initial Dose - 5 mg/hour continuous IV infusion Maintenance Dose - May increase by 2.5 mg/hour every 5 minutes (for rapid titration) to every 15 minutes (for gradual titration) up to a maximum of 15 mg/hour - Adjust infusion rate as needed to maintain desired response; in rapidly titrated patients, consider reduction to 3 mg/hour after response is achieved - Discontinue infusion if unacceptable hypotension or tachycardia occurs. «bu»Arterial Hypertension in Acute Ischemic Stroke«/bu» - Patient otherwise eligible for reperfusion treatment (alteplase) except blood pressure (BP) >185/110 mm Hg Initial Dose - 5 mg/hour continuous IV infusion Maintenance Dose - Titrate by 2.5 mg/hour at 5- to 15-minute intervals - Maximum Dose: 15 mg/hour When Goal BP Obtained - Adjust dose to maintain proper BP limits - If BP does not decline and remains >185/110 mm Hg, alteplase should not be administered. «b»Management of BP During and After Reperfusion Treatment (Alteplase) to Maintain BP ≤180/105 mm Hg«/b» «bi»If SBP>180 to 230 mmHg or DBP>105 to 120 mmHg«/bi» - Initiate 5 mg/hour continuous IV infusion - Titrate by 2.5 mg/hour at 5- to 15-minute intervals - Maximum Dose: 15 mg/hour - If hypertension is refractory or diastolic BP >140 mm Hg, consider other IV antihypertensives (eg, nitroprusside). «b»Substitution for Oral Therapy«/b» - 20 mg every 8 hours oral, equivalent to 0.5 mg/hour IV infusion - 30 mg every 8 hours oral, equivalent to 1.2 mg/hour IV infusion - 40 mg every 8 hours oral, equivalent to 2.2 mg/hour IV infusion «b»Conversion from IV to PO«/b» - Initiate oral antihypertensive at the same time that IV nicardipine is discontinued - If transitioning to oral nicardipine, start oral nicardipine 1 hour prior to IV discontinuation.

Nicotine

Nicorelief, Nicorette,Thrive, Nicotrol, Nicoderm

«bu»Smoking Cessation«/bu» - Patients should completely stop smoking upon initiation of therapy): «b»Gum«/b» - Chew 1 piece of gum when urge to smoke occurs - If strong or frequent cravings are present after 1 piece of gum, may use a second piece within the hour (do not continuously use one piece after the other) - Patients who smoke their first cigarette within 30 minutes of waking should use the 4 mg strength; otherwise the 2 mg strength is recommended «bi»Use according to the following 12-week dosing schedule«/bi» Weeks 1 to 6 - Chew 1 piece of gum every 1 to 2 hours (maximum: 24 pieces/day); to increase chances of quitting, chew at least 9 pieces/day during the first 6 weeks Weeks 7 to 9 - Chew 1 piece of gum every 2 to 4 hours (maximum: 24 pieces/day) Weeks 10 to 12 - Chew 1 piece of gum every 4 to 8 hours (maximum: 24 pieces/day) «b»Inhalation«/b» «bi»Initial Treatment«/bi» - 6 to 16 cartridges/day (at least 6 cartridges/day for the first 3 to 6 weeks) for up to 12 weeks; maximum: 16 cartridges/day. Note: Best effect achieved with frequent continuous puffing (20 minutes). Use beyond 6 months is not recommended (has not been studied). If patient is unable to stop smoking by the fourth week of therapy, consider discontinuation. «bi»Discontinuation of Therapy«/bi» - After initial treatment, gradually reduce daily dose over 6 to 12 weeks. Some patients may not require gradual reduction of dosage and may stop treatment abruptly. «b»Lozenge«/b» - 1 lozenge when urge to smoke occurs; do not use more than 1 lozenge at a time. Patients who smoke their first cigarette within 30 minutes of waking should use the 4 mg strength; otherwise the 2 mg strength is recommended. «bi»Use according to the following 12-week dosing schedule«/bi» Weeks 1 to 6 - 1 lozenge every 1 to 2 hours (maximum: 5 lozenges every 6 hours; 20 lozenges/day); to increase chances of quitting, use at least 9 lozenges/day during the first 6 weeks Weeks 7 to 9 - 1 lozenge every 2 to 4 hours (maximum: 5 lozenges every 6 hours; 20 lozenges/day) Weeks 10 to 12 - 1 lozenge every 4 to 8 hours (maximum: 5 lozenges every 6 hours; 20 lozenges/day) «b»Nasal Spray«/b» «bi»Initial Dose«/bi» - 1 to 2 doses/hour (each dose [2 sprays, one in each nostril] contains 1 mg of nicotine); adjust dose as needed based on patient response; do not exceed more than 5 doses (10 sprays) per hour [maximum: 40 mg/day (80 sprays)] or 3 months of treatment. Note: For best results, use at least the recommended minimum of 8 doses per day (less is unlikely to be effective). Use beyond 6 months is not recommended (has not been studied). If patient is unable to stop smoking by the fourth week of therapy, consider discontinuation. «bi»Discontinuation of Therapy«/bi» - Discontinue over 4 to 6 weeks. Some patients may not require gradual reduction of dosage and may stop treatment abruptly. «b»Transdermal Patch«/b» - Adjustment may be required during initial treatment (move to higher dose if experiencing withdrawal symptoms; lower dose if side effects are experienced). «bi»Patients smoking >10 cigarettes/day«/bi» - Begin with step 1 (21 mg/day) for 6 weeks, followed by step 2 (14 mg/day) for 2 weeks; finish with step 3 (7 mg/day) for 2 weeks «bi»Patients smoking ≤10 cigarettes/day«/bi» - Begin with step 2 (14 mg/day) for 6 weeks, followed by step 3 (7 mg/day) for 2 weeks «b»Gum«/b» - Chew slowly until it tingles, then place gum between cheek and gum until tingle is gone; repeat process until most of tingle is gone (~30 minutes). Do not eat or drink 15 minutes before using or while the gum is in mouth. «b»Lozenge«/b» - Do not chew or swallow; allow to dissolve slowly (~20 to 30 minutes); minimize swallowing and occasionally move lozenge from one side of the mouth to the other until completely dissolved. Do not eat or drink 15 minutes before using or while lozenge is in mouth. «b»Nasal Spray«/b» - Prime pump prior to first use (pump 6 to 8 times until fine spray appears) or if it has not been used for 24 hours (pump 1 to 2 times); avoid excessive priming. Blow nose prior to use. Tilt head back slightly and insert tip of bottle into nostril. Breathe through mouth and spray once in each nostril. Do not sniff, swallow, or inhale through the nose during administration. After administration, wait 2 to 3 minutes before blowing nose. Avoid contact with skin, eyes, and mouth (nicotine overdose can occur when nicotine is absorbed through the skin). «b»Oral Inhalation«/b» - Insert cartridge into inhaler and push hard until it pops into place. Replace mouthpiece and twist the top and bottom so that markings do not line up. Inhale deeply into the back of the throat or puff in short breaths. Nicotine in cartridge is used up after about 20 minutes of active puffing. Clean mouthpiece regularly with soap and water. «b»Transdermal Patch«/b» - Apply new patch to nonhairy, clean, dry skin on the upper body or upper outer arm; each patch should be applied to a different site. Apply immediately after removing backing from patch; press onto skin for ~10 seconds. Patch may be worn for 16 or 24 hours. If cigarette cravings occur upon awakening, wear for 24 hours; if vivid dreams or other sleep disturbances occur, remove the patch at bedtime and apply a new patch in the morning. Do not cut patch; causes rapid evaporation, rendering the patch useless. Do not wear more than 1 patch at a time; do not leave patch on for more than 24 hours (may irritate skin). Wash hands after applying or removing patch. Discard patches by folding adhesive ends together, replace in pouch and dispose of properly in trash.

NIFEdipine

Procardia, Adalat, Afeditab, Nifediac

- Dosage adjustments should occur at 7- to 14-day intervals to allow for adequate assessment of new dose; however, if clinically indicated, titration may be done more rapidly with appropriate monitoring; when switching from immediate-release to sustained-release formulations, use same total daily dose. «bu»Chronic Stable or Vasospastic Angina«/bu» «b»Immediate Release«/b» - Initial Dose: 10 mg 3 times daily - Usual Dose: 10 to 20 mg 3 times daily - Coronary artery spasm may require up to 20 to 30 mg 3 to 4 times daily - Single doses >30 mg and total daily doses >120 mg are rarely needed - Maximum Daily Dose: 180 mg daily - Do not use for acute anginal episodes - May precipitate myocardial infarction «b»Extended Release«/b» - Initial Dose: 30 or 60 mg once daily - Titrate as clinically indicated - Doses >90 mg daily should be used with caution and only if necessary - Maximum Daily Dose: 120 mg daily «bu»Hypertension«/bu» «b»Extended Release«/b» - Initial Dose: 30 or 60 mg once daily - Usual Dosage Range: 30 to 90 mg daily - Maximum Dose: 90 to 120 mg daily «bu»Achalasia«/bu» - 10 to 30 mg SL administered 30 to 45 minutes before meals - Clinical response is short acting and use does not provide complete relief of symptoms; consider risks before use «bu»Hypertension Emergency in Pregnancy«/bu» - SBP ≥160 mm Hg or DBP ≥110 mm Hg «b»Immediate Release«/b» - 10 mg PO x 1 dose - May repeat with a 20 mg dose in 20 minutes if needed «bu»High Altitude Pulmonary Edema«/bu» «b»Prevention«/b» - 30 mg ER every 12 hours starting the day before ascent and may be discontinued after staying at the same elevation for 5 days or if descent initiated «b»Treatment«/b» - 30 mg ER every 12 hours «bu»Pulmonary Hypertension«/bu» - Initial Dose: 60 mg ER once daily (initiate after demonstrating acute vasoreactivity) - May increase cautiously to 120 to 240 mg/day «bu»Raynaud's Phenomenon«/bu» - 30 to 120 mg ER once daily - 10 to 30 mg IR 3 times daily «bu»Ureteral Calculi (Distal)«/bu» - 10 to 30 mg IR 3 times daily for up to 4 weeks or until expulsion of lower stones

Nifurtimox

Lampit

Nilotinib

Tasigna

«bu»Acute Lymphoblastic Leukemia (ALL)«/bu» «b»Philadelphia Chromosome-positive (Ph+), Newly Diagnosed«/b» - 400 mg twice daily starting on day 8 of induction chemotherapy (in combination with daunorubicin, vincristine, and prednisolone) - Continue up to the start of stem cell transplant conditioning or until the end of consolidation therapy - Patients who completed 5 cycles of consolidation treatment received 2 years of nilotinib maintenance - Patients who underwent allogeneic stem cell transplant did not receive nilotinib after transplant «b»Philadelphia Chromosome-positive (Ph+), Relapsed/Refractory«/b» - 400 mg twice daily «bu»Chronic Myeloid Leukemia (CML)«/bu» «b»Philadelphia Chromosome-positive (Ph+), Newly-diagnosed in Chronic Phase«/b» - 300 mg twice daily «b»Discontinuation of Therapy«/b» - May consider nilotinib discontinuation in patients who have been treated with nilotinib for at least 3 years, maintained a molecular response of at least MR4.0 (corresponding to BCR-ABL/ABL ≤0.01% IS) for 1 year (prior to discontinuation), achieved an MR4.5 (corresponding to BCR-ABL/ABL ≤0.0032% IS) for the last assessment taken immediately prior to discontinuation, been confirmed to express the typical BCR-ABL transcripts (e13A2/b2a2 or e14a2/b3a2), no history of accelerated phase or blast crisis, and no history of prior attempts of treatment-free remission discontinuation that resulted in relapse. «b»Reinitiation of Therapy«/b» - Patients who lose major molecular response after nilotinib discontinuation must reinitiate treatment within 4 weeks at the dose used prior to discontinuation - Monitor BCR-ABL transcript levels monthly until major molecular response is re-established and every 12 weeks thereafter - BCR-ABL kinase domain mutation testing should be performed if major molecular response is not achieved after 3 months of therapy reinitiation. «b»Chronic Myeloid Leukemia (Ph+), Resistant or Intolerant in Accelerated Phase«/b» - 400 mg twice daily «b»Chronic Myeloid Leukemia (Ph+), Resistant or Intolerant in Chronic Phase«/b» - 400 mg twice daily «b»Discontinuation of Therapy«/b» - May consider nilotinib discontinuation in patients with CML in chronic phase (resistant or intolerant to prior imatinib therapy) who have been treated with nilotinib for at least 3 years, been treated with imatinib (only) prior to nilotinib treatment, achieved an MR4.5 (corresponding to BCR-ABL/ABL ≤0.0032% IS), achieved a sustained MR4.5 for a minimum of 1 year immediately prior to discontinuation, been confirmed to express the typical BCR-ABL transcripts (e13A2/b2a2 or e14a2/b3a2), no history of accelerated phase or blast crisis, and no history of prior attempts of treatment-free remission discontinuation that resulted in relapse. «b»Reinitiation of Therapy«/b» - Patients with confirmed loss of MR4.0 (2 consecutive readings separated by at least 4 weeks showing loss of MR4.0) or loss of major molecular response after nilotinib discontinuation must reinitiate treatment within 4 weeks at the dose used prior to discontinuation. Monitor BCR-ABL transcript levels monthly until previous major molecular response or MR4.0 is re-established and every 12 weeks thereafter. BCR-ABL kinase domain mutation testing should be performed if major molecular response is not achieved after 3 months of therapy reinitiation. «bu»Gastrointestinal Stromal Tumor (GIST), Refractory«/bu» - 400 mg twice daily until disease progression or unacceptable toxicity «b»Missed Doses«/b» - If a dose is missed, do not make up, resume with next scheduled dose. «b»CYP3A4 Inhibitors«/b» - Avoid the concomitant use of a strong CYP3A4 inhibitor with nilotinib. If a strong CYP3A4 inhibitor is required, interruption of nilotinib treatment is recommended. - If therapy cannot be interrupted and concurrent use with a strong CYP3A4 inhibitor cannot be avoided, consider reducing the nilotinib dose to 300 mg once daily in patients with resistant or intolerant Ph+ CML (chronic or accelerated phase) or to 200 mg once daily in newly diagnosed chronic phase Ph+ CML, with careful monitoring, especially of the QT interval. When a strong CYP3A4 inhibitor is discontinued, allow a washout period prior to adjusting nilotinib dose upward. «b»CYP3A4 Inducers«/b» - Avoid the concomitant use of a strong CYP3A4 inducer with nilotinib (based on pharmacokinetic parameters, an increased nilotinib dose is not likely to compensate for decreased exposure). «bu»Chronic Myeloid Leukemia (Philadelphia chromosome-positive [Ph+])«/bu» «b»Dosage Adjustment for Hematologic Toxicity Unrelated to Underlying Leukemia«/b» «bi»ANC <1,000/mm3 and/or platelets <50,000/mm3«/bi» - Withhold treatment, monitor blood counts «bi»If ANC >1,000/mm3 and platelets >50,000/mm3 within 2 weeks«/bi» - Resume at prior dose «bi»If ANC <1,000/mm3 and/or platelets <50,000/mm3 for >2 weeks«/bi» - Reduce dose to 400 mg once daily «b»Dosage Adjustment for Nonhematologic Toxicity«/b» «bi»Amylase or Lipase ≥ grade 3«/bi» - Withhold treatment, monitor serum amylase or lipase, resume treatment at 400 mg once daily when lipase or amylase returns to ≤ grade 1 «bi»Lipase Increases in Conjunction with Abdominal Symptoms«/bi» - Withhold treatment and consider diagnostics to exclude pancreatitis «bi»Clinically-significant Moderate or Severe Non-hematologic Toxicity«/bi» - Withhold treatment, upon resolution of toxicity, resume at 400 mg once daily; may escalate back to initial dose (300 mg twice daily or 400 mg twice daily depending on indication) if clinically appropriate «bi»Dosage Adjustment for QT Prolongation«/bi» - Repeat ECG ~7 days after any dosage adjustment - QTc >480 msec: Withhold treatment, monitor and correct potassium and magnesium levels; review concurrent medications - If QTcF returns to <450 msec and to within 20 msec of baseline within 2 weeks: Resume at prior dose - If QTcF returns to 450 to 480 msec after 2 weeks: Reduce dose to 400 mg once daily - If QTcF >480 msec after dosage reduction to 400 mg once daily: Discontinue treatment «bu»Acute Lymphoblastic Leukemia (Ph+), Newly Diagnosed«/bu» - Temporarily reduce nilotinib dose to 400 mg once daily for ≥ grade 3 nonhematologic toxicity (resume when improved to grade 1) - Severe recurrent adverse events despite dose reduction may require permanent discontinuation «bu»Chronic Myeloid Leukemia (CML)«/bu» - Indicated for initial treatment of newly diagnosed Philadelphia chromosome positive chronic phase chronic myeloid leukemia (Ph+ CP-CML) in children and adolescents aged ≥1 year - Also, indicated for children and adolescents aged ≥1 year with Ph+ CP-CML resistant or intolerant to prior tyrosine-kinase inhibitor (TKI) therapy - 230 mg/m² PO bid, round to the nearest 50 mg dose; not to exceed 400 mg/dose - Continue treatment until disease progression or unacceptable toxicity occurs «b»Neutropenia and Thrombocytopenia«/b» «bi»ANC <1 x 10^9/L and/or platelets <50x 10^9/L«/bi» - Stop nilotinib and monitor blood counts - Resume within 2 weeks to original dose if ANC >1.5 x 109/L and/or platelets >75 x 109/L - If ANC remains low for >2 weeks: Reduce dose to 230 mg/m² qDay - If event occurs after dose reduction, consider discontinuing treatment «b»QT Prolongation (QTc >480 msec)«/b» - Withhold drug and analyze serum potassium and magnesium; if below lower limit of normal, correct with supplements to within normal limits - Review concomitant medications for additive effects or interactions that increase nilotinib systemic exposure - Resume within 2 weeks at prior dose if QTc returns to <450 msec and to within 20 msec of baseline - If QTc is between 450-480 msec after 2 weeks, reduce nilotinib dose to 230 mg/m² qDay - Discontinue if QTc returns to >480 msec despite dose reduction - Repeat ECG ~7 days after any dose adjustment «b»Moderate or Severe Non-hematologic Toxicity«/b» - Interrupt nilotinib until toxicity has resolved - Resume treatment at 230 mg/m² qDay if previous dose was 230 mg/m² BID; discontinue treatment if prior dose was 230 mg/m² qDay - If clinically appropriate, consider re-escalation of the dose to 230 mg/m² BID «b»Elevated Serum Lipase or Amylase ≥Grade 3«/b» - Interrupt nilotinib until the event returns to ≤Grade 1 - Resume treatment at 230 mg/m² qDay if prior dose was 230 mg/m² BID; discontinue treatment if prior dose was 230 mg/m² qDay «b»Elevated Bilirubin or AST/ALT ≥Grade 3«/b» - Interrupt nilotinib until the event returns to ≤Grade 1 - Resume treatment at 230 mg/m² qDay if prior dose was 230 mg/m² BID; discontinue treatment if prior dose was 230 mg/m² qDay, and recovery to ≤Grade 1 takes >28 days - Consider discontinuation of treatment after a sustained molecular response - Monitor BCR-ABL transcript levels and complete blood count (CBC) with differential in patients who have discontinued therapy monthly for 1 year, then q6Weeks for the second year, and q12Weeks thereafter «b»Newly diagnosed Ph+ CML-CP«/b» - Treatment with nilotinib for at least 3 years - Maintain a molecular response of at least MR4.0 (corresponding to = BCR-ABL/ABL ≤0.01% IS) for 1 year prior to discontinuation of therapy - Achieved an MR4.5 for the last assessment taken immediately prior to discontinuation of therapy - Been confirmed to express the typical BCR-ABL transcripts (e13a2/b2a2 or e14a2/b3a2) - No history of accelerated phase or blast crisis - No history of prior attempts of treatment-free remission discontinuation that resulted in relapse - Patients with Ph+ CML-CP that are resistant or intolerant to treatment with imatinib - Treatment with nilotinib for at least 3 years - Previously treated with imatinib only prior to treatment with nilotinib - Achieved a molecular response of MR4.5 (corresponding to = BCR-ABL/ABL ≤ 0.0032% IS) - Sustained an MR4.5 for a minimum of 1 year immediately prior to discontinuation of therapy - Been confirmed to express the typical BCR-ABL transcripts (e13a2/b2a2 or e14a2/b3a2) - No history of accelerated phase or blast crisis - No history of prior attempts of treatment-free remission discontinuation that resulted in relapse - Reinitiation of treatment in patients who lose molecular response after discontinuation of therapy «b»Newly Diagnosed Patients«/b» - Patients who lose MMR must reinitiate treatment within 4 weeks at the dose level prior to discontinuing treatment - Monitor BCR-ABL transcript levels monthly until major molecular response is re-established and q12Weeks thereafter - Resistant or intolerant Ph+ CML (chronic phase or accelerated phase) - Patients resistant or intolerant to prior treatment that included imatinib with confirmed loss of MR4.0 (2 consecutive measures separated by at least 4 weeks showing loss of MR4.0) or loss of MMR must reinitiate treatment within 4 weeks at the dose level prior to discontinuation of therapy - Monitor BCR-ABL transcript levels monthly until previous major molecular response or MR 4.0 is re-established and q12Weeks thereafter «b»Strong CYP3A4 Inhibitors«/b» - Avoid if possible; for patients who cannot avoid use of strong CYP3A4 inhibitors, monitor closely for QT prolongation - However, there are no clinical data with this dose adjustment in patients receiving strong CYP3A4 inhibitors «b»Strong CYP3A4 Inducers«/b» - Avoid coadministration - Based on nonlinear pharmacokinetic profile of nilotinib, increasing the dose is unlikely to compensate for loss of nilotinib systemic exposure

Nilutamide

Nilandron

NiMODipine

Nymalize, Nimotop

Nintedanib

Ofev

Niraparib

Zejula

«bu»Ovarian, Fallopian Tube, or Primary Peritoneal Cancer«/bu» «b»Recurrent (Maintenance Treatment)«/b» - 300 mg once daily - Continue until disease progression or unacceptable toxicity - Begin treatment no later than 8 weeks following the most recent platinum-containing regimen. «b»Missed/Vomited Doses«/b» - If a dose is missed or vomited, an additional dose should not be taken that day - Resume dosing with the next scheduled daily dose. - Adverse reactions may be managed with treatment interruption, dose reduction, or discontinuation. «b»Recommended Niraparib Dosage Adjustment Levels«/b» - Starting dose: 300 mg/day - First Dose Reduction: Reduce to 200 mg/day. - Second Dose Reduction: Reduce to 100 mg/day. - If further dose reduction below 100 mg/day is needed, discontinue niraparib. «b»Hematologic Toxicity«/b» «bi»Platelets <100,000/mm3«/bi» First Occurrence - Withhold treatment for a maximum of 28 days and monitor blood counts weekly. When platelets are ≥100,000/mm3, resume niraparib at the same or at a reduced dose. If platelet count was <75,000/mm3, resume at a reduced dose. Second Occurrence - Withhold treatment for a maximum of 28 days and monitor blood counts weekly. When platelets are ≥100,000/mm3, resume niraparib at a reduced dose. Discontinue if platelet count has not returned to acceptable levels within 28 days of interrupting dose, or if dose has already been reduced to 100 mg/day. «bi»Neutrophils <1,000/mm3 or Hemoglobin <8 g/dL«/bi» - Withhold treatment for a maximum of 28 days and monitor blood counts weekly. When neutrophils are ≥1,500/mm3 or hemoglobin is ≥9 g/dL, resume niraparib at a reduced dose. Discontinue if neutrophils and/or hemoglobin have not returned to acceptable levels within 28 days of interrupting dose, or if dose has already been reduced to 100 mg/day. «bi»Hematologic Toxicity Requiring Transfusion«/bi» - Withhold niraparib. Consider platelet transfusion for platelets ≤10,000/mm3. If other risk factors (eg, concurrent anticoagulation or antiplatelet therapy), consider interrupting the anticoagulant/antiplatelet and/or transfusing to a higher platelet count. Resume niraparib at a reduced dose. «bi»Secondary Myelodysplastic Syndrome (MDS) or Acute Myeloid Leukemia (AML)«/bi» - Discontinue niraparib with confirmed diagnosis of MDS or AML. «b»Nonhematologic Toxicity«/b» «bi»Grade 3 or Higher Adverse Reaction«/bi» - Where prophylactic management is not feasible or persistent despite management - Withhold niraparib for up to 28 days or until resolution; may resume with the dose reduced (up to two dose reductions are permitted). Grade 3 or Higher Adverse Reaction Lasting More than 28 days at a Dose of 100 mg/day - Discontinue treatment.

Nirmatrelvir

Nirmatrelvir-Ritonavir

Paxlovid

Nisoldipine

Sular

Nitazoxanide

Alinia, NTZ

Nitisinone

Orfadin, Nityr, NTBC

Nitrofurantoin

Macrodantin, Furadantin, Macrobid

Nitroglycerin

NitroMist, Nitro-Dur, Rectiv, Nitro-Bid, Minitran, Nitro-Time, Nitronal, Nitrolingual, Nitrostat

Nitroprusside

Nitropress, Nipride, RTU

Nivolumab

Opdivo

Nivolumab-Relatlimab

Opdualag

Nizatidine

Axid

Norelgestromin

Norepinephrine

Levophed, Noradrenaline

«b»Administration of Vasopressors Through Peripheral Venous Catheters (CMAJ)«/b» «u»https://twitter.com/ApoThera/status/1667773828850937856«/u» «b»Dobutamine vs Alternative Vasoactives«/b» «u»https://twitter.com/ApoThera/status/1624600312224022529«/u» «b»IV Administration«/b» - Administer as a continuous infusion via an infusion pump - Dilute prior to use. Central line administration is preferred; extravasation may cause severe ischemic necrosis - Do not administer sodium bicarbonate (or any alkaline solution) through an IV line containing norepinephrine; inactivation of norepinephrine may occur. «b»Vesicant«/b» - Ensure proper needle or catheter placement prior to and during infusion; avoid extravasation. «b»Extravasation Management«/b» - If extravasation occurs, stop infusion immediately and disconnect (leave cannula/needle in place) - Gently aspirate extravasated solution (do NOT flush the line) - Remove needle/cannula - Elevate extremity - Initiate phentolamine (or alternative) antidote - Apply dry warm compresses «bi»Phentolamine«/bi» - Dilute 5 to 10 mg in 10 to 20 mL NS and administer into extravasation site as soon as possible after extravasation; may readminister if patient remains symptomatic or dilute 5 to 10 mg in 10 mL NS and administer into extravasation area (within 12 hours of extravasation). «bi»Nitroglycerin Topical 2% Ointment«/bi» Adults - Apply a 1-inch strip to the site of ischemia; may repeat every 8 hours as necessary Pediatrics - Apply 4 mm/kg as a thin ribbon to the site of ischemia; may repeat after 8 hours if needed or apply a 1-inch strip to the site of ischemia; may repeat every 8 hours as necessary «bi»Terbutaline«/bi» - Alternatives to Phentolamine - Infiltrate extravasation area using a solution of terbutaline 1 mg diluted in 10 mL NS (large extravasation site, administration volume varied from 3 to 10 mL) or 1 mg diluted in 1 mL NS (small/distal extravasation site, administration volume varied from 0.5 to 1 mL) «b»IV Preparation«/b» - Dilute with D5W, D5NS, or NS; dilution in NS is not recommended by the manufacturer; however, stability in NS has been demonstrated. - Concentrations ranging from 4 to 16 mcg/mL are typically used in clinical practice.

Norethindrone

Camila, Deblitane, Errin, Jencycla, Jolivette, Aygestin, Heather, Lyza, Nor-QD, Nora-BE, Norlyda, Norlyroc, Ortho Micronor, Sharobel

«bu»Abnormal Uterine Bleeding and Amenorrhea«/bu» - 2.5 to 10 mg/day for 5 to 10 days - Secretory transformation of the endometrium will occur when adequately primed with endogenous or exogenous estrogen - Withdrawal bleeding may be expected within 3 to 7 days after discontinuing norethindrone acetate «bu»Contraception«/bu» - 0.35 mg every day (no missed days) «b»Initial Dose«/b» - Start on first day of menstrual period or the day after a miscarriage or abortion - If switching from a combined oral contraceptive, begin the day after finishing the last active combined tablet. «b»Missed Dose«/b» - Take as soon as remembered. A back up method of contraception should be used for 48 hours if dose is taken ≥3 hours late. «b»Initiation of Therapy«/b» - May be started at any time in the menstrual cycle once it is determined that the woman is not pregnant. Back-up contraception is not needed if started within 5 days of onset of menstruation. If started >5 days after the onset of menstruation or at any time in a women experiencing amenorrhea (not postpartum), back up contraception should be used for 2 days. «b»Switching from a different Contraceptive to a Progestin-only Contraceptive«/b» - May be started at any time if it is determined that the woman is not pregnant - Unless the woman abstains from sexual intercourse, a backup method of contraception is needed if it has been >5 days since menstrual bleeding has begun. - When an additional method of contraception is needed, consider continuing the woman’s previous method for 2 days after starting the progestin-only contraceptive. «b»Switching from an IUD to a Progestin-only Contraceptive«/b» - Continue the IUD for at least 2 days after the progestin-only contraceptive is started or advise the woman to abstain from sexual intercourse or use a barrier contraceptive for 7 days before removing the IUD - Alternately, an emergency contraceptive may be used at the time of IUD removal. «bu»Endometriosis«/bu» - 5 mg/day for 14 days - Increase at increments of 2.5 mg/day every 2 weeks to reach 15 mg/day - Continue for 6 to 9 months or until breakthrough bleeding demands temporary termination

Norethindrone-Mestranol

Necon 1/50, Norinyl 1/50, Ortho Novum 1/50

Norgestimate

Norgestimate-Ethinyl Estradiol

Estarylla, Femynor, MonoNessa, Ortho-Cyclen, Previfem, Mono-Linya, Sprintec, Ortho Tri-Cyclen, Ortho Tri-Cyclen Lo, Tri-Estarylla, Tri Femynor, Tri-Linyah, Tri-Lo-Estarylla, Tri-Lo-Marzia,

«bu»Acne«/bu» «b»Ortho Tri-Cyclen, Tri-Estaryllla, TriNessa, Tri-Previfem, Tri-Sprintec«/b» - 1 tablet once daily «bu»Contraception«/bu» - 1 tablet once daily «b»Schedule 1 (Sunday starter)«/b» - Dose begins on first Sunday after onset of menstruation; if the menstrual period starts on Sunday, take first tablet that very same day - With a Sunday start, an additional method of contraception should be used until after the first 7 days of consecutive administration. «b»Schedule 2 (Day 1 starter)«/b» - Dose starts on first day of menstrual cycle taking 1 tablet daily. «b»Switching from a Different Contraceptive«/b» «bi»Oral Contraceptive«/bi» - Start on the same day that a new pack of the previous oral contraceptive would have been taken. «bi»Transdermal Patch, Vaginal Ring, Injection«/bi» - Start on the day the next dose would have been due. «bi»IUD or Implant«/bi» - Start on the day of removal - A backup method of contraception should be used for the first 7 days if IUD is not removed on the first day of the menstrual cycle. «b»Use After First Trimester Abortion or Miscarriage«/b» - Therapy may be started immediately. If not started within 5 days, a back-up method of contraception should be used for the first 7 days. «b»Use After Childbirth (in women who are not breast-feeding) or After Second Trimester Abortion or Miscarriage«/b» - Therapy may be started ≥4 weeks postpartum. Pregnancy should be considered prior to treatment if menstrual periods have not restarted. An additional method of contraception (nonhormonal) should be used until after the first 7 days of consecutive administration. «b»Missed or Late Doses«/b» - If one dose is late (<24 hours since dose should have been taken) or if one dose is missed (24 to <48 hours since dose should have been taken): Take dose as soon as possible. Continue remaining doses at the usual time (even if that means 2 doses on the same day). - If ≥2 consecutive doses are missed (≥48 hours since dose should have been taken): Take the most recently missed dose as soon as possible, discard any other missed doses. Continue remaining doses at the usual time (even if that means taking 2 doses on the same day); use back-up contraception until hormonal pills have been taken for 7 consecutive days. If doses were missed during the last week of hormonal (active) tablets (eg, days 15 to 21 of a 28 day pack), omit the hormone free interval by finishing the current pack and starting a new pack. If unable to start a new pack immediately, back up contraception is needed until hormonal pills from a new pack have been taken for 7 consecutive days. Consider use of emergency contraception in some situations «b»Limitations of Use«/b» - When used for acne, use only in females ≥15 years of age who achieved menarche, who also desire combination hormonal contraceptive therapy, and have no contraindications to combination hormonal contraceptive use

Norgestrel

Norgestrel-Ethinyl Estradiol

Cryselle 28, Elinest, Low-Ogestrel, Lo Ovral, Ogestrel

Nortriptyline

Pamelor

Nusinersen

Spinraza

Nystatin

Bio-Statin (Oral)

Nystatin (Topical)

Nyata, Nyamyc, Nystop, Pedi-Dri

Nystatin-Triamcinolone

Myco-Triacet II, Mycolog-II

Obeticholic Acid

Ocaliva

Obinutuzumab

Gazyva

«b»Premedication«/b» - Premedication with acetaminophen, an antihistamine, and a glucocorticoid (dexamethasone or methylprednisolone) 30 to 60 minutes prior to treatment may be necessary - Antihyperuricemic prophylaxis and adequate hydration are recommended for patients at high risk for tumor lysis syndrome. Antimicrobial, antiviral, and antifungal prophylaxis may be considered in certain patients. «bu»Chronic Lymphocytic Leukemia (CLL)«/bu» Cycle 1 - 100 mg on day 1, followed by 900 mg on day 2, followed by 1,000 mg weekly for 2 doses (days 8 and 15) Cycles 2 through 6 - 1,000 mg on day 1 every 28 days for 5 doses «b»Missed Doses«/b» - Administer the missed dose as soon as possible; adjust dosing schedule to maintain the time schedule between doses. In some cases, patients who do not complete the day 1 cycle 1 dose may proceed to the day 2 cycle 1 treatment (if appropriate). «bu»Follicular Lymphoma«/bu» «b»Previously Untreated«/b» - Patients with complete response or partial response to the initial 6 or 8 cycles of combination therapy (with either bendamustine or CHOP or CVP) should continue on obinutuzumab as monotherapy for up to 2 years. - Cycle 1 (either in combination with bendamustine or with CHOP or CVP chemotherapy): 1,000 mg weekly for 3 doses on day 1, day 8, and day 15 - Cycles 2 through 6 (in combination with bendamustine): 1,000 mg on day 1 every 28 days for 5 doses - Cycles 2 through 8 (in combination with CHOP): 1,000 mg on day 1 every 21 days for 5 doses (in combination with CHOP), followed by 1,000 mg on day 1 every 21 days for 2 doses (as monotherapy) - Cycles 2 through 8 (in combination with CVP): 1,000 mg on day 1 every 21 days for 7 doses «b»Obinutuzumab Monotherapy«/b» - 1,000 mg once every 2 months for up to 2 years beginning ~2 months after the last induction phase obinutuzumab dose. «b»Missed Doses«/b» - Administer the missed dose as soon as possible; adjust dosing schedule accordingly to maintain the time interval between chemotherapy cycles -During obinutuzumab monotherapy, maintain the original dosing schedule for subsequent doses. «bu»Follicular Lymphoma«/bu» «b»Relapsed/Refractory«/b» - Patients with stable disease, complete response, or partial response after 6 cycles of combination therapy (with bendamustine) should continue on obinutuzumab as monotherapy for up to 2 years. - Cycle 1 (in combination with bendamustine): 1,000 mg weekly for 3 doses on day 1, day 8, and day 15 - Cycles 2 through 6 (in combination with bendamustine): 1,000 mg on day 1 every 28 days for 5 doses «b»Obinutuzumab Monotherapy«/b» - 1,000 mg once every 2 months for up to 2 years beginning ~2 months after the last induction phase obinutuzumab dose. «b»Missed Doses«/b» - Administer the missed dose as soon as possible; adjust dosing schedule accordingly to maintain the time interval between chemotherapy cycles. During obinutuzumab monotherapy, maintain the original dosing schedule for subsequent doses. «b»Hematologic«/b» «bi»Grade 3 or 4 Neutropenia«/bi» - Consider treatment interruption and use of granulocyte colony-stimulating factors. In patients with severe and long-lasting (>1 week) neutropenia, antimicrobial prophylaxis is recommended until neutropenia improves to grade 1 or 2. «bi»Grade 3 or 4 thrombocytopenia«/bi» - Consider treatment interruption. «b»Infusion Reactions«/b» «bi»Mild to moderate (Grades 1 and 2)«/bi» - Reduce infusion rate or interrupt infusion and manage symptoms as appropriate. Upon symptom resolution, continue or resume infusion. If no further infusion reaction symptoms occur, may resume infusion rate escalation as appropriate for the treatment cycle dose. For CLL only, day 1 (cycle 1) infusion rate may be increased back up to a maximum of 25 mg/hour after 1 hour. «bi»Severe (Grade 3)«/bi» - Interrupt therapy; manage symptoms as appropriate. Upon symptom resolution, may reinitiate infusion at no more than 50% of the rate at which the reaction occurred. If no further infusion reaction symptoms occur, may resume infusion rate escalation as appropriate for the treatment cycle dose. For CLL only, day 1 (cycle 1) infusion rate may be increased back up to a maximum of 25 mg/hour after 1 hour. Permanently discontinue if ≥grade 3 infusion-related symptoms occur upon rechallenge. «b»Life-threatening (Grade 4)«/b» - Discontinue infusion immediately; permanently discontinue therapy. «b»Infection«/b» - Consider treatment interruption. «b»Other Toxicity«/b» - Consider treatment interruption for ≥ grade 2 nonhematologic toxicity. «bu»Chronic Lymphocytic Leukemia (CLL)«/bu» «b»Cycle 1, day 1 and 2 doses (100 mg and 900 mg, respectively)«/b» - Withdraw 40 mL of obinutuzumab solution from vial - Dilute 4 mL into a 100 mL infusion bag of NS (100 mg dose; use immediately) - Dilute remaining 36 mL into a 250 mL NS infusion bag (900 mg dose, for use on day 2); store at 2°C to 8°C (36°F to 46°F) for up to 24 hours; use immediately after reaching room temperature. Gently invert to mix; do not shake or freeze. «b»Cycle 1 (day 8 and 15 doses) and Cycles 2 through 6 (1,000 mg)«/b» - Withdraw 40 mL of obinutuzumab solution from vial. Dilute into a 250 mL NS infusion bag. Gently invert to mix; do not shake or freeze. «b»IV Administration«/b» - For IV infusion only - Do not administer IV push or as a bolus - Administer through a dedicated IV line; do not mix with or infuse with other medications - May use PVC or non-PVC administration sets - Premedication with acetaminophen, an antihistamine, and a glucocorticoid (dexamethasone or methylprednisolone) may be required to prevent infusion reactions (see below). - In patients with severe (grade 3 or 4) neutropenia lasting more than 1 week, antimicrobial prophylaxis is strongly recommended (continue until neutropenia resolves to grade 1 or 2); antiviral and antifungal prophylaxis should be considered. «b»Premedication to Prevent Infusion Reactions«/b» «bi»CLL (cycle 1 [days 1 and 2]) and FL (day 1)«/bi» - All patients should receive acetaminophen (650 to 1,000 mg) and an antihistamine (eg, diphenhydramine 50 mg) at least 30 minutes prior to infusion. - In addition, an IV glucocorticoid (dexamethasone 20 mg or methylprednisolone 80 mg) should be administered at least 1 hour prior to infusion. If a glucocorticoid-containing chemotherapy regimen is administered on the same day as obinutuzumab, the glucocorticoid may be administered as an oral medication if administered at least 1 hour prior to obinutuzumab (an IV glucocorticoid is therefore not required). «bi»All Subsequent Infusions«/bi» - All patients should receive acetaminophen 650 to 1,000 mg at least 30 minutes prior to infusion. - If patients experienced grade 1 or 2 infusion-related reaction with previous infusion: Administer an antihistamine (eg, diphenhydramine 50 mg) in addition to acetaminophen at least 30 minutes prior to infusion. - If patients experienced a grade 3 infusion-related reaction with previous infusion or have a lymphocyte count >25,000 cells/mm3 prior to next treatment: Administer an IV glucocorticoid (dexamethasone 20 mg or methylprednisolone 80 mg) at least 1 hour prior to infusion, in addition to acetaminophen and an antihistamine at least 30 minutes prior to infusion. «b»CLL Infusion Rate«/b» «bi»Cycle 1 (day 1)«/bi» - Infuse at 25 mg/hour over 4 hours; do not increase the infusion rate. «bi»Cycle 1 (day 2)«/bi» - If no reaction to previous infusion, initiate infusion at 50 mg/hour for 30 minutes; if tolerated, may escalate rate in increments of 50 mg/hour every 30 minutes to a maximum rate of 400 mg/hour. If an infusion reaction occurred during the previous infusion, initiate infusion at 25 mg/hour for 30 minutes; if tolerated, may escalate rate in increments of up to 50 mg/hour every 30 minutes to a maximum rate of 400 mg/hour. «bi»Cycle 1 (days 8 and 15), and Cycles 2 through 6«/bi» - If no reaction to previous infusion and the final infusion rate was 100 mg/hour or faster, initiate infusion at 100 mg/hour for 30 minutes; if tolerated, may escalate infusion rate in increments of 100 mg/hour every 30 minutes to a maximum rate of 400 mg/hour. If an infusion reaction occurred during the previous infusion, initiate infusion at 50 mg/hour for 30 minutes; if tolerated, may escalate rate in increments of 50 mg/hour every 30 minutes to a maximum rate of 400 mg/hour. «b»FL Infusion Rate«/b» Previously untreated or relapsed/refractory «bi»Cycle 1 (day 1)«/bi» - Initiate infusion at 50 mg/hour; if tolerated, may escalate rate in increments of 50 mg/hour every 30 minutes to a maximum rate of 400 mg/hour. «bi»All Subsequent FL Infusions«/bi» - If no reaction or grade 1 reaction to previous infusion and the final infusion rate was 100 mg/hour or faster, initiate infusion at 100 mg/hour for 30 minutes; if tolerated, may escalate rate in increments of 100 mg/hour every 30 minutes to a maximum rate of 400 mg/hour. If a grade 2 or higher infusion reaction occurred during the previous infusion, initiate infusion at 50 mg/hour for 30 minutes; if tolerated, may escalate rate in increments of 50 mg/hour every 30 minutes to a maximum rate of 400 mg/hour. «b»IV Preparation«/b» - Do not use other diluents (eg, dextrose) to prepare the infusion. Final concentration for administration should be 0.4 to 4 mg/mL. May use PVC or non-PVC infusion bags. - Follicular lymphoma (1,000 mg): Withdraw 40 mL of obinutuzumab solution from vial. Dilute into a 250 mL NS infusion bag. Gently invert to mix; do not shake or freeze. - Do not use other diluents (eg, dextrose) to prepare the infusion. Final concentration for administration should be 0.4 to 4 mg/mL. May use PVC or non-PVC infusion bags.

Ocrelizumab

Ocrevus

«b»IV Administration«/b» - Administer though a dedicated IV line using a 0.2 or 0.22 micron in-line filter. - Premedicate with methylprednisolone (100 mg IV) 30 minutes prior to each infusion, and an antihistamine (diphenhydramine) 30 to 60 minutes prior each infusion; may also consider premedication with acetaminophen. «bi»First 2 Infusions (300 mg dose)«/bi» - Begin infusion at 30 mL/hour - Increase by 30 mL/hour every 30 minutes to a maximum rate of 180 mL/hour - Infusion duration is 2.5 hours or longer. «bi»Subsequent Infusions (600 mg dose)«/bi» OPTION 1 - Begin infusion at 40 mL/hour - Increase by 40 mL/hour every 30 minutes to a maximum rate of 200 mL/hour - Infusion duration is 3.5 hours or longer OPTION 2 - May use this option if no prior serious infusion reaction with any previous ocrelizumab infusion - Start IV at 100 mL/hour for first 15 minutes - Increase to 200 mL/hour for next 15 minutes - Increase to 250 mL/hour for next 30 minutes - Increase to 300 mL/hour for remaining 60 minutes - Infusion duration: ≥2 hr - Monitor for infusion reactions during infusion and observe for at least one hour after infusion is complete. If infusion reaction occurs, interrupt infusion, discontinue or decrease the rate, depending on the severity of the reaction. - Inform patients that infusion reactions can occur up to 24 hour afterwards «b»IV Reconstitution«/b» - Dilute for infusion in NS (dilute 300 mg dose in a 250 mL bag and 600 mg dose in a 500 mL bag) to a final concentration of approximately 1.2 mg/mL. - Do not dilute in any other solutions. - Do not shake. - Incompatibilities between polyvinyl chloride (PVC) or polyolefin bags and ocrelizumab have not been observed «b»Dosage Adjustment for Infusion Reactions«/b» «bi»Mild to Moderate Reactions«/bi» - Reduce the infusion rate to one-half of the rate at which the reaction occurred; maintain reduced rate for at least 30 minutes - If the reduced rate is tolerated, increase the rate every 30 minutes by 30 mL/hour to a maximum rate of 180 mL/hour (for the 300 mg dose) or 40 mL/hour to a maximum rate of 200 mL/hours (for the 600 mg dose). «bi»Severe Reactions«/bi» - Interrupt infusion immediately and administer supportive management as needed - After all symptoms have resolved, restart infusion beginning at a rate one-half of the rate at onset of reaction - If the reduced rate is tolerated, increase the rate every 30 minutes by 30 mL/hour to a maximum rate of 180 mL/hour (for the 300 mg dose) or 40 mL/hour to a maximum rate of 200 mL/hours (for the 600 mg dose) «bi»Life-threatening Reactions«/bi» - Immediately stop and permanently discontinue infusion for life-threatening or disabling infusion reaction.

Octreotide

Bynfezia Pen, Longastatin, Mycapssa, SandoSTATIN

«bu»Acromegaly«/bu» «b»Initial SC Dose«/b» - 50 mcg SC every 8 hour - Bynfezia Pen or Sandostatin «b»Maintenance SC Dose«/b» - Titrate up to 500 mcg SC every 8 hour prn - Doses >300 mcg/day seldom result in additional benefit; if an increase in dose fails to provide additional benefit, reduce dosage - After successful treatment with solution for 2 weeks, initiate treatment with suspension (depot injection) «b»Dosing Titration«/b» - Measure IGF-I levels every 2 weeks after initiation or dosage change - Alternatively, measuring growth hormone levels at 1-4 hr intervals for 8-12 hr after administration; goal is to achieve growth hormone levels <5 ng/mL or IGF-I levels within normal reference ranges for age and sex - Once biochemical normalization, or maximal benefit is achieved, re-evaluate IGF-I or growth hormone levels at 6-month intervals «b»Initial IM Dose«/b» - 20 mg IM (gluteal) Depot Suspension every 4 weeks for 3 months - Sandostatin LAR Depot «b»Maintenance IM Dose«/b» - Titrate up or down to 10-30 mg IM every 4 weeks, depending on response - Not to exceed 40 mg, as follows «b»Symptoms Controlled«/b» - If GH < 1 ng/mL and IGF-1 normal, decrease dose to 10 mg IM intragluteally every 4 weeks; if GH < 2.5 ng/mL and IGF-1 normal, maintain dose at 20 mg IM every 4 weeks «b»Symptoms Uncontrolled«/b» - If GH > 2.5 ng/mL or IGF-I elevated, increase dose to 30 mg IM every 4 weeks; if symptoms persist, increase to 40 mg IM «b»Dosing Considerations«/b» - Monitor IGF-1 levels every 2 weeks to guide titration; goal: GH levels <5 ng/mL or IGF-1 levels <1.9 units/mL (men) and <2.2 units/mL (women) - Monitor IGF-1 or GH levels every 6 months - Withdraw drug yearly for 4 weeks (solution) or 8 weeks (suspension) from patients who have undergone irradiation to assess «b»Initial PO Dose«/b» - 20 mg PO bid (40 mg/day) - Mycapssa (PO) «b»Maintenance Dose«/b» - May titrate up in increments of 20 mg/day, based on IGF-1 levels and signs and symptoms «b»Maximum Dosage«/b» - 80 mg/day - Monitor IGF-1levels and signs and symptoms every 2 weeks during the dose titration, monthly during maintenance dosage, or as indicated - For 60 mg/day dose, administer as 40 mg in the AM and 20 mg in the PM «b»Dosage Interruptions & Modifications«/b» - If IGF-1 levels remain above the UNL after treatment with the maximum recommended dosage of 80 mg/day or the patient cannot tolerate treatment, consider discontinuing treatment and switching patient to another somatostatin analog - Withdraw therapy periodically to assess disease activity - If IGF-1 levels increase and signs and symptoms recur, resume therapy «bu»Carcinoid Tumor«/bu» «b»Initial SC Dose«/b» - 100-600 mcg/day SC divided every 6-12 hours - Bynfezia Pen or Sandostatin «b»Maintenance Dose«/b» - May titrate to 1500 mcg/day - Experience with doses >750 mcg/day is limited - Monitor urinary 5-hydroxyindole acetic acid (5-HIAA), plasma serotonin, and plasma substance - After successful treatment with solution for 2 weeks, initiate treatment with suspension (depot injection) «b»IM Dose«/b» - 20 mg IM Depot Suspension every 4 weeks for 2 months then modify dose based on response - May increase to 30 mg every 4 week if symptoms are inadequately controlled; decrease to 10 mg IM every 4 week for trial period if initially responsive to 20 mg dose - Dose >30 mg not recommended - Sandostatin LAR Depot «bu»VIPoma«/bu» «b»SC Injection«/b» - 200-300 mcg/day SC divided every 6-12 hr - After successful treatment with solution for 2 weeks, initiate treatment with suspension (depot injection) - Adjust dosage to achieve a therapeutic response; daily dosage is 150-750 mcg but usually doses >450 mcg/day are not required - Monitor plasma vasoactive intestinal peptide (VIP) - Bynfezia Pen or Sandostatin «b»IM Dose«/b» - Patients must be stabilized on subcutaneous octreotide for at least 2 weeks before switching to long-acting depot - Upon switch, administer 20 mg IM intragluteally every 4 weeks for 2 months - Continue solution for first 2 weeks; titrate suspension up or down to 10-30 mg IM every 4 weeks - Sandostatin LAR Depot «bu»Esophageal Variceal Bleeding«/bu» - 25-100 mcg IV bolus (usual bolus dose: 50 mcg) x 1 dose; then, - 25-50 mcg/hr continuous IV infusion for 2-5 days - May repeat bolus in first hr if hemorrhage not controlled «bu»GI or Pancreatic Fistula«/bu» - 50-200 mcg SC every 8 hr for 2-12 days «bu»AIDS-Related Diarrhea«/bu» - 100-500 mcg SC every 8 hr «bu»Ileostomy-Related Diarrhea«/bu» - 25 mcg/hr IV or 50 mcg SC every 12 hr «bu»Chemotherapy-Related Diarrhea«/bu» «b»Low-grade or Uncomplicated«/b» - 100-150 mcg SC every 8 hr for 1-30 days «b»Complicated«/b» - 100-150 mcg SC every 0 8hr or 25-50 mcg/hr IV - May increase to 500 mcg every 8 hr until controlled «b»Severe«/b» - 100-150 mcg SC every 8 hr - May increase to 500-1500 mcg SC/IV every 8 hr «bu»Dumping Syndrome«/bu» «b»IV Dose Regimens«/b» - 50-150 mcg IV daily - May adjust to 25-600 mcg/day dose range «b»IM Dose Regimens«/b» Suspension (depot injection) - 10-20 mg/month IM «bu»Chylothorax«/bu» «b»SC Dose Regimens«/b» - 50-100 mcg SC every 8 hr

Odesivimab

Odevixibat

Bylvay

Ofatumumab (IV)

Arzerra, HuMax-CD20

Ofatumumab (SC)

Kesimpta

Ofloxacin

Floxin

Ofloxacin (Ophthalmic)

Ocuflox

Ofloxacin (Otic)

Floxin Otic

OLANZapine

ZyPREXA, ZyPREXA Relprevv, ZyPREXA Zydis

«bu»Delirium«/bu» - 5 mg PO once daily for up to 5 days «bu»Delusional Parasitosis«/bu» «b»Initial Dose«/b» - 2.5 mg PO once daily «b»Maintenance Dose«/b» - Increase gradually based on response and tolerability up to 5 to 10 mg/day «b»Maximum Dose«/b» - 20 mg/day «bu»Post-Traumatic Stress Disorder (PTSD)«/bu» «b»Initial Dose«/b» - 5 to 10 mg PO once daily «b»Maintenance Dose«/b» - Adjust dose based on response and tolerability every 1 to 2 weeks, up to 20 mg daily «bu»Tourette Syndrome«/bu» «b»Initial Dose«/b» - 2.5 to 5 mg PO once daily «b»Maintenance Dose«/b» - Increase gradually based on response and tolerability to a usual dosage range of 2.5 to 20 mg daily - After initial dosage, increments of 2.5 to 5 mg PO weekly or biweekly were commonly used for dosage adjustments in clinical trials up to a maximum dosage of 20 mg/day «bu»Schizophrenia«/bu» «b»Initial Dose«/b» - 5 to 10 mg PO once daily THEN, - Increase to 10 mg PO once daily within 5 to 7 days Thereafter, - Adjust by 5 mg PO once daily at 1-week intervals, up to a recommended maximum of 20 mg/day «b»Maintenance Dose«/b» - 10 to 20 mg PO once daily - Doses up to 60 mg daily have been used in treatment-resistant schizophrenia; however, supporting evidence is limited «b»Special Risk Patients«/b» Initial Dose - 5 mg PO once daily is recommended in patients who are debilitated, who have a predisposition to hypotensive reactions, who exhibit a combination of factors that may result in slower metabolism of olanzapine (nonsmoking female patients ≥65 years), or who may be more pharmacodynamically sensitive to olanzapine; increase dose with caution as clinically indicated. «b»IM Extended-Release Injection«/b» - Establish tolerance to oral olanzapine prior to changing to extended-release injection. Maximum Dose - 300 mg «b»IM«/b» every 2 weeks OR - 405 mg «b»IM«/b» every 4 weeks «bi»Conversion from Olanzapine (PO) 10 mg Daily to IM Injection«/bi» Initial Dose - 210 mg IM every 2 weeks x 4 doses OR - 405 mg every 4 weeks x 2 doses Maintenance Dose - 150 mg IM every 2 weeks OR - 300 mg every 4 weeks «bi»Conversion from Olanzapine (PO) 15 mg Daily to IM Injection«/bi» Initial Dose - 300 mg every IM 2 weeks for 4 doses Maintenance Dose - 210 mg every IM 2 weeks OR - 405 mg IM every 4 weeks «bi»Conversion from Olanzapine (PO) 20 mg Daily to IM Injection«/bi» Initial and Maintenance Dose - 300 mg every 2 weeks «b»Special Risk Patients«/b» Initial Dose - 150 mg every 4 weeks is recommended in patients who are debilitated, who have a predisposition to hypotensive reactions, who exhibit a combination of factors that may result in slower metabolism of olanzapine (nonsmoking female patients ≥65 years), or who may be more pharmacodynamically sensitive to olanzapine; increase dose with caution as clinically indicated. «bu»Bipolar I Disorder«/bu» «b»Monotherapy«/b» Initial Dose - 10 to 15 mg PO once daily - Increase by 5 mg PO daily at intervals of not less than 24 hours Maintenance Dose - 5 to 20 mg PO daily - Recommended Maximum Dose: 20 mg/day «b»Combination with Lithium or Valproate Therapy«/b» Initial Dose - 10 mg PO once daily Dosing Range - 5 to 20 mg daily «bu»Chemotherapy-Associated Acute and Delayed Nausea or Vomiting, Prevention«/bu» - 10 mg PO on the day of chemotherapy (day 1), followed by, - 10 mg PO once daily days 2 to 4 (in combination with dexamethasone and palonosetron on day 1 only) «bu»Chemotherapy-associated Breakthrough Nausea or Vomiting«/bu» - 10 mg PO once daily for 3 days «bu»Agitation«/bu» «b»Short-acting Injection«/b» Initial Dose - 10 mg IM (a lower dose of 5 to 7.5 mg may be considered when clinical factors warrant) Maintenance Dose - Additional doses (up to 10 mg) may be considered, however, 2 hours after the initial dose and 4 hours after the second dose should be allowed between doses to evaluate response Maximum Total Dose - 30 mg/day «b»Special Risk Patients«/b» - Consider a lower dose of 2.5 mg in patients who are debilitated, who have a predisposition to hypotensive reactions, or who may be more pharmacodynamically sensitive to olanzapine. «b»Short-acting Injection«/b» - The IV route has only been studied in emergency departments, where patients can be closely monitored for respiratory depression - The World Federation of Societies of Biological Psychiatry (WFSBP) expert consensus panel recommends against the use of intravenous medications in the management of agitation except in cases where there is no alternative «bi»Monotherapy«/bi» - Initial Dose: 10 mg IV x 1 dose - May provide two additional 5 mg IV doses in 5-minute intervals if needed - Maximum: 20 mg x 1 dose - Lower doses of 5 mg IV as a single dose have been studied concomitantly with midazolam , however, concomitant use of parenteral olanzapine and benzodiazepines is not recommended due to potential for excessive sedation and cardiorespiratory depression. «bu»Depression«/bu» «b»Depression Associated with Bipolar Disorder«/b» «bi»Combination with Fluoxetine«/bi» - Initial Dose: 5 mg PO in the evening - Adjust as tolerated to usual range of 5 to 12.5 mg daily «b»Treatment-resistant Depression«/b» «b»Combination with Fluoxetine«/b» - Initial Dose: 5 mg PO in the evening - Adjust as tolerated to range of 5 to 20 mg daily «b»Olanzapine/Fluoxetine Combination [Symbyax]«/b» - When using individual components of fluoxetine with olanzapine rather than fixed dose combination product (Symbyax), approximate dosage correspondence is as follows: - Olanzapine 2.5 mg + fluoxetine 20 mg = Symbyax 3/25 - Olanzapine 5 mg + fluoxetine 20 mg = Symbyax 6/25 - Olanzapine 12.5 mg + fluoxetine 20 mg = Symbyax 12/25 - Olanzapine 5 mg + fluoxetine 50 mg = Symbyax 6/50 - Olanzapine 12.5 mg + fluoxetine 50 mg = Symbyax 12/50 «b»Special Risk Patients«/b» - Initial Dose: 2.5 to 5 mg PO once daily is recommended in patients who have a predisposition to hypotensive reactions, who have hepatic impairment, who exhibit a combination of factors that may result in slower metabolism of olanzapine (eg, female, elderly, nonsmoking status), or who may be more pharmacodynamically sensitive to olanzapine; increase dose with caution as clinically indicated. «b»Discontinuation of Therapy«/b» - American Psychiatric Association (APA), Canadian Psychiatric Association (CPA), and World Federation of Societies of Biological Psychiatry (WFSBP) guidelines recommend gradually tapering antipsychotics to avoid withdrawal symptoms and minimize the risk of relapse; risk for withdrawal symptoms may be highest with highly anti-cholinergic or dopaminergic antipsychotics. When stopping antipsychotic therapy in patients with schizophrenia, the CPA guidelines recommend a gradual taper over 6 to 24 months, and the APA guidelines recommend reducing the dose by 10% each month

OLANZapine-FLUoxetine

Symbyax

Olanzapine-Samidorphan

Lybalvi

«bu»Schizophrenia«/bu» «b»Initial Dose«/b» - Olanzapine-Samidorphan 5 mg-10 mg OR 10 mg-10 mg PO daily «b»Maintenance Dose«/b» - May adjust dosage at weekly intervals of 5 mg (based on the olanzapine component) depending on clinical response and tolerability - Not to exceed Olanzapine-Samidorphan 20 mg-10 mg PO daily «bu»Bipolar I Disorder«/bu» «b»Initial Dose«/b» - Olanzapine-Samidorphan 10 mg-10 mg OR 15 mg-10 mg PO daily for acute treatment of manic or mixed episodes - Adjust dose in increments/decrements of 5 mg (based on olanzapine component), if necessary, at intervals ≥24 hr - Not to exceed olanzapine 20 mg/samidorphan 10 mg daily «b»Maintenance Dose«/b» - Not to exceed Olanzapine-Samidorphan 20 mg-10 mg PO daily «b»Adjunctive to Lithium or Valproate«/b» «bi»Initial Dose«/bi» - 1 tablet (10 mg-10 mg) PO daily for acute treatment of manic or mixed episodes «bi»Maintenance Dose«/bi» - May adjust dosage at weekly intervals of 5 mg (based on the olanzapine component) depending on clinical response and tolerability - Not to exceed Olanzapine-Samidorphan 20 mg-10 mg daily «b»Hypotensive Patients«/b» - Patients who have a higher risk of hypotensive reactions, are at risk of slower olanzapine metabolism, or may be more pharmacodynamically sensitive to olanzapine - If dose escalation is necessary, increase dose slowly «b»Initiation in Patients Using Opioids«/b» - Contraindicated in patients using opioids or undergoing acute opioid withdrawal - Delay initiation if currently using opioids «bi»Short-acting Opioids«/bi» - At least for 7 days after last opioid use «bi»Long-acting Opioids«/bi» - At least for 14 days after last opioid use «b»Pregnancy Exposure Registry«/b» - Monitors pregnancy outcomes in women exposed to atypical antipsychotics during pregnancy - Encourage patients to register by contacting the National Pregnancy Registry for Atypical Antipsychotics at 1-866-961-2388 or visit https://womensmentalhealth.org/research/pregnancyregistry/atypicalantipsychotic/ «b»Infertility«/b» - Based on the pharmacologic action of olanzapine (D2 antagonism), an increase in serum prolactin levels may occur, which may lead to a reversible reduction in fertility in females of reproductive potential

Olaparib

Lynparza

Olaratumab

Lartruvo

Oliceridine

Olinvyk, Olinvo

Olipudase Alfa

Xenpozyme

«b»IV Administration«/b» - Consider pretreating with antihistamines, antipyretics, and/or corticosteroids - Prior to administration, inspect syringe or infusion bag for foaming; if present, let foam dissipate before administering - Use in-line low protein-binding 0.2-micron filter during administration - The following materials can be used: polyolefin or polyvinylchloride (PVC) with DEHP for infusion bags, polypropylene for syringes, polyurethane or PVC DEHP-free for infusion sets, and polyethersulfone or polytetrafluoroethylene for in-line filters - Infuse using at appropriate infusion rate (below) - In absence of infusion-associated reactions, increase infusion rate per steps of infusion as indicated (+/- 5 minutes) - Each infusion step will last for 20 minutes, except for the final step, which should last until completion of the infusion volume - Flush infusion line with 0.9% NaCl at end of infusion using same infusion rate as the last part of the infusion «b»Home Administration«/b» - Home administration under supervision of healthcare provider may be considered for patients on maintenance dose who are tolerating their infusion well - Dose and infusion rates should remain constant for home administration and cannot be changed without supervision of a physician; in case of missed doses or delayed infusion, contact physician «b»Adult Infusion Rate«/b» 0.1 mg/kg dose - Step 1: 20 mL/hr - Step 2: 60 mL/hr 0.3-3 mg/kg dose - Step 1: 3.33 mL/hr - Step 2: 10 mL/hr - Step 3: 20 mL/hr - Step 4: 33.33 mL/hr «b»Pediatric Infusion Rate«/b» 0.03 mg/kg dose - Step 1: 0.1 mg/kg/hr for entire infusion 0.1 mg/kg dose - Step 1: 0.1 mg/kg/hr - Step 2: 0.3 mg/kg hr 0.3mg/kg dose - Step 1: 0.1 mg/kg/hr - Step 2: 0.3 mg/kg/hr - Step 3: 0.6 mg/kg/hr 0.6-3 mg/kg dose - Step 1: 0.1 mg/kg/hr - Step 2: 0.3 mg/kg/hr - Step 3: 0.6 mg/kg/hr - Step 4: 1 mg/kg/hr «b»Missed Doses«/b» - A dose is considered missed when it is not administered within 3 days of the scheduled date «bi»1 Missed Dose«/bi» Escalation Phase - Administer last tolerated dose, then resume dose escalation at next infusion Maintenance Phase - Resume maintenance dose «bi»2 Consecutive Missed Doses«/bi» Escalation Phase - Administer 1 dose below last tolerated dose, then resume dose escalation at next infusion Maintenance Phase - Administer 1 dose below the maintenance dose, then resume the maintenance dose at next infusion «bi»≥3 Consecutive Missed Doses«/bi» Escalation Phase - Resume dose escalation starting with 0.3 mg/kg Maintenance Phase - Restart dosing at 0.3 mg/kg and follow escalation dosing schedule «b»IV Reconstitution«/b» - Determine number of vials to be reconstituted based on calculated dose - Remove vials from refrigeration and set aside for ~20-30 minutes to reach room temperature - Reconstitute each vial with 5.1 mL sterile water for injection by directing diluent flow to inside vial wall to avoid foaming - Gently roll and tilt vial(s) to reconstitute and avoid foaming - Each reconstituted vial yields 4 mg/mL as a clear, colorless solution - Visually inspect solution for particulate matter and discoloration; discard if discolored or particulates are visible «b»IV Dilution«/b» - Withdraw dose from reconstituted vial(s) and dilute with 0.9% NaCL in syringe or infusion bag depending on volume of infusion «bi»Weight <10 kg, Receiving 0.03-0.1 mg/kg Dose«/bi» - Infusion volume will vary to achieve fixed final concentration of 0.1 mg/mL (prepare in syringe for infusion) «bi»Weight 10-20 kg, Receiving 0.03 mg/kg Dose«/bi» - Infusion volume will vary to achieve fixed final concentration of 0.1 mg/mL (prepare in syringe for infusion) «bi»All Other Patient Weights and Doses«/bi» - Final concentration will vary to achieve a fixed total volume «bi»Total Volume ≤20 mL«/bi» - Prepare syringe - Inject required volume of reconstituted 4 mg/mL solution slowly down inside wall of syringe - Slowly add enough NS to obtain required total infusion volume (avoid foaming within syringe) «bi»Total Volume ≥50 mL«/bi» - Prepare Infusion Bag - Slowly add required volume of reconstituted 4 mg/mL solution into appropriate size NS infusion bag (avoid foaming within bag) to achieve total volume - Gently invert syringe or infusion bag to mix; do NOT shake - Since this is a protein solution, slight flocculation (thin translucent fibers) occurs occasionally after dilution - Vials are for single dose only; discard unused solution

Olmesartan

Benicar

Olmesartan-Amlodipine-Hydrochlorothiazide

Tribenzor

Olmesartan-Hydrochlorothiazide

Benicar HCT

Olodaterol

Striverdi Respimat

Olopatadine

Patanase (Nasal)

Olopatadine (Ophthalmic)

Pataday, Pazeo, Patanol

Olopatadine-Mometasone

Ryaltris (Nasal)

Olsalazine

Dipentum

Omadacycline

Nuzyra

Omalizumab

Xolair

Omaveloxolone

Skyclarys

Ombitasvir

Ombitasvir-Paritaprevir-Ritonavir-Dasabuvir

Viekira

Omega-3 Fatty Acids

Fish Oil, Lovaza, Triklo, Vascepa, Epanova, Expecta LIPIL, Omega Power, Omega-3, Maximum Red Krill, Salmon Oil-1000, Sam-E.P.A, Sea-Omega, Pro Nutrients Omega 3, Omega-3 IQ

Omeprazole

PriLOSEC

Omeprazole-Sodium Bicarbonate

Konvomep, OmePPi, Zegerid

Omidenepag

Omlonti Ophthalmic Solution

OnabotulinumtoxinA

Botox, BTX-A, Botulinum Toxin Type A (Cosmetic)

Ondansetron

Zofran, Zuplenz

- Single IV doses >16 mg are no longer recommended due to the potential for QT prolongation. «bu»Chemotherapy-Induced Nausea & Vomiting«/bu» «b»Prophylaxis«/b» «bi»Moderately Emetogenic Chemotherapy«/bi» - 8 mg PO started 30 minutes before chemotherapy, then, every 12 hr for 1-2 days after chemotherapy «bi»Highly Emetogenic Chemotherapy«/bi» - 24 mg PO started 30 minutes before chemotherapy - 0.15 mg/kg IV over 15 min administered 30 min before chemotherapy, then, - 4 and 8 hr after first dose - Not to exceed 16 mg (32 mg no longer recommended because of increased risk of QT prolongation) «bu»Postoperative Nausea & Vomiting«/bu» «b»Prophylaxis«/b» - 4 mg IV/IM immediately before anesthesia or after procedure or 16 mg PO 1 hr before anesthesia - Patients >80 kg may need additional 4 mg IV «bu»Radiation-Induced Nausea & Vomiting«/bu» «b»Prophylaxis«/b» «bi»Total Body Radiation Therapy«/bi» - 8 mg PO 1-2 hours before radiation therapy; administered each day «bi»Single High-dose Fraction Therapy to Abdomen«/bi» - 8 mg PO 1-2 hr before radiation therapy - Administer subsequent doses every 8 hr after first dose 1-2 days after completion of therapy «bi»Daily Fractions to Abdomen«/bi» - Administer 8 mg PO 1-2 hr before radiotherapy - Administer subsequent doses every 8 hr after first dose each day radiotherapy is given «bu»Cholestatic Pruritus«/bu» - 8 mg divided every 12 hour OR - 8 mg every 8-12 hour PO for 7 days up to 5 months OR - 4-8 mg intermittent short-term IV dosing used in adults; single dose of 4 mg single dose used in pregnancy «bu»Uremic Pruritus«/bu» - 8 mg divided every 12 hr OR - 8 mg every 8-12 hr PO for 14 days up to 5 months «bu»Spinal Opioid-Induced Pruritus«/bu» «b»Prophylaxis«/b» - 4-8 mg IV 20-30 min prior to spinal opioid therapy - May repeat dosing at 12, 24, 36, 48 hr after spinal opioid dosing «b»Treatment«/b» - 4-8 mg IV «bu»Rosacea«/bu» - 4-8 mg PO every 12hr for up to 3 weeks OR - 12 mg IV daily for 4 days «bu»Hyperemesis Gravidarum«/bu» - 10 mg IV every 8 hr prn «b»Oral Administration«/b» - Oral dosage forms should be administered 30 minutes prior to chemotherapy; 1 to 2 hours before radiotherapy; 1 hour prior to the induction of anesthesia «b»Orally Disintegrating Tablets Administration«/b» - Do not remove from blister until needed - Peel backing off the blister, do not attempt to push tablet through the foil. - Using dry hands, place tablet on tongue and allow to dissolve. - Swallow with saliva (no need to administer with liquids). «b»Oral Soluble Film Administration«/b» - Do not remove from pouch until immediately before use. - Using dry hands, place film on top of tongue and allow to dissolve (4 to 20 seconds). - Swallow with or without liquid. - If using more than one film, each film should be allowed to dissolve completely before administering the next film. «b»IM Administration«/b» - Should be administered undiluted. «b»IV Administration«/b» «bi»IVPB«/bi» - Infuse diluted solution over 15 minutes; 24-hour continuous infusions have been reported, but are rarely used. - Chemotherapy-induced nausea and vomiting: Give first dose 30 minutes prior to beginning chemotherapy. «bi»IV Push«/bi» - Prevention of postoperative nausea and vomiting: Single doses may be administered IV injection as undiluted solution over at least 30 seconds but preferably over 2 to 5 minutes «b»IVPB Infusion Preparation«/b» «bi»Prevention of Chemotherapy-Induced Nausea and Vomiting«/bi» - Dilution is required prior to IV infusion - Dilute in 50 mL D5W or NS. In pediatric patients between 6 months and 1 year of age and/or ≤10 kg, may dilute in 10 to 50 mL D5W or NS, depending on fluid needs of the patient. Use diluted solutions within 24 hours of preparation. «bi»Prevention of Postoperative Nausea and Vomiting«/bi» - No dilution is required. «b»Oral Solution Preparation«/b» - If commercial oral solution is unavailable, a 0.8 mg/mL syrup may be made with ondansetron tablets, Ora-Plus® (Paddock), and any of the the following syrups: Cherry syrup USP, Syrpalta® (HUMCO), Ora-Sweet® (Paddock), or Ora-Sweet® Sugar-Free (Paddock). - Crush ten 8 mg tablets in a mortar and reduce to a fine powder (flaking of the tablet coating occurs) - Add 50 mL Ora-Plus® in 5 mL increments, mixing thoroughly; mix while adding the chosen syrup in incremental proportions to almost 100 mL; transfer to a calibrated bottle, rinse mortar with syrup, and add sufficient quantity of syrup to make 100 mL. - Label "shake well" and "refrigerate" - Stable for 42 days refrigerated «b»Rectal Suppositories Preparation«/b» - Calibrate a suppository mold for the base being used - Determine the displacement factor (DF) for ondansetron for the base being used (Fattibase® = 1.1; Polybase® = 0.6) - Weigh the ondansetron tablet(s) - Divide the tablet weight by the DF; this result is the weight of base displaced by the drug - Subtract the weight of base displaced from the calculated weight of base required for each suppository - Grind the ondansetron tablets in a mortar and reduce to a fine powder - Weigh out the appropriate weight of suppository base - Melt the base over a water bath (<55°C) - Add the ondansetron powder to the suppository base and mix well - Pour the mixture into the suppository mold and cool - Stable for at least 30 days refrigerated

Opicapone

Ongentys

Opium

Deodorized Tincture of Opium, DTO, Opium Tincture

Oprelvekin

Neumega, Recombinant Interleukin-11, rhIL-11

Oritavancin

Orbactiv, Kimyrsa

Orlistat

Alli, Xenical

Orphenadrine

Norflex

Orphenadrine-Aspirin-Caffeine

Orphenadrine Compound, Norgesic

Oseltamivir

Tamiflu

Osilodrostat

Isturisa

Osimertinib

Tagrisso

Ospemifene

Osphena

Oteseconazole

Vivjoa

Oxacillin

Bactocill

Oxaliplatin

Eloxatin, Oxalatoplatin, Oxalatoplatinum

Oxandrolone

Oxandrin

Oxaprozin

Daypro

Oxazepam

Serax

OXcarbazepine

Trileptal, Oxtellar XR, OCBZ

«bu»Partial Seizures (Epilepsy)«/bu» «b»Adjunctive Therapy«/b» «bi»Immediate Release«/bi» - Initial Dose: 600 mg IR daily in 2 divided doses - Dose may be increased by as much as 600 mg/day increments at weekly intervals - Maximum Recommended Dose: 1,200 mg/day in 2 divided doses - Although doses >1,200 mg/day were somewhat more efficacious, most patients were unable to tolerate 2,400 mg/day (due to CNS effects). «bi»Extended Release«/bi» - Initial Dose: 600 mg ER once daily - Dosage may be increased by 600 mg/day increments at weekly intervals - Recommended daily dose is 1,200 to 2,400 mg once daily - Although daily doses >1,200 mg daily were somewhat more efficacious, most patients were unable to tolerate 2,400 mg daily (due to CNS effects). «b»Conversion to Monotherapy«/b» - Patients receiving concomitant antiepileptic drugs (AEDs) - 600 mg IR daily in 2 divided doses while simultaneously reducing the dose of concomitant AEDs. - Withdraw concomitant AEDs completely over 3 to 6 weeks, while increasing the oxcarbazepine dose in increments of 600 mg daily at weekly intervals, reaching the maximum oxcarbazepine dose (2,400 mg/day) in about 2 to 4 weeks (lower doses have been effective in patients in whom monotherapy has been initiated). «b»Initiation of Monotherapy«/b» - Patients not receiving prior AEDs - Initial Dose: 600 mg IR daily in 2 divided doses - Increase dose by 300 mg daily every third day to a dose of 1,200 mg daily - Higher dosages (2,400 mg daily) have been shown to be effective in patients converted to monotherapy from other AEDs «b»Conversion from IR to ER«/b» - Higher doses of extended release formulation may be necessary. «b»Concomitant Antiepileptic Drugs (AEDs)«/b» - Concomitant use with enzyme-inducing antiepileptic drugs (eg, carbamazepine, phenobarbital, phenytoin): Extended release: Consider initiating dose at 900 mg once daily. «bu»Bipolar Disorder«/bu» - Initial Dose: 300 mg PO daily - May titrate to 1800-2400 mg/day maximum «bu»Diabetic Neuropathy«/bu» - Initial Dose: 150-300 mg PO daily - May increase to 900-1200 mg/day (general recommendation) - Doses up to 1800 mg/day studied, with positive results «bu»Neuralgia/Neuropathy«/bu» - Initial Dose: 300 mg PO every 8-12 hour - May adjust dose to 400-2000 mg divided every 8-12hr (maximum tolerated or effective dose) «b»Strong CYP3A4 inducers or UGT Inducers«/b» - Strong CYP3A4 inducers and/or UGT inducers decrease systemic exposure to 10-monohydroxy derivative (MHD), the active metabolite - Dosage adjustment of oxcarbazepine may be required after initiation, dosage modification, or discontinuation of such induce «bi»Oxtellar XR«/bi» - Initiate at 900 mg qDay «bu»Partial Seizures (Epilepsy) Adjunctive Therapy«/bu» «b»Children 2 to 3 years«/b» «bi»Immediate Release«/bi» Initial Dose - 8 to 10 mg/kg/day, not to exceed 600 mg/day, given in 2 divided daily doses Maintenance Dose - The target maintenance dose should be achieved over 2 to 4 weeks, and is dependent upon patient weight (should not exceed 60 mg/kg/day given in 2 divided daily doses). <20 kg - Consider initiating dose at 16 to 20 mg/kg/day; maximum maintenance dose should be achieved over 2 to 4 weeks and should not exceed 60 mg/kg/day «b»Children 4 to 16 years«/b» «bi»Immediate Release«/bi» Initial Dose - 8 to 10 mg/kg/day, not to exceed 600 mg/day, given in 2 divided daily doses Maintenance Dose - The target maintenance dose should be achieved over 2 weeks, and is dependent upon patient weight, according to the following: - 20 to 29 kg: 900 mg daily in 2 divided doses - 29.1 to 39 kg: 1,200 mg daily in 2 divided doses - >39 kg: 1,800 mg daily in 2 divided doses «b»Children 6 to 17 years«b» «bi»Extended Release«/bi» Initial Dose - 8 to 10 mg/kg once daily (not to exceed 600 mg/day in the first week) Maintenance Dose - The target maintenance dose should be achieved over 2 to 3 weeks with dose increases of 8 to 10 mg/kg/day increments at weekly intervals (maximum dosage incremental increase: 600 mg) Target Maintenance Dose Depends on Weight: - 20 to 29 kg: 900 mg once daily - 29.1 to 39 kg: 1,200 mg once daily - >39 kg: 1,800 mg once daily «b»Conversion to Monotherapy«/b» - Patients receiving concomitant antiepileptic drugs (AEDs) «b»Children 4 to 16 years (Immediate Release)«/b» Initial Dose - 8 to 10 mg/kg/day in twice daily divided doses, while simultaneously initiating the dose reduction of concomitant antiepileptic drugs; the concomitant drugs should be withdrawn over 3 to 6 weeks. - Oxcarbazepine dose may be increased by a maximum of 10 mg/kg/day at weekly intervals. See below for recommended total daily dose by weight. «b»Initiation of Monotherapy«/b» - Patients not receiving prior AEDs «b»Children 4 to 16 years (Immediate Release)«/b» Initial Dose - 8 to 10 mg/kg/day in twice daily divided doses - Doses may be titrated by 5 mg/kg/day every third day. See below for recommended total daily dose by weight. «bi»Range of Maintenance Doses by Weight During Monotherapy«/bi» - 20 kg: 600 to 900 mg daily - 25 to 30 kg: 900 to 1,200 mg daily - 35 to 40 kg: 900 to 1,500 mg daily - 45 kg: 1,200 to 1,500 mg daily - 50 to 55 kg: 1,200 to 1,800 mg daily - 60 to 65 kg: 1,200 to 2,100 mg daily - 70 kg: 1,500 to 2,100 mg daily «b»Conversion from IR to ER«/b» «bi»Children ≥6 years and Adolescents«/bi» - Refer to adult dosing. «b»Concomitant Antiepileptic Drugs (AEDs)«/b» «bi»Children ≥6 years and Adolescents«/bi» - Refer to adult dosing.

Oxiconazole

Oxistat, Oxistat

Oxybutynin

Ditropan, Gelnique, Oxytrol

OxyCODONE

OxyCONTIN, Oxecta, Oxaydo, Roxicodone, Xtampza

Oxycodone-Acetaminophen

Roxicet, Endocet, Magnacet, Percocet, Primlev

Oxycodone-Aspirin

Endodan, Percodan

Oxycodone-Ibuprofen

Combunox

Oxymetazoline (Nasal)

Afrin Nasal Spray, Mucinex Nasal Spray

Oxymetazoline (Ophthalmic)

Visine-LR, Upneeq

Oxymetazoline (Topical)

Rhofade

Oxymetholone

Anadrol

OxyMORphone

Opana

«bu»Acute Pain«/bu» - Initial Dose: 1 to 1.5 mg IM/SC x 1 dose - Initial Dose: 0.5 mg IV x 1 dose - May repeat every 4 to 6 hours as needed «b»Labor Analgesia«/b» - Initial Dose 0.5 to 1 mg IM x dose - May repeat every 4 to 6 hours as needed «bi»Opioid-Naive Initial Dose«/bi» - 5 to 10 mg PO every 4 to 6 hours as needed - Dosage adjustment should be based on level of analgesia, side effects, pain intensity, and patient comorbidities. «b»Conversion from Oxymorphone PO to IV«/b» - Initiate parenteral oxymorphone with approximately one-tenth (1/10) of the total daily oral dose and administer in 4 or 6 equally divided doses. - Due to patient variability, closely monitor patient for analgesia and adverse reactions upon conversion. «b»Conversion from a Stable Dose of Oxymorphone IV«/b» - Initiate oral oxymorphone with approximately 10 times the total daily parenteral requirement administered in 4 to 6 equally divided doses. «b»Conversion from Other Opioids«/b» - Use standard conversion chart to convert total daily dose of current opioid to oxymorphone equivalent. Generally, start with one-half (1/2) the calculated total daily oxymorphone dosage and administer in divided doses every 4 to 6 hours. «bu»Chronic Pain«/bu» «b»Opioid-naive«/b» - Use as the first opioid analgesic or in patients who are not opioid tolerant - Initial Dose: 5 mg every 12 hours. «b»Opioid Tolerance«/b» - Patients already taking at least 60 mg of oral morphine daily, 25 mcg of transdermal fentanyl per hour, 30 mg of oral oxycodone daily, 8 mg oral hydromorphone daily, 25 mg oral oxymorphone daily, or an equivalent dose of another opioid for at least 1 week. «b»Conversion from Stable Dose of Oxymorphone IV to PO (ER)«/b» - Initiate extended-release oxymorphone with approximately 10 times the total daily parenteral requirement administered in 2 equally divided doses. Due to patient variability, closely monitor patient for analgesia and adverse reactions upon conversion. «b»Conversion of Stable Dose of Oxymorphone PO (IR) to PO (ER)«/b» - Using the same total daily dose, administer one-half (1/2) of the daily dose of immediate-release oxymorphone as the extended-release formulation every 12 hours «b»Conversion from Other Oral Opioids to Oxymorphone (ER)«/b» - Discontinue all other around-the-clock opioids when extended release oxymorphone is initiated. Substantial interpatient variability exists in relative potency of opioids. Therefore, it is safer to underestimate a patient’s daily oral oxymorphone requirement and provide breakthrough pain relief with rescue medication (eg, immediate release opioid) than to overestimate requirements. The conversion factors, per the manufacturer, in the chart (see table) provide an estimate to convert the daily dose of current opioid to an oxymorphone equivalent. Select the prior oral opioid, sum the current total daily dose, multiply by the conversion factor on the table to calculate the approximate oral oxymorphone daily dose, then divide daily dose by 2 to administer every 12 hours as oxymorphone extended release. Round down, if necessary, to the nearest strength available. For patients on a regimen of more than one opioid, calculate the approximate oral oxymorphone dose for each opioid and sum the totals to obtain the approximate total oxymorphone daily dose. For patients on a regimen of fixed-ratio opioid/nonopioid analgesic medications, only the opioid component of these medications should be used in the conversion. Note: The conversion factors in this conversion table are only to be used for the conversion from current opioid therapy to oxymorphone ER. Conversion factors in this table cannot be used to convert from oxymorphone ER to another opioid (doing so may lead to fatal overdose due to overestimation of the new opioid). This is not a table of equianalgesic doses. When converting from methadone to extended release oxymorphone, close monitoring is required. Ratio between methadone and other opioid agonists varies widely according to previous dose exposure. Methadone has a long half-life and can accumulate in the plasma. «b»Titration and Maintenance«/b» - Adjust therapy incrementally by 5 to 10 mg every 12 hours at intervals of every 3 to 7 days - Breakthrough pain may require a dose increase or rescue medication with an immediate-release analgesic. «b»Discontinuation of Therapy«/b» - Decrease previous daily dose by 25% to 50% every 2 to 4 days; monitor carefully for signs/symptoms of withdrawal - If patient displays withdrawal symptoms, increase dose to previous level and then reduce dose more slowly by increasing interval between dose reductions, decreasing amount of daily dose reduction, or both. «b»Limitations of Use«/b» - Reserve oxymorphone for use in patients for whom alternative treatment options (eg, nonopioid analgesics, opioid combination products) are ineffective, not tolerated, or would be otherwise inadequate to provide sufficient pain management. Oxymorphone ER is not indicated as an as-needed analgesic.

Oxytocin

Pitocin

- Dosage is determined by uterine response and must be individualized and initiated at a very low level for each patient. «bu»Induction or Stimulation of Labor«/bu» - IV Administration requires the use of an infusion pump - The ideal dosing regimen has not been determined and various protocols are available - Discontinue the oxytocin infusion immediately in the event of uterine hyperactivity and/or fetal distress. - If uterine contractions become too powerful, the infusion can be stopped abruptly. - Initial Dose: 0.5 to 1 milliunits/minute - Gradually increase dose in increments of 1 to 2 milliunits/minute every 30 to 60 minutes until desired contraction pattern is established - Dose may be decreased by similar increments after desired frequency of contractions is reached and labor has progressed to 5 to 6 cm dilation - Higher infusion rates may be needed prior to term due to a lower sensitivity of the uterus - Infusion rates up to 6 milliunits/minute provide oxytocin levels similar to those with spontaneous labor - Rates >9 to 10 milliunits/minute are rarely required. «b»Low-Dose Regimen«/b» - Initial Dose: 0.5 to 2 milliunits/minute - Incrementally increase by 1 to 2 milliunits/minute every 15 to 40 minutes «b»High-Dose Regimen«/b» - Initial Dose 6 milliunits/minute - Incrementally increase by 3 to 6 milliunits/minute every 15 to 40 minutes - Reduce the incremental increase to 3 milliunits/minute if hyperstimulation occurs - Reduce the incremental increase to 1 milliunit/minute for recurrent hyperstimulation «bu»Postpartum Uterine Bleeding«/bu» - 10 units IM after delivery of the placenta - 10 to 40 units IV added to a running infusion solution depending on amount of infusion fluid remaining (maximum: 40 units in 1,000 mL of IV fluid); adjust infusion rate to sustain uterine contraction and control uterine atony - Slow IV injections (5 or 10 units over 1 minute) are preferred for women without cardiovascular risk factors although rapid injections may be considered; very slow injections (≥5 minutes) are preferred for women with cardiovascular risk factors «bu»Adjunctive Treatment of Abortion«/bu» «b»Incomplete, Inevitable, or Elective Abortion«/b» - 10 units as an IV infusion after suction or a sharp curettage (used to help contract the uterus) «bu»Midtrimester Elective Abortion«/bu» - 10 to 20 milliunits/minute - Maximum Total Dose: 30 units/12 hours (may decrease injection to abortion time)

Ozanimod

Zeposia

Ozenoxacin

Xepi

PACLitaxel (Conventional)

Onxol, Taxol

PACLitaxel (Protein-Bound)

Abraxane, Nanoparticle Albumin-Bound Paclitaxel

«bu»Breast Cancer«/bu» «b»Metastatic«/b» - 260 mg/m2 IV every 3 weeks «bi»Off-label Dosing«/bi» - 100 to 150 mg/m2 IV on days 1, 8, and 15 of a 28-day cycle «bu»Non-Small Cell Lung Cancer (NSCLC)«/bu» «b»Locally Advanced or Metastatic«/b» - 100 mg/m2 IV on days 1, 8, and 15 of each 21-day cycle in combination with carboplatin «bu»Pancreatic Adenocarcinoma«/bu» «b»Metastatic«/b» - 125 mg/m2 IV on days 1, 8, and 15 of a 28-day cycle in combination with gemcitabine «bu»Melanoma«/bu» «b»Metastatic«/b» «bi»Previously Treated Patients«/bi» - 100 mg/m2 on days 1, 8, and 15 of a 28-day cycle; if tolerated, may increase dose by 25 mg/m2 in cycle 2 and beyond «bi»Previously Untreated Patients«/bi» - 150 mg/m2 on days 1, 8, and 15 of a 28-day cycle «bu»Ovarian, Fallopian Tube, or Primary Peritoneal Cancer«/bu» «b»Recurrent«/b» - 260 mg/m2 IV on day 1 of a 21-day cycle for 6 to 8 cycles - 100 mg/m2 IV on days 1, 8, and 15 of a 28-day cycle until disease progression or unacceptable toxicity «bu»Breast Cancer«/bu» «b»Every 3 week Regimen«/b» - Severe neutropenia (<500 cells/mm3) ≥1 week: Reduce dose to 220 mg/m2 for subsequent courses - Recurrent severe neutropenia: Reduce dose to 180 mg/m2 for subsequent courses - Sensory neuropathy - Grade 1 or 2: Dosage adjustment generally not required - Grade 3: Hold treatment until resolved to grade 1 or 2, then resume with reduced dose for all subsequent cycles - Severe sensory neuropathy: Reduce dose to 220 mg/m2 for subsequent courses - Recurrent severe sensory neuropathy: Reduce dose to 180 mg/m2 for subsequent courses «bu»Non-small cell lung cancer (NSCLC)«/bu» «b»Neutropenia: ANC <1,500 cells/mm3«/b» - Withhold therapy until ANC is ≥1,500 cells/mm3 on day 1 or ≥500 cells/mm3 on days 8 or 15 Reduce dose upon therapy reinitiation if: - Neutropenic fever (ANC <500 cells/mm3 with fever >38°C) or delay of next cycle by >7 days due to ANC <1,500 cells/mm3 or ANC <500 cells/mm3 for >7 days: - First occurrence: Permanently reduce dose to 75 mg/m2 - Second occurrence: Permanently reduce dose to 50 mg/m2 - Third occurrence: Discontinue therapy. «b»Thrombocytopenia«/b» - Platelet count <100,000 cells/mm3: Withhold therapy until platelet count is ≥100,000 cells/mm3 on day 1 or ≥50,000 cells/mm3 on days 8 or 15. Reduce dose upon therapy reinitiation if: Platelet count <50,000 cells/mm3: - First occurrence: Permanently reduce dose to 75 mg/m2 - Second occurrence: Discontinue therapy. «b»Sensory Neuropathy«/b» - Withhold therapy for grade 3 or 4 peripheral neuropathy. Resume therapy at reduced doses when neuropathy resolves completely or improves to grade 1: - First occurrence: Permanently reduce dose to 75 mg/m2 - Second occurrence: Permanently reduce dose to 50 mg/m2 - Third occurrence: Discontinue therapy. «bu»Pancreatic Adenocarcinoma«/bu» «b»Dose Level Reductions for Toxicity«/b» - Full dose: 125 mg/m2 - First dose reduction: 100 mg/m2 - Second dose reduction: 75 mg/m2 - If additional dose reduction is necessary: Discontinue. «b»Hematologic Toxicity«/b» «bi»Neutropenia and/or Thrombocytopenia«/bi» Day 1 - If ANC is <1,500 cells/mm3 or platelet count is <100,000 cells/mm3: Withhold therapy until ANC is ≥1,500 cells/mm3 and platelet count is ≥100,000 cells/mm3 Day 8 - If ANC is 500 to <1,000 cells/mm3 or platelet count is 50,000 to <75,000 cells/mm3: Reduce 1 dose level - If ANC is <500 cells/mm3 or platelet count is <50,000 cells/mm3: Withhold day 8 dose Day 15 If day 8 doses were reduced or given without modification: - If ANC is 500 to <1,000 cells/mm3 or platelet count is 50,000 to <75,000 cells/mm3: Reduce 1 dose level from day 8 - If ANC is <500 cells/mm3 or platelet count is <50,000 cells/mm3: Withhold day 15 dose If day 8 doses were withheld: - If ANC is ≥1000 cells/mm3 or platelet count is ≥75,000 cells/mm3: Reduce 1 dose level from day 1 - If ANC is 500 to <1,000 cells/mm3 or platelet count is 50,000 to <75,000 cells/mm3: Reduce 2 dose levels from day 1 - If ANC is <500 cells/mm3 or platelet count is <50,000 cells/mm3: Withhold day 15 dose

Pacritinib

Vonjo

Pafolacianine

Cytalux

Palbociclib

Ibrance

«bu»Breast Cancer, Advanced«/bu» «b»Initial Endocrine-Based Therapy (HER-2 negative)«/b» - 125 mg PO once daily for 21 days - Followed by 7 days off - Repeat every 28 days (in combination with continuous aromatase inhibitor therapy) - Continue until disease progression or unacceptable toxicity «b»Disease Progression following Endocrine Therapy (HER-2 negative)«/b» - 125 mg PO once daily for 21 days - Followed by 7 days off - Repeat every 28 days (in combination with fulvestrant [and an LHRH agonist (eg, goserelin) if pre- or perimenopausal]); continue until disease progression or unacceptable toxicity «b»Missed/Vomited Doses«/b» - If a dose is vomited or missed, an additional dose should not be taken that day. Resume dosing with the next scheduled daily dose. «b»Strong CYP3A Inhibitors«/b» - Avoid concomitant use with strong CYP3A inhibitors (eg, azole antifungals, clarithromycin, nefazodone, protease inhibitors, telithromycin, verapamil, grapefruit or grapefruit juice) and consider alternatives with no or minimal CYP3A inhibition. - If coadministration with a strong CYP3A inhibitor cannot be avoided, reduce palbociclib dose to 75 mg once daily. If the strong inhibitor is discontinued, increase palbociclib dose (after 3 to 5 inhibitor half-lives have elapsed) to the dose used prior to initiating the strong CYP3A inhibitor. «b»CYP3A Inducers«/b» - Avoid concomitant use with strong CYP3A inducers. - May require treatment interruption/delay, dose reduction, or discontinuation for some adverse reactions. The recommended first dose reduction is to 100 mg daily; if a second reduction is required, reduce dose to 75 mg daily - If dose reduction below 75 mg daily is required, discontinue treatment. «b»Hematologic Toxicity«/b» - Except lymphopenia unless associated with clinical events [eg, opportunistic infection]), according to Common Toxicity Criteria for Adverse Events Version 4: «bi»Grade 1 or 2«/bi» - No dosage adjustment required. «bi»Grade 3«/bi» Day 1 of Cycle - Withhold palbociclib therapy and repeat CBC with differential within 1 week - When improved to ≤ grade 2, initiate the next cycle at the same dose. Day 15 of first 2 Cycles - If at grade 3, continue palbociclib therapy at current dose to complete the cycle. - Repeat CBC with differential on day 22. If at grade 4 on day 22, withhold palbociclib treatment until resolved to ≤ grade 2 - After resolution, resume at next lower dose - Consider dose reduction in future cycles if recovery from grade 3 neutropenia is prolonged (>1 week) or for recurrent grade 3 neutropenia on day 1 of subsequent cycles. «bi»Grade 3 (ANC 500/mm3 to <1,000/mm3) Plus Fever ≥38.5°C and/or Infection at any Time«/bi» - Withhold palbociclib treatment until resolved to ≤ grade 2. Resume at next lower dose upon restarting. «bi»Grade 4 at any time«/bi» - Withhold palbociclib treatment until resolved to ≤ grade 2. After resolution, resume at next lower dose. «b»Nonhematologic Toxicity«/b» «bi»Grade 1 or 2«/bi» - No dosage adjustment required. «bi»Grade 3 or Higher«/bi» - If persistent despite optimal medical management: Withhold palbociclib until symptoms resolve to ≤ grade 1 or ≤ grade 2 (if toxicity is not a safety risk) - After resolution, resume at the next lower dose.

Palifermin

Kepivance

Paliperidone

Invega Sustenna, Invega Trinza, Invega Hafyera

«bu»Schizophrenia«/bu» - 6 mg PO every AM - May be titrated upward or downward in increments of 3 mg/day at intervals ≥5 days - Not to exceed 12 mg/day «b»IM, SR 1-month (Invega Sustenna)«/b» - 234 mg in deltoid on treatment day 1, then, - 156 mg 1 week later (day 8) - Recommended maintenance dose is 117 mg IM once monthly, although some patients may require lower or higher dosages (monthly dose range 39-234 mg) «b»IM, SR 3-months (Invega Trinza)«/b» - Patients must be adequately treated with Invega Sustenna (1-month paliperidone) for at least 4 months before initiating Invega Trinza - Dose initiation dependent on once-monthly Invega Sustenna dose - Initiate Invega Trinza when the next 1-month paliperidone dose is scheduled with an Invega Trinza dose based on the previous 1-month injection dose (see below) «b»Conversion from Monthly to 3-month Injection«/b» «bi»Invega Sustenna 78 mg/month«/bi» - Initiate Invega Trinza at 273 mg IM every 3 month «bi»Invega Sustenna 117 mg/month«/bi» - Initiate Invega Trinza at 410 mg IM every 3 month «bi»Invega Sustenna 156 mg/month«/bi» - Initiate Invega Trinza at 546 mg IM every 3 month «bi»Invega Sustenna 234 mg/month«/bi» - Initiate Invega Trinza at 819 mg IM every 3 month «b»Conversion from 3-month IM Injection to Tablet ER«/b» «bi»273 mg IM (last 3 months to 24 week)«/bi» - 3 mg ER tab «bi»410 mg IM (last 3 months to 24 week)«/bi» - 3 mg ER tab; 6 mg if >24wk «bi»546 mg IM (last 3 months to 18 week)«/bi» - 3 mg ER tab; 6 mg if 18-24 wk; 9 mg if >24 wk «bi»819 mg IM (last 3 months to 18 week)«/bi» - 6 mg ER tab; 9 mg if 18-24 wk; 12 mg if >24 wk «b»IM, ER 6-months (Invega Hafyera)«/b» Patients must be adequately treated with: - Invega Sustenna (1-month paliperidone) for at least 4 months OR - Invega Trinza (3-month paliperidone) for at least one 3-month cycle before initiating Invega Hafyera «b»Conversion from Monthly to 6-month Injection«/b» - Initiate Invega Hafyera when next Invega Sustenna dose is scheduled «bi»Invega Sustenna 156 mg/month«bi» - Initiate Invega Hafyera at 1,092 mg IM q6mo «bi»Invega Sustenna 234 mg/month«/bi» - Initiate Invega Hafyera at 1,560 mg IM q6mo - There are no equivalent doses of Invega Hafyera for Invega Sustenna 39-mg, 78-mg, or 117-mg doses, which were not studied «b»Conversion from 3-month to 6-month Injection«/b» - Initial Invega Hafyera dose is based on the previous Invega Trinza - Initiate Invega Hafyera when next Invega Trinza dose is scheduled - May administer Invega Hafyera dose up to 2 weeks before or after the next scheduled Invega Trinza «bi»Invega Trinza 546 mg every 3 months«/bi» - Initiate Invega Hafyera at 1,092 mg IM every 6 months «bi»Invega Trinza 819 mg every 3 months«/bi» - Initiate Invega Hafyera at 1,560 mg IM every 6 months - There are no equivalent doses of Invega Hafyera for Invega Trinza 273-mg or 410-mg doses, which were not studied «bi»Dosing Interval and Dosage Adjustments«/bi» - Following initial dose, administer Invega Hafyera IM every 6 months - May adjust dosage every 6 months between 1,092 mg and 1,560 mg based on individual response and tolerability, if necessary - D to the potential longer duration to Invega Hafyera, patient’s response to an adjusted dose may not be apparent for several months «bu»Schizoaffective Disorder«/bu» - Indicated for schizoaffective disorder as monotherapy and as an adjunct to mood stabilizers or antidepressants «b»PO Dosing«/b» - 6 mg PO daily in am (range 3-12 mg) - Titration may not be necessary; if exceeding 6 mg/day, increases of 3 mg/day recommended at intervals of 4 days of more; - Not to exceed 12 mg/day «b»IM Dosing«/b» Initial Dose -234 mg IM in deltoid on treatment day 1, then, - 156 mg IM 1 week later (day 8) Maintenance Dose - Administer once each month IM in deltoid or gluteal muscle - Adjust dose based on tolerability and/or efficacy using available strengths «b»Dosing Considerations«/b» - Patients with Parkinson disease or dementia with Lewy bodies can experience increased sensitivity to paliperidone - Manifestations can include confusion, obtundation, postural instability with frequent falls, extrapyramidal symptoms, and clinical features consistent with neuroleptic malignant syndrome - Maintenance dose ranges between 78-234 mg once monthly «b»Oral Administration«/b» - Administer without regard to meals - Extended release tablets should be swallowed whole with liquids; do not crush, chew, or divide. «b»IM Administration«/b» - Administer by IM route only as a single injection (do not divide); do not administer by any other route - Avoid inadvertent injection into vasculature. «b»Monthly Paliperidone (Invega Sustenna)«/b» - Do not mix with any other product or diluent - Prior to injection, shake syringe for at least 10 seconds to ensure a homogenous suspension - Administer using only the needles that are provided in the kit - The 2 initial injections should be administered in the deltoid muscle using a 11/2 inch, 22-gauge needle for patients ≥90 kg, and a 1 inch, 23-gauge needle for patients <90 kg - The 2 initial deltoid intramuscular injections help attain therapeutic concentrations rapidly. Alternate deltoid injections (right and left deltoid muscle). - The second dose may be administered 4 days before or after the weekly time point - Monthly maintenance doses can be administered in either the deltoid or gluteal muscle - Administer injections in the gluteal muscle using a 11/2 inch, 22-gauge needle (regardless of patient weight) in the upper-outer quadrant of the gluteal area. - Alternate gluteal injections (right and left gluteal muscle) - The monthly maintenance dose may be administered 7 days before or after the monthly time point. «b»Three-month Paliperidone (Invega Trinza)«/b» - Prior to injection, shake syringe for with tip pointing up at least 15 seconds to ensure a homogenous suspension - Inject within 5 minutes of shaking vigorously. - Inject slowly, deep into the deltoid or gluteal muscle. - Must be administered using only the thin wall needles that are provided in the pack. - Do not use needles from monthly IM paliperidone or other commercially-available needles to reduce the risk of blockage. - Administer into the center of the deltoid muscle using a 11/2 inch, 22-gauge thin wall needle for patients ≥90 kg, and a 1 inch, 22-gauge thin wall needle for patients <90 kg. - Alternate deltoid injections (right and left deltoid muscle). - Administer injections in the gluteal muscle using a 11/2 inch, 22-gauge thin wall needle (regardless of patient weight) in the upper-outer quadrant of the gluteal area. - Alternate gluteal injections (right and left gluteal muscle). - In the event of an incompletely administered dose, do not re-inject the dose remaining in the syringe and do not administer another dose. - Closely monitor and treat the patient with oral supplementation as clinically appropriate until the next scheduled 3-month injection.

Palivizumab

Synagis

Palonosetron

Aloxi

Pamidronate

Aredia

Pancrelipase (Lipase-Protease-Amylase)

Pertzye, Zenpep, Creon, Pancreaze, Ultresa, Viokace

- Administer with meals or snacks and swallow whole with a generous amount of liquid. - Do not crush or chew; retention in the mouth before swallowing may cause mucosal irritation. - Usually half the prescribed dose for an individualized full meal should be given with each snack - The total daily dose should reflect approximately 3 meals plus 2 or 3 snacks per day. «b»Capsules, Delayed Release«/b» - If necessary, capsules may be opened and contents added to a small amount (approximately 10 mL) of soft acidic food (pH ≤4.5), such as applesauce; do not crush microspheres when mixing. - The food should be swallowed immediately after mixing; do not chew. The food should be at room temperature (Creon, Ultresa) - Follow with water or juice to ensure complete ingestion and that no medication remains in the mouth. - When administering to infants <1 year, do not mix with breast milk or infant formula. Open capsule and place the contents directly into the mouth or mix with approximately 10 mL of soft acidic food (pH ≤4.5), such as applesauce or other acidic commercially prepared baby food (pears or bananas); do not crush microspheres when mixing - The food should be at room temperature (Creon, Ultresa) - Administer immediately after mixing (or within 15 minutes of mixing using Pancreaze) - Follow with infant formula or breast milk to ensure complete ingestion and that no medication remains in the mouth. «b»Tablets: Viokace«/b» - Tablets are not enteric coated and should be taken with a proton pump inhibitor. «b»Administration via Gastrostomy-Tube«/b» «bi»Creon«/bi» - An in vitro study demonstrated that Creon delayed-release capsules sprinkled onto a small amount of baby food (pH <4.5; applesauce or bananas manufactured by both Gerber and Beech-Nut) stirred gently and after 15 minutes was administered through the following G-tubes without significant loss of lipase activity: Kimberly-Clark MIC Bolus size 18 French, Kimberly-Clark MIC-KEY size 16 French, Bard Tri-Funnel size 18 French, and Bard Button size 18 French «bi»Pertzye«/bi» - May administer up to two 4,000 unit capsules via G-tube with a diameter of 14 French or larger diameter tube. Thoroughly mix contents of one or two 4,000 unit capsules in ≥10 mL applesauce to create a uniform suspension; do not crush microspheres. - Administer via a 35 mL slip tip syringe; flush with ~10 mL of water. Administer immediately after mixing; do not save for later use. If dose requires > two 4,000 unit capsules, repeat.

Pancuronium

Pavulon

Panitumumab

Vectibix, rHuMAb-EGFr

Panobinostat

Farydak

Pantoprazole

Protonix

«bu»Erosive Esophagitis Associated with GERD«/bu» «b»Treatment«/b» - 40 mg PO once daily for up to 8 weeks - An additional 8 weeks may be used in patients who have not healed after an 8-week course - Lower doses (20 mg once daily) have been used successfully in mild GERD treatment «b»Maintenance of Healing Dose«/b» - 40 mg PO once daily - 20 mg PO once daily has been used successfully in maintenance of healing - 40 mg IV once daily for 7 to 10 days «bu»Zollinger-Ellison Syndrome«/bu» - Initial Dose: 40 mg PO twice daily - Adjust dose based on patient needs; doses up to 240 mg daily have been administered - 80 mg IV every 12 hours - Adjust dose based on acid output measurements - 160 to 240 mg daily in divided doses has been used for a limited period (up to 7 days) «bu»Prevention of Rebleeding in Peptic Ulcer«/bu» - Loading Dose of 80 mg IV x 1, then, - 8 mg/hour continuous IV infusion for 72 hours «b»Intermittent Dosing«/b» - Loading Dose of 80 mg followed by either 40 mg every 12 hours for 72 hours or - 40 mg every 6 hours for 72 hours - May also administer 40 mg every 12 hours for 72 hours without a loading dose - After completion, continue therapy with a single daily-dose oral PPI for a duration dictated by the underlying etiology - 40 mg PO once daily for 2 to 4 weeks (treatment of duodenal ulcer) or 4 to 8 weeks (treatment of gastric ulcer) «bu»Helicobacter Pylori Eradication«/bu» «b»Clarithromycin Triple Regimen«/b» - 40 to 80 mg twice daily in combination with clarithromycin 500 mg twice daily and either amoxicillin 1 g twice daily or metronidazole 500 mg 3 times per day; continue regimen for 14 days - Avoid use of clarithromycin triple therapy in patients with risk factors for macrolide resistance (eg, prior macrolide exposure, local clarithromycin resistance rates ≥15%, eradication rates with clarithromycin-based regimens ≤85%) «b»Bismuth Quadruple Regimen«/b» - 40 mg twice daily in combination with tetracycline 500 mg 4 times per day, metronidazole 250 mg 4 times per day or 500 mg 3 or 4 times per day, and either bismuth subcitrate 120 to 300 mg 4 times per day or bismuth subsalicylate 300 mg 4 times per day; continue regimen for 10 to 14 days. «b»Concomitant Regimen«/b» - 40 mg twice daily in combination with amoxicillin 1 g twice daily, clarithromycin 500 mg twice daily, and either metronidazole or tinidazole 500 mg twice daily; continue regimen for 10 to 14 days. «b»Sequential Regimen«/b» - 40 mg twice daily plus amoxicillin 1 g twice daily for 5 to 7 days; then continue pantoprazole along with clarithromycin 500 mg twice daily, and either metronidazole or tinidazole 500 mg twice daily for 5 to 7 days. «b»Hybrid Regimen«/b» - 40 mg twice daily plus amoxicillin 1 g twice daily for 7 days; then continue pantoprazole and amoxicillin along with clarithromycin 500 mg twice daily, and either metronidazole or tinidazole 500 mg twice daily for 7 days. «b»Levofloxacin Triple Regimen«/b» - 40 mg twice daily in combination with amoxicillin 1 g twice daily and levofloxacin 500 mg once daily; continue regimen for 10 to 14 days. «bu»Prevention of NSAID-induced Ulcers«/bu» - 20 to 40 mg PO once daily «b»IV Administration«/b» - Flush IV line before and after administration with D5W, NS, or LR. In-line filter not required. «bi»2-minute Infusion«/bi» - The volume of reconstituted solution (4 mg/mL) may be administered intravenously over at least 2 minutes. «bi»15-minute Infusion«/bi» - Infuse over ~15 minutes at a rate of ~7 mL/minute (3 mg/minute). «bi»Continuous Infusion«/bi» - May also be administered as a continuous infusion for the prevention of rebleeding with in peptic ulcer bleed «b»Oral Administration«/b» «bi»Tablet«/bi» - Should be swallowed whole, do not split, crush, or chew - May administer with or without food; concomitant administration of antacids does not affect absorption. «bi»Delayed-release Oral Suspension«/bi» - Should only be administered in apple juice or applesauce and taken ~30 minutes before a meal; do not chew or crush granules - Do not administer with any other liquid (eg, water) or foods. «bi»Oral Administration in Applesauce«/bi» - Sprinkle intact granules on 1 teaspoon of applesauce and swallow within 10 minutes of preparation. «bi»Oral Administration in Apple Juice«/bi» - Empty intact granules into 5 mL of apple juice, stir for 5 seconds (granules will not dissolve), and swallow immediately after preparation - Rinse container once or twice with apple juice and swallow immediately. «b»Nasogastric Tube Administration«/b» - Separate the plunger from the barrel of a 60 mL catheter tip syringe and connect to a ≥16 French nasogastric tube. - Holding the syringe attached to the tubing as high as possible, empty the contents of the packet into barrel of the syringe, add 10 mL of apple juice and gently tap/shake the barrel of the syringe to help empty the syringe - Add an additional 10 mL of apple juice and gently tap/shake the barrel to help rinse. Repeat rinse at least twice with 10 mL aliquots of apple juice - No granules should remain in the syringe. «b»IV Reconstitution«/b» «bi»40 mg Dose«/bi» - Reconstitute 1 vial with 10 mL of NS - Further dilute with 100 mL of D5W, NS, or LR to a final concentration of ~0.4 mg/mL. «bi»80 mg Dose«/bi» - Reconstitute 2 vials each with 10 mL of NS - Combine the content of both vials and further dilute with 80 mL of D5W, NS, or LR to a final concentration of ~0.8 mg/mL. «bi»2-minute Infusion«/bi» - Reconstitute with 10 mL of NS to a final concentration of ~4 mg/mL. «b»Oral Suspension (2 mg/mL) Suspension«/b» A 2 mg/mL pantoprazole oral suspension may be made with pantoprazole tablets, sterile water, and sodium bicarbonate powder. Remove the Protonix® imprint from twenty 40 mg tablets with a paper towel dampened with ethanol (improves the look of product) - Let tablets air dry - Crush the tablets in a mortar and reduce to a fine powder - Transfer to a 600 mL beaker, and add 340 mL sterile water - Place beaker on a magnetic stirrer. Add 16.8 g of sodium bicarbonate powder and stir for about 20 minutes until the tablet remnants have disintegrated - While stirring, add another 16.8 g of sodium bicarbonate powder and stir for about 5 minutes until powder has dissolved - Add enough sterile water for irrigation to bring the final volume to 400 mL. Mix well - Transfer to amber-colored bottle - Label "shake well" and "refrigerate" - Stable for 62 days refrigerated.

Pantothenic Acid

Panto-250, Vitamin B5, Calcium Pantothenate

Papaverine

Pavabid

Papillomavirus (9-Valent) Vaccine (Human, Recomb)

HPV 9-Valent Recomb Vaccine, Gardasil 9, HPV9

Papillomavirus (Types 16,18) Vaccine (Human)

HPV Bivalent (16 & 18) Vaccine, HPV2

Papillomavirus (Types 6, 11, 16, 18) Vaccine

HPV Quadrivalent Vaccine, HPV4, 4-Valent HPV

Parathyroid Hormone (Recombinant)

Natpara, rhPTH(1-84)

«bu»Hypoparathyroidism«/bu» - Prior to initiation of therapy, confirm that the serum calcium concentration is >7.5 mg/dL and the 25-hydroxyvitamin D stores are sufficient (correct if insufficient) - Initial Dose: 50 mcg SC once daily. «b»Dosage Adjustment«/b» - Active forms of vitamin D and calcium supplementation may require adjustment during parathyroid hormone therapy based on albumin-corrected serum calcium concentrations; consult parathyroid hormone product labeling for more information. - Serum calcium (albumin-corrected) cannot be maintained >8 mg/dL without an active form of vitamin D and/or calcium supplementation: Increase the parathyroid hormone dose in increments of 25 mcg/day every 4 weeks; maximum daily dose: 100 mcg/day - Serum calcium (albumin-corrected) repeatedly >9 mg/dL after discontinuation of active forms of vitamin D and calcium supplementation decreased to a dose sufficient to meet daily needs: May decrease the parathyroid hormone dose to a minimum of 25 mcg/day «b»Maintenance Dose«/b» - Use the lowest dose required to prevent both hypocalcemia and hypercalciuria while maintaining albumin-corrected serum calcium concentrations at the lower half of the normal range (ie, between 8 and 9 mg/dL) without the need for active forms of vitamin D and with calcium supplementation sufficient to meet the patient’s daily requirements. «b»Discontinuation or Interruption of Therapy«/b» - An abrupt interruption or discontinuation may result in severe hypocalcemia; resume treatment with or increase the dose of an active form of vitamin D and calcium supplementation (if indicated). «b»Missed Dose«/b» - Administer parathyroid hormone as soon as reasonably feasible; additional calcium should be administered in the event of hypocalcemia. «b»Limitations of Use«/b» - Because of the potential risk of osteosarcoma, recommended only for patients who cannot be well-controlled on calcium supplements and active forms of vitamin D alone; has not been studied in patients with hypoparathyroidism caused by calcium-sensing receptor mutations or in patients with acute postsurgical hypoparathyroidism

Paricalcitol

Zemplar

- In stage 3 to 5 CKD maintain Ca x P <55 mg2/dL2, reduce or interrupt dosing if recommended calcium phosphorus product (Ca x P) is exceeded or hypercalcemia is observed «bu»Secondary Hyperparathyroidism Associated with Chronic Renal Failure (Stage 5 CKD)«/bu» - 0.04 to 0.1 mcg/kg (2.8 to 7 mcg) IV given as a bolus dose no more frequently than every other day at any time during dialysis - Dose may be increased by 2 to 4 mcg every 2 to 4 weeks - Doses as high as 0.24 mcg/kg (16.8 mcg) have been administered safely The dose of paricalcitol should be adjusted based on serum intact PTH (iPTH) levels, as follows: - Same or increasing iPTH level: Increase paricalcitol dose - iPTH level decreased by <30%: Increase paricalcitol dose - iPTH level decreased by >30% and <60%: Maintain paricalcitol dose - iPTH level decrease by >60%: Decrease paricalcitol dose - iPTH level 1.5 to 3 times upper limit of normal: Maintain paricalcitol dose «b»Oral Dose«/b» - Initial dose is calculated, in mcg, based on baseline iPTH level divided by 80 and administered 3 times weekly, no more frequently than every other day - To reduce the risk of hypercalcemia initiate only after baseline serum calcium has been adjusted to ≤9.5 mg/dL. «b»Dose Titration«/b» - Titration dose (mcg) = Most recent iPTH level (pg/mL) divided by 80 - In situations where monitoring of iPTH, calcium, and phosphorus occurs less frequently than once per week, a more modest initial and dose titration rate may be warranted: - Modest titration dose (mcg) = Most recent iPTH level (pg/mL) divided by 100 «b»Dosage Adjustment for Elevated Serum Calcium«/b» - Decrease dose by 2 to 4 mcg. «bu»Secondary Hyperparathyroidism Associated with Stage 3 and 4 CKD«/bu» Initial dose based on baseline serum iPTH: - iPTH ≤500 pg/mL: 1 mcg PO once daily or 2 mcg PO 3 times/week - iPTH >500 pg/mL: 2 mcg PO once daily or 4 mcg PO 3 times/week «b»Dosage Adjustment Based on iPTH Level Relative to Baseline«/b» - Adjust dose at 2- to 4-week intervals: - iPTH same or increased: Increase paricalcitol dose by 1 mcg PO once daily or 2 mcg 3 PO times/week - iPTH decreased by <30%: Increase paricalcitol dose by 1 mcg PO once daily or 2 mcg 3 PO times/week - iPTH decreased by ≥30% and ≤60%: Maintain paricalcitol dose - iPTH decreased by >60%: Decrease paricalcitol dose by 1 mcg once daily* or 2 mcg 3 times/week - iPTH <60 pg/mL: Decrease paricalcitol dose by 1 mcg once daily* or 2 mcg 3 times/week - If patient is taking 1 mcg PO once daily and further dose reduction is needed, decrease to 1 mcg PO 3 times/week. If further dose reduction is required, withhold therapy as needed and restart at a lower dosing frequency.

Paritaprevir

Paromomycin

Humatin

PARoxetine

Paxil, Brisdelle, Pexeva

«bu»Major Depressive Disorder (MDD)«/bu» «b»Paxil, Pexeva«/b» - Initial Dose: 20 mg once daily, preferably in the morning - Increase if needed by 10 mg/day increments at intervals of at least 1 week - Maximum Dose: 50 mg/day «b»Paxil CR«/b» - Initial Dose: 25 mg once daily - Increase if needed by 12.5 mg/day increments at intervals of at least 1 week - Maximum Dose: 62.5 mg/day «bu»Generalized Anxiety Disorder (GAD)«/bu» «b»Paxil, Pexeva«/b» - Initial Dose: 20 mg once daily, preferably in the morning (if dose is increased, adjust in increments of 10 mg/day at 1-week intervals) - Doses of 20 to 50 mg/day were used in clinical trials, however, no greater benefit was seen with doses >20 mg. «bu»Obsessive-Compulsive Disorder (OCD)«/bu» «b»Paxil, Pexeva«/b» - Initial Dose: 20 mg once daily, preferably in the morning - Increase if needed by 10 mg/day increments at intervals of at least 1 week - Recommended Dose: 40 mg/day - Dose Range: 20 to 60 mg/day - Maximum Dose: 60 mg/day «bu»Panic Disorder«/bu» «b»Paxil, Pexeva«/b» - Initial Dose: 10 mg once daily, preferably in the morning - Increase if needed by 10 mg/day increments at intervals of at least 1 week - Recommended Dose: 40 mg/day - Dose Range: 10 to 60 mg/day - Maximum Dose: 60 mg/day «b»Paxil CR«/b» - Initial Dose: 12.5 mg once daily - Increase if needed by 12.5 mg/day at intervals of at least 1 week - Maximum Dose: 75 mg/day «bu»Premenstrual Dysphoric Disorder (PMDD)«/bu» «b»Paxil CR«/b» - Initial Dose: 12.5 mg once daily in the morning - May be increased to 25 mg/day - Dosing changes should occur at intervals of at least 1 week - May be given daily throughout the menstrual cycle or limited to the luteal phase. «bu»Post-traumatic Stress Disorder (PTSD)«/bu» «b»Paxil«/b» - Initial Dose: 20 mg once daily, preferably in the morning - Increase if needed by 10 mg/day increments at intervals of at least 1 week - Dose Range: 20 to 50 mg - Limited data suggest doses of 40 mg/day were not more efficacious than 20 mg/day. «bu»Social Anxiety Disorder«/bu» «b»Paxil«/b» - Initial Dose: 20 mg once daily, preferably in the morning - Recommended Dose: 20 mg/day - Range Dose: 20 to 60 mg/day; doses >20 mg may not have additional benefit «b»Paxil CR«/b» - Initial Dose: 12.5 mg once daily, preferably in the morning - May be increased by 12.5 mg/day at intervals of at least 1 week - Maximum Dose: 37.5 mg/day «bu»Vasomotor Symptoms of Menopause«/bu» «b»Brisdelle«/b» - 7.5 mg once daily at bedtime «b»Paxil CR«/b» (off-label use) - 12.5 to 25 mg once daily «b»Discontinuation of Therapy«/b» - Upon discontinuation of antidepressant therapy, gradually taper the dose to minimize the incidence of withdrawal symptoms and allow for the detection of re-emerging symptoms. Evidence supporting ideal taper rates is limited. APA and NICE guidelines suggest tapering therapy over at least several weeks with consideration to the half-life of the antidepressant; antidepressants with a shorter half-life may need to be tapered more conservatively. In addition for long-term treated patients, WFSBP guidelines recommend tapering over 4 to 6 months. If intolerable withdrawal symptoms occur following a dose reduction, consider resuming the previously prescribed dose and/or decrease dose at a more gradual rate «b»Switching to or from an MAO Inhibitor«/b» - Allow 14 days to elapse between discontinuing an MAO inhibitor intended to treat psychiatric disorders and initiation of paroxetine. - Allow 14 days to elapse between discontinuing paroxetine and initiation of an MAO inhibitor intended to treat psychiatric disorders.

Pasireotide

Signifor, Signifor LAR

Patiromer Sorbitex Calcium

Veltassa

Patisiran

Onpattro

«b»IV Administration«/b» - Use a dedicated line with an infusion set containing a 1.2-micron PES in-line infusion filter - Use infusion sets and lines that are DEHP-free - Infuse diluted solution intravenously, via an ambulatory infusion pump, over ~80 minutes, at an initial infusion rate of approximately 1 mL/min for the first 15 minutes, then increase to ~3 mL/min for the remainder of the infusion; duration of the infusion may be extended in the event of an IRR - Administer only through a free-flowing venous access line; monitor infusion site for possible infiltration during drug administration; suspected extravasation should be managed according to local standard practice for nonvesicants - Observe patient during infusion and, if clinically indicated, following infusion - After completion of infusion, flush IV line with 0.9% NaCl to ensure that all the drug has been administered «b»IV Preparation«/b» - Must filter and dilute solution prior to IV infusion; the solution should be prepared by a healthcare professional using aseptic technique - Remove vial from refrigerator and allow to warm to room temperature; do not shake or vortex - Inspect visually for particulate matter and discoloration; do not use if discoloration or foreign particles are present; the product is a white to off-white, opalescent, homogeneous solution; a white to off-white coating may be observed on inner surface of vial, typically at liquid-headspace interface; product quality is not impacted by presence of white to off-white coating - Calculate required dose based on recommended weight-based dosage - Withdraw entire contents of one or more vials into single sterile syringe - Filter solution through a sterile 0.45-micron polyethersulfone (PES) syringe filter into a sterile container - Withdraw required volume of filtered solution from sterile container using a sterile syringe - Dilute required volume of filtered solution into an infusion bag containing 0.9% NaCl for a total volume of 200 mL; use infusion bags that are di(2-ethylhexyl)phthalate-free (DEHPfree) - Gently invert bag to mix solution; do not shake; do not mix or dilute with other drugs - Discard any unused portion - Product does not contain preservatives; the diluted solution should be administered immediately after preparation; if not used immediately, store infusion bag at room temperature (up to 30°C [86°F]) for up to 16 hr (including infusion time); do not freeze

PAZOPanib

Votrient

«bu»Renal Cell Carcinoma (RCC)«/bu» «b»Advanced«/b» - 800 mg PO once daily «bu»Soft Tissue Sarcoma (STS)«/bu» «b»Advanced«/b» - 800 mg PO once daily «bu»Thyroid Cancer«/bu» «b»Advanced Differentiated«/b» - 800 mg PO once daily until disease progression or unacceptable toxicity «b»Missed Doses«/b» -If a dose is missed, do not take if <12 hours until the next dose. «b»Initial Dosage Reduction«/b» - Prior to dose reduction, temporarily discontinue therapy if 24-hour urine protein ≥3 g or for other toxicities when clinically indicated. RCC - Reduce to 400 mg once daily STS - Reduce to 600 mg once daily Further Modification: RCC, STS - Adjust dose in 200 mg increments or decrements based on individual tolerance; maximum dose: 800 mg Hypertension - Manage as appropriate with antihypertensive therapy and interrupt treatment or reduce dose as clinically warranted. Hypertension (severe, persistent, and refractory to antihypertensives and dose reduction) or Evidence of Hypertensive Crisis - Discontinue treatment. Infection, Serious - Consider treatment interruption or discontinuation. Proteinuria (24-hour urine protein ≥3 g) - Interrupt treatment and reduce the dose. Proteinuria (recurrent 24-hour urine protein ≥3 g refractory to dose reduction) - Discontinue treatment. «b»Pulmonary Toxicity«/b» Interstitial Lung Disease (ILD) or Pneumonitis - Discontinue treatment. Reversible Posterior Leukoencephalopathy Syndrome (RPLS) - Permanently discontinue. Thrombotic Microangiopathy (TMA) - Permanently discontinue. Wound Dehiscence - Discontinue treatment «b»CYP3A4 Inhibitors«/b» - Avoid concomitant strong CYP3A4 inhibitors (may increase pazopanib concentrations) - If pazopanib must be administered concomitantly with a potent enzyme inhibitor, reduce pazopanib to 400 mg once daily with careful monitoring; further dosage reductions may be needed if adverse events occur. «b»CYP3A4 Inducers«/b» - Avoid concomitant strong CYP3A4 inducers (may decrease pazopanib concentrations); use of pazopanib is not recommended in situations where the chronic use of a strong CYP3A4 inducer is required.

Peanut Arachis Hypogaea Allergen Powder

Palforzia

«bu»Peanut Allergy«/bu» «b»Children 4-17 year«/b» - Administer initial dose escalation to patients aged 4-17 yr; up-dosing and maintenance may be continued in patients aged ≥4 yr - Use in conjunction with a peanut-avoidant diet - Treatment is administered in 3 sequential phases: Initial dose escalation, up-dosing, and maintenance - Mix capsule/sachet powder with a few spoonfuls of refrigerated or room temperature semisolid food (eg, applesauce, yogurt, pudding) and consume promptly «b»Initial Dose Escalation (Single Day Dose Escalation)«/b» Separate each dose by a 20- to 30-minute observation period - Dose level A: 0.5 mg (one 0.5-mg capsule) - Dose level B: 1 mg (one 1-mg capsule) - Dose level C: 1.5 mg (one 0.5-mg capsule; one 1-mg capsule) - Dose level D: 3 mg (three 1-mg capsules) - Dose level E: 6 mg (six 1-mg capsules) Instructions - Dose escalation supplied as a single card consisting of 5 blisters containing 13 capsules administered in sequential order on a single day - Administer under supervision of a healthcare professional in a healthcare setting with ability to manage severe allergic reactions, including anaphylaxis - Separate each dose by a 20- to 30-minute observation period - Do not omit any dose level - Observe for 60 minutes after last dose until patient is suitable for discharge - Discontinue if symptoms requiring medical intervention (eg, use of epinephrine) occur with any dose - Patients who tolerate at least the 3-mg single dose (Level D) must return to the healthcare setting for up-dosing initiation; if possible, begin up-dosing the next day - Repeat initial dose escalation in a healthcare setting if patient is unable to begin up-dosing within 4 days «b»Up-dosing«/b» Consume only 1 dose per day at approximately the same time each day Dose levels are at 2-week intervals (first dose of each level under observation in healthcare setting) Dose level 1: 3 mg (three 1-mg capsules) Dose level 2: 6 mg (six 1-mg capsules) Dose level 3: 12 mg (two 1-mg capsules; one 10-mg capsule) Dose level 4: 20 mg (one 20-mg capsule) Dose level 5: 40 mg (two 20-mg capsules) Dose level 6: 80 mg (four 20-mg capsules) Dose level 7: 120 mg (one 20-mg capsule; one 100-mg capsule) Dose level 8: 160 mg (three 20-mg capsules; one 100-mg capsule) Dose level 9: 200 mg (two 100-mg capsules) Dose level 10: 240 mg (two 20-mg capsules; two 100-mg capsules) Dose level 11: 300 mg (one 300-mg sachet) Instructions - Complete initial dose escalation before starting up-dosing - Up-dosing consists of 11 dose levels and is initiated at a 3-mg dose (Level 1) - The first dose of each new up-dosing level is administered under the supervision of a healthcare professional in a healthcare setting with the ability to manage potentially severe allergic reactions, including anaphylaxis - Observe patients after administering first dose of a new up-dosing level for at least 60 minutes until suitable for discharge - If the patient tolerates the first dose of the increased dose level, the patient may continue that dose level at home - Each dose should be consumed daily with a meal at approximately the same time each day, preferably in the evening - Administer all the dose levels in sequential order at 2-week intervals if tolerated; do not progress through up-dosing more rapidly or omit a dose level - Do not consume more than 1 dose per day; instruct patients not to consume a dose at home on the same day as a dose consumed in the clinic - Consider dose modification or discontinuation for patients who do not tolerate up-dosing «b»Maintenance Dosing«/b» - 300 mg PO daily - Complete all dose levels of up-dosing before starting maintenance - Daily maintenance is required to maintain effectiveness of immunotherapy - Continue to monitor patient at regular intervals to assess for adverse effects «b»Limitation of Use«/b» - Not indicated for emergency treatment of allergic reactions, including anaphylaxis - Verify the patient has injectable epinephrine and instruct patient on appropriate use «b»Dosage Modifications«/b» - Dose modifications are not appropriate during initial dose escalation - Temporary dose modification may be required for patients who experience allergic reactions during up-dosing or maintenance, for patients who miss doses, or for practical reasons of patient management - Modify dose for allergic reactions, including GI reactions, that are severe, recurrent, bothersome, or last >90 minutes during up-dosing or maintenance - Use clinical judgment to determine the best course of action, which can include maintaining the dose level for longer than 2 weeks, reducing, withholding, or discontinuing «b»Consecutive Missed Doses«/b» 1-2 Consecutive Days - Resume at same dose level ≥3 Consecutive Days - Instruct patient to consult clinician; resumption of dosing should be done under medical supervision «b»Discontinuation of Treatment«/b» - Patients unable to tolerate doses up to and including 3-mg dose during initial dose escalation - Patients with suspected eosinophilic esophagitis - Patients unable to comply with the daily dosing requirements - Patients with recurrent asthma exacerbations or persistent loss of asthma control

Pegaptanib

Macugen

PEGaspargase

Oncaspar, Polyethylene Glycol-L-asparaginase

«bu»Acute Lymphoblastic Leukemia (ALL)«/bu» - 2500 units/m2 IM/IV every 4 days (as part of a combination chemotherapy regimen) - Do not administer more frequently than every 14 days «b»Dose Adjustments«/b» «bi»Hyperammonemia-Related Fatigue«/bi» - Continue therapy for grade 2 toxicity - If grade 3 toxicity occurs, reduce dose by 25%; resume full dose when toxicity ≤grade 2 (make up for missed doses). - If grade 4 toxicity occurs, reduce dose by 50%; resume full dose when toxicity ≤grade 2 (make up for missed doses). «bi»Hyperglycemia«/bi» - Continue therapy for uncomplicated hyperglycemia. - If hyperglycemia requires insulin therapy, hold pegaspargase (and any concomitant corticosteroids) until blood glucose controlled; resume dosing at prior dose level. - For life-threatening hyperglycemia or toxicity requiring urgent intervention, hold pegaspargase (and corticosteroids) until blood glucose is controlled with insulin; resume pegaspargase and do not make up for missed doses. «bi»Hypersensitivity Reactions«/bi» - May continue dosing for urticaria without bronchospasm, hypotension, edema, or need for parenteral intervention - If wheezing or other symptomatic bronchospasm with or without urticaria, angioedema, hypotension, and/or life-threatening hypersensitivity reactions occur, discontinue pegaspargase. Replace pegaspargase with asparaginase (Erwinia). «bi»Hypertriglyceridemia«/bi» - If serum triglyceride level <1,000 mg/dL, continue pegaspargase but monitor closely for pancreatitis. If triglyceride level >1,000 mg/dL, hold pegaspargase and monitor; resume therapy at prior dose level after triglyceride level returns to baseline. «bi»Pancreatitis«/bi» - Asymptomatic amylase or lipase >3 times ULN (chemical pancreatitis) or radiologic abnormalities only: Continue pegaspargase and monitor levels closely. - Clinical pancreatitis (abdominal pain with amylase or lipase >3 times ULN for >3 days and/or development of pancreatic pseudocyst): Permanently discontinue pegaspargase. «b»CNS Thrombosis and Bleeding«/b» «bi»Thrombosis«/bi» - Continue therapy for abnormal laboratory findings without a clinical correlate. If grade 3 toxicity occurs, discontinue therapy; if CNS signs/symptoms are fully resolved and further pegaspargase doses are required, may resume therapy at a lower dose and/or longer intervals between doses. Discontinue therapy for grade 4 toxicity. «bi»Hemorrhage«/bi» - Discontinue therapy; do not withhold therapy for abnormal laboratory findings without a clinical correlate. If grade 3 toxicity occurs, discontinue therapy; if CNS signs/symptoms are fully resolved and further pegaspargase doses are required, may resume therapy at a lower dose and/or longer intervals between doses. Discontinue therapy for grade 4 toxicity. «b»Non-CNS Thrombosis and Bleeding«/b» «bi»Thrombosis«/bi» - Continue therapy for abnormal laboratory findings without a clinical correlate. If grade 3 or 4 toxicity occurs, withhold therapy until acute toxicity and clinical signs resolve and anticoagulant therapy is stable or completed. Do not withhold therapy for abnormal laboratory findings without clinical correlate. «bi»Hemorrhage«/bi» - If grade 2 bleeding in conjunction with hypofibrinogenemia occurs, withhold therapy until bleeding ≤ grade 1. Do not withhold therapy for abnormal laboratory findings without clinical correlate. For grade 3 or 4 bleeding, withhold therapy until bleeding ≤ grade 1 and until acute toxicity and clinical signs resolve and coagulant replacement therapy is stable or completed.

Pegcetacoplan

Empaveli

Pegcetacoplan Intravitreal

Syfovre

Pegfilgrastim

Fylnetra, Fulphila, Neulasta, G-CSF, Neulasta Onpro, , Pegylated G-CSF, Nyvepria, Udenyca, Ziextenzo

«b»SC Administration«/b» - Administer subcutaneously - Do not use 6 mg fixed dose in infants, children, or adolescents <45 kg - Pegfilgrastim is available in prefilled syringes for manual subcutaneous administration or as a kit for use with the On-body injector - Direct administration of doses <6 mg using the prefilled syringe is not recommended by the manufacturer (it does not have graduation marks necessary for accurate measurement of doses other than 6 mg) - Use caution to avoid dosing errors. «b»Manual Subcutaneous Administration«/b» - Administer to outer upper arms, abdomen (except within 2 inches of navel), front middle thigh, or upper outer buttocks - Allow prefilled syringe to reach room temperature for at least 30 minutes prior to injection - Engage/activate needle guard following use to prevent accidental needlesticks «b»On-body Injector«/b» - A health care provider must fill the On-body injector (OBI) prior to applying to the patient’s skin - Apply to intact, nonirritated skin on the back of the arm or abdomen (only use the back of the arm if caregiver is available to monitor OBI injection status) - The OBI system will deliver pegfilgrastim over ~45 minutes approximately 27 hours after application - The OBI delivery system may be applied on the same day as chemotherapy administration as long as pegfilgrastim is delivered at least 24 hours after chemotherapy is administered - Keep the OBI dry for ~3 hours before dose delivery - Provide patient training and instruct patients to notify health care provider immediately if OBI malfunctions or did not perform as intended - A missed dose may occur if the OBI fails or leaks; if a dose is missed, administer a new dose by manual subcutaneous injection as soon as possible after discovery of missed dose - Do not expose the OBI to oxygen-rich environments (hyperbaric chambers), MRI, x-ray (including airport x-ray), CT-scan, or ultrasound (may damage injector system) - Keep the OBI at least 4 inches away from electrical equipment, including cell phones, cordless phones, microwaves, and other common appliances (injector may not work properly) - The OBI is not recommended for use in patients with acute hematopoietic radiation injury syndrome - The OBI has not been studied in pediatric patients. Refer to prescribing information for further details. - The prefilled syringe provided in the OBI kit contains overfill to compensate for loss during delivery; do not use for manual subcutaneous injection (will result in higher than recommended dose) - Do not use prefilled syringe intended for manual injection to fill the OBI; may result in lower than intended dose - The OBI is only for use with pegfilgrastim; do not use to deliver other medications.

Peginterferon Alfa 2a

Pegasys, PEG-IFN Alfa-2a

Peginterferon Alfa 2b

Sylatron, PegIntron, Peg-Intron Redipen

Peginterferon Beta 1a

Plegridy

Pegloticase

Krystexxa, PEG-Uricase, Pegylated Urate Oxidase

Pegunigalsidase Alfa

Elfabrio

«b»IV Administration«/b» - Administer pre-treatment regimen if applicable - Appropriate medical support measures including cardiopulmonary resuscitation equipment should be readily available during administration - Use an in-line low protein-binding, 0.2 micron, in-line filter - At end of infusion, flush line with NS using same infusion rate at completion of infusion - Do not infuse in same IV line with other products - If initial 4-6 infusions tolerated, duration of every third infusion may be decreased in decrements of 30 minutes as tolerated; minimum recommended infusion duration is 1.5 hr «b»Infusion Rate for Initial 4-6 Doses«/b» - Base infusion rate on actual body weight Enzyme Replacement Therapy (ERT)-Experienced <70 kg - 150 mL total infusion volume at 0.83 mL/min (50 mL/hr) 70-100 kg - 250 mL total infusion volume at 1.39 mL/min (83 mL/hr) >100 kg - 500 mL total infusion volume at 2.78 mL/min 167 mL/hr) Enzyme Replacement Therapy (ERT)-Naïve <70 kg - 150 mL total infusion volume at 0.63 mL/min (37.5 mL/hr) 70-100 kg - 250 mL total infusion volume at 1 mL/min (60 mL/hr) >100 kg - 500 mL total infusion volume at 1.38 mL/min (83 mL/hr) Previously Treated with an ERT with Infusion Over 3 hours - Use the same infusion rate for pegunigalsidase alfa infusion - May decrease duration of every third infusion after the initial 4-6 infusions in decrements of 30 minutes as tolerated; - Minimum recommended infusion duration is 1.5 hr «b»Home Infusion«/b» - May consider for patients who have reached an infusion duration that is tolerated well - Decision to move to home infusion based on evaluation and recommendation by a healthcare provider - Infusion duration should remain constant for home administration and duration should only be decreased in a healthcare facility - Contact clinician if dose is missed dose or delayed «b»IV Preparation«/b» - Determine number of pegunigalsidase alfa vials to be diluted based on actual body weight in kg and the recommended dose - Round number of vials up to next whole number - Remove vials from refrigerator and allow to sit for 15-30 minutes at room temperature before use; do not use an external heat source to heat product (heat may damage product) - Visually inspect solution for particulate matter and discoloration - Solution should be clear and colorless; discard vial(s) if solution discolored or if visible particulate matter is present - Dilute solution required for dose in NS to a total volume based on Actual Body Weight (ABW) Total Volume of Dilution and ABW - <70 kg: 150 mL - 70-100 kg: 250 mL - >100 kg: 500 mL - Before adding volume of pegunigalsidase alfa dose, remove equal volume of 0.9% NaCl from infusion bag - Withdraw dose from vials and inject solution directly into NS through infusion bag port; do not inject in the airspace within the infusion bag - Discard any unused solution remaining in vial(s) - Gently invert infusion bag to mix; avoid vigorous shaking or agitation

Pegvaliase

Palynziq, Pegylated Phenylalanine Ammonia Lyase (PAL)

«bu»Phenylketonuria (PKU)«/bu» «b»Induction«/b» - Initial Dose: 2.5 mg SC once weekly for 4 weeks «b»Titration«/b» - Based on tolerability, titrate dose in a stepwise manner over at least 5 weeks, to achieve a dosage of 20 mg SC daily «bi»Weekly Titration Schedule«/bi» - Week 1: 2.5 mg twice weekly - Week 2: 10 mg once weekly - Week 3: 10 mg twice weekly - Week 4: 10 mg 4x/week - Week 5: 10 mg once daily Additional time may be needed for dose escalation depending on tolerability «b»Maintenance Dose«/b» - Therapeutic response may not be achieved until patient is titrated to an effective maintenance dosage - Use lowest effective and tolerated dose - Assess patient tolerability, blood phenylalanine concentrations, and dietary protein and phenylalanine intake throughout treatment - Maintain at 20 mg SC daily for at least 24 weeks - May increase, but not exceed 40 mg/day in patients who have been maintained continuously on 20 mg daily for at least 24 weeks and who have not achieved either a 20% reduction in blood phenylalanine concentration from pretreatment baseline or a blood phenylalanine concentration ≤600 micromol/L «b»Premedication«/b» - Consider premedication with an H1-receptor antagonist, H2-receptor antagonist, and/or antipyretic prior to administration based upon tolerability «b»Missed Dose«/b» - If a dose is missed, instruct patients to take their next dose as scheduled and to not take 2 doses to make up for the missed dose «b»Discontinuation«/b» - Discontinue in patients who have not achieved a response (at least a 20% reduction in blood phenylalanine concentration from pretreatment baseline or a blood phenylalanine concentration ≤600 micromol/L) after 16 weeks of continuous treatment with maximum dosage 40 mg/day «b»Dose Reduction for Low Phenylalanine Concentrations«/b» - Blood phenylalanine concentrations <30 micromol/L: Reduce dose and/or modify dietary protein and phenylalanine intake to maintain blood phenylalanine concentrations within a clinically acceptable range and >30 micromol/L «b»Readministration Following Anaphylaxis«/b» - If dose is readministered after an anaphylaxis episode, administer the first dose following the anaphylaxis episode under the supervision of a healthcare provider equipped to manage anaphylaxis and closely observe for >60 minutes following the dose - Based on patient tolerability and therapeutic response, subsequent dose titration

Pegvisomant

Somavert

Pembrolizumab

Keytruda

PEMEtrexed

Alimta

Pemigatinib

Pemazyre

«bu»Cholangiocarcinoma«/bu» - Each Cycle is 21 days - 13.5 mg PO daily c 14 consecutive days, then, - 7 days off therapy - Continue treatment until disease progression or unacceptable toxicity occurs «b»Dose Reductions for Adverse Reactions«/b» «bi»First Dose Reduction«/bi» - 9 mg PO daily for first 14 days of each 21-day cycle «bi»Second Dose Reduction«/bi» - 4.5 mg PO daily for first 14 days of each 21-day cycle «bi»Patients Unable to Tolerate 4.5 mg PO Daily«/bi» - Permanently discontinue «b»Retinal Pigment Epithelial Detachment (RPED)«/b» «bi»Asymptomatic and Stable on Serial Examination«/bi» - Continue treatment «bi»Symptomatic OR Worsening on Serial Examination«/bi» - Withhold - Resume at a lower dose if asymptomatic and improved on subsequent examination «bi»Symptoms Persist or Examination Does NOT Improve«/bi» - Consider permanent discontinuation based on clinical status «b»Hyperphosphatemia«/b» - Initiate phosphate lowering therapy and monitor serum phosphate weekly «bi»Serum Phosphate >7 to ≤10 mg/dL«/bi» - Withhold if levels are still ≥7 mg/dL within 2 weeks of starting phosphate lowering therapy - Resume at the same dose when phosphate levels are <7 mg/dL for first occurrence - Resume at a lower dose level for subsequent recurrences «bi»Serum Phosphate >10 mg/dL«/bi» - Withhold if levels are still >10 mg/dL within 1 week of starting phosphate lowering therapy - Resume at the next lower dose level when phosphate levels are <7 mg/dL - Permanently discontinue for recurrence of serum phosphate >10 mg/dL following 2 dose reductions «b»Other Adverse Reactions«/b» «bi»Grade 3«/bi» - Withhold until resolves to Grade ≤1; resume at next lower dose if resolves within 2 weeks - Permanently discontinue if unresolved within 2 weeks OR for recurrent Grade 3 after 2 dose reductions «bi»Grade 4«/bi» - Permanently discontinue «b»CYP3A Inhibitors«/b» - Avoid coadministration with strong and moderate CYP3A inhibitors - If use cannot be avoided; reduce dose (13.5 mg to 9 mg, 9 mg to 4.5 mg) - If the strong or moderate CYP3A inhibitor is discontinued, increase pemigatinib dose (after 3 plasma half-lives of the CYP3A inhibitor) to dose taken before initiating inhibitor «b»Dosing Considerations«/b» - Verify pregnancy status of females of reproductive potential before initiation «b»Contraception«/b» «bi»Females of Reproductive Potential or Males with Female Partners of Reproductive Potential«/bi» - Use effective contraception during treatment and for at least 1 week after final dose «b»Missed Dose«/b» - Missed dose by ≥4 hr or vomited dose: Resume dosing at next scheduled dose

Penbutolol

Levatol

Penciclovir

Denavir

PenicillAMINE

Cuprimine, Depen Titratabs

Penicillin G Benzathine

Bicillin L-A

Penicillin G Benzathine-Penicillin G Procaine

Bicillin C-R

Penicillin G Potassium

Pfizerpen-G, Pen GK

Penicillin G Procaine

Procaine Penicillin G, Wycillin

Penicillin V Potassium

Penicillin VK, Pen VK

Pentamidine

Pentam

Pentamidine (Oral Inhalation)

Nebupent

Pentazocine

Talwin

Pentazocine-Acetaminophen

Talacen

Pentazocine-Naloxone

Talwin NX

PENTobarbital

Nembutal

Pentosan Polysulfate Sodium

Elmiron

Pentostatin

Nipent, Deoxycoformycin, Co-Vidarabine

«bu»Hairy Cell Leukemia«/bu» - 4 mg/m2 IV every 2 weeks - The optimal duration has not been determined; in the absence of unacceptable toxicity, may continue until complete response is achieved or until 2 doses after complete response - Discontinue after 6 months if partial or complete response is not achieved. «bu»Acute Graft-versus-Host Disease (GVHD), Steroid-Refractory«/bu» - Initial Therapy: 1.5 mg/m2 IV days 1 to 3 and days 15 to 17 (in combination with corticosteroids) «bu»Steroid-Refractory Disease«/bu» - 1.5 mg/m2 IV daily for 3 days - May repeat after 2 weeks if needed «bu»Chronic Graft-versus-Host Disease (GVHD)«/bu» «b»Steroid-Refractory«/b» - 4 mg/m2 IV once every 2 weeks - Discontinue after 6 months for sustained objective response, or continue every 2 to 4 weeks for up to 12 months if still improving - 4 mg/m2 once every 2 weeks for 3 months «bu»Chronic Lymphocytic Leukemia (CLL)«/bu» «b»Previously Treated«/b» - 4 mg/m2 IV once every 3 weeks (in combination with cyclophosphamide and rituximab) for 6 cycles «b»Previously Untreated«/b» - 2 mg/m2 IV once every 3 weeks (in combination with cyclophosphamide and rituximab) for 6 cycles «bu»Cutaneous T-cell Lymphoma, Mycosis Fungoides/Sezary Syndrome«/bu» - 4 mg/m2 IV once weekly for 3 weeks, then, - Every 2 weeks for 6 weeks, then, - Once monthly for a maximum of 6 months «bu»T-cell Prolymphocytic Leukemia«/bu» «b»Refractory«/b» - 4 mg/m2 IV once weekly for 4 weeks then, - Every 2 weeks until optimum response is achieved - 4 mg/m2 once weekly for 4 weeks then every 2 weeks (in combination with alemtuzumab) until complete or best response or up to a total of 14 doses «b»Monitoring Parameters«/b» «bi»ANC <200/mm3 (with baseline ANC >500/mm3)«/bi» - Temporarily interrupt treatment until ANC returns to pre-dose levels. «bi»CNS Toxicity«/bi» - Withhold treatment or discontinue. «bi»Active Infection«/bi» - Interrupt treatment until infection is controlled. «bi»Rash«/bi» - Severe rashes may require treatment interruption or discontinuation. «bi»Other Severe Adverse Reactions«/bi» - Withhold treatment or discontinue.

Pentoxifylline ER

Trental, Oxpentifylline

Peramivir

Rapivab

Perampanel

Fycompa

Perfluorohexyloctane

Miebo Ophthalmic Solution

Perflutren Lipid Microsphere

DEFINITY

«b»IV Bolus (Undiluted) Administration«/b» «bi»Cardiovascular Imaging«/bi» - Administer only after activation in the Vialmix apparatus - Administer within 30 to 60 seconds of activation - Follow each injection with a 10 mL saline flush. «bi»Focal Liver Lesion Evaluation«/bi» - Administer only after activation in the Vialmix apparatus - Follow each injection with a 5 mL saline flush «b»IV Bolus (Diluted) Administration«/b» - Administer only after activation in the Vialmix apparatus - Administer slowly up to 3 mL of solution - Subsequent boluses of 1 to 2 mL may be used prn «b»IV Infusion Rate Administration«/b» - Initial Dose: 4 mL/minute (or 240 mL/hour) up to 10 mL/minute (or 600 mL/hour) - Adjust flow rate for optimal image enhancement. «b»IV Preparation«/b» - Prior to administration, product must be activated - To activate, first bring vial to room temperature - Vial should then be shaken for 45 seconds using the Vialmix apparatus (which should be obtained from the manufacturer) - Do not use if the 45 second activation cycle has not been completed - Following activation, the product will appear as a milky white suspension and may be used immediately - Activated product must be used within 12 hours - If not used within 5 minutes of activation, resuspend by inverting the vial and using hand agitation for 10 seconds - To withdraw product, invert vial and aseptically position needle (18 or 20 gauge) or dispensing pin (Intellipin) in center of liquid; do not inject air - Once withdrawn from vial into a syringe, use immediately by administering as an undiluted bolus, a diluted bolus, or as an IV infusion - Do not allow product to stand in syringe - Product does not contain bacterial preservative - Vial is for single use only «bi»Bolus (Undiluted)«/bi» - Withdraw activated product into a 3 or 5 mL syringe. «bi»Bolus (Diluted)«/bi» - Withdraw 8.7 mL of preservative free saline into a 10 mL syringe; then, using the same syringe, slowly withdraw 1.3 mL of activated product into the syringe - Gently hand agitate syringe to evenly distribute microspheres prior to injection - Some have also prepared diluted bolus using 1.5 mL of activated product and 8.5 mL of preservative free saline «bi»IV Infusion«/bi» - Withdraw 1.3 mL activated product into a 3 or 5 mL syringe; then add to 50 mL preservative free saline - Gently squeeze IV bag to evenly distribute microspheres prior to administration.

Perflutren Protein A Microsphere

OPTISON

Perindopril

Aceon

Perindopril-Amlodipine

Prestalia

Permethrin

Acticin, Elimite, Nix

Perphenazine

Trilafon

Perphenazine-Amitriptyline

Etrafon

«bu»Depression and Anxiety«/bu» - Initial Dose: One tablet (Amitriptyline 25 mg/Perphenazine 2 mg or Amitriptyline 25 mg/Perphenazine 4 mg) 3 or 4 times daily or 1 tablet (Amitriptyline 50 mg/Perphenazine 4 mg) 2 times daily - Maximum Daily Dose: Amitriptyline 200 mg/perphenazine 16 mg - Maintenance Dose: Smallest dose necessary for symptom relief; usually 1 tablet (Amitriptyline 25 mg/Perphenazine 2 mg or Amitriptyline 25 mg/Perphenazine 4 mg) 2 to 4 times daily or 1 tablet (Amitriptyline 50 mg/Perphenazine 4 mg) 2 times daily «bu»Schizophrenia with Depressive Symptoms«/bu» - Initial Dose: Two tablets (Amitriptyline 25 mg/Perphenazine 4 mg) 3 times daily - If necessary, a fourth dose may be given at bedtime - Maximum Daily Dose: Amitriptyline 200 mg/Perphenazine 16 mg - Maintenance: Smallest dose necessary for symptom relief; usually 1 tablet (Amitriptyline 25 mg/Perphenazine 2 mg or Amitriptyline 25 mg/Perphenazine 4 mg) 2 to 4 times daily or 1 tablet (Amitriptyline 50 mg/Perphenazine 4 mg) 2 times daily «b»Discontinuation of Therapy«/b» - Upon discontinuation of antidepressant therapy, gradually taper the dose to minimize the incidence of withdrawal symptoms and allow for the detection of re-emerging symptoms - Evidence supporting ideal taper rates is limited - APA and NICE guidelines suggest tapering therapy over at least several weeks with consideration to the half-life of the antidepressant; antidepressants with a shorter half-life may need to be tapered more conservatively - In addition for long-term treated patients, WFSBP guidelines recommend tapering over 4-6 months - If intolerable withdrawal symptoms occur following a dose reduction, consider resuming the previously prescribed dose and/or decrease dose at a more gradual rate «b»Switching to or from an MAO Inhibitor«/b» - Allow 14 days to elapse between discontinuing an MAO inhibitor intended to treat psychiatric disorders and initiation of Amitriptyline/Perphenazine. - Allow 14 days to elapse between discontinuing Amitriptyline/Perphenazine and initiation of an MAO inhibitor intended to treat psychiatric disorders.

Pertuzumab

Perjeta

«bu»Breast Cancer«/bu» «b»Metastatic HER2+«/b» - 840 mg IV over 60 minutes x 1 dose THEN - 420 mg IV over 30 to 60 minutes every 3 weeks until disease progression or unacceptable toxicity (in combination with trastuzumab and docetaxel) «b»Early HER2+«/b» «bi»Adjuvant Treatment«/bi» - 840 mg IV over 60 minutes x 1 dose THEN, - 420 mg IV over 30 to 60 minutes every 3 weeks for a total of 1 year (up to 18 cycles) or until disease progression or unacceptable toxicity (whichever occurs first); as part of a combination regimen containing trastuzumab and including standard anthracycline- and/or taxane-based therapy; pertuzumab and trastuzumab should begin on day 1 of the first taxane-containing cycle «bi»Neoadjuvant Treatment«/bi» - 840 mg IV over 60 minutes x 1 dose THEN, - 420 mg IV over 30 to 60 minutes every 3 weeks for 3 to 6 cycles - May be administered as one of the regimens below - Postoperatively, continue trastuzumab to complete 1 year of treatment. - Four preoperative cycles of pertuzumab, trastuzumab, and docetaxel, followed by 3 postoperative cycles of fluorouracil, epirubicin, and cyclophosphamide (FEC) - Three or four preoperative cycles of FEC (alone) followed by 3 or 4 preoperative cycles of pertuzumab, trastuzumab, and docetaxel - Six preoperative cycles of pertuzumab, trastuzumab, docetaxel, and carboplatin - Four preoperative cycles of dose-dense doxorubicin and cyclophosphamide alone, followed by 4 preoperative cycles of pertuzumab, trastuzumab, and paclitaxel - For pertuzumab, trastuzumab, and taxane combination regimens, pertuzumab and trastuzumab may be administered in any order; however, the taxane should be given after pertuzumab and trastuzumab. Pertuzumab (and trastuzumab) should be administered following completion of the anthracycline therapy in patients receiving anthracycline-based regimens - Observe patients for 30 to 60 minutes after each pertuzumab infusion and before subsequent infusions of trastuzumab or docetaxel. «b»Missed Doses or Delays«/b» - If <6 weeks has elapsed, administer the 420 mg maintenance dose; do not wait until the next planned dose - If ≥6 weeks has elapsed, readminister the 840 mg initial dose (over 60 minutes), and then follow with a maintenance dose of 420 mg (over 30 to 60 minutes) every 3 weeks. - Dose reductions are not recommended for pertuzumab - If trastuzumab is withheld, pertuzumab should also be withheld - If trastuzumab is discontinued, pertuzumab should be discontinued «b»Infusion-Related Reaction«/b» - Slow or interrupt the infusion «b»Serious Hypersensitivity or Anaphylaxis«/b» - Discontinue immediately «b»Cardiotoxicity«/b» «bi»Metastatic Breast Cancer«/bi» - Pre-treatment LVEF should be ≥50% LVEF Decline to <40% or LVEF 40% to 45% with Fall of ≥10% Points Below Pretreatment Values - Withhold treatment (pertuzumab and trastuzumab) for at least 3 weeks - May resume if LVEF either returns to >45% or to 40% to 45% with fall of <10% points below pretreatment values - If LVEF declines and has not improved, or has declined further at the subsequent assessment, strongly consider discontinuing pertuzumab (and trastuzumab). «bi»Early Breast Cancer«/bi» - Pre-treatment LVEF should be ≥55% LVEF Decline to <50% with Fall of ≥10% Points Below Pre-treatment Values - Withhold treatment (pertuzumab and trastuzumab) for at least 3 weeks - May resume if LVEF either returns to ≥50% or <10% points below pretreatment values - If LVEF declines and has not improved, or has declined further at the subsequent assessment, strongly consider discontinuing pertuzumab (and trastuzumab).

Pertuzumab-Trastuzumab-Hyaluronidase

Phesgo

Pexidartinib

Turalio

«bu»Tenosynovial Giant Cell Tumor«/bu» - 400 mg PO bid on an empty stomach until disease progression or unacceptable toxicity «b»Missed or Vomited Dose«/b» - Instruct patient to take the next dose at its scheduled time «b»Strong CYP3A or UGT Inhibitors«/b» - Avoid coadministration - If unable to avoid concomitant use, reduce pexidartinib (see following) - If strong CYP3A or UGT inhibitor discontinued, increase pexidartinib dose (after 3 plasma half-lives of the strong CYP3A or UGT inhibitor) to the dose that was used before starting the inhibitor «b»Strong CYP3A or UGT Inhibitors«/b» - Planned total daily dose of 800 mg: Modify to 200 mg bid - Planned total daily dose of 600 mg: Modify to 200 mg bid - Planned total daily dose of 400 mg: Modify to 200 mg daily «b»Acid-reducing Agents«/b» - Avoid coadministration of proton pump inhibitors (PPIs) - Alternatives to PPI - Locally acting antacid: Administer pexidartinib at least 2 hr before or 2 hr after - H2-receptor antagonist: Administer pexidartinib at least 2 hr before or 10 hr after «b»Dose Reduction Schedule«/b» - First reduction: 200 mg in AM and 400 mg in PM - Second reduction: 200 mg BID - Permanently discontinue if unable to tolerate 200 mg bid «bi»>3-5x ULN«/bi» - Withhold and monitor liver tests weekly - If AST and ALT are ≤3x ULN within 4 weeks, resume at reduced dose - If AST or ALT is not ≤3x ULN in 4 weeks, permanently discontinue «bi»>5-10x ULN«/bi» - Withhold and monitor liver tests twice weekly - If AST and ALT are ≤3x ULN within 4 weeks, resume at reduced dose - If AST or ALT are not ≤3x ULN in 4 weeks, permanently discontinue «bi»>10 ULN«/bi» - Permanently discontinue - Monitor liver tests twice weekly until AST or ALT ≤5x ULN, then weekly until ≤3x ULN «b»Increase ALP and GGT«/b» «bi»ALP >2x ULN with GGT >2x ULN«/bi» - Permanently discontinue - Monitor liver tests twice weekly until ALP ≤5x ULN, then weekly until ≤2x ULN «b»Increased Bilirubin«/b» «bi»Total bilirubin (TB) >ULN to <2x ULN or direct bilirubin (DB) >ULN and <1.5x ULN«/bi» - Withhold and monitor liver tests twice weekly - If an alternate cause for increased bilirubin confirmed and bilirubin is not «bi»TB ≥2x ULN or DB >1.5x ULN«/bi» - Permanently discontinue - Monitor liver tests twice weekly until bilirubin ≤ULN «b»Other Severe/Intolerable Adverse Effects or Laboratory Abnormalities«/b» - Withhold until improvement or resolution - Resume at reduced dose upon improvement or resolution

Phenazopyridine

Baridium, Pyridium, Urinary Pain Relief

Phendimetrazine

Bontril PDM, Bock-Arate

Phenelzine

Nardil

«bu»Depression«/bu» - Initial Dose: 15 mg PO 3 times daily - Early Phase: Increase rapidly, based on patient tolerance, to 60 to 90 mg/day - May take ≥ 4 weeks of 60 mg/day therapy before clinical response - Maintenance Dose: After maximum benefit is obtained, slowly reduce dose over several weeks; dose may be as low as 15 mg once daily to 15 mg every other day «b»Discontinuation of Therapy«/b» - Upon discontinuation of antidepressant therapy, gradually taper the dose to minimize the incidence of withdrawal symptoms and allow for the detection of re-emerging symptoms - Evidence supporting ideal taper rates is limited - APA and NICE guidelines suggest tapering therapy over at least several weeks with consideration to the half-life of the antidepressant; antidepressants with a shorter half-life and MAO inhibitors may need to be tapered more conservatively - In addition for long-term treated patients, WFSBP guidelines recommend tapering over 4-6 months - If intolerable withdrawal symptoms occur following a dose reduction, consider resuming the previously prescribed dose and/or decrease dose at a more gradual rate «b»Switching to or from an MAO Inhibitor«/b» - Allow 14 days to elapse between discontinuing an alternative antidepressant without long half-life metabolites (TCAs, paroxetine, fluvoxamine, venlafaxine) or MAO inhibitor intended to treat psychiatric disorders and initiation of phenelzine. - Allow 5 weeks to elapse between discontinuing fluoxetine (with long half-life metabolites) intended to treat psychiatric disorders and initiation of phenelzine. - Allow 14 days to elapse between discontinuing phenelzine and initiation of an alternative antidepressant or MAO inhibitor intended to treat psychiatric disorders. «b»Use with other MAO Inhibitors (such as linezolid or IV methylene blue)«/b» - Do not initiate phenelzine in patients receiving linezolid or IV methylene blue; consider other interventions for psychiatric condition (Zyvox prescribing information; methylene blue prescribing information). - If urgent treatment with linezolid or IV methylene blue is required in a patient already receiving phenelzine and potential benefits outweigh potential risks, discontinue phenelzine promptly and administer linezolid or IV methylene blue. Monitor for serotonin syndrome for 2 weeks or until 24 hours after the last dose of linezolid or IV methylene blue, whichever comes first. May resume phenelzine 24 hours after the last dose of linezolid or IV methylene blue

PHENobarbital

Luminal

Phenoxybenzamine

Dibenzyline

Phentermine

Atti-Plex P, Adipex-P, Lomaira, Suprenza

Phentermine-Topiramate

Qsymia, Qnexa

Phentolamine

Regitine, OraVerse

«bu»Extravasation of Norepinephrine Management«/bu» «b»Local Infiltration«/b» - Inject 5 to 10 mg (diluted in 10 mL 0.9% sodium chloride) into extravasation area (as soon as possible after extravasation is noted but within 12 hours of extravasation). «bu»Extravasation of other Sympathomimetic Vasopressors Management«/bu» - Infiltrate extravasation site with 5 to 10 mg diluted in 10 to 20 mL 0.9% sodium chloride as soon as possible after extravasation - May readminister if patient remains symptomatic «bu»Diagnosis of Pheochromocytoma«/bu» «b»Phentolamine-Blocking Test«/b» - The phentolamine-blocking test for the diagnosis of pheochromocytoma has largely been supplanted by the measurement of catecholamine concentrations and catecholamine metabolites (metanephrine) in the plasma and urine - Reserve phentolamine for cases when additional confirmation is necessary to determine diagnosis - 5 mg IM/IV x 1 dose «bu»Hypertensive Episodes Associated with Pheochromocytoma«/bu» «b»Prevention and Management«/b» - In the perioperative period, the use of other agents may be preferred due to slow onset of action and prolonged duration of phentolamine in comparison to the other agents (nitroprusside) - Preoperative: 5 mg IM/IV given 1 to 2 hours before surgery and repeat if needed. «b»Intraoperative«/b» - Administer 5 mg IV as indicated to prevent or control paroxysms of hypertension, tachycardia, respiratory depression, seizure, or other effects associated with epinephrine intoxication resulting from tumor manipulation or other stressor (intubation) «bu»Hypertensive Crisis«/bu» - Generally used in the setting of catecholamine excess (eg, pheochromocytoma) - 1 to 5 mg IV bolus - Maximum Single Dose: 15 mg - A continuous infusion may be administered after initial bolus dosing (1 mg/hour titrated to blood pressure response) to a maximum infusion rate of 40 mg/hour «bu»Reversal of Oral Soft Tissue (Lip, Tongue) Anesthesia«/bu» «b»Infiltration or Block Technique«/b» «bi»OraVerse«/bi» - Submucosal oral injection - Dose is based upon the number of cartridges of local anesthetic administered. «b»Infiltration or Block Injection«/b» - 0.1 mg if one-quarter cartridge of anesthesia was administered - 0.2 mg if one-half cartridge of anesthesia was administered - 0.4 mg if 1 cartridge of anesthesia was administered - 0.8 mg if 2 cartridges of anesthesia were administered «bu»Extravasation of Sympathomimetic Vasopressors Treatment«/bu» «b»Children and Adolescents«/b» «bi»Local Norepinephrine Extravasation«/bi» - Infiltrate area of extravasation with a small amount of a 0.5 to 1 mg/mL solution as soon as extravasation is noted but within 12 hours of extravasation «bi»Extravasation of Dopamine, Epinephrine, Norepinephrine, Phenylephrine«/bi» - Infiltrate area of extravasation with a small amount (1 mL given in 0.2 mL aliquots SC) of a 0.5 to 1 mg/mL solution within 12 hours of extravasation. - Total dose required depends on the size of extravasation; dose may be repeated if required. When reported, the total dose needed was 1 to 5 mL of a 1 mg/mL solution; however, other concentrations could be used «bu»Diagnosis of Pheochromocytoma«/bu» «b»Children and Adolescents«/b» «bi»Phentolamine Blocking Test«/bi» - The phentolamine-blocking test for the diagnosis of pheochromocytoma has largely been supplanted by the measurement of catecholamine concentrations and catecholamine metabolites (metanephrine) in the plasma and urine; reserve phentolamine for cases when additional confirmation is necessary to determine diagnosis: - IM: 3 mg - IV: 1 mg - 0.05 to 0.1 mg/kg/dose - Maximum Single Dose: 5 mg «bu»Hypertensive Episodes Associated with Pheochromocytoma«/bu» «b»Children and Adolescents«/b» «bi»Prevention and Treatment«/bi» - In the perioperative period, the use of other agents may be preferred due to slow onset of action and prolonged duration of phentolamine in comparison to the other agents (eg, nitroprusside) «bi»Preoperative«/bi» - IM, IV: 1 mg given 1 to 2 hours before surgery and repeat if needed «bi»Intraoperative«/bi» - IV: 1 mg as indicated to prevent or control paroxysms of hypertension, tachycardia, respiratory depression, seizure, or other effects associated with epinephrine intoxication resulting from tumor manipulation «bu»Reversal of Oral Soft Tissue Anesthesia«/bu» «b»OraVerse«/b» - Dose is based upon the number of cartridge(s) of local anesthetic administered; location and administration technique (infiltration or block injection) should be the same as used for local anesthetic administration. «b»Children ≥3 years weighing ≥15 kg and Adolescents«/b» Submucosal Oral Injection «bi»Infiltration or Block Technique«/bi» Maximum Dose - 15 to <30 kg: 0.2 mg/dose - ≥30 kg: 0.8 mg/dose; Note: A dose of >0.4 mg has not been studied in children <4 years «b»Children Pharmacokinetics«/b» - OraVerse Cmax ~3.5-fold higher in children weighing 15 to 30 kg compared with children weighing >30 kg «b»Extravasation Management (Treatment), Sympathomimetic Vasopressors«/b» - Stop vesicant infusion immediately and disconnect IV line (leave needle/cannula in place) - Gently aspirate extravasated solution from the IV line (do NOT flush the line) - Remove needle/cannula - Elevate extremity - Inject small amounts of phentolamine 5 to 10 mg in 10 to 20 mL saline into extravasation site (as soon as possible but within 12 hours of extravasation) - Apply dry warm compresses «b»Pheochromocytoma Diagnosis«/b» - Patient should be supine throughout test, preferable in a quiet, dark room. - Blood pressure should be monitored every 10 minutes for at least 30 minutes, delay phentolamine administration until after blood pressure is stable (at an untreated, hypertensive level). - A drop in blood pressure >35 mm Hg (systolic) and >25 mm Hg (diastolic) is considered a positive response - If blood pressure is elevated, unchanged, or decrease is <35 mm Hg (systolic) and <25 mm Hg (diastolic), then response is negative - Confirm positive response with other diagnostic measure - Negative responses do not exclude a pheochromocytoma diagnosis, particularly in patients with paroxysmal hypertension where an incidence of false negatives is high. «b»IM Administration«/b» - After IM injection, monitor blood pressure every 5 minutes for 35 to 40 minutes. - Blood pressure drops to above parameters within 20 minutes are considered positive. «b»IV Administration«/b» - Inject rapidly (after venous response to venipuncture has subsided); then monitor blood pressure immediately after injection, every 30 seconds for 3 minutes, then every minute for 7 minutes - Maximum response is generally achieved within 2 minutes; duration may last 15 to 30 minutes (although return to prior blood pressure may be sooner). «b»Pheochromocytoma-Associated Hypertensive Episode«/b» - Administer IM or IV 1 to 2 hours prior to surgery and repeat during surgery (IV) if necessary. «b»Reversal of Oral Soft Tissue Anesthesia (OraVerse)«/b» «bi»Submucosal Oral Injection«/bi» - Use the same location and dental technique employed for administration of the local anesthetic. «b»Hypertensive Crisis«/b» - Administer as an IV bolus - May follow with a continuous IV infusion «b»Reconstitution«/b» «bi»Powder for Injection«/bi» - Reconstitute 5 mg vial with 1 mL sterile water for injection - For treatment of extravasation, further dilute 5 to 10 mg in 10 mL of normal saline (manufacturer’s recommendation) or in 10 to 20 mL of saline

Phenylepherine-Triprolidine-Codeine

Histex-AC

Phenylephrine

Vazculep, Sudogest PE, NeoSynephrine, Neofrin

«b»Administration of Vasopressors Through Peripheral Venous Catheters (CMAJ)«/b» «u»https://twitter.com/ApoThera/status/1577719315977031680«/u» «b»Dobutamine vs Alternative Vasoactives«/b» «u»https://twitter.com/ApoThera/status/1624600312224022529«/u» «b»IV Administration«/b» «bi»Hypotension/Shock«/bi» - May be administered as an intermittent IV bolus over 20 to 30 seconds or via continuous infusion (after diluting). When administering as a continuous infusion, central line administration is preferred. IV infusions require an infusion pump. «bi»Hypotension During Anesthesia«/bi» - Administer as an IV bolus over 20 to 30 seconds. - Vesicant; ensure proper needle or catheter placement prior to and during infusion; avoid extravasation. «b»Extravasation Management«/b» - If extravasation occurs, stop infusion immediately and disconnect (leave cannula/needle in place) - Gently aspirate extravasated solution (do NOT flush the line) - Remove needle/cannula - Elevate extremity - Initiate phentolamine (or alternative antidote) - Apply dry warm compresses «bi»Phentolamine«/bi» - Dilute 5 to 10 mg in 10 to 20 mL NS and administer into extravasation site as soon as possible after extravasation; may readminister if patient remains symptomatic. «bi»Nitroglycerin Topical 2% Ointment«/bi» Adults - Apply a 1-inch strip to the site of ischemia - May repeat every 8 hours as necessary Pediatrics - Apply 4 mm/kg as a thin ribbon to the site of ischemia - May repeat after 8 hours if needed or apply a 1-inch strip to the site of ischemia - May repeat every 8 hours as necessary «b»IV Infusion Preparation«/b» - May dilute 10 mg in 500 mL NS or D5W (Vazculep preferred dilution) - May also dilute 50 mg in 500 mL NS, 100 mg in 500 mL NS, or 1250 mg in 500 mL NS «b»IV Injection Preparation«/b» - May dilute with NS to a concentration of 0.1 mg/mL - May also dilute with SWFI, NS, or D5W to a higher concentration of 1 mg/mL - For bolus administration, Vazculep prescribing information recommends dilution to the lower concentration of 0.1 mg/mL solution in NS or D5W. «b»Intracavernous Injection Prepartion«/b» - off-label route - Dilute with NS to a concentration of 0.1 to 0.5 mg/mL - Lower concentrations should be used for patients with severe cardiovascular disease

Phenylephrine (Nasal)

Decongestant Nose Drops, Afrin, Neo-Synephrine, Rhinall

Phenylephrine (Ophthalmic)

Altafrin, Mydfrin, Neofrin

Phenylephrine (Topical)

Anurx, Preparation H, Hemorrhoidal, Rectacaine, Anu-Med, Hem-Prep

Phenylephrine-Ibuprofen

Advil Congestion Relief, Advil Sinus Congestion & Pain

Phenylephrine-Ketorolac

Omidria

Phenylephrine-Pramoxine-Glycerin-Petrolatum

Preparation H Totables

Phenytoin

Dilantin,Di-Phen, Phenytek, Phenytoin Infatabs

«bu»Status Epilepticus«/bu» «b»IV«/b» «bi»Loading Dose«/bi» - 20 mg/kg IV at a maximum rate of 50 mg/minute - If necessary, may give an additional dose of 5 to 10 mg/kg 10 minutes after the loading dose «bi»Initial Maintenance Dose«/bi» - 100 mg IV/PO every 6 to 8 hours «bu»Seizures«/bu» «b»Immediate Release Tablet«/b» «bi»Initial Dose«/bi» - 100 mg 3 times daily - Individualize dosage with dosage adjustments at no less than 7- to 10-day intervals - Maintenance Dose: 300 to 400 mg/day; an increase to 600 mg/day may be necessary «b»Immediate Release Suspension«/b» «bi»Initial Dose«/bi» - 125 mg 3 times daily, individualize dosage with dosage adjustments at no less than 7- to 10-day intervals - An increase to 625 mg/day may be necessary «b»Extended Release«/b» «bi»Loading Dose«/bi» - 1 g divided into 3 doses (400, 300, 300 mg) administered at 2-hour intervals - Begin maintenance dosage 24 hours after loading dose. - Do not use loading dose regimen in patients with a history of renal or hepatic disease - Reserve for patients who require rapid steady state serum levels, when IV administration is not desirable, and for patients in a clinic or hospital setting where phenytoin levels can be closely monitored. «b»Initial Dosage (Treatment Naïve)«/b» - 100 mg 3 times daily; adjust dosage at no less than 7- to 10-day intervals - Maintenance Dose: 100 mg 3 to 4 times daily, doses up to 200 mg 3 times a day may be necessary. May consider converting patients established on 100 mg 3 times daily to 300 mg once daily. «b»IV and PO Conversion«/b» - Total daily dose should be equal when converting between IV and oral routes - Dosage adjustments and closer serum monitoring may be necessary when switching dosage forms - If using the IV route in a patient who cannot take oral formulations, convert to the oral formulation as soon as possible. «b»Obesity«/b» «bi»Loading Dose«/bi» - 14 mg/kg (IBW) + 19 mg/kg (weight in excess of IBW) - Maximum Dose: 2 g - May also target a specific concentration (15 to 20 mg/L) by using the Vd obtained from patients with obesity - Vd (obesity) = 0.65 L/kg [(IBW) + 1.33 (TBW – IBW)] - Loading Dose = Calculated Vd (obesity) (target concentration) «bi»Maintenance Dose«/bi» - Base on ideal body weight if using weight-based regimens or use conventional daily doses with adjustments based upon therapeutic drug monitoring and clinical effectiveness. «b»Oral Administration«/b» «bi»Immediate Release«/bi» - Divide daily dose into 2 to 3 doses per day - If the daily dosage cannot be divided equally, take the larger dose before retiring. «bi»Chewable Tablets«/bi» - May chew thoroughly before swallowing or swallow whole. «bi»Oral Suspension«/bi» - Shake well prior to use; measure and administer dose using a calibrated oral dosing syringe (or other accurate dose-measuring device). - Absorption is impaired when phenytoin suspension is given concurrently to patients who are receiving continuous nasogastric feedings. - A method to resolve this interaction is to divide the daily dose of phenytoin and withhold the administration of nutritional supplements for 1 to 2 hours before and after each phenytoin dose. - The manufacturer recommends not to administer concomitantly with an enteral feeding preparation. «bi»Extended Release«/bi» - Usually dosed every 12 hours; however, in patients with sufficiently long half-life, may be dosed every 24 hours. «bi»IM Administration«/bi» - Avoid IM administration due to severe risk of local tissue destruction and necrosis; use fosphenytoin if IM administration necessary - The manufacturer's labeling includes IM administration; however, in general the IM route should be avoided and should NOT be used for status epilepticus. «bi»IV Administration«/bi» - Fosphenytoin may be considered for loading in patients who are in status epilepticus, hemodynamically unstable, or develop hypotension/bradycardia with IV administration of phenytoin - Although phenytoin may be administered by direct IV injection, it is preferable that phenytoin be administered via infusion pump either undiluted or diluted in normal saline as an IV piggyback (IVPB) to prevent exceeding the maximum infusion rate (monitor closely for extravasation during infusion). - Administer directly into a large peripheral or central vein through a large-gauge catheter. - Infusion must be completed within 4 hours after dilution in normal saline. - The maximum rate of IV administration is 50 mg/minute in adults. - Highly sensitive patients (eg, elderly patients, patients with preexisting cardiovascular conditions) should receive phenytoin more slowly (20 mg/minute). - In pediatric patients, the manufacturer recommends a maximum rate of 1 to 3 mg/kg/minute or 50 mg/minute (whichever is slower); however, a lower maximum rate of 0.5 to 1 mg/kg/minute is used clinically - When using IV route for oral replacement, administer at slower rate as either a loading dose or by intermittent infusion. - An in-line 0.22- to 0.55-micron filter is recommended for IVPB solutions due to the potential for precipitation of the solution. - Following IV administration, NS should be injected through the same needle or IV catheter to prevent irritation. «b»SC Administration«/b» - Not recommended because of the possibility of local tissue damage (due to high pH). «b»Vesicant«/b» - Ensure proper needle or catheter placement prior to and during IV infusion. Avoid extravasation. «b»Extravasation Management«/b» - If extravasation occurs, stop infusion immediately and disconnect (leave needle/cannula in place) - Gently aspirate extravasated solution (do NOT flush the line) - Remove needle/cannula - Elevate extremity and apply dry heat - Closely monitor for tissue sloughing or compartment syndrome - There is conflicting information regarding an antidote; some sources recommend not to use an antidote or to use hyaluronidase in refractory cases, while other sources recommend hyaluronidase. «bi»Hyaluronidase (if appropriate)«/bi» - Administer SC four separate 0.2 mL injections of a 15 units/mL solution (using a 25-gauge needle) into area of extravasation «b»IV Preparation«/b» - May be further diluted in NS to a final concentration ≥5 mg/mL - Infusion must be completed within 4 hours after preparation - Do not refrigerate.

Physostigmine

Antilirium, Eserine Salicylate

Phytonadione

Vitamin K, Phytomenadione

- Oral route is more effective than the SC route in the treatment of nonbleeding patients with warfarin-associated coagulopathy - SC route has therefore fallen out of favor due to erratic and unpredictable absorption. - The IV route may be used in selected nonbleeding patients and should be used in patients with major bleeding due to warfarin-associated coagulopathy. - IM route should be avoided due to the risk of hematoma formation. «bu»Hypoprothrombinemia due to Drugs or Factors Limiting Absorption or Synthesis«/bu» Initial Dose - 2.5 to 25 mg PO/IV/SC x 1 dose - Rarely up to 50 mg «bu»Acute Liver Failure Coagulopathy«/bu» - 5 to 10 mg IV/SC at least one dose «bu»Vitamin K Deficiency (Supratherapeutic INR) Secondary to VKAs (Warfarin)«/bu» «b»INR above therapeutic range to <4.5 (no evidence of bleeding)«/b» - Lower or hold next VKA dose and monitor frequently - When INR approaches desired range, resume VKA dosing with a lower dose «b»INR 4.5 to 10 (no evidence of bleeding)«/b» - Omit next 1 or 2 VKA doses - Monitor INR more frequently, and resume with an appropriately adjusted VKA dose when INR in desired range - May consider administering vitamin K orally 1 to 2.5 mg if other risk factors for bleeding exist - Others have recommended consideration of vitamin K 1 mg orally or 0.5 mg IV «b»INR >10 (no evidence of bleeding)«/b» - Administer vitamin K orally 2.5 to 5 mg, expect INR to be reduced within 24 to 48 hours - Monitor INR more frequently and give additional vitamin K at an appropriate dose if necessary - Resume warfarin at an appropriately adjusted dose when INR is in desired range - Others have recommended consideration of vitamin K 2 to 2.5 mg orally or 0.5 to 1 mg IV «b»Minor Bleeding at any INR Elevation«/b» - Hold warfarin - May administer vitamin K orally 2.5 to 5 mg - Monitor INR more frequently - May repeat dose after 24 hours if INR correction incomplete - Resume warfarin at an appropriately adjusted dose when INR is in desired range «b»Major Bleeding at any INR Elevation«/b» - Administration of four-factor prothrombin complex concentrate (PCC) and IV vitamin K 5 to 10 mg in this setting. - The only available four-factor PCC in the US is Kcentra - Other four-factor PCCs not available in the US include Beriplex P/N, Cofact, and Octaplex - Bebulin VH and Profilnine SD do not contain adequate levels of factor VII and are considered three-factor PCCs. - Use of high doses of vitamin K (10 to 15 mg) may cause warfarin resistance for ≥1 week. During this period of resistance, heparin or low-molecular-weight heparin (LMWH) may be given until INR responds «bu»Preprocedural/Surgical INR Normalization in Patients Receiving Warfarin«/bu» - 1 to 2.5 mg PO once administered on the day before surgery - Recheck INR on day of procedure/surgery - Others have recommended the use of vitamin K 1 mg orally for mild INR elevations (INR 3.0 to 4.5) «bu»Intracranial Hemorrhage Associated with VKA (warfarin)«/bu» «b»Initial Dose«/b» - 10 mg IV once given as soon as possible and concomitantly with 4-factor prothrombin complex concentrate (PCC) for INR ≥1.4 (3-factor PCC may be given concomitantly with phytonadione but 4-factor PCC is preferred). - Subsequent phytonadione administration is guided by follow-up INR - If subsequent INR ≥1.4 within the first 24 to 48 hours after the initial dose, give a repeat dose of phytonadione 10 mg IV

Pibrentasvir

Piflufolastat

Pylarify

Pilocarpine

Salagen

Pilocarpine (Ophthalmic)

Isopto Carpine, Vuity

Pimavanserin

Nuplazid

Pimecrolimus

Elidel

Pimozide

Orap

- An ECG should be performed baseline and periodically thereafter, especially during dosage adjustment. «bu»Tourette Disorder«/bu» - Initial Dose: 1 to 2 mg/day PO in divided doses, then, - Increase dosage as needed every other day - Maximum Dose: 10 mg/day or 0.2 mg/kg/day (whichever is less) - If therapy requires exceeding dose of 4 mg/day, CYP2D6 geno-/phenotyping should be performed; CYP2D6 poor metabolizers should be dose titrated in ≥14-day increments and should not receive doses in excess of 4 mg/day. «bu»Delusional Parasitosis«/bu» - Initial Dose: 0.5 to 2 mg PO once daily - Increase dose based on response and tolerability in 1 mg increments every 3 to 7 days up to a usual dosage of 2 to 4 mg daily (doses up to 12 mg daily have been studied, however manufacturer labeling recommends a maximum dose of 10 mg/day or 0.2 mg/kg/day) - Consider taper of therapy in decrements of ≥1 mg weekly after adequate relief of symptoms for 1 month; assess for return of symptoms and need for continued long-term treatment «b»Discontinuation of Therapy«/b» - The manufacturer and American Psychiatric Association (APA), Canadian Psychiatric Association (CPA), and World Federation of Societies of Biological Psychiatry (WFSBP) guidelines recommend gradually tapering antipsychotics to avoid withdrawal symptoms and minimize the risk of relapse; risk for withdrawal symptoms may be highest with highly anti-cholinergic or dopaminergic antipsychotics. When stopping antipsychotic therapy in patients with schizophrenia, the CPA guidelines recommend a gradual taper over 6 to 24 months, and the APA guidelines recommend reducing the dose by 10% each month. Continuing anti-parkinsonism agents for a brief period after discontinuation may prevent withdrawal symptoms. When switching antipsychotics, 3 strategies have been suggested: cross-titration (gradually discontinuing the first antipsychotic while gradually increasing the new antipsychotic), overlap and taper (maintaining the dose of the first antipsychotic while gradually increasing the new antipsychotic, then tapering the first antipsychotic), and abrupt change (abruptly discontinuing the first antipsychotic and either increasing the new antipsychotic gradually or starting it at a treatment dose). Evidence supporting ideal switch strategies and taper rates is limited, and results are conflicting. «b»ECG Changes«/b» Children - QTc prolongation >0.47 seconds or >25% above baseline: Decrease dose. Adults - QTc prolongation >0.52 seconds or >25% above baseline: Decrease dose. «b»NMS Syndrome«/b» - Discontinue (monitor carefully if therapy is reinitiated). «b»Tardive Dyskinesia Signs/Symptoms«/b» - Consider discontinuing.

Pindolol

Visken

Pioglitazone

Actos

Pioglitazone-Glimepiride

Duetact

Pioglitazone-Metformin

Actoplus Met

Piperacillin

Piperacillin-Tazobactam

Zosyn

Pirfenidone

Esbriet

«bu»Idiopathic Pulmonary Fibrosis (IPF)«/bu» «bi»Days 1 to 7«/bi» - 267 mg 3 times daily - Total dose: 801 mg/day «bi»Days 8 to 14«/bi» - 534 mg 3 times daily - Total dose: 1,602 mg/day «bi»Day 15 and thereafter«/bi» - 801 mg 3 times daily - Total dose: 2,403 mg/day - Maximum dose: 2,403 mg/day «b»Reinitiation of Therapy Following Interruption«/b» - If interruption <14 consecutive days, may reinitiate therapy at previous daily dose without retitration - if interruption ≥14 consecutive days, reinitiate therapy with the initial 2-week titration period up to recommended daily dose. «b»Strong CYP1A2 Inhibitors«/b» - Reduce pirfenidone to 267 mg 3 times daily - Total dose: 801 mg/day «b»Moderate CYP1A2 Inhibitors«/b» - Reduce pirfenidone to 534 mg 3 times daily (total dose: 1,602 mg/day) when used concomitantly with ciprofloxacin 1,500 mg/day «b»Gastrointestinal«/b» - Nausea, diarrhea, dyspepsia, vomiting - There are no specific dosage adjustments provided in the manufacturer’s labeling; however, consider temporary dosage reduction and/or therapy interruption to allow for resolution of symptoms. «b»Hepatic«/b» «bi»ALT/AST >3 to ≤5 x ULN (without hyperbilirubinemia)«/bi» - Rule out alternative causes and discontinue potentially confounding medications - As clinically appropriate, may continue current dose, may reduce dose (specific dosing reductions are not provided in manufacturer’s labeling), or may temporarily discontinue therapy. Once aminotransferase elevations have resolved, may be re-titrated to the recommended daily dose. Monitor LFTs closely thereafter. «bi»ALT/AST >3 to ≤5 x ULN with Hyperbilirubinemia or Symptoms«/bi» - Discontinue therapy promptly and do not reinitiate «bi»ALT/AST >5 x ULN (Regardless of Serum Bilirubin Concentrations)«/bi» - Discontinue therapy promptly and do not reinitiate «b»Photosensitivity Reaction or Rash«/b» - There is no specific dosage adjustment provided in the manufacturer’s labeling; however, consider temporary dosage reduction and/or therapy interruption to allow for resolution of symptoms.

Piroxicam

Feldene

Pirtobrutinib

Jaypirca

Pitavastatin

Livalo, Zypitamag, Nikita

Pitolisant

Wakix

Plasminogen

Ryplazim

Plazomicin

Zemdri

Plecanatide

Trulance

Plerixafor

Mozobil

Pneumococcal Conjugate Vaccine (13-Valent)

Prevnar 13, PCV13

Pneumococcal Polysaccharide Vaccine (23-Valent)

Pneumovax 23, PPV23

Pneumococcal Vaccine (15-valent)

Vaxneuvance

Pneumococcal Vaccine (20-Valent)

Prevnar 20, PCV20

Podofilox

Condylox

Polatuzumab

Polivy

«b»IV Administration«/b» - IV infusion only - Administer via dedicated infusion line equipped with sterile, nonpyrogenic, low-protein-binding in-line or add-on filter (0.2- or 0.22-micron pore size) and catheter - Initial dose: Infuse over 90 minutes; monitor patients for infusion-related reactions during infusion and for at least 90 minutes following completion of initial dose - Subsequent doses (if previous infusion was well tolerated): Infuse over 30 minutes; monitor during infusion and for at least 30 minutes after completion of infusion «b»Premedication«/b» - If not already premedicated for rituximab product, administer an antihistamine and antipyretic at least 30-60 minutes before polatuzumab vedotin for potential infusion-related reactions - Administer prophylaxis for Pneumocystis jiroveci pneumonia and herpes virus during treatment - Consider prophylactic GCSF administration for neutropenia - Administer tumor lysis syndrome prophylaxis for patients at increased risk of tumor lysis syndrome «b»IV Reconstitution«/b» - Polatuzumab vedotin is a cytotoxic drug; follow applicable special handling and disposal procedures - Visually inspect for particulate matter and discoloration prior to administration, whenever solution and container permit - Reconstitute immediately before dilution - Calculate dose, total volume of reconstituted solution required, and number of vials needed - Reconstitute each 140-mg vial by slowly injecting 7.2 mL of sterile water for injection with the stream directed toward the inside wall of the vial to obtain a concentration of 20 mg/mL of polatuzumab vedotin - Gently swirl vial until completely dissolved; do not shake - Inspect reconstituted solution for discoloration and particulate matter; should appear colorless to slightly brown, clear to slightly opalescent, and free of visible particulates - Do not use if the reconstituted solution is discolored, cloudy, or contains visible particulates; do not freeze or expose to direct sunlight - Dilute polatuzumab vedotin to a final concentration of 0.72-2.7 mg/mL in at least a 50-mL IV infusion bag containing 0.9% NaCl, 0.45% NaCl, or D5W - Withdraw the required volume of reconstituted solution and dilute into IV infusion bag - Discard any unused portion left in the vial - Gently mix IV bag by slowly inverting the bag; do not shake - Visually inspect IV bag for particulates and discard if present - Limit agitation of diluted product during preparation and transportation to administration site - Do not transport diluted product - If prepared solution will be transported to a separate facility, remove air from the infusion bag to prevent aggregation - If air is removed, an infusion set with a vented spike is required to ensure accurate dosing during infusion through an automated system (eg, pneumatic tube, automated cart)

Polidocanol

Varithena, Asclera

Poliovirus Vaccine (Inactivated)

IPOL, Salk Vaccine, IPV, Poliovax, Imovax Polio

Poly-L-Lactic Acid

Sculptra, Sculptra Aesthetic, PLLA

Polyethylene Glycol 3350

HealthyLax, MiraLax, PEGyLAX, GaviLAX, GlycoLax,

Polyethylene Glycol-Electrolyte (PEG) 3350

Colyte, GaviLyte-C, GaviLyte-G, GoLYTELY, MiraLax, MoviPrep, NuLYTELY, Plenvu, TriLyte,

«bu»Bowel Cleansing«/bu» - CoLyte, GaviLyte-C, GaviLyte-G, GaviLyte-N, GoLYTELY, NuLYTELY, TriLyte «b»Oral«/b» - 240 mL (8 oz) every 10 minutes until 4 L are consumed or the rectal effluent is clear; rapid drinking of each portion is preferred to drinking small amounts continuously «b»Nasogastric«/b» - 20-30 mL/minute until 4 L are administered or the rectal effluent is clear - MoviPrep: Oral: Administer 2 L total with an additional 1 L of clear fluid prior to colonoscopy as follows: «b»Split Dose (2 day Regimen)«/b» - Dose 1: Evening before colonoscopy (10-12 hours before dose 2): 240 mL (8 oz) every 15 minutes until 1 L (entire contents of container) is consumed. Then fill container with 480 mL (16 oz) of clear liquid and consume prior to going to bed. - Dose 2: On the morning of the colonoscopy (beginning at least 3.5 hours prior to procedure): 240 mL (8 oz) every 15 minutes until 1 L (entire contents of container) is consumed. Then fill container with 480 mL (16 oz) of clear liquid and consume at least 2 hours before the procedure. «b»Evening Only Dose (1 day Regimen)«/b» - Dose 1: Evening before colonoscopy (at least 3.5 hours before bedtime): 240 mL (8 oz) every 15 minutes until 1 L (entire contents of container) is consumed - Dose 2: ~90 minutes after starting dose 1: 240 mL (8 oz) every 15 minutes until 1 L (entire contents of container) is consumed. Then fill container with 1 L (32 oz) of clear liquid and consume all of the liquid prior to going to bed. «bu»Whole Bowel Irrigation«/bu» «b»Nasogastric«/b» - 1500-2000 mL/hour until the rectal effluent is clear. - Continue treatment at least until the rectal effluent is clear; treatment duration may be extended based on corroborative evidence of continued presence of poisons in the GI tract as determined by radiographic means or the presence of the poison in the effluent. «bi»CoLyte, GaviLyte-C, GaviLyte-G, GaviLyte-N, GoLYTELY, NuLYTELY, TriLyte«/bi» - Using the container provided, add lukewarm water (may use tap water) up to the 4 L water mark - Shake vigorously several times to ensure dissolution of the powder - No additional ingredients or flavors should be added to the solution (other than the flavor packets provided). «b»MoviPrep«/b» - Mix the contents of pouch A and pouch B (one each) in container provided - Add lukewarm water to fill line (~1 L); mix the solution until dissolved - No additional ingredients or flavors should be added to the solution. «b»Concentrations for Reconstituted Solutions«/b» «bi»CoLyte, GaviLyte-C«/bi» - When dissolved in sufficient water to make 4 L, the final solution contains PEG-3350 18 mmol/L, sodium 125 mmol/L, sulfate 80 mmol/L, chloride 35 mmol/L, bicarbonate 20 mmol/L, and potassium 10 mmol/L «bi»GaviLyte-G, GoLYTELY«/bi» - When dissolved in sufficient water to make 4 L, the final solution contains PEG-3350 17.6 mmol/L, sodium 125 mmol/L, sulfate 40 mmol/L, chloride 35 mmol/L, bicarbonate 20 mmol/L, and potassium 10 mmol/L «bi»GaviLyte-N, NuLYTELY, TriLyte«/bi» - When dissolved in sufficient water to make 4 L, the final solution contains PEG-3350 31.3 mmol/L, sodium 65 mmol/L, chloride 53 mmol/L, bicarbonate 17 mmol/L, and potassium 5 mmol/L.

Polyethylene Glycol-Electrolyte Solution-Bisacodyl

GaviLyte-H Bowel Prep Kit,

Polymyxin B

Polymyxin B Sulfate

- Dosing presented as units; 10,000 units = 1 mg «bu»CNS Infections«/bu» «b»Intrathecal«/b» - 50,000 units Intrathecal once daily x 3 to 4 days, then, - Every other day for at least 2 weeks after cultures of the CSF are negative «b»Alternate Dosing«/b» - 50,000 units (Intrathecal, Intraventricular) once daily x7 days - Used in combination with other IV antibiotics (meropenem) «bu»Ocular Infections«/bu» «b»Ophthalmic«/b» - A concentration of 0.1% to 0.25% (10,000 to 25,000 units/mL) is administered as 1 to 3 drops every hour, then, - Increasing the interval as response indicates. - A subconjunctival injection of up to 100,000 units/day may be used for P. aeruginosa corneal and conjunctival infections. - Avoid total systemic and ophthalmic doses of >25,000 units/kg/day «bu»Systemic Infections«/bu» - 15,000-25,000 units/kg/day IV divided every 12hr - Maximum Dose: 25,000 units/kg/day - 25,000-30,000 units/kg/day IM divided q4-6hr - Routine IM administration not recommended due to severe pain at injection site. - Infections (intraabdominal infections, pneumonia [hospital-acquired or ventilator-associated], sepsis), due to susceptible multidrug-resistant gram-negative bacilli (Pseudomonas aeruginosa, Acinetobacter) «b»Severe Infections«/b» «bi»MIC ≤2 mcg/mL«/bi» - Loading Dose: 25,000 units/kg/dose IV infused over 2 hours x 1 dose - Maintenance Dose: 30,000 units/kg/day divided every 12 hours - 25,000 to 30,000 units/kg/day in 2 divided doses without a loading dose «b»Moderate Infections«/b» «bi»MIC ≤1 mcg/mL«/bi» - 25,000 units/kg/day IV divided every 12 hours «b»Inhalation«/b» - 500,000 units INH every 12 hours - An aerosolized beta-2 agonist should be given ~20 minutes prior to polymyxin B - Colistimethate sodium is preferred in patients with hospital or ventilator-associated pneumonia - In the treatment of pneumonia, concomitant IV administration may also be necessary «bu»Selective Gastrointestinal Tract Decontamination«/bu» - 1,000,000 units PO 4 times daily for 2 days prior to surgery through post-operative day 3 in combination with oral tobramycin and oral amphotericin B - To minimize resistance development and preserve polymyxin effectiveness for severe systemic infections, use for selective decontamination is strongly discouraged

Polymyxin B-Bacitracin (Ophthalmic)

AK-Poly-Bac, Polycin, Polycin B

Polymyxin B-Bacitracin (Topical)

Double Antibiotic, Polysporin

Polymyxin B-Trimethoprim (Ophthalmic)

Polytrim

Polysaccharide Iron Complex

Hytinic, Ferrex, iFerex, Niferex, EZFE 200, Ferric x-150, Myferon, NovaFerrum, Nu-Iron, PIC 200, Poly-Iron 150

Polysaccharide Iron Complex-Folic Acid

NovaFerrum

Polysaccharide Iron Complex-Vitamin B12-Folic Acid

Myferon 150 Forte, iFerex 150 Forte, Poly-Iron 150, BiferaRx, Irofol

Pomalidomide

Pomalyst

«bu»Multiple Myeloma«/bu» - 4 mg PO daily on Days 1-21 of repeated 28-day cycles until disease progression - Give in combination with low-dose dexamethasone «b»Low-dose Dexamethasone«/b» - Give PO only on Days 1, 8, 15, and 22 of each 28-day cycle «bi»≤75 years«/bi» - 40 mg/day «bi»>75 years«/bi» - 20 mg/day «bu»Kaposi Sarcoma«/bu» «b»AIDS-related Kaposi Sarcoma (KS)«/b» - 5 mg PO daily on Days 1-21 of each 28-day cycle - Continue until disease progression or unacceptable toxicity - Continue HAART as HIV treatment «b»Kaposi Sarcoma in HIV-negative«/b» - 5 mg PO qDay on Days 1-21 of each 28-day cycle - Continue until disease progression or unacceptable toxicity «b»Prior to Initiation«/b» «bi»Females of Reproductive Potential«/bi» - Obtain 2 negative pregnancy tests and use contraception methods - To initiate a new cycle, the neutrophil count must be ≥500/mcL and the platelet count must be ≥50,000/mcL «b»Contraception«/b» «bi»Females of Reproductive Potential«/bi» - Must commit either to abstain continuously from heterosexual sexual intercourse or to use 2 methods of reliable birth control simultaneously: one highly effective form of contraception – tubal ligation, IUD, hormonal (birth control pills, injections, hormonal patches, vaginal rings, or implants), or partner’s vasectomy, and 1 additional effective contraceptive method– male latex or synthetic condom, diaphragm, or cervical cap - Contraception must begin 4 weeks prior to initiating treatment, during therapy, during dose interruptions, and continuing for 4 weeks following discontinuation of therapy - Contraception is indicated even where there has been a history of infertility, unless due to hysterectomy; refer to a qualified provider of contraceptive methods, if needed «bi»Males with Female Partner of Reproductive Potential«/bi» - Drug is present in semen of males who take drug - Must always use a latex or synthetic condom during any sexual contact with females of reproductive potential while taking drug and for up to 4 weeks after discontinuing therapy, even if they have undergone a successful vasectomy - Male patients taking drug must not donate sperm «bi»Infertility«/bi» - Based on findings in animals, female fertility may be compromised by treatment «b»Dosage Modifications«/b» «bi»Neutropenia (MM)«/bi» ANC <500/mcL or febrile neutropenia (fever >38.5ºC and ANC <1000/mcL) - Withhold until ANC ≥500/mcL and follow CBC weekly - Resume at 1 mg less than previous dose For each subsequent ANC drop <500/mcL - Withhold until ANC ≥500/mcL - Resume at 1 mg less than previous dose - Permanently discontinue if unable to tolerate 1 mg daily «bi»Neutropenia (KS)«/bi» ANC 500 to <1000/mcL - Day 1 of cycle: Withhold until ANC ≥1000/mcL, resume at the same dose - During cycle: Continue at the current dose ANC <500/mcL - Withhold until ANC ≥1000/mcL, resume at the same dose «bi»Febrile Neutropenia (KS)«/bi» - ANC <1000/mcL and single temperature ≥38.3ºC or sustained temperature ≥38.3ºC for >1 hr - Withhold until ANC ≥1000/mcL, resume at dose 1 mg less than the previous dose - Permanently discontinue if unable to tolerate 1 mg qDay «bi»Thrombocytopenia (MM)«/bi» Platelet Count <25,000/mcL - Withhold until platelets >50,000/mcL and follow CBC weekly - Resume at 1 mg less than previous dose For each subsequent drop <25,000/mcL - Withhold, resume at 1 mg less than previous dose if platelet count ≥50,000/mcL - Permanently discontinue if unable to tolerate 1 mg daily «bi»Thrombocytopenia (KS) H4«/bi» - Platelet count 25,000 to <50,000/mcL Day 1 of Cycle - Withhold until platelet count ≥50,000/mcL - Resume at the same dose During cycle - Continue at the current dose «bi»Platelet Count <25,000/mcL«/bi» - Permanently discontinue «bi»Other Toxicities«/bi» Angioedema, skin exfoliation, bullae, or any other severe dermatologic reaction: - Permanently discontinue Grade 3 or 4 Toxicities - Withhold and resume at 1 mg less than the previous dose when toxicity has resolved to Grade ≤2 at the physician’s discretion «bi»Strong CYP1A2 Inhibitors«/bi» - Avoid coadministration with strong CYP1A2 inhibitors - If unavoidable, reduce pomalidomide dose to 2 mg

PONATinib

Iclusig

«bu»Acute Lymphoblastic Leukemia (ALL)«/bu» - Philadelphia chromosome-positive (Ph+), T315I-positive or in patients for whom no other tyrosine kinase inhibitor therapy is indicated Initial Dose - 45 mg PO once daily - The optimal ponatinib dose has not been identified. Consider discontinuing therapy if no response has occurred by 3 months (90 days) of therapy. «bu»Chronic Myeloid Leukemia (CML)«/bu» - Chronic, accelerated, or blast phase - T315I-positive or in patients for whom no other tyrosine kinase inhibitor therapy is indicated - Initial Dose: 45 mg once daily; consider reducing the dose for patients in chronic or accelerated phase who have achieved a major cytogenetic response - Ponatinib is not recommended for treatment of newly diagnosed chronic phase CML. «b»Strong CYP3A Inhibitors«/b» - Reduce ponatinib dose to 30 mg once daily when administered with concomitant strong CYP3A inhibitors (eg, boceprevir, clarithromycin, conivaptan, grapefruit juice, indinavir, itraconazole, ketoconazole, lopinavir/ritonavir, nefazodone, nelfinavir, posaconazole, ritonavir, saquinavir, telaprevir, telithromycin, voriconazole). «b»Hematologic Toxicity«/b» «bi»ANC <1000/mm3 or platelets <50,000/mm3«/bi» First Occurrence - Interrupt therapy; upon recovery of ANC to ≥1500/mm3 and platelets to ≥75,000/mm3, resume therapy at 45 mg daily. Second Occurrence - Interrupt therapy; upon recovery of ANC to ≥1500/mm3 and platelets to ≥75,000/mm3, resume therapy at a reduced dose of 30 mg daily. Third Occurrence - Interrupt therapy; upon recovery of ANC to ≥1500/mm3 and platelets to ≥75,000/mm3, resume therapy at a reduced dose of 15 mg daily. «b»Nonhematologic Toxicity«/b» «bi»Arterial or Venous Occlusive Reactions«/bi» - Interrupt therapy; do not resume ponatinib in the event of serious occlusive events unless the potential benefit of therapy outweighs the risk of recurrent occlusions and other treatment options are not available. «bi»Pancreatitis and Lipase Elevations«/bi» Asymptomatic Grade 1 or 2 Serum Lipase Elevation - Consider interrupting therapy or dose reduction. Asymptomatic Grade 3 or 4 Serum Lipase Elevation (>2 times ULN) or Asymptomatic Radiologic Pancreatitis (grade 2) - If toxicity occurs at a dose of 45 mg daily, interrupt therapy; upon recovery to ≤grade 1 (<1.5 times ULN), resume therapy at a reduced dose of 30 mg daily. If toxicity occurs at a dose of 30 mg daily, interrupt therapy; upon recovery to ≤grade 1, resume therapy at a reduced dose of 15 mg daily. If toxicity occurs at a dose of 15 mg daily, discontinue therapy. Symptomatic Grade 3 Pancreatitis - If toxicity occurs at a dose of 45 mg daily, interrupt therapy; upon recovery of serum lipase elevation to ≤grade 1 and complete symptom resolution, resume therapy at a reduced dose of 30 mg daily. If toxicity occurs at a dose of 30 mg daily, interrupt therapy; upon recovery of serum lipase elevation to ≤grade 1 and complete symptom resolution, resume therapy at a reduced dose of 15 mg daily. If toxicity occurs at a dose of 15 mg daily, discontinue therapy. Grade 4 Pancreatitis - Discontinue therapy. «b»Reversible Posterior Leukoencephalopathy Syndrome (RPLS)«/b» - Interrupt therapy for RPLS diagnosis; resume only if RPLS resolves and if the benefit outweighs the risk. «b»Other Nonhematologic Toxicities«/b» - For serious reactions (other than arterial or venous occlusion), modify the dose or interrupt treatment; do not restart therapy until symptom resolution or unless the benefit of therapy outweighs the risk of recurrent toxicity. «b»Limitations of Use«/b» - Ponatinib is not indicated and not recommended for treatment of newly diagnosed chronic phase CML.

Ponesimod

Ponvory

«bu»Multiple Sclerosis«/bu» «b»Initiation«/b» - Starter pack must be used for initiating treatment - 2 mg PO daily initially - Increase dose as per dose titration regimen (14-day titration) «b»Dose Titration Regimen«/b» Days 1-2 - 2 mg PO daily Days 3-4 - 3 mg PO daily Days 5-6 - 4 mg PO daily Day 7 - 5 mg PO daily Day 8 - 6 mg PO daily Day 9 - 7 mg PO daily Day 10 - 8 mg PO daily Day 11 - 9 mg PO daily Days 12-14 - 10 mg PO daily «b»Maintenance Dose«/b» Day 15 and thereafter - 20 mg PO daily «b»Monitoring«/b» «bi»Before First Dose«/bi» - Recent CBC count, including lymphocyte count (within the last 6 months or after discontinuing previous MS therapy) - ECG - Review medication history for drugs that may slow HR or AV conduction, antineoplastic agents, immunosuppressives, or immune-modulating therapies - Recent (within last 6 months) AST/ALT and bilirubin levels - Evaluate fundus, including macula - Test for antibodies to varicella zoster virus (VZV); VZV vaccination for antibody-negative patients recommended; if vaccination required, administer at least 1 month before initiating ponesimod «bi»First Dose Monitoring«/bi» - Recommended for the following: Patients with sinus bradycardia (HR <55 beats per minute [bpm]), first- or second-degree (Mobitz type I) AV block, or a history of myocardial infarction (MI) or heart failure (HF) occurring >6 months before initiating treatment and in stable condition - Administer in setting where bradycardia can be appropriately managed - Monitor HR and BP at least hourly for 4 hr after first dose for signs and symptoms of bradycardia - Obtain an ECG before dosing and at the end of 4-hr observation period «bi»After 4-hour Monitoring«/bi» - If symptomatic bradycardia, bradyarrhythmia, or conduction-related symptoms, or if new-onset second-degree or higher AV block or QTc ≥500 msec occur, initiate appropriate management, begin continuous ECG monitoring, and continue monitoring until resolution if no pharmacological treatment is required - If pharmacological treatment is required, continue monitoring overnight and repeat 4-hr monitoring after second dose «bi»Possible Abnormalities 4 hours Post Dose«/bi» - If any of these abnormalities are present after 4 hr (even in absence of symptoms), continue monitoring until resolution - HR <45 bpm - HR is at lowest value post dose, suggesting that maximum pharmacodynamic effect on the heart may not have occurred - ECG shows new-onset second-degree or higher AV block «b»Consult Cardiologist«/b» During treatment initiation for patients with the following: - Preexisting heart and cerebrovascular conditions - Prolonged QTc interval before dosing or during 4-hr observation, or at additional risk for QT prolongation - Coadministration with drugs that slow HR or AV conduction, or that prolong QT with a known risk of torsades de pointes «b»Contraception«/b» «bi»Females of Childbearing Potential«/bi» Before Initiating - Counsel on potential for risks to the fetus During Treatment - Use effective contraception Discontinuation - Elimination of ponesimod from body may take ~1 week, potential risk to the fetus may persist - Use effective contraception during this period «b»Reinitiation After Interruption«/b» - Interruption during treatment, especially during titration, is not recommended «bi»<4 Consecutive Doses Missed«/bi» During Titration - Resume with first missed titration dose and resume titration schedule at that dose and titration day During Maintenance - Resume maintenance dose «bi»≥4 Consecutive Doses Missed«/bi» During Titration or Maintenance - Reinitiate with Day 1 of titration regimen (new starter pack) - Complete first-dose monitoring if recommended

Poractant Alfa

Curosurf, Porcine Lung Surfactant

- Take from refrigerator and warm to room temperature. Inspect for discoloration. The color should be white to creamy white. Gently turn the vial upside down to get a uniform suspension. Do not shake. Slowly withdraw the entire contents into a 3 mL or 5 mL plastic syringe through a large gauge needle (at least 20 gauge); discard the excess through the catheter so that only the total dose to be given remains in the syringe. - Before administering, assure proper placement and patency of the endotracheal tube. The endotracheal tube may be suctioned before administering the poractant alpha. The drug is administered intratracheally through a 5-French end-hole catheter cut to a standard length of 8 cm or through a secondary lumen of a dual-lumen endotracheal tube (without interrupting mechanical ventilation). Up to 2 repeated doses may be administered, using the same technique at 12-hour intervals. - Administration using a 5-French end-hole catheter: The infant should be stable before proceeding with administration. Keep the head and body of the infant in alignment without inclination and with either the right or left side dependent. Prior to administration, the infant's ventilator settings should be changed to a rate of 40-60 breaths/minute, inspiratory time 0.5 seconds, and supplemental oxygen to maintain SaO2 >92%. Briefly disconnect the endotracheal tube from the ventilator, insert the 5-French catheter. Administer dose in equally 2 divided aliquots. Instill the first aliquot (1.25 mL/kg birth weight for the initial dose; 0.635 mL/kg birth weight for repeat doses), remove the catheter and manually ventilate the infant with 100% oxygen at a rate of 40-60 breaths/minute for 1 minute. When the infant is stable, reposition the infant such that the other side is dependent and administer the remaining aliquot (1.25 mL/kg birth weight for the initial dose; 0.635 mL/kg birth weight for repeat doses) using the same technique. Do not suction the airways for 1 hour after instillation unless signs of significant airway obstruction occur. Resume ventilator management and clinical care. - Insert the first aliquot (1.25 mL/kg birth weight) and position the infant so that either the right or left side is dependent for the aliquot. Remove the catheter and manually ventilate the infant with 100% oxygen at a rate of 40-60 breaths/minute for 1 minute. When the infant is stable, reposition the infant such that the other side is dependent and administer the remaining aliquot using the same technique. Remove the catheter without flushing. Do not suction the airways for 1 hour after instillation unless signs of significant airway obstruction occur. Resume ventilator management and clinical care. - Administration using the secondary lumen of a dual-lumen endotracheal tube: The infant should be stable before proceeding with dosing. Keep the head and body of the infant in alignment without inclination. Administer poractant alfa through the proximal end of the secondary lumen of the endotracheal tube as a single dose over 1 minute (without interrupting mechanical ventilation); transient increases in F1O2, ventilatory rate, or peak inspiratory pressure (PIP) may be required. Do not suction airways for 1 hour after instillation unless signs of significant airway obstruction occur. - Prior to administration, warm suspension to room temperature. Gently turn the vial over to obtain a uniform suspension; do not shake.

Porfimer

Photofrin

Posaconazole

Noxafil

Potassium Acetate

Potassium Aminobenzoate

M2 Potassium, Potaba

Potassium Bicarbonate

Potassium Bicarbonate-Potassium Chloride

K-Lyte/Cl

Potassium Bicarbonate-Potassium Citrate

Effer-K, Klor-Con/EF, K-Vescent, K-Prime

Potassium Chloride

Klor-Con, Micro-K, K-Tab, KCl, KDur

- When maintaining normal daily requirements, IV doses should be incorporated into the patient's maintenance IV fluids - Intermittent IV potassium administration should be reserved for more severe depletion situations in patients undergoing ECG monitoring. Doses expressed as mEq of potassium. «bu»Normal Daily Requirements«/bu» - 40 to 80 mEq IV/PO daily «bu»Hypokalemia«/bu» «b»Prevention«/b» - 20 to 40 mEq/day in 1 to 2 divided doses «b»Treatment of Mild to Moderate Hypokalemia (PO)«/b» - If deficits are severe or ongoing losses are great, IV route should be considered. «bi»Capsules, Tablets, Oral Solution«/bi» - Usual Dose: 40 to 100 mEq daily in divided doses - Limit single doses to 20 to 25 mEq/dose to avoid GI discomfort. «bi»Powder for Oral Solution (Klor-Con)«/bi» - Usual Dose: 40 to 100 mEq daily in 2 to 5 divided doses - Limit single doses to 40 mEq/dose - Maximum Dose: 200 mEq/24 hours. «b»Treatment of Severe Hypokalemia«/b» - 40 mEq PO 3 to 4 times per day - May also administer 20 mEq every 2 to 3 hours in conjunction with IV potassium administration with careful monitoring - Administration of dose >40 mEq orally per dose are typically not well tolerated, resulting in GI irritation and nausea. «bi»Intermittent IV Infusion«/bi» - ≤10 mEq/hour - May repeat as needed based on frequently obtained lab values - Central line infusion and continuous ECG monitoring highly recommended for infusions >10 mEq/hour. «b»Potassium Dosage/Rate of Infusion«/b» - 10 mEq of potassium chloride will roughly increase serum levels by 0.1 mEq/L. - Patients with more severe forms of hypokalemia (serum potassium levels <3.5 mEq/L) may require increased amounts due to total body potassium deficit «b»Serum Potassium >2.5 to 3.5 mEq/L«/b» - Maximum Infusion Rate: 10 mEq/hour - Maximum Concentration: 40 mEq/L - Maximum 24-hour Dose: 200 mEq «b»Serum Potassium <2.5 mEq/L or Symptomatic Hypokalemia«/b» - Excluding emergency treatment of cardiac arrest - Maximum Infusion Rate (central line only): 40 mEq/hour in presence of continuous ECG monitoring and frequent lab monitoring; in selected situations, patients may require up to 400 mEq/24 hours. «b»IV Administration«/b» - Potassium must be diluted prior to parenteral administration. - For IV infusion; do not administer IV push. - In general, the rate of administration may be dependent on patient condition and specific institution policy. - Usual Rate Range: 0.2 to 0.5 mEq/kg/hour up to 10 mEq to 20 mEq/hour have been used «bi»Critical Care Setting Dose Range«/bi» - Maximum Rate: 1 mEq/kg/hour up to 40 mEq/hour - Continuous cardiac monitoring recommended for rates >0.5 mEq/kg/hour «b»Adults«/b» - Some clinicians recommend that the maximum concentration for peripheral infusion is 10 mEq/100 mL and maximum rate of administration for peripheral infusion is 10 mEq/hour - ECG monitoring is recommended for peripheral or central infusions >10 mEq/hour in adults. With central line administration, higher concentrations and more rapid rates of infusion may be used; concentrations of 20 to 40 mEq/100 mL at a maximum rate of 40 mEq/hour via central line have been safely administered «b»Vesicant/Irritant (at concentrations >0.1 mEq/mL)«/b» - Ensure proper needle or catheter placement prior to and during IV infusion - Avoid extravasation. «b»Extravasation Management«/b» - If extravasation occurs, stop infusion immediately and disconnect (leave needle/cannula in place) - Gently aspirate extravasated solution (do NOT flush the line) - Initiate hyaluronidase antidote; remove needle/cannula - Apply dry cold compresses; elevate extremity. «bi»Hyaluronidase«/bi» Intradermal or SC - Inject a total of 1 to 1.7 mL (15 to 25 units/mL) as five separate 0.2 to 0.3 mL injections (using a 25-gauge needle) into area of extravasation at the leading edge in a clockwise manner «b»Oral Administration«/b» - Oral dosage forms should be taken with meals (or immediately after eating) and a full glass of water or other liquid to minimize the risk of GI irritation - Prescribing information for the various oral preparations recommend that no more than 20 mEq to 40 mEq should be given as single dose. «bi»Capsule Oral Administration«/bi» MicroK - Swallow whole, do not chew - Capsules may also be opened and contents sprinkled on a spoonful of applesauce or pudding and should be swallowed immediately without chewing. «bi»Powder Oral Administration«/bi» Klor-Con - Dissolve one packet in at least 120 mL of cold water or other beverage prior to administration - If GI irritation occurs, increase dilution. «bi»Tablet Administration«/bi» K-Tab, Kaon-Cl, Klor-Con - Swallow tablets whole; do not crush, chew, or suck on tablet. Klor-Con M - Swallow tablets whole; do not crush, chew, or suck on tablet - Tablet may also be broken in half and each half swallowed separately; the whole tablet may be dissolved in ~4 ounces of water (allow ~2 minutes to dissolve, stir well and drink immediately) «b»IV Preparation«/b» - Potassium must be diluted prior to parenteral administration - The concentration of infusion may be dependent on patient condition and specific institution policy - Some clinicians recommend that the maximum concentration for peripheral infusion is 10 mEq/100 mL and 20-40 mEq/100 mL for central infusions.

Potassium Citrate

Urocit-K

Potassium Clavulanate

Clavulanic Acid

Potassium Gluconate

K-99

Potassium Iodide and Iodine

Lugol's Solution, Strong Iodine Solution

Potassium Phosphate Dibasic

K-Phos

«bu»Acute Treatment of Hypophosphatemia«/bu» - If phosphate repletion is required and a phosphate product is not available at your institution, consider the use of sodium glycerophosphate pentahydrate (Glycophos) as a suitable substitute. Concentration and dosing are different from FDA-approved products; use caution when switching between products - The concomitant amount of potassium must be calculated into the total electrolyte content. For each 1 mmol of phosphate, ~1.5 mEq of potassium will be administered. - Repletion of severe hypophosphatemia should be done IV because large doses of oral phosphate may cause diarrhea and intestinal absorption may be unreliable. Reserve intermittent IV infusion for severe depletion situations; may require continuous cardiac monitoring depending on potassium administration rate. - If potassium >4.0 mEq/L consider phosphate replacement strategy without potassium (sodium phosphates). Patients with severe renal impairment were excluded from phosphate supplement trials. - 1 mmol phosphate = 31 mg phosphorus; 1 mg phosphorus = 0.032 mmol phosphate. «b»Low Dose«/b» - If serum phosphate losses are recent and uncomplicated - Initial Dose: 0.08 mmol/kg over 6 hours «b»Intermediate Dose«/b» - If serum phosphorus level <1 mg/dL (<0.32 mmol/L) - Initial Dose: 0.16 mmol/kg per dose over 6 hours - The initial dose may be increased by 25% to 50% if the patient is symptomatic secondary to hypophosphatemia and lowered by 25% to 50% if the patient is hypercalcemic. - Do not exceed the maximum dose of 0.24 mmol/kg/dose (or 16.9 mmol for a 70-kg patient). «b»Critically-ill Adults Receiving Concurrent Enteral/Parenteral Nutrition«/b» - Round doses to the nearest 7.5 mmol for ease of preparation - If administering with phosphate-containing parenteral nutrition, do not exceed 15 mmol/L within parenteral nutrition. «b»Low Dose, Serum Phosphorus Level 2.3 to 3 mg/dL (0.74 to 0.96 mmol/L)«/b» - 0.16 to 0.32 mmol/kg over 4 to 6 hours «b»Intermediate Dose, Serum Phosphorus Level 1.6 to 2.2 mg/dL (0.51 to 0.71 mmol/L)«/b» - 0.32 to 0.64 mmol/kg over 4 to 6 hours «b»High Dose, Serum Phosphorus <1.5 mg/dL (<0.5 mmol/L)«/b» - 0.64 to 1 mmol/kg over 8 to 12 hours «b»Obesity«/b» - May use adjusted body weight for patients weighing >130% of ideal body weight (and BMI<40 kg/m2) by using [IBW + 0.25 (actual body weight - IBW)]. «b»Parenteral Nutrition«/b» - 10 to 15 mmol/1,000 kcal IV or - 20 to 40 mmol/24 hours IV «bu»Urine Acidification«/bu» - 1,000 mg PO 4 times daily «bu»Acute Treatment of Hypophosphatemia«/bu» - If phosphate repletion is required and a phosphate product is not available at your institution, consider the use of sodium glycerophosphate pentahydrate (Glycophos) as a suitable substitute. Concentration and dosing are different from FDA-approved products; use caution when switching between products - The concomitant amount of potassium must be calculated into the total electrolyte content. For each 1 mmol of phosphate, ~1.5 mEq of potassium will be administered. Therefore, if ordering 30 mmol of potassium phosphate, the patient will receive ~45 mEq of potassium. With orders for IV phosphate, there is considerable confusion associated with the use of millimoles (mmol) versus milliequivalents (mEq) to express the phosphate requirement. The most reliable method of ordering IV phosphate is by millimoles, then specifying the potassium or sodium salt. Doses listed as mmol of phosphate. - Intermittent IV infusion should be reserved for severe depletion situations; may require continuous cardiac monitoring depending on potassium administration rate. It is difficult to determine total body phosphorus deficit. There are no prospective studies of parenteral phosphate replacement in children. The following weight-based guidelines for adult dosing may be cautiously employed in pediatric patients. Guidelines differ based on degree of illness, use of TPN, and severity of hypophosphatemia. Note: 1 mmol phosphate = 31 mg phosphorus; 1 mg phosphorus = 0.032 mmol phosphate. «b»Low Dose«/b» - If serum phosphate losses are recent and uncomplicated - Initial Dose: 0.08 mmol/kg IV over 6 hours «b»Intermediate Dose«/b» - If serum phosphorus level <1 mg/dL (<0.32 mmol/L) - Initial Dose: 0.16 mmol/kg IV per dose over 6 hours - The initial dose may be increased by 25% to 50% if the patient is symptomatic secondary to hypophosphatemia and lowered by 25% to 50% if the patient is hypercalcemic. - Do not exceed the maximum dose of 0.24 mmol/kg/dose (or 16.9 mmol for a 70-kg patient). «b»Critically-ill Adults Receiving Concurrent Enteral/Parenteral Nutrition«/b» - Round doses to the nearest 7.5 mmol for ease of preparation. - If administering with phosphate-containing parenteral nutrition, do not exceed 15 mmol/L within parenteral nutrition. «b»Low Dose, Serum Phosphorus Level 2.3 to 3 mg/dL (0.74 to 0.96 mmol/L)«/b» - 0.16 to 0.32 mmol/kg IV over 4 to 6 hours «b»Intermediate Dose, Serum Phosphorus Level 1.6 to 2.2 mg/dL (0.51 to 0.71 mmol/L)«/b» 0.32 to 0.64 mmol/kg IV over 4 to 6 hours «b»High Dose, Serum Phosphorus <1.5 mg/dL (<0.5 mmol/L)«/b» - 0.64 to 1 mmol/kg IV over 8 to 12 hours «b»Obesity«/b» - May use adjusted body weight for patients weighing >130% of ideal body weight (and BMI<40 kg/m2) by using [IBW + 0.25 (actual body weight - IBW)]. «b»Parenteral Nutrition«/b» - Infants and Children: 0.5 to 2 mmol/kg/24 hours IV - Children >50 kg and Adolescents: 10 to 40 mmol/24 hours «bu»Low Urinary Phosphate«/bu» - 1-2 tablets PO every 6 hr «b»IV Administration«/b» - Injection must be diluted in appropriate IV solution and volume prior to administration. - For adult patients with severe symptomatic hypophosphatemia (<1.5 mg/dL), may administer at rates up to 15 mmol phosphate/hour (this rate will deliver potassium at 22.5 mEq/hour) - Potassium infusion rates >10 mEq/hour should be administered via central line (minimizes burning and phlebitis) - ECG monitoring is recommended for potassium infusions >10 mEq/hour in adults or >0.5 mEq/kg/hour in children - In patients with renal dysfunction and/or less severe hypophosphatemia, slower administration rates (eg, over 4 to 6 hours) or oral repletion is recommended. «b»Vesicant/Irritant (may depend on concentration)«/b» - Ensure proper needle or catheter placement prior to and during IV infusion - Avoid extravasation. «b»Extravasation Management«/b» - If extravasation occurs, stop infusion immediately and disconnect (leave needle/cannula in place) - Gently aspirate extravasated solution (do NOT flush the line) - Initiate hyaluronidase antidote; remove needle/cannula - Apply dry cold compresses; elevate extremity «bi»Hyaluronidase«/bi» - Intradermal or SC - Inject a total of 1 mL (15 units/mL) as five separate 0.2 mL injections (using a 25-gauge needle) into area of extravasation at the leading edge in a clockwise manner «b»Oral Administration«/b» - Administer at mealtime and at bedtime - Dissolve tablets in 6 to 8 oz of water prior to administration to avoid GI injury - For best results, soak tablets in water for at least 2 to 5 minutes and stir - If any tablet particles remain undissolved, crush and stir vigorously to speed dissolution. «b»IV Preparation«/b» - Intermittent infusion doses of potassium phosphate are typically prepared in 100 to 250 mL of NS or D5W (usual phosphate concentration range: 0.15 to 0.6 mmol/mL) «bi»Suggested Maximum Concentrations«/bi» Central Line Administration - 26.8 mmoL potassium phosphate/100 mL (40 mEq potassium/100 mL) Peripheral Line Administration - 6.7 mmoL potassium phosphate/100 mL (10 mEq potassium/100 mL) - Observe the vial for the presence of translucent visible particles - Do not use vial if particles are present - Dilute in a compatible IV fluid.

Potassium Phosphate-Sodium Phosphate

Phos-NaK, K-Phos Neutral, Neutra-Phos

PrabotulinumtoxinA

Jeuveau

PRALAtrexate

Folotyn

«b»Vitamin Supplements Before Initial Pralatrexate Dose«/b» «bi»Folic Acid«/bi» - 1 to 1.25 mg/day orally beginning 10 days prior to initial pralatrexate dose - Continue during treatment and for 30 days after last pralatrexate dose «bi»Vitamin B12«/bi» - 1,000 mcg IM within 10 weeks prior to initial pralatrexate dose and every 8 to 10 weeks thereafter (after first dose, subsequent B12 doses may be administered on the same day as pralatrexate). - Prior to administering any dose, mucositis should be ≤grade 1 and absolute neutrophil count (ANC) should be ≥1,000/mm3; platelets should be ≥100,000/mm3 for the first dose and ≥50,000/mm3 for subsequent doses «bu»Peripheral T-cell Lymphoma (PTCL)«/bu» «b»Relapsed or Refractory«/b» - 30 mg/m2 IV once weekly for 6 weeks of a 7-week treatment cycle - Continue until disease progression or unacceptable toxicity «bu»Cutaneous T-cell Lymphoma«/bu» «b»Relapsed or Refractory«/b» - 15 mg/m2 IV once weekly for 3 weeks of a 4-week treatment cycle - Severe or intolerable adverse events may require dose omission, reduction or interruption - Do not make up omitted doses at the end of a cycle; do not re-escalate dose after a reduction due to toxicity. «b»Hematologic Toxicity«/b» «bi»Platelets«/bi» <50,000/mm3 (for 1-week duration) - Omit dose; continue at previous dose if platelets recover within 1 week <50,000/mm3 (for 2-week duration) - Omit dose; decrease to 20 mg/m2 (10 mg/m2 in patients with eGFR 15 to <30 mL/minute/1.73 m2) if platelets recover within 2 weeks <50,000/mm3 (for 3-week duration) - Discontinue treatment. «bi»ANC«/bi» 500 to 1,000/mm3 without fever (for 1-week duration) - Omit dose; continue at previous dose if ANC recovers within 1 week 500 to 1,000/mm3 with fever or ANC <500/mm3 (for 1-week duration) - Omit dose, give filgrastim or sargramostim support; continue at previous dose (with growth factor support) if ANC recovers within 1 week 500 to 1,000/mm3 with fever or ANC <500/mm3 (recurrent or for 2-week duration) - Omit dose and give filgrastim or sargramostim support; decrease to 20 mg/m2 (10 mg/m2 in patients with eGFR 15 to <30 mL/minute/1.73 m2) with growth factor support if ANC recovers within 2 weeks 500 to 1,000/mm3 with fever or ANC <500/mm3 (second recurrence or for 3 week duration) - Discontinue treatment. «b»Nonhematologic Toxicity«/b» «bi»Mucositis on Day of Treatment«/bi» Grade 2 - Omit dose - Continue at previous dose when recovers to ≤ grade 1 Grade 3 or recurrent grade 2 - Omit dose and decrease to 20 mg/m2 (10 mg/m2 in patients with eGFR 15 to <30 mL/minute/1.73 m2) when recovers to ≤grade 1 Grade 4 - Discontinue treatment «b»Non-hematologic Toxicity«/b» Grade 3 - Omit dose - Decrease to 20 mg/m2 (10 mg/m2 in patients with eGFR 15 to <30 mL/minute/1.73 m2) when recovers to ≤ grade 2 Grade 4 - Discontinue treatment.

Pralidoxime

Protopam, 2PAM Antidote, Pralidoxime Auto Injector

Pralsetinib

Gavreto

Pramipexole

Mirapex

Pramlintide

SymlinPen

Pramoxine-Hydrocortisone

Enzone, ProctoFoam HC, Epifoam, Analpram HC, ProCort, Pramosone, Pramosone E

Prasterone

Intrarosa

Prasugrel

Effient

Pravastatin

Pravachol

Praziquantel

Biltricide

Prazosin

Minipress, Furazosin

Prednicarbate

Dermatop

PrednisoLONE

Prelone, Millipred, Orapred, Pediapred, Veripred, Flo-Pred

«bu»Kawasaki Syndrome«/bu» Refractory Cases «b»IVIG«/b» - 2 gm/kg IV over 8 to 12 hours THEN, - Second dose (2 gm/kg) if still febrile after 1st dose AND «b»Prednisolone«/b» - 2 mg/kg PO once daily x 15 days «bu»Asthma Exacerbations«/bu» «b»Children ≤2 years«/b» - 1 to 2 mg/kg/day (maximum: 20 mg daily) for up to 5 days «b»Children 3 to 5 years«/b» - 1 to 2 mg/kg/day (maximum: 30 mg daily) for up to 5 days «b»Children 6 to 11 years«/b» - 1 to 2 mg/kg/day (maximum: 40 mg daily) usually given for 3 to 5 days «b»Children ≥12 years and Adolescents«/b» - Refer to adult dosing. «b»Short-Course "Burst" (Acute Asthma)«/b» - 1 to 2 mg/kg/day in single dose or 2 divided doses for 3 to 10 days - Maximum Dose: 60 mg/day - Burst should be continued until symptoms resolve or patient achieves peak expiratory flow 80% of personal best; usually requires 3 to 10 days of treatment; longer treatment may be required «b»Long-Term Treatment«/b» - 0.25 to 2 mg/kg/day given as a single dose in the morning or every other day as needed for asthma control - Maximum Dose: 60 mg/day «b»Children ≥12 years and Adolescents«/b» - Refer to adult dosing. «bu»Anti-inflammatory or Immunosuppressive Dose«/bu» «b»Children and Adolescents«/b» - 0.1 to 2 mg/kg/day PO in 3 or 4 divided dose «bu»Nephrotic Syndrome Steroid Sensitive (SSNS)«/bu» «b»Children and Adolescents«/b» - Initial episode: 2 mg/kg/day or 60 mg/m2/day once daily (maximum daily dose: 60 mg/day) for 4 to 6 weeks; then, - Adjust to an alternate-day schedule of 1.5 mg/kg/dose or 40 mg/m2/dose on alternate days as a single dose (maximum dose: 40 mg/dose) - Duration of therapy based on patient response «bi»Relapse«/bi» - 2 mg/kg/day or 60 mg/m2/day once daily (maximum daily dose: 60 mg/day) - Continue until complete remission for at least 3 days; then, - Adjust to an alternate-day schedule of 1.5 mg/kg/dose or 40 mg/m2/dose on alternate days as a single dose (maximum dose: 40 mg/dose) - Recommended duration of alternate day dosing is variable: may continue for at least 4 weeks then taper - Longer duration of treatment may be necessary in patients who relapse frequently, some patients may require up to 3 months of treatment «b»Maintenance Therapy for Frequently Relapsing SSNS«/bi» - Taper previous dose down to lowest effective dose which maintains remission using an alternate day schedule; usual effective range: 0.1 to 0.5 mg/kg/dose on alternating days; other patients may require doses up to 0.7 mg/kg/dose every other day «bu»Bell’s Palsy«/bu» «b»Adolescents ≥16 year«/b» - 50 mg PO daily (in 1 or 2 divided doses) for 10 days - Treatment should begin within 72 hours of onset of symptoms

PrednisoLONE (Ophthalmic)

Pred Forte, Pred Mild, Omnipred, Econopred

Prednisolone-Sulfacetamide (Ophthalmic)

Blephamide, AK-Cide

PredniSONE

Deltasone, Rayos, Deltacortisone, Deltasone

«b»General Dosing«/b» - Initial Dose: 5 to 60 mg daily «b»Prednisone Taper«/b» - Day 1: 30 mg divided as 10 mg before breakfast, 5 mg at lunch, 5 mg at dinner, 10 mg at bedtime - Day 2: 5 mg at breakfast, 5 mg at lunch, 5 mg at dinner, 10 mg at bedtime - Day 3: 5 mg 4 times daily (with meals and at bedtime) - Day 4: 5 mg 3 times daily (breakfast, lunch, bedtime) - Day 5: 5 mg 2 times daily (breakfast, bedtime) - Day 6: 5 mg before breakfast «bu»Thyrotoxicosis, Type 2 Amiodarone-induced«/bu» - 40 mg once daily x 14 to 28 days - Gradually taper over 2 to 3 months depending on clinical response - Use in combination with an antithyroid agent if etiology of thyrotoxicosis (type 1 or type 2) cannot be unequivocally determined or if patient is too clinically unstable to allow a trial of monotherapy «bu»Acute Asthma«/bu» - 40 to 60 mg PO daily for 3 to 10 days - Administer as single or 2 divided doses «bu»Acute Exacerbations of Chronic Obstructive Pulmonary Disease (COPD)«/bu» - 40 mg once daily for 5 days «bu»Anaphylaxis«/bu» «b»Adjunctive Treatment«/b» - 0.5 mg/kg x 1 dose «bu»Antineoplastic«/bu» «b»Usual Dose Range«/b» - 10 mg PO daily to 100 mg/m2/day (depending on indication) - Refer to specific protocol for dosing and administration details. «bu»Autoimmune Hepatitis«/bu» - 60 mg PO daily for 1 week THEN, - 40 mg PO daily for 1 week THEN, - 30 mg PO daily for 2 weeks THEN, - 20 mg PO daily - Half this dose should be given when used in combination with azathioprine «bu»Bell Palsy«/bu» - 60 mg PO daily for 5 days, followed by a 5-day taper - Treatment should begin within 72 hours of onset of symptoms «bu»Crohn Disease«/bu» «b» Moderate/Severe«/b» - 40 to 60 mg PO daily until resolution of symptoms and resumption of weight gain - Usual Duration: 7 to 28 days «bu»Dermatomyositis/Polymyositis«/bu» - 1 mg/kg PO daily - Range Dose: 0.5 to 1.5 mg/kg/day, often in conjunction with steroid-sparing therapies; depending on response/tolerance, consider slow tapering after 2 to 8 weeks depending on response; taper regimens vary widely, but often involve 5 to 10 mg decrements per week and may require 6 to 12 months to reach a low once-daily or every-other-day dose to prevent disease flare «bu»Duchenne Muscular Dystrophy«/bu» - 0.75 mg/kg/day or 10 mg/kg/weekend, divided over 2 days - When used daily, the dose may be decreased to 0.3 mg/kg/day in patients who experience adverse reactions. - Doses as high as 1.5 mg/kg/day have been studied, but there is no evidence that doses above 0.75 mg/kg/day provide greater efficacy «bu»Giant Cell Arteritis«/bu» - 40 to 60 mg daily - Typically requires 1 to 2 years of treatment, but may begin to taper after 2 to 3 months; «bu»Glucocorticoid Remediable Aldosteronism Treatment«/bu» - 2.5 to 5 mg once daily preferably at bedtime to suppress early morning ACTH surge «bu»Gout Treatment«/bu» «b»Acute Flare«/b» - ≥0.5 mg/kg for 5 to 10 days OR - 30 to 35 mg daily for 3 to 5 days «bu»Graves Orbitopathy«/bu» - 0.4 to 0.5 mg/kg/day starting 1 to 3 days after radioactive iodine treatment, and continued for 1 month, then gradually taper over 2 months «bu»Herpes Zoster«/bu» - 60 mg daily for 7 days, followed by 30 mg daily for 7 days, then 15 mg daily for 7 days «bu»Immune Thrombocytopenia«/bu» - 1 to 2 mg/kg/day «b»Pregnancy«/b» - 10 to 20 mg/day - Adjust to the minimum effective dose to achieve response; generally continue for at least 21 days, then taper to the minimum effective dose required to maintain platelet count «bu»Lupus Nephritis Induction«/bu» «b» Class III-IV Lupus Nephritis«/b» - 0.5 to 1 mg/kg/day (after glucocorticoid pulse) tapered after a few weeks to lowest effective dose, in combination with an immunosuppressive agent «b»Class V Lupus Nephritis«/b» - 0.5 mg/kg/day for 6 months in combination mycophenolate mofetil; if not improved after 6 months, use 0.5 to 1 mg/kg/day (after a glucocorticoid pulse) for an additional 6 months in combination with cyclophosphamide «bu»Multiple Sclerosis«/bu» «b»Acute Exacerbations«/b» - 200 mg daily for 1 week, followed by 80 mg every other day for 1 month. «bu»Pericarditis«/bu» «b»Recurrent Pericarditis«/b» - 1 to 1.5 mg/kg once daily for at least 1 month - Taper dose over a 3-month period «bu»Tuberculosis Pericarditis«/bu» - 1 to 2 mg/kg once daily for 5 to 7 days followed by 6 to 8 weeks of tapering or - 60 mg once daily for 4 weeks, followed by 30 mg once daily for 4 weeks, 15 mg once daily for 2 weeks, and 5 mg once daily for 1 week «bu»Pneumocystis Pneumonia in HIV-infected«/bu» «b»Adjunctive Therapy«/b» - 40 mg twice daily for 5 days beginning as early as possible and within 72 hours of PCP therapy, then, - 40 mg once daily on days 6 through 10, then, - 20 mg once daily on days 11 through 21 «bu»Polymyalgia Rheumatica«/bu» - Initial Dose: 12.5 to 25 mg PO daily - Consider higher doses within this range for patients at high risk of relapse and low risk of adverse events - Consider lower doses within this range for patients with high risk factors for side effects (eg, diabetes, osteoporosis, glaucoma) - Single daily doses are preferred over divided daily doses - Avoid initial doses ≤7.5 mg/day or >30 mg/day. «b»Tapering«/b» - For initial dosing, taper to a dose of 10 mg/day within 4 to 8 weeks. If relapse occurs, increase dosing to the prerelapse dose and gradually taper back to the dose which relapse occurred within 4 to 8 weeks - Once remission is achieved (initial or relapse therapy), taper daily dose by 1 mg every 4 weeks (or by 1.25 mg decrements if using schedules such as 10 mg and 7.5 mg on alternate days) until discontinuation. «bu»Prostate Cancer«/bu» «b»Metastatic«/b» - 5 mg twice daily (in combination with abiraterone) until disease progression or unacceptable toxicity or - 10 mg once daily (in combination with cabazitaxel) for up to 10 cycles or - 5 mg twice daily (in combination with docetaxel) for up to 10 cycles «bu»Rheumatoid Arthritis«/bu» - ≤10 mg daily «bu»Subacute Thyroiditis«/bu» - 40 mg/day for 1 to 2 weeks - Gradually taper over 2 to 4 weeks or longer depending on clinical response «bu»Takayasu Arteritis«/bu» - 40 to 60 mg daily - Taper to lowest effective dose when ESR and CRP levels are normal - Usual Duration: 1 to 2 years «bu»Tuberculosis«/bu» «b»Severe Paradoxical Reactions«/b» - 1 mg/kg/day x 1 dose - Gradually reduce after 1 to 2 weeks «bu»Acute Asthma«/bu» «b»Infants and Children <12 years«/b» - 1 to 2 mg/kg/day for 3 to 10 days - Maximum Dose: 60 mg/day «b»Children ≥12 years and Adolescents«/b» - Refer to adult dosing. «bu»Antineoplastic«/bu» «b»Children and Adolescents«/b» - Refer to adult dosing or to specific protocol. «bu»Autoimmune Hepatitis«/bu» «b»Infants, Children, and Adolescents«/b» «bi»Monotherapy or in Combination with Azathioprine«/bi» - Initial Dose: 1 to 2 mg/kg/day for 2 weeks (maximum: 60 mg/day), followed by a taper over 6 to 8 weeks to a dose of 0.1 to 0.2 mg/kg/day or 2.5 to 5 mg daily «bu»Bell Palsy«/bu» «b»Infants, Children, and Adolescents <16 years«/b» - 1 mg/kg/day for 1 week, then taper over 1 week; ideally start within the 72 hours of onset of symptoms - Maximum Daily Dose: 60 mg/day «b»Adolescents ≥16 years«/b» - Refer to adult dosing. «bu»Duchenne Muscular Dystrophy«/bu» «b»Children ≥ 4 years and Adolescents«/b» - 0.75 mg/kg/day or 10 mg/kg/weekend, divided over 2 days - The dose may be decreased to 0.3 mg/kg/day in patients who experience adverse reactions - Doses as high as 1.5 mg/kg/day have been studied, but there is no evidence that doses above 0.75 mg/kg/day provide greater efficacy «bu»Nephrotic Syndrome; Steroid Sensitive (SSNS)«/bu» «b»Children and Adolescents«/b» - Initial Episode: 2 mg/kg/day or 60 mg/m2/day once daily - Maximum Daily Dose: 60 mg/day for 4 to 6 weeks; then, - Adjust to an alternate-day schedule of 1.5 mg/kg/dose or 40 mg/m2/dose on alternate days as a single dose, maximum dose: 40 mg/dose «bi»Relapse«/bi» - 2 mg/kg/day or 60 mg/m2/day once daily - Maximum Daily Dose: 60 mg/day - Continue until complete remission for at least 3 days; then, adjust to an alternate-day schedule of 1.5 mg/kg/dose or 40 mg/m2/dose on alternate days as a single dose, maximum dose: 40 mg/dose, recommended duration of alternate day dosing is variable: may continue for at least 4 weeks then taper - Longer duration of treatment may be necessary in patients who relapse frequently, some patients may require up to 3 months of treatment «b»Maintenance Therapy for Frequently Relapsing SSNS«/b» - Taper previous dose down to lowest effective dose which maintains remission using an alternate day schedule - Usual Effective Range: 0.1 to 0.5 mg/kg/day on alternating days; other patients may require doses up to 0.7 mg/kg/dose every other day «bu»Pneumocystis Pneumonia in HIV-Infected«/bu» «b»Infants and Children«/b» «bi»Adjunctive Therapy«/bi» - 1 mg/kg twice daily on days 1 to 5, followed by 0.5 to 1 mg/kg twice daily on days 6 to 10, followed by 0.5 mg/kg once daily on days 11 through 21 «b»Adolescents«/b» «bi»Adjunctive Therapy«/bi» - Refer to adult dosing.

Pregabalin

Lyrica

Prilocaine

Citanest Plain Dental

Primaquine

Prymaccone

Primidone

Mysoline, Desoxyphenobarbital, Primaclone

Probenecid

Benemid

Procainamide

Procanbid, Pronestyl

Procarbazine

Matulane, Ibenzmethyzin, Benzmethyzin

- Procarbazine is associated with a high emetic potential; antiemetics are recommended to prevent nausea and vomiting. The manufacturer suggests that an estimated lean body mass be used in obese patients and patients with rapid weight gain due to edema, ascites, or abnormal fluid retention. «bu»Hodgkin Lymphoma«/bu» «b»MOPP Regimen«/b» - While procarbazine is approved as part of the MOPP regimen, the MOPP regimen is generally no longer used due to improved toxicity profiles with other combination regimens used in the treatment of Hodgkin lymphoma. «b»BEACOPP Standard or Escalated Regimen«/b» - 100 mg/m2 PO days 1 to 7 every 21 days (in combination with bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, and prednisone) for 8 cycles «bu»Non-Hodgkin Lymphomas (NHL)«/bu» «b»CEPP Regimen«/b» - 60 mg/m2 PO days 1 to 10 every 28 days in combination with cyclophosphamide, etoposide and prednisone «b»PEP-C Regimen«/b» - 50 mg PO daily at bedtime (length of induction cycle depends on phase of treatment and blood counts; frequency may vary based on tolerance in maintenance cycle; in combination with prednisone, etoposide, and cyclophosphamide) «bu»CNS Tumors, Anaplastic Oligodendroglioma/Oligoastrocytoma«/bu» «b»PCV Regimen«/b» - 60 mg/m2 days 8 to 21 every 6 weeks (in combination with lomustine and vincristine) for 6 cycles (van den Bent, 2006) or - 75 mg/m2 days 8-21 every 6 weeks (in combination with lomustine and vincristine) for up to 4 cycles «bu»Primary CNS Lymphoma«/bu» - 100 mg/m2 for 7 days in cycles 1, 3, and 5 (in combination with methotrexate [high-dose], vincristine, methotrexate [intrathecal], leucovorin, dexamethasone, cytarabine [high-dose], and whole brain radiation) «b»Withhold Reatment (Promptly) for Any of the Following«/b» - CNS toxicity (eg, paresthesia, confusion, neuropathy), hematologic toxicity (WBC <4000/mm3 or platelets <100,000/mm3), hypersensitivity, gastrointestinal toxicities (stomatisis, diarrhea), and hemorrhage or bleeding.

Prochlorperazine

Compazine, Chlormeprazine

Progesterone

Prometrium, Crinone, Progestin, Pregnenedione

Proguanil

Promethazine

Phenergan, Phenerzine, Phenadoz, Promethegan

Promethazine-Codeine

Phenergan-Codeine, Promethegan-Codeine

Promethazine-Dextromethorphan

Phenergan-Dextromethorphan (DM)

Promethazine-Phenylephrine

Promethazine VC Plain, Phenergan VC Plain

Promethazine-Phenylephrine-Codeine

M-Phen, Promethazine VC/Codeine

Propafenone

Rythmol

- Patients who exhibit significant widening of QRS complex or second- or third-degree AV block may need dose reduction. «bu»Atrial Fibrillation (AFib)«/bu» «b»Capsule ER«/b» «bi»Initial Dose«/bi» - 225 mg every 12 hours to prevent AFib recurrence «bi»Maintenance Dose«/bi» - Dosage increase may be made at a minimum of 5-day intervals - May increase to 325 mg every 12 hours; if further increase is necessary, - May increase to 425 mg every 12 hours «b»Tablet IR«/b» «bi»Initial Dose«/bi» - 150 mg every 8 hours to prevent AFib recurrence «bi»Maintenance Dose«/bi» - Dosage increase may be made at minimum of 3- to 4-day intervals - May increase to 225 mg every 8 hours; if further increase is necessary, - May increase to 300 mg every 8 hours «bu»Paroxysmal Supraventricular Tachycardia (PSVT)«/bu» «b»Tablet IR«/b» «bi»Initial Dose«/bi» - 150 mg every 8 hours to prevent recurrence ventricular arrhythmias «bi»Maintenance Dose«/bi» - Dosage increase may be made at minimum of 3- to 4-day intervals - May increase to 225 mg every 8 hours; if further increase is necessary, - May increase to 300 mg every 8 hours «bu»Supraventricular Tachycardia (SVT)«/bu» «b»Tablet IR«/b» «bi»Initial Dose«/bi» - 150 mg every 8 hours «bi»Maximum Maintenance Dose«/bi» - 300 mg every 8 hours «b»Tablet ER«/b» «bi»Initial Dose«/bi» - 225 mg every 12 hours «bi»Maximum Maintenance Dose«/bi» - 425 mg every 12 hours «bu»Paroxysmal Atrial Fibrillation«/bu» «b»Pharmacologic Cardioversion«/b» - May be used on an outpatient basis (“Pill-in-the-pocket”) - An initial inpatient cardioversion trial should have been successful before sending patient home on this approach. - Patient must be taking an AV nodal-blocking agent (beta-blocker, nondihydropyridine calcium channel blocker) prior to initiation of antiarrhythmic. «bi»Weight <70 kg«/bi» - 450 mg IR Tab PO x 1 dose - May not repeat in ≤24 hours «bi»Weight ≥70 kg«/bi» - 600 mg IR Tab PO x 1 dose - May not repeat in ≤24 hours

Propantheline

Pro Banthine

Propofol

Diprivan, Fresenius Propoven

«bu»Refractory Status Epilepticus«/bu» «b»Loading Dose«/b» - 1 to 2 mg/kg with initiation of a continuous infusion «b»Continuous Infusion«/b» - Initial Dose: 20 mcg/kg/minute (1.2 mg/kg/hour) - If the patient experiences breakthrough status epilepticus while on continuous infusion, increase infusion rate by 5 to 10 mcg/kg/minute (0.3 to 0.6 mg/kg/hour) every 5 minutes (may also administer a 1 mg/kg bolus dose with continuous infusion titration) - Mechanical ventilation and cardiovascular monitoring required - Titrate dose to cessation of electrographic seizures or burst suppression «b»Dose Range«/b» - 30 to 200 mcg/kg/minute (1.8 to 12 mg/kg/hour) - Use caution with doses >80 mcg/kg/minute (>4.8 mg/kg/hour) for >48 hours - Prior to withdrawal, a period of at least 24 to 48 hours of electrographic control is recommended; withdraw gradually to prevent recurrent status epilepticus - Dosage must be individualized based on total body weight and titrated to the desired clinical effect - Wait at least 3 to 5 minutes between dosage adjustments to clinically assess drug effects «bu»General Anesthesia«/bu» - Increase dose in patients with chronic alcoholism - Decrease dose with acutely intoxicated (alcoholic) patients «b»Induction of General Anesthesia«/b» «bi»Healthy adults, ASA-PS 1 or 2, <55 years«/bi» - 2 to 2.5 mg/kg IV (~40 mg every 10 seconds until onset of induction) «bi»Debilitated, ASA-PS 3 or 4«/bi» - Refer to geriatric dosing «b»Maintenance of General Anesthesia«/b» «bi»Healthy adults, ASA-PS 1 or 2, <55 years«/bi» - Initial Dose: 100 to 200 mcg/kg/minute (or 6 to 12 mg/kg/hour) for 10 to 15 minutes - Usual Maintenance Infusion Rate: 50 to 100 mcg/kg/minute (or 3 to 6 mg/kg/hour) to optimize recovery time. - IV Intermittent Bolus: 25 to 50 mg increments as needed «bi»Debilitated, ASA-PS 3 or 4«/bi» - IV Infusion: Refer to geriatric dosing «b»Monitored Anesthesia Care Sedation«/b» «bi»Healthy adults, ASA-PS 1 or 2, <55 years«/bi» - Slow IV Infusion: 100 to 150 mcg/kg/minute (or 6 to 9 mg/kg/hour) for 3 to 5 minutes or - Slow IV Injection: 0.5 mg/kg over 3 to 5 minutes followed by IV infusion of 25 to 75 mcg/kg/minute (or 1.5 to 4.5 mg/kg/hour) or - Incremental Bolus Doses: 10 mg or 20 mg «bi»Debilitated or ASA-PS 3 or 4 Patients«/bi» - Use 80% of healthy adult dose «bu»ICU Sedation in Intubated Mechanically-Ventilated Patients«/bu» - Avoid rapid bolus injection - Individualize dose and titrate to response. «b»Continuous Infusion«/b» - Initial Dose: 5 mcg/kg/minute (or 0.3 mg/kg/hour) - Increase by 5 to 10 mcg/kg/minute (or 0.3 to 0.6 mg/kg/hour) every 5 to 10 minutes until desired sedation level is achieved - Usual Maintenance Dose: 5 to 50 mcg/kg/minute (or 0.3 to 3 mg/kg/hour) - Reduce dose after adequate sedation established and adjust to response (evaluate frequently to use minimum dose for sedation) - Daily interruption with retitration or a light target level of sedation is recommended to minimize prolonged sedative effects «bi»Elderly, Debilitated, or ASA-PS 3 or 4 Patients«/bi» - Refer to geriatric dosing. «bu»Postoperative Nausea and Vomiting (PONV)«/bu» «b»Rescue Therapy«/b» - 15 to 20 mg IV x 1 dose - May be repeated

Propranolol

Pronol, Inderal, InnoPran, Hemangeol

Propranolol-Hydrochlorothiazide

Inderide

Propylthiouracil

PTU

Protamine

Protein C Concentrate (Human)

Ceprotin

Prothrombin Complex Concentrate (Human)

Kcentra, Beriplex P/N, Confidex

Protriptyline

Vivactil

«bu»Depression«/bu» - Initial Dose: 10 to 20 mg daily divided in 3 to 4 doses - Gradually increase based on response and tolerability to a usual dose of 20 to 60 mg/day in 3 to 4 divided doses - Maximum Dose: 60 mg/day «b»Discontinuation of Therapy«/b» - Upon discontinuation of antidepressant therapy, gradually taper the dose to minimize the incidence of withdrawal symptoms and allow for the detection of re-emerging symptoms - Evidence supporting ideal taper rates is limited - APA and NICE guidelines suggest tapering therapy over at least several weeks with consideration to the half-life of the antidepressant; antidepressants with a shorter half-life may need to be tapered more conservatively - In addition for long-term treated patients, WFSBP guidelines recommend tapering over 4-6 months. If intolerable withdrawal symptoms occur following a dose reduction, consider resuming the previously prescribed dose and/or decrease dose at a more gradual rate «b»Switching to or from an MAO Inhibitor to Treat Psychiatric Disorders«/b» - Allow 14 days to elapse between discontinuing an MAO inhibitor intended to treat psychiatric disorders and initiation of protriptyline. - Allow 14 days to elapse between discontinuing protriptyline and initiation of an MAO inhibitor intended to treat psychiatric disorders. «b»Use with Other MAO Inhibitors«/b» - Such as linezolid or IV methylene blue) - Do not initiate protriptyline in patients receiving linezolid or IV methylene blue; consider other interventions for psychiatric condition. - If urgent treatment with linezolid or IV methylene blue is required in a patient already receiving protriptyline and potential benefits outweigh potential risks, discontinue protriptyline promptly and administer linezolid or IV methylene blue. Monitor for serotonin syndrome for 2 weeks or until 24 hours after the last dose of linezolid or IV methylene blue, whichever comes first. May resume protriptyline 24 hours after the last dose of linezolid or IV methylene blue.

Prucalopride

Motegrity

Pseudoephedrine

Biofed, Nasal Decongestant, Nexafed, Zephrex-D, SudaFED

Pseudoephedrine-Desloratadine

Clarinex-D 12 Hr, Clarinex-D 24 Hr

Psyllium

Alramucil, Konsyl, Reguloid, Metamucil Fiber, Natural Fiber, Reguloid, Sorbulax, Evac

Pyrazinamide

Pyrazinoic Acid Amide

Pyridostigmine

Regonol, Mestinon

«bu»Myasthenia Gravis«/bu» «b»Oral Dose«/b» - 60 to 1,500 mg IR PO daily - Usually 600 mg/day divided into 5 to 6 doses, spaced to provide maximum relief - 180 to 540 mg SR once or twice daily (doses separated by at least 6 hours) - It may be necessary to use immediate-release therapy in conjunction with sustained-release therapy. «b»IM, IV Dose«/b» - To supplement during labor and postpartum, during myasthenic crisis, or when oral therapy is impractical: ~1/30th of oral dose; observe patient closely for cholinergic reactions - IM route preferred due to significant complications (cardiac arrest) observed with the IV route - May also administer as a continuous infusion for myasthenic crisis. «bi»Continuous Infusion«/bi» - 1 to 2 mg/hour IV with gradual titration in increments of 0.5 to 1 mg/hour - Up to a maximum rate of 4 mg/hour «bu»Reversal of Nondepolarizing Muscle Relaxants«/bu» - 0.1 to 0.25 mg/kg IV per dose (onset to peak effect is dose-dependent) - Return of twitch height to 90% of control occurs within ~6 minutes - Full recovery usually occurs within 15 to 30 minutes - The monitoring of muscle twitch response to peripheral nerve stimulation is advised; administer pyridostigmine after spontaneous recovery of neuromuscular function has begun. - Atropine sulfate or glycopyrrolate IV should be administered immediately prior to or simultaneously with pyridostigmine to minimize side effects. - Inadequate reversal is possible; manage by manual or mechanical ventilation until recovery is judged adequate (additional doses are not recommended). «bu»Soman Nerve Gas Exposure Pretreatment«/bu» «b»Military Use«/b» - Do not administer pyridostigmine after Soman exposure - If taken immediately before exposure (when gas attack alarm is given) or at the same time, it is not expected to be effective and may exacerbate the effects of a sub-lethal exposure to Soman. - 30 mg PO every 8 hours beginning several hours prior to exposure - Discontinue at first sign of Soman exposure, then, immediately begin atropine and pralidoxime. «bu»Disopyramide-induced Anticholingeric Adverse Effects«/bu» - 90 to 180 mg SR PO every 12 hours or as needed

Pyridoxine

Vitamin B6, Nestrex

Pyrilamine

Pyrimethamine

Daraprim

Quazepam

Doral

QUEtiapine

SEROquel

«bu»Bipolar Disorder«/bu» «b»Depressive Episodes«/b» «bi»Immediate Release«/bi» Initial Dose - 50 mg once daily at bedtime on day 1 THEN, - Increase to 100 mg once daily on day 2 THEN, - Increase by 100 mg daily each day until 300 mg once daily is reached by day 4 Usual Dose - 300 mg once daily Maximum Dose - 300 mg once daily. «bi»Extended Release«/bi» Initial Dose - 50 mg once daily on day 1 THEN, - Increase to 100 mg once daily on day 2 THEN - Increase by 100 mg once daily until 300 mg once daily is reached by day 4 Usual Dose - 300 mg once daily Maximum Dose - 300 mg once daily. «b»Mania«/b» - Monotherapy or as an adjunct to lithium or divalproex «bi»Immediate Release«/bi» Initial Dose - 50 mg PO bid on day 1 THEN, - Increase by 100 mg daily (administered twice daily) until 200 mg twice daily is reached by day 4 Maintenance Dose - May further increase to 800 mg daily by day 6 in increments of ≤200 mg daily Usual Dosage Range - 400 to 800 mg daily Maximum Dose - 800 mg daily «b»Manic or Mixed«/b» - Monotherapy or as an adjunct to lithium or divalproex «bi»Extended Release«/bi» Initial Dose - 300 mg once daily on day 1 THEN, - Increase to 600 mg once daily on day 2 THEN, - Adjust dose to between 400 to 800 mg once daily on day 3 Usual Dosage Range - 400 to 800 mg once daily Maximum Dose - 800 mg once daily «b»Maintenance Therapy«/b» Adjunct to Lithium or Divalproex «bi»Immediate Release or Extended Release«/bi» Usual Dosage Range - 400 to 800 mg daily Maximum Dose - 800 mg daily Maintenance Dose - In the maintenance phase, patients generally continue on the same dose on which they were stabilized - Average time of stabilization was 15 weeks in clinical trials - During maintenance treatment, periodically reassess need for continued therapy and the appropriate dose. «bu»Major Depressive Disorder«/bu» Adjunct to Antidepressants «bi»Extended Release«/bi» Initial Dose - 50 mg once daily on days 1 and 2 THEN, - Increase to 150 mg once daily on day 3 Usual Dosage Range - 150 to 300 mg daily Maximum Dose - 300 mg once daily «bu»Schizophrenia«/bu» «bi»Immediate Release«/bi» Initial Dose - 25 mg twice daily Maintenance Dose - Increase in increments of 25 to 50 mg divided 2 to 3 times daily on days 2 and 3 to a range of 300 to 400 mg daily in 2 to 3 divided doses by day 4 - Further adjustments as needed at intervals of at least 2 days in increments of 25 to 50 mg twice daily Usual Dosage Range - 150 to 750 mg daily Maximum Dose - 750 mg daily «bi»Extended Release«/bi» Initial Dose - 300 mg once daily Maintenance Dose - Increase in increments of up to 300 mg once daily (in intervals of ≥1 day) - Usual Dosage Range: 400 to 800 mg once daily Maximum Dose - 800 mg once daily. «b»Maintenance Therapy (Monotherapy)«/b» «bi»Extended Release«/bi» Usual Dosage Range - 400 to 800 mg once daily Maximum Dose - 800 mg once daily - During maintenance treatment, periodically reassess need for continued therapy and the appropriate dose. «bu»Delusional Parasitosis«/bu» «bi»Immediate Release«/bi» Initial Dose - 12.5 mg at bedtime Maintenance Dose - Increase every 3 to 7 days based on response and tolerability up to 200 to 300 mg at bedtime or in divided doses Maximum Dose - 800 mg/day «bu»Generalized Anxiety Disorder«/bu» «b»Monotherapy«/b» «bi»Extended Release«/bi» Initial Dose - 50 mg once daily at bedtime Maintenance Dose - Based on response and tolerability, after 3 days increase dose to 150 mg once daily at bedtime - Dosage adjustments up to 300 mg once daily at bedtime may be considered after at least 2 days of 150 mg daily «bu»ICU Delirium«/bu» «bi»Immediate Release«/bi» Initial Dose - 50 mg twice daily Maintenance Dose - May increase as necessary on a daily basis in increments of 50 mg twice daily to a maximum dose of 400 mg daily «bu»Obsessive-Compulsive Disorder«/bu» «b»Treatment-Resistant Augmentation«/b» «bi»Immediate Release«/bi» Initial Dose - 25 to 50 mg once daily Maintenance Dose - Increased gradually based on response and tolerability up to 400 mg/day «bu»Post-Traumatic Stress Disorder«/bu» «bi»Immediate Release«/bi» Initial Dose - 25 mg at bedtime Maintenance Dose - Increase dose at 25 mg increments every 1 to 2 days up to 100 mg at bedtime by the end of week 1 - Further adjust dose based on response and tolerability at increments of 25 mg/day or up to 100 mg/week, to a maximum dose of 400 mg/day administered in 1 or 2 divided doses «b»Switching from IR to ER«/b» - May convert patients from immediate release to extended release tablets at the equivalent total daily dose and administer once daily; individual dosage adjustments may be necessary. «b»Re-initiation of Treatment«/b» - Patients who have discontinued therapy for >1 week should generally be retitrated following reinitiation of therapy - Patients who have discontinued <1 week, can generally be reinitiated on their previous maintenance dose «b»Strong CYP3A4 Inhibitor«/b» - Decrease quetiapine to one-sixth of the original dose - When strong CYP3A4 inhibitor is discontinued, increase quetiapine by sixfold. «b»Strong CYP3A4 Inducer«/b» - Increase quetiapine up to fivefold of the original dose when combined with chronic treatment (>7 to 14 days) of a strong CYP3A4 inducer - Titrate based on clinical response and tolerance - When the strong CYP3A4 inducer is discontinued, decrease quetiapine to the original dose within 7 to 14 days. «b»Discontinuation of Therapy«/b» - The manufacturer and American Psychiatric Association (APA), Canadian Psychiatric Association (CPA), and World Federation of Societies of Biological Psychiatry (WFSBP) guidelines recommend gradually tapering antipsychotics to avoid withdrawal symptoms and minimize the risk of relapse

Quinapril

Accupril

Quinapril-Hydrochlorothiazide

Accuretic

QuiNIDine

Quin-Tab, Quinidex, Quinaglute, Quinidine Gluconate

- Dosage expressed in terms of the salt: 267 mg of quinidine gluconate = 200 mg of quinidine sulfate. «bu»Atrial Fibrillation/Flutter«/bu» - Pharmacological conversion - Discontinue use if at any time during therapy, the QRS complex widens to 130% of its pretreatment duration, the QTc interval widens to 130% of its pretreatment duration and is >500 msecs, P waves disappear, or the patient develops significant tachycardia, symptomatic bradycardia, or hypotension; consider other means of cardioversion (eg direct current cardioversion). Discontinue if sinus rhythm is not restored in a reasonable amount of time. For patients with structural heart disease or other risk factors for toxicity, initiate or dose-adjust in a setting where continuous monitoring and resuscitation are available. Monitor patients for 2 to 3 days once the appropriate dose has been achieved. «b»Immediate Release«/b» - Initial Dose: 400 mg/dose every 6 hours - If after 4 or 5 doses there is no conversion, may increase cautiously to desired effect «b»Extended Release«/b» «bi»Quinidine Sulfate«/bi» - Initial Dose: 300 mg PO every 8 to 12 hours - The dose may be increased cautiously to desired effect «bi»Quinidine Gluconate«/bi» - Initial Dose: 648 mg PO every 8 hours - If after 3 or 4 doses there is no conversion, may increase cautiously to desired effect. - Initial Dose: 324 mg PO every 8 hours for 2 days; then, - 648 mg PO every 12 hours for 2 days; then, - 648 mg PO every 8 hours for up to 4 days. - The 4 day stretch may come at one of the lower doses if a lower dose is the highest tolerated dosing regimen. IV - Usual <5 mg/kg IV (but may need up to 10 mg/kg) at 0.25 mg/kg/min «bu»Paroxysmal Supraventricular Tachycardia (PSVT)«/bu» «b»Quinidine Sulfate«/b» - 400-600 mg PO every 2-3 hr until paroxysm terminated «b»Quinidine Gluconate«/b» - 400 - 600 mg PO every 2-3 hr until paroxysm is terminated - Usual <5 mg/kg IV (but may need up to 10 mg/kg) at 0.25 mg/kg/min «bu»Premature Atrial/Ventricular Contractions«/bu» «b»Quinidine Sulfate«/b» - 200-300 mg PO every 6-8 hr «bu»Severe Malaria Treatment«/bu» «b»Quinidine Gluconate«/b» - 10 mg/kg IV infused over 60 to 120 minutes, then, - 0.02 mg/kg/minute continuous IV infusion for ≥24 hours - Alternatively, may administer 24 mg/kg loading dose over 4 hours, followed by 12 mg/kg over 4 hours every 8 hours (beginning 8 hours after initiation of the loading dose) - Complete treatment with oral quinine once parasite density <1% and patient can receive oral medication; total duration of treatment (quinidine/quinine): 3 days (Africa or South America) or 7 days (Southeast Asia); use in combination with doxycycline, tetracycline, or clindamycin - Close monitoring, including telemetry, required

Quinine

QM-260, Qualaquin

Quinupristin

Quinupristin-Dalfopristin

Synercid

RABEprazole

AcipHex, Pariprazole

«bu»Duodenal Ulcer«/bu» - 20 mg once daily for ≤4 weeks - Additional therapy to achieve healing may be required for some patients «bu»Gastric Ulcers«/bu» - 20 mg once daily up to 6 weeks - Additional therapy to achieve healing may be required for some patients «bu»Gastroesophageal Reflux Disease (GERD)«/bu» «b»Erosive or Ulcerative GERD«/b» - 20 mg once daily for 4 to 8 weeks - If inadequate response, may repeat up to an additional 8 weeks - Maintenance Dose: 20 mg once daily «b»Symptomatic GERD«/b» - 20 mg once daily for ≤4 weeks; if inadequate response - May repeat for an additional 4 weeks «bu»Helicobacter Pylori Eradication«/bu» - 20 mg twice daily administered with amoxicillin 1,000 mg and clarithromycin 500 mg twice daily for 7 days «b»Clarithromycin Triple Regimen«/b» - 20 to 40 mg twice daily in combination with clarithromycin 500 mg twice daily and either amoxicillin 1 g twice daily or metronidazole 500 mg 3 times per day - Continue regimen for 14 days - Avoid use of clarithromycin triple therapy in patients with risk factors for macrolide resistance (eg, prior macrolide exposure, local clarithromycin resistance rates ≥15%, eradication rates with clarithromycin-based regimens ≤85%) «b»Bismuth Quadruple Regimen«/b» - 20 mg twice daily in combination with tetracycline 500 mg 4 times per day, metronidazole 250 mg 4 times per day or 500 mg 3 or 4 times per day, and either bismuth subcitrate 120 to 300 mg 4 times per day or bismuth subsalicylate 300 mg 4 times per day; continue regimen for 10 to 14 days. «b»Concomitant Regimen«/b» - 20 mg twice daily in combination with amoxicillin 1 g twice daily, clarithromycin 500 mg twice daily, and either metronidazole or tinidazole 500 mg twice daily; continue regimen for 10 to 14 days. «b»Sequential Regimen«/b» - 20 mg twice daily plus amoxicillin 1 g twice daily for 5 to 7 days; then continue rabeprazole along with clarithromycin 500 mg twice daily, and either metronidazole or tinidazole 500 mg twice daily for 5 to 7 days. «b»Hybrid Regimen«/b» - 20 mg twice daily plus amoxicillin 1 g twice daily for 7 days; then continue rabeprazole and amoxicillin along with clarithromycin 500 mg twice daily, and either metronidazole or tinidazole 500 mg twice daily for 7 days. «b»Levofloxacin Triple Regimen«/b» - 20 mg twice daily in combination with amoxicillin 1 g twice daily and levofloxacin 500 mg once daily - Continue regimen for 10 to 14 days «bu»Zollinger-Ellison Syndrome«/bu» - Initial Dose: 60 mg once daily - Adjust dose to patient needs (some may require divided doses) - Doses as high as 100 mg once daily and 60 mg twice daily have been used - Continue as long as clinically indicated. «bu»Nonerosive Reflux Disease (NERD)«/bu» - 10 mg (maximum: 20 mg once daily) for 4 weeks - Lack of symptom control after 4 weeks warrants further evaluation

Rabies Immune Globulin, Human (RIG)

Imogam Rabies-HT, HyperRAB, Kedrab

Rabies Vaccine Adsorbed

Imovax Rabies, RabAvert

«b»IM Administration«/b» - For IM administration only - Do not administer intradermally or SC - In adults and children, administer IM injections in the deltoid muscle - For younger children, use the outer aspect of the thigh. - Avoid administration into the gluteal area; may result in lower response. - Postexposure prophylaxis should begin with immediate cleansing of wounds with soap and water; if available, a virucidal agent (povidone-iodine solution) should be used to irrigate the wounds. - Do not mix rabies vaccine and human rabies immune globulin in the same syringe, and do not administer in the same anatomical site. - Do not mix with other vaccines or injections; separate needles and syringes should be used for each injection - To prevent syncope related injuries, adolescents and adults should be vaccinated while seated or lying down. - US law requires that the date of administration, the vaccine manufacturer, lot number of vaccine, and the administering person's name, title, and address be entered into the patient's permanent medical record. - For patients at risk of hemorrhage following intramuscular injection, the vaccine should be administered intramuscularly if, in the opinion of the physician familiar with the patient's bleeding risk, the vaccine can be administered by this route with reasonable safety. If the patient receives antihemophilia or other similar therapy, intramuscular vaccination can be scheduled shortly after such therapy is administered. A fine needle (23 gauge or smaller) can be used for the vaccination and firm pressure applied to the site (without rubbing) for at least 2 minutes. - The patient should be instructed concerning the risk of hematoma from the injection. Patients on anticoagulant therapy should be considered to have the same bleeding risks and treated as those with clotting factor disorders «b»Reconstitution«/b» - Reconstitute with provided diluent - Gently swirl to dissolve - Use immediately after reconstitution «bi»Imovax«/bi» - Suspension will appear pink to red «bi»RabAvert«/bi» - Suspension will appear clear to slightly opaque to slightly pink

Radium Ra 223

Xofigo

Raloxifene

Evista, Keoxifene

Raltegravir

Isentress

«bu»HIV-1 Infection«/bu» - Raltegravir film-coated tablets and chewable tablets or oral suspension are not bioequivalent and are not substitutable on a mg/mg basis «b»Infants and Children weighing 3 to <20 kg«/b» «bi»Oral Suspension (10 mg/mL)«/bi» - Weight-directed dosing: 6 mg/kg/dose twice daily - Maximum Dose: 100 mg/dose Fixed-Dosing - 3 to <4 kg: 25 mg (2.5 mL) twice daily. - 4 to <6 kg: 30 mg (3 mL) twice daily. - 6 to <8 kg: 40 mg (4 mL) twice daily. - 8 to <11 kg: 60 mg (6 mL) twice daily. - 11 to <14 kg: 80 mg (8 mL) twice daily. - 14 to <20 kg: 100 mg (10 mL) twice daily. «b»Children weighing ≥11 kg«/b» «bi»Chewable Tablets«/bi» - Weight-directed dosing: 6 mg/kg/dose twice daily; maximum dose: 300 mg/dose Fixed-Dosing - 11 to <14 kg: 75 mg (3 x 25 mg tablet) twice daily. - 14 to <20 kg: 100 mg (1 x 100 mg tablet) twice daily. - 20 to <28 kg: 150 mg (1.5 x 100 mg tablet) twice daily. - 28 to <40 kg: 200 mg (2 x 100 mg tablet) twice daily. - ≥40 kg: 300 mg (3 x 100 mg tablet) twice daily. «b»Children and Adolescents Weighing ≥25 kg«/b» - who are able to swallow a tablet whole«/bi» «bi»Film-coated Tablets«/bi» - 400 mg twice daily. «b»Children and Adolescents Weighing ≥40 kg who are treatment-naïve«/b» - 400 mg twice daily or 1,200 mg (2 x 600 mg tablet) once daily - Patients virologically suppressed on an initial regimen of raltegravir 400 mg twice daily may switch to 1,200 mg (2 x 600 mg tablet) once daily. «b»Dosage Adjustment for Rifampin Coadministration«/b» - There are no data to guide dose adjustment in patients <18 years. «bu»HIV-1 Nonoccupational Postexposure Prophylaxis (nPEP)«/bu» (off-label use) - Initiate therapy within 72 hours of exposure and continue for 28 days - Use in combination with other antiretroviral agents. «b»Infants and Children <2 years«/b» «bi»Oral Suspension«/bi» - 6 mg/kg/dose twice daily «b»Children ≥2 years«/b» «bi»Chewable Tablets«/bi» - 11 to <14 kg: 75 mg twice daily - 14 to <20 kg: 100 mg twice daily - 20 to <28 kg: 150 mg twice daily - 28 to <40 kg: 200 mg twice daily - ≥40 kg: 300 mg twice daily «b»Children ≥ 6 years weighing >25 kg«/b» - who are able to swallow a tablet whole «bi»Film-coated Tablet«/bi» - 400 mg PO bid «b»Adolescents«/b» «bi»Film-coated Tablet«/bi» - Refer to adult dosing «b»Children Pharmacokinetics«/b» - At birth, the enzyme responsible for the metabolism of raltegravir is low and increases over first 4 to 6 weeks of life. In neonates <4 weeks of age, raltegravir competes with bilirubin for albumin protein binding sites and may increase unconjugated bilirubin concentrations; however, in vitro data suggests that this effect unlikely to be significant at typical serum concentration

Ramelteon

Rozerem

Ramipril

Altace

Ramucirumab

Cyramza

Ranibizumab

Byooviz, Cimerli, Lucentis

Ranibizumab Intravitreal Implant

Susvimo

RaNITidine

Zantac, Deprizine FusePaq

Ranolazine ER

Ranexa

Rasagiline

Azilect

Rasburicase

Elitek, Recombinant Urate Oxidase

Ravulizumab

Ultomiris

Raxibacumab

Regadenoson

Lexiscan

Regorafenib

Stivarga

«bu»Colorectal Cancer«/bu» «b»Metastatic«/b» - 160 mg once daily for the first 21 days of each 28-day cycle - Continue until disease progression or unacceptable toxicity «bu»Gastrointestinal Stromal Tumor (GIST)«/bu» «b»Locally-Advanced Unresectable, or Metastatic«/b» - 160 mg once daily for the first 21 days of each 28-day cycle - Continue until disease progression or unacceptable toxicity «bu»Hepatocellular Carcinoma«/bu» - 160 mg once daily for the first 21 days of a 28-day cycle - Continue until disease progression or unacceptable toxicity «b»Missed Doses«/b» - Do not administer 2 doses on the same day to make up for a missed dose from the previous day. - If dose reduction is necessary, reduce in 40 mg increments; the lowest recommended dose is 80 mg/day. «b»Dermatologic«/b» «bi»Grade 2 Hand-foot Skin Reaction (HFSR; Palmar-Plantar Erythrodysesthesia Syndrome [PPES]) of Any Duration«/bi» - Reduce dose to 120 mg once daily for first occurrence. - If grade 2 HFSR recurs at this dose, further reduce the dose to 80 mg once daily. - Interrupt therapy for grade 2 HFSR that is recurrent or fails to improve within 7 days in spite of dosage reduction. «bi»Grade 3 HFSR«/bi» - Interrupt therapy for a minimum of 7 days. Upon recovery, reduce dose to 120 mg once daily. - If grade 2 to 3 toxicity recurs at this dose, further reduce dose to 80 mg once daily upon recovery. - Interrupt therapy for grade 2 to 3 HFSR that is recurrent or fails to improve within 7 days in spite of dosage reduction. «bi»Recurrent or Persistent HFSR at 80 mg daily«/bi» - Discontinue treatment. «bi»Other Dermatologic Toxicity«/bi» - Withhold treatment, reduce dose or permanently discontinue treatment depending on the severity and persistence of the dermatologic toxicity - Symptomatic relief may be managed with supportive measures. «b»Hypertension«/b» «bi»Grade 2 (symptomatic)«/bi» - Interrupt therapy. «b»Infection«/b» «bi»Grade 3 or 4 (or worsening infection of any grade)«/bi» - Interrupt therapy; resume regorafenib at the same dose following infection resolution. «b»Other Toxicity«/b» «bi»Any Grade 3 or 4 Adverse Reaction«/bi» - Other than hepatotoxicity or infection - Interrupt therapy; upon recovery, reduce dose to 120 mg once daily (except infection). - If any grade 3 or 4 adverse reaction occurs (other than hepatotoxicity or infection) while on this reduced dose, may further reduce dose to 80 mg once daily upon recovery. - For any grade 4 adverse reaction, only resume therapy if the benefit outweighs the risk. Permanently discontinue therapy if unable to tolerate 80 mg once daily. «bi»Gastrointestinal Perforation/Fistula«/bi» - Discontinue permanently «bi»Hemorrhage (Severe or Life-threatening)«/bi» - Discontinue permanently «bi»Reversible posterior leukoencephalopathy syndrome (RPLS)«/bi» - Discontinue. «bi»Wound Dehiscence«/bi» - Discontinue.

Relebactam

Relugolix

Orgovyx

Relugolix-Estradiol-Norethindrone

Myfembree

Remdesivir

Veklury, GS-5734

«b»IV Infusion Administration«/b» - Remdesivir should be administered via intravenous (IV) infusion only. - Do not administer as an intramuscular (IM) injection - Remdesivir is to be administered via intravenous infusion in a total volume of up to 250 mL 0.9% saline over 30 to 120 minutes. «b»IV Infusion Reconstitution«/b» - Remove the required number of single-dose vial(s) from storage «bi»For Each Vial«/bi» - Aseptically reconstitute remdesivir lyophilized powder by addition of 19 mL of Sterile Water for Injection using a suitably sized syringe and needle per vial. - Discard the vial if a vacuum does not pull the Sterile Water for Injection into the vial. - Immediately shake the vial for 30 seconds. - Allow the contents of the vial to settle for 2 to 3 minutes. A clear solution should result. - If the contents of the vial are not completely dissolved, shake the vial again for 30 seconds and allow the contents to settle for 2 to 3 minutes. - Repeat this procedure as necessary until the contents of the vial are completely dissolved. - Following reconstitution, each vial contains 100 mg/20 mL (5 mg/mL) of remdesivir solution. - Parenteral drug products should be inspected visually for particulate matter and discoloration prior to administration, whenever solution and container permit. - After reconstitution, the total storage time before administration should not exceed 4 hours at room temperature or 24 hours at refrigerated temperature (2°C to 8°C [36°F to 46°F]). - Care should be taken during admixture to prevent inadvertent microbial contamination. As there is no preservative or bacteriostatic agent present in this product, aseptic technique must be used in preparation of the final parenteral solution. It is always recommended to administer IV medication immediately after preparation when possible. «b»Volume of 0.9% Saline to Withdraw from the Infusion Bag«/b» «bi»Remdesivir Dose 200mg/250mL NS«/bi» Required Volume of reconstituted Remdesivir for Injection - 40 mL (2 x 20 mL) Volume of Saline to be Withdrawn and Discarded from 0.9% Saline Infusion Bag - 40 mL «bi»Remdesivir Dose 200mg/100mL NS«/bi» Required Volume of reconstituted Remdesivir for Injection - 40 mL (2 x 20 mL) Volume of Saline to be Withdrawn and Discarded from 0.9% Saline Infusion Bag - 40 mL «bi»Remdesivir Dose 100mg/250mL NS«/bi» Required Volume of reconstituted Remdesivir for Injection - 20 mL (1 x 20 mL) Volume of Saline to be Withdrawn and Discarded from 0.9% Saline Infusion Bag - 20 mL «bi»Remdesivir Dose 100mg/100mL NS«/bi» Required Volume of reconstituted Remdesivir for Injection - 20 mL (1 x 20 mL) Volume of Saline to be Withdrawn and Discarded from 0.9% Saline Infusion Bag - 20 mL Withdraw the required volume of saline from the bag using an appropriately sized syringe and needle. - Discard the saline that was withdrawn from the bag. - Withdraw the required volume of reconstituted remdesivir for injection from the remdesivir vial using an appropriately sized syringe. - Discard any unused portion remaining in the remdesivir vial. - Transfer the required volume of reconstituted remdesivir for injection the selected infusion bag. - Gently invert the bag 20 times to mix the solution in the bag - Do not shake. - The prepared diluted solution is stable for 4 hours at room temperature (20°C to 25°C [68°F to 77°F]) or 24 hours in the refrigerator at 2°C to 8°C (36°F to 46°F).

Remifentanil

Ultiva

«bu»Anesthesia«/bu» «b»IV Continuous Infusion«/b» «bi»Induction of Anesthesia«/bi» - 0.5 to 1 mcg/kg/minute; if endotracheal intubation is to occur in <8 minutes, an initial dose of 1 mcg/kg may be administered over 30 to 60 seconds «bi»Coronary Bypass Surgery«/bi» - 1 mcg/kg/minute «bi»Maintenance of Anesthesia«/bi» - Supplemental bolus dose of 1 mcg/kg may be administered every 2 to 5 minutes. - Consider increasing concomitant anesthetics with infusion rate >1 mcg/kg/minute. - Infusion rate can be titrated upward in increments of 25% to 100% or downward in decrements of 25% to 50% every 2 to 5 minutes. - With nitrous oxide (66%): 0.4 mcg/kg/minute (range: 0.1 to 2 mcg/kg/minute) - With isoflurane: 0.25 mcg/kg/minute (range: 0.05 to 2 mcg/kg/minute) - With propofol: 0.25 mcg/kg/minute (range: 0.05 to 2 mcg/kg/minute) - Coronary bypass surgery: 1 mcg/kg/minute (range: 0.125 to 4 mcg/kg/minute); - Supplemental Dose: 0.5 to 1 mcg/kg «bu»Analgesia«/bu» «b»Continuation as an Analgesic in Immediate Postoperative Period«/b» - 0.1 mcg/kg/minute (Range: 0.025 to 0.2 mcg/kg/minute) - Infusion rate may be adjusted every 5 minutes in increments of 0.025 mcg/kg/minute. - Bolus doses are not recommended. - Infusion rates >0.2 mcg/kg/minute are associated with respiratory depression. «b»Coronary Bypass Surgery«/b» - Continuation as an analgesic into the ICU: 1 mcg/kg/minute (range: 0.05 to 1 mcg/kg/minute) «b»Analgesic Component of Monitored Anesthesia Care«/b» Supplemental oxygen is recommended: «bi»Single IV dose Administered 90 Seconds Prior to Local Anesthetic«/bi» - Remifentanil alone: 1 mcg/kg over 30 to 60 seconds - With midazolam: 0.5 mcg/kg over 30 to 60 seconds «bi»Continuous Infusion Beginning 5 minutes Prior to Local Anesthetic«/bi» - Remifentanil alone: 0.1 mcg/kg minute - With midazolam: 0.05 mcg/kg/minute «bi»Continuous Infusion Administered After Local Anesthetic«/bi» - Remifentanil alone: 0.05 mcg/kg/minute (range: 0.025 to 0.2 mcg/kg/minute) - With midazolam: 0.025 mcg/kg/minute (range: 0.025 to 0.2 mcg/kg/minute) - Following local or anesthetic block, infusion rate should be decreased to 0.05 mcg/kg/minute; rate adjustments of 0.025 mcg/kg/minute may be done at 5-minute intervals. Infusion rates >0.2 mcg/kg/minute are associated with respiratory depression. «b»Critically-ill Patients«/b» - Loading Dose: 1.5 mcg/kg, then, - 0.008 to 0.25 mcg/kg/minute (or 0.5 to 15 mcg/kg/hour) - Initial dose should be based on ideal body weight (IBW) in obese patients (>30% over IBW)

Remimazolam

Byfavo

Repaglinide

Prandin

Repaglinide-Metformin

PrandiMet

Reslizumab

Cinqair

Respiratory Syncytial Virus Vaccine (GSK)

Arexvy, RSV Vaccine Adjuvant

Respiratory Syncytial Virus Vaccine (Pfizer)

Abrysvo, RSV Vaccine Adjuvant

«b»IM Administration«/b» - For IM injection only «b»IM Preparation«/b» - Prepare by reconstituting lyophilized antigen component (sterile white powder) with the accompanying prefilled syringe containing sterile water diluent component and a vial adapter Step 1 - Removal of cap - Remove plastic flip off cap from vial and cleanse rubber stopper -Without removing vial adapter from its packaging, peel off top cover Step 2 - Attachment of vial adapter - Hold base of vial on flat surface - Keep vial adapter in packaging and orient it vertically over center of vial so that adapter spike aligns with center of vial’s rubber stopper - Connect vial adapter to vial with a straight downward push; vial adapter will lock into place - Do not push vial adapter in at an angle as this may result in leaking during use - Remove vial adapter packaging Step 3 - Removal of syringe cap - For all syringe assembly steps, hold syringe only by Luer lock adapter located at tip of the syringe; this will prevent Luer lock adapter from detaching during use - Remove syringe cap by slowly turning cap counter-clockwise while holding Luer lock adapter Step 4 - Connection of syringe to vial adapter - Hold the syringe’s Luer lock adapter and connect it to vial adapter by turning clockwise Stop turning when you feel resistance, overtightening syringe may result in leaking during use - When syringe is securely attached to vial adapter, there will be a small space between top of vial adapter and the Luer lock adapter of syringe Step 5 - Reconstitution of lyoophilized antigen component - Inject entire contents of syringe containing sterile water diluent into vial - Do not remove empty syringe - While holding plunger rod down, gently swirl vial in circular motion until powder is completely dissolved (<1 min) - Do not shake Step 6 - Withdrawal of reconstituted vaccine - Invert vial completely with vial adapter and syringe still attached - Slowly withdraw entire contents into syringe to ensure ~0.5 mL dose of vaccine for administration - Do not pull plunger rod out Step 7 - Disconnection of syringe - Hold Luer lock adapter of syringe and disconnect syringe from vial adapter by turning counter-clockwise Step 8 - Attachement of new needle - Attach sterile needle suitable for IM injection to syringe containing vaccine Step 9 - Visual inspection - Solution should appear clear and colorless - Inspect visually for particulate matter and discoloration - Discard if either condition is present - Store at room temperature and use within 4 hr after reconstitution

Retapamulin

Altabax

Reteplase

Retavase, Recombinant Plasminogen Activator, r-PA

Revefenacin

Yupelri

Rezafungin

Rezzayo

Rho(D) Immune Globulin

WinRho, HypRho-D, HyperRHO, RhoIGIV, RhoGAM,Gamulin Rh, MicRhoGAM, Rhesonativ, HyperRHO, Rhophylac

Ribavirin

Rebetol, Ribasphere, Copegus, Tribavirin, RibaTab, Moderiba

«bu»Chronic Hepatitis C«/bu» - In combination with pegterferon alfa-2a (Pegasys) - Dose reductions/interruptions recommended if Hgb falls «b»Tablets (Copegus)«/b» - In combination with peginterferon alfa-2a «bi»Genotype 1, 4; HIV-free (<75 kg)«/bi» - 1000 mg/day PO divided every 12 hr x 48 weeks «bi»Genotype 1, 4; HIV-free (≥75 kg)«/bi» - 1200 mg/day PO divided every 12 hr x 48 weeks «bi»Genotype 2/3; HIV-free«/bi» - 800 mg/day PO divided every 12 hr x 24 weeks «bu»Chronic Hepatitis C Coinfected with HIV«/bu» «b»Ribavirin«/b» - 800 mg PO divided every 12 hr (regardless of genotype) AND «b»Peginterferon alfa-2a«/b» - 180 mcg SC every week «b»Rebetol Capsule, Oral Solution, Ribasphere Combo with Peginterferon alfa 2b«/b» «bi»<66 kg (145 lb)«/bi» - 800 mg/day (400 mg AM and 400 PM) AND Peginterferon 1.5 mcg/kg/Wk SC «bi»66-80 kg (145-177 lb)«/bi» - 1000 mg/day (400 mg AM and 600 PM) + Peginterferon 1.5 mcg/kg/Wk SC «bi»81-105 kg (178-231 lb)«/bi» - 1200 mg/day (600 mg AM and 600 PM) + Peginterferon 1.5 mcg/kg/Wk SC «bi»>105 kg (231 lb)«/bi» - 1400 mg/day (600 mg AM and 800 PM) + Peginterferon 1.5 mcg/kg/Wk SC «bi»Recommended Therapy Duration«/bi» - Genotype 1: 48 weeks - Genotype 2,3: 24 weeks «b»Patients Who Previously Failed Therapy«/b» - 48 weeks, regardless of genotype «b»Ribavirin (Rebetol capsule and solution; Ribasphere) with Interferon alfa 2b«/b» «bi»≤75 kg«/bi» - 400 mg PO qAM, 600mg PO qPM plus 3 million IU three times weekly SC for 24-48 weeks «bi»>75 kg«/bi» - 600 mg PO q12hr plus 3 million IU three times weekly SC for 24-48 weeks «bi»Recommended Therapy Duration«/bi» - Patients previously untreated with interferon: 24-48 weeks - Patients who relapse following inteferon monotherapy: 24 weeks «bu»HIV/HCV Coinfection«/bu» «b»Copegus«/b» - 800 mg/d PO divided every 12h x 48 weeks - RibaPak, Copegus, Ribasphere and equivalents used with peginterferon alfa-2a (Pegasys) «bi»Coadministered Dose of Peginterferon alfa-2a«/bi» - 180 mcg weekly

Ribavirin (Oral Inhalation)

Virazole, Tribavirin, RTCA

Ribociclib

Kisqali

«bu»Breast Cancer«/bu» «b»Advanced or Metastatic (HR-Positive, HER-2 Negative)«/b» Initial Dose - 600 mg PO once daily x 21 days Maintenance Dose - Followed by a 7-day rest period to complete a 28-day treatment cycle (in combination with continuous letrozole) - Continue until disease progression or unacceptable toxicity - May also be administered in combination with other aromatase inhibitors. «b»Missed Doses«/b» - If a dose is missed or vomited, do not administer an additional dose that day - Resume ribociclib dosing with the next usual dose. «b»Strong CYP3A Inhibitors«/b» - Avoid concomitant use with strong CYP3A inhibitors and consider alternatives with less potential for CYP3A inhibition - If coadministration with a strong CYP3A inhibitor cannot be avoided, reduce ribociclib dose to 400 mg once daily - If the strong inhibitor is discontinued, increase ribociclib dose (after at least 5 inhibitor half-lives have elapsed) to the dose used prior to initiating the strong CYP3A inhibitor. «b»Recommended Dosage Adjustment Levels«/b» Starting Dose - 600 mg/day. First Dose Reduction - Reduce to 400 mg/day. Second Dose Reduction - Reduce to 200 mg/day. - If further dose reduction below 200 mg/day is needed, discontinue ribociclib «b»Grade 1 or 2 Neutropenia«/b» - ANC 1,000/mm3 to below the lower limit of normal - No dosage adjustment necessary. «b»Grade 3 Neutropenia«/b» - ANC 500 to <1,000/mm3 - Interrupt treatment until recovery to grade 2 or lower and then resume ribociclib at the same dose - For recurrent grade 3 neutropenia, interrupt treatment until recovery and then resume ribociclib at the next lower dose level. «b»Grade 3 Neutropenia with Neutropenic Fever«/b» - A single episode of fever >38.3°C or fever above 38°C for more than 1 hour and/or concurrent infection - Interrupt treatment until recovery to grade 2 or lower and then resume ribociclib at the next lower dose level. «b»Grade 4 Neutropenia«/bi» - ANC <500/mm3 - Interrupt treatment until recovery to grade 2 or lower and then resume ribociclib at the next lower dose level. «b»Cardiovascular QT Prolongation«/b» «bi»QTcF >480 msec«/bi» - Interrupt treatment - When QTcF resolves to <481 msec, may resume ribociclib at the same dose level - If QTcF ≥481 msec recurs, interrupt treatment until QTcF resolves to <481 msec and resume ribociclib at the next lower dose level. «bi»QTcF >500 msec«/bi» - Interrupt treatment for QTcF >500 msec on at least 2 separate ECGs (within the same visit) - If QTcF resolves to <481 msec, may resume ribociclib at the next lower dose level. - If QTcF interval prolongation is either >500 msec or >60 msec increase from baseline AND associated with torsades de pointes, polymorphic ventricular tachycardia, unexplained syncope, or signs/symptoms of serious arrhythmia, permanently discontinue ribociclib. «b»Other Non-hematologic Toxicities«/b» «bi»Grade 1 or 2«/bi» - No dosage adjustment necessary - Initiate appropriate medical management and monitoring as indicated. «bi»Grade 3«/bi» - Interrupt treatment until recovery to grade 1 or lower and then resume ribociclib at the same dose level. - If grade 3 toxicity recurs, interrupt treatment until recovery to grade 1 or lower and then resume ribociclib at the next lower dose level. «bi»Grade 4«/bi» - Discontinue ribociclib.

Ribociclib-Letrozole

Kisqali-Femara

Riboflavin

B-2-400, Lactoflavin, Vitamin B2, Vitamin G

Rifabutin

Mycobutin, Ansamycin

RifAMPin

Rifadin, Rifampicin, Rimactane

Rifamycin

Aemcolo

Rifapentine

Priftin

RifAXIMin

Xifaxan

Rilonacept

Arcalyst

Rilpivirine

Edurant

Riluzole

Rilutek, Tiglutik, Exservan

RimabotulinumtoxinB

Myobloc, Botulinum Toxin Type B

RiMANTAdine

Flumadine

Rimegepant

Nurtec ODT

Rimexolone

Vexol

Riociguat

Adempas

Ripretinib

Qinlock

«bu»Gastrointestinal Stromal Tumors«/bu» - 150 mg PO daily - Continue until disease progression or unacceptable toxicity «b»Pregnancy«/b» - Verify pregnancy status of females of reproductive potential before initiating «b»Contraception«/b» «bi»Females of Reproductive Potential«/bi» - Use effective contraception during treatment and for at least 1 week after the final dose «bi»Males with Female Partners of Reproductive Potential«/bi» - Use effective contraception during treatment and for at least 1 week after the final dose «b»Infertility«/b» - Based on findings from animal studies, fertility may be impaired in males of reproductive potential «b»Missed Dose«/b» - <8 hr passed since missed scheduled dose: May take missed dose «b»Vomited Dose«/b» - Do not to take an additional dose and continue with next scheduled dose «b»Dose Reduction Recommendations«/b» - Reduce to 100 mg daily - Unable to tolerate 100 mg/day: Permanently discontinue «b»Left Ventricular Systolic Dysfunction (LVSD)«/b» «bi»Grade 3 or 4«/bi» - Permanently discontinue «b»Palmoplantar Erythrodysesthesia Syndrome (PPES)«/b» «bi»Grade 2«/bi» - Withhold until Grade ≤1 or baseline; resume at the same dose if resolved within 7 days; otherwise, resume at reduced dose - Consider re-escalating dose if maintained at Grade ≤1 or baseline for at least 28 days - If PPES recurs, withhold until Grade ≤1 or baseline and then resume at a reduced dose regardless of time to improvement «bi»Grade 3«/bi» - Withhold for at least 7 days or until Grade ≤1or baseline (maximum 28 days) and then resume at reduced dose - Consider re-escalating dose if maintained at Grade ≤1 for at least 28 days «b»Hypertension«/b» «bi»Grade 3«/bi» - Symptomatic: Withhold until symptoms resolve and blood pressure (BP) is controlled; resume at the same dose if BP is controlled to Grade ≤1 or baseline; otherwise, resume at reduced dose - Grade 3 hypertension recurs: Withhold until symptoms resolve and BP is controlled; resume at reduced dose «bi»Grade 4«/bi» - Permanently discontinue «b»Arthralgia or Myalgia«/b» «bi»Grade 2«/bi» - Withhold until Grade ≤1 or baseline; resume at the same dose if resolved within 7 days; otherwise, resume at reduced dose - Consider re-escalating dose if maintained at Grade ≤1 or baseline for at least 28 days If arthralgia or myalgia recurs, withhold until Grade ≤1 or baseline and then resume at a reduced dose regardless of time to improvement «bi»Grade 3«/bi» - Withhold for at least 7 days or until Grade ≤1 or baseline (maximum 28 days) and then resume at reduced dose - Consider re-escalating dose if maintained at Grade ≤1 or baseline for at least 28 days «b»Other Adverse Reactions«/b» «bi»Grade 3 or 4«/bi» - Withhold for at least 7 days or until Grade ≤1 or baseline (maximum 28 days) and then resume at reduced dose; otherwise permanently discontinue - Consider re-escalating dose if maintained at Grade ≤1 for at least 28 days - If Grade 3 or 4 recurs, permanently discontinue

Risankizumab

Skyrizi

Risdiplam

Evrysdi

«b»Oral Administration«/b» - Take once daily after a meal at approximately the same time each day - Drink water after administration to ensure drug is completely swallowed «bi»Nasogastric or Gastrostomy Tube«/bi» - Flush tube with water after administering «bi»Breastfed Infants«/bi» - Administer after breastfeeding «b»Oral Solution (0.75 mg/mL) Reconstitution«/b» - Gently tap bottom of closed glass bottle to loosen powder - Remove cap, but do not throw away - Carefully pour 79 mL of purified water into bottle to yield 0.75 mg/mL oral solution; do not mix with formula or milk - Insert press-in bottle adapter into bottle opening by pushing it down against bottle lip; ensure it is completely pressed against bottle lip - Re-cap bottle tightly and shake well for 15 seconds; wait for 10 minutes; solution should appear clear; if not, shake well again for another 15 seconds - Write expiration date (calculated as 64 days after constitution) and lot number on bottle label; peel off the part of the bottle label listing the powder expiration date - Put bottle back in its original carton - Select appropriate oral syringes (6 mL or 12 mL) based on dose and remove other oral syringes from the carton - Dispense with the “Instructions for Use” and FDA-approved patient labeling; alert patients to read the important handling information described in the Instructions for Use «b»Caution«/b» - Exercise caution handling the powder for oral solution; avoid inhalation and direct contact with skin or mucous membranes with the dry powder and constituted solution - If such contact occurs, wash thoroughly with soap and water; rinse eyes with water - Wear disposable gloves during preparation and cleanup procedure - Instruct patients or caregivers to prepare the dose using the reusable oral syringe provided - Risdiplam must be taken immediately after it is drawn up into the oral syringe; if not taken within 5 minutes, discard the drug from the oral syringe and prepare a new dose - Do not mix with formula or milk

Risedronate

Actonel, Atelvia, Actonel with Calcium

RisperiDONE

RisperDAL

- When reinitiating treatment after discontinuation, the initial titration schedule should be followed - Limiting initial oral dose to 2 mg daily (in 1 or 2 divided doses) may reduce the risk of orthostatic hypotension/syncope. «bu»Bipolar Mania«/bu» - Monotherapy or as an adjunct to lithium or divalproex - Initial Dose: 2 to 3 mg PO once daily; if needed, adjust dose by 1 mg daily in intervals ≥24 hours - Dosing Range: 1 to 6 mg daily. - Maintenance Dose: No dosing recommendation available for treatment >3 weeks' duration «bu»Bipolar I Disorder«/bu» - Monotherapy or as an adjunct to lithium or divalproex «b»Risperdal Consta«/b» - 25 mg IM every 2 weeks - If unresponsive, some may benefit from larger doses (37.5 to 50 mg) - Maximum Dose: 50 mg every 2 weeks - Dosage adjustments should not be made more frequently than every 4 weeks. - A lower initial dose of 12.5 mg may be appropriate in some patients (eg, hepatic or renal impairment, poor tolerability to other psychotropic medications). - Establishment of tolerability to oral risperidone is recommended prior to initiation of Risperdal Consta. Oral risperidone (or other antipsychotic) should be administered with the initial injection of Risperdal Consta and continued for 3 weeks (then discontinued) to maintain adequate therapeutic plasma concentrations prior to main release phase of risperidone from injection site. «bu»Schizophrenia«/bu» - Initial Dose: 2 mg daily in 1 to 2 divided doses - May be increased by 1 to 2 mg daily at intervals ≥24 hours to a recommended dosage range of 4 to 8 mg daily - Daily dosages >6 mg do not appear to confer any additional benefit, and the incidence of extrapyramidal symptoms is higher than with lower doses - Dose Range Studied in Clinical Trials: 4 to 16 mg daily - Recommended Maintenance Dosage Range: 2 to 8 mg daily «b»Risperdal Consta«/b» - Initial Dose: 25 mg IM every 2 weeks; if unresponsive, some may benefit from larger doses (37.5 to 50 mg) - Maximum Dose: 50 mg every 2 weeks - No additional benefit was observed with doses >50 mg; however, a higher incidence of adverse reactions was observed. Dosage adjustments should not be made more frequently than every 4 weeks - A lower initial dose of 12.5 mg may be appropriate in some patients (eg, demonstrated poor tolerability to other psychotropic medications). - Establishment of tolerability to oral risperidone is recommended prior to initiation of Risperdal Consta. Oral risperidone (or other antipsychotic) should be administered with the initial injection of Risperdal Consta and continued for 3 weeks (then discontinued) to maintain adequate therapeutic plasma concentrations prior to main release phase of risperidone from injection site. «bu»Delusional Parasitosis«/bu» (off-label use) - Initial Dose: 0.5 mg at bedtime - Increase gradually based on response and tolerability up to 1 to 2 mg given at bedtime or in 2 divided doses - Doses up to 8 mg/day have been evaluated «bu»Major Depressive Disorder«/bu» (off-label use) - Adjunct to antidepressants - Initial Dose: 0.25 mg to 0.5 mg daily - Slowly adjust dose based on response and tolerability up to 3 mg/day «bu»Post-Traumatic Stress Disorder (PTSD)«/bu» (off-label use) - Initial Dose: 0.5 to 1 mg at bedtime or 0.5 mg twice daily - May adjust dose based on response and tolerability to a maximum of 8 mg daily - Total daily dose may be given in 2 or 3 divided doses - Average Dose in Clinical Trials: 1.25 to 3.75 mg daily «bu»Tourette Syndrome«/bu» (off-label use) - Initial Dose: 0.25 mg once daily - Increase gradually based on response and tolerability up to a usual dosage of 0.25 to 6 mg daily - Dosage adjustments in clinical trials were commonly in increments of <0.5 mg twice daily and at intervals ≥3 days «b»Discontinuation of Therapy«/b» - American Psychiatric Association (APA), Canadian Psychiatric Association (CPA), and World Federation of Societies of Biological Psychiatry (WFSBP) guidelines recommend gradually tapering antipsychotics to avoid withdrawal symptoms and minimize the risk of relapse; risk for withdrawal symptoms may be highest with highly anti-cholinergic or dopaminergic antipsychotics - When stopping antipsychotic therapy in patients with schizophrenia, the CPA guidelines recommend a gradual taper over 6 to 24 months, and the APA guidelines recommend reducing the dose by 10% each month - Continuing anti-parkinsonism agents for a brief period after discontinuation may prevent withdrawal symptoms «bu»Bipolar Mania«/bu» - Monotherapy or as an adjunct to lithium or divalproex «b»Children and Adolescents 10 to 17 years«/b» - Initial Dose: 0.5 mg once daily - Dose may be adjusted in increments of 0.5 to 1 mg daily at intervals ≥24 hours to a dose of 1 to 2.5 mg daily - Doses ranging from 0.5 to 6 mg daily have been evaluated; however doses >2.5 mg daily do not confer additional benefit and are associated with increased adverse events - Patients experiencing persistent somnolence may benefit from dividing the dosage into twice-daily doses. - Maintenance Dose: No dosing recommendation available for treatment >3 weeks' duration «bu»Irritability Associated with Autistic Disorder«/bu» «b»Children ≥5 years and Adolescents«/b» «bi»<15 kg«/bi» - Use with caution; specific dosing recommendations not available «bi»15 to <20 kg«/bi» - Initial Dose: 0.25 mg daily - May increase dose to 0.5 mg daily after ≥4 days, maintain dose for ≥14 days - In patients not achieving sufficient clinical response, may increase dose by 0.25 mg daily in ≥2-week intervals. - Doses ranging from 0.5 to 3 mg daily have been evaluated. - Following clinical response, consider gradually lowering dose. Patients experiencing persistent somnolence may benefit from a once-daily dose administered at bedtime, dividing the dosage into twice-daily doses, or a reduction of the dose. «bi»≥20 kg«/bi» - Initial Dose: 0.5 mg daily - May increase dose to 1 mg daily after ≥4 days, maintain dose for ≥14 days - In patients not achieving sufficient clinical response, may increase dose by 0.5 mg daily in ≥2-week intervals. Doses ranging from 0.5 to 3 mg daily have been evaluated. - Following clinical response, consider gradually lowering dose. «bu»Schizophrenia«/bu» «b»Adolescents 13 to 17 years«/b» - Initial Dose: 0.5 mg once daily - Dose may be adjusted in increments of 0.5 to 1 mg daily at intervals ≥24 hours to a dose of 3 mg daily - Doses ranging from 1 to 6 mg daily have been evaluated; however, doses >3 mg daily do not confer additional benefit and are associated with increased adverse events - Patients experiencing persistent somnolence may benefit from dividing the dosage into twice-daily doses. «bu»Tourette Syndrome«/bu» «b»Children and Adolescents«/b» - Initial Dose: 0.125 to 0.5 mg once daily - Increase gradually based on response and tolerability up to a usual dosage of 0.75 to 3 mg daily - Dosage adjustments in clinical trials were commonly in increments of <0.5 mg twice daily and at intervals ≥3 days; doses up to 4 mg daily have been evaluated in children and up to 6 mg daily in adolescents «b»Elderly Pharmacokinetics«/b» Oral - Renal clearance of parent drug and active metabolite was decreased.

Ritonavir

Norvir,

RiTUXimab

Riabni, Rituxan, Ruxience, Truxima

Rituximab-Hyaluronidase

Rituxan Hycela, Anti-CD20 Monoclonal Antibody

«b»Premedication«/b» - Premedicate with acetaminophen and an antihistamine prior to each dose (consider glucocorticoid premedication if necessary). Antihyperuricemic therapy and aggressive hydration are recommended for patients at risk for tumor lysis syndrome (high tumor burden or lymphocytes >25,000/mm3). In patients with chronic lymphocytic leukemia (CLL), Pneumocystis jirovecii pneumonia (PCP) and antiherpetic viral prophylaxis is recommended during treatment (and for up to 12 months following treatment). «bu»Chronic Lymphocytic Leukemia (CLL)«/bu» - Rituximab 1,600 mg/hyaluronidase 26,800 units (fixed dose) SC on day 1 of a 28-day cycle in cycles 2 through 6 (in combination with fludarabine and cyclophosphamide - IV rituximab should be administered in cycle 1 «bu»Diffuse Large B-cell Lymphoma«/bu» - Rituximab 1,400 mg/hyaluronidase 23,400 units (fixed dose) SC on day 1 of cycles 2 through 8 in combination with cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) - IV rituximab should be administered in cycle 1 «bu»Follicular Lymphoma«/bu» «b»Previously Untreated«/b» «bi»Induction«/bi» - Rituximab 1,400 mg/hyaluronidase 23,400 units (fixed dose) SC on day 1 of a 21-day cycle in cycles 2 through 8 (in combination with chemotherapy) - IV rituximab should be administered in cycle 1 - In patients with complete or partial response following combination chemotherapy, initiate maintenance treatment «bi»Maintenance«/bi» - In patients with complete or partial response, initiate rituximab 1,400 mg/hyaluronidase 23,400 units (fixed dose) SC once every 8 weeks for 12 doses - Maintenance treatment should be initiated 8 weeks following completion of initial combination chemotherapy treatment. «b»Non-progressing Disease following 6 to 8 cycles of First-line CVP Chemotherapy«/b» - Rituximab 1,400 mg/hyaluronidase 23,400 units (fixed dose) SC once weekly for 3 weeks - IV rituximab should be administered in week 1 for a total of 4 weeks of therapy) at 6-month intervals to a maximum of 16 doses. «b»Relapsed or Refractory«/b» - Rituximab 1,400 mg/hyaluronidase 23,400 units (fixed dose) SC once weekly for 3 or 7 weeks - IV rituximab should be administered in week 1 for a total of 4 or 8 weeks of therapy «b»Relapsed or Refractory (Retreatment)«/b» - Rituximab 1,400 mg/hyaluronidase 23,400 units (fixed dose) SC once weekly for 3 weeks - IV rituximab should be administered in week 1 for a total of 4 weeks of therapy «b»Limitations of Use«/b» - Initiate treatment with rituximab/hyaluronidase only after patients have received at least 1 full dose of a rituximab product by IV infusion - Rituximab/Hyaluronidase is not indicated for the treatment of non-malignant conditions.

Rivaroxaban

Xarelto

«bu»Deep Vein Thrombosis (DVT) Prophylaxis«/bu» «b»Orthopedic Surgery«/b» - Administer initial dose at least 6-10 hr after surgery once hemostasis has been established «bi»Knee Replacement«/bi» - 10 mg PO daily for 12 days «bi»Hip Replacement«/bi» - 10 mg PO daily for 35 days - Take with or without food «bu»Deep Vein Thrombosis and/or Pulmonary Embolism Treatment«/bu» - 15 mg PO every 12 hour for 21 days with food THEN - 20 mg PO daily «b»Reduction in Risk of Recurrence of DVT or PE«/b» - Indicated for reduction in risk of recurrence of DVT and/or PE in patients at continued risk for recurrent DVT and/or PE after completion of initial treatment lasting ≤6 months - 10 mg PO daily with or without food, after at least 6 months of standard anticoagulant treatment «b»Reduction of Risk of Major Cardiovascular Events«/b» - In combination with aspirin, is indicated to reduce the risk of major cardiovascular events (cardiovascular [CV] death, myocardial infarction [MI] and stroke) in patients with chronic coronary artery disease (CAD) or peripheral artery disease (PAD) - 2.5 mg PO BID, plus aspirin (75-100 mg) daily with or without food «bu»Superficial Vein Thrombosis, Acute Symptomatic«/bu» - 10 mg PO once daily for 45 days «bu»Nonvalvular Atrial Fibrillation«/bu» - Reduce the risk of stroke and systemic embolism - 20 mg PO daily with the evening meal «b»Conversion from Warfarin«/b» - Discontinue warfarin and initiate rivaroxaban as soon as INR falls to <3.0 (US labeling) or ≤2.5 (Canadian labeling) «b»Conversion to Warfarin«/b» - Rivaroxaban affects INR; therefore, initial INR measurements after initiating warfarin may be unreliable. - Discontinue rivaroxaban and initiate both warfarin and a parenteral anticoagulant at the time the next dose of rivaroxaban would have been taken (other approaches to this conversion may be acceptable). - Continue rivaroxaban concomitantly with warfarin until INR ≥2.0 and then discontinue rivaroxaban. Note: Caution must be employed with this strategy given the lack of an antidote for rivaroxaban reversal. During the first 2 days of concomitant therapy, usual doses of warfarin may be given without INR testing. - Thereafter, while on concomitant therapy, measure INR daily just prior to the next scheduled rivaroxaban dose, as appropriate. After rivaroxaban has been discontinued, INR testing may be done at least 24 hours after the last rivaroxaban dose. «b»Conversion from Continuous Infusion Unfractionated Heparin«/b» - Initiate rivaroxaban at the time of heparin discontinuation «b»Conversion to Continuous Infusion Unfractionated Heparin«/b» - Discontinue rivaroxaban and initiate continuous infusion unfractionated heparin at the time the next dose of rivaroxaban would have been taken. «b»Conversion from Anticoagulants (other than warfarin and continuous infusion unfractionated heparin)«/b» - Discontinue current anticoagulant and initiate rivaroxaban ≤2 hours prior to the next regularly scheduled evening dose of the discontinued anticoagulant. - Discontinue current anticoagulant and initiate rivaroxaban ≤2 hours prior to the next regularly scheduled evening dose of the discontinued anticoagulant; patients previously receiving prophylactic doses of anticoagulant may initiate rivaroxaban ≥6 hours after last prophylactic dose. «b»Conversion to Other Anticoagulants (other than warfarin)«/b» - Discontinue rivaroxaban and initiate the anticoagulant at the time the next dose of rivaroxaban would have been taken «b»Conversion for Surgery and Invasive Procedures«/b» - Always consider renal function and how that might affect drug clearance when determining when to hold rivaroxaban prior to surgery or invasive procedures. «b»Conversion for Low Bleeding Risk Associated with the Surgery/Procedure«/b» - Do not discontinue rivaroxaban for noninvasive procedures with low procedural bleeding risk (minor dental, minor dermatologic, ophthalmologic, endoscopy without biopsy) «b»Conversion for Moderate or High Bleeding Risk Associated with the Surgery/Procedure«/b» - Discontinue rivaroxaban at least 24 to 48 hours prior to surgery/procedures associated with a moderate or high bleeding risk - Anticoagulation bridging using parenteral anticoagulation during the rivaroxaban interruption is recommended only in patients undergoing a procedure/surgery associated with a high procedural bleeding risk (cardiovascular/thoracic surgery, intra-abdominal/pelvic surgery, major orthopedic surgery, neurosurgery, cardiac catheterization via femoral artery) and who have a moderate to high thromboembolic risk (eg, recent pulmonary embolism, certain mechanical valve prosthesis) «b»Conversion for Cardiac Catheterization and Percutaneous Coronary Intervention (PCI)«/b» - Patients receiving rivaroxaban undergoing cardiac catheterization or PCI who have stable ischemic heart disease and who are not at a high risk for thrombosis should have rivaroxaban withheld until the anticoagulant effect has dissipated (at least 24 hours in advance) - In the absence of high risk thrombotic features, patients should not be bridged with a heparin before or after the procedure - Radial access catheterization is preferred due to lower risk of hemorrhagic complications compared to femoral access. Following PCI, routine use of rivaroxaban (coupled with clopidogrel alone or with dual antiplatelet therapy [DAPT]), cannot be recommended at present due to a paucity of available data «b»Conversion for Catheter Ablation of AF«/b» - Continuous or interrupted rivaroxaban may be used pre-ablation. Use of rivaroxaban before the procedure results in a need for increased heparin doses compared to patients on warfarin. - Following ablation, if hemostasis has been achieved, rivaroxaban can generally be reintroduced within 4 to 8 hours after sheath removal. - Rivaroxaban therapy should continue for a minimum of 2 to 3 months after ablation and further use should be based on CHA2DS2-VASc score «b»Conversion for Electronic Device Implantation«/b» - Practice patterns are highly variable due to limited available data. - In general, rivaroxaban should be discontinued at least 24 hours in advance of the procedure. - Typically, rivaroxaban can be restarted 24 to 48 hours after the procedure. - However, clinicians should manage patients on an individual basis «b»Conversion for Neuraxial Anesthesia«/b» - Discontinue rivaroxaban 3 to 5 days before neuraxial block - Resume 12 hours after the procedure if thrombotic risk is high «b»Body weight >120 kg«/b» - Did not significantly influence rivaroxaban exposure. - Clinical outcomes in postoperative thromboprophylaxis trials were also not affected by weight (up to 190 kg). - Therefore, dosage adjustment may not be required. The International Society on Thrombosis and Haemostasis (ISTH) 2016 guideline suggests avoiding the use of rivaroxaban (and other direct oral anticoagulants) in patients with a BMI >40 kg/m2 or weight >120 kg due to the lack of clinical data in this population. - If used in a patient with a BMI >40 kg/m2 or weight >120 kg, ISTH suggests measuring peak and trough levels using an antifactor Xa assay or mass spectrometry. If drug level is below the expected range, ISTH suggests changing to a vitamin K antagonist rather than adjusting the dose of rivaroxaban

Rivastigmine

Exelon

Rizatriptan

Maxalt, Maxalt MLT, RizaFilm. Rizatriptan Film

Rocuronium

Zemuron

«bu»Rapid Sequence Intubation«/bu» - 0.6 to 1.2 mg/kg IV «b»Obesity«/b» - In adult patients with morbid obesity (BMI >40 kg/m2), the use of 1.2 mg/kg using ideal body weight (IBW) provided a short onset of action and excellent or good intubating conditions at 60 seconds in one study «bu»Tracheal Intubation«/bu» - Initial Dose: 0.45 to 0.6 mg/kg IV - Administration of 0.3 mg/kg IV may also provide optimal conditions for tracheal intubation «b»Obesity«/b» - May use ideal body weight (IBW) for morbidly obese (BMI >40 kg/m2) adult patients - Onset time may be slightly delayed using IBW - The manufacturer recommends dosing based on actual body weight in all obese patients. «bu»Maintenance for Continued Surgical Relaxation«/bu» - 0.1 to 0.2 mg/kg - Repeat as needed or a continuous infusion of 10 to 12 mcg/kg/minute (0.6 to 0.72 mg/kg/hour) only after recovery of neuromuscular function is evident - Infusion rates have ranged from 4 to 16 mcg/kg/minute (0.24 to 0.96 mg/kg/hour) - Inhaled anesthetic agents prolong the duration of action of rocuronium - Use lower end of the dosing range; redosing interval guided by monitoring with a peripheral nerve stimulator. «bu»Preinduction Defasciculation«/bu» (off-label use) - 0.03 to 0.06 mg/kg IV given 1.5 to 3 minutes before administration of succinylcholine «bu»ICU Paralysis«/bu» - Facilitate mechanical ventilation in Adequately sedated patients - Initial Bolus Dose: 0.6 to 1 mg/kg IV x 1 dose, then, - 8 to 12 mcg/kg/minute (0.48 to 0.72 mg/kg/hour) continuous infusion - Monitor depth of blockade every 2 to 3 hours initially until stable dose, then every 8 to 12 hours; adjust rate of administration by 10% increments according to peripheral nerve stimulation response or desired clinical response - When possible, minimize depth and duration of paralysis. - Stopping the infusion for some time until forced to restart based on patient condition is recommended to reduce post-paralytic complications (acute quadriplegic myopathy syndrome) - Intermittent dosing has also been described with an initial loading dose of 50 mg followed by 25 mg given when peripheral nerve stimulation returns.

Roflumilast

Daliresp

Roflumilast (Topical)

Zoryve

Rolapitant

Varubi

RomiDEPsin

Istodax

RomiPLOStim

Nplate

«bu»Hematopoietic Syndrome of Acute Radiation Syndrome«/bu» - 10 mcg/kg SC x 1 dose - Administer as soon as possible after suspected or confirmed exposure to radiation levels >2 gray (Gy) - To increase survival in adults and in pediatric patients (including term neonates) acutely exposed to myelosuppressive doses of radiation «bu»Chronic Immune Thrombocytopenia (ITP)«/bu» - Indicated in children ≥1 year with immune thrombocytopenia (ITP) for ≥6 months who have had an insufficient response to corticosteroids, immunoglobulins, or splenectomy «b»Initial Dose«/b» - 1 mcg/kg SC weekly - Actual body weight at initiation of treatment should always be used when calculating initial dose «b»Maintenance Dose«/b» - In pediatric patients, future dose adjustments are based on changes in platelet counts and changes in body weight; reassess body weight q12Weeks «b»Dosage Adjustment Recommendations«/b» - Adjust weekly dose by increments of 1 mcg/kg until the patient achieves a platelet count ≥50x 10^9/L as necessary to reduce the risk for bleeding - Not to exceed maximum weekly dose of 10 mcg/kg «bi»Dose Adjustment by Platelet Count«/bi» Platelets <50x 10^9/L - Increase by 1 mcg/kg Platelet >200 to ≤400x 10^9/L for 2 Consecutive Weeks - Reduce by 1 mcg/kg Platelet >400x 10^9/L - Do not give dose - Continue weekly platelet assessment - If platelets fall to <200x 10^9/L, resume at dose reduced by 1 mcg/kg «b»Limitations of Use«/b» - Not indicated for thrombocytopenia due to myelodysplastic syndrome (MDS) or any cause of thrombocytopenia other than chronic ITP - Only in patients with ITP whose degree of thrombocytopenia and clinical condition increases the risk for bleeding - Do not use as an attempt to normalize platelet counts «b»Dosage Recommendations for All Patients«/b» - Use the lowest dose to achieve and maintain a platelet count ≥50x 10^9/L as necessary to reduce the risk for bleeding -Administer as a weekly SC injection with dose adjustments based upon platelet count response - Prescribed dose may be a very small volume (0.15 mL); administer only with syringe that contains 0.01 mL graduations - Discontinue if the platelet count does not increase to sufficient level in order to avoid clinically important bleeding after 4 weeks at the maximum weekly dose of 10 mcg/kg

Romosozumab

Evenity

Ropeginterferon

Besremi

ROPINIRole

Requip, Requip XL

«bu»Parkinson Disease«/bu» «b»Immediate-Release Tablet«/b» - Week 1: 0.25 mg 3 times daily; total daily dose: 0.75 mg - Week 2: 0.5 mg 3 times daily; total daily dose: 1.5 mg - Week 3: 0.75 mg 3 times daily; total daily dose: 2.25 mg - Week 4: 1 mg 3 times daily; total daily dose: 3 mg - After week 4, if necessary, daily dosage may be increased by 1.5 mg/day on a weekly basis up to a dose of 9 mg/day, and then by up to 3 mg/day weekly to a total of 24 mg/day. If a significant interruption in therapy with ropinirole occurs, retitration may be warranted. - The dosage should be increased to achieve a maximum therapeutic effect, balanced against the principal side effects of nausea, dizziness, somnolence and dyskinesia. Recommended starting dose is 0.25 mg 3 times daily; based on individual patient response, the dosage should be titrated with weekly increments as described above. «bi»Parkinson Disease Discontinuation Taper«/bi» - Gradually taper over 7 days as follows - Reduce frequency of administration from 3 times daily to twice daily for 4 days, then reduce to once daily for remaining 3 days. «b»Extended-Release Tablet«/b» - Initial Dose: 2 mg once daily for 1 to 2 weeks, then, - Increases of 2 mg/day at weekly or longer intervals based on therapeutic response and tolerability; there was no additional benefit shown for doses greater than 8 mg/day in advanced Parkinson disease or 12 mg/day in early Parkinson disease - Maximum Dose: 24 mg/day - If a significant interruption in therapy with ropinirole occurs, retitration may be warranted. When discontinuing gradually taper over 7 days. «bu»Restless Legs Syndrome (RLS)«/bu» «b»Immediate-Release Tablet«/b» - Initial Dose: 0.25 mg once daily 1 to 3 hours before bedtime - Dose may be increased after 2 days to 0.5 mg daily, and after 7 days to 1 mg daily. - Dose may be further titrated upward in 0.5 mg increments every week until reaching a daily dose of 3 mg during week 6. Daily dose may be increased to a maximum of 4 mg beginning week 7. - If a significant interruption in therapy with ropinirole occurs, retitration may be warranted. Gradually taper dose if discontinuation is warranted. «b»Converting from Ropinirole IR to ER Tablets«/b» - Choose a once daily extended-release dose that most closely matches current immediate-release daily dose.

Ropivacaine

Naropin

Rosiglitazone

Avandia

Rosiglitazone-Glimepiride

Avandaryl

Rosiglitazone-Metformin

Avandamet

Rosuvastatin

Crestor, Ezallor Sprinkle

«bu»Hypercholesterolemia«/bu» - 10-20 mg PO daily - Not to exceed 40 mg/day - After initiation or upon titration, analyze lipid levels within 2-4 weeks and adjust dosage accordingly «bu»Homozygous Familial Hypercholesterolemia«/bu» - 20 mg PO daily - Not to exceed 40 mg/day - After initiation or upon titration, analyze lipid levels within 2-4 weeks and adjust dosage accordingly «bu»Slowing Progression of Atherosclerosis«/bu» - 10-20 mg PO daily - Not to exceed 40 mg/day - After initiation or upon titration, analyze lipid levels within 2-4 weeks and adjust dosage accordingly «b»Concomitant with Cyclosporine«/b» - Rosuvastatin dose should not exceed 5 mg once daily «b»Concomitant with Gemfibrozil«/b» - Avoid concurrent use; if unable to avoid concurrent use - Initiate rosuvastatin at 5 mg once daily - Maximum Dose: 10 mg/day «b»Concomitant with Atazanavir/Ritonavir, Lopinavir/Ritonavir, or Simeprevir«/b» - Initiate rosuvastatin at 5 mg once daily - Maximum Dose: 10 mg/day «b»Hematuria and/or Persistent, Unexplained Proteinuria while on 40 mg daily«/b» - Reduce dose and evaluate causes. «b»Severe Muscle Symptoms or Fatigue«/b» - Promptly discontinue use - Evaluate CPK, creatinine, and urinalysis for myoglobinuria «b»Mild to Moderate Muscle Symptoms«/b» - Discontinue use until symptoms can be evaluated - Evaluate patient for conditions that may increase the risk for muscle symptoms (hypothyroidism, reduced renal or hepatic function, rheumatologic disorders such as polymyalgia rheumatica, steroid myopathy, vitamin D deficiency, or primary muscle diseases) - Upon resolution, resume the original or lower dose of rosuvastatin. If muscle symptoms recur, discontinue rosuvastatin use - After muscle symptom resolution, may then use a low dose of a different statin; gradually increase if tolerated - In the absence of continued statin use, if muscle symptoms or elevated CPK continues after 2 months, consider other causes of muscle symptoms - If determined to be due to another condition aside from statin use, may resume statin therapy at the original dose

Rosuvastatin-Ezetimibe

Roszet

Rotavirus Vaccine Live Oral

Rotarix, RotaTeq

«b»Oral Administration«/b» - For oral administration only; do not give by injection. - May be administered before or after food, milk, or breast milk. - To avoid potential eye splashes caused by coughing, sneezing, and spitting, administer gently inside the cheek - Do not mix with other vaccines or injections - US federal law requires that the name of medication, date of administration, the vaccine manufacturer, lot number of vaccine, and the administering person's name, title, and address be entered into the patient's permanent medical record. «bi»Rotarix«/bi» - Using oral applicator, administer contents into infant’s inner cheek. - Dispose of applicator and vaccine vial in biologic waste container. «bi»RotaTeq«/bi» - Gently squeeze dose from ready-to-use dosing tube into infant’s inner cheek - After use, dispose of the empty tube and cap in a biologic waste container. - Although the Rotarix prescribing information states that a regurgitated or spit out dose may be repeated, the AAP, ACIP, and the RotaTeq prescribing information do not recommend readministering doses. Any remaining dose(s) should be administered on schedule «b»Rotarix Reconstitution«/b» - Reconstitute only with provided diluent and transfer adapter. - After removing the vial cap, connect transfer adapter onto vial and push downwards until transfer adapter is in place. - Shake oral applicator containing the liquid diluent (suspension will be a turbid liquid). - Connect oral applicator to transfer adapter and transfer entire contents (diluent) of oral applicator into the lyophilized vaccine. - With transfer adapter in place, shake vigorously. - Withdraw entire mixture back into oral applicator. - Twist and remove oral applicator. «b»RotaTeq Reconstitution«/b» - Clear the fluid from the dispensing tip by holding the tube vertically and tapping the cap. - Puncture the dispensing tip by screwing the cap clockwise until it becomes tight and then remove the cap by turning it counterclockwise.

Rotigotine

Neupro

Rucaparib

Rubraca

Rufinamide

Banzel, Xilep

Ruxolitinib

Jakafi

- Consider gradually tapering off (by 5 mg twice daily each week) if discontinuing for reasons other than thrombocytopenia. «bu»Myelofibrosis«/bu» - Initial Dose (based on platelet count, titrate dose thereafter based on efficacy and safety): - Platelets >200,000/mm3: 20 mg PO bid - Platelets 100,000 to 200,000/mm3: 15 mg PO bid - Platelets 50,000 to <100,000/mm3: 5 mg PO bid «b»Dosage Modification Based on Response in Patients with Baseline Platelet Count ≥100,000/mm3 Prior to Initial Treatment with Ruxolitinib«/b» - For insufficient response (with adequate platelet and neutrophil counts), may increase the dose in 5 mg PO bid increments to a maximum dose of 25 mg twice daily - Do not increase during initial 4 weeks and no more frequently than every 2 weeks. - Discontinue treatment after 6 months if no reduction in spleen size or no improvement in symptoms. When discontinuing for reasons other than thrombocytopenia, consider gradually tapering by ~5 mg twice daily per week. «b»Dose Increases May be Considered If Meet All of the Following Situations«/b» - Failure to achieve either a 50% reduction (from baseline) in palpable spleen length or a 35% reduction (from baseline) in spleen volume (measured by CT or MRI) - Platelet count >125,000/mm3 at 4 weeks (and never <100,000/mm3) - Absolute neutrophil count (ANC) >750/mm3 «b»Dosage Modification for Bleeding Requiring Intervention«/b» Regardless of platelet count - Interrupt treatment until bleeding resolved - May consider resuming at the prior dose if the underlying cause of bleeding has resolved or at a reduced dose if the underlying cause of bleeding persists. «b»Dosage Modification Based on Response in Patients with Baseline Platelet 50,000 to <100,000/mm3 Prior to Initial Treatment with Ruxolitinib«/b» - For insufficient response (with adequate platelet and neutrophil counts) - May increase the dose in 5 mg daily increments to a maximum dose of 10 mg twice daily - Do not increase during initial 4 weeks and no more frequently than every 2 weeks. - Discontinue treatment after 6 months if no reduction in spleen size or no improvement in symptoms. «b»Dose Increases May be Considered If Meet All of the Following Situations«/b» - Platelet count remains ≥40,000/mm3 and did not decrease more than 20% in prior 4 weeks - Absolute neutrophil count (ANC) >1,000/mm3 - No adverse event or hematological toxicity resulting in dose reduction or interruption occurred in prior 4 weeks «bu»Polycythemia Vera«/bu» «b»Initial Dose«/b» - 10 mg PO bid - Titrate dose based on efficacy and safety «b»Dose Modification Due to Insufficient Response«/b» - If response is insufficient and platelet, hemoglobin, and neutrophil counts are adequate, the dose may be increased in 5 mg twice daily increments to a maximum of 25 mg twice daily, Do not increase dose in the first 4 weeks of treatment and not more frequently than every 2 weeks. «b»Consider Dose Increases in Patients Who Meet All of the Following Conditions«/b» - Inadequate efficacy demonstrated by one or more of the following: Continued need for phlebotomy, WBC >ULN of normal range, platelet count >ULN of normal range, or palpable spleen that is reduced by <25% from baseline. - Platelet count ≥140,000/mm3 - Hemoglobin ≥12 g/dL - ANC ≥1,500/mm3 «b»Strong CYP3A4 Inhibitors and Fluconazole (≤200 mg)«/b» - Avoid concomitant use with fluconazole doses >200 mg daily. «bi»Myelofibrosis«/bi» Initial Dose - Platelets ≥100,000/mm3: 10 mg twice daily. - Platelets 50,000/mm3 to < 100,000/mm3: 5 mg once daily. - Monitor closely and further adjust dose based on safety and efficacy. «bi»Polycythemia Vera«/bi» - Initial Dose (ruxolitinib naïve): 5 mg twice daily - Stabilized on ruxolitinib ≥10 mg twice daily: Reduce dose by 50% (rounded up to the closest available tablet strength). - Stabilized on ruxolitinib 5 mg twice daily: Reduce dose to 5 mg once daily. - Stabilized on ruxolitinib 5 mg once daily: Avoid strong CYP3A4 inhibitors or fluconazole or interrupt treatment for the duration of strong CYP3A4 inhibitor or fluconazole use. - Monitor closely and further adjust dose based on safety and efficacy. «b»Dosage Modification for Treatment Interruption«/b» If baseline platelet count ≥100,000/mm3 prior to initial treatment with ruxolitinib and: - Platelets <50,000/mm3 and ANC <500/mm3: Interrupt treatment; upon platelet recovery (to ≥50,000/mm3) or ANC recovery (to ≥750/mm3), dosing may be restarted or increased based on the following platelet or ANC levels - Platelets ≥125,000/mm3: Dose should be at least 5 mg twice daily below the dose at treatment interruption, up to a maximum of 20 mg twice daily - Platelets 100,000 to <125,000/mm3: Dose should be at least 5 mg twice daily below the dose at treatment interruption, up to a maximum of 15 mg twice daily - Platelets 75,000 to <100,000/mm3: Dose should be at least 5 mg twice daily below the dose at treatment interruption, up to a maximum of 10 mg twice daily for at least 2 weeks; may increase to 15 mg twice daily if stable - Platelets 50,000 to <75,000/mm3: 5 mg twice daily for at least 2 weeks; may increase to 10 mg twice daily if stable - Platelets <50,000/mm3: Continue to withhold treatment - ANC ≥750/mm3: Resume at 5 mg once daily or 5 mg twice daily below the largest dose in the week prior to treatment interruption, whichever is greater - Long-term maintenance at 5 mg twice daily has not demonstrated responses; limit use of the dose level to patients where the benefits outweigh risks If baseline platelet count 50,000 to <100,000/mm3 prior to initial treatment with ruxolitinib and: - Platelets <25,000/mm3 and ANC <500/mm3: Interrupt treatment; upon platelet recovery (to ≥35,000/mm3) or ANC recovery (to ≥750/mm3), resume at 5 mg once daily or 5 mg twice daily below the largest dose in the week prior to treatment interruption, whichever is greater - Note: Long-term maintenance at 5 mg twice daily has not demonstrated responses; limit use of the dose level to patients where the benefits outweigh risks Dosage reduction for thrombocytopenia in patients with baseline platelet count ≥100,000/mm3 prior to initial treatment with ruxolitinib: Dosage reduction for thrombocytopenia in patients with baseline platelet 50,000 to <100,000/mm3 prior to initial treatment with ruxolitinib: Platelets 25,000 to <35,000/mm3 and platelet count decreased <20% during prior 4 weeks: - If current daily dose >5 mg: Reduce dose by 5 mg once daily - If current dose 5 mg once daily: Continue 5 mg once daily Platelets 25,000 to <35,000/mm3 and platelet count decreased ≥20% during prior four weeks: - If current daily dose >10 mg: Reduce dose by 5 mg twice daily - If current dose 5 mg twice daily: Reduce dose to 5 mg once daily - If current dose 5 mg once daily: Continue 5 mg once daily - Platelets <25,000 mm3: Continue to withhold treatment - Note: Long-term maintenance at 5 mg twice daily has not demonstrated responses; limit use of the dose level to patients where the benefits outweigh risks Polycythemia Vera «b»Hematologic Toxicity«/b» - Hemoglobin ≥12 g/dL AND platelets ≥100,000/mm3: No dosage adjustment necessary. - Hemoglobin 10 to <12 g/dL AND platelets 75,000 to <100,000/mm3: Consider dosage adjustment to avoid dose interruptions due to anemia and thrombocytopenia. - Hemoglobin 8 to <10 g/dL OR platelets 50,000 to <75,000/mm3: Reduce dose by 5 mg twice daily; for patients currently receiving 5 mg twice daily, reduce dose to 5 mg once daily. - Hemoglobin <8 g/dL OR platelets <50,000/mm3 OR ANC <1,000/mm3: Interrupt dosing. Dosage reduction following treatment interruption (use the most severe category of hemoglobin, platelets or ANC to determine reinitiation dose): - Hemoglobin <8 g/dL OR platelets <50,000/mm3 OR ANC <1,000/mm3: Continue to hold. - Hemoglobin 8 to <10 g/dL OR platelets 50,000 to <75,000/mm3 OR ANC 1,000 to <1,500/mm3: Restart at a maximum of 5 mg twice daily (continue treatment for at least 2 weeks, if stable, then may increase dose by 5 mg twice daily) or no more than 5 mg twice daily less than the dose that resulted in dose interruption - Hemoglobin 10 to <12 g/dL OR platelets 75,000 to <100,000/mm3 OR ANC 1,500 to <2,000/mm3: Restart at a maximum of 10 mg twice daily (continue treatment for at least 2 weeks, if stable, then may increase dose by 5 mg twice daily) or no more than 5 mg twice daily less than the dose that resulted in dose interruption - Hemoglobin ≥12 g/dL OR platelets ≥100,000/mm3 OR ANC ≥2,000/mm3: Restart at a maximum of 15 mg twice daily (continue treatment for at least 2 weeks, if stable, then may increase dose by 5 mg twice daily) or no more than 5 mg twice daily less than the dose that resulted in dose interruption - Note: If dose interruption was required while receiving 5 mg twice daily, may restart at 5 mg twice daily or 5 mg once daily (but not higher) once hemoglobin is ≥10 g/dL, platelets are ≥75,000/mm3, and ANC is ≥1,500/mm3 - Dose management after restarting treatment: After restarting following a dose interruption, the dose may be titrated, although the maximum total daily dose should not exceed 5 mg less than the dose resulting in the interruption (unless dose interruption following phlebotomy-associated anemia, in which case the maximum total daily dose is not limited). «bu»Acute Graft versus Host Disease«/bu» - Indicated for treatment of steroid-refractory acute graft-versus-host disease (GVHD) in adults and children (≥12 years) «b»<12 years«/b» - Safety and efficacy not established «b»≥12 years«/b» - Initial Dose: 5 mg PO bid - May increase to 10 mg bid after at least 3 days if ANC and platelet counts have not decreased by ≥50% compared to baseline - Consider tapering after 6 months of treatment in patients with response who have discontinued therapeutic doses of corticosteroids «b»Tapering Dose«/b» - Taper by 1 dose level ~ every 8 weeks (10 mg bid to 5 mg bid to 5 mg daily) - Patients unable to tolerate 5 mg daily: Interrupt treatment until clinical and/or laboratory parameters recover - If acute GVHD signs or symptoms recur during or after taper, consider retreatment «b»Dose Modifications (Acute GVHD)«/b» - Clinically significant thrombocytopenia after supportive measures: Reduce dose by 1 dose level; when platelets recover to previous values, restart dose to prior dose level ANC <1 X 10^9/L (dose-related): Hold dose for up to 14 days; resume at 1 dose level lower upon recovery Total bilirubin elevation, no liver GVHD Total bilirubin 3-5x ULN: Continue at 1 dose level lower until recovery Total bilirubin >5-10x ULN: Hold dose for up to 14 days until bilirubin ≤1.5x ULN; resume at current dose upon recovery Total bilirubin >10x ULN: Hold dose for up to 14 days until bilirubin ≤1.5x ULN; resume at 1 dose level lower upon recovery Total bilirubin elevation with liver GVHD Total bilirubin >3x ULN: Continue at 1 dose level lower until recovery «b»Renal Impairment«/b» «bi»Moderate or Severe (CrCl 15-59 mL/min)«/bi» - Reduce dose to 5 mg qDay «bi»ESRD (CrCl <15 mL/min) on Dialysis«/bi» - 5 mg once after dialysis session Hepatic impairment «b»Mild, Moderate, or Severe (Child-Pugh A, B, C) with any Platelet Count«/b» - No dosage adjustment necessary Stage 3 or 4 GvHD: Monitor blood cell counts more frequently for toxicity and consider 5 mg qDay «b»Strong CYP3A4 Inhibitors«/b» - Dose reductions for patients with acute GvHD on concomitant strong CYP3A4 inhibitors or fluconazole doses of ≥200 mg - Avoid fluconazole doses >200 mg/day concomitantly with ruxolitinib Coadministered with Ketoconazole - Reduce dose 5 mg PO qDay Coadministered with other CYP3A4 Inhibitors - No dosage adjustment necessary - Closely monitor blood cell counts for toxicity and adjust ruxolitinib dose if necessary when coadministered with itraconazole «b»CYP3A4 Inducers«/b» - No dose adjustment recommended; however, closely monitor and titrate dose based on safety and efficacy

Ruxolitinib (Topical)

Opzelura

Sacituzumab Govitecan

Trodelvy

«bu»Metastatic Breast Cancer«/bu» - Each cycle is 21 days - Days 1 and 8: 10 mg/kg IV - Continue treatment until disease progression or unacceptable toxicity - Do not administer doses >10 mg/kg «b»Infusion-related Reactions«/b» - Infusion-related reactions develop: Slow infusion rate or interrupt dose - Life-threatening infusion-related reactions: Permanently discontinue «b»Severe Neutropenia«/b» - Grade 4 neutropenia ≥7 days, OR - Grade 3 febrile neutropenia (absolute neutrophil count [ANC] <1,000/mm3 and fever ≥38.5ºC), OR - At time of scheduled treatment, Grade 3-4 neutropenia that delay dose by 2-3 weeks for recovery to Grade ≤1 «bi»Recommended Dose Modifications«/bi» First Occurrence - 25% dose reduction and administer granulocyte colony-stimulating factor (G-CSF) Second Occurrence - 50% dose reduction Third Occurrence - Discontinue treatment At the time of scheduled treatment, Grade 3-4 neutropenia that delay dose by >3 weeks for recovery to Grade ≤1: Discontinue treatment «b»Severe Non-neutropenic or Nonhematologic Toxicity«/b» - Grade 4 toxicity, OR - Any Grade 3-4 nausea, uncontrolled vomiting or diarrhea due to treatment that is refractory to antiemetics and antidiarrheal agents, OR - Other Grade 3-4 toxicity persisting >48 hr despite optimal medical management, OR At time of scheduled treatment, Grade 3-4 toxicity that delay dose by 2-3 weeks for recovery to Grade ≤1 «bi»Recommended Dose Modifications«/bi» First Occurrence - 25% dose reduction and administer granulocyte-colony stimulating factor (G-CSF) Second Occurrence - 50% dose reduction Third Occurrence - Discontinue treatment - In the event of any other Grade 3-4 toxicities that delay dose by >3 weeks for recovery to Grade ≤1: Discontinue treatment «b»Dosing Considerations«/b» - Do NOT substitute for or use with other drugs containing irinotecan or its active metabolite SN-38 - Verify pregnancy status in females of reproductive potential prior to initiation «b»Contraception«/b» Females of Reproductive Potential - Use effective contraception during treatment and for 6 months after final dose Males of Female Partners of Reproductive Potential - Use effective contraception during treatment and for 3 months final dose «b»Infertility«/b» - Based on findings in animals, fertility may be impaired in females of reproductive potential «b»Premedication«/b» - Before each dose, premedicate patients to prevent infusion-related reactions and CINV - Premedicate with antipyretics, H1 and H2 blockers, and corticosteroids for patients who had prior infusion reactions - Premedicate with a 2- or 3-drug combination regimen (eg, dexamethasone with either a 5-HT3 receptor antagonist or a NK1 receptor antagonist, as well as other drugs as indicated) «b»IV Administration«/b» - IV infusion only; do not administer as IV push or bolus - Protect infusion bag from light - Upon completion, flush IV line with 20 mL 0.9% NaCl Infusion times First infusion: Infuse over 3 hr; monitor for signs or symptoms of infusion-related reactions during the infusion and for at least 30 min after infusion Subsequent infusions: Infuse over 1-2 hr if prior infusions were tolerated; monitor during the infusion and for at least 30 min after infusion «b»IV Reconstitution«/b» - Cytotoxic drug; follow applicable special handling and disposal procedures - Calculate required dose (mg) - Allow the required number of vials to warm to room temperature - Slowly inject 20 mL of 0.9% NaCl into each vial; resulting concentration will be 10 mg/mL - Gently swirl vials and allow to dissolve for up to 15 minutes; do not shake - Visually inspect vial(s) for particulate matter and discoloration before administration, whenever solution and container permit - Reconstituted solution should be free of visible particulates, clear, and yellow; discard reconstituted solution if it is cloudy or discolored - Use immediately to prepare a diluted solution «bi»IV Dilution«/bi» - Calculate required volume of the reconstituted solution needed to obtain the appropriate dose - Withdraw this amount from the vial(s); discard of any unused solution - Slowly inject reconstituted solution into a 0.9% NaCl polypropylene (PP) infusion bag, to minimize foaming; do not shake the contents - Adjust volume in the infusion bag as needed to obtain a final concentration of 1.1-3.4 mg/mL (total volume should not exceed 500 mL) «bi»Body weight >170 kg«/bi» - Divide total dose equally between two 500-mL infusion bags and infuse sequentially via slow infusion

Sacubitril-Valsartan

Entresto

Safinamide

Xadago

Salicylic Acid

Salacyn, Salimez, Keralyt

«bu»Acne«/bu» «b»Salicylic Acid 0.5% to 2%«/b» - Apply thin layer to affected area 1 to 3 times daily. - Because excessive drying may occur, products that are labeled for multiple daily doses should be initiated with 1 dose daily and increased gradually. - Reduce to once daily or every other day if dryness or peeling occur. «b»Salicylic Acid ≤2%«/b» - Apply thin layer to affected area 1 to 3 times daily - Reduce to once daily or every other day if dryness or peeling occur. «b»Cleansers: Salicylic Acid ≤2%«/b» - Use to cleanse skin 1 to 2 times daily. «b»Gel Mask: Salicylic acid 0.5%«/b» - Use 1 to 2 times per week. «bu»Callus and Corns«/bu» - Before applying product, soak area in warm water for 5 minutes; dry area thoroughly, then apply medication. «b»Gel, Liquid: Salicylic acid 13.9 to 17.6%«/b» - Apply one drop to cover corn or callus - Let dry - Repeat once or twice daily until corn is removed for up to 14 days. «b»Pads: Salicylic Acid 40%«/b» - Apply directly over affected area; leave in place for 48 hours - Some products may be cut to fit area or secured with adhesive strips. May repeat procedure every 48 hours as needed for up to 14 days. «bu»Dandruff, Psoriasis, or Seborrheic Dermatitis«/bu» «b»Cream, gel: Salicylic acid 3%«/b» - Apply to affected area 1 to 4 times daily. «b»Shampoo: Salicylic Acid 3%«/b» - Apply to wet hair and gently massage into scalp; work up lather; rinse thoroughly. Use at least twice weekly. «bu»Dermatitis«/bu» «b»Topical: Ointment: Salicylic Acid 3% (Bensal HP only)«/b» - Apply twice daily - Reevaluate if improvement is not seen within 7 days. «bu»Hyperkeratotic Skin Disorders«/bu» «b»Cream, Lotion: Salicylic Acid 6% (Salacyn)«/b» - Apply daily to affected area before bedtime - Hydrate skin for at least 5 minutes prior to application - Area should be covered; however, do not use occlusive dressings, clothing, or petrolatum-based products that may increase absorption - Wash off in morning. Once affected area becomes clear, occasional use will maintain remission. «b»Lotion: Salicylic Acid 5% (Salitech)«/b» - Apply to the affected area and occlude overnight - Wash the affected area with a gentle cleanser prior to application - In areas where occlusion is difficult or impossible, application may be more frequent. «b»Foam: Salicylic Acid 6% (Salvax)«/b» - Apply to affected area twice daily «b»Gel: Salicylic Acid 6% (Keralyt)«/b» - Apply daily to affected area and occlude overnight - Hydrate skin for at least 5 minutes prior to application - Wash off in morning. Once affected area becomes clear, occasional use will maintain remission. - If applying the gel to the scalp, initially wash off after 10 to 20 minutes, but may be left on for up to 1 hour if needed as treatment progresses; avoid contact with normal hair or skin. Shampoo: «b»Salicylic Acid 6% (Keralyt)«/b» - To use as a concentrated scalp treatment, apply daily to affected areas of scalp while hair is dry - Leave on for 5 minutes; may gradually increase contact time to 1 hour - After treatment, wash hair thoroughly with water or nonmedicated shampoo - To use as a medicated shampoo, apply daily to scalp while hair is wet; work into a lather; leave on for several minutes, then rinse - Once affected area becomes clear, occasional use will maintain remission. «b»Salicylic Acid 6% (Salex)«/b» - Apply to scalp while hair is wet; work into a lather; leave on for several minutes, then rinse - Repeat as needed. Once affected area becomes clear, occasional use will maintain remission. «bu»Warts«/bu» «b»Liquid, Solution: Salicylic acid 26% to 28.5% (Salisol Forte, UltraSal-ER, Virasal)«/b» - Adults: Soak wart in warm water for 5 minutes. - Dry area thoroughly. Apply to entire wart surface, allow to dry, and then apply a second time. - Avoid contact with surrounding skin. - Continue therapy once or twice daily. - Resolution may be expected after 4 to 6 weeks; some warts may take longer to remove. «b»Liquid: Salicylic Acid 17%«/b» - Soak wart in warm water for 5 minutes - Dry area thoroughly. Apply 1 drop to cover wart. - Let dry. - Repeat once or twice daily until wart is removed for up to 12 weeks. «b»Pads: Salicylic Acid 40%«/b» - Soak wart in warm water for 5 minutes. - Dry area thoroughly. - Apply medicated pad directly over wart and secure firmly to skin. - Repeat every 48 hours as needed until wart is removed for up to 12 weeks. - For external use only; not for ophthalmic, oral, or vaginal use. - Avoid contact with eyes and mucous membranes. - Discontinue use if excessive peeling or stinging occurs. - Unless hands are being treated, wash them thoroughly after application. «b»Keralyt Gel Administration«/b» - If applying to scalp, may wash off with warm water or Keralyt shampoo. «b»Keralyt Shampoo Administration«/b» - Apply to affected areas of dry scalp; leave on for 5 minutes and then rinse off with water or nonmedicated shampoo; gradually increase treatment time up to 1 hour. Alternatively, may apply as a medicated shampoo; wet hair and apply to scalp; work into lather, leave on for several minutes, then rinse. «b»Salvax Foam Administration«/b» - Shake vigorously before use; turn nozzle down to dispense foam - Rub in until completely absorbed «b»Bensal HP Administration«/b» - Rinse area with water or saline. - Pat dry. - Using a cotton tipped applicator, apply thin continuous layer (~1/8th inch thick) directly to wound or to a dry gauze to place directly over wound. - Do not use wet-to-dry dressings or wet-packs (will dilute ointment and decrease efficacy). - Slight burning may occur for 3 to 5 minutes after application. - Apply dressing to shield the area from clothes or exposure to water or dirt; expose treatment area to air when possible. «b»Acne Products Administration«/b» - Do not apply to broken skin or large areas of the body. - Except for products intended for use while bathing, apply to clean, dry skin. Creams, gels, and lotions should be applied in a thin layer to the affected area only. - Products used for cleansing should be massaged gently into wet skin, worked into lather and rinsed thoroughly. - For products used as a mask, apply a thin layer to the face, avoiding mouth and eyes. Allow to dry for 5 minutes or until mask turns white. Once mask has dried, rinse thoroughly and pat dry. - Medicated pads should be used to cover affected area with thin layer of salicylic acid; do not leave pad on skin. - Bath gels should be massaged over skin prone to acne while in the shower or bath; rinse well. «b»Corn and Callus Products Administration«/b» - Allow affected area to soak in warm water for 5 minutes and allow dry thoroughly before applying product. «b»Wart Products Administration«/b» - After soaking in water for 5 minutes, may remove loosened wart tissue with a brush, wash cloth, or emery board prior to drying skin and applying medication. - For products in a collodion-like vehicle, avoid inhaling vapors.

Salmeterol

Serevent

Salsalate

Amigesic, Disalcid

Samarium Sm 153 Lexidronam

Quadramet

Sapropterin

Kuvan, Phenoptin

Saquinavir

Invirase, Fortovase, SQV

Sarecycline

Seysara

Sargramostim

Leukine, Prokine

- May round the dose to the nearest vial size «bu»Acute Myeloid Leukemia«/bu» - Following induction chemotherapy «b»Adults ≥55 years«/b» - 250 mcg/m2/day IV infused over 4 hours starting approximately on day 11 or 4 days following the completion of induction chemotherapy (if day 10 bone marrow is hypoplastic with <5% blasts) - Continue until ANC >1,500/mm3 for 3 consecutive days or a maximum of 42 days - If ANC >20,000/mm3, interrupt treatment or reduce the dose by 50%. - If a second cycle of chemotherapy is necessary, administer ~4 days after the completion of chemotherapy if the bone marrow is hypoplastic with <5% blasts - Discontinue sargramostim immediately if leukemic regrowth occurs. - If a severe adverse reaction occurs, reduce the dose by 50% or temporarily discontinue the dose until the reaction abates. «bu»Bone Marrow Transplantation«/bu» «b»Allogeneic or Autologous Failure or Engraftment Delay«/b» - 250 mcg/m2/day IV infused over 2 hours for 14 days - If engraftment has not occurred after 7 days off sargramostim, may repeat - If engraftment still has not occurred after 7 days off sargramostim, a third course of 500 mcg/m2/day for 14 days may be attempted. - If there is still no improvement, it is unlikely that further dose escalation will be of benefit. - If a severe adverse reaction occurs, reduce the dose by 50% or temporarily discontinue the dose until the reaction abates - If blast cells appear or disease progression occurs, discontinue treatment - If ANC >20,000 cells/mm3, interrupt treatment or reduce the dose by 50%. «bu»Myeloid Reconstitution«/bu» «b»After Allogeneic or Autologous Bone Marrow Transplantation«/b» - 250 mcg/m2/day IV infused over 2 hours, begin 2 to 4 hours after the marrow infusion and ≥24 hours after chemotherapy or radiotherapy, when the post marrow infusion ANC is <500/mm3, and continue until ANC >1,500/mm3 for 3 consecutive days - If ANC >20,000/mm3, interrupt treatment or reduce the dose by 50%. - If a severe adverse reaction occurs, reduce dose by 50% or temporarily discontinue the dose until the reaction abates - If blast cells appear or progression of the underlying disease occurs, discontinue treatment «bu»Peripheral Stem Cell Transplantation (Autologous)«/bu» «b»Mobilization«/b» - 250 mcg/m2/day IV infused over 24 hours or - 250 mcg/m2/day SC once daily - Continue the same dose throughout peripheral blood progenitor cell collection - If WBC >50,000/mm3, reduce the dose by 50%. - The optimal schedule for peripheral blood progenitor cell collection has not been established (usually begun by day 5 and performed daily until protocol specified targets are achieved). If adequate numbers of progenitor cells are not collected, consider other mobilization therapy. «b»Post-transplant«/b» - 250 mcg/m2/day IV infused over 24 hours) or - 250 mcg/m2/day SC once daily beginning immediately following infusion of progenitor cells; continue until ANC is >1,500/mm3 for 3 consecutive days. «bu»Hematopoietic Radiation Injury Syndrome«/bu» «b»Acute«/b» - 250 mcg/m2/day SC - Continue until ANC >1,000/mm3 - Initiate within 24 hours of exposure of a dose ≥2 gray (Gy) and/or significant decrease in absolute lymphocyte count, or for anticipated neutropenia <500/mm3 for ≥7 days «bu»Primary Prophylaxis of Neutropenia«/bu» «b»Patients Receiving Chemotherapy (outside transplant and AML) or High Risk for Neutropenic Fever«/b» - 250 mcg/m2/day SC (may round to the nearest vial size, beginning at least 24 hours after chemotherapy administration - Continue until ANC >1,500/mm3 for 3 consecutive days

Sarilumab

Kevzara

Satralizumab

Enspryng

«bu»Neuromyelitis Optica Spectrum Disorder (NMOSD)«/bu» «b»Loading Dose«/b» - 120 mg SC at Weeks 0, 2, and 4 «b»Maintenance Dose«/b» - 120 mg SC every 4 weeks «b»Restart After Liver Transaminase Elevation«/b» «bi»<12 weeks«/bi» - 120 mg SC every 4 weeks «bi»≥12 weeks«/bi» - 120 mg SC every 4 weeks at Weeks 0, 2, and 4, then, - 120 mg SC every 4 weeks - Week 0 refers to first administration after missed dose - If treatment restarted, closely monitor liver parameters; discontinue if any subsequent increased ALT/AST and/or bilirubin above the ULN observed and do not reinitiate «b»Neutrophil Count«/b» - <1 x 109/L: Interrupt dosing until >1 x 109/L «b»Before Every Dose«/b» - Assess for active infection, including localized infections; in case of active infection, delay use until the infection is resolved «b»Before Initiating«/b» «bi»Tuberculosis (TB)«/bi» - Evaluate for active tuberculosis (TB) and test for latent TB infection - Consult infectious disease expert if positive «bi»Hepatitis B Virus (HBV)«/bi» - Perform hepatitis B virus (HBV) screening - Consult liver disease expert for patients who are negative for HBsAg and positive for HB core antibody (HBcAb+) or are HBV carriers (HBsAg+) - Complete scheduled vaccinations «bi»Liver Transaminases«/bi» Before initiating: Assess liver transaminases and serum bilirubin; caution if AST/ALT levels >1.5x ULN «b»During Treatment«/b» «bi»Liver Transaminases«/bi» - Measure ALT/AST every 4 weeks x 3 months, then, - Measure every 3 months x 1 year, and thereafter as clinically needed «b»Neutrophil Counts«/b» - Monitor neutrophils 4-8 weeks after initiation and thereafter at regular clinically determined intervals «b»Delayed or Missed Doses«/b» - Recommendations for any reason other than increased liver enzymes «bi»<8 weeks During Maintenance or Missed Loading Dose«/bi» - Administer 120 mg SC as soon as possible, and do not wait until the next planned dose Maintenance Period - After delayed/missed dose administered, reset dose schedule to every 4 weeks Second Loading Dose Delayed/Missed - Administer dose as soon as possible, then administer third (final) loading dose 2 weeks later Third Loading Dose Delayed/Missed - Administer dose as soon as possible, then, - First maintenance dose 4 weeks later «bi»8 to <12 Weeks«/bi» - 120 mg SC at 0 and 2 weeks, followed by, - 120 mg SC every 4 Weeks «bi»≥12 Weeks«/bi» - 120 mg SC at 0, 2, and 4 weeks, followed by, - 120 mg SC every 4 weeks

SAXagliptin

Onglyza

SAXagliptin-MetFORMIN

Kombiglyze

Scopolamine

Transderm-Scop, Scopace, Maldemar

Sebelipase Alfa

Kanuma

Secnidazole

Solosec

Secobarbital

Seconal, Quinalbarbitone Sodium

Secretin

ChiRhoStim, SecreFlo

Secukinumab

Cosentyx

Segesterone-Ethinyl Estradiol

Annovera

Selegiline

Eldepryl, Emsam, Zelapar, L-Deprenyl

«bu»Depression«/bu» - Initial Dose: 6 mg/24 hours Transdermal once daily - Target Dose: 6 mg/24 hours once daily - May titrate based on clinical response in increments of 3 mg/day every 2 weeks up to a maximum of 12 mg/24 hours «bu»Parkinson Disease«/bu» - 5 mg PO bid with breakfast and lunch with concomitant carbidopa/levodopa therapy - Maximum Dose: 10 mg/day. - Initial Dose: 1.25 mg ODT once daily with concomitant carbidopa/levodopa therapy for at least 6 weeks - May increase to 2.5 mg ODT once daily based on clinical response and tolerability - Maximum Dose: 2.5 mg/day «b»Concomitant Therapy with Carbidopa/Levodopa«/b» - After 2 to 3 days, an attempt may be made to reduce the dose of levodopa/carbidopa by 10% to 30%. - Further reductions of levodopa/carbidopa may be possible during continued selegiline therapy. «b»Discontinuation of Therapy«/b» - Upon discontinuation of antidepressant or antiparkinsonian therapy, gradually taper the dose to minimize the incidence of withdrawal symptoms and allow for the detection of re-emerging symptoms. Evidence supporting ideal taper rates is limited. APA and NICE depression guidelines suggest tapering therapy over at least several weeks with consideration to the half-life of the antidepressant; antidepressants with a shorter half-life and MAO inhibitors may need to be tapered more conservatively. In addition for long-term treated patients, WFSBP guidelines recommend tapering over 4 to 6 months. If intolerable withdrawal symptoms occur following a dose reduction, consider resuming the previously prescribed dose and/or decrease dose at a more gradual rate «b»Switching to or from an MAO Inhibitor Intended to Treat Psychiatric Disorders«/b» - Allow 14 days (or a time equal to 4 to 5 half-lives of the drug) to elapse between discontinuing an alternative antidepressant without long half-life metabolites (eg, TCAs, paroxetine, fluvoxamine, venlafaxine) or MAO inhibitor intended to treat psychiatric disorders and initiation of selegiline - Allow 5 weeks to elapse between discontinuing fluoxetine (with long half-life metabolites) intended to treat psychiatric disorders and initiation of selegiline. - Allow 14 days to elapse between discontinuing selegiline and initiation of an alternative antidepressant or MAO inhibitor intended to treat psychiatric disorders.

Selenium

Se Aspartate, Selenimin, Selenicaps-200, Selepen, Oceanic Selenium

Selenium Sulfide (Topical)

Tersi, Anti-Dandruff Shampoo, Dandrex, Selsun Blue Medicated Treatment, SelRx, Selsun Rx, TersiFoam

Selexipag

Uptravi

Selinexor

Xpovio

Selpercatinib

Retevmo

«bu»Non-Small Cell Lung Cancer (NSCLC)«/bu» «b»<50 kg«/b» - 120 mg PO bid «b»≥50 kg«/b» - 160 mg PO bid - Continue until disease progression or unacceptable toxicity «bu»Medullary Thyroid Cancer«/bu» «b»<50 kg«/b» - 120 mg PO bid «b»≥50 kg«/b» - 160 mg PO BID - Continue until disease progression or unacceptable toxicity «bu»Thyroid Cancer«/bu» «b»<50 kg«/b» - 120 mg PO bid «b»≥50 kg«/b» - 160 mg PO bid - Continue until disease progression or unacceptable toxicity «b»Missed Dose«/b» - Do not take a missed dose unless it is more than 6 hr until next scheduled dose «b»Vomited Dose«/b» - Do not take an additional dose; resume dosing with the next scheduled dose «b»Pregnancy«/b» - Verify pregnancy status in females of reproductive potential before initiating «b»Contraception«/b» - Use effective contraception during treatment and for 1 week after final dose in females of reproductive potential and in males with female partners of reproductive potential «b»Fertility«/b» - May impair fertility in females and males of reproductive potential «b»Dose Reduction Recommendations«/b» «bi»Weight <50 kg«/bi» - First Reduction: 80 mg PO daily bid - Second Reduction: 40 mg PO bid - Third reduction: 40 mg PO daily - Permanently discontinue if unable to tolerate third dose reduction «bi»Weight ≥50 kg«/bi» - First Reduction: 120 mg PO bid - Second Reduction: 80 mg PO bid - Third Reduction: 40 mg bid - Permanently discontinue if unable to tolerate third dose reduction «b»Hepatotoxicity grade 3 or 4«/b» - Withhold dosing and monitor AST/ALT once weekly until resolution to Grade 1 or baseline - Resume at reduced dose by 2 dose levels and monitor AST/ALT once weekly until 4 weeks after reaching dose taken prior to the onset of Grade 3 or 4 increased AST or ALT - Increase dose by 1 dose level after a minimum of 2 weeks without recurrence, and then increase to dose taken before Grade 3 or 4 increased AST or ALT after minimum of 4 weeks without recurrence «b»Hypertension«/b» «bi»Grade 3«/bi» - Withhold dosing for Grade 3 hypertension that persists despite optimal antihypertensive therapy; resume at reduced dose when hypertension controlled «bi»Grade 4«/bi» - Discontinue «b»QT Prolongation«/b» «bi»Grade 3«/bi» - Withhold dosing until recovery to baseline or Grade ≤1; resume at reduced dose «bi»Grade 4«/bi» - Discontinue «b»Hemorrhagic Events Grade 3 or 4«/b» - Withhold dosing until recovery to baseline or Grade ≤1 - Discontinue for severe or life-threatening hemorrhagic events «b»Hypersensitivity Reactions All Grades«/b» - Withhold dosing until resolution; initiate corticosteroids - Resume at reduced dose by 3 dose levels while continuing corticosteroids - Increase dose by 1 dose level each week until the dose taken prior to hypersensitivity event is reached, then taper corticosteroids «b»Other Adverse Effects Grade 3 or 4«/b» - Withhold dosing until recovery to baseline or Grade ≤1 - Resume at reduced dose «b»CYP3A Inhibitors«/b» - Avoid coadministration; if unable to avoid, reduce selpercatinib dose - After inhibitor has been discontinued for 3-5 elimination half-lives, resume selpercatinib at dose take prior to initiated the CYP3A inhibitor «bi»Moderate CYP3A Inhibitor«/bi» - If current dose is 120 mg bid, reduce to 80 mg bid - If current dose is 160 mg bid, reduce to 120 mg bid «bi»Strong CYP3A Inhibitor«/bi» - If current dose is 120 mg bid, reduce to 40 mg bid - If current dose is 160 mg bid, reduce to 80 mg bid «b»Acid-reducing Agents«/b» - Avoid with PPIs, histamine-2 (H2) receptor antagonists, or locally acting antacids «bi»If unable to avoid«/bi» PPIs - Take with food when coadministered H2 Receptor Antagonist - Take selpercatinib 2 hr before or 10 hr after an H2 antagonist Locally Acting Antacid - Take selpercatinib 2 hr before or 2 hr after antacid

Selumetinib

Koselugo

«bu»Type 1 Neurofibromatosis«/bu» «b»<2 years or BSA <0.55 m2«/b» - Safety and efficacy not established «b»≥2 years«/b» «bi»BSA ≥0.55 m2«/bi» - 25 mg/m2 PO bid (~q12hr) «bi»Recommended Dosage Based on BSA«/bi» 0.55-0.69 m2 - 20 mg PO every AM and 10 mg PO every PM 0.7-0.89 m2 - 20 mg PO bid 0.9-1.09 m2 - 25 mg PO bid 1.1-1.29 m2 - 30 mg PO bid 1.3-1.49 m2 - 35 mg PO bid 1.5-1.69 m2 - 40 mg PO bid 1.7-1.89 m2 - 45 mg PO bid ≥1.9 m2 - 50 mg PO bid «b»Dose Reductions for Adverse Reactions Based on BSA«/b» «bi»First Dose Reduction«/bi» 0.55-0.69 m2 - 10 mg bid 0.7-0.89 m2 - 20 mg every AM and 10 mg every PM 0.9-1.09 m2 - 25 mg every AM and 10 mg every PM 1.1-1.29 m2 - 25 mg every AM and 20 mg every PM 1.3-1.49 m2 - 25 mg bid 1.5-1.69 m2 - 30 mg bid 1.7-1.89 m2 - 35 mg every AM and 30 mg every PM ≥1.9 m2 - 35 mg bid «bi»Second Dose Reduction«/bi» 0.55-0.69 m2 - 10 mg daily 0.7-1.09 m2 - 10 mg bid 1.1-1.29 m2 - 20 mg every AM and 10 mg every PM 1.3-1.49 m2 - 25 mg every AM and 10 mg every PM 1.5-1.89 m2 - 25 mg every AM and 20 mg every PM ≥1.9 m2 - 25 mg bid «bi»Subsequent Dose Reductions«/bi» - Permanently discontinue in patients unable to tolerate selumetinib after 2 dose reductions «b»Cardiomyopathy«/b» «bi»Asymptomatic Decrease in LVEF ≥10% from Baseline and Lower Level of Normal (LLN)«/bi» - Withhold until resolution; resume at reduced dose «bi»Symptomatic Decreased LVEF OR Grade 3 or 4 Decreased LVEF«/bi» - Permanently discontinue «b»Ocular Toxicity«/b» «bi»Retinal Pigment Epithelial Detachment (RPED)«/bi» - Withhold until resolution; resume at reduced dose «bi»Retinal vein occlusion (RVO)«/bi» - Permanently discontinue «b»Gastrointestinal Toxicity«/b» «bi»Grade 3 Diarrhea«/bi» - Withhold until improved to Grade <1; resume at same dose; permanently discontinue if no improvement within 3 days «bi»Grade 4 Diarrhea OR Grade 3 or 4 Colitis«/bi» - Permanently discontinue «b»Skin Toxicity«/b» «bi»Grade 3 or 4«/bi» - Withhold until improvement; resume at reduced dose «b»Increased Creatine Phosphokinase (CPK)«/b» «bi»Grade 4 Increased CPK OR any Increased CPK and Myalgia«/bi» - Withhold until improved to Grade <1; resume at reduced dose; permanently discontinue if no improvement within 3 weeks «b»Other Adverse Reactions«/b» «bi»Intolerable Grade 2 OR Grade 3«/bi» - Withhold until improved to Grade <1; resume at reduced dose «bi»Grade 4«/bi» - Withhold until improved to Grade <1; resume at reduced dose; consider discontinuation «b»Strong or Moderate CYP3A4 Inhibitors or Fluconazole«/b» - Avoid coadministration - If coadministration cannot be avoided, reduce selumetinib dosage based on the recommendations below - Resume selumetinib after discontinuation of the strong or moderate CYP3A4 inhibitor or fluconazole for 3 elimination half-lives - Reduce current dose by 5 mg/m2 (eg, 25 mg/m2 to 20 mg/m2 OR 20 mg/m2 to 15 mg/m2) «b»Dosage Reduction to 20 mg/m2 Based on BSA«/b» 0.55-0.69 m2 - 10 mg BID 0.7-0.89 m2 - 20 mg every AM and 10 mg every PM 0.9-1.09 m2 - 20 mg bid 1.1-1.29 m2 - 25 mg bid 1.3-1.49 m2 - 30 mg every AM and 25 mg ever PM 1.5-1.69 m2 - 35 mg every AM and 30 mg every PM 1.7-1.89 m2 - 35 mg bid ≥1.9 m2 - 40 mg bid «b»Dosage Reduction to 15 mg/m2 Based on BSA«/b» 0.55-0.69 m2 - 10 mg qDay 0.7-0.89 m2 - 10 mg bid 0.9-1.09 m2 - 20 mg every AM and 10 mg every PM 1.1-1.29 m2 - 25 mg every AM and 10 mg every PM 1.3-1.49 m2 - 25 mg every AM and 20 mg every PM 1.5-1.69 m2 - 25 mg bid 1.7-1.89 m2 - 30 mg every AM and 25 mg every PM ≥1.9 m2 - 30 mg bid «b»Missed Dose«/b» - Do not take a missed dose unless it is >6 hr until the next scheduled dose - If vomiting occurs after administration, do not take an additional dose, but continue with the next scheduled dose «b»Contraception«/b» Females of reproductive potential or males with females of reproductive potential: Use effective contraception during treatment and for 1 week after the last dose

Semaglutide

Ozempic, Rybelsus, Wegovy

«bu»Diabetes Mellitus, Type 2«/bu» «b»Initial SC Dose«/b» - 0.25 mg SC weekly for 4 weeks «b»Maintenance SC Dose«/b» - Increase the dosage to 0.5 mg weekly - If glycemic control not achieved after at least 4 weeks on 0.5-mg dose, can increase to 1 mg weekly «b»Initial PO Dose«/b» - 3 mg PO once daily x 30 days «b»Maintenance PO Dose«/b» - Increase to 7 mg PO once daily; after 30 days on 3 mg/day After 30 days on 7 mg/day - May increase dose to 14 mg PO daily if additional glycemic control needed - The 3-mg dose is intended for treatment initiation and is not effective for glycemic control - Taking two 7-mg tablets to achieve 14 mg dose is not recommended «b»Switching Between Ozempic (SC) and Rybelsus (PO)«/b» «bi»Taking 14 mg/day PO«/bi» - Transition to 0.5 mg SC weekly on day after last PO dose «bi»Taking 0.5 mg/week SC«/bi» - Transition to 7 mg or 14 mg PO starting up to 7 days after last SC injection - There is no equivalent PO dose for the 1-mg SC dose «b»Missed Oral Dose«/b» - If a dose is missed, the missed dose should be skipped, and the next dose should be taken the following day «b»Limitations of Use«/b» «bi»Ozempic, Rybelsus«/bi» - Not recommended as a first-line therapy for patients who have inadequate glycemic control on diet and exercise because of the uncertain relevance of rodent C-cell tumor findings to humans - Has not been studied in patients with a history of pancreatitis - Consider other antidiabetic therapies in patients with a history of pancreatitis - Not a substitute for insulin. - Not indicated for use in patients with type 1 diabetes mellitus or for the treatment of patients with diabetic ketoacidosis, as it would not be effective in these settings «bu»Weight Management«/bu» «b»Weeks 1-4«/b» - 0.25 mg SC once weekly «b»Weeks 5-8«/b» - 0.5 mg SC once weekly «b»Weeks 9-12«/b» - 1 mg SC once weekly «b»Week 13-16«/b» - 1.7 mg SC once weekly «b»Maintenance Dose«/b» Week 17 and onward - 2.4 mg SC once weekly - Initiate with low dose and gradually escalate to maintenance dose of 2.4 mg/week SC to minimize GI adverse reactions - If unable to tolerate a dose during escalation, consider delaying dose escalation for 4 weeks - If unable to tolerate maintenance dose of 2.4 mg once-weekly, may temporarily decreased to 1.7 mg once weekly, for a maximum of 4 weeks; after 4 weeks, increase back to maintenance 2.4 mg once-weekly; discontinue if not tolerated after second attempt - In patients with type 2 diabetes, monitor blood glucose before initiating and during treatment «b»Missed SC Dose (Wegovy)«/b» - If 1 dose is missed and the next scheduled dose is >2 days away (48 hr), administer missed dose as soon as possible - If 1 dose is missed and the next scheduled dose is <2 days away (48 hr), do not administer the dose; resume dosing on regularly scheduled day of the week - If >2 consecutive doses are missed, resume dosing as scheduled or, if needed, reinitiate and follow dose escalation schedule, which may reduce the occurrence of GI symptoms associated with reinitiating treatment «b»Limitations of Use«/b» «bi»Wegovy«/bi» - Contains semaglutide and should not be coadministered with other semaglutide-containing products or with any other GLP-1 receptor agonist - Safety and effectiveness in combination with other products intended for weight loss, including prescription drugs, OTC drugs, and herbal preparations, have not been established «b»Oral Administration«/b» - Take at least 30 minutes before first food, beverage, or other oral medication of the day with no more than 4 oz of plain water only - Waiting <30 minutes, or taking with food, beverages (other than plain water), or other oral medications decrease efficacy by decreasing semaglutide absorption - Waiting to take after 30 minutes to eat may increase semaglutide absorption - Swallow tablets whole; do not split, crush, or chew «b»SC Administration (Ozempic)«/b» - Administer SC to abdomen, thigh, or upper arm - Administer once weekly, on the same day each week, at any time of the day, with or without meals - Day of weekly administration can be changed if necessary as long as the time between 2 doses is at least 2 days (>48 hours) - Use a different injection site each week when injecting in the same body region - Visually inspect before use; drug should appear clear and colorless - Do not use semaglutide if particulate matter and coloration observed - When used with insulin, administer as separate injections and never mix the products; it is acceptable to inject semaglutide and insulin in the same body region but injections should not be adjacent to each other «bi»Missed SC Dose (Ozempic)«/bi» If Missed Dose is ≤5 days - Administer dose as soon as possible If Missed Dose >5 days - Skip missed dose and administer next dose on the regularly scheduled day - Patients can then resume their regular once weekly dosing schedule «b»SC Administration (Wegovy)«/b» - Administer SC to abdomen, thigh, or upper arm - The time of day and the injection site can be changed without dose adjustment - Administer once weekly, on the same day each week, at any time of day, with or without meals - Visually inspect before use; drug should appear clear and colorless - Do not use semaglutide if particulate matter and coloration observed «bi»Missed SC Dose (Wegovy)«/bi» - If 1 dose is missed and the next scheduled dose is >2 days away (48 hr), administer missed dose as soon as possible - If 1 dose is missed and the next scheduled dose is <2 days away (48 hr), do not administer the dose; resume dosing on regularly scheduled day of the week - If >2 consecutive doses are missed, resume dosing as scheduled or, if needed, reinitiate and follow dose escalation schedule, which may reduce the occurrence of GI symptoms associated with reinitiating treatment

Sennosides

Lax Prepare, Senexon, Ex-Lax, Senokot, Senna, SennaCon, Geri-kot

Serdexmethylphenidate

Serdexmethylphenidate-Methylphenidate

Azstarys

Sertaconazole

Ertaczo

Sertraline

Zoloft

Setmelanotide

Imcivree

Sevelamer

Renvela, Renagel

Sildenafil

Revatio, Viagra

Silodosin

Rapaflo

Siltuximab

Sylvant

Silver Nitrate

AgNO3

Silver Sulfadiazine

Silvadene, Thermazene, Silver Sulphadiazine, SSD Cream

Simethicone

Anti-Gas/80, Phazyme, Gas-X, Mylicon, Mytab Gas, Gas Relief

Simvastatin

Zocor, FloLipid

«bu»Hypercholesterolemia«/bu» «b»Usual Dosage Range«/b» - 5-40 mg PO once daily «b»Initial Dose«/b» - 10-20 mg PO once daily in the evening «b»Patients at High CHD Risk«/b» - Start 40 mg/day «bu»Homozygous Familial Hypercholesterolemia«/bu» «b»Recommended Dose«/b» - 40 mg PO once daily in the evening «bu»Prevention of Coronary Events«/bu» - 5-40 mg PO once daily in the evening «b»Moderate Reduction of LDL-C Desired«/b» - 5-10 mg PO once daily in the evening - Adjust dose to achieve goal «b»Reduction of >40% of LDL-C Desired«/b» - 40 mg PO once daily in the evening - Adjust dose to achieve goal - Presence of CHD or at high risk for cardiovascular events, including patients with diabetes, PVD, history of stroke or other cerebrovascular disease: 40 mg PO qDay in the evening adjunct to diet therapy (initiate simultaneously); adjust dose to achieve goal «bu»Primary and Secondary Prevention of Atherosclerotic Cardiovascular Disease (ASCVD)«/bu» «b»Primary Prevention«/b» «bi»LDL-C ≥190 mg/dL«/bi» - High-intensity therapy agent atorvastatin or rosuvastatin recommended «bi»Type 1 or 2 Diabetes«/bi» 40-75 years - Moderate-intensity therapy: 20-40 mg simvastatin PO qDay 40-75 years and 10 year Estimated risk of ASCVD ≥7.5% - High-intensity therapy agent atorvastatin or rosuvastatin recommended 40-75 years and 10 year estimated risk of ASCVD ≥7.5% - Moderate-intensity therapy: 20-40 mg simvastatin PO qDay; may consider high-intensity therapy agent atorvastatin or rosuvastatin «b»Secondary Prevention«/b» - Presence of ASCVD, including stroke/TIA or peripheral arterial disease believed to be of atherosclerotic origin or post-CABG «bi»≤75 years«/bi» - Treat with high-intensity therapy agent atorvastatin or rosuvastatin «bi»>75 years«/bi» - Administer 20-40 mg simvastatin PO qDay (moderate-intensity therapy); not candidate for high-intensity therapy «b»Dosage Modifications«/b» «bi»Severe renal Impairment (CrCl <30 mL/min)«/bi» - 5 mg PO daily initially «bi»Coadministration with Dronedarone, Verapamil, or Diltiazem«/bi» - Do not exceed 10 mg/day «bi»Coadministration with Amiodarone, Amlodipine, or Ranolazine«/bi» - Do not exceed 20 mg/day «bi»Coadministration with Lomitapide«/bi» - Reduce simvastatin dose by 50%, and do not exceed 20 mg/day (or 40 mg/day in those previously tolerating 80 mg/day) when initiating lomitapide «b»Dosing Considerations«/b» - Lipid determinations should be performed after 4 weeks of therapy and periodically thereafter «b»Restricted Dosing«/b» - 80 mg/day should be used only for individuals who have been taking simvastatin 80 mg chronically (eg, ≥12 months) without evidence of myopathy or rhabdomyolysis - Patients tolerating 80 mg who need to be initiated on an interacting drug that is contraindicated or associated with a maximum dose for simvastatin should be switched to an alternative statin with less potential for drug-drug interactions - Patients unable to achieve their LDL-C goal utilizing 40 mg/day should not be titrated to 80 mg (increased risk for myopathy) but should instead be placed on alternative LDL-C-lowering treatment that provides greater LDL-C lowering «b»Overdose Management«/b» - Adverse drug reactions from overdose may include peripheral neuropathy, diarrhea, increased K+, myopathy, rhabdomyolysis, acute renal failure, elevated LFTs, and eye lens opacities - Treatment is supportive

Sinecatechins

Veregen, Catechins, Kunecatechins, Polyphenols

Siponimod

Mayzent

«bu»Multiple Sclerosis«/bu» «b»Patients with CYP2C9 genotypes *1/*1, *1/*2, or *2/*2«/b» - Initiate with a 5-day titration - Maintenance Dose (Day 6): 2 mg PO daily - Use a starter pack for patients who will be titrated to the 2-mg maintenance dosage - Do not use starter pack for patients who will be titrated to the 1-mg maintenance dosage «bi»Titration for the 2-mg/day Maintenance Dose«/bi» - Day 1: 0.25 mg (1 x 0.25 mg) PO - Day 2: 0.25 mg (1 x 0.25 mg) PO - Day 3: 0.50 mg (2 x 0.25 mg) PO - Day 4: 0.75 mg (3 x 0.25 mg) PO - Day 5: 1.25 mg (5 x 0.25 mg) PO - Day 6 and thereafter: 2 mg (1 x 2 mg) PO daily «b»Patients with CYP2C9 genotypes *1/*3 or *2/*3«/b» - Initiate with a 4-day titration - Maintenance Dose (Day 5): 1 mg PO daily - Do not use the starter pack for patients who will be titrated to the 1-mg maintenance dosage «bi»Titration for 1-mg/day Maintenance Dose«/bi» - Day 1: 0.25 mg (1 x 0.25 mg) PO - Day 2: 0.25 mg (1 x 0.25 mg) PO - Day 3 0.50 mg (2 x 0.25 mg) PO - Day 4: 0.75 mg (3 x 0.25 mg) PO - Day 5 and thereafter: 1 mg (4 x 0.25 mg) PO daily «b»Reinitiation After Treatment Interruption«/b» - After completing initial titration, if maintenance treatment is interrupted for 4 or more consecutive daily doses, reinitiate treatment with Day 1 of the titration regimen - Also complete first-dose monitoring in patients for whom it is recommended «b»Assessments Prior to First Dose«/b» «bi»CYP2C9 Genotype Determination«/bi» - Test patients for CYP2C9 variants to determine CYP2C9 genotype «bi»Complete Blood Count«/bi» - Review results of a recent complete blood count (CBC) «bi»Ophthalmic Evaluation«/bi» - Obtain an evaluation of the fundus, including the macula «bi»Cardiac Evaluation«/bi» - Obtain an electrocardiogram (ECG) to determine whether preexisting conduction abnormalities are present. In patients with certain preexisting conditions, advice from a cardiologist and first-dose monitoring is recommended - Determine whether patients are taking drugs that could slow heart rate or atrioventricular (AV) conduction «bi»Current or Prior Medications«/bi» - If patients are taking antineoplastic, immunosuppressive, or immune-modulating therapies, or if there is a history of prior use of these drugs, consider possible unintended additive immunosuppressive effects before initiating treatment «bi»Vaccinations«/bi» - Test patients for antibodies to varicella zoster virus (VZV) before initiating therapy; VZV vaccination of antibodynegative patients is recommended prior to commencing treatment «bi»Liver Function Tests«/bi» - Obtain recent (within last 6 months) transaminase and bilirubin levels «b»Contraception«/b» - Before initiating treatment, counsel women of childbearing potential on the potential risks to the fetus - Advise on effective contraception during treatment - Since it takes ~10 days to eliminate drug from the body after discontinuation, potential risks to the fetus may persist and women should use effective contraception during this period

Sipuleucel-T

Provenge

Sirolimus

Rapamune, Rapamycin

«bu»Lymphangioleiomyomatosis«/bu» Initial Dose - 2 mg once daily. - Obtain trough concentration in 10 to 20 days - Adjust dose to maintain a target concentration of 5 to 15 ng/mL «b»Dosage Adjustment for Lymphangioleiomyomatosis«/b» - Once the maintenance dose is adjusted, further adjustments should be made at 7- to 14-day intervals to account for the long half-life of sirolimus. - In general, dose proportionality may be assumed. - New sirolimus dose equals current dose multiplied by (target concentration divided by current concentration). - Once a stable dose is achieved, trough concentrations should be assessed at least every 3 months. «bu»Renal Transplant (Rejection Prophylaxis)«/bu» «b»Low-to-Moderate Immunologic Risk«/b» «bi»<40 kg«/bi» Loading Dose - 3 mg/m2 PO on day 1 Maintenance Dose - 1 mg/m2 PO once daily «bi»≥40 kg«/bi» Loading Dose - 6 mg PO on day 1 Maintenance Dose - 2 mg PO once daily «b»High Immunologic Risk«/b» Loading Dose - Up to 15 mg PO on day 1 Maintenance Dose - 5 mg PO daily - Obtain trough concentration between days 5 to 7 and adjust accordingly. - Continue concurrent cyclosporine/sirolimus/corticosteroid therapy for 1 year following transplantation. - Further adjustment of the regimen must be based on clinical status. «b»Dosage Adjustment«/b» - Sirolimus dosages should be adjusted in small increments to maintain 24-hour trough concentrations within desired range based on risk and concomitant therapy. - Dosage should be adjusted at intervals of 7 to 14 days to account for the long half-life of sirolimus. - Maximum Loading Dose: 40 mg/day (although typical loading doses are not generally this high). - Whole blood concentrations should not be used as the sole basis for dosage adjustment (monitor clinical signs/symptoms, tissue biopsy, and laboratory parameters). «b»Maintenance Therapy after Withdrawal of Cyclosporine«/b» - According to the manufacturer, cyclosporine withdrawal is not recommended in high immunological risk renal transplant patients. - Following 2 to 4 months of combined therapy, withdrawal of cyclosporine may be considered in low-to-moderate immunologic risk patients. - Cyclosporine should be discontinued over 4 to 8 weeks, and a necessary increase in the dosage of sirolimus (up to fourfold) should be anticipated due to removal of metabolic inhibition by cyclosporine and to maintain adequate immunosuppressive effects. - Dose-adjusted trough target concentrations are typically 16 to 24 ng/mL for the first year post-transplant and 12 to 20 ng/mL thereafter (per the manufacturer; measured by chromatographic methodology). - Target trough concentrations of ~5 to 15 ng/mL are often used in clinical practice; refer to specific institutional protocol for target sirolimus trough concentrations. «bu»Graft-Versus-Host Disease (GVHD)«/bu» «b»Prevention«/b» - 12 mg loading dose on day -3, followed by 4 mg daily (target trough level: 3 to 12 ng/mL); taper off after 6 to 9 months «b»Treatment of Refractory Acute GVHD«/b» - 4 to 5 mg/m2 PO for 14 days (no loading dose) «b»Treatment of Chronic GVHD«/b» - 6 mg loading dose, followed by 2 mg daily (target trough level: 7 to 12 ng/mL) for 6 to 9 months «bu»Lung Transplantation Rejection Prophylaxis«/bu» Loading Dose - 5 mg once Maintenance Dose - 3 mg once daily - Titrate to a target trough level of 5 to 13 ng/mL - Do not initiate sirolimus until after the bronchial anastomosis has completely healed (approximately 90 days) due to potential fatal airway dehiscence with earlier initiation «bu»Renal Angiomyolipoma«/bu» Initial Dose - 0.5 mg/m2 once daily titrated to a target trough level of 3 to 6 ng/mL (may increase to target trough level of 6 to 10 ng/mL if <10% reduction in lesion diameters at 2 months) for 2 years

Sirolimus (Topical)

Hyftor

Sirolimus Protein Bound

Fyarro

SITagliptin

Januvia

SITagliptin-MetFORMIN

Janumet

Smallpox Monkeypox Vaccine (Live)

Jynneos

Smallpox Vaccine, Live

ACAM2000, Vaccinia

Sodium Acetate

Sodium Bicarbonate

Soda Mint, Neut, Baking Soda,

- 1 mEq NaHCO3 is equivalent to 84 mg; each g of NaHCO3 provides ~12 mEq each of sodium and bicarbonate ions. Each oral tablet (650 mg) contains 7.7 mEq each of sodium and bicarbonate ions. «bu»Cardiac Arrest«/bu» - Initial: 1 mEq/kg/dose - Repeat doses should be guided by arterial blood gases - Routine use of NaHCO 3 is not recommended - May be considered in the setting of prolonged cardiac arrest only after adequate alveolar ventilation has been established and effective cardiac compressions - In some cardiac arrest situations (eg, metabolic acidosis, hyperkalemia, or tricyclic antidepressant overdose), sodium bicarbonate may be beneficial. «bu»Metabolic Acidosis in Chronic Kidney Disease (CKD)«/bu» - Initial Dose: 15.4 to 23.1 mEq/day in divided doses (650 mg tablet 2 to 3 times daily) - Titrate to normal serum bicarbonate concentrations (23 to 29 mEq/L) or up to 5850 mg/day; baking soda may be used as an alternative in patients who cannot take tablets - Avoid exceeding serum bicarbonate concentrations >32 mEq/L since this has been associated with increased mortality in patients with CKD «bu»Metabolic Acidosis«/bu» - Dosage should be based on the following formula if blood gases and pH measurements are available: - HCO3 -(mEq) = 0.5 x weight (kg) x [24 - serum HCO3 -(mEq/L)] or HCO3 -(mEq) = 0.5 x weight (kg) x [desired increase in serum HCO3 -(mEq/L)] - Administer 1/2 dose initially, then remaining 1/2 dose over the next 24 hours; monitor pH, serum HCO3 -, and clinical status - These equations provide an estimated replacement dose. The underlying cause and degree of acidosis may result in the need for larger or smaller replacement doses. In most cases, the initial goal of therapy is to target a pH of ~7.2 and a plasma bicarbonate level of ~10 mEq/L to prevent overalkalinization. According to the ARDSNet protocol, if pH remains <7.15 after ventilator adjustments, may give NaHCO3 - If acid-base status is not available: 2 to 5 mEq/kg IV infusion over 4 to 8 hours; subsequent doses should be based on patient's acid-base status. «bu»Hyperkalemia«/bu» - 50 mEq IV over 5 minutes (as appropriate, consider methods of enhancing potassium removal/excretion) «bu»Renal Tubular Acidosis«/bu» - Distal: 0.5 to 2 mEq/kg/day in 4 to 5 divided doses - Proximal: Initial: 5 to 10 mEq/kg/day; maintenance: Increase as required to maintain serum bicarbonate in the normal range «bu»Urine Alkalinization«/bu» - Initial Dose: 48 mEq (4 g), then, - 12 to 24 mEq (1 to 2 g) every 4 hours - Dose should be titrated to desired urinary pH - Doses up to 16 g/day (200 mEq) in patients <60 years and 8 g (100 mEq) in patients >60 years - Administration of 48 mEq (4 g) every 8 hours for a total daily dose of 144 mEq (12 g) has also been shown to achieve a urinary pH of at least 7 after a period of 10 hours in one study of healthy volunteers - Intravenous administration is preferred in specific overdoses (salicylate) with a target urinary pH of 7.5 to 8.5 «bu»Antacid«/bu» - 325 mg to 2 g 1 to 4 times/day «bu»Neutralize Lidocaine with Epinephrine Dental Anesthetic«/bu» - Neutralizing additive - Mix 10 parts anesthetic (lidocaine with epinephrine) to 1 part 8.4% sodium bicarbonate - Add 0.18 mL sodium bicarbonate to 1.8 mL cartridge of lidocaine 2% with epinephrine 1:50,000 or 1:100,000 - Add 2 mL sodium bicarbonate to 20 mL vial of lidocaine 2% with epinephrine 1:100,000 - Add 3 mL sodium bicarbonate to 30 mL vial of lidocaine 2% with epinephrine 1:100,000 - Add 5 mL sodium bicarbonate to 50 mL vial of lidocaine 2% with epinephrine 1:100,000 «bu»Prevention of Contrast-Induced Nephropathy«/bu» (off-label use) - 154 mEq/L IV infusion sodium bicarbonate in D5W solution: 3 mL/kg/hour for 1 hour immediately before contrast injection, then, - 1mL/kg/hour during contrast exposure and for 6 hours after procedure «bu»Cardiac Arrest«/bu» «b»Infants and Children«/b» - 1 mEq/kg/dose IV/IO - Repeat doses should be guided by arterial blood gases - Children <2 years of age should receive 4.2% (0.5 mEq/mL) solution - If I.O. route is used for administration and is subsequently used to obtain blood samples for acid-base analysis, results will be inaccurate. - Routine use of NaHCO 3 is not recommended. - May be considered in the setting of prolonged cardiac arrest only after adequate alveolar ventilation has been established and effective cardiac compressions. - In some cardiac arrest situations (eg, metabolic acidosis, hyperkalemia, or tricyclic antidepressant overdose), sodium bicarbonate may be beneficial. Metabolic acidosis: IV: Infants and Children: Dosage should be based on the following formula if blood gases and pH measurements are available: - HCO3 -(mEq) = 0.5 x weight (kg) x [24 - serum HCO3 -(mEq/L)] or HCO3 -(mEq) = 0.5 x weight (kg) x [desired increase in serum HCO3 -(mEq/L)] - Administer 1/2 dose initially, then remaining 1/2 dose over the next 24 hours; monitor pH, serum HCO3 -, and clinical status. Note: These equations provide an estimated replacement dose. The underlying cause and degree of acidosis may result in the need for larger or smaller replacement doses. In most cases, the initial goal of therapy is to target a pH of ~7.2 and a plasma bicarbonate level of ~10 mEq/L to prevent overalkalinization. - If acid-base status is not available: Dose for older Children: 2-5 mEq/kg IV infusion over 4-8 hours; subsequent doses should be based on patient's acid-base status. «bu»Chronic Renal Failure«/bu» «b»Children«/b» - Initiate when plasma HCO3 - <15 mEq/L: 1-3 mEq/kg/day - Renal tubular acidosis, distal: Oral: Children: 2-3 mEq/kg/day - Renal tubular acidosis, proximal: Children: Initial: 5-10 mEq/kg/day - Maintenance Dose: Increase as required to maintain serum bicarbonate in the normal range «bu»Urine Alkalinization«/bu» «b»Children«/b» - 1-10 mEq (84-840 mg)/kg/day in divided doses every 4-6 hours - Dose should be titrated to desired urinary pH.

Sodium Citrate

Sodium Citrate-Citric Acid

Bicitra, Oracit, Shohl's Solution, Virtrate-2

Sodium Ferric Gluconate Complex in Sucrose

Ferric Gluconate, Ferrlecit

Sodium Glycerophosphate Pentahydrate

Glycophos

- When converting from inorganic phosphate products (sodium phosphate and potassium phosphate), maintain the same mmol amount of phosphate. Doses are listed as mmol of phosphate. Sodium glycerophosphate pentahydrate 306.1 mg = sodium glycerophosphate 216 mg = phosphate 1 mmol. Sodium glycerophosphate pentahydrate will provide 2 mEq of sodium for every 1 mmol of phosphate delivered. «bu»Phosphate Replacement, Parenteral Nutrition«/bu» - 10-20 mmol per day IV admixed within parenteral nutrition solution - Dosage should be individualized. «bu»Acute Treatment of Hypophosphatemia«/bu» - It is difficult to provide concrete guidelines for the treatment of severe hypophosphatemia because the extent of total body deficits and response to therapy are difficult to predict. Aggressive doses of phosphate may result in a transient serum elevation followed by redistribution into intracellular compartments or bone tissue. It is recommended that repletion of severe hypophosphatemia be done IV because large doses of oral phosphate may cause diarrhea and intestinal absorption may be unreliable. Intermittent IV infusion should be reserved for severe depletion situations; requires continuous cardiac monitoring. Guidelines differ based on degree of illness, need/use of TPN, and severity of hypophosphatemia. Obese patients and/or severe renal impairment were excluded from phosphate supplement trials. Note: 1 mmol phosphate = 31 mg phosphorus; 1 mg phosphorus = 0.032 mmol phosphate. «b»Critically-ill with Concurrent Enteral/Parenteral Nutrition«/b» - Round doses to the nearest 7.5 mmol for ease of preparation. - If administering with phosphate-containing parenteral nutrition, do not exceed 15 mmol/L within parenteral nutrition. «bi»Weight«/bi» - May use adjusted body weight for patients weighing >130% of ideal body weight (and BMI <40 kg/m2) by using [IBW + 0.25 (ABW-IBW)]: «bi»Low Dose, Serum Phosphorus Level 2.3-3 mg/dL (0.74-0.96 mmol/L)«/bi» - 0.16-0.32 mmol/kg over 4-6 hours «bi»Intermediate Dose, Serum Phosphorus level 1.6-2.2 mg/dL (0.51-0.71 mmol/L)«/bi» - 0.32-0.64 mmol/kg over 4-6 hours «bi»High Dose, Serum Phosphorus <1.5 mg/dL (<0.5 mmol/L)«/bi» - 0.64-1 mmol/kg over 8-12 hours «b»Parenteral Nutrition«/b» - 10-15 mmol/1000 kcal IV or 20-40 mmol/24 hours - Must be diluted before administration; appropriate volume of diluent and maximum concentration have not been determined for intermittent phosphate repletion. Administer within 24 hours of preparation due to risk of microbial contamination. «bu»Phosphate Replacement, Parenteral Nutrition«/bu» «b»Infants«/b» - 1-1.5 mmol/kg per day admixed within parenteral nutrition solution - Dosage should be individualized. - With orders for IV phosphate, there is considerable confusion associated with the use of millimoles (mmol) versus milliequivalents (mEq) to express the phosphate requirement. The most reliable method of ordering IV phosphate is by millimoles. - It is difficult to provide concrete guidelines for the treatment of severe hypophosphatemia because the extent of total body deficits and response to therapy are difficult to predict. Aggressive doses of phosphate may result in a transient serum elevation followed by redistribution into intracellular compartments or bone tissue. It is recommended that repletion of severe hypophosphatemia be done IV because large doses of oral phosphate may cause diarrhea and intestinal absorption may be unreliable. Intermittent IV infusion should be reserved for severe depletion situations; requires continuous cardiac monitoring. Guidelines differ based on degree of illness, need/use of TPN, and severity of hypophosphatemia. Obese patients and/or severe renal impairment were excluded from phosphate supplement trials. Note: 1 mmol phosphate = 31 mg phosphorus; 1 mg phosphorus = 0.032 mmol phosphate. - There are no prospective studies of parenteral phosphate replacement in children. The following weight-based guidelines for adult dosing may be cautiously employed in pediatric patients. Guidelines differ based on degree of illness, use of TPN, and severity of hypophosphatemia. «bi»Low Dose, Serum Phosphorus Losses are Recent and Uncomplicated«/bi» - 0.08 mmol/kg over 6 hours «bi»Intermediate Dose, Serum Phosphorus Level 0.5-1 mg/dL (0.16-0.32 mmol/L)«/bi» - 0.16-0.24 mmol/kg over 6 hours - The initial dose may be increased by 25% to 50% if the patient is symptomatic secondary to hypophosphatemia, and lowered by 25% to 50% if the patient is hypercalcemic. «b»Critically-ill with Concurrent Enteral/Parenteral Nutrition«/b» - Round doses to the nearest 7.5 mmol for ease of preparation. If administering with phosphate-containing parenteral nutrition, do not exceed 15 mmol/L within parenteral nutrition. May use adjusted body weight for patients weighing >130% of ideal body weight (and BMI <40 kg/m2) by using [IBW + 0.25 (ABW-IBW)]: «bi»Low Dose, Serum Phosphorus Level 2.3-3 mg/dL (0.74-0.96 mmol/L)«/bi» - 0.16-0.32 mmol/kg over 4-6 hours «bi»Intermediate Dose, Serum Phosphorus Level 1.6-2.2 mg/dL (0.51-0.71 mmol/L)«/bi» - 0.32-0.64 mmol/kg over 4-6 hours «bi»High Dose, Serum Phosphorus <1.5 mg/dL (<0.5 mmol/L)«/bi» - 0.64-1 mmol/kg over 8-12 hours «b»Parenteral Nutrition«/b» «bi»Infants and Children«/bi» - 0.5-2 mmol/kg/24 hours «bi»Children >50 kg and Adolescents«/bi» - 10-40 mmol/24 hours

Sodium Hyaluronate

Amvisc, Bionect, Durolane, Euflexxa, Gelsyn-3, Healon, HyGel, Hylase Wound, Supartz, Synvisc, Synvisc-One

«bu»Osteoarthritis of the Knee (Intra-articular)«/bu» «b»Euflexxa«/b» - Inject 20 mg (2 mL) once weekly x 3 weeks (total of 3 injections) «b»Gel-One«/b» - Inject 30 mg (3 mL) x 1 dose «b»Gelsyn-3«/b» - Inject 16.8 mg (2 mL) once weekly x 3 weeks (total of 3 injections) «b»GenVisc 805, Supartz, Supartz FX«/b» - Inject 25 mg (2.5 mL) once weekly x 5 weeks (total of 5 injections) - Some patients may benefit from a total of 3 injections «b»Hyalgan«/b» - Inject 20 mg (2 mL) once weekly x 5 weeks (total of 5 injections) - Some patients may benefit with a total of 3 injections «b»Hymovis«/b» - Inject 24 mg (3 mL) once weekly x 2 weeks (total of 2 injections) «b»Monovisc«/b» - Inject 88 mg (4 mL) x 1 dose «b»Orthovisc«/b» - Inject 30 mg (2 mL) once weekly x 3 to 4 weeks (total of 3 to 4 injections) «b»Synvisc«/b» - Inject 16 mg (2 mL) once weekly x 3 weeks (total of 3 injections) «b»Synvisc-One«/b» -Inject 48 mg (6 mL) x 1 dose «b»Visco-3«/b» - Inject 25 mg (2.5 mL) once weekly x 3 weeks (total of 3 injections) «bu»Ophthalmic Viscoelastic Devices«/bu» «b»Amvisc, Amvisc Plus, Provisc«/b» - Depends upon procedure (slowly introduce a sufficient quantity into eye) «bu»Facial Wrinkles/Folds (Intradermal)«/bu» - Formulations differ in terms of recommended injection depth - Juvederm (all formulations except Voluma XC), Restylane, Restylane Defyne, Restylane-L, and Restylane Refyne are intended for mid to deep intradermal injection - Perlane and Restylane Lyft are intended for injection into the deep dermis to superficial subcutis «b»Juvederm)«/b» - Inject as required for cosmetic result - Typical treatment regimen requires 1.6 to 1.7 mL/treatment site - Typical volume for repeat treatment is 0.56 to 0.7 mL/treatment site - Maximum: 20 mL/60 kg/year «b»Perlane, Restylane Lyft«/b» - Inject as required into deep dermis/superficial subcutis for cosmetic result - Median Total Dose: 3 mL (Perlane) - Maximum Dose: 6 mL per treatment «b»Restylane, Restylane-L«/b» - Inject as required for cosmetic result - Median Total Dose: 3 mL - Maximum Dose: 6 mL per treatment «b»Restylane Defyne«/b» - Inject as required for cosmetic result - Typical treatment is generally ~1.4 mL/treatment site - Typical repeat treatment is ~0.7 mL/treatment site «b»Restylane Refyne«/b» - Inject as required for cosmetic result - Typical treatment is generally ~1.5 mL/treatment site - Typical repeat treatment is ~1 mL/treatment site «bu»Cheek Augmentation (SC/Supraperiosteal)«/bu» «b»Juvaderm Voluma XC«/b» - Inject as required for cosmetic result - Typical treatment regimen requires small boluses of 0.1 to 0.2 mL over a large area to volumize and contour the cheek - An additional treatment may be needed to achieve the desired level of correction - Maximum Dose: 20 mL/60 kg/year «b»Restylane Lyft«/b» - Maximum Dose: 6 mL per treatment «bu»Lip Augmentation (Submucosal)«/bu» «b»Juvederm Ultra XC«/b» - Approximately 2.2 mL to the lips and perioral area; correct to 100% of desired volume effect (do not overcorrect) - Repeat treatment is generally 1.5 mL - Maximum Dose: 20 mL/60 kg/year «b»Juvederm Volbella XC«/b» - Approximately 2.6 mL to the lips and perioral area - Correct to 100% of desired volume effect (do not overcorrect) - Repeat treatment is generally 1.6 mL - Maximum Dose: 20 mL/60 kg/year Restylane, Restylane-L, Restylane Silk - Maximum Dose: 1.5 mL per lip (upper or lower) per treatment session «bu»Perioral Rhytids (Intradermal)«/bu» «b»Restylane Silk«/b» - Maximum Dose: 1 mL per correction per treatment session «b»Juvederm Volbella XC«/b» - Refer to lip augmentation dosing «bu»Skin Ulcers and Wounds (Topical)«/bu» «b»Bionect Cream, Gel«/b» - Apply a thin layer to clean and disinfected wound or ulcer bid or tid Hylase Wound Gel - Apply liberally to ulcer cavity or wound and to surrounding areas once daily «bu»Interstitial Cystitis Refractory (Intravesical)«/bu» - 40 mg in 50 mL saline intravesically (retain in bladder for at least 30 minutes) once weekly for 4 weeks, then monthly for up to 1 year in patients showing an initial response «b»Intra-articular Administration«/b» - Inject directly into the knee joint - Do not inject extra-articularly or into the synovial capsule or tissues - Do not use disinfectants containing quaternary ammonium salts for skin cleansing prior to injection - Remove synovial fluid or effusion, if present, prior to injection - If used for bilateral treatment, use a separate syringe for each knee «b»Ophthalmic Administration«/b» - Allow to reach room temperature prior to use - Drug may become cloudy or form a slight precipitate after administration; clinical significance unknown, but cloudy or precipitated material should be removed by irrigation or aspiration «b»Topical Administration«/b» «bi»Bionect Products«/bi» - Clean and disinfect wound prior to use (do not use quaternary ammonium salts due to potential for hyaluronic acid precipitation), and debride if necessary - Apply a thin layer to wound or ulcer without extensive rubbing - After application, cover the area with a sterile gauze pad and if necessary, an elastic or compressive bandage. «bi»Hylase Wound«/bi» - Clean ulcer or wound with normal saline, remove excess moisture with dry gauze, then apply gel liberally to wound or ulcer and surrounding areas. - After application, cover the area with a sterile nonstick gauze pad and adhesive tape/bandage. «b»Intradermal/Submucosal/Subcutaneous/Supraperiosteal Administration«/b» - Do not inject into a blood vessel - Following injection, slowly massage area so that it conforms to the contour of the surrounding tissue - May apply ice pack to injection site for a short period immediately after administration if treatment area swollen - Prior to treatment, the patient should avoid taking aspirin, nonsteroidal anti-inflammatory medications, St John wort, or high doses of vitamin E supplements; these agents may increase bruising and bleeding at the injection site. - Juvederm (all formulations except Voluma XC) is intended for mid-to-deep intradermal injection. - Juvederm Voluma XC is intended for subcutaneous and/or supraperiosteal injection. - Juvederm Ultra XC is also intended for submucosal injection (lip augmentation). - Perlane is intended for injection into the deep dermis to superficial subcutis. - Restylane and Restylane-L are intended for mid-to-deep intradermal injection (facial wrinkles) or submucosal injection (lip augmentation). - Restylane Defyne and Restylane Refyne are intended for mid-to-deep intradermal injection (facial wrinkles). - Restylane Lyft is intended for deep dermis to superficial subcutis (facial wrinkles) or subcutaneous and/or supraperiosteal (cheek augmentation). - Restylane Silk is intended for mid to deep dermis (periorbital rhytids) or submucosal injection (lip augmentation).

Sodium Iodide

Hicon

Sodium Nitrite Sodium Thiosulfate

Nithiodote

Sodium Oxybate

Gamma Hydroxybutyric Acid, GHB, Xyrem

Sodium Phenylacetate-Sodium Benzoate

Ammonul

Sodium Phenylbutyrate-Taurursodiol

Relyvrio, AMX0035

Sodium Phosphates

Fleet Enema, Fleet Pedia-Lax Enema, OsmoPrep

Sodium Polystyrene Sulfonate

Kalexate, Kayexalate, Kionex, SPS

Sodium Tetradecyl Sulfate

Sotradecol, Trombovar

Sodium Thiosulfate

Pedmark, Pentahydrate, Sodium Hyposulfate

«b»IV Administration (Pedmark)«/b» - Infuse over 15 min starting 6 hour after completing cisplatin infusion - For multiday cisplatin regimens, administer 6 hour after each cisplatin infusion but at least 10 hour before the next cisplatin infusion - Do not start if <10 hour before starting next cisplatin infusion «bi»Pre-medications (Pedmark)«/bi» - Administer antiemetics before each infusion - For hypersensitivity reactions, administer antihistamines and glucocorticoids (if appropriate) before each subsequent infusion «b»IV Preparation (Pedmark)«/b» - Visually inspect contents of vial(s) for particulate matter and discoloration - Discard if discolored or contains visible particulates - Withdraw calculated dose from vial(s) into a syringe or transfer calculated dose into an empty infusion bag - Once drug is withdrawn, use immediately - If not used immediately, may store in an infusion bag for ≤18 hours at 20-22°C (68- 72°F); discard unused portion - No incompatibilities have been observed between sodium thiosulfate with infusion bags made of polyvinyl chloride, ethylene vinyl acetate, or polyolephin «b»IV Administration«/b» «bi»Cyanide Poisoning«/bi» - Administer by IV infusion over 10 to 30 minutes immediately after the administration of sodium nitrite - Decrease rate of infusion in the event of significant hypotension. «bi»Calciphylaxis«/bi» - Administer by IV infusion over 30 to 60 minutes «b»Extravasation Management«/b» - Stop vesicant infusion immediately and disconnect IV line (leave needle/cannula in place) - Gently aspirate extravasated solution from the IV line (do NOT flush the line) - Remove needle/cannula (temporarily keep in place for cisplatin extravasation to allow for sodium thiosulfate administration through the needle/cannula) - Elevate extremity «bi»Mechlorethamine«/bi» - Inject subcutaneously (off-label route) into the extravasation site using ≤25-gauge needle - Change needle with each injection «bi»Cisplatin, Concentrated«/bi» - Inject into the existing IV line - Consider also injecting 1 mL as 0.1 mL subcutaneous injections (clockwise) into the area around the extravasation using a new 25- or 27-gauge needle for each injection «bi»Bendamustine«/bi» - SC: Bendamustine extravasation may be managed with sodium thiosulfate in the same manner as mechlorethamine extravasation «b»Preparation«/b» «bi»Calciphylaxis«/bi» - May dilute dose in 100 mL of NS «bi»Extravasation Management«/bi» - Off-label use/route - To prepare a 1/6 M solution for SubQ administration (off-label route), add 4 mL of a 10% sodium thiosulfate solution to 6 mL SWFI or 1.6 mL of a 25% sodium thiosulfate solution to 8.4 mL SWFI

Sodium Zirconium Cyclosilicate

Lokelma

Sofosbuvir

Sovaldi

«bu»Hepatitis C Virus Infection«/bu» - Indicated for treatment of chronic hepatitis C virus (HCV) infection as a component of a combination antiviral regimen for patients with HCV mono-infection and HCV/HIV-1 coinfection - Treatment regimen and duration are dependent on both viral genotype and patient population «b»Genotype 1 or 4«/b» - 400 mg PO daily plus ribavirin and peginterferon alfa for 12 weeks - May consider sofosbuvir plus ribavirin for 24 weeks in genotype 1 patients ineligible to receive peg-interferon-based regimen «b»Genotype 2«/b» - 400 mg PO daily plus ribavirin for 12 weeks «b»Genotype 3«/b» - 400 mg PO daily plus ribavirin for 24 weeks «b»Hepatocellular Carcinoma Awaiting Liver Transplantation«/b» - For prevention of post-transplant HCV reinfection - 400 mg PO daily plus ribavirin for up to 48 weeks or until the time of liver transplantation, whichever occurs first «b»Ribavirin Dosage Regimen with Sofosbuvir (Genotypes 1, 2, 3, and 4)«/b» - Take with food - <75 kg : 500 mg PO bid - ≥75 kg: 600 mg PO bid «b»Peginterferon alfa Regimen with Sofosbuvir (Genotype 1 or 4)«/b» - Peginterferon alfa 2a: 180 mcg SC weekly - Peginterferon alfa 2b: 1.5 mcg/kg/week SC; not to exceed 150 mcg/week «b»Dose Modification Genotypes 1 and 4«/b» «bi»Serious Adverse Reactions Potentially Related to Peginterferon alfa and/or Ribavirin«/bi» - Reduction of sofosbuvir dose not recommended - Discontinue sofosbuvir therapy if the agents used in combination are discontinued - Should reduce or discontinue dose of peginterferon alfa and/or ribavirin following the recommendations of their respective prescribing information «b»Dose Modification Genotypes 2 and 3«/b» «bi»Serious Adverse Reaction Potentially Related to Ribavirin«/bi» - Modify or discontinue ribavirin dose «bi»Hemoglobin <10 g/dL without Cardiac Disease«/bi» - Reduce ribavirin dose to 600 mg/day PO divided bid with food «bi»Hemoglobin <8.5 g/dL without Cardiac Disease«/bi» - Discontinue ribavirin «bi»Cardiac Disease and Hemoglobin Decreased ≥2 g/dL During 4 Week Period«/bi» - Reduce ribavirin dose to 600 mg/day PO divided BID with food «bi»Cardiac Disease and Hemoglobin <12 g/dL Despite 4 Weeks at Reduced Dose«/bi» - Discontinue ribavirin - After discontinuing the dose may attempt to restart ribavirin at 600 mg PO divided bid and further increase it to 800 mg PO divided bid - Increasing the dose to 1000-1200 mg/day not recommended

Sofosbuvir-Velpatasvir

Epclusa

Sofosbuvir-Velpatasvir-Voxilaprevir

Vosevi

Solifenacin

VESIcare

Solriamfetol

Sunosi

Somapacitan

Sogroya

Somatropin

Genotropin, Humatrope, hGH, Norditropin, Nutropin, Omnitrope,

Sonidegib

Odomzo, Erismodegib

SORAfenib

NexAVAR

- Interrupt treatment (temporarily) in patients undergoing major surgical procedures. «bu»Hepatocellular Cancer (HCC)«/bu» - 400 mg PO bid - Continue until no longer clinically benefiting or until unacceptable toxicity occurs «bu»Renal Cell Cancer (RCC)«/bu» «b»Advanced«/b» - 400 mg PO bid - Continue until no longer clinically benefiting or until unacceptable toxicity occurs «bu»Thyroid Cancer«/bu» «b»Differentiated«/b» - 400 mg PO bid - Continue until no longer clinically benefiting or until unacceptable toxicity occurs «bu»Angiosarcoma«/bu» - 400 mg PO bid «bu»Gastrointestinal Stromal Tumor (GIST)«/bu» - 400 mg PO bid - Temporary interruption and/or dosage reduction may be necessary for management of adverse drug reactions. «b»Cardiovascular Toxicity«/b» «bi»Cardiac Ischemia or Infarction«/bi» - Consider temporary interruption or permanent discontinuation. «bi»Hypertension, Severe or Persistent (Despite Antihypertensive Therapy)«/bi» - Consider temporary interruption or permanent discontinuation. «bi»QT Prolongation«/bi» - QTc Interval >500 msec or ≥60 msec Increase from Baseline - Interrupt treatment «b»Gastrointestinal Perforation«/b» - Permanently discontinue. «b»Hemorrhage Requiring Medical Intervention«/b» - Consider permanent discontinuation. «b»Stevens-Johnson Syndrome or Toxic Epidermal Necrolysis«/b» - Discontinue therapy «b»Dermatologic Toxicities (HCC or RCC)«/b» «bi»Grade 1«/bi» - Any occurrence: Continue treatment and consider topical therapy for symptomatic relief «bi»Grade 2«/bi» First Occurrence - Continue treatment and consider topical therapy for symptomatic relief; if no improvement within 7 days, interrupt treatment and decrease dose (see below) No Improvement within 7 days or Second or Third Occurrence - Withhold drug until toxicity resolves to grade 0-1, then decrease dose by 1 level (400 mg daily or 400 mg every 7 other day) Fourth Occurrence - Discontinue «bi»Grade 3«/bi» First or Second Occurrence - Withhold drug until toxicity resolves to grade 0-1, then decrease dose by 1 level (400 mg daily or 400 mg every7 other day) Third Occurrence - Discontinue «b»Dermatologic Toxicities (DTC)«/b» «bi»Dose Reduction Schedule«/bi» First reduction to 600 mg/day - 400 mg and 200 mg administered 12 h apart Second Reduction to 400 mg/day - 200 mg q12hr Third Reduction to 200 mg/day - 200 mg once daily «bi»Grade 1«/bi» Any Occurrence - Continue treatment «bi»Grade 2«/bi» First Occurrence - Decrease dose to 600 mg/day; if no improvement, see below No Improvement within 7 days at Reduced Dose or Second Occurrence - Withhold drug until toxicity resolves to grade 1; if drug resumed, decrease dose per schedule Third Occurrence - Withhold drug until toxicity resolves to grade 1; if drug resumed, decrease dose per schedule Fourth Occurrence - Discontinue «bi»Grade 3«/bi» First Occurrence - Withhold drug until toxicity resolves to grade 1; if drug resumed, decrease dose by 1 dose level Second Occurrence - Withhold drug until toxicity resolves to grade 1; if drug resumed, decrease dose by 2 dose levels Third Occurrence - Discontinue

Sorbitol

Sotagliflozin

Inpefa

Sotalol

Betapace, Betapace AF, Sotylize, Sorine

- Baseline QTc interval and creatinine clearance must be determined prior to initiation. If CrCl ≤60 mL/minute, dosing interval adjustment is necessary - Sotalol should be initiated and doses increased in a hospital for at least 3 days with facilities for cardiac rhythm monitoring and assessment - Proarrhythmic events can occur after initiation of therapy and with each upward dosage adjustment. «bu»Atrial Fibrillation/Flutter«/bu» «b»Symptomatic«/b» «bi»IV Infusion Substitution for Sotalol PO«/bi» - Initial Dose: 75 mg IV infused over 5 hours bid «bi»Dose Adjustment«/bi» - If the initial dose does not reduce the frequency of relapse and excessive QTc prolongation does not occur - May increase to 112.5 mg twice daily - If at steady state this dose still does not control arrhythmia and QTc prolongation does not occur, may further increase dose to 150 mg twice daily. - Maximum Dose: 150 mg twice daily «bi»Oral«/bi» - Initial Dose: 80 mg PO bid - If the initial dose does not reduce frequency of relapse and excessive QTc prolongation does not occur after 3 days, the dose may be increased to 120 mg twice daily - May further increase to a maximum dose of 160 mg twice daily if response is inadequate and QTc prolongation is not excessive. «b»Conversion from Sotalol (PO) to Sotalol (IV)«/b» - 80 mg oral equivalent to 75 mg IV - 120 mg oral equivalent to 112.5 mg IV - 160 mg oral equivalent to 150 mg IV «bu»Ventricular Arrhythmias«/bu» «b»IV Infusion substitution for Sotalol PO«/b» - Initial dose: 75 mg IV infused over 5 hours twice daily - If the initial dose does not reduce the frequency of relapse and excessive QTc prolongation does not occur, may increase after at least 3 days to 112.5 mg twice daily - May further increase dose every 3 days in increments of 75 mg/day. - Dose Range: 75 to 150 mg twice daily - Maximum Dose: 300 mg twice daily «b»Oral«/b» - Initial Dose: 80 mg PO bid - Dose may be increased (in increments of 80 mg/day gradually to 160 to 320 mg daily; allow 3 days between dosing increments in order to attain steady-state plasma concentrations and to allow for monitoring of QT intervals - Usual Dose Range: 160 to 320 mg in 2 to 3 divided doses. - Some patients, with life-threatening refractory ventricular arrhythmias, may require total daily doses as high as 480 to 640 mg; however, these doses should only be prescribed when the potential benefit outweighs the increased risk of adverse events. «b»Conversion from Sotalol (PO) to Sotalol (IV)«/b» - 80 mg oral equivalent to 75 mg IV - 120 mg oral equivalent to 112.5 mg IV - 160 mg oral equivalent to 150 mg IV «bu»Monomorphic Ventricular Tachycardia«/bu» «b»Hemodynamically Stable«/b» - 1.5 mg/kg IV over 5 minutes - Clinical trial employed standard dose of 100 mg «bu»Supraventricular Tachycardia«/bu» - Initial Dose: 40 to 80 mg PO every 12 hours - Maximum Maintenance Dose: 160 mg every 12 hours «b»Dose Modifications«/b» «bi»QTc ≥500 msec During Initiation Period«/bi» - Betapace/Betapace AF, Sotylize: Reduce dose, prolong the dosing interval (Sotylize), or discontinue sotalol - Sotalol injection: Reduce dose, prolong the infusion time by decreasing the infusion rate, or discontinue sotalol «bi»QTc ≥520 msec During Maintenance Period«/bi» - Betapace/Betapace AF, sotalol injection) - Reduce dose and carefully monitor QTc until <520 msec - If QTc interval ≥520 msec on the lowest maintenance dose, discontinue sotalol. «bi»QTc ≥550 msec«/bi» - Betapace/Betapace AF, Sorine - Reduce dose or discontinue sotalol.

Sotorasib

Lumakras

Sotrovimab

GSK COVID-19 Monoclonal Antibody, Xevudy,

Sparsentan

Filspari

Spesolimab

Spevigo

Spinosad

Natroba, NatrOVA

Spironolactone

Aldactone, CaroSpir

«bu»Primary Hyperaldosteronism«/bu» «b»Tablet«/b» - 100 to 400 mg PO daily in preparation for surgery initially - Short-term preoperative treatment of patients with primary hyperaldosteronism - Long-term maintenance therapy for patients with discrete aldosterone-producing adrenal adenomas who are not candidates for surgery or for patients with bilateral micro or macronodular adrenal hyperplasia (idiopathic hyperaldosteronism) - May be used as long-term maintenance therapy at the lowest effective for patients who are considered unsuitable for surgery «bu»Edematous Conditions«/bu» «b»Tablet«/b» - 100 mg daily or divided every 12 hr for 5 days initially; then, - Adjust does based on patient response Dose Range - 25-200 mg PO daily or divided every 12 hr «b»Oral Suspension«/b» - 75 mg PO daily or divided doses initially; if sole therapy, administer for ≥5 days before increasing dose to obtain effect - Management of edema in patients with cirrhosis of the liver when edema are unresponsive to fluid and sodium restriction or nephrotic syndrome when treatment of the underlying disease, fluid restriction and sodium intake, and the use of other diuretics produce an inadequate response «bu»Essential Hypertension«/bu» - Adjunctive therapy for hypertension, to lower blood pressure «b»Tablets«/b» Initial Dose - 25-100mg PO daily or divided every 12 hr - May adjust dosage to patient response every 2 weeks «b»Oral Suspension«/b» Initial Dose - 20-75 mg PO daily or divided doses - May adjust dosage to patient response every 2 weeks «bu»Congestive Heart Failure (CHF)«/bu» «b»Tablet«/b» Initial Dose - 25 mg PO daily if serum potassium ≤5 mEq/L and eGFR >50 mL/min/1.73 m² - If tolerated, may increase to 50 mg/day as clinically indicated - If 25 mg/day not tolerated, reduce frequency to every other day «b»Oral Suspension«/b» - 20 mg PO daily - If initial 20 mg dose is tolerated, dosage can be increased to 37.5 mg as clinically indicated «bu»Hypokalemia«/bu» Dose Range - 25-100 mg PO daily «bu»Hirsutism«/bu» «b»Women with Hirsutism«/b» - 50-200 mg PO daily or divided every 12 hr «bu»Acne«/bu» «b»Females with Hormonal Acne«/b» - 50-200 mg PO daily or divided every 12 hr

Spironolactone-Hydrochlorothiazide

Aldactazide

SSKI

Saturated Solution of Potassium Iodide, ThyroShield, iOSAT, ThyroSafe

«bu»Antidote«/bu» - Thyroid Block following Nuclear Radiation Emergency (iOSAT, ThyroSafe, ThyroShield)] - Dosing should continue for 10 to 14 days or as directed by public officials (until risk of exposure has passed or other measures are implemented) «b»Infants ≤1 month«/b» - 16.25 mg once daily «b»Infants >1 month to Children ≤3 years«/b» - 32.5 mg once daily «b»Children >3 to ≤12 years«/b» - 65 mg once daily «b»Children >12 years and Adolescents weighing <68 kg«/b» - 65 mg once daily «b»Children >12 years and Adolescents weighing ≥68 kg«/b» - 130 mg once daily «bu»Sporotrichosis«/bu» «b»Initial Dose«/b» - 50 mg (1 drop or 0.05 mL of SSKI) PO tid «b»Maintenance Dose«/b» - Increase as tolerated up to a maximum of 2,500 mg (50 drops or 2.5 mL) or 1 drop/kg (0.05 mL/kg) 3 times daily, whichever is lower - Continue for 2 to 4 weeks after lesions have resolved (usual duration: 3 to 6 months) «bu»Thyroidectomy Preparation«/bu» «b»Children and Adolescents«/b» - Patients unable to receive concurrent antithyroid therapy: 150 to 350 mg (3 to 7 drops or 0.15 to 0.35 mL) 3 times daily - Patients receiving concurrent antithyroid therapy: 50 to 100 mg (1 to 2 drops or 0.05 to 1 mL) 3 times daily - Administer SSKI for 10 days before surgery - If patient is not euthyroid prior to surgery, consider concurrent beta-blockade (eg, propranolol) in the immediate preoperative period to reduce the risk of thyroid storm. «bu»Thyroid Gland Protection During Radiopharmaceutical Use«/bu» «b»Infants <5 kg«/b» - 16 mg once daily «b»Infants and Children 1 month to 3 years or 5 to 15 kg«/b» - 32 mg once daily «b»Children and Adolescents 3 to 13 years or 15 to <50 kg«/b» - 65 mg once daily «b»Adolescents >13 years or ≥50 kg«/b» - 130 mg once daily - Begin at 1 to 48 hours prior to exposure. - Continue potassium iodide after radiopharmaceutical administration until risk of exposure has diminished (treatment duration and time of initiation is dependent on the radiopharmaceutical, consult specific protocol. «bu»Thyrotoxic Crisis/Thyroid Storm«/bu» - Administer preferably 2 hours after antithyroid drug administration «b»Infants«/b» - SSKI 100 mg (2 drops or 0.1 mL) 4 times daily «b»Children«/b» - SSKI 250 mg (5 drops or 0.25 mL) 2 to 4 times daily

Stavudine

Zerit, d4T

Stiripentol

Diacomit

Streptomycin

«b»Usual Dosage Range«/b» - 15 to 30 mg/kg/day or 1 to 2 g daily «bu»Brucellosis«/bu» - 1 g IM daily in 2 to 4 divided doses for 14 to 21 days (with doxycycline) «bu»Enterococcal Endocarditis«/bu» - 1 g IM every 12 hours for 2 weeks, then, - 500 mg IM every 12 hours for 4 weeks in combination with penicillin - 15 mg/kg/day (maximum: 1g) IM in divided doses every 12 hours in combination with ampicillin or penicillin for 4 weeks (native valve and symptoms present <3 months); ≥6 weeks (native valve and symptoms present ≥3 months or prosthetic valve) «bu»Streptococcal Endocarditis«/bu» - 1 g IM every 12 hours for 1 week, then, - 500 mg IM every 12 hours for 1 week in combination with penicillin. «bu»Mycobacterium Avium Complex (MAC)«/bu» - Adjunct therapy with macrolide, rifamycin, and ethambutol - 8 to 25 mg/kg IM 2 to 3 times weekly for first 2 to 3 months for severe disease - Maximum single dose for age >50 years: 500 mg «b»MAC Disease, Disseminated in HIV-infected Patients«/b» - 1 g IM daily as optional adjunct therapy with ethambutol (plus clarithromycin or azithromycin) «bu»Mycobacterium Kansasii Disease«/bu» «b»Rifampin-resistant«/b» - 750 mg IM to 1 g daily (as part of a three-drug regimen based on susceptibilities) «bu»Mycobacterium Ulcerans (Buruli Ulcers)«/bu» - 15 mg/kg (maximum dose: 1 g) IM once daily in combination with rifampin for 8 weeks or in combination with rifampin for 4 weeks, then, - 4 weeks of rifampin and clarithromycin «bu»Plague«/bu» - 1 g IM twice daily for a minimum of 10 days - 30 mg/kg/day (maximum dose: 2 g) divided every 12 hours until the patient is afebrile for at least 2 to 3 days - Full course is considered 10 days «bu»Tuberculosis«/bu» «b»Daily Therapy«/b» - 15 mg/kg/day (maximum: 1 g) IM daily «b»Directly Observed Therapy (DOT), Twice Weekly«/b» - 25 to 30 mg/kg (maximum: 1.5 g) IM twice weekly «b»Directly Observed Therapy (DOT), 3 Times Weekly«/b» - 25 to 30 mg/kg (maximum: 1.5 g) IM three times weekly «bi»Alternate Dosing«/bi» - 15 mg/kg (maximum dose: 1 g) IM once daily for 5 to 7 days per week for 2 to 4 months, then, - 15 mg/kg (maximum dose: 1 g) IM 2 to 3 times weekly «bu»Tularemia«/bu» - 1 to 2 g IM daily in divided doses every 12 hours for 7 to 14 days until the patients is afebrile for 5 to 7 days

Streptozocin

Zanosar

Strontium-89 Chloride

Metastron

Succimer

Chemet, Meso 2,3-dimercaptosuccinic acid (DMSA)

Succinylcholine Chloride

Anectine, Quelicin, Suxamethonium Chloride

Sucralfate

Carafate

Sucroferric Oxyhydroxide

Velphoro

SUFentanil

Sufenta

SUFentanil SL

Dsuvia

Sugammadex

Bridion

Sulbactam

Sulbactam-Durlobactam

Xacduro

Sulconazole

Exelderm

Sulfacetamide (Ophthalmic)

Bleph-10, AK-Sulf, Sulamyd, Cetamide, Isopto Cetamide

Sulfacetamide (Topical)

Ovace Plus, Seb-Prev Wash, Klaron, Sulamyd

Sulfacetamide Sodium Sulfur

AVAR, Plexion, Sumaxin, Rosula, Sulfacet R, Prascion Cleanser, Rosanil

SulfADIAZINE

Lantrisul, Neotrizine

Sulfamethoxazole

Sulfamethoxazole-Trimethoprim

Bactrim, Co-Trimoxazole, Septra, Septra DS, Cotrim, Cotrimoxazole, Sulfatrim, SMX-TMP

Sulfanilamide

AVC Vaginal

SulfaSALAzine

Azulfidine, Azulfidine EN

Sulfisoxazole

Sulfur Hexafluoride

Lumason

«b»IV Administration«/b» - Administer suspension as IV bolus injection immediately after reconstitution - Provides useful echocardiographic signal intensity for 2 minutes following the injection - If not used immediately after reconstitution, the microspheres should be resuspended by a few seconds of hand agitation before the suspension is withdrawn into the syringe «b»Intravesical (Urinary Instillation) Administration«/b» - Insert a sterile 6-8 french urinary catheter into the bladder under sterile conditions - Empty the bladder of urine, and then fill the bladder with 0.9% NaCl to ~33-50% of its predicted total volume - The total bladder volume in children is calculated as: [(age in years + 2) x 30] mL - Administer as an intravesical bolus injection through the urinary catheter - Continue filling the bladder with saline until the patient has the urge to micturate or at the first sign of back pressure to the infusion - Immediately following the first voiding, the bladder may be refilled with normal saline for a second cycle of voiding and imaging, without the need of a second administration «b»IV Preparation«/b» - Using aseptic techniques, reconstitute vial using mini-spike with prefilled syringe contents (5 mL NaCl 0.9%) - Do not remove syringe and mini-spike from vial - Shake vigorously for 20 seconds, mixing all contents in the vial - Resulting suspension should appear as a homogenous, white, milky liquid; this indicates formation of sulfur hexafluoride lipid microspheres - Following reconstitution, resulting suspension contains 1.5-5.6 x108 lipid microspheres/mL with 45 mcg/mL of sulfur hexafluoride - Invert vial and syringe and slowly withdraw 2 mL of the reconstituted suspension into the syringe - Unscrew syringe from mini-spike and immediately connect the syringe to the dosage administration line (20 G) «b»Intravesical (Urinary Instillation) Preparation«/b» «bi»Doses ≥1 mL«/bi» - Invert the system and slowly withdraw the intended volume of suspension into the syringe «bi»Doses <1 mL«/bi» - Withdraw 2 mL of the reconstituted suspension into the 5 mL syringe and measure the volume of sulfur hexafluoride to inject by using the 0.2 mL graduations between the 1-2 mL marks

Sulfuric Acid-Sulf Phenolics

Debacterol

Sulindac

Clinoril, Sulin

SUMAtriptan

Onzetra, Imitrex, Alsuma, Zembrace SymTouch, Sumavel, Tosymra

«bu»Migraine«/bu» - A single dose of 25 mg, 50 mg, or 100 mg tab PO x 1 dose (taken with fluids) - If a satisfactory response has not been obtained at 2 hours, a second dose may be administered - Results from clinical trials show that initial doses of 50 mg and 100 mg are more effective than doses of 25 mg, and that 100 mg doses do not provide a greater effect than 50 mg and may have increased incidence of side effects. - Although doses of up to 300 mg/day have been studied, the total daily dose should not exceed 200 mg «b»Intranasal Powder«/b» - A single dose of 22 mg (11 mg nosepiece in each nostril). - If headache has not resolved within 2 hours or returns, the dose may be repeated once ≥2 hours after the first dose (maximum: 44 mg [4 nosepieces] per 24 hours or 22 mg [2 nosepieces] and one dose of another sumatriptan product [separated by ≥2 hours] per 24 hours). - The safety of treating an average of >4 headaches in a 30-day period has not been established. «b»Intranasal Solution«/b» - A single dose of 5 mg, 10 mg, or 20 mg administered in one nostril. - A 10 mg dose may be achieved by administering a single 5 mg dose in each nostril. - If headache has not resolved within 2 hours or returns, the dose may be repeated once after 2 hours, not to exceed a total daily dose of 40 mg. - In clinical trials, a greater number of patients responded to initial doses of 20 mg versus 5 or 10 mg. - The safety of treating an average of >4 headaches in a 30-day period has not been established. «b»Imitrex SC«/b» - 6 mg SC x 1 dose - May repeat if needed ≥1 hour after initial dose Maximum - 6 mg SC per dose - Two 6 mg injections per 24-hour period - Maximum cumulative dose of 12 mg in 24 hours, separated by at least 1 hour «b»Sumavel SC«/b» - 6 mg SC x 1 dose Maximum - 6 mg SC per dose - Two 6 mg injections per 24-hour period - Maximum cumulative dose of 12 mg in 24 hours, separated by at least 1 hour «b»Alsuma SC«/b» - 6 mg SC x 1 dose Maximum - 6 mg SC per dose - Two 6 mg injections per 24-hour period - Maximum cumulative dose of 12 mg in 24 hours, separated by at least 1 hour «b»Zembrace SC«/b» - 3 mg SC x 1 dose Maximum - 6 mg SC per dose - Two 6 mg injections per 24-hour period - Maximum cumulative dose of 12 mg in 24 hours, separated by at least 1 hour «bu»Cluster Headache«/bu» «b»SC (excluding Zembrace)«/b» - Initial Dose: 6 mg - May repeat if needed ≥1 hour after initial dose - Maximum Dose: 6 mg per dose; two 6 mg injections per 24-hour period - Administer as soon as symptoms appear. «b»Intranasal Powder Administration«/b» - For intranasal administration with the Xsail device only - Remove the clear device cap from the reusable delivery device; remove one 11 mg disposable nosepiece from the foil pouch and click into the device body - Prior to administration, pierce the capsule inside the nosepiece by pressing and releasing the white piercing button one time on the device body. - Insert the nosepiece into one nostril so there is a tight seal; rotate the device to place the mouthpiece in the mouth. - Blowing forcefully through the mouthpiece for 2 to 3 seconds will deliver the powder into the nasal cavity; vibration may occur. Do not press white button while blowing into mouthpiece. - Once administered into the first nostril, remove and discard nosepiece; repeat same process using a second 11 mg nosepiece into the other nostril to administer the remainder of the 22 mg dose. «b»Intranasal Spray Administration«/b» - Each nasal spray unit is preloaded with 1 dose - Do not test the spray unit before use - Remove unit from plastic pack when ready to use - While sitting down, gently blow nose to clear nasal passages - Keep head upright and close one nostril gently with index finger - Hold container with other hand, with thumb supporting bottom and index and middle fingers on either side of nozzle - Insert nozzle into nostril about 1/2 inch; close mouth - Take a breath through nose while releasing spray into nostril by pressing firmly on blue plunger - Remove nozzle from nostril - Keep head level for 10 to 20 seconds and gently breathe in through nose and out through mouth - Do not breathe deeply «b»SC Administration«/b» - Not for IM or IV use - Needle penetrates 1/4 inch of skin; use in areas of the body with adequate skin and subcutaneous thickness (lateral thigh or upper arm) - In patients receiving doses other than 4 or 6 mg, use the 6 mg single-dose vial instead of the autoinjector device. «b»Needleless administration (Sumavel DosePro)«/b» - Administer to the abdomen (>2 inches from the navel) or thigh - Not for IM or IV administration - Do not administer to other areas of the body (arm) - Device is for single use only, discard after use; do not use if the tip of the device is tilted or broken. «b»Oral Liquid (5 mg/mL) Preparation«/b» - A 5 mg/mL oral liquid preparation made from tablets and one of three different vehicles (Ora-Sweet®, Ora-Sweet® SF, or Syrpalta® syrups). - Ora-Plus® Suspending Vehicle is used with Ora-Sweet® or Ora-Sweet® SF to facilitate dispersion of the tablets (Ora-Plus® is not necessary if Syrpalta® is the vehicle). - Crush nine 100 mg tablets in a mortar and reduce to a fine powder. - Add 40 mL of Ora-Plus® in 5 mL increments and mix thoroughly between each addition; rinse mortar and pestle 5 times with 10 mL of Ora-Plus®, pouring into bottle each time, and add quantity of appropriate syrup (Ora-Sweet® or Ora-Sweet® SF) sufficient to make 180 mL. - Store in amber glass bottles in the dark; label "shake well", "refrigerate", and "protect from light". - Stable for 21 days refrigerated.

Sumatriptan-Naproxen

Treximet

SUNItinib

Sutent

«bu»Gastrointestinal Stromal Tumor (GIST)«/bu» - 50 mg PO once daily for 4 weeks of a 6-week treatment cycle (4 weeks on, 2 weeks off) «b»GIST Off-label Dosing«/b» - 37.5 mg once daily - Continuous daily dosing «bu»Pancreatic Neuroendocrine Tumors (PNET)«/bu» «b»Advanced«/b» - 37.5 mg once daily, continuous daily dosing - Maximum Daily Dose: 50 mg «bu»Renal Cell Cancer«/bu» «b»Adjuvant Treatment«/b» - 50 mg once daily for 4 weeks of a 6-week treatment cycle (4 weeks on, 2 weeks off) for 9 cycles «b»Advanced«/b» - 50 mg once daily for 4 weeks of a 6-week treatment cycle (4 weeks on, 2 weeks off) «bu»Soft Tissue Sarcoma«/bu» «b»Non-GIST«/b» - 37.5 mg once daily - Continuous daily dosing «bu»Thyroid Cancer«/bu» «b»Refractory«/b» - 50 mg once daily for 4 weeks of a 6-week treatment cycle (4 weeks on, 2 weeks off) «b»Strong CYP3A4 Inhibitor«/b» - Avoid concomitant administration with strong CYP3A4 inhibitors (ketoconazole) - If concomitant administration with a strong CYP3A4 inhibitor cannot be avoided, consider a dose reduction to a minimum of 37.5 mg/day (GIST, RCC) or 25 mg/day (PNET). «b»CYP3A4 Inducer«/b» - Avoid concomitant administration with CYP3A4 inducers (rifampin) - If concomitant administration with a CYP3A4 inducer cannot be avoided, consider a dosage increase (with careful monitoring for toxicity) to a maximum of 87.5 mg/day (GIST, RCC) or 62.5 mg/day (PNET). - Dosage modifications should be done in increments or decrements of 12.5 mg; individualize based on safety and tolerability. «b»Cardiac Toxicity«/b» «bi»Ejection Fraction <50% but >20% Below Baseline or Below the Lower Limit of Normal«/bi» - Interrupt treatment and/or reduce dose. «bi»Clinical Signs/Symptoms of HF«/bi» - Discontinue treatment. «b»Dermatologic Toxicity«/b» - Signs/symptoms of erythema multiforme (EM), Stevens-Johnson syndrome (SJS), and toxic epidermal necrolysis (TEN), including progressive skin rash, often with blisters or mucosal lesions: Discontinue sunitinib; do not restart treatment if SJS or TEN are suspected. «bi»Necrotizing Fasciitis«/bi» - Discontinue sunitinib. «bi»Hypertension, Severe«/bi» - Temporarily interrupt treatment until hypertension is controlled. «bi»Nephrotic Syndrome«/bi» - Discontinue treatment. «b»Proteinuria«/b» «bi»Urine Protein ≥3 g/24 hours«/bi» - Interrupt treatment and reduce the dose. «bi»Persistent Urine Protein ≥3 g/24 hours Despite Dose Reductions«/bi» - Discontinue treatment. «bi»Reversible Posterior Leukoencephalopathy (RPLS)«/bi» - Temporarily withhold treatment; after resolution, may resume with discretion. «bi»Thrombotic Microangiopathy«/bi» - Discontinue treatment

Sutimlimab

Enjaymo

Suvorexant

Belsomra

Suzetrigine

Journavx

Tacrolimus

Hecoria, Prograf, Astagraf, Envarsus, FK506,

«bu»Heart Transplant«/bu» «b»Initial Dose«/b» - 0.01 mg/kg/day continuous IV infusion - 0.075 mg/kg/day IR PO divided every 12 hr - Administer initial dose no sooner than 6 hr after transplantation «bu»Liver Transplant«/bu» «b»Initial Dose«/b» - 0.03-0.05 mg/kg/day continuous IV infusion - 0.1-0.15 mg/kg/day IR PO divided every 12 hr initially - Administer initial dose no sooner than 6 hr after transplantation «bu»Kidney Transplant«/bu» «b»Prograf«/b» «bi»Initial Dose«/bi» - 0.2 mg/kg/day IR PO divided every 12 hr with azathioprine - 0.1 mg/kg/day IR PO divided every 12 hr with MMF/IL-2 receptor antagonist - 0.03-0.05 mg/kg/day continuous IV infusion initially «b»Astagraf XL«/b» - Prophylaxis of organ rejection in patients receiving kidney transplants - Used concomitantly with MMF and corticosteroids, with or without basiliximab induction «bi»With Basiliximab Induction«/bi» - MMF, corticosteroids, and initial tacrolimus dose may be administered before or within 48 hr after completion of renal transplantation but may be delayed until renal function has recovered - 15 mg/kg PO once daily «bi»Without Induction«/bi» - When agent is used with MMF and corticosteroids, preoperative dose should be given as single dose within 12 hr before reperfusion; initial postoperative dose should be given ≥4 hr after preoperative dose and ≤12 hr after reperfusion Preoperative - 0.1 mg/kg PO once daily Postoperative - 0.2 mg/kg PO once daily Postoperative Oliguria - Initial postoperative dose should be administered ≥6 hr and ≤48 hr after transplantation but may be delayed until renal function shows evidence of recovery «b»Envarsus XR«/b» «bi»Conversion from Tacrolimus IR«/bi» - Indicated for prophylaxis of organ rejection in kidney transplant patients converted from tacrolimus immediate-release formulations in combination with other immunosuppressants - Administer an Envarsus XR dose that is 80% of the total daily dose of the tacrolimus immediate-release product - Monitor whole blood tacrolimus levels and titrate to achieve target whole blood trough concentration ranges of 4-11 ng/mL «b»De Novo Kidney Transplant«/b» - Indication for prophylaxis of organ rejection in de novo kidney transplant patients in combination with other immunosuppressants - Initiate at 0.14 mg/kg/day - Monitor whole blood tacrolimus levels and titrate to achieve target whole blood trough concentration ranges of 6-11 ng/mL (month 1) and 4-11 ng/mL (>month 1) «b»CYP3A5*1 Allele«/b» - African-American patients, compared to Caucasian patients, may need to be titrated to higher dosages to attain comparable trough concentrations ~80% of the African-American patients are carriers of the active, wild type CYP3A5*1 allele, resulting in a higher rate of tacrolimus clearance because of rapid metabolism «b»CYP3A4 Inducers or Inhibitors«/b» - Dosage adjustment of Envarsus XR may be necessary - Monitor tacrolimus trough concentrations ≥2 times on separate days during first week after initiation of dosing and after any change in dosage, after a change in coadministration of CYP3A inducers and/or inhibitors «b»Dosing Considerations«/b» - Capsules and granules are not interchangeable or substitutable with other tacrolimus extended-release products; due to the rate of absorption following administration an extended-release tacrolimus is not equivalent to immediate-release tacrolimus drug product - Under- or overexposure to tacrolimus may result in graft rejection or other serious adverse reactions - African-American patients may need to be titrated to higher dosages to attain comparable trough concentrations compared to Caucasian patients - Dosage adjusted according to clinical response and observed tacrolimus whole-blood trough concentrations - Monitor Serum Potassium «b»Kidney Transplant«/b» «bi»Trough level«/bi» Prograf with Azathioprine - Months 1-3: 7-20 ng/mL - Months 4-12: 5-15 ng/mL Prograf with MMF/IL-2 Receptor Antagonist - Months 1-12: 4-11 ng/mL Astragraf XL with Basiliximab Induction - During month 1: 7-15 ng/mL - Months 2-6: 5-15 ng/mL - Months >6: 5-10 ng/mL Astragraf XL Without Induction - During month 1: 10-15 ng/mL - Months 2-6: 5-15 ng/mL - Months >6: 5-10 ng/mL Envarsus XR - 4-11 ng/mL «b»Liver Transplant«/b» «bi»Trough level«/bi» Prograf with Corticosteroids only - Months 1-12: 5-20 ng/mL «b»Heart Transplant«/b» «bi»Trough level«/bi» Prograf with Azathioprine or MMF - Months 1-3: 10-20 ng/mL - Months ≥4: 5-15 ng/mL «bu»Liver Transplant«/bu» «b»Prograf«/b» «bi»Initial Dose«/bi» - Administer initial dose no sooner than 6 hr after transplantation - 0.03-0.05 mg/kg/day continuous IV infusion - Capsules: 0.15-0.2 mg/kg/day PO divided every 12 hr - Granules: 0.2 mg/kg/day PO divided in 2 doses, administered every 12 hr «bu»Heart Transplant«/bu» «b»Prograf«/b» «bi»Initial Dose«/bi» - Administer initial dose no sooner than 6 hr after transplantation - 0.01 mg/kg/day continuous IV infusion «b»Oral Capsules and Granules«/b» - 0.3 mg/kg/day PO divided in 2 doses - Administered every 12 hr «bu»Kidney Transplant«/bu» «b»Prograf«/b» «bi»Initial Dose«/bi» - Administer initial dose no sooner than 24 hr after transplantation - 0.03-0.05 mg/kg/day continuous IV infusion «b»Oral Capsules and Granules«/b» - 3 mg/kg/day PO divided in 2 doses - Administered every 12 hr «b»CYP3A5*1 Allele«/b» - African-American patients, compared to Caucasian patients, may need to be titrated to higher dosages to attain comparable trough concentrations ~80% of the African-American patients are carriers of the active, wild type CYP3A5*1 allele, resulting in a higher rate of tacrolimus clearance because of rapid metabolism «b»Dosing Considerations«/b» - Capsules and granules are not interchangeable or substitutable with other tacrolimus extended-release products; owing to the rate of absorption following administration an extended-release tacrolimus is not equivalent to immediate-release tacrolimus drug product - Under- or overexposure to tacrolimus may result in graft rejection or other serious adverse reactions - Do not use without supervision of a physician with experience in immunosuppressive therapy - African-American patients may need to be titrated to higher dosages to attain comparable trough concentrations compared to Caucasian patients «b»IV Formulation«/b» - Intravenous use is recommended for patients who cannot tolerate oral formulations, and conversion from IV to PO tacrolimus is recommended as soon as oral therapy can be tolerated to minimize the risk of anaphylactic reactions that occurred with injectables containing castor oil derivatives - Patients receiving the injection should be under continuous observation for at least the first 30 minutes following the start of the infusion and at frequent intervals thereafter - If signs or symptoms of anaphylaxis occur, stop the infusion - Aqueous epinephrine solution and a source of oxygen should be available at the bedside - Adjust dose according to clinical response and trough tacrolimus concentration Trough level (months 1-12): 5-20 ng/mL «b»IV Administration«/b» - If IV administration is necessary, administer by continuous infusion (generally, over 24 hours) - Do not use PVC tubing when administering diluted solutions - Do not mix with solutions with a pH ≥9 (acyclovir or ganciclovir) due to chemical degradation of tacrolimus (use different ports in multilumen lines) - Do not alter dose with concurrent T-tube clamping - Adsorption of the drug to PVC tubing may become clinically significant with low concentrations. «b»Oral Administration«/b» «bi»Immediate Release«/bi» - Administer with or without food; be consistent with timing and composition of meals if GI intolerance occurs and administration with food becomes necessary (per manufacturer). - If dosed once daily, administer in the morning. - If dosed twice daily, doses should be 12 hours apart. - If the morning and evening doses differ, the larger dose (differences are never >0.5 to 1 mg) should be given in the morning. - Some data suggests that the larger dose should be given in the evening since tacrolimus exposure may be reduced in the evening. - If dosed 3 times daily, separate doses by 8 hours. Combination Therapy with Everolimus for Liver Transplantation - Administer tacrolimus at the same time as everolimus. «bi»Extended Release«/bi» - For all US preparations, administer on an empty stomach at least 1 hour before or 2 hours after a meal - Advagraf labeling suggests that the capsule may be taken with food if necessary but should be administered consistently with or without food. - Swallow whole, do not chew, crush, or divide. - Take once daily in the morning at a consistent time each day. - Missed doses may be taken up to 14 hours (15 hours for Envarsus XR) after scheduled time; if >14 hours (>15 hours for Envarsus XR), resume at next regularly scheduled time; do not double a dose to make up for a missed dose. «bi»Nasogastric Tube«/bi» - If unable to swallow capsules, contents of immediate release capsule(s) may be mixed with water and flushed through a nasogastric tube - Clamp nasogastric tube for 30 to 60 minutes after administration - Dosing for immediate release capsules is not equivalent to dosing of Envarsus XR. - When switching from Envarsus XR to immediate release capsules for nasogastric administration, consider administering a 20% to 30% higher total daily dose of immediate release tacrolimus. «bi»Sublingual«/bi» - If unable to swallow capsules, tacrolimus may be administered sublingually (at a reduced dose) by opening the immediate-release capsules and placing the contents of the capsule(s) under the tongue, allowing contents to completely dissolve - The patient should avoid swallowing for 5 to 15 minutes and avoid oral intake for 15 to 30 minutes; also avoid mechanical suctioning for at least 30 minutes after administration. Absorption of a single dose of tacrolimus suspension given by the sublingual route was inadequate «b»Injection Preparation«/b» - Dilute with 5% dextrose injection or 0.9% sodium chloride injection to a final concentration between 0.004 mg/mL and 0.02 mg/mL. «b»Oral Suspension (1 mg/mL) Preparation«/b» - A 1 mg/mL tacrolimus oral suspension may be made with immediate release capsules, sterile water, Ora-Plus, and Ora-Sweet - Pour the contents of six 5 mg capsules into a plastic amber prescription bottle. - Add ~5 mL of sterile water and agitate bottle until drug disperses into a slurry. - Add equal parts Ora-Plus and Ora-Sweet in sufficient quantity to make 30 mL. - Store in plastic amber prescription bottles; label "shake well." - Stable for 4 months at room temperature «b»Oral Suspension (0.5 mg/mL) Preparation«/b» - A 0.5 mg/mL tacrolimus oral suspension may be made with immediate release capsules and a 1:1 mixture of Ora-Plus and Simple Syrup, N.F. - Mix the contents of six 5 mg tacrolimus capsules with quantity of vehicle sufficient to make 60 mL - Store in glass or plastic amber prescription bottles; label "shake well." - Stable for 56 days at room temperature

Tacrolimus (Topical)

Protopic

Tadalafil

Adcirca, Cialis, Alyq

Tafamidis

Vyndamax

Tafamidis Meglumine

Vyndaqel

Tafasitamab

Monjuvi

«bu»Diffuse Large B-Cell Lymphoma«/bu» «b»Relapsed or Refractory«/b» «bi»Cycle 1«/bi» - Lenalidomide 25 mg PO daily on days 1 through 21 - Tafasitamab 12 mg/kg IV on days 1, 4, 8, 15, 22 «bi»Cycles 2 and 3«/bi» - Lenalidomide 25 mg PO daily on days 1 through 21 - Tafasitamab 12 mg/kg IV on days 1, 8, 15, and 22 «bi»Cycle 4 and Thereafter«/bi» - Lenalidomide 25 mg PO daily on days 1 through 21 - Tafasitamab 12 mg/kg IV on days 1 and 15 «b»Duration of Therapy«/b» - Administer tafasitamab in combination with lenalidomide for up to 12 cycles, then, - Continue tafasitamab as monotherapy until disease progression or unacceptable toxicity «b»Pre-medication«/b» - Administer 30 min to 2 hour before starting infusion - Premedications may include acetaminophen, histamine H1-receptor antagonists, histamine H2-receptor antagonists, and/or glucocorticosteroids - No infusion-related reactions during first 3 infusions: Premedication is optional for subsequent infusions - If an infusion-related reaction occurs, administer premedications before each subsequent infusion «b»Infusion-related Reactions«/b» «bi»Grade 2«/bi» - Interrupt infusion immediately and manage signs and symptoms - Once signs and symptoms resolve to Grade ≤1, resume at ≤50% of rate at which reaction occurred - If no further reaction occurs within 1 hour and vital signs are stable, may increase infusion rate every 30 min as tolerated to rate at which the reaction occurred «bi»Grade 3«/bi» - Interrupt infusion immediately and manage signs and symptoms - Once signs and symptoms resolve to Grade ≤1, resume infusion at ≤25% of rate at which reaction occurred - If no further reaction occurs within 1 hour and vital signs are stable, may increase infusion rate every 30 min as tolerated to up to 50% of the rate at which reaction occurred - Stop infusion immediately if reaction returns after re-challenge «bi»Grade 4«/bi» - Stop infusion immediately and permanently discontinue «b»Thrombocytopenia«/b» «bi»Platelet Count ≤50,000/mcL«/bi» - Withhold tafasitamab and lenalidomide and monitor CBC count weekly until platelet count ≥50,000/mcL - Resume tafasitamab at same dose and lenalidomide at reduced dose «b»Neutropenia«/b» - Defined as a neutrophil count ≤500/mcL, or neutrophil count ≤1,000/mcL for ≥7 days, or with an increase of body temperature ≥100.4ºF (38ºC) - Withhold tafasitamab and lenalidomide and monitor CBC count weekly until neutrophil count ≥1,000/mcL - Resume tafasitamab at same dose and lenalidomide at reduced dose «b»Contraception«/b» «bi»Females of Reproductive Potential«/bi» - Use effective contraception during treatment and for at least 3 months after final dose «b»Fetal/Neonatal Adverse Reactions«/b» - IgG monoclonal antibodies are transferred across the placenta - May cause depletion of fetal CD19-positive immune cells - Defer administering live vaccines to neonates and infants exposed to tafasitamab in utero until completing a hematology evaluation

Tafenoquine

Krintafel, Arakoda

«bu»Malaria«/bu» «b»Prevention of Relapse Following Treatment of Acute P. Vivax Infection«/b» «bi»Krintafel Only (age ≥16 yr)«/bi» - 300 mg PO x 1 dose - Coadminister tafenoquine on the first or second day of the appropriate antimalarial therapy (eg, chloroquine) for acute P vivax malaria «b»Prophylaxis When Traveling to Malarious Area«/b» «bi»Arakoda only (age ≥18 years)«/bi» «b»Loading Regimen«/b» - For each of the 3 days before travel to a malarious area - 200 mg PO daily x 3 days «b»Maintenance Regimen«/b» - While in malarious area: 200 mg once weekly starting 7 days after the last loading regimen dose «b»Terminal Prophylaxis Regimen«/b» - In the week following exit from the malarious area: 200 mg PO as a single, one-time dose, taken 7 days after the last maintenance dose «b»Missed Doses«/b» «bi»Krintafel«/bi» - In the event of vomiting within 1 hr after dosing, a repeat dose should be given; do not redose more than once «bi»Arakoda«/bi» One Loading Dose Missed - Replace with 1 dose of 200 mg so that a total of 3 daily loading doses have been taken; begin maintenance dose 1 week after the last loading dose Two Loading Doses Missed - Replace with 2 doses of 200 mg on 2 consecutive days so that a total of 3 daily loading doses have been taken; begin maintenance dose 1 week after the last loading dose One Maintenance (weekly) Dose Missed - 1 dose of 200 mg on any day up to the time of the next scheduled weekly dose Two Maintenance (weekly) Doses Missed - 1 dose of 200 mg on any day up to the time of the next scheduled weekly dose ≥ Three Maintenance (weekly) Doses Missed - 2 doses of 200 mg, taken as 200 mg once daily for 2 days up to the time of the next weekly dose Terminal Prophylaxis Dose Missed - 1 dose of 200 mg as soon as remembered «b»Limitation of Use«/b» - Not indicated for treatment of acute P vivax malaria «b»Tests Prior to Initiation«/b» - All patients must be tested for glucose-6-phosphate dehydrogenase (G6PD) deficiency Pregnancy testing is recommended for females of reproductive potentia «b»Clinical Considerations«/b» - Malaria during pregnancy increases the risk for adverse pregnancy outcomes, including maternal anemia, prematurity, spontaneous abortion, and stillbirth «b»Pregnancy Testing«/b» - Verify the pregnancy status in females of reproductive potential prior to initiating treatment «b»Contraception«/b» - May cause hemolytic anemia in a G6PD-deficient fetus - Advise females of reproductive potential that treatment during pregnancy is not recommended and to avoid pregnancy or use effective contraception for 3 months after the tafenoquine dose

Tafluprost

Zioptan

Tagraxofusp

Elzonris

«bu»Blastic Plasmacytoid Dendritic Cell Neoplasm«/bu» - 12 mcg/kg IV daily on days 1-5 - Repeat cycle every 21 days - Continue treatment until disease progression or unacceptable toxicity - Dosing period may be extended for dose delays up to Day 10 of the cycle «b»Premedication«/b» - Premedicate with an H1-histamine antagonist (diphenhydramine), H2-histamine antagonist (eg, ranitidine), corticosteroid (50 mg IV methylprednisolone or equivalent) and acetaminophen (or paracetamol) ~60 min prior to each infusion «b»Dosage Modifications Based on Parameter and Severity Criteria«/b» «bi»ALT or AST >5 x ULN«/bi» - Withhold until AST/ALT ≤2.5x ULN «bi»SCr >1.8 mg/dL or CrCl ≤60 mL/min«/bi» - Withhold until serum creatinine ≤1.8 mg/dL or CrCl ≥60 mL/min «bi»SBP ≥160 mm Hg or ≤80 mm Hg«/bi» - Withhold until SBP <160 mm Hg or >80 mm Hg «bi»Heart Rate (HR) ≥130 bpm or ≤40 bpm«/bi» - Withhold until HR is <130 bpm or >40 bpm «bi»Body Temp ≥38°C«/bi» - Withhold until body temperature <38°C «b»Hypersensitivity Reactions«/b» «bi»Mild or Moderate«/bi» - Withhold until any mild or moderate hypersensitivity reaction resolves - Resume at the same infusion rate «bi»Severe or Life-threatening«/bi» - Discontinue permanently «b»Capillary Leak Syndrome (CLS) Guidelines«/b» «bi»Before first dose in Cycle 1«/bi» Serum albumin <3.2 g/dL - Administer when serum albumin ≥3.2 g/dL «bi»During Treatment«/bi» - Interrupt dosing until relevant CLS sign/symptom resolves while implementing the following actions Serum Albumin <3.5 g/dL or Reduced by ≥0.5 g/dL from Albumin Before Dosing Initiation of Current Cycle - Administer albumin 25g IV (q12h or more frequently) until serum albumin ≥3.5 g/dL AND ≤0.5 g/dL lower than albumin before dosing initiation of the current cycle Predose Body Weight Increased by ≥1.5 kg over Previous Day’s Predose Weight - Administer albumin 25g IV (q12h or more frequently) and manage fluid status as clinically indicated (IV fluids and vasopressors if hypotensive and diuretics if normotensive and hypertensive) until body weight increase has resolved Edema, Fluid Overload, and/or Hypotension - Administer albumin 25g IV (q12h or more frequently) until serum albumin ≥3.5 g/dL, methylprednisolone (or equivalent) 1 mg/kg/day IV, and aggressive management of fluid status and hypotension if present (may include IV fluids and/or diuretics or other blood pressure management) until CLS sign/symptom resolves or as clinically indicated «b»Dosing Considerations«/b» - Before the first dose in Cycle 1, ensure serum albumin ≥3.2 g/dL - Monitor vital signs and check albumin, transaminases, and creatinine prior to preparing each dose - Conduct pregnancy testing in females of reproductive potential within 7 days before initiating treatment «b»Contraception«/b» - Advise females to use acceptable contraceptive methods during treatment and for at least 1 week after last dose «b»IV Administration«/b» «bi»Cycle 1«/bi» - Administer in an inpatient setting with patient observation through ≤24 hr after last infusion «bi»Subsequent Cycles«/bi» - Administer in an inpatient setting or a suitable outpatient ambulatory care setting equipped with appropriate monitoring for patients with hematopoietic malignancies undergoing treatment - Establish IV access and maintain with sterile 0.9% NaCl - Administer prepared dose via infusion syringe pump over 15 min - Total infusion time is controlled using a syringe pump to deliver entire dose and saline flush over 15 minutes - After infusion set setup: Administer within 4 hr at room temperature - Refer to the prescribing information for infusion pump set up «b»IV Reconstitution«/b» - Prior to dose preparation, thaw at room temperature, 15-25°C (59-77°F), for 15-30 min in original carton, and verify thaw visually; may be held at room temperature for ~1 hr prior to dosage preparation - Do not force-thaw; do not refreeze vial once thawed - Visually inspect vial for particulate matter and discoloration prior to administration - Thawed drug appears as a clear, colorless liquid that may contain a few white-to-translucent particles - Prepare 10 ml of tagraxofusp 100 mcg/mL - Transfer 9 mL of 0.9% NaCl to an empty sterile 10-mL vial - Gently swirl drug vial to mix contents, remove cap, and withdraw 1 mL of thawed drug - Transfer 1 mL into sterile 10-mL vial containing 0.9% NaCl - Gently invert vial ≥3x to mix contents; do not shake vigorously - Final concentration of diluted solution is 100 mcg/mL «b»Prepare Infusion Set«/b» - Calculate and draw up required volume of diluted solution (100 mcg/mL) according to patient’s weight - If dose requires >10 mL, prepare a second vial of diluted solution - Refer to prescribing information for further details on infusion set setup - Do not reuse excess diluted drug solution; discard any excess material immediately following infusion

Talazoparib

Talzenna

Talc (Sterile)

Sclerosol Intrapleural

- For intrapleural (pleurodesis) administration only - Not for IV administration - Administer after adequate drainage of the effusion or air «b»Sclerosol Intrapleural Aerosol«/b» - Shake well and attach delivery tube - Insert delivery tube through pleural trocar, manually press on actuator button of canister to release; point in several different directions to distribute to all pleural surfaces. - Keep canister in an upright position for optimal distribution. - Rate of delivery is 1.2 g per second. «b»Sterile Talc Powder«/b» - Administer as a suspension - Shake well before instillation - Vent the 10 mL air headspace and empty contents of each syringe into chest cavity through the chest tube by gently applying pressure to syringe plunger - After administration, clamp the chest tube for 1 to 2 hours and then drain the pleural fluid; the chest tube can be removed when drainage is <100 to 150 mL/24 hours «b»Steritalc«/b» - Slurry for tube thoracostomy - Shake syringe well prior to administration to redisperse talc and avoid settling. - Immediately prior to administration, vent the 10 mL air headspace from each syringe and administer talc suspension through the chest tube (follow standard procedures). - Inject slurry through pleural drainage into pleural cavity; clamp pleural drainage and retain negative pressure in the pleural cavity. - With slurry in cavity, re-position patient regularly to achieve even slurry distribution - Aspirate slurry through pleural drainage. «b»Insufflation/Poudrage«/b» - Perform procedure with a tube thoracoscopy - Follow device instructions for insufflation or poudrage - After use, some talc may remain in the vial (discard unused portion) «bi»2 or 4 g vials«/bi» - Introduce cannula into trocar, distribute talc evenly in pleural cavity by spraying several times and changing cannula direction every few sprays. «bi»3 g vial«/bi» - Keep product upright during use; avoid contact between the cannula tip and tissue or body fluids (may result in blocked cannula; if blockage occurs, shorten cannula with a scalpel, cutting perpendicular to cannula and ensuring the cut edge is straight and smooth) - Proceed with intervention by introducing cannula into the trocar, distribute the talc evenly in the pleural cavity by pressing insufflation bulb carefully and at regular intervals - After spraying a few times, change the cannula direction. «b»Sterile Talc Powder«/b» - Vent bottle with needle; slowly add NS 50 mL to bottle using aseptic technique. - Swirl the bottle to disperse talc and avoid settling - Divide the contents of bottle into two 60 mL syringes (25 mL of talc suspension in each). - Add an additional NS 25 mL to each syringe for a total of 50 mL (2.5 g/50 mL). - Draw syringe back to add 10 mL air to facilitate mixing prior to administration. - Shake well to resuspend prior to use. - If not used immediately, label “For pleurodesis only; NOT for IV administration.” «b»Steritalc«/b» - Slurry for tube thoracostomy (2 g or 4 g dosage forms) - Do not prepare the slurry in advance - Use slurry immediately after preparation - Prepare the talc suspension using aseptic technique in an appropriate laminar flow hood. - Fully bend or remove the flap into the direction of the arrow; puncture top to mix slurry. Using a 16-gauge needle attached to a 60-mL Luer Lok syringe, draw up 50 mL NS, vent the talc bottle with a needle and slowly inject the 50 mL NS into the glass vial; swirl glass vial to disperse talc powder - Divide the contents of the glass vial equally into two 60-mL Luer Lok syringes (with a 16-gauge needle on each syringe) by withdrawing 25 mL of the suspension into each syringe while continuously swirling - Add NS to a total volume of 50 mL in each syringe. Draw back to the 60 mL mark on each syringe to add 10 mL air to serve as a headspace for mixing prior to administration - When preparing from a 2 g vial, each syringe contains 1 g sterile talc in 50 mL NS with an air headspace of 10 mL and when preparing from a 4 g vial, each syringe contains 2 g sterile talc in 50 mL NS with an air headspace of 10 mL - Label “For pleurodesis only; NOT for IV administration.” - Shake syringe well prior to administration to re-suspend «b»Insufflation/Poudrage (2, 3, or 4 g dosage forms)«/b» «bi»2 or 4 g vials«/bi» - Use a device approved or cleared for Steritalc insufflation/poudrage - Fully remove top from vial; fill vial content into the applicator for insufflation/poudrage and follow the selected device manufacturer's instructions for insufflation/poudrage. «bi»3 g vial«/bi» - The 3 g vial is designed for use/sterile talc administration in combination with a compatible approved/cleared device (eg, Novatech TALCAIR) intended for manual insufflation of medical grade talc into the pleural cavity during pleurodesis - Remove the aluminum tear-off cap from the vial; remove vial stopper; close vial with the vial coupling, firmly press vial coupling onto the vial until lid clicks onto the vial top by placing the vial on a firm/level base - Connect the insufflation bulb to the vial coupling using the Luer lock connector and ensure that all components are firmly connected with each other.

Taliglucerase Alfa

Elelyso

Talimogene Laherparepvec

Imlygic

Tamoxifen

Soltamox, Nolvadex

Tamsulosin

Flomax

Tapentadol

Nucynta

«bu»Neuropathic Pain Associated with Diabetic Peripheral Neuropathy«/bu» «b»Extended Release«/b» «bi»Opioid Naive«/bi» - Use as the first opioid analgesic or use in patients who are not opioid tolerant - Initial Dose: 50 mg every 12 hours «b»Conversion from Other Opioids to Tapentadol ER«/b» - Initial: 50 mg every 12 hours «b»Conversion from Tapentadol IR to ER«/b» - Convert using same total daily dose but divide into 2 equal doses and administer every 12 hours. «b»Conversion from Methadone to Tapentadol ER«/b» - Close monitoring is required when converting methadone to another opioid - Ratio between methadone and other opioid agonists varies widely according to previous dose exposure - Methadone has a long half-life and can accumulate in the plasma. «b»Dosage Titration«/b» - Titrate in increments of 50 mg no more frequently than twice daily every 3 days to effective dose - Therapeutic Range: 100 to 250 mg every 12 hours «bu»Pain Management«/bu» «b»Tablets IR and Solution«/b» «bi»Day 1«/bi» - 50 to 100 mg (2.5 to 5 mL) every 4 to 6 hours as needed - May administer a second dose ≥1 hour after the initial dose - Maximum Dose on First Day: 700 mg/day «bi»Day 2 and Subsequent Dosing«/bi» - 50 to 100 mg (2.5 to 5 mL) every 4 to 6 hours as needed - Maximum Dose: 600 mg/day «bi»Conversion from Tapentadol IR to ER«/bi» - Convert using same total daily dose but divide into 2 equal doses and administer every 12 hours. «b»Extended-Release«/b» «bi»Opioid Naive«/bi» - Use as the first opioid analgesic or use in patients who are not opioid tolerant - Initial Dose: 50 mg every 12 hours «bi»Conversion from Other Opioids to Tapentadol ER«/bi» - Initial: 50 mg every 12 hours «bi»Conversion from Tapentadol IR to ER«/bi» - Convert using same total daily dose but divide into 2 equal doses and administer every 12 hours. «bi»Conversion from Methadone to Tapentadol ER«/bi» - Close monitoring is required when converting methadone to another opioid - Ratio between methadone and other opioid agonists varies widely according to previous dose exposure - Methadone has a long half-life and can accumulate in the plasma. «bi»Dosage Titration«/bi» - Titrate in increments of 50 mg no more frequently than twice daily every 3 days to effective dose - Therapeutic Range: 100 to 250 mg every 12 hours «b»Discontinuation of Therapy«/b» - Decrease previous daily dose by 25% to 50% each day every 2 to 4 days; mmonitor carefully for signs/symptoms of withdrawal. If patient displays withdrawal symptoms, increase dose to previous level and then reduce dose more slowly by increasing interval between dose reductions, decreasing amount of daily dose reduction, or both «b»Limitations of Use«/b» - Reserve tapentadol for use in patients for whom alternative treatment options (nonopioid analgesics, opioid combination products) are ineffective, not tolerated, or would be otherwise inadequate to provide sufficient management of pain. Tapentadol ER is not indicated as an as-needed analgesic.

Tapinarof

Vtama (Topical)

Tasimelteon

Hetlioz

Tavaborole

Kerydin

Tazarotene

Avage, Tazorac, Fabior, Arazlo

Tazemetostat

Tazverik

«bu»Epithelial Sarcoma«/bu» - 800 mg PO bid - Continue until disease progression or unacceptable toxicity «b»Missed Dose«/b» - Do not take an additional dose if a dose is missed or vomiting occurs after dose, but continue with the next scheduled dose «b»Contraception«/b» «bi»Females of Reproductive Potential«/bi» - Use effective non-hormonal contraception during treatment and for 6 months after the final dose - May render some hormonal contraceptives ineffective «bi»Males with Female Partners of Reproductive Potential«/bi» - Use effective contraception during treatment and for at least 3 months after the final dose «b»Dose Reduction Schedule«/b» «bi»First Reduction«/bi» - 600 mg PO bid «bi»Second Reduction«/bi» - 400 mg PO bid - Permanently discontinue if unable to tolerate 400 mg bid «b»Neutropenia«/b» «bi»Neutrophil count <1 x 109/L«/bi» - Withhold until neutrophil count ≥1 x 109/L or baseline «bi»First Occurrence«/bi» - Resume at same dose «bi»Second and Third Occurrences«/bi» - Resume at reduced dose - Permanently discontinue after fourth occurrence «b»Thrombocytopenia«/b» «bi»Platelet count <50 x 109/L«/bi» - Withhold until platelet count ≥75 x 109/L or baseline «bi»First and Second Occurrences«/bi» - Resume at reduced dose - Permanently discontinue after third occurrence «b»Anemia«/b» «bi»Hemoglobin <8 g/dL«/bi» - Withhold until improvement to at least Grade 1 or baseline, then resume at same or reduced dose «b»Grade 3 Adverse Reactions«/b» - Withhold until improvement to at least Grade 1 or baseline «bi»First and Second Occurrences«/bi» - Resume at reduced dose - Permanently discontinue after third occurrence «b»Grade 4 Adverse Reactions«/b» - Withhold until improvement to at least Grade 1 or baseline «bi»First and Second Occurrences«/bi» - Resume at reduced dose - Permanently discontinue after second occurrence «b»Strong CYP3A Inhibitors«/b» - Avoid use «b»Moderate CYP3A Inhibitors«/b» - Avoid use - If coadministration with a moderate CYP3A inhibitor cannot be avoided, reduce dose «bi»Current dose 800 mg bid«/bi» - Reduce to 400 mg bid «bi»Current dose 600 mg bid«/bi» - Reduce to 400 mg for first dose and 200 mg for second dose «bi»Current dose 400 mg bid«/bi» - Reduce to 200 mg bid - After discontinuation of the moderate CYP3A inhibitor for 3 elimination half-lives, resume tazemetostat dose that was taken before initiating the inhibitor

Tazobactam

Tebentafusp

Kimmtrak

«bu»Uveal Melanoma«/bu» - Treatment of HLA-A*02:01-positive adults with unresectable or metastatic uveal melanoma «b»Day 1«/b» - 20 mcg IV «b»Day 8«/b» - 30 mcg IV «b»Day 15 and weekly thereafter«/b» - 68 mcg IV - Continue until unacceptable toxicity or disease progression occurs «b»Contraception«/b» - Females of reproductive potential: Use effective contraception during treatment and for 1 week following last dose «b»Cytokine Release Syndrome (CRS)«/b» «bi»Moderate«/bi» - Defined as temperature ≥38°C with hypotension that responds to fluids (does not require vasopressors) OR hypoxia requiring low-flow nasal canula (≤6 L/min) or blow-by oxygen - If hypotension and hypoxia do not improve within 3 hr or CRS worsens, escalate care and manage according to next higher level of severity - For persistent moderate (lasting 2-3 hr) or recurrent CRS, administer corticosteroid premedication (eg, dexamethasone 4 mg or equivalent) at least 30 minutes before next dose «bi»Severe«/bi» - Defined as temperature ≥38°C with hemodynamic instability requiring a vasopressor (with or without vasopressin) OR worsening hypoxia or respiratory distress requiring high-flow nasal canula (>6 L/min oxygen) or face mask - Withhold until CRS and sequelae resolves - Administer IV corticosteroid (eg, 2 mg/kg/day methylprednisolone or equivalent) - Resume at same dose level (ie, do not escalate if severe CRS occurred during initial dose escalation; resume escalation once dosage is tolerated) For severe CRS, administer corticosteroid premedication (eg, dexamethasone 4 mg or equivalent) at least 30 minutes before next dose «bi»Life-threatening«/bi» - Defined as temperature ≥38°C with hemodynamic instability requiring multiple vasopressors (excluding vasopressin) OR worsening hypoxia or respiratory distress despite oxygen administration requiring positive pressure - Permanently discontinue - Administer IV corticosteroid (eg, 2 mg/kg/day methylprednisolone or equivalent) «b»Skin Reactions«/b» «bi»Grade 2 or 3«/bi» - Withhold until Grade ≤1 or baseline - Resume at same dose level (ie, do not escalate if Grade 3 skin reactions occurred during initial dose escalation; resume escalation once dose is tolerated) - For persistent reactions not responding to oral steroids, consider IV corticosteroid (eg, 2 mg/kg/day methylprednisolone or equivalent) «bi»Grade 4«/bi» - Permanently discontinue - Administer IV corticosteroid (eg, 2 mg/kg/day methylprednisolone or equivalent) «b»Elevated Liver Enzymes«/b» «bi»Grade 3 or 4«/bi» - Withhold until Grade ≤1 or baseline - Occurs in Grade 3 CRS setting: Resume at same dose level; resume escalation if next administration is tolerated - Occurs outside Grade 3 CRS setting: Resume escalation if current dose <68 mcg, or resume at same dose level if dose escalation completed - Administer IV corticosteroids if no improvement within 24 hr «b»Other Adverse Reactions«/b» «bi»Grade 3«/bi» - Withhold until Grade ≤1 or baseline - Resume at same dose level (ie, do not escalate if other Grade 3 adverse reaction occurred during initial dose escalation; resume escalation once dosage is tolerated) «bi»Grade 4«/bi» - Permanently discontinue «b»IV Administration«/b» - Administer IV infusion immediately following preparation - Infuse over 15-20 minutes through a dedicated IV line; use sterile, nonpyrogenic, low–protein binding 0.2–micron inline filter infusion set - Administer entire contents of infusion bag within 4 hr from time of preparation including duration of infusion - Do not mix with other drugs or administer other drugs through same IV line - Once infusion completed, flush infusion line with sterile 0.9% NaCl to ensure that entire contents of infusion bag are administered - Administer first 3 infusions in an appropriate healthcare setting; observe patient for at least 16 hr following the first 3 infusions and for at least 30 minutes after future infusions - If patient does not experience Grade 2 or worse hypotension (requiring medical intervention) during or after third infusion, administer subsequent doses in an appropriate ambulatory-care setting, and monitor patients for a minimum of 30 minutes after infusion «b»IV Preparation«/b» - Requires 2-step dilution process for preparing final dose for infusion - Visually inspect vials and infusion bags for particulate matter and discoloration before administering «bi»Prepare Infusion Bag«/bi» - Using a 1-mL syringe with graduations of 2 decimal places and a sterile needle, withdraw calculated volume (listed below) of albumin (human) into syringe 5% (50 g/L) concentration: 0.5 mL 20% (200 g/L) concentration: 0.13 mL 25% (250 g/L): 0.1 mL - Add albumin to 100-mL 0.9% NaCl bag constructed of polyolefins (PO) (eg, polyethylene [PE] and polypropylene [PP]) or polyvinyl chloride (PVC) to make a final 250 mcg/mL albumin concentration - Gently homogenize prepared solution by completing the following - Invert infusion bag so that bag is upside-down, with entry port positioned on top; then tap side of port tubing to ensure the release of any residual solution -Mix prepared solution by gently rotating bag lengthwise 360º from inverted position ≥5 times; do not shake infusion bag - Repeat these steps an additional 3 times «bi»Dilute Tebentafusp Solution Before Administration«/bi» - Do not shake vial - Using a 1-mL syringe with graduations of 2 decimal places and a sterile needle, withdraw required drug volume and add to prepared 100-mL infusion bag containing 0.9% NaCl plus albumin - Dose and drug volume to add to prepared infusion bag Day 1: 20 mcg (0.1 mL) Day 8: 30 mcg (0.15 mL) Day 15 and weekly thereafter: 68 mcg (0.34 mL) - Discard any unused portion in accordance with local requirements; do not prepare more than 1 dose from vial - Gently homogenize prepared solution by completing the following - Invert infusion bag so that bag is upside-down, with entry port positioned on top; then tap side of port tubing to ensure the release of any residual solution - Mix prepared solution by gently rotating bag lengthwise 360º from inverted position ≥5 times; do not shake infusion bag - Repeat these steps an additional 3 times

Tecovirimat

TPOXX

Tedizolid

Sivextro

Teduglutide (rDNA)

Gattex

Telavancin

Vibativ

Telmisartan

Micardis

Telmisartan-Amlodipine

Twynsta

Telmisartan-Hydrochlorothiazide

Micardis HCT

Telotristat

Xermelo

Temazepam

Restoril

Temozolomide

Temodar

«b»Premedication and Monitoring«/b» - Temozolomide is associated with a moderate emetic potential - Antiemetics are recommended to prevent nausea and vomiting - Prior to dosing, ANC should be ≥1,500/mm3 and platelets ≥100,000/mm3 «bu»Anaplastic Astrocytoma«/bu» «b»Refractory«/b» - Initial Dose: 150 mg/m2 IV/PO once daily for 5 consecutive days of a 28-day treatment cycle. - If ANC ≥1,500/mm3 and platelets ≥100,000/mm3, on day 1 of subsequent cycles, may increase to 200 mg/m2 once daily for 5 consecutive days of a 28-day treatment cycle. May continue until disease progression. «b»Dosage Modification for Toxicity«/b» «bi»ANC <1,000/mm3 or platelets <50,000/mm3 on day 22 or day 29 (day 1 of next cycle)«/bi» - Postpone therapy until ANC >1,500/mm3 and Platelets >100,000/mm3 - Reduce dose by 50 mg/m2/day (but not below 100 mg/m2) for subsequent cycle «bi»ANC 1,000 to 1,500/mm3 or Platelets 50,000-100,000/mm3 on day 22 or day 29 (day 1 of next cycle)«/bi» - Postpone therapy until ANC >1,500/mm3 and platelets >100,000/mm3; maintain initial dose «bu»Glioblastoma Multiforme«/bu» - Newly diagnosed, high-grade glioma «b»Concomitant Phase«/b» - 75 mg/m2 IV/PO once daily for 42 days with focal radiotherapy (60 Gy administered in 30 fractions) - PCP prophylaxis is required during concomitant phase and should continue in patients who develop lymphocytopenia until lymphocyte recovery to ≤grade 1 - Obtain weekly CBC. - Continue at 75 mg/m2 IV/PO once daily throughout the 42-day concomitant phase (up to 49 days) as long as ANC ≥1,500/mm3, platelet count ≥100,000/mm3, and nonhematologic toxicity ≤grade 1 (excludes alopecia, nausea/vomiting) «b»Dosage Modification for Toxicity«/b» «bi»ANC ≥500/mm3 but <1,500/mm3 or Platelet Count ≥10,000/mm3 but <100,000/mm3 or grade 2 Nonhematologic Toxicity (excludes alopecia, nausea/vomiting)«/bi» - Interrupt therapy «bi»ANC <500/mm3 or Platelet count <10,000/mm3 or grade 3/4 Nonhematologic Toxicity (excludes alopecia, nausea/vomiting)«/bi» - Discontinue therapy «b»Maintenance Phase«/b» - Consists of 6 treatment cycles - Begin 4 weeks after concomitant phase completion - Note: Each subsequent cycle is 28 days (consisting of 5 days of drug treatment followed by 23 days without treatment) - Draw CBC on day 22 (or within 48 hours of day 22); hold next cycle and do weekly CBC until ANC >1,500/mm3 and platelet count >100,000/mm3; dosing modification should be based on lowest blood counts and worst nonhematologic toxicity during the previous cycle. «b»Cycle 1«/b» - 150 mg/m2 once daily for 5 days of a 28-day treatment cycle «b»Cycles 2 to 6«/b» - May increase to 200 mg/m2 once daily for 5 days - Repeat every 28 days (if ANC ≥1,500/mm3, platelets ≥100,000/mm3 and nonhematologic toxicities for cycle 1 are ≤grade 2 [excludes alopecia, nausea/vomiting]) - If dose was not escalated at the onset of cycle 2, do not increase for cycles 3 to 6) «b»Dosage Modification (During Maintenance Phase) for Toxicity«/b» «bi»ANC <1,000/mm3, platelet count <50,000/mm3, or grade 3 nonhematologic toxicity (excludes alopecia, nausea/vomiting) during previous cycle«/bi» - Decrease dose by 1 dose level (by 50 mg/m2/day for 5 days), unless dose has already been lowered to 100 mg/m2/day, then discontinue therapy. «bi»If dose reduction <100 mg/m2/day is required or grade 4 nonhematologic toxicity (excludes alopecia, nausea/vomiting), or if the same grade 3 nonhematologic toxicity occurs after dose reduction«/bi» - Discontinue therapy «bu»Cutaneous T-cell Lymphoma, Advanced«/bu» «b»Mycosis Fungoides (MF) and Sézary Syndrome«/b» - 200 mg/m2 IV/PO once daily for 5 days every 28 days for up to 1 year «bu»Ewing’s Sarcoma«/bu» (off-label use) «b»Recurrent or Progressive«/b» - 100 mg/m2/dose IV/PO days 1 to 5 every 21 days (in combination with irinotecan) «bu»Glioblastoma Multiforme«/bu» (off-label use) «b»Recurrent Glioma«/b» - 200 mg/m2 PO once daily for 5 days every 28 days; if previously treated with chemotherapy, initiate at 150 mg/m2 once daily for 5 days every 28 days and increase to 200 mg/m2 once daily for 5 days every 28 days with cycle 2 if no hematologic toxicity «bu»Melanoma«/bu» «b»Advanced or Metastatic«/b» - 200 mg/m2 PO once daily for 5 days every 28 days (for up to 12 cycles) - For subsequent cycles reduce dose to 75% of the original dose for grade 3/4 hematologic toxicity and reduce the dose to 50% of the original dose for grade 3/4 nonhematologic toxicity «bu»Neuroendocrine Tumors«/bu» «b»Advanced or Metastatic«/b» - 150 mg/m2 PO once daily for 7 days every 14 days (in combination with thalidomide) until disease progression or - 200 mg/m2 PO once daily (at bedtime) days 10 to 14 of a 28-day treatment cycle (in combination with capecitabine) «bu»Primary CNS Lymphoma«/bu» «b»Refractory«/b» - 150 mg/m2 PO once daily for 5 days every 28 days, initially in combination with rituximab (for 4 cycles) Followed by Temozolomide Monotherapy - 150 mg/m2 PO once daily for 5 days every 28 days for 8 cycles or 150 mg/m2 PO once daily on days 1 to 7 and 15 to 21 every 28 days (initially in combination with rituximab for 1 or 2 cycles), followed by temozolomide maintenance monotherapy: 150 mg/m2 PO once daily for 5 days every 28 days «bu»Soft Tissue Sarcoma«/bu» «b»Soft Tissue Sarcoma, Metastatic or Unresectable«/b» - 75 mg/m2 PO once daily for 6 weeks «bu»Hemangiopericytoma/Solitary Fibrous Tumor«/bu» - 150 mg/m2 PO once daily days 1 to 7 and days 15 to 21 of a 28-day treatment cycle (in combination with bevacizumab) - Temozolomide is associated with a moderate emetic potential - Antiemetics are recommended to prevent nausea and vomiting. «b»Oral Administration«/b» - Swallow capsules whole with a glass of water - Absorption is affected by food; therefore, administer consistently either with food or without food (was administered in studies under fasting and nonfasting conditions) - May administer on an empty stomach and/or at bedtime to reduce nausea and vomiting - Do not repeat dose if vomiting occurs after dose is administered; wait until the next scheduled dose - Do not open or chew capsules; avoid contact with skin or mucous membranes if capsules are accidentally opened or damaged. «b»IV Administration«/b» - Infuse over 90 minutes. Flush line before and after administration - May be administered through the same IV line as sodium chloride 0.9%; do not administer other medications through the same IV line. «b»IV Reconstitution«/b» - Bring to room temperature prior to reconstitution - Reconstitute each 100 mg vial with 41 mL sterile water for injection to a final concentration of 2.5 mg/mL - Swirl gently; do not shake. Place dose without further dilution into a 250 mL empty sterile infusion bag - Infusion must be completed within 14 hours of reconstitution. «b»Oral Suspension (10 mg/mL) Preparation«/b» - A 10 mg/mL temozolomide oral suspension may be compounded in a vertical flow hood - Mix the contents of ten 100 mg capsules and 500 mg of povidone K-30 powder in a glass mortar; add 25 mg anhydrous citric acid dissolved in 1.5 mL purified water and mix to a uniform paste; mix while adding 50 mL Ora-Plus in incremental proportions - Transfer to an amber plastic bottle, rinse mortar 4 times with small portions of either Ora-Sweet or Ora-Sweet SF, and add quantity of Ora-Sweet or Ora-Sweet SF sufficient to make 100 mL - Store in plastic amber prescription bottles; label "shake well" and "refrigerate"; include the beyond-use date - Stable for 7 days at room temperature or 60 days refrigerated (preferred).

Temsirolimus

Torisel

Tenapanor

Ibsrela

Tenecteplase

TNK tPA, TNKase

Teniposide

Vumon

Tenofovir AF

Vemlidy, Tenofovir Alafenamide

Tenofovir DF

Viread, Tenofovir Disoproxil Fumarate

«bu»Hepatitis B Infection«/bu» - 300 mg PO once daily - Concurrent use with adefovir and/or tenofovir Combination products should be avoided. «b»Treatment Duration«/b» - Treatment duration for nucleos(t)ide analog-based therapy (tenofovir) is variable and influenced by HBeAg status, duration of HBV suppression, and presence of cirrhosis/decompensation «b»Patients without Cirrhosis«/b» «bi»HBeAg Positive Immune-active Chronic Hepatitis«/bi» -Treat until HBeAg seroconversion; after seroconversion, prolonged duration of therapy is often required in patients treated with nucleos(t)ide anaglogues, - Optimal duration is unknown; however, consolidation therapy is generally a minimum of 12 months of persistently normal ALT and undetectable serum HBV DNA levels after HBeAg seroconversion «b»HBeAg-negative Immune-active Chronic Hepatitis«/bi» - Indefinite antiviral therapy is suggested unless there is competing rationale for discontinuation (risk/benefit decision); treatment discontinuation may be considered in patients with loss of HBsAg; however, there is insufficient evidence to guide decisions in these patients. «b»Patients with Cirrhosis«/b» «bi»HBeAg-positive Immune-active Chronic Hepatitis«/bi» - In patients who seroconvert on therapy, continue antiviral therapy indefinitely due to concerns with decompensation and death, unless there is a strong competing rationale for discontinuation. «bi»HBeAg-negative Immune-active Chronic Hepatitis«/bi» - Treatment discontinuation is not recommended due to potential for decompensation and death «bu»HIV-1 Infection«/bu» - 300 mg once daily (in combination with other antiretrovirals) - Tenofovir is a component of recommended initial regimens in treatment-naive patients (when coadministered with emtricitabine plus dolutegravir, with emtricitabine plus darunavir/ritonavir, or with emtricitabine plus raltegravir; lamivudine may be substituted for emtricitabine in any of these regimens) and is a component of a recommended initial regimen in treatment-naive patients with pre-ART CrCl >70 mL/minute (when coadministered with emtricitabine plus elvitegravir/cobicistat «bu»HIV-1 Nonoccupational Postexposure Prophylaxis (nPEP)«/bu» - 300 mg once daily for 28 days (in combination with other antiretroviral agents) - Initiate therapy within 72 hours of exposure - The fixed dose emtricitabine and tenofovir disoproxil fumarate combination product is recommended for these components of the 3-drug regimen «bu»HIV-1 Occupational Postexposure Prophylaxis (oPEP)«/bu» - 300 mg once daily in combination with emtricitabine and raltegravir - Initiate therapy as soon as possible after occupational exposure (and within 72 hours) and continue for 4 weeks. - The fixed dose emtricitabine and tenofovir disoproxil fumarate combination product is recommended for these components of the 3-drug regimen

Teplizumab

Tzield, Teplizumab-mzwv

Tepotinib

Tepmetko

«bu»Non–Small Cell Lung Cancer (NSCLC)«/bu» - 450 mg PO daily - Continue until disease progression or unacceptable toxicity «b»Missed Dose«/b» «bi»≥8 hr from Next Scheduled Dose«/bi» - Take as soon as possible «bi»<8 hr from Next Scheduled Dose«/bi» - Skip dose and take next dose at regular scheduled time «bi»Vomited Dose«/bi» - Skip dose and take next dose at regular scheduled time «b»Pregnancy«/b» - Verify pregnancy status in females of reproductive potential before initiating «b»Patient Selection«/b» - Select patients for treatment based on presence of METex14 skipping alterations in tumor biopsy specimen or plasma (if tumor biopsy cannot be obtained) - If alterations are undetected in plasma, re-evaluate the feasibility of tumor biopsy An FDA-approved test for detection of METex14 skipping alteration is not available «b»Dosage Modifications«/b» - Recommended dose reduction to manage adverse reactions: 225 mg PO daily - Permanently discontinue if unable to tolerate 225 mg PO daily «b»Interstitial Lung Disease (ILD) or Pneumonitis«/b» «bi»Suspected ILD (Any Grade)«/bi» - Withhold «bi»Confirmed ILD«/bi» - Permanently discontinue «b»Increased AST/ALT and/or Total Bilirubin«/b» «bi»Grade 3 Increased AST/ALT without Increased TB«/bi» - Withhold until recovery to baseline ALT/AST - If recovered to baseline ≤7 days, resume at same dose; otherwise, resume at a reduced dose «bi»Grade 3 Increased TB without Concurrent Increased AST/ALT«/bi» - Withhold until recovery to baseline total bilirubin - If recovered to baseline ≤7 days, resume at reduced dose; otherwise, permanently discontinue «bi»Permanently Discontinue«/bi» - Grade 4 increased ALT/AST without increased total bilirubin - ALT/AST >3x ULN with total bilirubin >2x ULN without cholestasis or hemolysis - Grade 4 increased total bilirubin without concurrent increased AST/ALT «b»Other Adverse Reactions«/b» «bi»Grade 2«/bi» - Maintain dose - If intolerable, consider withholding until resolved, then resume at reduced dose «bi»Grade 3«/bi» - Withhold until resolved, then resume at reduced dose «bi»Grade 4«/bi» - Permanently discontinue

Teprotumumab

Tepezza

Terazosin

Hytrin

Terbinafine

Terbinex, LamISIL

Terbinafine (Topical)

LamISIL AT, Athlete's Foot, LamISIL AT Jock Itch

Terbutaline

Brethaire, Brethine, Bricanyl

«b»IV Administration«/b» - Use infusion pump «b»Oral Administration«/b» - Administer around-the-clock to promote less variation in peak and trough serum levels «b»Inhalation Administration«/b» «bi»Bricanyl Turbuhaler«/bi» - After removing lid, patient should hold inhaler upright and turn blue grip as far as it will go in one direction then turn it back to original position. - Clicking sound indicates that inhaler is ready for use - Patient should exhale fully but not into the inhaler and then place mouthpiece gently between teeth, close lips around inhaler and inhale deeply - Inhaler should be removed from mouth prior to exhaling - Instruct patients to rinse mouth with water after each inhalation as some medication may stick to the inside of the mouth and throat - If inhaler is dropped or shaken, or if patient exhales into the inhaler after a dose is loaded, the dose will be lost and a new dose should be loaded and inhaled - Outside of mouthpiece should be cleaned once weekly with a dry tissue - Instruct patient to keep inhaler dry. First appearance of red mark in dose indicator (window underneath mouthpiece) indicates that 20 doses remain - When red mark reaches bottom of dose indicator no doses remain and Turbuhaler should be discarded. «b»Extravasation«/b» «bi»SC«/bi» Extravasation Management, Sympathomimetic Vasopressors - Stop vesicant infusion immediately and disconnect IV line (leave needle/cannula in place) - Gently aspirate extravasated solution from the IV line (do NOT flush the line); - Remove needle/cannula - Elevate extremity - Infiltrate extravasation area with terbutaline solution 1 mg diluted with 10 mL (large extravasation site) or 1 mg diluted in 1 mL (small/distal extravasation site) of 0.9% sodium chloride into extravasation site «bi»Extravasation Management«/bi» - Using vial for injection, dilute 1 mg in 10 mL (large extravasation site) or 1 mg in 1 mL (small/distal extravasation site) of 0.9% sodium chloride «b»Oral Suspension (1 mg/mL) Preparation«/b» - A 1 mg/mL oral suspension may be made with tablets. Crush twenty-four 5 mg tablets in a mortar and reduce to a fine powder - Add 5 mL purified water USP and mix to a uniform paste; mix while adding simple syrup, NF in incremental proportions to almost 120 mL; transfer to a calibrated bottle, rinse mortar with vehicle, and add quantity of simple syrup, NF sufficient to make 120 mL - Label "shake well" and "refrigerate" - Stable for 30 days.

Terconazole

Terazol, Zazole, Triaconazole, Terazol 3, Terazol 7

Teriflunomide

Aubagio

Teriparatide (Recombinant)

Forteo, Recombinant Human Parathyroid Hormone

Terlipressin

Terlivaz

Tesamorelin

Egrifta

Testosterone

Natesto, AndroGel, Shotest, Testim, Fortesta, Vogelxo, Striant, Androderm, Testopel, Axiron, Depo-Testosterone, Aveed, Jatenzo, Tlan

«bu»Breast Cancer«/bu» «b»Testosterone Enanthate«/b» - 200 to 400 mg IM every 2 to 4 weeks «bu»Delayed Puberty«/bu» «b»Testosterone Enanthate«/b» Males - 50 to 200 mg IM every 2 to 4 weeks for a limited duration (4 to 6 months) «b»SC Implantation Pellet«/b» Males - 150 to 450 mg every 3 to 6 months - Dosing is generally at the lower range for a limited duration (4 to 6 months) «bu»Hypogonadism«/bu» «b»Jatenzo«/b» «bi»Starting Dose«/bi» - 237 mg PO bid with food «bi»Maintenance Dose«/bi» - Measure serum testosterone concentrations 6 hr after morning dose in plain tubes, clotted at room temperature for 30 minutes prior to centrifugation - Adjust dose based on serum testosterone measurement - Wait 7 days after starting treatment or adjusting the dose before checking the serum testosterone concentration; thereafter, periodically monitor serum testosterone concentrations 6 hr after morning dose «bi»Adjust Dose Based on Testosterone Level«/bi» <425 ng/dL - Current bid dose 158 mg: Increase to 198 mg bid - Current bid dose 198 mg: Increase to 237 mg bid - Current bid dose 237 mg: Increase to 316 mg (two 158-mg cap) bid - Current bid dose 316 mg: Increase to 396 mg (two 198-mg cap) bid 425-970 ng/dL - No dose change >970 ng/dL - Current bid dose 396 mg: Decrease to 316 mg bid - Current bid dose 316 mg: Decrease to 237 mg bid - Current BID dose 237 mg: Decrease to 198 mg bid - Current bid dose 198 mg: Decrease to 158 mg bid - Current bid dose 158 mg: Discontinue treatment «b»Tlando«/b» «bi»Starting Dose«/bi» - 225 mg PO bid with food - Monitoring for continued use or discontinuation - Monitor serum testosterone (8-9 hr after morning dose) 3-4 weeks after initiating, and periodically thereafter «bi»Serum Testosterone Measurements«/bi» - Serum testosterone 300-1080 ng/dL: Continue - Serum testosterone <300 ng/dL: Discontinue - Serum testosterone >1080 ng/dL: Discontinue «b»Testosterone Enanthate or Testosterone Cypionate«/b» - 50 to 400 mg IM every 2 to 4 weeks - 75 to 100 mg/week IM or 150 to 200 mg IM every 2 weeks «b»Testosterone Undecanoate«/b» «bi»Initial Dose«/bi» - 750 mg IM x 1 dose THEN, - 750 mg IM administered 4 weeks later «bi»Maintenance Dose«/bi» - 750 mg IM administered every 10 weeks thereafter. «b»Testosterone Gel: Natesto«/b» - 11 mg (2 pump actuations; 1 actuation per nostril) intranasally 3 times daily (6 to 8 hours apart) - Total daily dose: 33 mg «bi»Less than Normal Range«/bi» - Consider alternative treatment if consistently <300 ng/mL «bi»Greater than Normal Range«/bi» - Discontinue if consistently >1050 ng/mL «b»Oral: (Andriol)«/b» «bi»Initial Dose«/bi» - 120 to 160 mg daily in 2 divided doses for 2 to 3 weeks «bi»Maintenance Dose«/bi» - Adjust according to individual response and/or testosterone levels - Usual maintenance dose: 40 to 120 mg daily (in divided doses) «b»Pellet (SC Implantation)«/b» - 150 to 450 mg every 3 to 6 months «b»Topical«/b» «bi»Buccal«/bi» - 30 mg twice daily (every 12 hours) applied to the gum region above the incisor tooth - Discontinue if serum testosterone concentrations are consistently outside of the normal range. «b»AndroGel 1%«/b» - 50 mg applied once daily in the morning to the shoulder and upper arms, or abdomen. Dosage range: 50 to 100 mg daily. «bi»Less than Normal Range«/bi» - Increase dose from 50 mg to 75 mg or from 75 mg to 100 mg once daily «bi»Greater than Normal Range«/bi» - Decrease dose - Discontinue if consistently above normal at 50 mg daily «b»AndroGel 1.62%«/b» - 40.5 mg applied once daily in the morning to the shoulder and upper arms - Dosage Range: 20.25 mg to 81 mg daily - Maximum Dose: 81 mg/day. >750 ng/dL - Decrease dose by 20.25 mg daily ≥350 ng/dL to ≤750 ng/dL - Maintain current dose <350 ng/dL - Increase dose by 20.25 mg daily «b»Fortesta«/b» - 40 mg once daily in the morning. Apply to the thighs - Dosing range: 10 to 70 mg daily - Maximum Dose: 70 mg/day «bi»Dose Adjustment Based on Serum Testosterone Levels«/bi» - ≥2500 ng/dL: Decrease dose by 20 mg daily - ≥1250 to <2500 ng/dL: Decrease dose by 10 mg daily - ≥500 and <1250 ng/dL: Maintain current dose - <500 ng/dL: Increase dose by 10 mg daily «b»Testim«/b» - 50 mg applied once daily (preferably in the morning) to the shoulder and upper arms - If testosterone concentrations are less than the normal range, dosage may be increased from 50 mg to 100 mg once daily; maximum: 100 mg/day. «b»Vogelxo«/b» - 50 mg applied once daily to the shoulder and/or upper arms - Dosage may be increased to a maximum of 100 mg/day «bi»Dose Adjustment Based on Testosterone Levels«/bi» - Less than normal range: Increase dose from 50 mg to 100 mg once daily «b»Axiron Solution«/b» - 60 mg once daily (dosage range: 30 to 120 mg daily) - Apply to the axilla at the same time each morning «bi»Dose Adjustment Based on Serum Testosterone Levels«/bi» >1050 ng/dL - Decrease 60 mg daily dose to 30 mg daily - if levels >1050 ng/dL persist after dose reduction, discontinue therapy <300 ng/dL - Increase 60 mg daily dose to 90 mg daily, or increase 90 mg daily dose to 120 mg daily «b»Androderm Transdermal System«/b» «bi»Initial Dose«/bi» - 4 mg TD daily (as one 4 mg/day patch; do not use two 2 mg/day patches) «bi»Dose Adjustment Based on Testosterone Levels«/bi» >930 ng/dL - Decrease dose to 2 mg daily 400 to 930 ng/dL - Continue 4 mg daily <400 ng/dL - Increase dose to 6 mg daily(as one 4 mg/day and one 2 mg/day patch) «b»Dosing Conversion«/b» - The 2.5 mg/day and the 5 mg/day patches have been discontinued in the US; atients may be switched from the 2.5 mg/day patch, 5 mg/day patch, or the combination (ie, 7.5 mg/day) as follows: - From 2.5 mg/day patch to 2 mg/day patch - From 5 mg/day patch to 4 mg/day patch - From 7.5 mg daily (one 2.5 mg/day and one 5 mg/day patch) to 6 mg daily (one 2 mg/day and one 4 mg/day patch) - Patch change should occur at the next scheduled dosing - Measure early morning testosterone concentrations ~2 weeks after switching therapy. «b»IM Administration«/b» - Administer by deep IM injection into the gluteal muscle. «bi»Testosterone Undecanoate«/bi» - Inject into the gluteus medius - Alternate injection between left and right buttock - Avoid intravascular injection, may lead to pulmonary oil microembolism - Avoid the superior gluteal arteries and sciatic nerve «b»Intranasal Gel (Natesto)«/b» - Administer intranasally 3 times daily, 6 to 8 hours apart, preferably at the same time each day - Prime pump prior to first use by inverting then depressing pump 10 times (discard this portion of product into sink) - Blow nose prior to application - To administer the dose, insert actuator into nostril until pump reaches base of nose; tilt so the tip is in contact with the lateral wall of nostril - Depress slowly until pump stops, then remove from nose while wiping tip to transfer gel to lateral side of nostril - Following administration, press on the nostrils at a point just below the bridge of the nose and lightly massage - Refrain from blowing nose or sniffing for 1 hour after administration - If gel gets on hands, wash with warm soap and water - Temporarily discontinue with episodes of severe rhinitis; if severe rhinitis symptoms persist consider an alternative therapy. «b»Oral, Buccal Application (Striant)«/b» - One mucoadhesive for buccal application (buccal system) should be applied to a comfortable area above the incisor tooth twice daily - Gently push the curved side against the upper gum - Hold buccal system firmly in place by pushing down on outside of the upper lip for 30 seconds to ensure adhesion - The buccal system should adhere to gum until it is removed - Rotate to alternate sides of mouth with each application - If the buccal system falls out, replace with a new system - If the system falls out within the first 8 hours of dosing, replace with a new buccal system and continue for a total of 12 hours from the placement of the first system - If the system falls out of position after 8 hours of dosing, a new buccal system should be applied and it may remain in place for 12 hours, then continue with the next regularly scheduled dosing - System will soften and mold to shape of gum as it absorbs moisture from mouth - Do not chew or swallow the buccal system - The buccal system will not dissolve; gently remove by sliding downwards from gum; avoid scratching gum - Remove prior to routine morning and evening oral care, prior to application of new system. «b»Oral Capsule (Andriol)«/b» - Administer with meals - Should be swallowed whole - Do not crush or chew. «b»Subcutaneous Implant (Testopel)«/b» - Using strict sterile technique, must be surgically implanted. «b»Transdermal Patch (Androderm)«/b» - Apply to skin immediately upon removal from the protective pouch. Apply at the same time each night to clean, dry area of skin on the back, abdomen, upper arms, or thigh - Do not apply to bony areas or parts of the body that are subject to prolonged pressure while sleeping or sitting - Do not apply to oily, damaged or irritated skin - Do not apply to the scrotum. Rotate administration sites, allowing 7 days between applying to the same site - Avoid showering, washing the site, or swimming for ≥3 hours after application - Following patch removal, mild skin irritation may be treated with OTC hydrocortisone cream - A small amount of triamcinolone acetonide 0.1% cream may be applied under the system to decrease irritation; do not use ointment (triamcinolone ointment decreases testosterone absorption) - Dispose of any used or unused patches by folding adhesive ends together, replace in pouch or sealed container and discard properly in trash away from children and pets. «b»Topical Gel and Solution«/b» - Alcohol-based gels and solutions are flammable; avoid fire, flames, or smoking until dry - Testosterone may be transferred to another person following skin-to-skin contact with the application site - Strict adherence to application instructions is needed in order to decrease secondary exposure - Thoroughly wash hands after application and cover application site with clothing (ie, shirt) once gel or solution has dried, or clean application site thoroughly with soap and water prior to contact in order to minimize transfer - In addition to skin-to-skin contact, secondary exposure has also been reported following exposure to secondary items (eg, towel, shirt, sheets) - If secondary exposure occurs, the other person should thoroughly wash the skin with soap and water as soon as possible - The application sites and doses of these products are not interchangeable. «bi»AndroGel 1%«/bi» - Apply at the same time each morning to clean, dry, intact skin to an area of the shoulder, upper arms, and/or abdomen that will be covered by a short sleeve t-shirt - Do not apply to other parts of the body such as the genitals, chest, back, axillae, or knees. Upon opening the packet(s), the entire contents should be squeezed into the palm of the hand and immediately applied to the application site(s) - Alternatively, a portion may be squeezed onto palm of hand and applied, repeating the process at the same or other site until entire packet has been applied - Avoid swimming, showering or washing the application site for ≥5 hours following application - Cover application site with clothing (eg t-shirt) once the gel has dried. When using the multidose pump, prime pump 3 times (and discard this portion of product) prior to initial use. Each actuation delivers 12.5 mg of testosterone (4 actuations = 50 mg; 6 actuations = 75 mg; 8 actuations = 100 mg) - When using the pump, the gel may be delivered into the palm of the hand prior to application or applied directly to the application site. «bi»AndroGel 1.62%«/bi» - Apply at the same time each morning to clean, dry, intact skin to an area of the shoulder and upper arms that will be covered by a short sleeve t-shirt - Do not apply to other parts of the body such as the abdomen, genitals, chest, axillae, or knees. Upon opening the packet(s), the entire contents should be squeezed into the palm of the hand and immediately applied to the application site(s). Alternatively, a portion may be squeezed onto palm of hand and applied, repeating the process at the same or other site until entire packet has been applied. Avoid swimming, showering or washing the application site for ≥2 hours following application. Cover application site with clothing (eg t-shirt) once the gel has dried. When using the multidose pump, prime pump 3 times (and discard this portion of product) prior to initial use. Each actuation delivers 20.25 mg of testosterone (2 actuations = 40.5 mg; 3 actuations = 60.75 mg; 4 actuations = 81 mg). When using the pump, the gel may be delivered into the palm of the hand prior to application or applied directly to the application site. «bi»Axiron«/bi» - Apply using the applicator to clean, dry, intact skin on an area of the axilla at the same time each morning. Do not apply to other parts of the body (eg, abdomen, genitals, shoulders, upper arms). Avoid washing the site or swimming for 2 hours after application. Prior to first use, prime the applicator pump by depressing it 3 times (discard this portion of the product). After priming, position the nozzle over the applicator cup and depress pump fully one time; ensure liquid enters cup. Each pump actuation delivers testosterone 30 mg. No more than 30 mg (one pump) should be added to the cup at one time. The total dose should be divided between axilla (example, 30 mg/day: apply to one axilla only; 60 mg/day: apply 30 mg to each axilla; 90 mg/day: apply 30 mg to each axilla, allow to dry, then apply an additional 30 mg to one axilla; etc). To apply dose, keep applicator upright and wipe into the axilla; if solution runs or drips, use cup to wipe. Do not rub into skin with fingers or hand. If more than one 30 mg dose is needed, repeat process. Apply roll-on or stick antiperspirants or deodorants prior to testosterone. Once application site is dry, cover with clothing. After use, rinse applicator under running water and pat dry with a tissue. «bi»Fortesta«/bi» - Apply to clean dry intact skin once daily in the morning to skin of front and inner thighs. Do not apply to genitals or other parts of the body. Use one finger to rub gel evenly onto skin of each thigh. Avoid showering, washing the site, or swimming for ≥2 hours after application. Prior to first dose, prime the pump by holding canister upright and fully depressing the pump 8 times (discard this portion of the product). Each pump actuation delivers testosterone 10 mg. The total dose should be divided between thighs (example, 10 mg/day: apply 10 mg to one thigh only; 20 mg/day: apply 10 mg to each thigh; 30 mg/day: apply 20 mg to one thigh and 10 mg to the other thigh; etc). Once application site is dry, cover with clothing. «bi»Testim«/bi» - Apply once daily (preferably in the morning) to clean, dry, intact skin to an area of the shoulder and upper arms that will be covered by a short sleeve t-shirt. Do not apply to the genitals or abdomen. Upon opening the tube, the entire contents should be squeezed into the palm of the hand and immediately applied to the application site(s). Avoid swimming, showering or washing the application site for ≥2 hours following application. Cover application site with clothing (eg t-shirt) once the gel has dried. «bi»Vogelxo«/bi» - Apply once daily at the same time each morning to clean dry intact skin to an area of the shoulder and upper arms that will be covered by a short sleeve t-shirt. Do not apply to the genitals or to the abdomen. Upon opening the tube or packet, the entire contents should be squeezed into the palm of the hand and immediately applied to the application site(s). If two doses (testosterone 100 mg) are needed, apply one dose (50 mg) to upper arm and or/shoulder, then apply the second dose (50 mg) to the opposite upper arm and/or shoulder. Avoid showering, washing the site, or swimming for at least 2 hours following application. Cover application site with clothing (eg t-shirt) once the gel has dried. When using the multidose pump, prime pump 3 times by fully depressing the pump mechanism (actuation) and discard this portion of product. Each actuation delivers testosterone 12.5 mg (4 actuations = 50 mg; 8 actuations = 100 mg). «b»Injection«/b» «bi»Testosterone Enanthate, Testosterone Cypionate«/bi» - Warm and rotate vial between palms of hands to redissolve crystals that have formed after storage. «bi»Testosterone Undecanoate«/bi» - Inject 3 mL of air through the gray rubber stopper into the vial to create positive pressure, and then withdraw 3 mL of solution (750 mg) from the vial. Expel any air bubbles from the syringe and change the syringe needle to a new IM needle. Discard unused portion.

Tetanus Diphtheria

Tenivac, Td, Diphtheria-Tetanus Toxoids

Tetanus Immune Globulin (Human)

Hyper Tet, HyperTET S/D, TIG

Tetanus Toxoid Adsorbed

Tetanus Toxoid (Adsorbed)

«b»IM Administration«/b» - Inject intramuscularly in the area of the vastus lateralis (midthigh laterally) or deltoid - Do not inject into gluteal area - Shake well prior to withdrawing dose; do not use if product does not form a suspension. - For patients at risk of hemorrhage following intramuscular injection, the ACIP recommends “it should be administered intramuscularly if, in the opinion of the physician familiar with the patient's bleeding risk, the vaccine can be administered by this route with reasonable safety - If the patient receives antihemophilia or other similar therapy, intramuscular vaccination can be scheduled shortly after such therapy is administered. - A fine needle (23 gauge or smaller) can be used for the vaccination and firm pressure applied to the site (without rubbing) for at least 2 minutes. - The patient should be instructed concerning the risk of hematoma from the injection.” - Patients on anticoagulant therapy should be considered to have the same bleeding risks and treated as those with clotting factor disorders - Simultaneous administration of vaccines helps ensure the patients will be fully vaccinated by the appropriate age. - Simultaneous administration of vaccines is defined as administering >1 vaccine on the same day at different anatomic sites. - The use of licensed combination vaccines is generally preferred over separate injections of the equivalent components. - Separate vaccines should not be combined in the same syringe unless indicated by product specific labeling. - Separate needles and syringes should be used for each injection. - The ACIP prefers each dose of a specific vaccine in a series come from the same manufacturer when possible. - Adolescents and adults should be vaccinated while seated or lying down. - In general, preterm infants should be vaccinated at the same chronological age as full-term infants. - Antipyretics have not been shown to prevent febrile seizures. Antipyretics may be used to treat fever or discomfort following vaccination. - One study reported that routine prophylactic administration of acetaminophen to prevent fever prior to vaccination decreased the immune response of some vaccines; the clinical significance of this reduction in immune response has not been established.

Tetanus-Diphtheria-Acellular Pertussis Vaccine

Adacel, Daptacel, Infanrix, Tdap, DTaP, Tetanus-Diphtheria-Acellular Pertussis Vaccine

- Tdap can be administered regardless of the interval between the last tetanus or diphtheria toxoid containing vaccine - Tdap is currently recommended for a single dose only, except pregnant females who should receive a Tdap dose during each pregnancy (preferably during the early part of 27 and 36 weeks’ gestation) «bu»Booster Immunization«/bu» «b»Adults ≥19 years«/b» - 0.5 mL per IM x 1 dose - A single dose of Tdap should be given to replace a single dose of the 10 year Td booster in patients who have not previously received Tdap or for whom vaccine status is not known. - A single dose of Tdap is recommended for health care personnel who have not previously received Tdap and who have direct patient contact - Tdap should be administered regardless of interval since last tetanus- or diphtheria-containing vaccine «b»Adults (Adacel [≤64 years], Boostrix)«/b» - 0.5 mL IM x 1 dose - Administered 5 years after last dose of tetanus toxoid, diphtheria toxoid, and/or pertussis-containing vaccine «bu»Tetanus Prophylaxis in Wound Management«/bu» - Adacel or Boostrix may be used as an alternative to Td vaccine when a tetanus toxoid-containing vaccine is needed for wound management, and in whom the pertussis component is also indicated - Tetanus prophylaxis in patients with wounds should be based on if the wound is clean or contaminated, the immunization status of the patient - Wound management includes proper use of tetanus toxoid and/or tetanus immune globulin (TIG), wound cleaning, and (if required) surgical debridement and the proper use of antibiotics. - Patients with an uncertain or incomplete tetanus immunization status should have additional follow up to ensure a series is completed - Patients with a history of Arthus reaction following a previous dose of a tetanus toxoid-containing vaccine should not receive a tetanus toxoid-containing vaccine until >10 years after the most recent dose even if they have a wound that is neither clean nor minor

Tetrabenazine

Xenazine

Tetracaine (Ophthalmic)

Altacaine, TetraVisc, Tetcaine, AK-T-Caine

Tetracycline

Achromycin, TCN, Ala-Tet

«b»Usual Dosage Range«/b» - 250 to 500 mg every 6 to 12 hours «bu»Acne Vulgaris«/bu» - Initial Dose: 1 g daily in divided doses - Reduce gradually to 125 to 500 mg/day once improvement is noted - The shortest possible duration should be used to minimize development of bacterial resistance; re-evaluate at 3 to 4 months «bu»Helicobacter Pylori Eradication«/bu» «b»Bismuth Quadruple Regimen«/b» - 500 mg PO qid, in combination with standard-dose proton pump inhibitor twice daily, metronidazole 250 mg 4 times daily or 500 mg 3 or 4 times daily, and either bismuth subcitrate 120 to 300 mg 4 times daily or bismuth subsalicylate 300 mg 4 times daily; continue regimen for 10 to 14 days. «bu»Severe Malaria Treatment«/bu» - 250 mg PO qid for 7 days with quinidine gluconate - Quinidine gluconate duration is region specific - Consult CDC for current recommendations «bu»Uncomplicated Malaria Treatment«/bu» - 250 mg PO qid for 7 days with quinine sulfate - Quinine sulfate duration is region specific - Consult CDC for current recommendations «bu»Periodontitis«/bu» - 250 mg PO every 6 hours until improvement (usually 10 days) «bu»Syphilis«/bu» «b»Penicillin-allergy«/b» - 500 mg PO qid «b»Early Syphilis (Primary or Secondary«/b» - 500 mg PO qid for 14 days «b»Latent Syphilis«/b» - 500 mg PO qid for 28 days «bu»Tularemia«/bu» «b»Mild to Moderate«/b» - 500 mg PO qid for at least 14 days «bu»Chronic Bronchitis«/bu» «b»Acute Exacerbation«/b» - 500 mg PO every 12 hr or - 250 mg PO every 6 hr - 500 mg PO every 6 hr may be required for severe infections or for those infections which do not respond to the smaller doses «bu»Brucellosis«/bu» - 500 mg PO every 6 hr for 3 weeks accompanied by streptomycin, 1 g IM bid for the first week, then, daily the second week «bu»Gonorrhea«/bu» - 500 mg PO every 6 hr for 7 days «bu»Uncomplicated Urethral, Endocervical or Rectal Infections«/bu» - Infections in adults caused by Chlamydia Trachomatis - 500 mg PO every 6 hr for at least seven days «bu»Vibrio Cholerae«/bu» - 500 mg qid for 3 days

Tetrahydrozoline (Nasal)

Tyzine, Tetryzoline

Tetrahydrozoline (Ophthalmic)

Clarif-Eye, Visine, Opti-Clear, Tetryzoline

Tezacaftor-Ivacaftor

Symdeko

Tezepelumab

Tezspire

Thalidomide

Thalomid

«bu»Erythema Nodosum Leprosum, Acute Cutaneous«/bu» - Initial Dose: 100 to 300 mg once daily at bedtime - Continue until signs/symptoms subside (usually ~2 weeks), then taper off in 50 mg decrements every 2 to 4 weeks - For severe cases with moderate to severe neuritis, corticosteroids may be initiated with thalidomide (taper off and discontinue corticosteroids when neuritis improves) - Maintain on the minimum dosage necessary to control the reaction - Efforts to taper off should be attempted every 3 to 6 months, in decrements of 50 mg every 2 to 4 weeks. «b»Weighing <50 kg«/b» - Initiate at lower end of the dosing range «b»Severe Cutaneous Reaction or Patients Previously Requiring High Doses«/b» - May be initiated at up to 400 mg once daily at bedtime or in divided doses «bu»Multiple Myeloma«/bu» «b»Newly Diagnosed«/b» - 200 mg once daily at bedtime (in combination with dexamethasone) «b»Multiple Myeloma Off-label Dosing or Combinations«/b» «bi»Combination with Bortezomib and Dexamethasone«/bi» - Induction Therapy: 100 mg once daily for the first 14 days, then, - 200 mg once daily for 3 (21-day) cycles or 100 mg once daily for up to 8 (21-day) cycles «bi»Combination with Melphalan and Prednisone«/bi» - 200 to 400 mg once daily or - 100 mg once daily or - 50 to 100 mg once daily, depending on patient tolerance «b»Maintenance Dose«/b» - Following autologous stem cell transplant - 200 mg once daily starting 3 to 6 months after transplant - Continue until disease progression or unacceptable toxicity or - 100 mg once daily starting 42 to 60 days following transplant - Increase to 200 mg once daily after 2 weeks if tolerated; continue for up to 12 months (in combination with prednisolone) «b»Salvage Therapy«/b» - Initial Dose: 200 mg once daily at bedtime - May increase daily dose by 200 mg every 2 weeks for 6 weeks (if tolerated) to a maximum of 800 mg once daily at bedtime or - 100 mg once daily (in combination with dexamethasone) or - 200 mg once daily (in combination with bortezomib and dexamethasone) for 1 year or - 400 mg once daily at bedtime (in combination with dexamethasone, cisplatin, doxorubicin, cyclophosphamide and etoposide) «b»Dosage Modifications«/b» «bi»Constipation, Oversedation«/bi» - Temporarily withhold or continue with a reduced dose «bi»Peripheral Neuropathy«/bi» - The manufacturer recommends to temporarily withhold or continue with a reduced dose. The follow adjustments have also been recommended - Grade 1: Reduce dose by 50% - Grade 2: Temporarily interrupt therapy; once resolved to ≤ grade 1, resume therapy with a 50% dosage reduction (if clinically appropriate) - Grade 3 or higher: Discontinue therapy «bu»AIDS-related Aphthous Stomatitis«/bu» - 200 mg PO daily at bedtime for up to 8 weeks, if no response, then, - 200 mg bid for 4 weeks «bu»Chronic Graft-versus-Host Disease (cGVHD)«/bu» «b»Refractory Treatment«/b» - Initial Dose: 100 mg once daily at bedtime, with dose escalation up to 400 mg daily in 3 to 4 divided doses or - Initial Dose: 50 to 100 mg tid - Maximum Dose: 600 to 1,200 mg daily or 200 mg 4 times daily (dose adjusted to goal thalidomide concentration of ≥5 mcg/mL 2 hours postdose) or 100 to 300 mg qid «bu»Systemic Light Chain Amyloidosis«/bu» - 200 mg PO daily (starting dose 50 to 100 mg once daily - Titrate at 4-week intervals) in combination with cyclophosphamide and dexamethasone «bu»Uremic Pruritus«/bu» «b»Refractory«/b» - 100 mg PO daily at bedtime «bu»Waldenström Macroglobulinemia«/bu» - ≤200 mg once daily for up to 52 weeks (in combination with rituximab) «b»ANC ≤750/mm3«/b» - Withhold treatment if clinically appropriate «b»Grade 3 or 4 Adverse Reactions«/b» - Consider dose reduction, delay or discontinuation (based on clinical judgment).

Theophylline

Theo-250, Theo-24, Elixophyllin, Uniphyl, Theochron, Aminophylline

«b»Theophylline Dosing«/b» - All dosages expressed as aminophylline - Use ideal body weight to calculate dose - Individualize dose based on steady-state serum concentrations - Theophylline dose is ~79% of aminophylline dose. «bu»Acute Bronchospasm«/bu» «b»Loading Dose«/b» - Patients not currently taking theophylline: 5-7 mg/kg IV/PO; not to exceed 25 mg/min «bi»Aminophylline«/bi» - 6-7 mg/kg IV infused over 20 minutes «b»Maintenance Dose«/b» - 0.4-0.6 mg/kg/hr IV to maintain levels 10-15 mg/L - 4.8-7.2 mg/kg PO (extended release) every 12 hr to maintain levels 10-15 mg/L «b»Smokers«/b» - 0.79 mg/kg/hr IV for next 12 hours after loading dose, then, - 0.63 mg/kg/hr or 5 mg/kg ER PO every 8 hr «b»Drugs Decrease Theophylline Clearance«/b» «bi»Cimetidine, Ciprofloxacin, and Erythromycin and Other Macrolides«/bi» - 0.2-0.3 mg/kg/hr IV/PO ER every 12-24hr «b»Congestive Heart Failure (CHF)«/b» - 0.39 mg/kg/hr IV for next 12 hours after loading dose, then, - 0.08-0.16 mg/kg/hr «b»Dosing Considerations«/b» - For PO loading, use Theophylline IR - If patient is already taking theophylline, give smaller loading dose - Use IBW to calculate dose - 1 mg/kg results in 2 mg/L (34.4 mmol/L) increase in serum theophylline «b»Therapeutic Range«/b» - 10-20 mg/L (172-344 mmol/L) «b»Aminophylline«/b» - All dosages expressed as aminophylline; use IBW (theophylline distributes poorly into body fat) to calculate dose; individualize dose based on steady-state serum concentrations - If administering aminophylline, increase dose by 25% (aminophylline is approximately 79-86% theophylline) - Treatment of asthma and acute COPD exacerbations with aminophylline is not recommended by current clinical practice guidelines «bu»Reversible Airflow Obstruction, Acute Symptoms«/bu» «b»Loading Dose (IV)«/b» (Desired Serum Theophylline Concentration - Measured Serum Theophylline Concentration) (Vd) Patients who have not received aminophylline or theophylline in the previous 24 hours: 5.7 mg/kg. Patients who have received aminophylline or theophylline in the previous 24 hours: - A loading dose should not be given before obtaining a serum theophylline concentration. «b»Maintenance Dose (IV)«/b» - Dosing presented is to achieve a target theophylline concentration of 10 mcg/mL. - Lower initial doses may be required in patients with reduced theophylline clearance - Dosage should be adjusted according to serum level measurements. «bi»Adults ≤60 years«/bi» - 0.51 mg/kg/hour - Maximum Dose: 1,139 mg/day unless serum levels indicate need for larger dose. «bi»Adults >60 years«/bi» - 0.38 mg/kg/hour - Maximum Dose: 507 mg/day unless serum levels indicate need for larger dose. «b»Cardiac Decompensation Cor Pulmonale, Sepsis with Multiorgan Failure, and Shock«/b» - 0.25 mg/kg/hour - Maximum Dose: 507 mg/day unless serum levels indicate need for larger dose. «b»Dosage Adjustment Based on Serum Theophylline Concentrations«/b» - Recheck serum theophylline concentration 24 hours after dosage adjustment. «bi»<9.9 mcg/mL«/bi» - If dosage is tolerated, but symptoms are not controlled, increase infusion rate ~25%. «bi»10 to 14.9 mcg/mL«/bi» - Maintain infusion rate if dosage is tolerated and symptoms controlled - Recheck serum concentrations at 24-hour intervals - If symptoms are not controlled and dosage is tolerated, consider adding additional medications to treatment regimen. «bi»15 to 19.9 mcg/mL«/bi» - Consider 10% dose reduction in infusion rate to improve safety margin even if dose is tolerated. «bi»20 to 24.9 mcg/mL«/bi» - Decrease infusion rate by 25% even if no adverse effects present. «bi»25 to 30 mcg/mL«/bi» - Stop infusion for 24 hours and decrease subsequent infusion rate at least 25% - If symptomatic, stop infusion and consider whether overdose treatment is indicated. «bi»>30 mcg/mL«/bi» - Stop infusion and treat overdose; if resumed, decrease subsequent infusion rate at least 50%. «bu»Reversal of Adenosine-, Dipyridamole-, or Regadenoson-induced Adverse Reactions (angina, hypotension) During Nuclear Cardiac Stress Testing«/bu» - 50 to 250 mg IV over 30 to 60 seconds - Repeat as necessary - Since adenosine-induced side effects are short lived after discontinuation of the infusion, aminophylline administration is only very rarely required «bu»Acute Bronchospasm«/bu» «b»Loading Dose«/b» - No theophylline administered in previous 24 hours: 5-7 mg/kg IV/PO - IV infused over 20-30 minutes «b»Maintenance Dose«/b» «bi»1.5-6 months«/bi» - 0.5 mg/kg/hr IV or 10 mg/kg/day PO in divided doses «bi»6-12 months«/bi» - 0.6-0.7 mg/kg/hr IV or 12-18 mg/kg/day PO in divided doses «bi»1-9 years«/bi» - 1 mg/kg/hr IV or 8 mg/kg PO (extended release) every 8 hr «bi»9-12 years«/bi» - 0.8-0.9 mg/kg/hr IV or 6.4 mg/kg PO (extended release) every 8 hr «bi»12-16 years«/bi» - 0.7 mg/kg/hr IV or 5.6 mg/kg PO (extended release) every 8 hr «bu»Neonatal Apnea«/bu» «b»Loading Dose«/b» - 4-5 mg/kg PO/IV once «b»Maintenance Dose«/b» - 3-6 mg/kg/day PO/IV divided every 8 hr «b»Dosing Considerations«/b» - If administering aminophylline, increase dose by 20-25% (aminophylline is approximately 79-86% theophylline) - Use ideal body weight to calculate dose - 1 mg/kg results in 2 mg/L (34.4 mmol/L) increase in serum theophylline «bu»Reversible Airflow Obstruction, Acute Symptoms«/bu» «b»Loading Dose«/b» - IV: Refer to adult dosing. «b»Maintenance Dose«/b» IV - Dosing presented is to achieve a target theophylline concentration of 10 mcg/mL unless otherwise noted - Lower initial doses may be required in patients with reduced theophylline clearance - Dosage should be adjusted according to serum level measurements. «bi»Infants 4 to 6 weeks«/bi» - 1.9 mg/kg/dose every 12 hours (to achieve a target concentration of 7.5 mcg/mL for neonatal apnea). «bi»Infants 6 to 52 weeks«/bi» - Dose (mg/kg/hour) = [(0.008 x age in weeks) + 0.21] divided by 0.79 «bi»Children 1 to <9 years«/bi» - 1.01 mg/kg/hour «bi»Children 9 to <12 years«/bi» - 0.89 mg/kg/hour «bi»Adolescents 12 to <16 years«/bi» Cigarette or Marijuana Smokers - 0.89 mg/kg/hour Nonsmokers - 0.63 mg/kg/hour - Maximum Dose: 1,139 mg/day unless serum levels indicate need for larger dose «bi»Adolescents ≥16 years«/bi» - Refer to adult dosing «b»Cardiac Decompensation, Cor Pulmonale, Sepsis with Multiorgan Failure, and Shock«/b» - Refer to adult dosing - Dosage adjustment based on serum theophylline concentrations - Recheck serum theophylline concentration 12 hours after dosage adjustment. «bi»<9.9 mcg/mL«/bi» - If dosage is tolerated, but symptoms are not controlled, increase infusion rate ~25%. «bi»10 to 14.9 mcg/mL«/bi» - Maintain infusion rate if dosage is tolerated and symptoms controlled - Recheck serum concentrations at 24-hour intervals - If symptoms are not controlled and dosage is tolerated, consider adding additional medications to treatment regimen. «bi»15 to 19.9 mcg/mL«/bi» - Consider 10% dose reduction in infusion rate to improve safety margin even if dose is tolerated. «bi»20 to 24.9 mcg/mL«/bi» - Decrease infusion rate by 25% even if no adverse effects present. «bi»25 to 30 mcg/mL«/bi» - Stop infusion for 12 hours and decrease subsequent infusion rate at least 25% - If symptomatic, stop infusion and consider whether overdose treatment is indicated. «bi»>30 mcg/mL«/bi» - Stop infusion and treat overdose; if resumed, decrease subsequent infusion rate at least 50%. «b»IV Administration«/b» - For IV administration only - Loading doses should be administered IV over 30 minutes. «bi»Infusion Rate«/bi» - Infusion rate should not exceed 21 mg/hour in patients with cor pulmonale, cardiac decompensation, hepatic impairment, patients >60 years, or patients taking medications which reduce theophylline clearance. «bi»Off-label Use«/bi» - For reversal of adenosine-, dipyridamole-, or regadenoson-induced adverse events during nuclear cardiac stress testing, administer IV undiluted over 30 to 60 seconds, repeat as necessary - Since adenosine-induced side effects are short lived after discontinuation of the infusion, aminophylline administration is only very rarely required «bi»Loading Dose«/bi» - Administer loading dose over 30 minutes - Follow with a continuous infusion as appropriate - For patients with cor pulmonale, cardiac decompensation, hepatic impairment, the elderly or patients taking drugs that reduce theophylline clearance, the maximum infusion rate should not exceed 17 mg/hour unless patient continues to be symptomatic, steady state serum concentrations is <10 mcg/mL, and serum concentrations can be monitored at 24-hour intervals - Do not administer solutions containing dextrose simultaneously through the same administration set as blood, as this may result in pseudoagglutination or hemolysis «b»Vesicant«/b» - Ensure proper needle or catheter placement prior to and during IV infusion - Avoid extravasation «b»Extravasation Management«/b» - If extravasation occurs, stop infusion immediately and disconnect (leave needle/cannula in place) - Gently aspirate extravasated solution (do NOT flush the line) - Initiate hyaluronidase antidote - Remove needle/cannula; apply dry cold compresses - Elevate extremity. «bi»Hyaluronidase: Intradermal or SC«/bi» - Inject a total of 1 mL (15 units/mL) as five separate 0.2 mL injections (using a 25-gauge needle) into area of extravasation at the leading edge in a clockwise manner «b»Oral Extended Release«/b» - Administer consistently with or without food (to maintain a consistent drug level) - Do not chew or crush tablets - May split tablet if scored - An intact matrix tablet may pass in stool. «bi»12-hour Formulation«/bi» - May be administered as once daily dosing in non-smokers (with appropriate total body clearance) and patients with low dosage requirements; consider only after titrated to therapeutic levels - Base once-daily dosing on the twice daily dosing and initiate at the end of the last every 12-hour dosing interval - Once-daily dosing should not be administered at night (after the evening meal). «bi»24-hour Formulation«/bi» - Administer each morning at approximately the same time; avoid administration at night (after the evening meal) - Patients who require a high dose (≥900 mg or 13 mg/kg, whichever is less), should take medication less than 1 hour before a high-fat meal (significant increase in peak serum level and absorption may occur) - Patients should consistently take theophylline with food or in fasting state. - Twice daily dosing may be considered in patients who metabolize theophylline rapidly (younger patients, smokers, and some nonsmoking adults) and who have symptoms at the end of a dosing interval; administer one dose in the morning and the second dose 10 to 12 hours later (but before the evening meal); avoid administration at night (after the evening meal) «b»Oral Suspension (5 mg/mL) Preparation«/b» - A 5 mg/mL oral suspension may be made with tablets - Crush one 300 mg extended release tablet in a mortar and reduce to a fine powder. - Add small portions of a 1:1 mixture of Ora-Sweet® and Ora-Plus® and mix to a uniform paste; mix while adding the vehicle in equal proportions to almost 60 mL; transfer to a calibrated bottle, rinse mortar with vehicle, and add sufficient quantity of vehicle to make 60 mL - Label "shake well" - Stable for 90 days at room temperature.

Thiamine

Vitamin B1

Thioguanine

Tabloid, 6TG, 6Thioguanine

Thioridazine

Mellaril

Thiotepa

Tepadina, Thioplex, Triethylenethiophosphoramide, TSPA, tespa

«b»Premedications«/b» - In children, thiotepa is associated with a high emetic potential at doses ≥300 mg/m2 and is associated with a moderate emetic potential (depending on dose/indication) in adults - Antiemetics may be recommended to prevent nausea and vomiting. «b»IV Administration«/b» - Administer over 3 hours via a central line (when administering as part of the preparative regimen for hematopoietic stem cell transplantation in class 3 beta-thalassemia) - Infusion times may vary by protocol or dose for off-label uses; refer to specific protocols - Filtering does not alter thiotepa potency «bi»Tepadina«/bi» - Administer using a 0.2 micron in-line filter; flush line prior to and after infusion with ~5 mL NS. «b»Intrathecal Administration«/b» - Off-label use/route - Administer in 10 mL (preservative free) buffered solutions «b»Tepadina Reconstitution«/b» - Reconstitute each 15 mg vial with 1.5 mL SWFI, or each 100 mg vial with 10 mL SWFI, to a concentration of 10 mg/mL - Gently mix by repeated inversions - Solution may be clear or opalescent; do not use if particulate matter is present. - Further dilute reconstituted solution for IV infusion in 500 mL NS (1,000 mL NS if dose >500 mg) - If dose is <250 mg, dilute in an appropriate volume of NS to achieve a final concentration of 0.5 to 1 mg/mL. «bi»Generic Product Labeling«/bi» - Reconstitute each 15 mg vial with 1.5 mL SWFI to a concentration of ~10 mg/mL. - Solutions for IV use should be further diluted in NS injection prior to infusion. - Filter through a 0.22 micron filter (polysulfone membrane [Sterile Aerodisc] or triton-free cellulose mixed ester [Millex-GS]) prior to administration; do not use solutions which precipitate or remain opaque after filtering - Solutions for intravesicular administration should be diluted in 30 to 60 mL NS. «bi»Intrathecal Reconstitution«/bi» - Off-label use/route - Dilute to a concentration of 1 mg/mL in preservative-free buffered solution - Intrathecal medications should not be prepared during the preparation of any other agents.

Thiothixene

Navane

Thonzonium

Thrombin (Topical)

Recothrom, Evithrom, Thrombi-Gel, Thrombogen, Thrombin JMI, Thrombi-Pad

«b»Administration«/b» - For topical use only - Do not administer intravenously or intra-arterially. «bi»Evithrom«/bi» - Sponge or suction target surface free of blood prior to application (do not wipe). - Use syringe and small-gauge needle to apply; avoid sponging the clot after application - When used in conjunction with absorbable gelatin sponge, transfer solution to sterile container and immerse gelatin sponge(s) into solution; vigorously knead until all air is expelled and sponge can return to its original size and shape; hold sponge in place with gauze or cotton pledget using moderate pressure until hemostasis is achieved. «bi»Recothrom«/bi» - May apply reconstituted solution directly using ZymoGenetics spray applicator kit or in combination with absorbable gelatin sponge - When using spray applicator, use the sterile bowl in kit as receptacle for reconstituted solution; refer to spray kit manufacturer’s labeling for spray pump and syringe spray assembly and use. When used in conjunction with absorbable gelatin sponge(s), transfer solution to sterile container and immerse gelatin sponge(s) into solution until completely saturated; gently squeeze to remove excess solution; apply sponge(s) to bleeding site in a single layer. «bi»Thrombi-Gel«/bi» - After wetting, place directly over bleeding source and apply adjunct manual compression until hemostasis is achieved; may cut or roll to desired shape prior to wetting. «bi»Thrombin-JMI«/bi» - Sponge (do not wipe) application surface prior to use, if possible - Apply as dry powder or reconstituted solution - When used as a solution, flood surface using a sterile syringe with a small-gauge needle or use in conjunction with Thrombin-JMI pump spray kit, syringe spray kit, epistaxis kit, or FloSeal NT; refer to manufacturer’s kit labeling for assembly and use. When used in conjunction with absorbable gelatin sponge, immerse sponge strips into solution; vigorously knead sponge with moistened gloved fingers until all air is expelled; apply saturated sponge to bleeding area; hold in place with gauze or cotton pledget using moderate pressure until hemostasis is achieved - Product is most effective when it mixes freely with blood as soon as it reaches the surface. Avoid sponging of treated surfaces. «bi»Thrombi-Pad«/bi» - Apply dry or wet directly to the bleeding source and apply adjunct manual compression; may be left in place for up to 24 hours - To remove, do not disrupt clot by physical manipulation - If pad adheres to the site, irrigate with nonheparinized NS and remove. «b»Reconstitution«/b» «bi»Evithrom«/bi» - Reconstitute with 2 mL of SWFI using device provided by the manufacturer - Shake gently to dissolve until clear. «bi»Recothrom«/bi» - Reconstitute using diluent provided in prefilled syringe - Gently swirl to dissolve powder; avoid excessive agitation; powder should dissolve within 1 minute at room temperature - For some vial sizes, do not use diluent syringe to withdraw solution from vial. «bi»Thrombi-Gel«/bi» - Must wet with NS or SWFI before use; may cut or roll to desired shape prior to wetting. - Refer to manufacturer’s labeling for fluid volume used for wetting a specific product. - Once wetted and prior to applying, knead thoroughly to saturate the pad and remove trapped air bubbles. «bi»Thrombin-JMI«/bi» - Used as drug powder or wetted - If wetted, reconstitute with sodium chloride 0.9% or provided diluent to a concentration of 1,000 to 2,000 units/mL using a syringe or transfer device. - In cases in which approximately 1,000 units/mL is desired, reconstitute with entire vial of provided diluent. «bi»Thrombi-Pad«/bi» - Used dry or wetted with up to 10 mL of NS.

Thyroid

Armour Thyroid, Westhroid, Nature-Throid, Thyroid Desiccated

Thyrotropin Alfa

Thyrogen

TiaGABine

Gabitril

Ticagrelor

Brilinta

Ticarcillin

Ticarcillin-Clavulanic Acid

Timentin

Tick-Borne Encephalitis Vaccine

TicoVac, TBE Vaccine

Tigecycline

Tygacil

Tildrakizumab

Ilumya

Timolol

Blocadren, Timol

Timolol (Ophthalmic)

Timoptic, Betimol, Timoptic XE, Istalol, Timoptic Ocudose

Timolol-Brimonidine Tartrate (Ophthalmic)

Combigan

Tinidazole

Tindamax

Tioconazole

Vagistat-1

Tiotropium

Spiriva

Tiotropium-Olodaterol

Stiolto Respimat

Tipiracil

Tipranavir

Aptivus

Tirbanibulin (Topical)

Klisyri

Tirofiban

Aggrastat

Tirzepatide

Mounjaro, Zepbound

Tisagenlecleucel

Kymriah

«bu»Acute Lymphoblastic Leukemia«/bu» «b»Lymphodepleting Chemotherapy«/b» «bi»Fludarabine«/bi» - 30 mg/m² IV daily x 4 days AND «bi»Cyclophosphamide«/bi» - 500 mg/m² IV daily x 2 days starting with the first dose of fludarabine FOLLOWED BY «bi»Tisagenlecleucel IV Infusion«/bi» - Administer 2-14 days after completing lymphodepleting chemotherapy - Premedicate with acetaminophen and diphenhydramine (see Administration) ≤50 kg - 0.2-5 x 10^6 CAR-positive viable T cells/kg >50 kg - 0.1-2.5 x 10^8 CAR-positive viable T cells/kg - Infuse autologously prepared, weight-based IV for individual patient at 10-20 mL/min - Do not use a leukocyte-depleting filter - Adjust infusion rate as appropriate for smaller children and smaller volumes «bu»Large B-Cell Lymphoma«/bu» «b»Lymphodepleting Chemotherapy«/b» - Lymphodepleting chemotherapy may be omitted if WBC count ≤1 x 10^9/L within 1 week before tisagenlecleucel infusion «bi»Fludarabine«/bi» - 25 mg/m² IV daily for 3 days AND «bi»Cyclophosphamide«/bi» - 250 mg/m² IV daily for 3 days starting with the first dose of fludarabine OR «bi»Bendamustine«/bi» - 90 mg/m² IV daily for 2 days if a patient experienced a previous Grade 4 hemorrhagic cystitis with cyclophosphamide or demonstrates resistance to a previous cyclophosphamide containing regimen FOLLOWED BT «bi»Tisagenlecleucel IV Infusion«/bi» - Administer 2-11 days after completing lymphodepleting chemotherapy - Premedicate with acetaminophen and diphenhydramine - 0.6-6 x 10^8 CAR-positive viable T cells/kg «b»Contraception«/b» - See the prescribing information for fludarabine and cyclophosphamide for information on the need for effective contraception in patients who receive the lymphodepleting chemotherapy; limited exposure data available concerning the duration of contraception following treatment with tisagenlecleucel «b»Dosage Modifications«/b» «bi»Cytokine Release Syndrome (CRS) Management«/bi» Prodromal Syndrome Symptoms - Low-grade fever, fatigue, anorexia - Observe in person; exclude infection; administer antibiotics per local guidelines if neutropenic; provide symptomatic support CRS Requiring Mild Intervention - 1 or more symptoms of the following: High fever, hypoxia, mild hypotension - Administer antipyretics, oxygen, IV fluids, and/or low-dose vasopressors as needed CRS Requiring Moderate to Aggressive Intervention - 1 or more symptoms of the following: Hemodynamic instability despite IV fluids and vasopressor support, and/or worsening respiratory distress (including pulmonary infiltrates, increasing oxygen requirement including high-flow oxygen, and/or need for mechanical ventilation), and/or rapid clinical deterioration - Administer high-dose or multiple vasopressors, oxygen, mechanical ventilation, and/or other supportive care as needed - Administer tocilizumab, weight <30 kg: 12 mg/kg IV infused over 1 hr - Administer tocilizumab, weight ≥30 kg: 8 mg/kg IV infused over 1 hr; not to exceed 800 mg/dose - Repeat tocilizumab as needed at a minimum interval of 8 hr if there is no clinical improvement - If no response to second dose of tocilizumab, consider a third dose or pursue alternative measures for CRS treatment - Not to exceed a total of 4 tocilizumab doses - If no clinical improvement within 12-18 hr after the first tocilizumab dose, or worsening at any time, administer methylprednisolone 2 mg/kg as an initial dose, then 2 mg/kg/day until vasopressors and high flow oxygen are no longer needed, then taper methylprednisolone «b»Dosing Considerations«/b» - For autologous use only - Adult relapsed or refractory DLBCL Limitation of Use - Not indicated for treatment of patients with primary central nervous system lymphoma «b»Premedication«/b» - Premedicate with acetaminophen and diphenhydramine or another H1-antihistamine ~30-60 minutes before tisagenlecleucel infusion - Do not use corticosteroids at any time except in the case of a life-threatening emergency «b»IV Infusion Administration«/b» - Administer IV infusion at 10-20 mL/min, adjusted as appropriate for smaller children and smaller volume - Infusion bag volume ranges from 10-50 mL - Do not use a leukocyte-depleting filter; prime tubing prior to infusion with 0.9% NaCl - Infuse all contents of the infusion bag; rinse infusion bag with 10-30 mL 0.9% NaCl while maintaining a closed tubing system to assure as many cells as possible are infused into the patient - Follow local biosafety guidelines applicable for handling and disposal of such products «b»IV Preparation«/b» - Confirm infusion time in advance, and adjust start time for thaw so that tisagenlecleucel is available for infusion when recipient is ready - Ensure 2 doses of tocilizumab and emergency equipment are available prior to infusion and during the recovery period; premedicate patient - Confirm patient identity prior to preparation, match the patient's identity with the patient identifiers on the tisagenlecleucel infusion bag; tisagenlecleucel is for autologous use only - Inspect the infusion bag for any breaks or cracks before thawing; if bag is compromised, do not infuse the contents; contact Novartis at 1-844-4KYMRIAH - Place infusion bag inside a second, sterile bag in case of a leak and to protect ports from contamination; thaw infusion bag at 37°C using either a water bath or dry thaw method until there is no visible ice in the infusion bag - Remove bag from thawing device immediately; do not store product bag at 37°C - Once thawed, stored at room temperature (20-25°C) for up to 30 minutes - Do not wash, spin down, and/or resuspend tisagenlecleucel in new media prior to infusion; inspect contents of the thawed infusion bag for any visible cell clump; if visible cell clumps remain, gently mix the contents of the bag; small clumps of cellular material should disperse with gentle manual mixing - Do not infuse tisagenlecleucel if clumps are not dispersed, the infusion bag is damaged or leaking, or otherwise appears to be compromised; if this occurs, contact Novartis at 1-844-4KYMRIAH

Tisotumab Vedotin

Tivdak

Tivozanib

Fotivda

Tixagevimab-Cilgavimab

Evusheld, AstraZeneca COVID-19 Monoclonal Antibody

«bu»Pre-exposure COVID-19 Prophylaxis«/bu» - Tixagevimab 300 mg IM x 1 dose AND - Cilgavimab 300 mg IM x1 dose administered as separate, consecutive IM injections «b»Patient Selection Criteria«/b» - Moderately-to-Severely immunocompromised patients due to a medical condition or medications/treatment and may not mount an adequate immune response to COVID-19 vaccination, or have a history of severe adverse reactions to a COVID-19 vaccine and/or component(s) - Patients are not currently infected with SARS-CoV-2 virus and have not recently been exposed to an individual infected with SARS-CoV-2 «b»Dosing Considerations«/b» - Patients who have already received the previously authorized dose (150 mg of tixagevimab and 150 mg of cilgavimab) should receive an additional dose of 150 mg of tixagevimab and 150 mg of cilgavimab as soon as possible to raise their monoclonal antibody levels to those expected for patients receiving the higher dose «b»Repeat Dosing«/b» - Longer-term data from PROVENT clinical trial indicate that tixagevimab and cilgavimab may be effective for preexposure prophylaxis for 6 months after administration - While SARS-CoV-2 remains in circulation, individuals who qualify for tixagevimab and cilgavimab, per the conditions of the EUA, may be redosed every 6 months - Because it is unclear which SARS-CoV-2 variant or Omicron subvariant will become dominant in the United States over the next few months, the recommended timing for repeat at higher dose cannot be provided at this time but therapy will be monitored dosing recommendations updated - Only studied in single-dose studies; safety and efficacy data are not available with repeat dosing «b»Limitations of Use«/b» - Not authorized for treatment of COVID-19 or for pos-texposure prophylaxis of COVID-19 in individuals who have been exposed to someone infected with SARS-CoV-2 - Pre-exposure prophylaxis is not a substitute for vaccination in individuals for whom COVID-19 vaccination is recommended; individuals for whom COVID-19 vaccination is recommended, including those who are moderately to severely immunocompromised who may benefit from COVID-19 vaccination, should receive COVID-19 vaccination - Administer at least 2 weeks after vaccination in individuals who have received a COVID-19 vaccine «b»Medical Conditions/Treatment Examples Resulting in Moderate-to-Severe Immunocompromise«/b» - Active treatment for solid tumor and hematologic malignancies - Receipt of solid-organ transplant and taking immunosuppressive therapy - Receipt of chimeric antigen receptor (CAR) T-cell or hematopoietic stem cell transplant (within 2 years of transplantation or taking immunosuppression therapy) - Moderate or severe primary immunodeficiency (eg, DiGeorge syndrome, Wiskott-Aldrich syndrome) - Advanced or untreated HIV infection (HIV with CD4 cell counts <200/mm3, history of an AIDS-defining illness without immune reconstitution, or clinical manifestations of symptomatic HIV) - Active treatment with high-dose corticosteroids (ie, ≥20 mg prednisone or equivalent per day when administered for ≥2 weeks), alkylating agents, antimetabolites, transplant-related immunosuppressive drugs, cancer chemotherapeutic agents classified as severely immunosuppressive, tumor-necrosis factor (TNF) blockers, and other biologic agents that are immunosuppressive or immunomodulatory (eg, B-cell–depleting agents)

TiZANidine

Zanaflex, Sirdalud

Tobramycin

Nebcin

- Individualization is critical because of the low therapeutic index. «b»Underweight and Non-obese«/b» - Use of total body weight (TBW) instead of IBW for determining the initial mg/kg/dose is widely accepted - IBW also may be used to determine doses for patients who are neither underweight nor obese «bu»Severe Life-threatening Infections«/bu» «b»Conventional«/b» - 1 to 2.5 mg/kg/dose IV/IM every 8 to 12 hours - To ensure adequate peak concentrations early in therapy, higher initial dosage may be considered in selected patients when extracellular water is increased (edema, septic shock, postsurgical, and/or trauma) «b»Once-Daily«/b» - 4 to 7 mg/kg/dose once daily - Some clinicians recommend this approach for all patients with normal renal function; this dose is at least as efficacious with similar, if not less, toxicity than conventional dosing. «bu»Brucellosis«/bu» - 240 mg (IM) daily or - 5 mg/kg (IV) daily for 7 days - Either regimen recommended in combination with doxycycline «bu»Cholangitis«/bu» - 4 to 6 mg/kg once daily with ampicillin «bu»CNS Shunt Infection«/bu» - Intrathecal (off-label route) - 5 to 20 mg/day «bu»Diverticulitis«/bu» «b»Complicated«/b» - 1.5 to 2 mg/kg IV/IM every 8 hours with ampicillin and metronidazole «bu»Meningitis«/bu» «b»Enterococcus or Pseudomonas Aeruginosa«/b» - 5 mg/kg/day IV in divided doses every 8 hours administered with another bacteriocidal drug «bu»Pelvic Inflammatory Disease«/bu» - Loading Dose: 2 mg/kg, then, - Maintenance Dose: 1.5 mg/kg every 8 hours or 4.5 mg/kg once daily «bu»Plague (Yersinia Pestis)«/bu» - Treatment: 5 mg/kg/day IV/IM - Followed by postexposure prophylaxis with doxycycline «bu»Hospital Acquired Pneumonia (HAP) or Ventilator-Associated Pneumonia (VAP)«/bu» - 5 to 7 mg/kg/day IV daily x 7 days - May consider shorter or longer duration depending on rate of clinical improvement - When used as empiric therapy, use in combination with an agent active against S. aureus and an additional antipseudomonal agent - Aminoglycosides are not recommended as monotherapy in patients with hospital-acquired or ventilator-associated pneumonia due to P. aeruginosa «bu»Endocarditis Prophylaxis«/bu» «b»Dental, Oral, Upper Respiratory Procedures, GI/GU Procedures«/b» - 1.5 mg/kg with ampicillin (50 mg/kg) 30 minutes prior to procedure «bu»Tularemia«/bu» - 5 mg/kg/day IV/IM divided every 8 hours for 1 to 2 weeks «bu»Urinary Tract Infection (UTI)«/bu» - 1.5 mg/kg/dose IV/IM every 8 hours «b»Moderate Obesity (TBW/IBW ≥1.25) or Morbid Obesity [TBW/IBW >2]«/b» - Initial dosage requirement may be estimated using a dosing weight of IBW + 0.4 (TBW - IBW)

Tobramycin (Ophthalmic)

Tobrasol, Tobrex, AKTob, Tobrexan

Tobramycin (Oral Inhalation)

Tobi Podhaler, Bethkis, Kitabis Pak, TOBI

Tobramycin-Dexamethasone (Ophthalmic)

TobraDex

Tocilizumab

Actemra, Atlizumab, RoActemra

«bu»Rheumatoid Arthritis«/bu» «b»Initial Dose (IV)«/b» - 4 mg/kg «b»IV«/b» over 60 min every 4 weeks «b»Maintenance Dose (IV)«/b» - May increase to 8 mg/kg «b»IV«/b» every 4 weeks based on clinical response - Reduction of dose from 8 mg/kg to 4 mg/kg «b»IV«/b» is recommended for management of certain dose-related laboratory changes «b»Maximum Dose (IV)«/b» - 800 mg/dose «b»IV«/b» every 4 weeks «b»SC Injection«/b» «bi»Weight <100 kg«/bi» - 162 mg SC every other week - Followed by an increase to every week based on clinical response «bi»Weight ≥100 kg«/bi» - 162 mg SC every week «b»Transition from IV to SC«/b» - Administer first SC dose instead of the next scheduled IV dose «bu»Giant Cell Arteritis«/bu» «b»Initial Dose (SC)«/b» - 162 mg «b»SC«/b» once weekly in combination with a tapering course of glucocorticoids «b»Maintenance Dose«/b» - Based on clinical considerations, may consider administering 162 mg «b»SC«/b» every other week in combination with a tapering course of glucocorticoids - May be used alone following discontinuation of glucocorticoids (interruption of dosing may be needed for management of dose-related laboratory abnormalities, IV administration is not approved for GCA) «bu»Cytokine Release Syndrome (CRS)«/bu» «b»Initial Dose (IV)«/b» - 8 mg/kg «b»IV«/b» infusion over 60 min - SC is not approved for CRS «b»Maintenance Dose (IV)«/b» - May administer up to 3 additional doses of tocilizumab if no clinical improvement in signs/symptoms of CRS after first dose - Interval between consecutive doses should be >8 hr - May be administered as monotherapy or with corticosteroids «b»Maximum Dose«/b» - 800 mg/dose «bu»COVID-19«/bu» «b»Initial Dose«/b» - 8 mg/kg «b»IV«/b» infusion over 60 min «b»Maintenance Dose«/b» - May administer up to 1 additional «b»IV«/b» dose of tocilizumab if no clinical improvement in signs/symptoms after first dose «b»Maximum Dose«/b» - 800 mg/dose «b»(IV)«/b» - Interval between consecutive doses should be >8 hr - May be administered as monotherapy or with corticosteroids «b»Dosage Modifications«/b» - Dose reductions have not been studied in PJIA and SJIA populations - The following dosage modifications apply to RA and GCA patients «b»Neutropenia«/b» ANC >1000 cells/mm³ - Maintain dose ANC 500-1000 cells/mm³ - Hold treatment until ANC >1000 cells/mm³ - Resume at 4 mg/kg IV and increase to 8 mg/kg IV as clinically appropriate - Resume 162 mg SC at every other week and increase frequency to every week as clinically appropriate ANC <500 cells/mm³ - Discontinue therapy «b»Thrombocytopenia«/b» <50,000 cells/mm³ - Discontinue therapy 50,000-10,000 cells/mm³ - Hold treatment until >100,000 cells/mm³ - IV: Resume therapy at 4 mg/kg and increase to 8 mg/kg if clinically appropriate - SC: Resume at 162 mg every other week and increase frequency to every week as clinically appropriate «b»Dosing Considerations«/b» - Monitor neutrophils, platelets, and ALT/AST 4-8 weeks following of therapy and every 3 months thereafter - Monitor lipids 4-8 weeks following initiation of therapy and then at ~24 week intervals «b»Use Not Recommended«/b» - ANC <2000/mm³ - Platelets <100,000/mm³ - ALT or AST >1.5x ULN - Patients with severe or life-threatening CRS frequently have cytopenias or elevated ALT or AST due to the lymphodepleting chemotherapy or CRS - Evaluate potential benefit of treating CRS versus the risks of short-term treatment with tocilizumab «bu»Systemic Juvenile Idiopathic Arthritis«/bu» «b»IV Infusion«/b» - Infuse over 60 minutes «bi»≥2 years (<30 kg)«/bi» - 12 mg/kg IV every 2 weeks «bi»≥2 years (≥30 kg)«/bi» - 8 mg/kg IV every 2 weeks «b»SC Injection«/b» - When transitioning from IV to SC administration, administer the first SC dose instead of the next scheduled IV dose «bi»≥2 years (<30 kg)«/bi» - 162 mg SC once every 2 weeks «bi»≥2 years (≥30 kg)«/bi» - 162 mg SC once weekly «bu»Polyarticular Juvenile Idiopathic Arthritis«/bu» «b»IV Infusion«/b» - Infuse over 60 minutes «bi»≥2 years (<30 kg)«/bi» - 10 mg/kg IV every 4 weeks «bi»≥2 years (≥30 kg)«/bi» - 8 mg/kg IV every 4 weeks «b»SC Injection«/b» - When transitioning from IV to SC administration, administer the first SC dose instead of the next scheduled IV dose «bi»≥2 years (<30 kg)«/bi» - 162 mg SC once every 3 weeks «bi»≥2 years (≥30 kg)«/bi» - 162 mg SC once every 2 weeks «bu»Cytokine Release Syndrome (CRS)«/bu» - SC is not approved for CRS - Infuse over 60 minutes «b»≥2 years (<30 kg)«/b» - 12 mg/kg IV x 1 dose «b»≥2 years (≥30 kg)«/b» - 8 mg/kg IV x 1 dose - May be administered as monotherapy or with corticosteroids - May administer up to 3 additional doses of tocilizumab if no clinical improvement in signs/symptoms after first dose - Interval between consecutive doses should be >8 hr Maximum Dose - 800 mg/dose «bu»COVID-19«/bu» - Emergency Use Authorization - SC is not approved for COVID-19 - Infuse (IV) over 60 minutes «b»≥2 years (<30 kg)«/b» - 12 mg/kg IV x 1 dose «b»≥2 years (≥30 kg)«/b» - 8 mg/kg IV x 1 dose - May be administered as monotherapy or with corticosteroids - May administer up to 1 additional dose of tocilizumab if no clinical improvement in signs/symptoms of CRS after first dose - Interval between consecutive doses should be >8 hr Maximum Dose - 800 mg/dose «b»Dosage Modifications«/b» - Dose reduction has not been studied in the PJIA and SJIA populations - Dose interruptions are recommended for liver enzyme abnormalities, low neutrophil counts, and low platelet counts in patients with PJIA and SJIA at levels similar to what is outlined for adults with RA - The following dosage modifications apply to RA and GCA patients

Tofacitinib

Xeljanz, Xeljanz ER

«bu»Psoriatic Arthritis«/bu» - Use in combination with nonbiologic disease-modifying antirheumatic drugs [DMARDs] - 5 mg IR PO bid - 11 mg ER PO daily «bu»Rheumatoid Arthritis«/bu» - Monotherapy or in combination with nonbiologic disease-modifying antirheumatic drugs - 5 mg IR PO bid - 11 mg ER PO daily «bu»Ulcerative Colitis«/bu» «b»Induction (Xeljanz)«/b» - 10 mg PO bid x 8 weeks - Evaluate patients and transition to maintenance therapy depending on therapeutic response - If needed, continue for maximum of 16 weeks - Discontinue after 16 weeks if adequate therapeutic benefit not achieved «b»Maintenance (Xeljanz)«/b» - 5 or 10 mg PO bid - May consider 10mg PO bid (limited to shorter duration) in patients with loss of response during maintenance treatment - Use the lowest effective dose needed to maintain response «b»Induction (Xeljanz XR)«/b» - 22 mg PO daily for at least 8 weeks - Evaluate patients and transition to maintenance therapy depending on therapeutic response - If needed, continue for maximum of 16 weeks - Discontinue after 16 weeks if adequate therapeutic benefit not achieved «b»Maintenance (Xeljanz XR)«/b» - 11 mg PO once daily - May consider 22 mg PO daily (limited to shorter duration) in patients with loss of response during maintenance treatment - Use the lowest effective dose needed to maintain response «bu»Ankylosing Spondylitis«/bu» - Adults who have an inadequate response or are intolerant to ≥1 TNF blockers «b»Xeljanz«/b» - 5 mg PO bid «b»Xeljanz XR«/b» - 11 mg PO daily «b»Infection«/b» - If a patient develops a serious infection, interrupt treatment until the infection is controlled. «b»Lymphopenia«/b» Lymphocytes ≥500 cells/mm3 - Maintain dose. Lymphocytes <500 cells/mm3 - Confirmed by repeat evaluation - Discontinue therapy. «b»Neutropenia«/b» ANC >1,000 cells/mm3 - Maintain dose. ANC Persistently Between 500 to 1,000 cells/mm3 - Interrupt therapy - Resume at 5 mg immediate release twice daily or 11 mg extended release once daily when ANC >1,000 cells/mm3. ANC <500 cells/mm3 - Confirmed by repeat evaluation - Discontinue therapy. «b»Anemia«/b» Hemoglobin <8 g/dL or decrease >2 g/dL - Confirmed by repeat evaluation - Interrupt therapy until hemoglobin values have normalized. Hemoglobin ≥9 g/dL and decrease ≤2 g/dL - Maintain dose «b»Dosing Considerations«/b» - When transitioning from immediate release to extended release, begin extended release the day following the last dose of 5 mg immediate release - Tofacitinib should not be used in combination with biologic DMARDs or with strong immunosuppressants, such as azathioprine, tacrolimus, or cyclosporine - Do not initiate therapy in patients with an absolute lymphocyte count <500 cells/mm3, absolute neutrophil count <1,000 cells/mm3, or hemoglobin <9 g/dL.

TOLAZamide

Tolinase

TOLBUTamide

Orinase

Tolcapone

Tasmar

Tolmetin

Tolectin

Tolnaftate (Topical)

LamISIL, Tinactin, Athletes Foot Spray, Absorbine, Ting Antifungal, Jock Itch Spray, Fungi-Guard, Fungoid-D, Podactin, Tinaspore

Tolterodine

Detrol, Detrol LA

Tolvaptan

Samsca, Jynarque, Jinarc

«bu»Hyponatremia«/bu» «b»Samsca«/b» «bi»Initial Dose«/bi» - 15 mg PO daily «bi»Maintenance Dose«/bi» - After at least 24 hours, may increase to 30 mg once daily to a maximum of 60 mg once daily titrating at 24-hour intervals to desired serum sodium concentration. - Avoid fluid restriction during the first 24 hours of therapy - Do not use for more than 30 days due to the risk of hepatotoxicity «b»Limitations of Use«/b» - Not indicated for use when urgent treatment of hyponatremia is required to prevent or treat serious neurological symptoms. It has not been established that raising serum sodium with tolvaptan provides symptomatic benefit. «bu»Autosomal Dominant Polycystic Kidney Disease (ADPKD)«/bu» «b»Jinarc«/b» - Prior to initiating therapy, restrict overnight fluid intake for 10 to 14 hours to assess ability to concentrate urine using urine osmolality or specific gravity (less accurate) - Upon initiation of therapy fluid intake should not be restricted. «bi»Initial Dose«/bi» - 60 mg/day in divided doses (45 mg upon wakening and 15 mg approximately 8 hours later) «bi»Maintenance Dose«/bi» - Titrate per response and tolerability at intervals of at least 7 days to 90 mg/day (60 mg upon wakening and 30 mg approximately 8 hours later) and then to 120 mg/day (90 mg upon wakening and 30 mg approximately 8 hours later) - Downward titration may be necessary based on tolerability - Maintain patient on highest tolerated dose to decrease urine osmolality 200 to 300 mOsm/kg (preferable in most cases) from baseline. - Urine osmolality or specific gravity should be measured before morning dose. - Urine osmolality <300 mOsm/kg (corresponds to a specific gravity of 1.005) should be maintained at all times if possible - Avoid unnecessary interruptions in therapy; however if the ability to drink or accessibility to water is limited therapy should be interrupted «b»Limitations of Use«/b» - Clinical trials evaluated ADPKD patients having a total kidney volume ≥750 mL with relatively preserved renal function (eg, estimated creatinine clearance ≥60 mL/minute, generally corresponding to a CKD-EPI eGFR ≥30 mL/minute/1.73 m2 at the time of therapy initiation). «b»Strong CYP3A Inhibitors«/b» «bi»Tolvaptan 120 mg/day or 90 mg/day«/bi» - Reduce dose to 30 mg/day administered upon wakening - Titrate cautiously per response and tolerability - Further downward titration or discontinuation of concurrent therapy may be necessary based on tolerability. «bi»Tolvaptan 60 mg/day«/bi» - Reduce dose to 15 mg/day administered upon wakening - Titrate cautiously per response and tolerability - Further downward titration or discontinuation of concurrent therapy may be necessary based on tolerability. «b»Moderate CYP3A Inhibitors«/b» - Decrease daily dose by 50% administered as split regimen with first dose upon wakening and second dose ~8 hours later (120 mg/day [90 mg + 30 mg/day] is reduced to 60 mg/day [45 mg + 15 mg/day]) - When adjusting the dose reduce the first daily dose as needed and maintain the second daily dose at 15 mg.

Topiramate

Eprontia, Qudexy XR, Topamax, Topiragen, Trokendi XR

Topotecan

Hycamtin, Hycamptamine

- Baseline neutrophil count should be ≥1,500/mm3 and platelets should be ≥100,000/mm3 prior to treatment; for re-treatment, neutrophil count should be >1,000/mm3; platelets >100,000/mm3 and hemoglobin ≥9 g/dL. IV doses should generally not exceed 4 mg; verify dose prior to administration. «bu»Cervical Cancer«/bu» «b»Recurrent or Resistant«/b» - 0.75 mg/m2/day IV x 3 days in combination with cisplatin on day 1 only, [with hydration]) every 21 days «bu»Ovarian Cancer«/bu» «b»Metastatic«/b» - 1.5 mg/m2/day IV x 5 consecutive days every 21 days or - 1.25 mg/m2/day IV x 5 days every 21 days until disease progression or unacceptable toxicity or a maximum of 12 months or - 4 mg/m2 on days 1, 8, and 15 every 28 days until disease progression or unacceptable toxicity or a maximum of 12 months «bu»Small Cell Lung Cancer (SCLC)«/bu» «b»Relapsed«/b» - 1.5 mg/m2/day IV for 5 consecutive days every 21 days - 2.3 mg/m2/day PO for 5 consecutive days every 21 days (round dose to the nearest 0.25 mg); if patient vomits after dose is administered, do not give a replacement dose. «bu»Ewing Sarcoma«/bu» «b»Relapsed/Refractory or Metastatic«/b» - 0.75 mg/m2/day IV x 5 consecutive days every 21 days (in combination with cyclophosphamide) «bu»Primary CNS Lymphoma«/bu» «b»Relapsed or Refractory«/b» - 1.5 mg/m2 IV x 5 days every 21 days for a maximum of 10 cycles or until disease progression or unacceptable toxicity «bu»Rhabdomyosarcoma, Metastatic«/bu» «b»Adults <21 years«/b» - 0.75 mg/m2/day IV x 5 consecutive days every 21 days for 2 cycles (window therapy; in combination with cyclophosphamide) - If objective response occurred by week 6, follow with alternating cycles of vincristine, topotecan, and cyclophosphamide (VTC) with vincristine, dactinomycin, and cyclophosphamide (VAC) (Walterhouse 2004) «b»Dose Modification«/b» «bi»Cervical Cancer«/bi» - Cisplatin may also require dosage adjustment - Severe febrile neutropenia (<1,000/mm3 with temperature of ≥38°C) or platelet count <25,000/mm3: Reduce topotecan to 0.6 mg/m2/day for subsequent cycles (may consider G-CSF support [beginning on day 4] prior to instituting dose reduction for neutropenic fever). - If necessary, may further reduce dose to 0.45 mg/m2/day for subsequent cycles. «bi»Ovarian Cancer«/bi» - Dosage adjustment for hematological effects - Severe neutropenia (<500/mm3) or platelet count <25,000/mm3: Reduce dose to 1.25 mg/m2/day for subsequent cycles (may consider G-CSF support [beginning on day 6] prior to instituting dose reduction for severe neutropenia). «bi»Small cell lung cancer (SCLC)«/bi» - Dosage adjustment for hematological effects - Severe neutropenia (<500/mm3) or platelet count <25,000/mm3: Reduce dose to 1.25 mg/m2/day for subsequent cycles (may consider G-CSF support [beginning on day 6] prior to instituting dose reduction for severe neutropenia). «b»Oral«/b» «bi»Severe Neutropenia (Neutrophils <500/mm3 Associated with Fever or Infection or Lasting ≥7 days) or Prolonged Neutropenia (Neutrophils 500/mm3 to 1,000/mm3 lasting Beyond day 21) or Platelets <25,000/mm3«/bi» - Reduce dose by 0.4 mg/m2/day for subsequent cycles. «bi»Diarrhea (Grade 3 or 4)«/bi» - Do not administer to patients with grade 3 or 4 diarrhea - Upon recovery to ≤grade 1 toxicity, reduce dose by 0.4 mg/m2/day for subsequent cycles.

Toremifene

Fareston

Torsemide

Demadex, Soaanz

Trabectedin

Yondelis, Ecteinascidin

Tralokinumab

Adbry, Tralokinumab-lDRM

TraMADol

ConZip, Synapryn FusePaq, Ultram, Ultram ER, Ryzolt, EnovaRX-Tramadol, Durela, Ralivia, Zytram XL, Tridural, Qdolo

«bu»Pain Management«/bu» «b»Immediate Release«/b» «bi»Chronic«/bi» Initial Dose - 25 mg PO every morning Maintenance Dose - Increased by 25-50 mg/day every 3 days up to 50-100 mg PO every 4-6 hr prn Maximum Dose - 400 mg/day «bi»Acute«/bi» - 50-100 mg PO every 4-6 hr prn Maximum Dose - 400 mg/day «b»Extended Release«/b» Initial Dose - 100 mg PO once daily Maintenance Dose - Increased by 100 mg/day every 5 days Maximum Dose - 300 mg/day «b»Oral Solution«/b» - Equivalent to tramadol 4.4 mg/mL Initial Dose - 25 mg PO daily Maintenance Dose - May titrate in 25-mg increments as separate doses every 3 days to 100 mg/day (25 mg qid) THEN, - May increase total daily dose by 50-mg increments as tolerated every 3 days to 200 mg/day (50 mg qid) THEN, - After titration, 50-100 mg every 4-6 hr prn for pain relief Maximum Dose - 400 mg/day - For rapid onset of analgesic effect and benefits outweigh risks of discontinuation due to adverse events associated with high initial doses: 50-100 mg every 4-6 hr prn for pain relief «bu»Restless Legs Syndrome«/bu» - 50 to 100 mg PO once daily at bedtime or during the night - Doses as high as 150 mg/day have been used «b»Limitations of Use«/b» - Reserve tramadol for use in patients for whom alternative treatment options (nonopioid analgesics) are ineffective, not tolerated, or would be otherwise inadequate to provide sufficient management of pain. Tramadol ER is not indicated as an as-needed analgesic «b»IR to ER Conversion«/b» - Round total daily dose down to nearest 100 mg - Do not chew, crush, split, or dissolve «b»Oral Solution to ER Conversion«/b» - Bioavailability of oral solution compared to extended release tramadol is unknown - Closely monitor for signs of excessive sedation and respiratory depression when converting formulations «b»Zytram XL«/b» - Patients not currently on immediate-release tramadol or opioids: 150 mg once daily; if pain relief is not achieved may titrate by increasing dosage incrementally, with sufficient time to evaluate effect of increased dosage; generally not more often than every 7 days (maximum: 400 mg/day) «b»Discontinuation of Therapy«/b» - For patients on long-term opioid therapy, decrease dose by 25% to 50% every 2 to 4 days - Monitor carefully for signs/symptoms of withdrawal. If patient displays withdrawal symptoms, increase dose to previous level and then reduce dose more slowly by increasing interval between dose reductions, decreasing amount of daily dose reduction, or both - Do not abruptly discontinue «b»Access to Naloxone«/b» - Discuss availability of naloxone and assess need for naloxone, both when initiating and renewing treatment - Consider prescribing naloxone based on the risk factors for overdose

Tramadol-Acetaminophen

Ultracet

Trametinib

Mekinist

«bu»Breast Cancer«/bu» «b»Adjuvant Treatment«/b» - Indicated for adjuvant treatment of HER-2 overexpressing breast cancer «bi»Combination with Doxorubicin, Cyclophosphamide, and either Paclitaxel or Docetaxel«/bi» Herceptin, Ogivri, Herzuma, Ontruzant, Trazimera, Kanjinti - 4 mg/kg IV over 90 min THEN, - 2 mg/kg IV over 30 min weekly during chemotherapy for the first 12 weeks (paclitaxel or docetaxel) - One week following the last weekly dose, initiate 6 mg/kg IV every 3 weeks; infuse over 30-90 min - Administer for a total of 52 weeks «bi»Combination with Docetaxel and Carboplatin«/bi» Herceptin, Ogivri, Herzuma, Ontruzant, Trazimera, Kanjinti - 4 mg/kg IV over 90 min THEN, - 2 mg/kg IV over 30 min weekly during chemotherapy for the first 18 weeks (docetaxel/carboplatin) - One week following the last weekly dose, initiate 6 mg/kg IV every 3 weeks; infuse over 30-90 min - Administer for a total of 52 weeks «bi»Single Agent Following Completion of Multi-modality, Anthracycline-based Chemotherapy«/bi» Herceptin, Ogivri, Ontruzant, Trazimera, Kanjinti - 8 mg/kg IV over 90 min THEN, - 6 mg/kg as an IV over 30−90 min every 3 weeks - Administer for a total of 52 weeks - Extending adjuvant treatment beyond one year not recommended «b»Metastatic«/b» Herceptin, Ogivri, Herzuma, Ontruzant, Trazimera, Kanjinti - 4 mg/kg IV over 90 min THEN, - 2 mg/kg IV over 30 min every week - Continue until disease progression «bu»Gastric Cancer«/bu» Herceptin, Ogivri, Ontruzant, Trazimera, Kanjinti - 8 mg/kg IV over 90 min THEN, - 6 mg/kg IV every 3 weeks - Infuse IV over 30-90 min, continue until disease progression «b»Dosage Modifications«/b» - Modifications required for serious adverse events, including hypersensitivity reaction (anaphylaxis), infusion reactions (fatalities), decreased left ventricular function, and pulmonary events (ARDS) «b»Infusion Reactions«/b» Mild-Moderate Infusion Reactions - Decrease infusion rate. Dyspnea, Clinically Significant Hypotension - Interrupt infusion Severe or Life-threatening Infusion Reactions - Discontinue. «b»Cardiomyopathy«/b» - Assess LVEF prior to initiation and frequently during treatment - Withhold for at least 4 weeks - ≥16% absolute decrease in LVEF from pretreatment values - LVEF below institutional limits of normal and ≥10% absolute decrease in LVEF from pretreatment values - Resume drug if, within 4-8 weeks, the LVEF returns to normal and absolute decrease from baseline is ≤15% - Permanently discontinue for a persistent (>8 weeks) LVEF decline or for suspension of drug on >3 occasions for cardiomyopathy «b»Cardiotoxicity«/b» - LVEF ≥16% decrease from baseline or LVEF below normal limits and ≥10% decrease from baseline: Withhold treatment for at least 4 weeks and repeat LVEF every 4 weeks - May resume trastuzumab treatment if LVEF returns to normal limits within 4 to 8 weeks and remains at ≤15% decrease from baseline value - Discontinue permanently for persistent (>8 weeks) LVEF decline or for >3 incidents of treatment interruptions for cardiomyopathy.

Trastuzumab Deruxtecan

Enhertu

«bu»Breast Cancer«/bu» - Do not substitute for or with trastuzumab or ado-trastuzumab emtansine - 5.4 mg/kg IV every 3 weeks (21-day cycle) until disease progression or unacceptable toxicity «b»Dose Reduction Schedule«/b» «bi»First Dose Reduction«/bi» - 4.4 mg/kg «bi»Second Dose Reduction«/bi» - 3.2 mg/kg «bi»Further Dose Reduction Required«/bi» - Discontinue treatment «b»Interstitial Lung Disease (ILD)/Pneumonitis«/b» «bi»Asymptomatic ILD/Pneumonitis (Grade 1)«/bi» - Interrupt dose until resolved to Grade 0, then maintain dose (if resolved in ≤28 days from date of onset) OR reduce dose 1 level (if resolved in >28 days from date of onset) - Consider corticosteroid treatment as soon as ILD/pneumonitis is suspected «bi»Symptomatic ILD/Pneumonitis (Grade 2 or Greater)«/bi» - Permanently discontinue; promptly initiate corticosteroid treatment as soon as ILD/pneumonitis suspected «b»Neutropenia«/b» «bi»Grade 3 (<1 to 0.5 x 109/L)«/bi» - Interrupt until resolved to Grade ≤2, then maintain dose «bi»Grade 4 (<0.5 x 109/L)«/bi» - Interrupt until resolved to Grade ≤2; reduce dose by 1 level «bi»Febrile Neutropenia H4«/bi» - ANC <1 x 109/L and temperature >38.3ºC or sustained temperature of ≥38ºC for >1 hr - Interrupt dose until resolved, then reduce to 1 dose level «b»Left Ventricular Dysfunction (LVEF)«/b» «bi»LVEF >45% and Absolute Decrease from Baseline is 10-20%«/bi» - Continue with treatment «bi»LVEF 40-45% and Absolute Decrease from Baseline is <10%«/bi» - Continue treatment; repeat LVEF assessment within 3 weeks «bi»LVEF 40-45% and Absolute Decrease from Baseline is 10-20%«/bi» - Repeat LVEF assessment within 3 weeks; permanently discontinue treatment (if LVEF has not recovered to within 10% from baseline) OR resume at the same dose (if LVEF recovers to within 10% from baseline) «bi»LVEF <40% or Absolute Decrease from Baseline is >10%«/bi» - Interrupt dose; repeat LVEF assessment within 3; if LVEF of <40% or absolute decrease from baseline of > 20% is confirmed, permanently discontinue treatment «b»Symptomatic Congestive Heart Failure (CHF)«/b» - Permanently discontinue «b»Contraception«/b» «bi»Females of Reproductive Potential«/bi» - Use effective contraception during treatment and for at least 7 months following the last dose «bi»Males with Female Partners of Reproductive Potential«/bi» - Use effective contraception during treatment and for at least 4 months following the last dose «b»Infertility«/b» - Based on findings in animal toxicity studies, may impair male reproductive function and fertility «b»Missed Dose«/b» - If a planned dose is delayed or missed, administer as soon as possible; do not wait until the next planned cycle - Adjust treatment schedule to maintain a 3-week interval between doses - Administer infusion at the dose and rate the patient tolerated in the most recent infusion

trastuzumab-Hyaluronidase

Herceptin Hylecta

«bu»Adjuvant Breast Cancer«/bu» «b»Adjuvant treatment of HER2-overexpressing Breast Cancer«/b» - In combination with doxorubicin, cyclophosphamide, and either paclitaxel or docetaxel - In combination with docetaxel and carboplatin - As a single agent following multimodality anthracycline-based therapy - 600 mg Trastuzumab-10,000 units Hyaluronidase SC every 3 weeks - Continue treatment for 52 weeks or until disease recurrence, whichever occurs first; extending treatment in adjuvant breast cancer >1 year is not recommended «bu»Metastatic Breast Cancer«/bu» - HER2-overexpressing metastatic breast cancer in combination with paclitaxel for first-line treatment or as a single agent in patients who have received ≥1 chemotherapy regimens for metastatic disease - 600 mg Trastuzumab- 10,000 units Hyaluronidase SC every 3 weeks - Continue until disease progression «b»Cardiomyopathy«/b» - Withhold dose for ≥4 weeks - ≥16% absolute decrease in left ventricular ejection fraction (LVEF) from baseline - LVEF below institutional limits of normal and ≥10% absolute decrease in LVEF from baseline - Resume if, within 4−8 weeks, LVEF returns to normal limits and absolute decrease from baseline is ≤15% «bi»Permanently Discontinue«/bi» - Persistent (>8 weeks) LVEF decline - Withheld dose on >3 occurrences for cardiomyopathy «b»Dosing Considerations«/b» - No loading dose is required - No dose adjustments for body weight or for different concomitant chemotherapy regimens are required - Do not substitute Trastuzumab-Hyaluronidase for or with Ado-Trastuzumab emtansine «b»Cardiac Monitoring«/b» - Conduct thorough cardiac assessment (eg, history, physical examination, and determination of LVEF by echocardiogram, multigated acquisition scan) - Baseline LVEF measurement immediately prior to initiation - LVEF measurements q3Months during and upon completion of treatment - Repeat LVEF measurement at 4-week intervals if dose is withheld - LVEF measurements q6Months for ≥2 yr following completion of trastuzumab/hyaluronidase as a component of adjuvant therapy «b»Patient Selection«/b» - Select patients based on an FDA-approved companion diagnostic for trastuzumab - Assess HER2 protein overexpression and HER2 gene amplification using FDA-approved tests specific for breast cancer by laboratories with demonstrated proficiency - Information on FDA-approved tests for detecting HER2 protein overexpression and HER2 gene amplification is available at: http://www.fda.gov/CompanionDiagnostics «b»Contraception«/b» - Use effective contraception during treatment and for 7 months following the last dose «b»Missed Dose«/b» - If 1 dose is missed, administer missed dose as soon as possible; interval between subsequent doses should not be <3 weeks

«bu»Pulmonary Arterial Hypertension (PAH)«/bu» «b»Injectable«/b» - Patients who require transition from epoprostenol, to reduce the rate of clinical deterioration; carefully consider the risks and benefits of each drug prior to transition - Initial Dose: 1.25 ng/kg/min continuous SC/IV infusion (0.625 ng/kg/min if not tolerated) - Initial dose should be the same as the current dose the patient is receiving using the external infusion pump at the time of transition - Titrate by no more than 1.25 ng/kg/min every week x first 4 weeks, then, - No more than 2.5 ng/kg/min every week - Little experience with doses >40 ng/kg/min «b»Oral Inhalation«/b» - Initial Dose: 18 mcg (3 breaths), per treatment session, qid; if 3 breaths not tolerated, decrease to 1-2 breaths and later increase to 3 breaths as tolerated If tolerated, increase by 3 breaths/dose (18 mcg) every 1-2Weeks - Target Maintenance: 54 mcg (9 breaths), per treatment session qid «b»Oral Tablet«/b» - Initial Dose: 0.25 mg PO bid with food, taken ~12 hr apart - Increase dose as tolerated to achieve optimal clinical response by increments or 0.25-0.5 mg bid every 3-4 days; if 0.25 mg BID dose increments are not tolerated consider titrating slower - Total daily dose can be divided and given TID with food (~8 hr apart), titrating by increments of 0.125 mg tid - Maximum Dose: Determined by tolerability; mean dose in a controlled clinical trial at 12 weeks was 3.4 mg be; maximum doses studied were 12 mg bid in the 12-week blinded study and up to 21 mg BID in an open-label long-term study - If intolerable adverse effects occur, decrease dose by 0.25 mg increments «b»Transition from SC/IV to Oral«/b» - Decrease the dose of the SC or IV treprostinil while simultaneously increasing the oral dose - The SC/IV dose can be reduced up to 30 ng/kg/min per day and the oral dose simultaneously increased up to 6 mg/day (2 mg tid) if tolerated - The following equation can be used to estimate a comparable total daily dose of oral treprostinil in mg using a patient’s dose of SC/IV treprostinil (in ng/kg/min) and weight (in kg) Oral total daily dose (mg) = 0.0072 x SC/IV dose (ng/kg/min) x weight (kg) «bu»Pulmonary Arterial Hypertension«/bu» «b»<16 years (Injectable)«/b» - Safety and efficacy not established «b»<18 years (Oral Inhalation, Tablet)«/b» - Safety and efficacy not established «b»Injectable (≥16 years)«/b» - Initial Dose: 1.25 ng/kg/min continuous SC/IV infusion (0.625 ng/kg/min if not tolerated) - Titrate by no more than 1.25 ng/kg/min every week x first 4 weeks, then no more than 2.5 ng/kg/min qWeek - Little experience with doses >40 ng/kg/min «b»Oral Inhalation (≥18 years)«/b» - Initial Dose: 18 mcg (3 breaths), per treatment session, qid; if 3 breaths not tolerated, decrease to 1-2 breaths and later increase to 3 breaths as tolerated - If tolerated, increase by 3 breaths/dose (18 mcg) every 1-2 weeks - Target Maintenance Dose: 54 mcg (9 breaths), per treatment session qid «b»Oral Tablet (≥18 years)«/b» - Initial Dose: 0.25 mg PO bid with food, taken ~12 hr apart - Increase dose as tolerated to achieve optimal clinical response by increments or 0.25-0.5 mg bid every 3-4 days; if 0.25 mg bid dose increments are not tolerated consider titrating slower - Total daily dose can be divided and given tid with food (~8 hr apart), titrating by increments of 0.125 mg tid - Maximum Dose: Determined by tolerability; mean dose in a controlled clinical trial at 12 weeks was 3.4 mg BID; maximum doses studied were 12 mg bid in the 12-week blinded study and up to 21 mg BID in an open-label long-term study - If intolerable adverse effects occur, decrease dose by 0.25 mg increments «b»Transition from SC/IV to Oral«/b» - Decrease the dose of the SC or IV treprostinil while simultaneously increasing the oral dose - The SC/IV dose can be reduced up to 30 ng/kg/min per day and the oral dose simultaneously increased up to 6 mg/day (2 mg tid) if tolerated - The following equation can be used to estimate a comparable total daily dose of oral treprostinil in mg using a patient’s dose of SC/IV treprostinil (in ng/kg/min) and weight (in kg) Oral total daily dose (mg) = 0.0072 x SC/IV dose (ng/kg/min) x weight (kg) - Avoid treatment interruptions or rapid large dosage reductions with use of inhalation, IV, or SC formulations - Immediate access to medication, a back-up inhalation device, or pump and infusion sets is essential to prevent treatment interruptions. «b»Inhalation Administration«/b» - Do not mix with other medications - For inhalation only via the Tyvaso Inhalation System - Prior to the first treatment session of each day, transfer the entire contents of one ampule into the medicine chamber; one ampule contains sufficient volume of medication for all 4 treatment sessions in a single day - Between each session, the device should be capped and stored upright with the remaining medication inside - At the end of each day, the medicine chamber and any remaining medication must be discarded - Avoid contact of solution with eyes or skin; wash hands after handling. «b»IV Infusion Administration«/b» - IV use is recommended when SC infusion is not tolerated or when the benefit outweighs the potential risks of an indwelling central venous catheter - Solution must be diluted in SWFI, NS, Remodulin sterile diluent, or Flolan sterile diluent prior to use and administered by continuous infusion using a central indwelling catheter and infusion pump - The ambulatory infusion pump should be small and lightweight; have occlusion/no delivery, low battery, programming error, and motor malfunction alarms; have ± 6% accuracy of the programmed rate; and be positive pressure driven - The reservoir should be made of polyvinyl chloride, polypropylene, or glass. Peripheral infusion may be used temporarily until central line is established - Infusion sets with an in-line 0.22 or 0.2 micron filter should be used for central and peripheral administration. «b»Oral Administration«/b» - Administer with food (minimum of 250 calories containing 30% to 50% fat) - Swallow tablets whole; do not crush, split or chew; use only intact tablets. «b»SC Infusion Administration«/b» (Preferred) - Administer undiluted via continuous SC infusion using an appropriately designed infusion pump - The ambulatory infusion pump should be small and lightweight; be able to adjust infusion rates in ~0.002 mL/hour increments; have occlusion/no delivery, low battery, programming error, and motor malfunction alarms; have ± 6% accuracy of the programmed rate; and be positive pressure driven. - The reservoir should be made of polyvinyl chloride, polypropylene, or glass. Proactively manage infusion-site reactions based on individual patient needs and by combining multiple strategies, including improved dosing strategies (more rapid dose escalation), appropriate site selection, less frequent infusion site changes (every 2 to 5 weeks, and analgesic care (pharmacologic and nonpharmacologic) when pain occurs. Rotate infusion site when patient experiences continued site pain, itching, erythema, drainage, or bleeding; decreased site pain and need for site changes or discontinuation due to site pain may be reduced in patients who are managed proactively in this manner «b»SC Reconstitution«/b» - For SC infusion, product should NOT be diluted prior to use «b»IV Reconstitution«/b» - For IV infusion, dilute in SWFI, NS, Remodulin sterile diluent, or Flolan sterile diluent to a final volume of either 50 mL or 100 mL (dependent on system reservoir and calculated dose).

Adjust dose depending upon condition being treated and response of patient. The lowest possible dose should be used to control the condition; when dose reduction is possible, the dose should be reduced gradually. «bu»Dermatoses (Steroid-Responsive)«/bu» «b»Acetonide (Kenalog-10)«/b» - 1 mg Intralesional - Initial dose varies depending on the specific disease and lesion being treated - May be repeated at weekly or less frequent intervals - Multiple sites may be injected if they are 1 cm or more apart «b»Aristospan Hexacetonide (5 mg/mL)«/b» - Intralesional, Sublesional: Up to 0.5 mg/square inch of affected skin - Dose Range: 2 to 48 mg/day «bu»Inflammatory/Allergic Conditions/Other Steroid-Responsive Systemic Conditions«/bu» «b»Acetonide (Kenalog-40)«/b» - Initial: 60 mg IM x 1 dose - Adjust dose to a range of 40 to 80 mg - For patients with hay fever or pollen asthma who are not responding to pollen administration and other conventional therapy, a single injection of 40 mg to 100 mg per season may be given. «bu»Multiple Sclerosis, Acute Exacerbation«/bu» - Treatment guidelines recommend the use of high dose IV or oral methylprednisolone for acute exacerbations of multiple sclerosis «b»Acetonide (Kenalog-40)«/b» - 160 mg IM daily for 1 week, then, - 64 mg IM every other day for 1 month. «bu»Rheumatic or Arthritic Disorders«/bu» - Intra-articular (or similar injection as designated) «b»Acetonide«/b» «bi»Intra-articular, Intrabursal, Tendon Sheaths«/bi» Smaller Joints - 2.5 to 5 mg Larger Joints - 5 to 15 mg - May require up to 10 mg for small joints and up to 40 mg for large joints - Maximum dose/treatment (several joints at one time): 80 mg «b»Zilretta Only«/b» «bi»Intra-articular«/bi» - Single Dose: 32 mg - For osteoarthritis (OA) pain of the knee only (use for OA pain of shoulder and hip have not been evaluated) - Use is not suitable for small joints (eg, hand) - Safety and efficacy of repeat administration has not been studied. «b»Hexacetonide (Aristospan 20 mg/mL)«/b» «bi»Intra-articular«/bi» - Average Dose: 2 to 20 mg - Smaller Joints (interphalangeal, metacarpophalangeal): 2 to 6 mg - Large Joints (knee, hip, shoulder): 10 to 20 mg - Frequency of injection into a single joint is every 3 to 4 weeks as necessary; to avoid possible joint destruction use as infrequently as possible. «b»Acetonide (Kenalog-40)«/b» - Initial Dose: 60 mg - Dose Range: 2.5 to 100 mg/day «bu»Pericarditis«/bu» «bi»Intrapericardial«/bi» - Off-label route - 300 mg/m2 as a single dose or 50 mg every 6 hours for 2 to 3 days - May use in conjunction with oral colchicine therapy - Administration may be painful and appropriate analgesic premedication (morphine) should be administered - Shake well before use to ensure suspension is uniform - Inspect visually to ensure no clumping; administer immediately after withdrawal so settling does not occur in the syringe - Do not administer any product IV or via the epidural or intrathecal route. «b»Kenalog-10 Injection Administration«/b» - For intra-articular or intralesional administration only - When administered intralesionally, inject directly into the lesion (intradermally or subcutaneously) - One mL syringes with a 23- to 25-gauge needle are preferable for intralesional injections. «b»Kenalog-40 Injection Administration«/b» - For intra-articular, soft tissue or IM administration - When administered IM, inject deep into the gluteal muscle using a minimum needle length of 11/2 inches for adults - Obese patients may require a longer needle - Alternate sites for subsequent injections - Avoid IM injections into deltoid area. «b»Zilretta Injection Administration«/b» - For intra-articular administration only - Do not administer IV, IM, SC, intrathecally, intraocularly, intradermally, or via epidural - Prepare suspension only using the diluent supplied in the kit (refer to manufacturer labeling for preparation instructions and administration techniques). - Promptly inject after preparation - If needed, may store suspension in the vial ≤4 hours at ambient conditions; gently swirl vial to resuspend any settled microspheres prior to preparing syringe for injection - Aspiration of synovial fluid may be performed based on clinical judgment prior to administration. «b»Intrapericardial Administration«/b» Triamcinolone Hexacetonide - Instillation of triamcinolone suspension (diluted in 100 mL of warm [37°C] NS) may be administered as a slow injection over a 7F pigtail catheter introduced after pericardiocentesis - May be painful and appropriate analgesic premedication (morphine) should be administered «b»Hexacetonide Administration«/b» - Dilute with a compatible solution prior to administration. «b»Aristospan (5 mg/mL) Administration«/b» - For intralesional or sublesional administration only - Use a ≥23-gauge needle «b»Aristospan (20 mg/mL) Administration«/b» - For intra-articular and soft tissue administration only - Use a ≥23-gauge needle «b»Hexacetonide Injectable Suspension Reconstitution«/b» - Avoid diluents containing parabens, phenol, or other preservatives (may cause flocculation) - Suspension for intralesional use may be diluted with lidocaine 1% or 2% (or similar local anesthetic), D5NS, D10NS, NS, or SWFI to a 1:1, 1:2, or 1:4 concentration - Solutions for intra-articular use, may be diluted with lidocaine 1% or 2% (or similar local anesthetics.

«bu»Chemotherapy-Induced Myelosuppression«/bu» - 240 mg/m2/dose IV completed within 4 hour before chemotherapy on each day chemotherapy is administered - Interval between doses on sequential days should not be >28 hour «b»Injection-site Reactions«/b» - Includes phlebitis and thrombophlebitis «bi»Grade 1«/bi» - Tenderness with or without symptoms (warmth, erythema, itching) - Interrupt or slow infusion - If diluent/flush was NS, consider changing to D5W for subsequent infusions «bi»Grade 2«/bi» - Pain, lipodystrophy, edema, phlebitis - Interrupt infusion - If pain not severe, follow Grade 1; otherwise, stop infusion in extremity and rotate site of infusion to alternative extremity - If diluent/flush was 0.9% NaCl, consider changing to D5W for subsequent infusions - May also consider central access «bi»Grade 3 or 4«/bi» - Stop infusion and permanently discontinue Grade 3 - Ulceration or necrosis, severe tissue damage; operative intervention indicated Grade 4 - Life-threatening consequences; urgent interventions indicated «b»Acute Drug Hypersensitivity Reactions«/b» «bi»Grade 2«/bi» - Moderate; minimal, local, or noninvasive intervention indicated; limiting activities of daily living (ADL) - Stop infusion and hold until recovery to Grade ≤1 or baseline, then consider resumption - If Grade 2 recurs, permanently discontinue «bi»Grade 3 or 4«/bi» Grade 3 - Severe or medically significant, but not immediately life-threatening; hospitalization or prolongation of hospitalization indicated; disabling; limiting self-care ADL Grade 4 - Life-threatening consequences; urgent intervention indicated - Permanently discontinue «b»Interstitial Lung Disease/Pneumonitis«/b» «bi»Grade 2 (Symptomatic)«/bi» - Hold until recover to Grade ≤1 or baseline - Consider resumption «bi»Permanently Discontinue«/bi» - Grade 2 Recurs - Grade 3: Severe symptoms; limiting self-care ADL; oxygen indicated - Grade 4: Life-threatening respiratory compromise; urgent intervention indicated (eg, tracheotomy or intubation) «b»Other Toxicities«/b» «bi»Hold Until Recovery to Grade ≤1 or Baseline«/bi» Grade 3 - Severe/medically significant but not immediately life-threatening; require hospitalization or prolonging hospital stay; disabling; limiting self-care ADL - Consider resumption «bi»Permanently Discontinue«bi» - Grade 3 recurs - Grade 4: Life-threatening consequences, urgent intervention indicated «b»Females of Reproductive Potential«/b» - Pregnancy test recommended before initiation «b»Contraception«/b» «bi»Females of Reproductive Potential«/bi» - Use effective contraception during treatment and for at least 3 weeks after final dose «b»Infertility«/b» - No studies performed - Based on animal studies, fertility may be impaired in females of reproductive potential «b»Missed Dose«/b» - Discontinue chemotherapy on day dose was missed - Consider resuming both trilaciclib and chemotherapy on next scheduled chemotherapy «b»Discontinuing Treatment«/b» - Wait 96 hr from last trilaciclib dose before resumption of chemotherapy only

«bu»Advanced or Metastatic Breast Cancer«/bu» - 300 mg PO bid in combination with trastuzumab and capecitabine - Continue until disease progression or unacceptable toxicity - Refer to the full prescribing information for trastuzumab and capecitabine for additional information «b»Dosage Modifications«/b» - Refer to the full prescribing information for trastuzumab and capecitabine for dosage modifications «b»Dose Reductions for Adverse Reactions«/b» «bi»First Dose Reduction«/bi» - 250 mg PO bid «bi»Second Dose Reduction«/bi» - 200 mg PO bid «bi»Third Dose Reduction«/bi» - 150 PO bid - Patient unable to tolerate 150 mg PO BID: Permanently discontinue «b»Diarrhea«/b» «bi»Grade 3 with Antidiarrheal Treatment«/bi» - Initiate or intensify appropriate medical therapy; hold until recovery to Grade ≤1, then resume at the same dose level «bi»Grade 3 without Antidiarrheal Therapy«/bi» - Initiate or intensify appropriate medical therapy; hold until recovery to Grade ≤1, then resume at the same dose level or at next lower dose level «bi»Grade 4«/bi» - Permanently discontinue «b»Hepatoxicity«/b» «bi»Grade 2 Bilirubin (>1.5 to 3x ULN)«/bi» - Hold until recovery to Grade ≤1, then resume at the same dose level «bi»Grade 3 ALT or AST (>5 to 20x ULN) OR Grade 3 Bilirubin (>3 to 10x ULN)«/bi» - Hold until recovery to Grade ≤1, then resume at the next lower dose level «bi»Grade 4 ALT/AST (>20x ULN) OR Grade 4 Bilirubin (>10x ULN)«/bi» - Permanently discontinue «bi»ALT/AST >3x ULN AND Bilirubin >2x ULN«/bi» - Permanently discontinue «b»Other Adverse Reactions«/b» «bi»Grade 3«/bi» - Hold until recovery to Grade ≤1, then resume at the next lower dose level «bi»Grade 4«/bi» - Permanently discontinue «bi»Strong CYP2C8 Inhibitors«/bi» - Avoid use; if combination is unavoidable, reduce tucatinib to 100 mg PO bid - After discontinuation of strong CYP2C8 inhibitor for 3 elimination half-lives, resume tucatinib dose that was taken before initiating the inhibitor «b»Pregnancy«/b» - Verify pregnancy status of females of reproductive potential before initiating «b»Contraception«/b» - Females of reproductive potential or males with female partners of reproductive potential: Use effective contraception during treatment and at least 1 week after final dose «b»Infertility«/b» - May impair male and female fertility «b»Missed or Vomited Dose«/b» - Take next dose at usual scheduled time

«b»June 1, 2022«/b» FDA approval of Ukoniq (umbralisib) is withdrawn due to safety concerns «bu»Marginal Zone Lymphoma«/bu» - 800 mg PO daily - Continue until disease progression or unacceptable toxicity «bu»Follicular Lymphoma«/bu» - 800 mg PO daily - Continue until disease progression or unacceptable toxicity «b»Missed Dose«/b» «bi»Vomited Dose«/bi» - Skip dose - Wait for next scheduled dose «bi»Missed Dose ≥12 hr from Next Dose«/bi» - Take as soon as possible «bi»Missed Dose <12 hr from Next Dose«/bi» - Skip dose - Wait for next scheduled dose «b»Dose Reduction Adverse Reactions«/b» «bi»First-dose Reduction«/bi» - 600 mg PO daily «bi»Second-dose Reduction«/bi» - 400 mg PO daily - Unable to tolerate 400 mg/day: Permanently discontinue «b»Neutropenia«/b» «bi»ANC 0.5-1 x 10^9/L«/bi» - Maintain dose - If recurs or persistent, then withhold until ANC ≥1 x 109/L, then, - Resume at same dose «bi»ANC <0.5 x 10^9/L«/bi» - Withhold until ANC ≥0.5 x 109/L, then, - Resume at same dose - If recurs, then resume at reduced dose «b»Thrombocytopenia«/b» - Platelet count 25 to <50 x 109/L with bleeding OR <25 x 109/L - Withhold until platelet count ≥25 x 109/L and bleeding resolved (if applicable), then, - Resume at same dose - If recurs, withhold until resolved, then resume at reduced dose «b»Infection«/b» - Includes opportunistic infection «bi»Grade 3 or 4 Infection«/bi» - Withhold until resolved, then resume at same or reduced dose «bi»Pneumocystis Jirovecii Pneumonia (PJP)«/bi» Suspected PJP - Withhold until evaluated Confirmed PJP - Permanently discontinue «bi»Cytomegalovirus (CMV) Infection«/bi» - Withhold until infection or viremia resolves, then, - Resume at same or reduced dose - Monitor for CMV reactivation by polymerase chain reaction or antigen test at least monthly «b»Elevated ALT/AST«/b» ALT/AST >5x to <20x ULN - Withhold until AST/ALT <3x ULN, then, - Resume at reduced dose ALT/AST >20x ULN - Discontinue «b»Diarrhea or Non-infectious Colitis«/b» Withhold until resolved, then, resume at same or reduced dose - Persistent Mild or Moderate Diarrhea (≤6 stools/day over baseline) OR - Persistent asymptomatic (Grade 1) colitis - If recurs, withhold until resolved, then resume at reduced dose Withhold until resolved, then resume at reduced dose - Severe diarrhea (>6 stools/day over baseline) OR - Abdominal pain, stool with mucus or blood, change in bowel habits, peritoneal signs Discontinue - Recurrent severe diarrhea or colitis (any grade) - Life-threatening diarrhea or noninfectious colitis «b»Severe Cutaneous Reactions«/b» «bi»Severe«/bi» - Withhold until resolved, then resume at reduced dose or discontinue - If recurs after rechallenge, discontinue «bi»Discontinue«/bi» - Life-threatening cutaneous reactions - Stevens-Johnson syndrome, toxic epidermal necrolysis, drug reaction with eosinophilia and systemic symptoms (any grade) «b»Other Adverse Reactions«/b» «bi»Severe«/bi» - Withhold until resolved, then resume at same or reduced dose «bi»Life-threatening«/bi» - Discontinue «b»Prophylaxis«/b» - Provide prophylaxis for PJP during treatment - Consider prophylactic antivirals during treatment to prevent CMV infection, including CMV reactivation «b»Pregnancy«/b» - Verify pregnancy status in females of reproductive potential before initiation

«bu»Assisted Reproductive Technologies (ART)«/bu» «b»Females«/b» - Starting on day 2 or 3 of cycle, administer 225 units SC once daily for the first 5 days - May be administered together with menotropins and the total initial dose of both products combined should not exceed 225 units (menotropins 150 units and urofollitropin 75 units; or menotropins 75 units and urofollitropin 150 units). - Adjust dose after 5 days based on ultrasound monitoring of ovarian response and measurement of serum estradiol levels. - Do not make additional adjustments more frequently than once every 2 days or by >75-150 units - Dose should be individualized - Use the lowest dose consistent with the expectation of good results - Over the course of treatment, doses may vary depending on individual patient response. «bi»Maximum Daily Dose«/bi» - 450 units (of urofollitropin, or menotropins plus urofollitropin) - Treatment >12 days is not recommended; once adequate follicular development is evident, hCG should be administered. - Withhold the hCG dose if ovarian monitoring suggests an increased risk of OHSS. «bu»Ovulation Induction«/bu» «b»Females«/b» Initial Dose - 150 units IM/SC once daily x 5 days in the first cycle of treatment Maintenance Dose - After 5 days, dose adjustments up to 75-150 units can be made every ≥2 days based on ultrasound monitoring of ovarian response and/or measurement of serum estradiol levels Maximum Daily Dose - 450 units; treatment >12 days is not recommended - If response to follitropin is appropriate, administer hCG; withhold the hCG dose if ovarian monitoring suggests an increased risk of OHSS and advise the patient to refrain from intercourse - For subsequent cycles, the starting dose and dosage adjustments should be determined based on historical ovarian response. «bu»Spermatogenesis«/bu» - Pretreat with hCG until serum testosterone is in normal range - Administer 150 units follitropin 3 times/week with hCG 3 times/week - Continue with lowest dose needed to stimulate spermatogenesis - Not to exceed 300 units 3 times/week - May administer for up to 18 months

Ursodiol

Actigall, Urso 250, Urso Forte

- Do not administer with aluminum-based antacids or bile acid sequestrants - If aluminum-based antacids are needed, administer 2 hours after ursodiol; administer ursodiol 5 hours or more after bile acid sequestrants - Urso Forte can be split into halves for appropriate dosage; do not chew. - Urso and Urso Forte should be taken with food «b»Oral Suspension (60 mg/mL) Preparation«/b» - A 60 mg/mL ursodiol oral suspension may be made with capsules - Empty the contents of twelve 300 mg capsules into a mortar - Add small portions of glycerin and mix to a uniform paste; mix while adding simple syrup in incremental proportions to almost 60 mL; transfer to a calibrated bottle, rinse mortar with vehicle, and add quantity of vehicle sufficient to make 60 mL - Label "shake well" and "refrigerate" - Stable for 35 days refrigerated «b»Oral Suspension (20 mg/mL) Preparation«/b» - A 20 mg/mL ursodiol oral suspension may be made with capsules and either a 1:1 mixture of Ora-Sweet and Ora-Plus or a 1:1 mixture of methylcellulose 1% and syrup NF. Empty the contents of seventeen 300 mg capsules into a mortar. Add small portions of the chosen vehicle and mix to a uniform paste; mix while adding the vehicle in incremental proportions to almost 255 mL; transfer to a calibrated bottle, rinse mortar with vehicle, and add quantity of vehicle sufficient to make 255 mL. Label "shake well" and "refrigerate". Stable for 91 days refrigerated «b»Oral Suspension (25 mg/mL) Preparation«/b» - A 25 mg/mL ursodiol oral suspension may be made with capsules. Empty the contents of ten 300 mg capsules into a mortar; add 10 mL Glycerin, USP and mix until smooth. Mix while adding 60 mL Ora-Plus; transfer mixture to a light-resistant bottle, rinse mortar with a small amount of Orange Syrup, NF, and add quantity of syrup sufficient to make 120 mL. Label "shake well". Stable for 60 days at room temperature or refrigerated «b»Oral Suspension (50 mg/mL) Preparation«/b» - A 50 mg/mL ursodiol oral suspension may be made with tablets and 60 mL of either a 1:1 mixture of Ora-Plus and strawberry syrup or a 1:1 mixture of Ora-Plus and Ora-Sweet SF. Crush twelve 250 mg tablets in a mortar and reduce to a fine powder. Add small portions of the chosen vehicle and mix to a uniform paste; mix while adding the vehicle in incremental proportions to almost 60 mL; transfer to a calibrated bottle, rinse mortar with vehicle, and add quantity of vehicle sufficient to make 60 mL. Label "shake well" and "refrigerate". Stable for 90 days refrigerated (Johnson 2002).

Ustekinumab

Stelara

ValACYclovir

Valtrex

«bu»Herpes Labialis (Cold Sores)«/bu» - 2 g PO every 12 hours for 1 day «b»HIV-Infected Patients«/b» - 1 g PO bid for 5 to 10 days «bu»Herpes Zoster (Shingles)«/bu» - 1 g PO tid 7 days «b»HIV-Infected Patients, Acute Localized Dermatomal«/b» - 1 g 3 PO tid 7 to 10 days - Consider longer duration if lesions resolve slowly «bu»Herpes Simplex Virus (HSV), Genital Infection«/bu» «b»Initial Episode«/b» - 1 g PO bid x 10 days «b»Recurrent Episode«/b» - 500 mg PO bid x 3 days or 1,000 mg PO daily x 5 days «b»Reduction of Transmission«/b» - 500 mg PO daily (source partner) «b»Suppressive Therapy«/b» - 1 g PO daily - 500 mg PO daily in patients with ≤9 recurrences per year - Safety and efficacy have been documented for up to 1 year «b»HIV-Infected Patients (CD4 ≥100 cells/mm3)«/b» - 500 mg PO bid «bi»Initial or Recurrent Episodes«/bi» - 1 g twice daily for 5 to 10 days «bi»Chronic Suppressive Therapy«/bi» - 500 mg PO bid - Continue indefinitely regardless of CD4 count in patients with severe recurrences or in patients who want to minimize frequency of recurrences «bu»CMV Reactivation«/bu» - Prevention in allogeneic HSCT recipients - 2 g PO tid or qid in combination with screening for CMV reactivation - Begin at engraftment and continue to day 100 «bu»HSV Keratitis«/bu» «b»Epithelial Keratitis, Dendritic«/b» - 500 mg PO bid x 7 to 10 days «b»Epithelial Deratitis, Geographic«/b» - 1 g 3 PO tid x 14 to 21 days «bu»Stromal Keratitis«/bu» «b»Without Epithelial Ulceration«/b» - 500 mg PO daily, use in combination with therapeutic dose of topical corticosteroid, for the duration of corticosteroid treatment «b»With Epithelial Ulceration«/b» - 1 g 3 PO tid x 7 to 10 days, then reduce to 500 mg once daily; use in combination with therapeutic dose of topical corticosteroid, for the duration of corticosteroid treatment «bu»Endothelial Keratitis«/bu» - 500 mg PO bid x 7 to 10 days, then, - Reduce to 500 mg once daily - Use in combination with therapeutic dose of topical corticosteroid, for the duration of corticosteroid treatment. «bu»HSV Reactivation«/bu» - Prevention in seropositive HSCT recipients «b»Early Reactivation«/b» - 500 mg PO daily or 500 mg PO bid in highly immune-suppressed patients (eg, T cell depletion, anti-T cell antibodies, high-dose steroids) - Initiate at the beginning of conditioning therapy and continue until engraftment or until mucositis resolves «b»Late Reactivation«/b» - 500 mg PO bid «bu»Varicella (Chickenpox)«/bu» «b»HIV-infected patients«/b» - 1 g PO tid x 5 to 7 days in uncomplicated cases «bu»Varicella Zoster Virus (VZV)«/bu» «b»Acute retinal necrosis (ARN) in HIV-infected patients«/b» - 1 g PO tid x 6 weeks following initial treatment with acyclovir IV and intravitreal ganciclovir «b»VZV, Postexposure Prophylaxis (HSCT recipients)«/b» - 1 g PO tid, initiate within 96 hours (preferably, 48 hours) of exposure and continue until 22 days after exposure «b»VZV reactivation (prevention in HSCT recipients)«/b» - 500 mg PO bid x 1 year after HSCT

«bu»Complex Partial Seizures«/bu» - Indicated as monotherapy and adjunctive therapy for complex partial seizures that occur either in isolation or in association with other types of seizures «b»Valproate Sodium«/b» - 10-15 mg/kg/day IV divided every 12 hr infused over 1 hr - Maximum Dose: 60 mg/kg/day - Do not exceed 14 days (switch to PO as soon as possible) - Initial Dose: 10-15 mg/kg PO daily - May increase by 5-10 mg/kg/day PO at weekly intervals - May increase dose up to 60 mg/kg/day «b»Delayed Release Formulations«/b» - Usually administered at the same daily dose and frequency (bid/qid) as the regular release when converting from regular release to delayed release - Once therapy is stabilized, the frequency of the delayed release formulation is adjusted to bid/tid «b»Extended Release Formulation«/b» - Usually administered once daily in patients who convert from either regular or delayed release formulations - May require an increase in total daily dose between 8-20% to maintain similar serum concentrations «b»Conversion to Monotherapy from Adjunctive Therapy«/b» - Decrease concomitant antiepileptic drug (AED) by approximately 25% q2wk; may reduce dosage of concomitant AED when valproate therapy is initiated or 1 to 2 weeks following valproate initiation «bu»Simple & Complex Absence Seizures«/bu» - Indicated as sole and adjunctive therapy in the treatment of simple and complex absence seizures, and adjunctively in patients with multiple seizure types that include absence seizures «b»Valproate Sodium«/b» - 10-15 mg/kg/day IV divided every 12 hr infused over 1 hr - Maximum Dose 60 mg/kg/day - Do not exceed 14 days (switch to PO as soon as possible) «b»Depakene, Stavzor«/b» - 15 mg/kg/day PO initially, divided every 6-12 hr - Increase by 5-10 mg/kg/day at weekly intervals - May increase dose up to 60 mg/kg/day «b»Delayed Release Formulations«/b» - Usually administered at the same daily dose and frequency (bid/qid) as the regular release when converting from regular release to delayed release; once therapy is stabilized, the frequency of the delayed release formulation is adjusted to bid/tid «b»Extended Release Formulations«/b» - Usually administered once daily in patients who convert from either regular or delayed release formulations; may require an increase in total daily dose between 8-20% to maintain similar serum concentrations «b»Conversion to Monotherapy from Adjunctive Therapy«/b» - Decrease concomitant antiepileptic drug (AED) by approximately 25% q2wk; may reduce dosage of concomitant AED when valproate therapy is initiated or 1 to 2 weeks following valproate initiation «bu»Migraine Prophylaxis«/bu» «b»Stavzor«/b» - 250 mg PO every 12 hr - Adjust dose based on clinical response - Not to exceed 1000 mg/day «b»Depakote ER«/b» - 500 mg PO daily for 7 days - Based on patient response, may increase and adjust dose to 500-1000 mg/day «bu»Bipolar Mania«/bu» - Indicated for treatment of manic episodes associated with bipolar disorder «b»Stavzor«/b» - 750 mg/day PO in divided doses - Adjust dose as rapidly as possible to desired therapeutic effect - Not to exceed 60 mg/kg/day «b»Depakote ER«/b» - 25 mg/kg/day PO daily - Adjust dose to desired clinical effect, as rapidly as possible - Not to exceed 60 mg/kg/day «bu»Complex Partial Seizures«/bu» - Indicated as monotherapy and adjunctive therapy for complex partial seizures that occur either in isolation or in association with other types of seizures «b»<10 years«/b» - Safety and efficacy not established «b»Valproate Sodium«/b» - 10-15 mg/kg/day IV divided every 12 hr infused over 1 hr - Maximum Dose 60 mg/kg/day - Do not exceed 14 days (switch to PO as soon as possible) «b»Depakene or Stavzor«/b» - Initial Dose: 10-15 mg/kg PO daily - Increase by 5-10 mg/kg/day at weekly intervals - May increase dose up to 60 mg/kg/day «b»Delayed Release Formulations«/b» - Usually administered at the same daily dose and frequency (BID/QID) as the regular release when converting from regular release to delayed release; once therapy is stabilized, the frequency of the delayed release formulation is adjusted to BID/TID «b»Extended Release Formulation«/b» - Usually administered once daily in patients who convert from either regular or delayed release formulations; may require an increase in total daily dose between 8-20% to maintain similar serum concentrations «bu»Simple & Complex Absence Seizures«/bu» - Indicated for use as sole and adjunctive therapy in the treatment of simple and complex absence seizures, and adjunctively in patients with multiple seizure types that include absence seizures «b»<10 years«/b» - Safety and efficacy not established «b»Valproate Sodium«/b» - 10-15 mg/kg/day IV divided every 12 hr infused over 1 hr - Maximum Dose: 60 mg/kg/day - Do not exceed 14 days (switch to PO as soon as possible) «b»Stavzor«/b» - 250 mg PO every 12hr - Adjust dose based on clinical response up to 1000 mg/day «b»Delayed Release Formulations«/b» - Usually administered at the same daily dose and frequency (BID/QID) as the regular release when converting from regular release to delayed release; once therapy is stabilized, the frequency of the delayed release formulation is adjusted to BID/TID «b»Extended Release Formulations«/b» - Usually administered once daily in patients who convert from either regular or delayed release formulations; may require an increase in total daily dose between 8-20% to maintain similar serum concentrations

Vandetanib

Caprelsa, Zactima, Zictifa

«bu»Thyroid Cancer«/bu» «b»Medullary«/b» - Locally advanced or metastatic - 300 mg PO daily - Continue until disease progression or unacceptable toxicity - Do not initiate treatment unless QTcF <450 msec - Avoid concomitant use of QT-prolonging agents and strong CYP3A4 inducers - To reduce the risk of QT prolongation, maintain serum calcium and magnesium within normal limits and maintain serum potassium ≥4 mEq/L. «b»Missed Dose«/b» - Missed doses should be omitted if within 12 hours of the next scheduled dose. «b»Toxicity ≥ Grade 3«/b» - Interrupt dose until resolves or improves to grade 1, then resume at a reduced dose «b»Dosage Reduction«/b» - Reduce from 300 mg once daily to 200 mg once daily, further reduce if needed to 100 mg once daily - For recurrent toxicities, reduce dose to 100 mg once daily after symptom improvement to ≤ grade 1 toxicity, if continued treatment is warranted. «b»Management of Specific Toxicities«/b» «bi»Cardiac: QTcF >500 msec«/bi» - Withhold dose until QTcF returns to <450 msec, then resume at a reduced dose «b»Dermatologic Toxicity«/b» - Withhold treatment for dermatologic toxicity of grade 3 or higher - Consider a reduced dose or permanent discontinuation upon improvement in symptoms. - Permanently discontinue for severe dermatologic toxicity; may require systemic corticosteroid therapy. «b»Diarrhea (Severe)«/b» - Withhold treatment until resolution. Dose reduction is recommended when treatment is resumed - Closely monitor electrolytes and ECGs to detect QT prolongation resulting from dehydration. «b»Heart Failure«/b» - May require discontinuation. «b»Hemorrhage (Severe)«/b» - Discontinue. «b»Hypertension«/b» - Initiate or adjust antihypertensive therapy as needed; may require vandetanib dosage adjustment or treatment interruption; discontinue permanently if blood pressure cannot be adequately controlled. «b»Interstitial Lung Disease (ILD)/Pneumonitis«/b» - Interrupt therapy for acute or worsening pulmonary symptoms - Discontinue if ILD diagnosis is confirmed. «b»Ischemic Cerebrovascular Events (severe)«/b» - Discontinue treatment «b»Reversible posterior leukoencephalopathy syndrome (RPLS)«/b» - Discontinue treatment.

«bu»Diabetes Insipidus«/bu» - Dosage is highly variable; titrated based on serum and urine sodium and osmolality in addition to fluid balance and urine output - Use of vasopressin is impractical for chronic therapy. - 5 to 10 units IM/SC 2 to 4 times daily as needed «b»Continuous IV Infusion«/b» - Continuous infusion has not been formally evaluated in the post-neurosurgical adult. However, some convert IM/SubQ requirement to an hourly continuous IV infusion rate. «bu»Vasodilatory Shock«/bu» - Dosage provided is empirical - Titrate to lowest dose compatible with an acceptable response. «bu»Post-Cardiotomy Shock«/bu» - Initial Dose: 0.03 units/min - If the target blood pressure response is not achieved, titrate up by 0.005 units per minute at 10- to 15-minute intervals (maximum dose: 0.1 units per minute) - After target blood pressure has been maintained for 8 hours without the use of catecholamines, taper by 0.005 units per minute every hour as tolerated to maintain target blood pressure. «bu»Septic Shock«/bu» - Initial Rate: ≤0.03 units/min added to norepinephrine to raise MAP to target or to decrease norepinephrine dose - Use with caution in patients who are not euvolemic or at doses >0.03 units/ minute - Initial Rate: 0.01 units/min - If the target blood pressure response is not achieved, titrate up by 0.005 units/min at 10- to 15-minute intervals - Maximum Dose: 0.07 units/min. After target blood pressure has been maintained for 8 hours without the use of catecholamines, taper by 0.005 units per minute every hour as tolerated to maintain target blood pressure. «b»Discontinuation«/b» - If vasopressin is used concurrently with other catecholamines (norepinephrine), patients may experience hypotension if vasopressin is discontinued first. - To prevent subsequent hypotension after withdrawal of vasopressors, some experts recommend slowly tapering vasopressin (eg, reducing by 0.01 units per minute every 30 minutes) after the catecholamine(s) are discontinued until no longer required. «bu»Cadaveric Organ Donation (Hormonal Resuscitation)«/bu» - Initial Dose: 1 unit IV bolus x 1 dose, then, - 0.5 to 4 units/hour continuous IV infusion administered to the brain-dead donor who is hemodynamically unstable requiring significant vasopressor support - Titrate to SVR of 800 to 1200 dynes-sec/cm5; give concomitantly with levothyroxine or liothyronine (preferred), methylprednisolone, and continuous regular insulin infusion «bu»Central Diabetes Insipidus, Post-Traumatic«/bu» - Initial Rate: 2.5 units/hour - Titrate to adequately reduce urine output «bu»Gastroesophageal Variceal Hemorrhage«/bu» «b»Continuous IV Infusion«/b» - Initial Rate: 0.2 to 0.4 units/min - May titrate dose as needed to a maximum dose of 0.8 units/min - Maximum Duration: 24 hours at highest effective dose continuously (to reduce incidence of adverse effects) - Patient should also receive IV nitroglycerin concurrently to prevent myocardial ischemic complications. Monitor closely for signs/symptoms of ischemia (myocardial, peripheral, bowel)

«bu»Melanoma, Metastatic or Unresectable«/bu» «b»BRAF V600E Mutation«/b» - 960 mg PO every 12 hours - Continue until disease progression or unacceptable toxicity. «b»BRAF V600K mutation«/b» - 960 mg every 12 hours - Continue until disease progression or unacceptable toxicity «b»BRAF V600E or V600K mutations«/b» - 960 mg every 12 hours (in combination with cobimetinib) - Continue until disease progression or unacceptable toxicity «bu»Non-Small Cell Lung Cancer, Refractory«/bu» «b»BRAF V600E Mutation«/b» - 960 mg twice daily «bu»Erdheim-Chester Disease«/bu» «b»BRAF V600E Mutation«/b» - 960 mg PO every 12 hours - Continue until disease progression or unacceptable toxicity. «b»Missed Doses«/b» - A missed dose may be taken up to 4 hours prior to the next scheduled dose - If it is within 4 hours of the next scheduled dose, administer the next dose at the regular schedule - If vomiting occurs after a dose is taken, do not take an additional dose; continue with the next scheduled dose. «b»Strong CYP3A4 Inducers«/b» «bi»Carbamazepine, Phenytoin, Rifampin«/bi» - Avoid concomitant use of strong CYP3A4 inducers - If concomitant use cannot be avoided, increase the vemurafenib dose by 240 mg as tolerated. After the strong CYP3A4 inducer has been discontinued for 2 weeks, resume the vemurafenib dose that was used prior to initiating the CYP3A4 inducer. - Do not dose reduce below 480 mg twice daily «b»Grade 1 or Grade 2 (tolerable) Toxicity«/b» - No dosage adjustment recommended. «b»Grade 2 (Intolerable) or Grade 3 Toxicity«/b» «bi»First Incident«/bi» - Interrupt treatment until toxicity returns to grade 0 or 1, then resume at 720 mg twice daily «bi»Second Incident«/bi» - Interrupt treatment until toxicity returns to grade 0 or 1, then resume at 480 mg twice daily «bi»Third Incident«/bi» - Discontinue permanently. «b»Grade 4 Toxicity«/b» «bi»First Incident«/bi» - Interrupt treatment until toxicity returns to grade 0 or 1, then resume at 480 mg twice daily or discontinue permanently «bi»Second Incident«/bi» - Discontinue permanently. «b»Specific Toxicities«/b» «bi»New primary Cutaneous Malignancies«/bi» - No dosage adjustment recommended. «bi»Severe Hypersensitivity or Severe Dermatologic Toxicity«/bi» - Discontinue permanently. «bi»QTc Interval Changes«/bi» QTc >500 msec (Grade ≥3) - Temporarily withhold treatment, correct electrolytes and control risk factors for QT prolongation; may reinitiate with a dose reduction once QTc ≤500 msec (≤ grade 2). QTc Persistently >500 msec and >60 msec above Baseline - Discontinue permanently.

Venetoclax

Venclexta

«bu»Chronic Lymphocytic Leukemia (CLL)«/bu» «b»Relapsed/Refractory,17p Deletion«/b» - Escalate dose in weekly increments over 5 weeks to gradually debulk and reduce the risk of TLS: - Week 1: 20 mg once daily - Week 2: 50 mg once daily - Week 3: 100 mg once daily - Week 4: 200 mg once daily - Week 5 and thereafter: 400 mg once daily; continue until disease progression or unacceptable toxicity - Assess risk for Tumor Lysis Syndrome (TLS); administer prophylactic hydration and antihyperuricemics. «b»Premedications: Low Tumor Burden«/b» - All lymph nodes <5 cm and absolute lymphocyte count [ALC] <25,000/mm3 - Outpatient - Hydrate with 1.5 to 2 L of oral hydration and administer allopurinol (beginning 2 to 3 days prior to venetoclax initiation - Administer IV hydration for patients unable to tolerate oral hydration. «b»Premedications: Medium Tumor Burden«/b» - Any lymph node 5 to <10 cm or ALC ≥25,000/mm3 - Outpatient - Hydrate with 1.5 to 2 L of oral hydration (administer IV hydration for patients unable to tolerate oral hydration; consider additional IV hydration) and administer allopurinol (beginning 2 to 3 days prior to venetoclax initiation). «b»Premedications: High Tumor Burden«/b» - Any lymph node ≥10 cm OR ALC ≥25,000/mm3 and any lymph node ≥5 cm - Inpatient - Hydrate with 1.5 to 2 L of oral hydration (administer IV hydration for patients unable to tolerate oral hydration) and 150 to 200 mL/hour IV hydration as tolerated; administer allopurinol (beginning 2 to 3 days prior to venetoclax initiation) - Consider rasburicase if baseline uric acid is elevated. «b»Strong CYP3A Inhibitors«/b» - The use of strong CYP3A inhibitors is contraindicated at initiation of venetoclax and during dose escalation - For patients who have completed dose escalation and are on a steady daily venetoclax dose, reduce the venetoclax dose by at least 75% when a strong CYP3A inhibitor must be used concurrently. «b»Moderate CYP3A inhibitors and P-gp Inhibitors«/b» - Avoid concomitant use of venetoclax with moderate CYP3A and P-gp inhibitors (consider alternative treatments) - If concurrent use cannot be avoided, reduce the venetoclax dose by at least 50%. - Following discontinuation of the CYP3A or P-gp inhibitor: 2 to 3 days after the inhibitor is discontinued, resume the venetoclax dose that was used prior to initiating the CYP3A or P-gp inhibitor. «b»Interrupt or Reduce Dose for Toxicities«/b» - Reassess risk for tumor lysis syndrome in patients who have had an interruption in dosing of >1 week during the first 5 weeks or >2 weeks at 400 mg once daily (to determine if re-initiation with a reduced dose is necessary). «b»Tumor Lysis Syndrome (TLS)«/b» - Blood chemistry changes or symptoms suggestive of TLS: Withhold the next day's dose. - If resolved within 24 to 48 hours of the last dose: Resume at the same dose. - If blood chemistry changes require more than 48 hours to resolve: Resume at a reduced dose. «b»Clinical TLS«/b» - Laboratory TLS with clinical consequences such as acute renal failure, cardiac arrhythmias, sudden death, and/or seizure: Withhold dose; following resolution, resume at a reduced dose. «b»Hematologic Toxicity«/b» - Grade 3 or 4 neutropenia with infection or fever or grade 4 hematologic toxicities (except lymphopenia): «bi»First Occurrence«/bi» - Interrupt treatment. May administer granulocyte-colony stimulating factors (G-CSFs) with venetoclax to reduce infection risk associated with neutropenia. May resume at the same dose once toxicity is resolved to grade 1 or baseline. «bi»Second and Subsequent Occurrences«/bi» - Interrupt treatment. Consider G-CSFs as clinically indicated. Resume at a lower dose level once toxicity is resolved (see dosage reduction levels in above table; a larger dose reduction may be necessary based on clinical discretion). «b»Nonhematologic Toxicities, Grade 3 or 4 Toxicity«/b» «bi»First Occurrence«/bi» - Interrupt treatment. May resume at the same dose once toxicity is resolved to grade 1 or baseline (no dosage adjustment is necessary). «bi»Second and Subsequent Occurrences«/bi» - Interrupt treatment. Resume at a lower dose level once toxicity is resolved (see dosage reduction levels in above table; a larger dose reduction may be necessary based on clinical discretion).

Venlafaxine

Effexor, Effexor XR

Verapamil

Verelan, Calan, Iproveratril Hydrochloride

«bu»Angina«/bu» «b»Immediate Release«/b» - Initial Dose: 80 mg PO every 8 hr - Usual Range: 80-120 mg PO every 8 hr - Maximum Dose: 480 mg/day «b»Extended Release«/b» «bi»Covera-HS«/bi» - Initial Dose: 180 mg/day PO at bedtime - Maintenance Dose: 180-540 mg/day PO at bedtime «bu»Hypertension«/bu» «b»Immediate Release«/b» - Initial Dose: 80 mg PO every 8 hr - Maintenance Dose: 80-320 mg PO every 12 hr «b»Extended Release«/b» «bi»Calan, Isoptin SR«/bi» - 180 mg/day PO given in morning (120 mg/day initially if patient elderly or of small stature); for desired response - May be increased to 240 mg/day, then to 360 mg/day (either 180 mg every 12 hr or 240 mg in morning and 120 mg in evening) «bi»Verelan«/bi» - 180 mg/day PO (120 mg/day initially if patient elderly or of small stature); for desired response, may be increased to 240 mg/day PO, then by 120 mg/day at weekly intervals - Maximum Dose: 480 mg/day «bi»Verelan PM«/bi» - 200 mg/day PO at bedtime (100 mg/day if patient elderly or of small stature) - May be increased by 100 mg/day at weekly intervals as needed - Maximum Dose: 400 mg/day «bi»Covera-HS«/bi» - 180 mg/day PO at bedtime (120 mg/day initially if patient elderly or of small stature); for desired response - May be increased to 240 mg/day, then by 120 mg/day at weekly intervals - Maximum Dose: 480 mg/day «bu»Supraventricular Arrhythmia & Atrial Fibrillation/Flutter«/bu» - 2.5-5 mg IV over 2 minutes - 5-10 mg IV dose may be repeated after 15-30 minutes Alternatively, 0.075-0.15 mg/kg (not to exceed 10 mg) IV over 2 minutes; dose may be repeated once 30 minutes after first dose «bu»Chronic Atrial Fibrillation & Paroxysmal Supraventricular Tachycardia«/bu» - Treatment of chronic atrial fibrillation (rate control) - Prevention of paroxysmal supraventricular tachycardia «b»Immediate Release«/b» - 240-480 mg/day PO divided q6-8hr «bu»Tardive Dyskinesia«/bu» - 40 mg PO every 8 hr - May be titrated to 120 mg every 8 hr «bu»Migraine«/bu» «b»Prophylaxis«/b» - 160-320 mg PO every 6-8 hr

VinCRIStine (Conventional)

Vincasar, Oncovin, Leurocristine

VinCRIStine (Liposomal)

Marqibo

Vinorelbine

Navelbine

Vismodegib

Erivedge

Vitamin A

AFirm, Aquasol A, Oleovitamin A, Retinol, Retinyl Acetate, Retinyl Palmitate

«bu»von Willebrand Disease«/bu» «b»Control Bleeding Episodes«/b» - Indicated for on-demand treatment and control of bleeding episodes in adults with von Willebrand disease (VWD) «bi»Minor Hemorrhage«/bi» - Epistaxis (readily managed), menorrhagia, oral bleeding - Initial Dose: 40 to 50 units/kg - Maintenance Dose: 40 to 50 units/kg every 8 to 24 hours (as clinically required) - Adjust dose based on location and extent of bleeding. «bi»Major Hemorrhage«/bi» - CNS trauma, epistaxis (severe or refractory), GI bleeding, hemarthrosis, menorrhagia, traumatic hemorrhage - Initial Dose: 50 to 80 units/kg - Maintenance Dose: 40 to 60 units/kg every 8 to 24 hours for ~ 2 to 3 days - Adjust dose based on location and extent of bleeding - Maintain trough levels of VWF:RCo >50% «b»Calculating Dose of Recombinant Factor VIII (if needed)«/b» - Initial dose of von Willebrand factor (rVWF) should achieve >60% of vWF levels (based on vWF:RCo >0.6 IU/mL) and an infusion of recombinant factor VIII (rFVIII) should achieve factor VIII levels >40% (FVIII:C >0.4 IU/mL) - Administer rVWF with rFVIII if required, to control bleeding - Dosing should be at a ratio of 1.3:1 (ie, 30% more rVWF than rFVIII, based on the approximate mean recoveries to 1.5 and 2 IU/dL for rVWF and rFVIII, respectively) - Administer complete dose of rVWF followed by rFVIII within 10 minutes rVWF dose = dose (IU/kg) x weight (kg) rFVIII dose = rVWF dose divided by 1.3 «b»Perioperative Bleeding«/b» - Indicated for perioperative management of bleeding in adults with VWD «b»Elective Surgical Procedures«/b» - rVWF dose may be given 12-24 hr prior to surgery to allow the endogenous factor VIII levels to increase to at least 30 IU/dL (minor surgery) or 60 IU/dL (major surgery) - If FVIII:C levels are at or above the recommended minimum target levels, administer rVWF alone (without factor VIII treatment) within 1 hr prior to procedure - If FVIII:C level is below recommended minimum target level, administer complete rVWF dose followed by recombinant factor VIII within 10 min - Assess baseline VWF:RCo levels within 3 hr of administration of the 12-24 hr preoperative dose - If 12-24 hr preoperative dose is not administered, then assess baseline level VWF:RCo prior to surgery - When possible, measure incremental recovery (IR) before surgery «b»Emergency Surgery«/b» - In emergency surgery, a 12-24 hr preoperative dose in subjects requiring emergency surgery - Assess baseline VWF:RCo and FVIII:C levels within 3 hr prior to initiating the surgical procedure if it is feasible - Loading dose (1 hr preoperative dose): Calculate as the difference in the target peak and baseline plasma VWF:RCo levels divided by the IR - If baseline VWF:RCo and FVIII:C is not available, loading dose (1 hr preoperative dose) of rvWF 40-60 IU/kg VWF:RCo - Additionally, recombinant factor VIII at a dose of 30-45 IU/kg may be infused sequentially, preferably within 10 min after rvWF infusion in patients whose factor VIII plasma levels already are (or are highly likely to be) <40 to 50 IU/dL (minor surgery) or 80-100 IU/dL (major surgery) «b»Calculation of rvWF Dose«/b» «bi»Difference Plasma VWF:RCo«/bi» - Target peak plasma VWF:RCo – baseline plasma VWF:RCo Difference plasma VWF:RCo x body weight [BW] (kg) divided by incremental recovery as measured in the subject (if IR is not available, assume IR of 2.0 IU/dL per IU/kg) «bi»Recommended BW Based Dosing in the Absence of Baseline FVIII:C, VWF:RCo and Incremental Recovery«/bi» - VWF:RCo: 25-30 IU/kg (minor); 50±10 IU/kg (major) - FVIII:C: 20-25 IU/kg (minor); 40-50 IU/kg (major) - Frequency dosing range between BID and q48hr «bi»Recommended Target Peak Plasma Levels for the Perioperative Management of Bleeding«/bi» - VWF:RCo target peak plasma level: 50-60 IU/dL (minor); 100 IU/dL (major) - FVIII:C target peak plasma level: 40-50 IU/dL (minor); 80-100 IU/dL (major) - Monitor VWF:RCo and FVIII:C plasma levels starting 12-24 hr after surgery and at least q24hr in the perioperative period - Individualize intra- and postoperative maintenance regimen according to the pharmacokinetic results and intensity and duration of the hemostatic challenge «bi»Recommended Target Trough Plasma Levels and Minimum Duration of Treatment«/bi» - VWF:RCo target trough plasma level (≤72 hr post-surgery): ≥30 IU/dL (minor); >50 IU/dL (major) - VWF:RCo target trough plasma level (>72 hr post-surgery): >30 IU/dL (major) - FVIII:C target tough plasma level (≤72 hr post-surgery): >30 IU/dL (minor); >50 IU/dL (major) - FVIII:C target trough plasma level (>72 hr post-surgery): >30 IU/dL (major) Minimum duration of treatment: 48 hr (minor surgery); 72 hr (major surgery) - Frequency of dosing: q12-24hr to every other day

von Willebrand Factor Complex

Alphanate, Humate-P, Wilate, Antihemophilic Factor-VIII

«b»Oral Administration«/b» - Administer 1 hour before or 1 hour after a meal - Shake oral suspension for approximately 10 seconds before each use - Enteral tube feedings may decrease oral absorption; may hold tube feedings for 1 hour before and 1 hour after a voriconazole dose «b»IV Administration«/b» - Infuse over 1 to 2 hours (rate not to exceed 3 mg/kg/hour) - Do not administer as an IV bolus injection - Do not infuse concomitantly into same line or cannula with other drug infusions. - Do not infuse concomitantly even in separate lines or cannulas with concentrated electrolyte solutions or blood products - May be infused simultaneously with nonconcentrated electrolytes or TPN through a separate IV line. - If TPN is infused through a multiple lumen catheter, use a different port than used for voriconazole. «b»Intravitreal Administration«/b» - Administer an extemporaneously prepared solution of 100 mcg/0.1 mL of voriconazole in sterile water or NS intravitreally «b»Ophthalmic Administration«/b» - Administer an extemporaneously prepared voriconazole 10 mg/mL (1%) ophthalmic solution to the affected eye. «b»IV Reconstitution«/b» - Powder for injection: Reconstitute 200 mg vial with 19 mL of SWFI (use of automated syringe is not recommended) - Resultant solution (20 mL) has a concentration of 10 mg/mL - Prior to infusion, must dilute to <5 mg/mL with NS, LR, D5WLR, D5W1/2NS, D5W, D5W with KCl 20 mEq, 1/2NS, or D5WNS - Do not dilute with 4.2% sodium bicarbonate infusion. «b»Oral Suspension Preparation«/b» - Powder for oral suspension: Add 46 mL of water to the bottle to make 40 mg/mL suspension. - Shake vigorously for ~1 minute. Do not refrigerate or freeze. «b»Ophthalmic Solution Preparation«/b» - A 1% ophthalmic solution may be made using voriconazole powder for solution for intravenous infusion - Aseptically reconstitute 200 mg voriconazole powder with 19 mL of sterile water for injection or with sterile water for injection containing 0.01% benzalkonium chloride solution to obtain 20 mL of a 10 mg/mL (1%) solution. - Follow with sterile filtration through a 0.22 micron filter. Package in a sterile container for use as an eye drop solution. - Stability of the 1% solution prepared with sterile water for injection was demonstrated for up to 30 days. Protection from light and refrigeration did not have an effect on stability. - Stability of the 1% solution prepared with sterile water for injection containing 0.01% benzalkonium chloride solution and stored under refrigeration (2°C to 8°C [36°F to 46°F]) and in an amber high-density polyethylene (HDPE) eye drop bottle was demonstrated for up to 14 weeks «b»Hazardous Agent«/b» - Use appropriate precautions for handling and disposal

«bu»Deep VeinsThrombosis (DVT), Pulmonary Embolism (PE)«/bu» «b»Initial Dose«/b» - 2-5 mg PO/IV daily for 2 days or - 10 mg PO for 2 days in healthy individuals - Initiate warfarin on day 1 or 2 of LMWH or unfractionated heparin therapy and overlap until desired INR, then, discontinue heparin «b»Maintenance Dose«/b» - Check INR after 2 days and adjust dose according to results - Overlap warfarin and parenteral anticoagulant for at least 5 days until desired INR (>2.0) maintained for 24 hours, then discontinue parenteral therapy - Typical maintenance dose ranges between 2 and 10 mg/day - Consider dosage based on genotype «b»INR Range and Treatment Duration«/b» - Maintain an INR of 2.0-3.0 «bi»Surgery-provoked DVT or PE«/bi» - Treatment duration of 3 months «bi»Transient (Reversible) Risk Factor-induced DVT or PE«/bi» - Treatment duration of 3 months «bi»First Unprovoked Proximal DVT or PE«/bi» Low or Moderate Bleeding Risk - Extended treatment consideration with periodic (annual) risk-benefit analysis High Bleeding Risk - Treatment duration of 3 months «bi»First Unprovoked Distal DVT Regardless of Bleeding Risk«/bi» - Treatment duration of 3 months «bi»Second Unprovoked DVT or PE with Low or Moderate Bleeding Risk«/bi» - Extended treatment «bi»Second Unprovoked DVT or PE with High Bleeding Risk«/bi» - Treatment duration of 3 months «bi»DVT/PE and Active Cancer«/bi» - Extended treatment, with periodic risk-benefit analysis «bi»Prevention of VTE for Total Knee Arthroplasty, Total Hip Arthroplasty, and Hip Fracture Surgery«/bi» - Minimum treatment duration of 10-14 days, with a recommendation to extend outpatient therapy to 35 days - LMWH recommended over vitamin K antagonist therapy «bu»Stroke & Thromboembolism«/bu» «b»Prophylaxis and Treatment of Systemic Embolic Complications«/b» - Stroke associated with atrial fibrillation (AF) - Initial Dose: 2-5 mg PO/IV daily × 2 days or 10 mg PO × 2 days in healthy individuals - Check INR after 2 days and adjust dose according to results - Typical maintenance dose ranges between 2-10 mg/day - Consider dosage based on genotype «b»INR Range and Treatment Duration«/b» «bi»Non-valvular A-Fib«/bi» - Maintain an INR of 2.0-3.0 «bi»A-Fib and Stable CAD«/bi» - Adjusted-dose warfarin therapy (INR 2.0-3.0) without aspirin «bi»A-Fib with High Stroke Risk and Placement of Stent«/bi» - Triple therapy of dose-adjusted warfarin (INR 2.0-3.0), clopidogrel, and aspirin; for 1 month if bare metal stent; for 3-6 months for drug-eluting stent «bi»A-Fib with Intermediate to High Stroke Risk without Stent Placement«/bi» - 12 months of warfarin therapy (INR 2.0-3.0) with single antiplatelet regimen «bi»A-Fib for > 48 hours to Undergo Cardioversion«/bi» - Warfarin therapy (INR 2.0-3.0) for 3 weeks prior to and 4 weeks after cardioversion «b»Indications for Indefinite Treatment Duration«/b» «bi»Persistent or Paroxysmal Nonvalvular A-Fib in Patients«/bi» High Risk of Stroke - Patients who have risk factors for stroke, such as prior ischemic stroke, transient ischemic attack, or systemic embolism or who have 2 of the following risk factors--age greater than 75 years, moderately or severely impaired left ventricular systolic function and/or heart failure, history of hypertension, or diabetes mellitus Intermediate Risk of Ischemic Stroke - Patients who have 1 of the following risk factors--age >75 years, moderately or severely impaired left ventricular systolic function and/or heart failure, history of hypertension, or diabetes mellitus - AF and mitral stenosis - ≥2 episodes of documented DVT or PE «bu»Cardiac Valve Replacement«/bu» «b»Prophylaxis and Treatment of Thromboembolic Complications Associated with Cardiac Valve Replacement«/b» - Initial dose: 2-5 mg PO/IV daily × 2 days or - 10 mg PO × 2 days in healthy individuals - Check INR after 2 days and adjust dose according to results - Typical maintenance dose ranges between 2 and 10 mg/day - Consider dosage based on genotype (see Genomic Considerations) «b»INR and Treatment Duration«/b» «bi»Mitral Bioprosthetic Valve«/bi» - INR 2.0-3.0 for a 3-month treatment duration - If other risk factors for thromboembolism are present (AF, previous thromboembolism, left ventricular dysfunction), a longer duration may be necessary «bi»Aortic Mechanical Valve«/bi» - INR 2.0-3.0 for indefinite treatment duration «bi»Mitral Mechanical Valve, Caged Ball or Caged Disk Valve, or Both Aortic and Mitral Mechanical Valves«/bi» - INR 2.5-3.5 for indefinite treatment duration - Mechanical valves include bileaflet mechanical valves and Medtronic Hall tilting disk valves «bu»Post-Myocardial Infarction«/bu» - Reduction in the risk of death, recurrent MI, and thromboembolic events (eg, stroke, systemic embolization) after MI - Initial dose: 2-5 mg PO/IV qDay × 2 days, OR 10 mg PO × 2 days in healthy individuals - Check INR after 2 days and adjust dose according to results - Typical maintenance dose ranges between 2 and 10 mg/day «b»INR and Treatment Duration«/b» - Maintain INR between 2.0 and 3.0 - In patients who have not had stenting and who have anterior MI and left ventricular (LV) thrombus or high risk of LV thrombus (ejection fraction <40%, anteroapical wall-motion abnormality), treatment involves dual therapy of warfarin (INR 2.0-3.0) and low-dose aspirin 75-100 mg, daily; treatment duration is 3 months, after which warfarin is discontinued - In patients who have had bare-metal stent placement and who have anterior MI and LV thrombus or high risk of LV thrombus (ejection fraction <40%, anteroapical wall-motion abnormality), treatment involves triple therapy of warfarin (INR 2.0-3.0), low-dose aspirin, and clopidogrel 75 mg, daily for 1 month, followed by warfarin (INR 2.0-3.0) and single antiplatelet therapy for second and third month, after which warfarin is discontinued - In patients who have had drug-eluting stent placement and who have anterior MI and LV thrombus or high risk of LV thrombus (ejection fraction <40%, anteroapical wall-motion abnormality), treatment involves triple therapy of warfarin (INR 2.0-3.0), low-dose aspirin, and clopidogrel 75 mg, daily for 3-6 months, after which warfarin is discontinued «bu»Rheumatic Valve Disease«/bu» Rheumatic Valve Disease with Any of the Following - Atrial diameter >55 mm, left atrial thrombus, atrial fibrillation, and previous systemic embolism - Maintain INR 2.0-3.0 indefinitely «bu»Cryptogenic Stroke and Patent Foramen Ovale With DVT«/bu» - Maintain INR between 2.0 and 3.0 for 3 months «bu»Cardioembolic Stroke or TIA«/bu» - Maintain INR between 2.0 and 3.0 indefinitely - ACCP guidelines recommend dabigatran 150 mg PO twice daily over dose-adjusted warfarin therapy «bu»Systolic LV Dysfunction«/bu» - Systolic LV dysfunction without established CAD but with identified acute LV thrombus (eg, Takotsubo cardiomyopathy) - Maintain INR between 2.0 and 3.0 for at least 3 months «bu»Antiphospholipid Antibody Syndrome«/bu» (Off-label) - Antiphospholipid antibody syndrome with previous arterial or venous thromboembolism - Maintain INR between 2.0 and 3.0 indefinitely