2015

Lipincott
Pocket Drug Guide
for Nurses
Amy M. Karch, RN, MS
Associate Professor of Clinical Nursing
University of Rochester School of Nursing
Rochester, New York

ERRNVPHGLFRVRUJ
Publisher: Jay Abramovitz
Chief Nursing Officer: Judith A. Schilling McCann, RN, MSN
Product Director: David Moreau
Editor: Karen C. Comerford
Editorial Assistants: Jeri O’Shea and Linda K. Ruhf
Marketing Manager: Mark Wiragh
Art Director: Elaine Kasmer
Design: Joseph John Clark
Production Project Manager: Joan Sinclair
Manufacturing Manager: Kathleen Brown
Production Services: Aptara, Inc.

The clinical treatments described and recommended in this publication are based on research and consultation with
nursing, medical, and legal authorities. To the best of our knowledge, these treatments reflect currently accepted practice.
Nevertheless, they can’t be considered absolute and universal recommendations. For individual applications, all
recommendations must be considered in light of the patient’s clinical condition and before administration of new or
infrequently used drugs, in light of the latest package-insert information. The author and publisher disclaim any
responsibility for any adverse effects resulting from the suggested treatments, from any undetected errors, or from the
reader’s misunderstanding of the text.

© 2015 by Wolters Kluwer. All rights reserved. This book is protected by copyright. No part of it may be reproduced,
stored in a retrieval system, or transmitted, in any form or by any means—electronic, mechanical, photocopy, recording, or
otherwise—without prior written permission of the publisher, except for brief quotations embodied in critical articles
and reviews, and testing and evaluation materials provided by the publisher to instructors whose schools have adopted its
accompanying textbook. For information, write Wolters Kluwer, Two Commerce Square, 2001 Market Street, Philadelphia,
PA 19103.

Printed in China.

LPDGN15011014

ISBN: 978-1-4698-5333-8

CIP data available on request from the publisher.

Contents
Preface
Guide to abbreviations

Alphabetical Listing of Drugs by Generic Name

Patient Safety and Medication Administration
The seven rights of medication administration
Keeping patients safe
Avoiding dangerous abbreviations
Reporting medication errors
Guidelines for safe disposal of medications
Appendices
Appendix A: Alternative and complementary therapies
Appendix B: Topical drugs
Appendix C: Ophthalmic drugs
Appendix D: Laxatives
Appendix E: Combination products by therapeutic class
Appendix F: Hormonal contraceptives
Appendix G: Commonly used biologicals
Appendix H: Drugs commonly used to treat specific disorders
Bibliography
Index
Preface
The number of clinically important drugs increases every year, as does the nurse’s
responsibility for drug therapy. No practitioner can memorize all the drug information
necessary to provide safe and efficacious drug therapy. Compound the growing list of
drugs with a continuing shortage of pharmacists and an anticipated shortage of nurses,
and there is an ever-increasing risk of medication errors that lead to poor patient
outcomes.
The 2015 Lippincott Pocket Drug Guide for Nurses provides need-to-know information in
an abbreviated format. Drugs are listed alphabetically. Monographs are concise. Each
monograph provides the key information needed to ensure safe patient care:
Drug class
Pregnancy and Controlled Substance category
Black box warning, if appropriate
Indications and dosages
Dosage adjustments that also alert you, when appropriate, to the need to consult a
complete drug guide
Most common and most critical adverse effects
Key nursing and patient teaching points to ensure safe drug use.
The pocket size makes this book easy to carry into the clinical setting for a quick
check before administering the drug.
Following the drug monographs, a new section on patient safety reviews the rights of
medication administration, safety-oriented patient and family teaching, and other
aspects of safe drug administration. Appendices cover biological agents, topical drugs,
ophthalmic agents, laxatives, combination drugs, and contraceptives. There is also an
appendix of common diseases, with the drugs used to treat each disease. To keep the
book short and sweet, common abbreviations are used throughout; these are listed in the
abbreviations list on pages ix–xi.
In the rush of the clinical setting, this guide will provide the critical information you
need immediately. However, it is important to check complete facts and details as soon
as time allows to ensure that the best outcomes are achieved for each patient.
Amy M. Karch, RN, MS
Guide to abbreviations
Abbreviations in headings
BBW Black Box Warning
CLASS Therapeutic/Pharmacologic Class
PREG/CONT Pregnancy Risk Category/Controlled Substance Schedule
IND & DOSE Indications & Dosages
ADJUST DOSE Dosage Adjustment
ADV EFF Adverse Effects
NC/PT Nursing Considerations/Patient Teaching

Abbreviations in text
abd abdominal
ABG arterial blood gas
ACE angiotensin-converting enzyme
ACT activated clotting time
ACTH adrenocorticotropic hormone
ADH antidiuretic hormone
ADHD attention-deficit hyperactivity disorder
adjunct adjunctive
AHA American Heart Association
AIDS acquired immunodeficiency syndrome
ALL acute lymphocytic leukemia
ALT alanine transaminase
a.m. morning
AML acute myelogenous leukemia
ANA anti-nuclear antibodies
ANC absolute neutrophil count
aPTT activated partial thromboplastin time
ARB angiotensin II receptor blocker
ASA acetylsalicylic acid
AST aspartate transaminase
AV atrioventricular
bid twice a day (bis in die)
BP blood pressure
BPH benign prostatic hypertrophy
BSA body surface area
BUN blood urea nitrogen
CAD coronary artery disease
CABG coronary artery bypass graft
cAMP cyclic adenosine monophosphate
CBC complete blood count
CDC Centers for Disease Control and Prevention
CML chronic myelogenous leukemia
CNS central nervous system
conc concentration
COPD chronic obstructive pulmonary disease
CK creatine kinase
CR controlled-release
CrCl creatinine clearance
CSF cerebrospinal fluid
CV cardiovascular
CVP central venous pressure
CYP450 cytochrome P-450
D5W dextrose 5% in water
DIC disseminated intravascular coagulopathy
dL deciliter (100 mL)
DR delayed-release

DVT deep venous thrombosis

dx diagnosis
dysfx dysfunction
ECG electrocardiogram
ED erectile dysfunction
EEG electroencephalogram
ER extended-release
ET endotracheal
FDA Food and Drug Administration
5-FU fluorouracil
5-HIAA 5-hydroxyindole acetic acid
FSH follicle-stimulating hormone
g gram
GABA gamma-aminobutyric acid
GERD gastroesophageal reflux disease
GFR glomerular filtration rate
GGTP gamma-glutamyl transpeptidase
GI gastrointestinal
G6PD glucose-6-phosphate dehydrogenase
GU genitourinary
HCG human chorionic gonadotropin
Hct hematocrit
HDL high-density lipoprotein
HF heart failure
Hg mercury
Hgb hemoglobin
Hib Haemophilus influenzae type b
HIV human immunodeficiency virus
HMG-CoA 3-hydroxy-3-methylglutaryl coenzyme A
HPA hypothalamic-pituitary axis
hr hour
HR heart rate
HSV herpes simplex virus
hx history
IBS irritable bowel syndrome
ICU intensive care unit
IHSS idiopathic hypertrophic subaortic stenosis
IM intramuscular
INR International Normalized Ratio
IOP intraocular pressure
IV intravenous
kg kilogram
L liter
lb pound
LDL low-density lipoprotein
LFT liver function test
LH luteinizing hormone
LHRH luteinizing hormone-releasing hormone
m meter
MAC Mycobacterium avium complex
maint maintenance
MAO monoamine oxidase
MAOI monoamine oxidase inhibitor
max maximum
mcg microgram
mg milligram
mgt management

MI myocardial infarction
min minute
mL milliliter
mo month
MRSA methicillin-resistant Staphylococcus aureus
MS multiple sclerosis
NA not applicable
NG nasogastric
ng nanogram
NMJ neuromuscular junction
NMS neuroleptic malignant syndrome
NRTI nucleoside reverse transcriptase inhibitor
NSAID nonsteroidal anti-inflammatory drug
NSS normal saline solution
n/v nausea and vomiting
n/v/d nausea, vomiting, and diarrhea
OCD obsessive-compulsive disorder
oint ointment
OTC over-the-counter
P pulse
PABA para-aminobenzoic acid
PDA patent ductus arteriosus
PE pulmonary embolus
PEG percutaneous endoscopic gastrostomy
periop perioperative
PFT pulmonary function test
PG prostaglandin
pH hydrogen ion concentration

PID pelvic inflammatory disease

p.m. evening
PMDD premenstrual dysphoric disorder
PMS premenstrual syndrome
PO orally, by mouth (per os)
postop postoperative
preop preoperative
PRN when required (pro re nata)
PSA prostate-specific antigen
pt patient
PT prothrombin time
PTCA percutaneous transluminal coronary angioplasty
PTSD post-traumatic stress disorder
PTT partial thromboplastin time
PVCs premature ventricular contractions
px prophylaxis
q every
qid four times a day (quarter in die)
R respiratory rate
RBC red blood cell
RDA recommended dietary allowance
RDS respiratory distress syndrome
RSV respiratory syncytial virus
s&sx signs and symptoms
SA sinoatrial
SBE subacute bacterial endocarditis
sec second
SIADH syndrome of inappropriate antidiuretic hormone secretion

SLE systemic lupus erythematosus

sol solution
sp species
SR sustained-release
SSRI selective serotonin reuptake inhibitor
STD sexually transmitted disease
subcut subcutaneous
SWSD shift-work sleep disorder
s&sx signs and symptoms
sx symptoms
T3 triiodothyronine
T4 thyroxine (tetraiodothyronine)
TB tuberculosis
tbsp tablespoon
TCA tricyclic antidepressant
temp temperature
TIA transient ischemic attack
tid three times a day (ter in die)
TNF tumor necrosis factor
TPA tissue plasminogen activator
TPN total parenteral nutrition
TSH thyroid-stimulating hormone
tsp teaspoon
tx treatment
unkn unknown
URI upper respiratory (tract) infection
USP United States Pharmacopeia
UTI urinary tract infection

UV ultraviolet
VLDL very–low-density lipoprotein
VREF vancomycin-resistant Enterococcus faecium
w/ with
WBC white blood cell
wk week
XR extended-release
yr year
 abacavir (Ziagen)
CLASS Antiviral, NRTI
PREG/CONT C/NA

BBW Risk of severe to fatal hypersensitivity reactions; increased w/HLA-B*5701 allele.

Monitor for lactic acidosis, severe hepatomegaly.
IND & DOSE HIV infection (w/ other antiretrovirals). Adult: 300 mg PO bid or
600 mg/day PO. Child 3 mo–18 yr: 8 mg/kg PO bid; max, 300 mg/dose.
ADJUST DOSE Mild hepatic impairment
ADV EFF Fatigue, headache, insomnia, malaise, MI, n/v/d, rash, severe to fatal
hepatomegaly, severe to fatal lactic acidosis, severe hypersensitivity reactions,
weakness
INTERACTIONS Alcohol
NC/PT Give w/ other antiretrovirals. Suggest use of barrier contraceptives. Monitor for
s&sx of lactic acidosis, liver dysfx, hypersensitivity reactions.

abatacept (Orencia)
CLASS Antiarthritic, immune modulator
PREG/CONT C/NA

IND & DOSETx of adult rheumatoid arthritis. Over 100 kg: 1,000 mg/day IV. 60–100 kg:
750 mg/day IV. Under 60 kg: 500 mg/day IV. After initial dose, give at 2 and 4 wk, then
q 4 wk. Tx of juvenile idiopathic arthritis in child 6 yr and older. 75 kg or more: Use
adult dose; max, 1,000 mg/day. Under 75 kg: 10 mg/kg/day IV. After initial dose, give
at 2 and 4 wk.
ADV EFF Headache, hypersensitivity reactions and anaphylaxis, potentially serious
infection
INTERACTIONS Live vaccines; TNF antagonists (contraindicated)
NC/PT Monitor for s&sx of infection. Pretest for TB before beginning therapy. Do not give
w/ TNF antagonists. Do not give live vaccines during or for 3 mo after tx.

abciximab (ReoPro)
CLASS Antiplatelet, glycoprotein IIb/IIIa inhibitor
PREG/CONT C/NA

IND & DOSEAdjunct to percutaneous coronary intervention (PCI) to prevent cardiac

ischemic complications in pt undergoing PCI. Adult: 0.25 mg/kg by IV bolus 10–60
min before procedure, then continuous IV infusion of 0.125 mcg/kg/min for 12 hr (max,
10 mcg/min). Unstable angina not responding to conventional therapy when PCI
is planned within 24 hr, w/ heparin and aspirin therapy. Adult: 0.25 mg/kg by IV
bolus over at least 1 min, then 10 mcg/min by IV infusion for 19–24 hr, ending 1 hr
after PCI.
ADV EFF Bleeding, edema, hypotension, n/v, pain, thrombocytopenia
INTERACTIONS Anticoagulants, antiplatelets, thrombolytics
NC/PT Provide safety measures to protect pt from bleeding and monitor for signs of
bleeding. Monitor CBC. Give w/ heparin and aspirin therapy. Clearly mark chart that pt
is on drug.

abiraterone (Zytiga)
CLASS Antineoplastic, CYP17 inhibitor
PREG/CONT X/NA

IND & DOSE Tx of pts w/ metastatic castration-resistant prostate cancer who have
received prior chemotherapy containing docetaxel, w/ prednisone. Adult:
1,000 mg/day PO w/ 5 mg prednisone PO.
ADJUST DOSE Hepatic impairment
ADV EFF Adrenocortical insufficiency, arrhythmias, cardiac toxicity, cough, diarrhea,
dyspepsia, dyspnea, edema, hepatotoxicity, hot flushes, hypertension, hypokalemia,
nocturia, URI, UTI
INTERACTIONS CYP3A4 enzyme inducers, inhibitors; avoid use w/ CYP26 substrates
NC/PT Must be taken on empty stomach w/ no food 1 hr before or 2 hr after dosing. Not
for use in pregnancy, breast-feeding. Monitor closely for cardiac toxicity, hepatotoxicity,
adrenal insufficiency. Corticosteroids may be needed in stressful situations.

acamprosate calcium (Campral)

CLASS Antialcoholic, GABA analogue
PREG/CONT C/NA

IND & DOSEMaint of abstinence from alcohol as part of comprehensive psychosocial

tx mgt program. Adult: 666 mg PO tid; begin as soon as abstinence achieved.
ADJUST DOSE Renal impairment
ADV EFF Diarrhea, suicidality
INTERACTIONS Alcohol
NC/PT Ensure pt is abstaining from alcohol and is in comprehensive tx program. Pt may
take drug even if relapse occurs. Not for use in pregnancy, breast-feeding. Pt should
report thoughts of suicide.

acarbose (Precose)
CLASS Alpha-glucosidase inhibitor, antidiabetic
PREG/CONT B/NA

IND & DOSE Monotherapy or adjunct to diet to lower blood glucose in pts w/ type 2
diabetes. Adult: 25 mg PO tid w/ first bite of meal. Max for pt 60 kg or less, 50 mg PO
tid; over 60 kg, 100 mg PO tid. Combination tx w/ sulfonylureas, metformin, or
insulin to enhance glycemic control. Adult: Adjust dose based on blood glucose levels
in combination w/ dosage of other drugs used.
ADV EFF Abd pain, flatulence, hypoglycemia. n/v/d
INTERACTIONS Antidiabetics, celery, charcoal, coriander, dandelion root, digestive
enzymes, digoxin, fenugreek, garlic, ginseng, juniper berries
NC/PT Give w/ food. Monitor blood glucose. Pt should follow diet and exercise program.

acebutolol hydrochloride (Sectral)

CLASS Antiarrhythmic, antihypertensive, beta-adrenergic blocker
PREG/CONT B/NA

IND & DOSE Tx of hypertension. Adult: 400 mg/day PO. Maint dose, 200–1,200 mg/day
PO (larger dose in two divided doses). Mgt of PVCs. Adult: 200 mg PO bid. Range to
control PVCs, 600–1,200 mg/day PO. Discontinue gradually over 3 wk.
ADJUST DOSE Renal, hepatic impairment; elderly pts
ADV EFF Arrhythmias (bradycardia, tachycardia, heart block), bronchospasm,
constipation, decreased exercise tolerance, ED, flatulence, gastric pain, HF, n/v
INTERACTIONS Alpha blockers, aspirin, beta blockers, bismuth subsalicylate, calcium
channel blockers, clonidine, insulin, magnesium salicylate, NSAIDs, prazosin
NC/PT Monitor apical P; do not give if P is less than 45. May give w/ food. Withdraw
slowly over 3 wk after long-term therapy.

acetaminophen (Acephen, Ofirmev, Tylenol, etc)

CLASS Analgesic, antipyretic
PREG/CONT B/NA

IND & DOSETemporary reduction of fever; temporary relief of minor aches and pains
caused by common cold and influenza; headache, sore throat, toothache (pts 2 yr
and older); backache, menstrual cramps, minor arthritis pain, muscle aches (pts
over 12 yr). Adult, child over 12 yr (PO or rectal suppositories): 325–560 mg q 4–6 hr or
1,300 mg (ER) PO q 8 hr. Adult, child 13 yr and older, 50 kg or more: 1,000 mg IV q 6 hr
or 650 mg IV q 4 hr; max, 1,000 mg/dose IV or 4,000 mg/day IV. Child 13 yr, under
50 kg: 15 mg/kg IV q 6 hr or 12.5 mg/kg IV q 4 hr; max, 750 mg or 75 mg/kg/day. Child
2–12 yr: 15 mg/kg IV q 6 hr or 12 mg/kg IV q 4 hr; max, 75 mg/kg/day. Child: May
repeat PO or rectal doses four to five times/day; max, five doses in 24 hr or 10 mg/kg.
PO doses: 11 yr, 480 mg/dose; 9–10 yr, 400 mg/dose; 6–8 yr, 320 mg/dose; 4–5 yr,
240 mg/dose; 2–3 yr, 160 mg/dose; 12–23 mo, 120 mg/dose; 4–11 mo, 80 mg/dose; 0–3
mo, 40 mg/dose. PR doses: 6–12 yr, 325 mg q 4–6 hr; 3–6 yr, 120 mg q 4–6 hr; 12–36
mo, 80 mg q 4 hr; 3–11 mo, 80 mg q 6 hr.
ADV EFF Hepatic failure, hepatotoxicity, myocardial damage
INTERACTIONS Alcohol, anticholinergics, barbiturates, charcoal, carbamazepine,
hydantoins, oral anticoagulants, rifampin, sulfinpyrazone, zidovudine
NC/PT Do not exceed recommended dosage. Avoid combining (many products contain
acetaminophen). Administer IV over 15 min. Not recommended for longer than 10 days.
Overdose tx: acetylcysteine, possible life support.

acetazolamide (Diamox Sequels)

CLASS Antiepileptic, antiglaucoma, carbonic anhydrase inhibitor, diuretic
PREG/CONT C/NA

BBW Fatalities have occurred due to severe reactions; discontinue immediately if s&sx of
serious reactions. Use caution if pt receiving high-dose aspirin; anorexia, tachypnea,
lethargy, coma, death have occurred.
IND & DOSE Open-angle glaucoma. Adult: 250 mg–1 g/day PO, usually in divided doses,
or 1 ER capsule bid (a.m. and p.m.). Max, 1 g/day. Acute congestive angle-closure
glaucoma. Adult: 500 mg (ER) PO bid or 250 mg PO q 4 hr. Secondary glaucoma and
preoperatively. Adult: 250 mg PO q 4 hr, or 250 mg PO bid, or 500 mg PO bid (ER
capsules), or 500 mg PO followed by 125–250 mg PO q 4 hr. May give IV for rapid relief
of increased IOP: 500 mg IV, then 125–250 mg PO q 4 hr. Diuresis in HF. Adult: 250–
375 mg PO (5 mg/kg) daily in a.m. Drug-induced edema. Adult: 250–375 mg PO once
q day or for 1 or 2 days alternating w/ day of rest. Epilepsy. Adult: 8–30 mg/kg/day PO
in divided doses. Range, 375–1,000 mg/day. Acute altitude sickness. Adult, child 12 yr
and older: 500 mg–1 g/day PO in divided doses.
ADV EFF Urinary frequency
INTERACTIONS Amphetamines, lithium, procainamide, quinidine, salicylates, TCAs
NC/PT Do not give IM. Make oral liquid by crushing tablets and suspending in sweet
syrup (do not use alcohol or glycerin). Have IOP checked periodically. May cause
dizziness, increased urination. Pt should report flank pain, bleeding, weight gain of
more than 3 lb/day. Name confusion between Diamox and Trimox (ampicillin).

acetylcysteine (Acetadote)
CLASS Antidote, mucolytic
PREG/CONT B/NA

IND & DOSE Mucolytic adjuvant therapy for abnormal, viscid, or inspissated mucus
secretions in acute and chronic bronchopulmonary disease. Adult, child:
Nebulization w/ face mask, mouthpiece, tracheostomy: 3–5 mL of 20% sol or 6–10 mL of
10% sol tid or qid. Nebulization w/ tent, croupette: Up to 300 mL during a tx period.
Direct or by tracheostomy: 1–2 mL of 10%–20% sol q 1–4 hr. Percutaneous intratracheal
catheter: 1–2 mL of 20% sol or 2–4 mL of 10% sol q 1–4 hr. To prevent or lessen
hepatic injury that may occur after ingestion of potentially hepatotoxic dose of
acetaminophen. Adult, child: PO, 140 mg/kg loading dose, then 17 maint doses of
70 mg/kg q 4 hr, starting 4 hr after loading dose. IV, Loading dose, 150 mg/kg in
200 mL IV over 60 min; maint dose 50 mg/kg in 500 mL IV over 4 hr followed by
second maint dose of 100 mg/kg in 1,000 mL IV over 16 hr. Total IV dose, 300 mg/kg
over 21 hr.
ADV EFF Anaphylactoid reactions, bronchospasm, n/v, rhinorrhea
INTERACTIONS (in sol) Amphotericin B, erythromycin, hydrogen peroxide, lactobionate,
tetracycline
NC/PT Use water to remove sol from pt’s face. Monitor nebulizer for buildup of drug.
Have suction equipment available. May mix 20% sol w/ soft drinks to concentration of
5%. Dilute oral sol w/ water if using gastric tube. Warn pt of possible disagreeable odor
as nebulization begins. Pt should report difficulty breathing.

acitretin (Soriatane)
CLASS Antipsoriatic, retinoic acid
PREG/CONT X/NA

BBW Do not use in pregnancy; serious fetal harm possible. Males should not father a
child during and for 3 mo after tx.
IND & DOSE Tx of severe psoriasis. Adult: 25–50 mg/day PO w/ main meal.
ADV EFF Hepatotoxicity
INTERACTIONS Methotrexate, phenytoin, retinoids, vitamin D
NC/PT Pt must have monthly negative pregnancy tests and agree to use two forms of
contraception. Must have signed pt agreement in medical record. Pt may not donate
blood for 3 yr after tx. Pt should swallow tablets whole and not cut, crush, or chew
them; stop drug when lesions resolve; avoid sun exposure.

aclidinium bromide (Tudorza Pressair)

CLASS Anticholinergic, bronchodilator
PREG/CONT C/NA

IND & DOSE Long-term maint tx of bronchospasm associated w/ COPD. Adult:

400 mcg/actuation bid.
ADJUST DOSE Over 80 yr; under 60 kg; renal, hepatic impairment
ADV EFF Dry mouth, headache, nasopharyngitis, urine retention
INTERACTIONS Other anticholinergics; avoid this combination
NC/PT Ensure appropriate use of drug; use only w/ provided inhaler. Monitor for
hypersensitivity. Stop drug w/ paradoxical bronchospasm. Monitor for glaucoma. Have
pt void before each dose if urine retention occurs.

acyclovir (Zovirax)
CLASS Antiviral, purine nucleoside analogue
 PREG/CONT B/NA

IND & DOSE Herpes genitalis. Adult: 5 mg/kg IV infused over 1 hr q 8 hr for 5 days.
Herpes encephalitis. Adult: 10 mg/kg IV infused over 1 hr q 8 hr for 10 days. Herpes
simplex (immunocompromised pts). Adult: 5 mg/kg IV infused over 1 hr q 8 hr for 7
days. Varicella zoster (immunocompromised pts). Adult: 10 mg/kg IV infused over
1 hr q 8 hr for 7 days. Initial genital herpes. Adult: 200 mg PO q 4 hr five times daily
(1,000 mg/day) for 10 days. Long-term suppressive therapy. Adult: 400 mg PO bid for
up to 12 mo. Recurrent therapy. Adult: 200 mg IV q 4 hr five times daily for 5 days.
HSV infection. Child under 12 yr: 10 mg/kg IV infused over 1 hr q 8 hr for 7 days.
Varicella zoster. Child under 12 yr: 20 mg/kg IV over 1 hr q 8 hr for 7 days. Shingles,
HSV encephalitis. Child 3 mo to 12 yr: 20 mg/kg IV over 1 hr q 8 hr for 14–21 days.
Neonatal HSV. 10 mg/kg IV infused over 1 hr q 8 hr for 10 days. 2 yr or older and 40 kg
or less: 20 mg/kg/dose PO qid (80 mg/kg/day) for 5 days. Over 12 yr, over 40 kg: Give
adult dose. Ointment. All ages: Apply sufficient quantity to cover all lesions six
times/day (q 3 hr) for 7 days. 1.25-cm (0.5-in) ribbon of ointment covers 2.5 cm2 (4 in 2)
surface area. Cream. 12 yr and older: Apply enough to cover all lesions five times/day
for 4 days.
ADJUST DOSE Elderly pts, renal impairment
ADV EFF Inflammation or phlebitis at injection sites, n/v/d, transient topical burning w/
topical use
INTERACTIONS Nephrotoxic drugs, probenecid, zidovudine
NC/PT Ensure pt well hydrated. Wear rubber glove or finger cot when applying topically.
Drug not a cure and will not prevent recurrence. Pt should avoid sexual intercourse
when lesions are present; use condoms to prevent spread.

adalimumab (Humira)
CLASS Antiarthritic, TNF blocker
PREG/CONT B/NA

BBW Risk of serious infection, activation of TB; risk of lymphoma and other potentially
fatal malignancies in children, adolescents.
IND & DOSE Tx of rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis.
Adult: 40 mg subcut every other wk. Crohn’s disease/ulcerative colitis. Adult: Four
40-mg subcut injections in 1 day followed by 80 mg 2 wk later; 2 wk later begin 40 mg
every other wk maint. Plaque psoriasis. Adult: 80 mg subcut, then 40 mg every
other wk starting 1 wk later. Juvenile idiopathic arthritis: Child 30 kg and over: 40 mg
subcut every other wk. Child 15 to under 30 kg: 20 mg subcut every other wk.
ADV EFF Anaphylaxis, headache, injection-site reactions, malignancies, serious
infections
INTERACTIONS Anakinra, immunosuppressants, live vaccines
NC/PT High risk of infection; monitor pt, protect as appropriate. Monitor CNS for s&sx of
demyelinating disorders. Advise pt to avoid pregnancy. Teach proper administration
and disposal of syringes.

adefovir dipivoxil (Hepsera)

CLASS Antiviral, reverse transcriptase inhibitor
PREG/CONT C/NA

BBW Worsening hepatitis when discontinued. HIV resistance if used in undiagnosed HIV
infection (test before use). Monitor for renal and hepatic toxicity. Withdraw drug and
monitor if s&sx of lactic acidosis or steatosis.
IND & DOSE Tx of chronic hepatitis B. Adult, child 12 yr and older: 10 mg/day PO.
ADJUST DOSE Renal impairment
ADV EFF Asthenia, elevated LFTs, hepatitis exacerbation if discontinued, lactic
acidosis, nephrotoxicity, severe hepatomegaly w/ steatosis
INTERACTIONS Nephrotoxic drugs
NC/PT Test for HIV infection before starting tx. Monitor for renal/hepatic dysfx, lactic
acidosis, steatosis. Advise against use in pregnancy, breast-feeding. Drug does not cure
disease; use precautions. Advise pt to not run out of drug; serious hepatitis can occur w/
sudden stopping.

adenosine (Adenocard, Adenoscan)

CLASS Antiarrhythmic, diagnostic agent
PREG/CONT C/NA

IND & DOSE Conversion to sinus rhythm from supraventricular tachycardia

(Adenocard). Pts over 50 kg: 6 mg by IV bolus; may repeat within 1–2 min w/ 12-mg IV
bolus up to two times. Pts under 50 kg: 0.05–0.1 mg/kg rapid IV bolus; may repeat in 1–
2 min. Max single dose, 0.3 mg/kg. Diagnosis of suspected CAD, w/ thallium
(Adenoscan): Adult: 140 mcg/kg/min IV over 6 min; inject thallium at 3 min.
ADV EFF Bronchoconstriction, facial flushing, heart block
INTERACTIONS Carbamazepine, digoxin, dipyridamole, theophylline, verapamil
NC/PT Do not refrigerate; discard unused portions. Have emergency equipment on
standby and continuously monitor pt. Have methylxanthines on hand as antidote.

ado-trastuzumab (Kadcyla)
CLASS Antineoplastic, microtubular inhibitor
PREG/CONT D/NA

BBW Risk of hepatotoxicity, cardiac dysfunction, death. Can cause fetal harm.
IND & DOSE Tx of HER2-positive metastatic breast cancer in pts who have had prior
tx or have developed recurrence during or within 6 mo of tx. Adult: 3.6 mg/kg as IV
infusion every 3 wk until disease progression or toxicity.
ADV EFF Constipation, fatigue, headache, hepatotoxicity, infusion reactions, left
ventricular impairment, musculoskeletal pain, neurotoxicity, pulmonary toxicity,
thrombocytopenia
INTERACTIONS Strong CYP3A4 inhibitors; avoid this combination
NC/PT Ensure proper use; HER-2 testing required. Rule out pregnancy before starting tx
(contraceptives advised); not for use in breast-feeding. Monitor LFTs (before and
periodically during tx), cardiac output, respiratory function. Infusion reaction may
require slowing or interrupting infusion. Pt should mark calendar for infusion dates;
take safety precautions w/ neurotoxicity; report difficulty breathing, dark urine,
yellowing of skin/eyes, abdominal pain, swelling, dizziness.

DANGEROUS DRUG
afatinib (Gilotrif)
CLASS Antineoplastic, kinase inhibitor
PREG/CONT D/NA

IND & DOSE First-line tx of pts w/ metastatic non-small-cell lung cancer whose
tumors have epidermal growth factor receptor exon 19 deletions or exon 21
substitution Adult: 40 mg/day PO at least 1 hr before or 2 hr after meal.
ADV EFF Abd pain, bullous/exfoliative skin disorders, dehydration, diarrhea,
hepatotoxicity, keratitis, n/v/d, rash, stomatitis, weight loss
INTERACTIONS P-glycoprotein inducers/inhibitors
NC/PT Ensure proper dx. Monitor renal function/LFTs. Risk of dehydration. Pt should
avoid pregnancy, breast-feeding; perform proper mouth care; eat small, frequent meals;
report rash, difficulty breathing; severe n/v; urine, stool color changes.

aflibercept (Eylea)
CLASS Fusion protein, ophthalmic agent
PREG/CONT C/NA

Tx of pts w/ neovascular (wet) age-related macular degeneration. Adult:

IND & DOSE
2 mg (0.05 mL) by intravitreal injection q 4 wk for first 3 mo, then 2 mg once q 8 wk.
ADV EFF Cataract, endophthalmitis, eye infections, eye pain, increased IOP, retinal
detachment, thrombotic events, vision changes, vitreous floaters
NC/PT Monitor pt closely during and immediately after injection. Advise pt to
immediately report eye redness, sensitivity to light, sudden vision changes.

agalsidase beta (Fabrazyme)

CLASS Enzyme
PREG/CONT B/NA

IND & DOSE Tx of Fabry disease. Adult: 1 mg/kg IV q 2 wk at no more than 0.25 mg/min.
ADV EFF Anaphylaxis, potentially serious infusion reactions (chills, fever, dyspnea,
n/v, flushing, headache, chest pain, tachycardia, facial edema, rash)
NC/PT Ensure appropriate supportive measures available during infusion. Premedicate
w/ antipyretics; immediately discontinue if infusion reaction occurs.

albumin (human) (Albuminar, Buminate, Plasbumin)

CLASS Blood product, plasma protein
PREG/CONT C/NA

IND & DOSE Plasma volume expansion related to shock, burns, nephrosis, etc. Adult:
5%—500 mL by IV infusion as rapidly as possible; additional 500 mg in 15–30 min; 20%
or 25%—maintain plasma albumin conc at 2.5 ± 0.5 g/100 mL. Child: 0.6–1 g/kg, 25
g/day IV of 20% or 25%.
ADV EFF BP changes, chills, fever, flushing, HF, n/v, rash
NC/PT Monitor BP during infusion; discontinue if hypotension occurs. Stop infusion if
headache, fever, BP changes occur; treat w/ antihistamine. Adjust infusion rate based on
pt response.

albuterol sulfate (AccuNeb, Proventil HFA, Ventolin, VoSpire ER)

CLASS Antiasthmatic, beta agonist, bronchodilator, sympathomimetic
PREG/CONT C/NA

IND & DOSE Relief, prevention of bronchospasm in COPD. Adult: 2–4 mg PO tid–qid or
4–8 mg ER tablets q 12 hr. Child 6–12 yr: 2 mg PO three to four times/day or 4 mg ER
tablet PO q 12 hr. Child 2–5 yr: 0.1 mg/kg PO tid; max, 4 mg PO tid. Acute
bronchospasm. Adult: 1–2 inhalations q 4–6 hr; max, 12 inhalations/day; 2.5 mg tid–
qid by nebulization. Child 2–12 yr, over 15 kg: 2.5 mg bid–tid by nebulization; under
15 kg: 0.5% sol tid–qid by nebulization over 5–15 min. Exercise-induced
bronchospasm. Adult: 2 inhalations 15–30 min before exercise.
ADJUST DOSE Elderly pts, pts sensitive to beta-adrenergic stimulation
ADV EFF Anxiety, apprehension, bronchospasm, cardiac arrhythmias, fear, flushing,
n/v, pallor, sweating
INTERACTIONS Aminophylline, beta-adrenergics, digoxin, insulin, linezolid, QT-prolonging
drugs, sympathomimetics
NC/PT Do not exceed recommended doses. Have beta blocker on standby. Pt should not
cut, crush, or chew tablets. Dizziness may occur; use caution. Use inhalation for acute
bronchospasm.

DANGEROUS DRUG
aldesleukin (Proleukin)
CLASS Antineoplastic, immune modulator
PREG/CONT C/NA
IND & DOSE Tx of metastatic renal carcinoma, metastatic melanoma. Adult: 600,000
international units/kg IV q 8 hr over 15 min for total of 14 doses; 9 days of rest, then
repeat. Max, 28 doses/course.
ADV EFF Bone marrow suppression, cardiac arrhythmias, cardiac toxicity,
hepatotoxicity, hypotension, n/v/d, nephrotoxicity, pulmonary toxicity
INTERACTIONS Bone marrow suppressants, cardiotoxic drugs, CNS depressants,
dexamethasone, hepatotoxic drugs, nephrotoxic drugs
NC/PT Obtain baseline ECG. Protect pt from infection. Ensure proper mouth care. Pt
should avoid pregnancy, breast-feeding; report s&sx of bleeding or infection.

alendronate sodium (Binosto, Fosamax)

CLASS Bisphosphonate, calcium regulator
PREG/CONT C/NA

IND & DOSE Tx of postmenopausal osteoporosis; men w/ osteoporosis. Adult:

10 mg/day PO or 70 mg PO once a wk. Prevention of osteoporosis. Adult: 5 mg/day
PO or 35 mg PO once wkly. Tx of Paget disease. Adult: 40 mg/day PO for 6 mo; may
retreat after 6-mo tx-free period. Tx of glucocorticoid-induced osteoporosis. Adult:
5 mg/day PO (10 mg/day PO for postmenopausal women not on estrogen).
ADJUST DOSE Renal impairment
ADV EFF Bone pain, esophageal erosion, GI irritation, headache, n/v/d
INTERACTIONS Antacids, aspirin, calcium, iron, NSAIDs, ranitidine
NC/PT Give w/ full glass of water in a.m. at least 30 min before other food or
medication; have pt stay upright for 30 min and until first food of day. Monitor serum
calcium level; ensure pt has adequate calcium and vitamin D intake.

alfuzosin hydrochloride (Uroxatral)

CLASS Alpha-adrenergic blocker, BPH drug
PREG/CONT B/NA

IND & DOSE Tx of s&sx of BPH. Adult: 10 mg/day PO after same meal each day.
ADV EFF Dizziness, orthostatic hypotension
INTERACTIONS Adrenergic blockers, antihypertensives, itraconazole, ketoconazole,
phosphodiesterase inhibitors, protease inhibitors, ritonavir
NC/PT Ensure pt does not have prostate cancer. Monitor for orthostatic hypotension.
Advise pt to change positions slowly, take safety precautions for dizziness. Pt should not
cut, crush, or chew tablets; store tablets in dry place, protected from light.

alglucosidase alfa (Lumizyme, Myozyme)

CLASS Enzyme, Pompe’s disease drug
PREG/CONT B/NA
BBW Risk of life-threatening anaphylactic reactions; have medical support readily
available. Potential for rapid disease progression. Pt must be part of limited access
program (Lumizyme). Risk of cardiorespiratory failure; monitor pts w/ cardiorespiratory
disorders carefully (Myozyme).
IND & DOSE To increase ventilator-free survival in pts w/ infantile- onset Pompe’s
disease (Myozyme); tx of pts 8 yr and older w/ late-onset Pompe’s disease without
cardiac hypertrophy (Lumizyme). Adult, child: 20 mg/kg IV infusion over 4 hr q 2 wk.
ADV EFF Anaphylaxis, cardiopulmonary failure, chest discomfort, dyspnea, flushing,
neck pain, rapid progression of disease, rash, urticaria, v/d
NC/PT Have medical support readily available during administration. Begin infusion at
1 mg/kg/hr; increase by 2 mg/kg/hr to reach desired dose, carefully monitoring pt
response. Lumizyme available only by limited access program. Monitor for disease
progression.

aliskiren (Tekturna)
CLASS Antihypertensive, renin inhibitor
PREG/CONT D/NA

BBW Use during second, third trimesters of pregnancy can cause fetal injury or death.
IND & DOSE Tx of hypertension, alone or w/ other antihypertensives. Adult: 150–
300 mg/day PO.
ADJUST DOSE Severe renal impairment
ADV EFF Angioedema w/ respiratory symptoms, cough, diarrhea, dizziness, dyspepsia,
fatigue, GERD, headache, hypotension, URI
INTERACTIONS ACE inhibitors, ARBs, atorvastatin, furosemide, irbesartan, ketoconazole,
thiazides
NC/PT Rule out pregnancy; not for use in breast-feeding. Monitor potassium levels. Store
drug in dry place at room temp. Other drugs may also be needed to control BP.

allopurinol (Aloprim, Zyloprim)

CLASS Antigout, purine analogue
PREG/CONT C/NA

IND & DOSE Gout, hyperuricemia. Adult: 100–800 mg/day PO in divided doses.
Hyperuricosuria. Adult: 200–300 mg/day PO. Px of acute gouty attacks. Adult:
100 mg/day PO; increase by 100 mg/day at wkly intervals until uric acid is 6 mg/dL or
less. Px of uric acid nephropathy in certain malignancies. Adult: 600–800 mg/day
PO for 2–3 days w/ high fluid intake. Child 6–10 yr: 300 mg/day PO. Child under 6 yr:
150 mg/day PO. Recurrent calcium oxalate stones. Adult: 200–300 mg/day PO.
Parenteral use. Adult: 200–400 mg/m2/day IV to max of 600 mg/day as continuous
infusion or at 6-, 8-, 12-hr intervals. Child: 200 mg/m2/day IV as continuous infusion or
at 6-, 8-, 12-hr intervals.
ADJUST DOSE Elderly pts, renal impairment
ADV EFF Drowsiness, headache, n/v/d, serious to fatal skin reactions
INTERACTIONS ACE inhibitors, amoxicillin, ampicillin, anticoagulants, cyclophosphamide,
theophylline, thiazides, thiopurines
NC/PT Give after meals; encourage 2.5–3 L/day fluid intake. Check urine alkalinity. Pt
should discontinue at first sign of rash; avoid OTC medications.

almotriptan malate (Axert)

CLASS Antimigraine, serotonin selective agonist, triptan
PREG/CONT C/NA

IND & DOSE Tx of acute migraines w/ or without aura. Adult, child 12–17 yr: 6.25–
12.5 mg PO as single dose at first sign of migraine; may repeat in 2 hr. Max, 2
doses/24 hr.
ADJUST DOSE Hepatic, renal impairment
ADV EFF BP changes, dizziness, dry mouth, MI, nausea, pressure in chest
INTERACTIONS Antifungals, antivirals, ergots, ketoconazole, macrolides, MAOIs,
nefazodone, SSRIs
NC/PT For acute migraine, not px. Ensure pt has not used ergots within 24 hr. Not for use
in pregnancy. Pt should not take more than two doses/24 hr; discontinue if s&sx of
angina; monitor environment.

alogliptin (Nesina)
CLASS Antidiabetic, DPP-4 inhibitor
PREG/CONT B/NA

IND & DOSEAdjunct to diet, exercise to improve glycemic control in type 2 diabetes.
Adult: 25 mg/day PO.
ADJUST DOSE Renal impairment
ADV EFF Headache, hepatotoxicity, hypoglycemia, nasopharyngitis, pancreatitis, URI
NC/PT Ensure continued diet, exercise program. Monitor blood glucose, renal, liver,
pancreatic function. May give w/ other antidiabetics. Pt should continue diet and
exercise program, report uncontrolled blood glucose, all herbs/other drugs used.

alosetron (Lotronex)
CLASS 5-HT3 antagonist, IBS drug
PREG/CONT B/NA

BBW Only indicated for women with severe diarrhea-dominant IBS who have failed to
respond to conventional tx. Ensure pt understands risks of use and warning signs to
report. Discontinue immediately at signs of constipation, ischemic colitis.
IND & DOSE Tx of severe diarrhea-predominant IBS in women with chronic IBS, no
anatomic or biochemical abnormalities of GI tract, and who have failed to
respond to conventional therapy. Adult: 0.5–1 mg PO bid.
ADJUST DOSE Elderly pts, mild to moderate hepatic impairment
ADV EFF Constipation, ischemic colitis
INTERACTIONS Cimetidine, clarithromycin, fluoroquinolones, fluvoxamine, GI motility
drugs, itraconazole, ketoconazole, telithromycin, voriconazole
NC/PT Ensure pt has signed physician-pt agreement. Give w/ or without food. Monitor
for signs of constipation. Not for use in pregnancy. Regular follow-up required. Pt
should report constipation.

alpha1-proteinase inhibitor (Aralast NP, Prolastin, Zemaira)

CLASS Blood product
PREG/CONT C/NA

IND & DOSE Chronic replacement tx for pts w/ congenital alpha 1-antitrypsin
deficiency; tx of pts with early evidence of panacinar emphysema. Adult: 60 mg/kg
IV once wkly (Aralast NP, Prolastin). Chronic augmentation and maint therapy of pts
w/ alpha 1-proteinase inhibitor deficiency with emphysema. Adult: 0.08 mL/kg/min
IV over 15 min once a wk (Zemaira).
ADV EFF Dizziness, fever, flulike symptoms, light-headedness
NC/PT Warn pt that this is blood product and can carry risk of blood-borne diseases.
Discontinue if s&sx of hypersensitivity. Pt should report fever, chills, joint pain.

alprazolam (Niravam, Xanax)

CLASS Anxiolytic, benzodiazepine
PREG/CONT D/C-IV

IND & DOSEMgt of anxiety disorders; short-term relief of anxiety symptoms; anxiety
associated w/ depression. Adult: 0.25–0.5 mg PO tid; adjust to max 4 mg/day in
divided doses. Panic disorder. Adult: 0.5 mg PO tid; increase at 3- to 4-day intervals to
1–10 mg/day or 0.5–1 mg/day ER tablets. Range, 3–6 mg/day.
ADJUST DOSE Elderly pts, advanced hepatic disease, debilitation
ADV EFF Anger, apathy, confusion, constipation, crying, CV collapse, diarrhea,
disorientation, drowsiness (initially), drug dependence (withdrawal syndrome when
drug is discontinued), dry mouth, fatigue, hostility, lethargy, light-headedness, mild
paradoxical excitatory reactions during first 2 wk of tx, restlessness, sedation
INTERACTIONS Alcohol, carbamazepine, cimetidine, digoxin, disulfiram, grapefruit juice,
hormonal contraceptives, isoniazid, kava, ketoconazole, levodopa, omeprazole, valerian
root, valproic acid
NC/PT Taper gradually when discontinuing. Pt should not cut, crush, or chew ER tablet;
avoid alcohol, grapefruit juice; take safety measures w/ CNS effects. Name confusion w/
Xanax (alprazolam), Celexa (citalopram), and Cerebyx (fosphenytoin), and between
alprazolam and lorazepam.

alprostadil (Caverject, Muse, Prostin VR Pediatric)

CLASS Prostaglandin
PREG/CONT Unkn/NA

BBW Apnea occurs in 10%–12% of neonates treated w/ alprostadil, particularly those

weighing under 2 kg. Monitor respiratory status continuously; have ventilatory
assistance readily available. Move neonate often during first hr of infusion.
IND & DOSE Tx of ED. Adult: Intracavernous injection, 0.2–60 mcg using 0.5-in, 27–30
gauge needle; may repeat up to three times/wk. Urogenital system, 125–250 mcg; max,
2 systems/24 hr. Palliative tx to temporarily maintain patency of ductus
arteriosus. Child: 0.025–0.05 mcg/kg/min IV infusion; max, 0.4 mcg/kg/min if needed.
ADV EFF Apnea, bradycardia, cardiac arrest, flushing, hypotension, respiratory distress,
tachycardia; w/ intracavernous injection: penile fibrosis
NC/PT Constantly monitor arterial pressure and blood gases w/ IV use. Use extreme
caution. Teach pt injection technique, proper disposal of needles and syringes. Name
confusion w/ Prostin VR Pediatric (alprostadil), Prostin F2 (dinoprost—available outside
US), Prostin E2 (dinoprostone), and Prostin 15M (carboprost in Europe).

DANGEROUS DRUG
alteplase recombinant (Activase, Cathflo Activase)
CLASS Thrombolytic enzyme, TPA
PREG/CONT C/NA

IND & DOSE Acute MI. Adult over 67 kg: 100 mg as 15-mg IV bolus followed by 50 mg
infused over 30 min; then 35 mg over next 60 min. Adult 67 kg or less: 15-mg IV bolus
followed by 0.75 mg/kg infused over 30 min (max, 50 mg); then 0.5 mg/kg over next 60
min (max, 35 mg). For 3-hr infusion, 60 mg in first hr (6–10 mg as bolus); 20 mg over
second hr; 20 mg over third hr. Pts under 65 kg should receive 1.25 mg/kg over 3 hr.
Pulmonary embolism. Adult: 100 mg IV infusion over 2 hr, followed immediately by
heparin therapy when PTT or thrombin time returns to twice normal or less. Acute
ischemic stroke. Adult: 0.9 mg/kg (max, 90 mg total dose) infused over 60 min w/ 10%
given as IV bolus over first min. Restoration of function of central venous access
devices. Adult: 2 mg (Cathflo Activase) in 2 mL sterile water for injection; may repeat
after 2 hr.
ADV EFF Bleeding, cardiac arrhythmias, intracranial hemorrhage, n/v, urticaria
INTERACTIONS Anticoagulants, aspirin, dipyridamole
NC/PT Discontinue heparin and alteplase if serious bleeding occurs. Monitor coagulation
studies; apply pressure or pressure dressings as needed to control bleeding. Type and
cross-match blood. Initiate tx within first 6 hr of MI, within 3 hr of stroke.

DANGEROUS DRUG
altretamine (Hexalen)
CLASS Antineoplastic
PREG/CONT D/NA

BBW Must be used under supervision of oncologist. Monitor blood counts regularly;
monitor neurologic exams regularly for neurotoxicity.
IND & DOSE Palliative tx of pts w/ persistent or recurrent ovarian cancer following
first-line therapy w/ cisplatin and/or alkylating agent–based combination. Adult:
260 mg/m2/day PO for 14 or 21 consecutive days of 28-day cycle w/ meals or at
bedtime.
ADV EFF Bone marrow depression, neurotoxicity, n/v/d
INTERACTIONS Antidepressants, cimetidine, MAOIs, pyridoxine
NC/PT Not for use in pregnancy, breast-feeding. Monitor blood counts regularly. Perform
neurologic exam before and regularly during tx. Give antiemetic if n/v severe.

aluminum hydroxide gel (generic)

CLASS Antacid
PREG/CONT Unkn/NA

IND & DOSE Hyperacidity, symptomatic relief of upset stomach associated w/

hyperacidity. Adult: Tablets/capsules, 500–1,500 mg three to six times/day PO between
meals and at bedtime. Liquid, 5–10 mL between meals and at bedtime. Child: 5–15 mL
PO q 3–6 hr or 1–3 hr after meals and at bedtime. Px of GI bleeding in critically ill
infants. 2–5 mL/dose PO q 1–2 hr.
ADV EFF Constipation, intestinal obstruction
INTERACTIONS Benzodiazepines, corticosteroids, diflunisal, digoxin, fluoroquinolones, iron,
isoniazid, oral drugs, penicillamine, phenothiazines, ranitidine, tetracyclines
NC/PT Do not give oral drugs within 1–2 hr of this drug. Monitor serum phosphorus levels
w/ long-term therapy. Advise pt to chew tables thoroughly and follow w/ water.
Constipation may occur.

alvimopan (Entereg)
CLASS Peripheral mu-opioid receptor antagonist
PREG/CONT B/NA

BBW For short-term use in hospitalized pts only.

IND & DOSE To accelerate time to upper and lower GI recovery after partial large or
small bowel resection surgery w/ primary anastomosis. Adult: 12 mg 30 min–5 hr
before surgery, then 12 mg PO bid for up to 7 days. Max, 15 doses.
ADJUST DOSE Renal, hepatic impairment
ADV EFF Anemia, back pain, constipation, dyspepsia, flatulence, hypokalemia, MI, urine
retention
NC/PT Not for use w/ severe hepatic or renal dysfx. For short-term, in-hospital use only.
Recent use of opioids may lead to increased adverse effects.

amantadine (Symmetrel)
CLASS Antiparkinsonian, antiviral
PREG/CONT C/NA

IND & DOSE Influenza A virus px or tx. Adult: 200 mg/day PO or 100 mg PO bid for 10
days. Child 9–12 yr: 100 mg PO bid. Child 1–9 yr: 4.4–8.8 mg/kg/day PO in one or two
divided doses; max, 150 mg/day. Parkinsonism tx. Adult: 100 mg PO bid (up to
400 mg/day). Drug-induced extrapyramidal reactions. Adult: 100 mg PO bid, up to
300 mg/day in divided doses.
ADJUST DOSE Elderly pts, seizure disorders, renal disease
ADV EFF Dizziness, insomnia, n/d
INTERACTIONS Anticholinergics, hydrochlorothiazide, QT-prolonging drugs, triamterene
NC/PT Do not discontinue abruptly w/ Parkinson’s disease. Dispense smallest amount
possible. Safety precautions if dizziness occurs.

ambrisentan (Letairis)
CLASS Antihypertensive, endothelin receptor antagonist
PREG/CONT X/NA

BBW Rule out pregnancy before starting tx; may cause fetal harm. Pt should use two
forms of contraception.
IND & DOSE Tx of pulmonary arterial hypertension to improve exercise ability and
delay clinical worsening. Adult: 5–10 mg/day PO.
ADV EFF Abd pain, anemia, constipation, edema, flushing, liver impairment, nasal
congestion, nasopharyngitis, sinusitis, reduced sperm count
INTERACTIONS Cyclosporine
NC/PT Available only through restricted access program. Not for use in pregnancy,
breast-feeding; negative pregnancy test, use of two forms of contraception required. Pt
should not cut, crush, or chew tablets.

amifostine (Ethyol)
CLASS Cytoprotective
PREG/CONT C/NA

IND & DOSE To reduce cumulative renal toxicity associated w/ cisplatin therapy in
pts w/ advanced ovarian cancer; to reduce incidence of moderate to severe
xerostomia in pts w/ postoperative radiation for head and neck cancer. Adult:
910 mg/m2 IV daily over 15 min before chemotherapy, over 3 min before radiation
therapy.
ADJUST DOSE Elderly pts, CV disease
ADV EFF Cutaneous reactions, dizziness, hypocalcemia, hypotension, n/v
INTERACTIONS Cyclosporine
NC/PT Premedicate w/ antiemetic, dexamethasone. Monitor BP carefully during tx.
Discontinue at s&sx of cutaneous reaction.

amikacin sulfate (Amikin)

CLASS Aminoglycoside
PREG/CONT D/NA

BBW Monitor for nephrotoxicity, ototoxicity w/ baseline and periodic renal function and
neurologic examinations. Risk of serious toxicity, including neuromuscular blockade and
respiratory paralysis.
IND & DOSE Short-term tx of serious infections caused by susceptible strains of
Pseudomonas sp, Escherichia coli, indole-positive and indole-negative Proteus sp,
Providencia sp, Klebsiella sp, Enterobacter sp, Serratia sp, Acinetobacter sp,
suspected gram-negative infections before susceptibility is known; initial tx of
staphylococcal infection if penicillin contraindicated. Adult, child: 15 mg/kg/day
IM or IV in two to three equal doses at equal intervals, not to exceed 1.5 g/day, for 7–10
days. UTIs. Adult, child: 250 mg IM or IV bid.
ADJUST DOSE Elderly pts, renal failure
ADV EFF Anorexia, nephrotoxicity, n/v/d, ototoxicity, pain at injection site,
superinfections
INTERACTIONS Hetastarch in IV sol, NMJ blockers, ototoxic drugs, penicillin
NC/PT Culture before tx. Monitor renal function, length of tx. Ensure pt well hydrated.
Give IM dose by deep injection. Pt should report loss of hearing. Name confusion
between amikacin and anakinra.

amiloride hydrochloride (Midamor)

CLASS Potassium-sparing diuretic
PREG/CONT B/NA

BBW Monitor pt for hyperkalemia.

IND & DOSE Adjunctive tx for edema of HF or hypertension; to prevent hypokalemia
in pts at risk. Adult: Add 5 mg/day PO to usual antihypertensive dose; may increase
dose to 10–20 mg/day w/ careful electrolyte monitoring.
ADV EFF Anorexia, ED, n/v/d, weakness
INTERACTIONS ACE inhibitors, digoxin, potassium supplements, spironolactone,
triamterene
NC/PT Give early in day w/ food. Monitor weight, edema, serum electrolytes. Advise pt
to take early in day (so increased urination will not disturb sleep) and avoid foods high
in potassium.

amino acids (Aminosyn, FreAmine, HepatAmine, ProcalAmine, Travasol, etc)

CLASS Calorie agent, protein substrate
PREG/CONT C/NA

IND & DOSE To provide nutrition to pts in negative nitrogen balance and unable to
maintain in other ways. Adult: 1–1.5 g/kg/day amino acid injection IV into peripheral
vein; 250–500 mL/day amino acid injection IV mixed w/ appropriate dextrose,
vitamins, and electrolytes as part of TPN sol. Must be individualized. Hepatic
encephalopathy. Adult: 80–120 g amino acid/day; 500 mL HepatAmine w/ 500 mL 50%
dextrose and electrolyte sol IV over 8–12 hr/day. Child w/ renal failure. 0.5–1
g/kg/day amino acid IV mixed w/ dextrose as appropriate. Amino acids replacement.
Adult, child 16 yr and older: 1.5 g/kg/day IV. Child 13–15 yr: 1.7 g/kg/day IV. Child 4–
12 yr: 2 g/kg/day IV. Child 1–3 yr: 2–2.5 g/kg/day IV.
ADV EFF Dizziness, headache, infection, n/v, pain at infusion site, pulmonary edema
INTERACTIONS Tetracyclines
NC/PT Use strict aseptic technique in preparation, administration. Individualize dose
based on lab values. Replace all IV apparatus daily. Infuse slowly; monitor closely.

aminocaproic acid (Amicar)

CLASS Systemic hemostatic
PREG/CONT C/NA

IND & DOSE Tx of excessive bleeding due to systemic hyperfibrinolysis/ urinary

fibrinolysis. Adult: Initially, 5 g PO or IV followed by 1–1.25 g every hr to produce and
sustain plasma levels of 0.13 mg/mL; do not give more than 30 g/day. Acute bleeding.
Adult: 4–5 g IV in 250 mL diluent during first hr of infusion; then continuous infusion of
1 g/hr in 50 mL diluent. Continue for 8 hr or until bleeding stops. Px of recurrence of
subarachnoid hemorrhage. Adult: 36 g/day PO or IV in six divided doses.
ADV EFF Abd cramps, dizziness, headache, malaise, n/v/d, pulmonary embolism,
tinnitus
INTERACTIONS Estrogen, hormonal contraceptives
NC/PT Pt on oral therapy may need up to 10 tablets first hr and around-the-clock dosing.
Orient, support pt if CNS effects occur. Monitor for s&sx of clotting.

aminolevulinic acid hydrochloride (Levulan Kerastick)

CLASS Photosensitizer
 PREG/CONT C/NA

IND & DOSE Tx of nonkeratotic actinic keratosis of face and scalp w/ light therapy.
Adult: 20% sol applied directly to lesions, followed by light therapy within next 14–
18 hr; once q 8 wk if needed.
ADV EFF Local crusting, local erosion, itching, photosensitivity, scaling
NC/PT Clean and dry area; break ampule and apply directly to lesions. Light therapy
must be done in 14–18 hr. May repeat in 8 wk.

aminophylline (generic)
CLASS Bronchodilator, xanthine
PREG/CONT C/NA

IND & DOSE Symptomatic relief or prevention of bronchial asthma, reversible

bronchospasm associated w/ chronic bronchitis and emphysema; adjunct to
inhaled beta 2-selective adrenergic agonists and systemic corticosteroids for tx of
acute exacerbations of s&sx and reversible airflow obstruction associated w/
asthma. Adult: Initially, 300 mg PO in divided doses q 6–8 hr; after 3 days increase to
400 mg/day PO in divided doses q 6–8 hr; after 3 more days, if tolerated, 600 mg/day
PO in divided doses q 6–8 hr; adjust dose based on peak theophylline levels. Child:
Adjust dose based on response. Child 1–15 yr: Initially, 12–14 mg/kg/day PO in divided
doses q 4–6 hr (max, 300 mg/day); after 3 days, 16 mg/kg/day PO in divided doses q 4–
6 hr (max, 400 mg/day); after 3 more days, 20 mg/kg/day PO in divided doses q 4–6 hr
(max, 600 mg/day). IV infusion rate for rapid tx. Loading dose, 5.7 mg/kg over 30
min. Then, adult over 60 yr: 0.3 mg/kg/hr (max, 400 mg theophylline/day); healthy
nonsmoking adult, 0.4 mg/kg/hr (max, 900 mg theophylline/day); adult w/ cardiac
decompensation, cor pulmonale, hepatic impairment, sepsis w/ multiorgan failure, shock:
0.2 mg/kg/hr (max, 400 mg theophylline/day, 17 mg/hr); adolescent (nonsmoking) 12–
16 yr: 0.5 mg/kg/hr (max, 900 mg theophylline/day); adolescent smokers/child 9–12 yr:
0.7 mg/kg/hr; child 1–9 yr: 0.8 mg/kg/hr; infants 6–52 wk: mg/kg/hr = 0.008 × age
in wks + 0.21; neonates over 24 days, 1.5 mg/kg q 12 hr; neonates 24 days or younger,
1 mg/kg q 12 hr.
ADV EFF Related to serum theophylline levels: Anorexia, brain damage, circulatory
failure, dizziness, irritability, n/v/d, respiratory arrest, seizures, tachycardia
INTERACTIONS Acyclovir, allopurinol, beta blockers, cimetidine, clindamycin, diltiazem,
disulfiram, enoxacin, erythromycin, fluoroquinolones, fluvoxamine, hormonal
contraceptives, nicotine, NMJ blockers, pentoxifylline, phenytoin, sympathomimetics,
tetracyclines, thiabendzole, ticlopidine, verapamil, zileuton
NC/PT Maintain adequate hydration. Monitor serum theophylline levels carefully. Use in
pregnancy only if clearly needed. Pt should avoid excessive intake of caffeinated
beverages, report changes in smoking habits (smoking affects drug’s effectiveness).
 DANGEROUS DRUG
amiodarone hydrochloride (Cordarone, Pacerone)
CLASS Adrenergic blocker, antiarrhythmic
PREG/CONT D/NA

BBW Reserve use for life-threatening arrhythmias; serious toxicity, including

arrhythmias, pulmonary toxicity, possible.
IND & DOSE Tx of life-threatening recurrent ventricular arrhythmias. Adult: Loading
dose, 800–1,600 mg/day PO in divided doses for 1–3 wk; reduce dose to 600–
800 mg/day PO in divided doses for 1 mo; if rhythm stable, reduce dose to 400 mg/day
PO in one to two divided doses for maint dose. Or, 1,000 mg IV over 24 hr: 150 mg IV
loading dose over 10 min, followed by 360 mg IV over 6 hr at 1 mg/min, then 540 mg
IV at 0.5 mg/min over next 18 hr. After first 24 hr, maint infusion of 0.5 mg/min
(720 mg/24 hr) or less IV can be cautiously continued for 2–3 wk. Switch to PO form as
soon as possible. Convert to PO dose based on duration of IV therapy: Less than 1 wk,
initial PO dose is 800–1,600 mg; 1–3 wk, initial PO dose is 600–800 mg; more than
3 wk, initial PO dose is 400 mg.
ADV EFF Anorexia, ataxia, cardiac arrest, cardiac arrhythmias, constipation, corneal
microdeposits, fatigue, hepatotoxicity, hyperthyroidism, hypothyroidism, n/v,
photosensitivity, pulmonary toxicity
INTERACTIONS Azole antifungals, beta blockers, calcium channel blockers, digoxin,
ethotoin, fluoroquinolones, grapefruit juice, macrolide antibiotics, phenytoin, quinidine,
ranolazine, simvastatin, thioridazine, trazodone, vardenafil, warfarin, ziprasidone
NC/PT Monitor cardiac rhythm continually and pulmonary function w/ periodic chest X-
ray. Regular blood tests and serum-level checks needed. Obtain baseline ophthalmic
exam, then periodically. Not for use in pregnancy. Pt should avoid grapefruit juice,
report vision or breathing changes.

amitriptyline hydrochloride (generic)

CLASS Antidepressant, TCA
PREG/CONT D/NA

BBW Increased risk of suicidality in children, adolescents, young adults; monitor

carefully.
IND & DOSE Relief of sx of depression (endogenous). Adult, hospitalized pts: Initially,
100 mg/day PO in divided doses; gradually increase to 200–300 mg/day as needed.
Outpt: Initially, 75 mg/day PO in divided doses; may increase to 150 mg/day. Maint
dose, 40–100 mg/day (may give as single bedtime dose). Child 12 yr and older: 10 mg PO
tid, then 20 mg at bedtime. Chronic pain. Adult: 75–150 mg/day PO.
ADJUST DOSE Elderly pts
ADV EFF Anticholinergic effects, confusion, constipation, disturbed concentration, dry
mouth, MI, orthostatic hypotension, photosensitivity, sedation, stroke
INTERACTIONS Anticholinergics, barbiturates, cimetidine, clonidine, disulfiram, ephedrine,
epinephrine, fluoxetine, furazolidone, hormonal contraceptives, levodopa, MAOIs,
methylphenidate, nicotine, norepinephrine, phenothiazines, QT-prolonging drugs,
thyroid medication
NC/PT Restrict drug access in depressed or suicidal pts; give major portion at bedtime. Pt
should be aware of sedative effects and avoid driving, etc, not mix w/ other sleep-
inducing drugs, avoid prolonged exposure to sun or sunlamps, report thoughts of
suicide.

amlodipine besylate (Norvasc)

CLASS Antianginal, antihypertensive, calcium channel blocker
PREG/CONT C/NA

IND & DOSETx of chronic stable angina, Prinzmetal’s angina; to reduce angina risk
and need for revascularization procedures in pts w/ CAD without HF; tx of
essential hypertension. Adult: Initially, 5 mg/day PO; may gradually increase dose
over 7–14 days to max 10 mg/day PO. Tx of hypertension. Child 6–17 yr: 2.5–5 mg/
day PO.
ADJUST DOSE Elderly pts, hepatic impairment
ADV EFF Dizziness, fatigue, flushing, headache, lethargy, light-headedness, nausea,
peripheral edema
INTERACTIONS Anticholinergics, barbiturates, cimetidine, clonidine, disulfiram, ephedrine,
epinephrine, fluoxetine, furazolidone, hormonal contraceptives, levodopa, MAOIs,
methylphenidate, nicotine, norepinephrine, phenothiazines, QT-prolonging drugs,
thyroid medication
NC/PT Monitor closely when adjusting dose; monitor BP w/ hx of nitrate use. Monitor
cardiac rhythm during initiation and periodically during tx. Name confusion between
Norvasc (amlodipine) and Navane (thiothixene).

ammonium chloride (generic)

CLASS Electrolyte, urine acidifier
PREG/CONT C/NA

IND & DOSETx of hypochloremic states and metabolic alkalosis; urine acidification.
Adult: Dosage determined by pt’s condition and tolerance. Monitor dosage rate and
amount by repeated serum bicarbonate determinations. IV infusion should not exceed
conc of 1%–2% of ammonium chloride
ADV EFF Ammonia toxicity, hepatic impairment, pain at injection site
INTERACTIONS Amphetamine, chlorpropamide, dextroamphetamine, ephedrine, flecainide,
methadone, methamphetamine, mexiletine, pseudoephedrine
NC/PT Give IV slowly. Monitor for possible fluid overload, acidosis; have sodium
bicarbonate or sodium lactate available in case of overdose.

amoxapine (generic)
CLASS Anxiolytic, TCA
PREG/CONT C/NA

BBW Increased risk of suicidality in children, adolescents, young adults; monitor

carefully.
IND & DOSE Relief of sx of depression; tx of depression w/ anxiety or agitation. Adult:
Initially, 50 mg PO bid–tid; gradually increase to 100 mg PO bid–tid by end of first wk if
tolerated; increase above 300 mg/day only if dosage ineffective for at least 2 wk. Usual
effective dose, 200–300 mg/day.
ADJUST DOSE Elderly pts
ADV EFF Anticholinergic effects, confusion, constipation, disturbed concentration, dry
mouth, MI, orthostatic hypotension, photosensitivity, sedation, stroke
INTERACTIONS Anticholinergics, barbiturates, cimetidine, clonidine, disulfiram, ephedrine,
epinephrine, fluoxetine, furazolidone, hormonal contraceptives, levodopa, MAOIs,
methylphenidate, nicotine, norepinephrine, phenothiazines, QT-prolonging drugs,
thyroid medication
NC/PT Restrict drug access in depressed or suicidal pts; give major portion at bedtime. Pt
should be aware of sedative effects and avoid driving, etc, should not mix w/ other
sleep-inducing drugs, should avoid prolonged exposure to sun or sunlamps, report
thoughts of suicide.

amoxicillin trihydrate (Amoxil, Moxatag, Trimox)

CLASS Antibiotic, penicillin-type
PREG/CONT B/NA

IND & DOSE Tx of tonsillitis and pharyngitis caused by Streptococcus pyogenes (ER
tablet); infections due to susceptible strains of Haemophilus influenzae, Escherichia
coli, Proteus mirabilis, Neisseria gonorrhoeae, Streptococcus pneumoniae,
Enterococcus faecalis, streptococci, non–penicillinase-producing staphylococci,
Helicobacter pylori infection in combination w/ other agents; postexposure px
against Bacillus anthracis. Adult, child over 40 kg: URIs, GU, skin and soft-tissue
infections, 250 mg PO q 8 hr or 500 mg PO q 12 hr; severe infection, 500 mg PO q 8 hr
or 875 mg PO q 12 hr; postexposure anthrax px, 500 mg PO tid to complete 60-day
course after 14–21 days of a fluoroquinolone or doxycycline; lower respiratory infection,
500 mg PO q 8 hr or 875 mg PO bid; uncomplicated gonococcal infections, 3 g
amoxicillin PO as single dose; C. trachomatis in pregnancy, 500 mg PO tid for 7 days or
875 mg PO bid; tonsillitis/pharyngitis, 775 mg/day PO for 10 days w/ food (ER tablet);
H. pylori infection, 1 g PO bid w/ clarithromycin 500 mg PO bid and lansoprazole 30 mg
PO bid for 14 days. Child 3 mo and older, under 40 kg: URIs, GU infections, skin and soft-
tissue infections, 20 mg/kg/day PO in divided doses q 8 hr or 25 mg/kg/day PO in
divided doses q 12 hr; severe infection, 40 mg/kg/day PO in divided doses q 8 hr or
45 mg/kg/day PO in divided doses q 12 hr; postexposure anthrax px, 80 mg/kg/day PO
divided in three doses to complete 60-day course after 14–21 days of fluoroquinolone or
doxycycline tx. Child 3 mo and older: Mild to moderate URIs, GU infections, skin
infections, 20 mg/kg PO daily in divided doses q 8 hr or 25 mg/kg PO in divided doses q
12 hr; acute otitis media, 80–90 mg/kg/day PO for 10 days (severe cases) or 5–7 days
(moderate cases); gonorrhea in prepubertal children, 50 mg/kg PO w/ 25 mg/kg
probenecid PO as single dose; lower respiratory infections/severe URI, GU, and skin
infections, 40 mg/kg PO daily in divided doses q 8 hr or 45 mg/kg PO daily in divided
doses q 12 hr. Child up to 12 wk: 30 mg/kg PO daily in divided doses q 12 hr.
ADJUST DOSE Renal impairment
ADV EFF Abd pain, anaphylaxis, fever, gastritis, glossitis, n/v/d, sore mouth,
superinfections, wheezing
INTERACTIONS Chloramphenicol, hormonal contraceptives, probenecid, tetracyclines
NC/PT Culture before tx. Monitor for superinfections; n/v/d may occur. Pt should not cut,
crush, or chew ER tablets; should continue until at least 2 days after s&sx resolve;
complete full course.

DANGEROUS DRUG
amphotericin B; amphotericin B cholesteryl sulfate; amphotericin B, liposome
(Abelcet, AmBisome, Amphotec)
CLASS Antifungal
PREG/CONT B/NA

BBW Reserve systemic use for progressive or potentially fatal infections. Not for use in
noninvasive disease; toxicity can be severe.
IND & DOSE Tx of potentially fatal, progressive fungal infections not responsive to
other tx. Adult, child: 5 mg/kg/day IV as single infusion at 2.5 mg/kg/hr (Abelcet).
Aspergillosis. Adult, child: Initially, 3–4 mg/kg/day IV; Infuse at 1 mg/kg/hr
(Amphotec). Or, 3 mg/kg/day IV over more than 2 hr (AmBisome). Presumed fungal
infection in febrile neutropenic pts. Adult, child: 3 mg/kg/day IV (AmBisome).
Cryptococcal meningitis in HIV pts. Adult, child: 6 mg/kg/day IV (AmBisome).
Leishmaniasis. Adult, child: 3 mg/kg/day IV, days 1–5, 14, and 21 for
immunocompetent pts; 4 mg/kg/day IV, days 1–5, 10, 17, 24, 31, and 38 for
immunocompromised pts (AmBisome).
ADV EFF Cramping, dyspepsia, electrolyte disturbances, n/v/d, pain at injection site,
renal toxicity
INTERACTIONS Antineoplastics, corticosteroids, cyclosporine, digitalis, nephrotoxic drugs,
thiazide diuretics, zidovudine
NC/PT Dose varies among brand names; check carefully. Culture before tx. Monitor
injection sites, electrolytes, kidney function. Use antihistamines, aspirin, antiemetics,
meperidine to improve comfort, drug tolerance.

ampicillin (Principen)
CLASS Antibiotic, penicillin
PREG/CONT B/NA

IND & DOSE Tx of bacterial infections caused by susceptible strains; tx of GU

infections: Adult: 500 mg IM, IV, PO q 6 hr. Tx of respiratory tract infections. Adult:
250 mg IM, IV, PO q 6 hr. Tx of digestive system infections. Adult: 500 mg PO q 6 hr
for 48–72 hr after pt asymptomatic or eradication evident. Tx of STDs in pts allergic
to tetracycline. Adult: 3.5 g ampicillin PO w/ 1 g probenecid. Prevention of bacterial
endocarditis for dental, oral, or upper respiratory procedures in pts at high risk.
Adult: 2 g ampicillin IM or IV within 30 min of procedure. Child: 50 mg/kg ampicillin IM
or IV within 30 min of procedure. Six hr later, 25 mg/kg ampicillin IM or IV or
25 mg/kg amoxicillin PO. Tx of respiratory and soft-tissue infections. Adult, child
40 kg or more: 250–500 mg IV or IM q 6 hr. Under 40 kg: 25–50 mg/kg/day IM or IV in
equally divided doses at 6- to 8-hr intervals. 20 kg to 40 kg: 250 mg PO q 6 hr. Under
20 kg: 50 mg/kg/day PO in equally divided doses q 6–8 hr. Tx of GI and GU infections,
including women w/ N. gonorrhoeae. Adult, child over 40 kg: 500 mg IM or IV q 6 hr.
40 kg or less: 50 mg/kg/day IM or IV in equally divided doses q 6–8 hr. 20 kg to 40 kg:
500 mg PO q 6 hr. Under 20 kg: 100 mg/kg/day PO in equally divided doses q 6–8 hr. Tx
of bacterial meningitis. Adult, child: 150–200 mg/kg/day by continuous IV drip, then
IM injections in equally divided doses q 3–4 hr. Tx of septicemia. Adult, child: 150–
200 mg/kg/day IV for at least 3 days, then IM q 3–4 hr.
ADJUST DOSE Renal impairment
ADV EFF Abd pain, anaphylaxis, fever, gastritis, glossitis, n/v/d, sore mouth,
superinfections, wheezing
INTERACTIONS Atenolol, chloramphenicol, hormonal contraceptives, probenecid,
tetracyclines
NC/PT Culture before tx. Give on empty stomach. Do not give IM injections in same site.
Check IV site for thrombosis. Monitor for superinfections. Pt should use second form of
contraception while on drug. May experience n/v/d.

anagrelide (Agrylin)
CLASS Antiplatelet
PREG/CONT C/NA

IND & DOSE Tx of essential thrombocythemia secondary to myeloproliferative

disorders to reduce elevated platelet count and risk of thrombosis; to improve
associated s&sx, including thrombohemorrhagic events. Adult: Initially, 0.5 mg PO
qid or 1 mg PO bid; do not increase by more than 0.5 mg/day each wk. Max, 10 mg/day
or 2.5 mg as single dose. Child: Initially, 0.5 mg/day–0.5 mg PO qid; do not increase by
more than 0.5 mg/day each wk. Max, 10 mg/day or 2.5 mg in single dose.
ADJUST DOSE Moderate hepatic impairment
ADV EFF Abd pain, asthenia, bleeding, complete heart block, headache, HF, MI, n/v/d,
palpitations, pancreatitis, thrombocytopenia
INTERACTIONS Grapefruit juice
NC/PT Obtain platelet count q 2 days for first wk, then wkly. Provide safety measures.
Monitor for bleeding; mark chart for alert in invasive procedures. Not for use in
pregnancy. Pt should not drink grapefruit juice; should take on empty stomach. Name
confusion between Agrylin and Aggrastat (tirofiban).

anakinra (Kineret)
CLASS Antiarthritic, interleukin-1 receptor antagonist
PREG/CONT B/NA

IND & DOSE To reduce s&sx and slow progression of moderately to severely active
rheumatoid arthritis in pts who have failed on one or more disease-modifying
antirheumatic drugs. Adult 18 yr and older: 100 mg/day subcut at about same time
each day.
ADJUST DOSE Renal impairment
ADV EFF Infections, injection-site reactions, sinusitis, URI
INTERACTIONS Etanercept, immunizations, TNF blockers
NC/PT Increased risk of serious infection w/ TNF blockers; monitor pt carefully. Store
refrigerated, protected from light. Not for use in pregnancy. Rotate inject sites. Pt
should dispose of syringes, needles appropriately. Other antiarthritics may also be
needed. Name confusion between anakinra and amikacin.

DANGEROUS DRUG
anastrozole (Arimidex)
CLASS Antiestrogen, antineoplastic, aromatase inhibitor
PREG/CONT X/NA

IND & DOSE Tx of advanced breast cancer in postmenopausal women w/ disease

progression following tamoxifen tx; first-line tx of postmenopausal women w/
hormone receptor–positive or hormone receptor–unknown locally advanced or
metastatic breast cancer; adjuvant tx of postmenopausal women w/ hormone
receptor–positive early breast cancer. Adult: 1 mg/day PO.
ADV EFF Asthenia, back pain, bone pain, decreased bone density, fractures, hot flashes,
insomnia, n/v, pharyngitis
INTERACTIONS Estrogens, tamoxifen
NC/PT Monitor lipid levels periodically, bone density. Use analgesics for pain. Not for use
in pregnancy.
 anidulafungin (Eraxis)
CLASS Antifungal, echinocandin
PREG/CONT C/NA

IND & DOSE Tx of candidemia and other Candida infections. Adult: 200 mg by IV
infusion on day 1, then 100 mg/day by IV infusion; generally for minimum of 14 days.
Tx of esophageal candidiasis. Adult: 100 mg by IV infusion on day 1, then 50 mg/day
by IV infusion for minimum of 14 days.
ADV EFF Liver toxicity, n/v/d
NC/PT Culture before tx. Monitor LFTs. Not for use in pregnancy, breast-feeding.
Maintain fluid, food intake.

antihemophilic factor (Advate, Hemofil, Humate-P, ReFacto, Wilate, Xyntha)

CLASS Antihemophilic
PREG/CONT C/NA

IND & DOSE Tx of hemophilia A; short-term px (ReFacto) to reduce frequency of

spontaneous bleeding; surgical or invasive procedures in pts w/ von Willebrand
disease in whom desmopressin is ineffective or contraindicated. Adult, child: Dose
depends on weight, severity of deficiency, severity of bleeding; monitor factor VIII
levels to establish dose needed. Follow tx carefully w/ factor VIII level assays. Formulas
used as dosage guide:

ADV EFF AIDS (from repeated use of blood products), bronchospasm, hemolysis,
hepatitis, stinging at infusion site, tachycardia
NC/PT Monitor factor VIII levels regularly. Monitor pulse. Reduce rate of infusion w/
significant tachycardia. Pt should wear or carry medical alert information.

antithrombin, recombinant (ATryn)

CLASS Coagulation inhibitor
PREG/CONT C/NA

IND & DOSE Prevention of periop and peripartum thromboembolic events in pts w/
hereditary antithrombin deficiency. Adult: Individualize dose based on antithrombin
level; loading dose over 15 min IV followed by maint dose to keep antithrombin activity
levels 80%–120% of normal. Surgical pts, use formula 100 – baseline antithrombin
activity ÷ 2.3 × body wt; maint, divide by 10.2. Pregnant women, 100 – baseline
antithrombin activity ÷ 1.3 × body wt; maint, divide by 5.4.
ADV EFF Hemorrhage, infusion-site reactions
INTERACTIONS Heparin, low-molecular-weight heparin
NC/PT Not for use w/ allergy to goats or goat products. Follow clotting studies closely.

antithrombin III (Thrombate III)

CLASS Coagulation inhibitor
PREG/CONT C/NA

IND & DOSE Tx of pts w/ hereditary antithrombin III deficiency in connection w/

surgical or obstetrical procedures or when suffering from thromboembolism;
replacement tx in congenital antithrombin III deficiency. Adult: Dosage units =
desired antithrombin level (%) – baseline antithrombin level (%) × body wt (kg) ÷ 1.4
q 2–8 days IV.
ADV EFF Hemorrhage, infusion-site reactions
INTERACTIONS Heparin, low-molecular-weight heparin
NC/PT Frequent blood tests required. Dosage varies widely. Monitor for bleeding. Human
blood product; slight risk of blood-transmitted diseases.

DANGEROUS DRUG
apixaban (Eliquis)
CLASS Anticoagulant, direct thrombin inhibitor
PREG/CONT B/NA

IND & DOSE Reduction of stroke, embolism in pts w/ nonvalvular atrial fibrillation.
Adult: 5 mg PO bid.
ADJUST DOSE Elderly pts, severe renal impairment
ADV EFF Bleeding, rebound thrombotic events w/ discontinuation, severe
hypersensitivity reactions
INTERACTIONS Carbamazepine, clarithromycin, itraconazole, ketoconazole, other drugs
that increase bleeding, phenytoin, rifampin, ritonavir, St. John’s wort
NC/PT Not for use w/ artificial heart valves. Monitor for bleeding; do not stop suddenly.
Pt should avoid pregnancy, breast-feeding, OTC drugs that affect bleeding; ensure that
drug is not stopped suddenly; take safety precautions to avoid injury; report increased
bleeding, chest pain, headache, dizziness.

apomorphine (Apokyn)
CLASS Antiparkinsonian, dopamine agonist
PREG/CONT C/NA

IND & DOSE Intermittent tx of hypomobility “off” episodes caused by advanced

Parkinson’s disease. Adult: 2 mg subcut; increase slowly to max of 6 mg. Give 300 mg
trimethobenzamide PO tid for 3 days before starting to completion of 2 mo of tx.
ADV EFF Chest pain, dizziness, dyskinesia, edema, fibrotic complications, flushing,
hallucinations, hepatic impairment, melanoma, n/v, renal impairment, rhinorrhea,
sedation, somnolence, sweating, yawning
INTERACTIONS Antihypertensives, dopamine antagonists, 5-HT3 antagonists (granisetron,
ondansetron, etc), QT-prolonging drugs, vasodilators
NC/PT Give subcut injection in stomach, upper arm, or leg; rotate sites. Protect pt when
CNS effects occur. Teach proper drug administration, disposal of needles and syringes;
many CNS effects possible.

aprepitant (Emend), fosaprepitant (Emend for Injection)

CLASS Antiemetic, substance P and neurokinin 1 receptor antagonist
PREG/CONT B/NA

IND & DOSE With other antiemetics for prevention of acute and delayed n/v
associated w/ initial and repeat courses of moderately or highly emetogenic
cancer chemotherapy. Adult: Aprepitant, 125 mg PO 1 hr before chemotherapy (day 1)
and 80 mg PO once daily in a.m. on days 2 and 3 w/ dexamethasone, ondansetron; or
parenteral administration, fosaprepitant, 115 mg IV 30 min before chemotherapy on
day 1 of antiemetic regimen; infuse over 15 min. Child: 115 mg IV 30 min before
chemotherapy infused over 15 min on day 1 of antiemetic regimen; 125 mg/day PO
days 2 and 3. Postop n/v. Adult: 40 mg PO within 3 hr before anesthesia induction.
ADV EFF Anorexia, constipation, diarrhea, dizziness, fatigue
INTERACTIONS Docetaxel, etoposide, hormonal contraceptives, ifosfamide, imatinib,
irinotecan, paclitaxel, pimozide, vinblastine, vincristine, vinorelbine, warfarin
NC/PT Give first dose w/ dexamethasone 1 hr before start of chemotherapy; give
additional doses of dexamethasone and ondansetron as indicated as part of antiemetic
regimen. Give within 3 hr before anesthesia induction if used to prevent postop n/v.
Provide safety precautions, analgesics as needed. Not for use in pregnancy or breast-
feeding. Pt should use caution if dizziness, drowsiness occur.

arformoterol tartrate (Brovana)

CLASS Bronchodilator, long-acting beta agonist
PREG/CONT C/NA

BBW Increased risk of asthma-related death; alert pt accordingly. Contraindicated in

asthma without use of long-term control medication.
IND & DOSE Long-term maint tx of bronchoconstriction in pts w/ COPD. Adult: 15 mcg
bid (a.m. and p.m.) by nebulization. Max, 30 mcg total daily dose.
ADV EFF Asthma-related deaths, paradoxical bronchospasm
INTERACTIONS Beta-adrenergic blockers, diuretics, MAOIs, QT-prolonging drugs, TCAs
NC/PTNot for use in acute bronchospasm. Ensure pt continues other drugs to manage
COPD, especially long-term control drugs. Not for use in pregnancy, breast-feeding.
Teach proper use of nebulizer. Pt should have periodic evaluation of respiratory status.

DANGEROUS DRUG
argatroban (Argatroban)
CLASS Anticoagulant
PREG/CONT B/NA

IND & DOSE Px or tx of thrombosis in pts w/ heparin-induced thrombocytopenia,

including pts at risk undergoing percutaneous coronary intervention (PCI). Adult:
2 mcg/kg/min IV; PCI, bolus of 350 mcg/kg IV over 3–5 min, then 25 mcg/kg/min IV.
ADV EFF Bleeding, cardiac arrest, chest pain, dyspnea, fever, headache, hypotension,
n/v/d
INTERACTIONS Heparin, thrombolytics, warfarin
NC/PT Not for use in pregnancy, breast-feeding. Monitor for s&sx of bleeding.

aripiprazole (Abilify, Abilify Discmelt)

CLASS Atypical antipsychotic, dopamine/serotonin agonist and antagonist
PREG/CONT C/NA

BBW Elderly pts w/ dementia-related psychosis have increased risk of death if given
atypical antipsychotics. Risk of suicidal ideation increases w/ antidepressant use,
especially in children, adolescents, young adults; monitor accordingly.
IND & DOSE Oral sol may be substituted on mg-to-mg basis up to 25 mg of tablet. Pts
taking 30-mg tablets should receive 25 mg if switched to sol. Tx of schizophrenia.
Adult: 10–15 mg/day PO. Increase dose q 2 wk to max of 30 mg/day. Child 13–17 yr:
Initially, 2 mg/day PO. Adjust to 5 mg/day after 2 days, then to target dose of
10 mg/day; max, 30 mg/day. Tx of bipolar disorder. Adult: 15 mg/day PO as one dose;
maint, 15–30 mg/ day PO. Child 10–17 yr: Initially, 2 mg/day PO; titrate to 5 mg/day
after 2 days, then to 10 mg/day after another 2 days. Target dose, 10 mg/day; max,
30 mg/day. Tx of major depressive disorder. Adult: Initially, 2–5 mg/day PO; maint,
2–15 mg/day as adjunct therapy. Tx of agitation. Adult: 5.25–15 mg IM; usual dose,
9.75 mg IM. May give cumulative doses of up to 30 mg/day PO. Irritability associated
w/ autistic disorder. Child 6–17 yr: 2 mg/day PO; titrate to maint dose of 5–
15 mg/day.
ADV EFF Hyperglycemia, NMS, seizures (potentially life-threatening), suicidality,
weight gain
INTERACTIONS Alcohol, carbamazepine, CNS depressants, CYP2D6 inhibitors (fluoxetine,
paroxetine, quinidine), CYP3A4 inhibitors (ketoconazole), lorazepam
NC/PT Dispense least amount possible to suicidal pts. Ensure pt well hydrated. Switch to
oral sol w/ difficulty swallowing. Not for use in pregnancy, breast-feeding. Monitor
weight; assess for hyperglycemia. May react w/ many medications; monitor drug
regimen. Confusion between aripiprazole and proton pump inhibitors; use extreme
caution.

armodafinil (Nuvigil)
CLASS CNS stimulant, narcoleptic
PREG/CONT C/C-IV

IND & DOSE To improve wakefulness in pts w/ excessive sleepiness associated w/

obstructive sleep apnea/hypopnea syndrome; narcolepsy. Adult: 150–250 mg/day
PO as single dose in a.m. Shift work sleep disorder. Adult: 150 mg/day PO taken 1 hr
before start of work shift.
ADJUST DOSE Elderly pts, severe hepatic impairment
ADV EFF Dizziness, headache, insomnia, nausea, Stevens-Johnson syndrome
INTERACTIONS Cyclosporine, ethinyl estradiol, hormonal contraceptives, midazolam,
omeprazole, phenytoin, TCAs, triazolam, warfarin
NC/PT Rule out underlying medical conditions. Should be part of comprehensive program
for sleep. Provide safety measures if CNS effects occur. Not for use in pregnancy, breast-
feeding. Pt should use barrier contraceptives, avoid alcohol.

DANGEROUS DRUG
arsenic trioxide (Trisenox)
CLASS Antineoplastic
PREG/CONT D/NA

BBW Extremely toxic and carcinogenic; monitor blood counts, electrolytes. Prolonged
QT interval, arrhythmias; monitor ECG.
IND & DOSE Induction and remission of acute promyelocytic leukemia in pts
refractory to retinoid or anthracycline chemotherapy w/ t(15:17) translocation
or PML/RAR-alpha gene expression. Adult: Induction, 0.15 mg/kg/day IV until bone
marrow remission; max, 60 doses. Consolidation, 0.15 mg/kg/day IV starting 3–6 wk
after induction.
ADJUST DOSE Severe hepatic impairment
ADV EFF Abd pain, APL differentiation syndrome, cancer, complete heart block,
cough, dizziness, dyspnea, edema, fatigue, headache, hyperleukocytosis, leukocytosis,
n/v/d, prolonged QT
INTERACTIONS Cyclosporine, ethinyl estradiol, hormonal contraceptives, midazolam,
omeprazole, phenytoin, TCAs, triazolam, warfarin
NC/PT Monitor CBC, ECG, electrolytes closely. Provide comfort measures for GI effects,
safety measures for CNS effects. Not for use in pregnancy, breast-feeding.

asenapine (Saphris)
 CLASSAtypical antipsychotic, dopamine/serotonin antagonist
PREG/CONT C/NA

BBW Elderly pts w/ dementia-related psychosis have increased risk of death if given
atypical antipsychotics. Risk of suicidal ideation increases w/ antidepressant use,
especially in children, adolescents, young adults; monitor accordingly.
IND & DOSE Tx of schizophrenia. Adult: 5–10 mg sublingually bid. Acute tx of manic or
mixed episodes associated w/ bipolar I disorder; adjunctive therapy w/ lithium or
valproate for acute tx of manic or mixed episodes associated w/ bipolar I
disorder. Adult: 5–10 mg sublingually bid; may decrease to 5 mg/day if needed.
ADJUST DOSE Severe hepatic impairment
ADV EFF Akathisia, dizziness, extrapyramidal sx, NMS, prolonged QT, somnolence,
suicidality
INTERACTIONS Alcohol, antihypertensives, CNS depressants, fluvoxamine, QT-prolonging
drugs
NC/PT Monitor ECG periodically. Provide safety measures for CNS effects. Monitor
weight gain and blood glucose. Not for use in pregnancy, breast-feeding. Pt should
change positions slowly, take safety measures w/ CNS effects, report thoughts of suicide.

DANGEROUS DRUG
asparaginase Erwinia chrysanthemi (Erwinaze)
CLASS Antineoplastic
PREG/CONT C/NA

IND & DOSE Tx of pts w/ ALL who have developed sensitivity to asparaginase or
pegaspargase. Adult, child: 25,000/m2 international units IM for each scheduled dose of
pegaspargase or asparaginase; limit volume to 2 mL/injection.
ADV EFF Anaphylaxis, arthralgia, coagulation disorders, hyperglycemia, n/v,
pancreatitis, rash, seizures, urticaria
NC/PT Monitor for severe reaction, hyperglycemia, pancreatitis, coagulation disorders.
Not for use in pregnancy. Prepare calendar to keep track of appointments. Pt should
have regular blood tests.

aspirin (Bayer, Bufferin, Heartline, Norwich, St. Joseph’s, etc)

CLASS Analgesic, antiplatelet, antipyretic, salicylate
PREG/CONT D/NA

IND & DOSETx of mild to moderate pain, fever. Adult: 325–1,000 mg PO q 4–6 hr; max,
4,000 mg/day. SR tablets, 1,300 mg PO, then 650–1,300 mg q 8 hr; max, 3,900 mg/day.
Suppositories, 1 rectally q 4 hr. Child: 10–15 mg/kg/dose PO q 4 hr, up to 60–
80 mg/kg/day. Do not give to pts w/ chickenpox or flu symptoms. Arthritis. Adult: Up
to 3 g/day PO in divided doses. Child: 90–130 mg/kg/24 hr PO in divided doses at 6- to
8-hr intervals. Maintain serum level of 150–300 mcg/mL. Ischemic stroke, TIA. Adult:
50–325 mg/day PO. Angina, recurrent MI prevention. Adult: 75–325 mg/day PO.
Suspected MI. Adult: 160–325 mg PO as soon as possible; continue daily for 30 days.
CABG. Adult: 325 mg PO 6 hr after procedure, then daily for 1 yr. Acute rheumatic
fever. Adult: 5–8 g/day PO; modify to maintain serum salicylate level of 15–30 mg/dL.
Child: Initially, 100 mg/kg/day PO, then decrease to 75 mg/kg/day for 4–6 wk.
Therapeutic serum salicylate level, 150–300 mcg/mL. Kawasaki disease. Child: 80–
100 mg/kg/day PO divided q 6 hr; after fever resolves, 1–5 mg/kg/day once daily.
ADV EFF Acute aspirin toxicity, bleeding, dizziness, difficulty hearing, dyspepsia,
epigastric discomfort, nausea, occult blood loss, tinnitus
INTERACTIONS Alcohol, alkalinizers, antacids, anticoagulants, corticosteroids, furosemide,
nitroglycerin, NSAIDs, urine acidifiers
NC/PT Do not use in children w/ chickenpox or flu symptoms. Monitor dose for use in
children. Give w/ full glass of water. Pt should not cut, crush, or chew SR preparations;
check OTC products for aspirin content to avoid overdose; report ringing in ears, bloody
stools.

atazanavir sulfate (Reyataz)

CLASS Antiretroviral, protease inhibitor
PREG/CONT B/NA

IND & DOSE With other antiretrovirals for tx of HIV-1 infection. Adult: Therapy-naïve,
300 mg/day PO w/ 100 mg ritonavir PO once daily; if unable to tolerate ritonavir, can
give 400 mg PO once daily; therapy-experienced, 300 mg/day PO w/ 100 mg ritonavir
PO taken w/ food. Child 6–under 18 yr: Therapy-naïve, base dose on weight, 150–
300 mg/day atazanavir PO w/ 80–100 mg ritonavir daily PO; therapy-experienced, base
dose on weight, 200–300 mg/day atazanavir PO w/ 100 mg ritonavir PO.
ADJUST DOSE Hepatic, renal impairment
ADV EFF Headache, liver enzyme elevation, nausea, rash, severe hepatomegaly w/
steatosis (sometimes fatal)
INTERACTIONS Antacids, bosentan, indinavir, irinotecan, lovastatin, proton pump
inhibitors, rifampin, sildenafil, simvastatin, St. John’s wort, warfarin. Contraindicated
w/ ergot derivatives, midazolam, pimozide, triazolam
NC/PT Ensure HIV testing has been done. Monitor LFTs. Ensure pt takes drug w/ other
antiretrovirals. Withdraw drug at s&sx of lactic acidosis. Not for use in pregnancy,
breast-feeding. Does not cure disease. Pt should avoid St John’s wort, report use to all
health care providers.

atenolol (Tenormin)
CLASS Antianginal, antihypertensive, beta 1-adrenergic blocker
PREG/CONT D/NA
BBW Do not discontinue drug abruptly after long-term therapy; taper drug gradually
over 2 wk w/ monitoring; risk of MI, arrhythmias.
IND & DOSE Hypertension. Adult: 50 mg PO once/day; after 1–2 wk, may increase to
100 mg/day. Angina pectoris. Adult: Initially, 50 mg/day PO; up to 200 mg/day may
be needed. Acute MI. Adult: 100 mg/day PO or 50 mg PO bid for 6–9 days or until
discharge.
ADJUST DOSE Elderly pts, renal impairment
ADV EFF Bradycardia, bronchospasm, cardiac arrhythmias, ED, exercise tolerance
decrease, flatulence, gastric pain, laryngospasm, n/v/d
INTERACTIONS Ampicillin, anticholinergics, aspirin, bismuth subsalicylate, calcium salts,
clonidine, hormonal contraceptives, insulin, lidocaine, prazosin, quinidine, verapamil
NC/PT Do not stop suddenly; taper over 2 wk. Pt should take safety precautions w/ CNS
effects; report difficulty breathing.

atomoxetine hydrochloride (Strattera)

CLASS Selective norepinephrine reuptake inhibitor
PREG/CONT C/NA

BBW Increased risk of suicidality in children, adolescents. Monitor closely; alert

caregivers of risk.
IND & DOSE Tx of ADHD as part of total tx program. Adult, child over 70 kg: 40 mg/day
PO; increase after minimum of 3 days to target total daily dose of 80 mg PO. Max,
100 mg/day. Child 6 yr and older, 70 kg or less: 0.5 mg/kg/day PO; increase after
minimum of 3 days to target total daily dose of about 1.2 mg/kg/day PO. Max,
1.4 mg/kg or 100 mg/day, whichever is less.
ADJUST DOSE Hepatic impairment
ADV EFF Constipation, cough, dry mouth, insomnia, n/v, sudden cardiac death,
suicidality
INTERACTIONS CYP3A4 substrates, fluoxetine, MAOIs (do not give within 14 days of
atomoxetine), paroxetine, quinidine
NC/PT Ensure proper dx of ADHD; part of comprehensive tx program. Monitor growth.
Provide drug vacation periodically. Give before 6 p.m. to allow sleep. Not for use In
pregnancy. Pt should avoid OTC drugs, herbs that may be stimulants.

atorvastatin calcium (Lipitor)

CLASS Antihyperlipidemic, HMG-CoA inhibitor
PREG/CONT X/NA

IND & DOSEAdjunct to diet to lower total cholesterol, serum triglycerides, LDL and
increase HDL in pts w/ primary hypercholesterolemia, mixed dyslipidemia,
familial hypercholesterolemia, elevated serum triglycerides; to prevent MI, CV
disease in pts w/ many risk factors; to reduce risk of MI and CV events in pts w/
hx of CAD. Adult: 10–20 mg PO once daily without regard to meals; maint, 10–
80 mg/day PO. Child 10–17 yr: 10 mg PO daily; max, 20 mg/day.
ADV EFF Abd pain, constipation, cramps, flatulence, headache, liver failure,
rhabdomyolysis w/ renal failure
INTERACTIONS Antifungals, cimetidine, clarithromycin, cyclosporine, digoxin, diltiazem,
erythromycin, fibric acid derivatives, grapefruit juice, hormonal contraceptives,
nefazodone, niacin, protease inhibitors, tacrolimus
NC/PT Obtain baseline and periodic LFTs. Withhold drug in acute or serious conditions.
Give in p.m. Ensure pt is using diet and exercise program. Not for use in pregnancy. Pt
should report muscle pain. Name confusion between written orders for Lipitor
(atorvastatin) and Zyrtec (cetirizine).

atovaquone (Mepron)
CLASS Antiprotozoal
PREG/CONT C/NA

IND & DOSE Prevention and acute oral tx of mild to moderate Pneumocystis jiroveci
pneumonia in pts intolerant of trimethoprim-sulfamethoxazole. Adult, child 13–
16 yr: Prevention of P. jiroveci pneumonia, 1,500 mg PO daily w/ meal. Tx of P. jiroveci
pneumonia, 750 mg PO bid w/ food for 21 days.
ADJUST DOSE Elderly pts
ADV EFF Dizziness, fever, headache, insomnia, n/v/d
INTERACTIONS Rifampin
NC/PT Give w/ meals. Ensure drug is taken for 21 days for tx.

atropine sulfate (AtroPen, Isopoto Atropine)

CLASS Anticholinergic, antidote, belladonna
PREG/CONT C/NA

IND & DOSE Antisialagogue, tx of parkinsonism, bradycardia, pylorospasm, urinary

bladder relaxation, uterine relaxation. Adult: 0.4–0.6 mg PO, IM, IV, subcut. Child:
Base dose on weight, 0.1–0.4 mg PO, IM, IV, subcut. Bradyarrhythmia. Adult: 0.4–1 mg
(max, 2 mg) IV q 1–2 hr as needed. Child: 0.01–0.03 mg/kg IV. Antidote for
cholinergic drug overdose, organophosphorous insecticides; initial tx for nerve
agent poisoning. Adult: 2–3 mg parenterally; repeat until signs of atropine intoxication
appear. Use of auto-injector recommended. Ophthalmic sol for eye refraction. Adult:
1–2 drops into eye 1 hr before refracting. Ophthalmic sol for uveitis. Adult: 1–2 drops
into eye tid.
ADJUST DOSE Elderly pts
ADV EFF Altered taste perception, bradycardia, decreased sweating, dry mouth, n/v,
palpitations, paralytic ileus, predisposition to heat prostration, urinary hesitancy,
urine retention
INTERACTIONS Anticholinergics, antihistamines, haloperidol, MAOIs, phenothiazines, TCAs
NC/PT Ensure adequate hydration. Provide temp control. Monitor heart rate. Pt should
empty bladder before taking if urine retention occurs. Sugarless lozenges may help dry
mouth.

auranofin (Ridaura)
CLASS Antirheumatic, gold salt
PREG/CONT C/NA

BBW Discontinue at first sign of toxicity. Severe bone marrow depression, renal toxicity,
diarrhea possible.
IND & DOSE Mgt of pts w/ active classic rheumatoid arthritis who have insufficient
response to NSAIDs. Adult: 3 mg PO bid or 6 mg/day PO; after 6 mo may increase to
3 mg PO tid. Max, 9 mg/day.
ADV EFF Angioedema, bone marrow suppression, diarrhea, eye changes, GI bleeding,
gingivitis, interstitial pneumonitis, peripheral neuropathy, photosensitivity, rash,
renal failure, stomatitis
NC/PT Monitor blood counts; renal, lung function. Corticosteroids may help w/ mild
reactions. Pt should avoid ultraviolet light, use sunscreen or protective clothes.

avanafil (Stendra)
CLASS ED drug, phosphodiesterase-5 inhibitor
PREG/CONT C/NA

IND & DOSE Tx of ED. Adult: 100 mg PO 30 min before sexual activity; range, 50–200 mg
no more than once/day.
ADJUST DOSE Severe renal, hepatic impairment
ADV EFF Back pain, dyspepsia, flushing, headache, MI, nasal congestion, nasopharyngitis
INTERACTIONS Alcohol, alpha blockers, amprenavir, antihypertensives, aprepitant,
diltiazem, fluconazole, fosamprenavir, grapefruit juice, itraconazole, ketoconazole,
nitrates, ritonavir, verapamil
NC/PT Ensure proper dx. Does not prevent STDs; does not work in absence of sexual
stimulation. Pt should not use w/ nitrates, antihypertensives, grapefruit juice, alcohol;
report sudden loss of vision or hearing, erection lasting over 4 hr.

axitinib (Inlyta)
CLASS Antineoplastic, kinase inhibitor
PREG/CONT D/NA

IND & DOSETx of advanced renal cell cancer after failure of one prior systemic
therapy. Adult: 5 mg PO bid 12 hr apart w/ full glass of water.
ADJUST DOSE Hepatic impairment
ADV EFF Anorexia, asthenia, constipation, diarrhea, dysphonia, fatigue, hand-foot
syndrome, GI perforation/fistula, hemorrhage, hepatic injury, hypertension,
hypertensive crisis, hypothyroidism, proteinuria, RPLS, thrombotic events,
vomiting, weight loss
INTERACTIONS Strong CYP3A4/5 inhibitors or inducers (carbamazepine, dexamethasone,
ketoconazole, phenobarbital, phenytoin, rifabutin, rifampin, rifapentine, St. John’s
wort); avoid these combinations
NC/PT Monitor closely for adverse reactions; have supportive measures readily available.
Stop at least 24 hr before scheduled surgery. Not for use in pregnancy. Pt should take
w/ full glass of water, report s&sx of bleeding, severe headache, severe GI effects,
urine/stool changes.

azacitidine (Vidaza)
CLASS Antineoplastic, nucleoside metabolic inhibitor
PREG/CONT D/NA

IND & DOSE Tx of myelodysplastic syndrome, including refractory anemias and

chronic myelomonocytic leukemia. Adult: 75 mg/m2/day subcut for 7 days q 4 wk;
may increase to 100 mg/m2/ day after two cycles if no response. Pt should have at least
four cycles.
ADJUST DOSE Hepatic impairment
ADV EFF Bone marrow suppression, fever, hepatic impairment, injection-site
reactions, n/v/d, pneumonia, renal impairment
NC/PT Not for use in pregnancy. Men on drug should not father a child. Monitor CBC,
LFTs, renal function. Premedicate w/ antiemetic.

azathioprine (Azasan, Imuran)

CLASS Immunosuppressant
PREG/CONT D/NA

BBW Monitor blood counts regularly; severe hematologic effects may require stopping
drug. Increases risk of neoplasia; alert pt accordingly.
IND & DOSE Px of rejection w/ renal homotransplantation. Adult: 3–5 mg/kg/day PO
or IV as single dose on day of transplant; maint, 1–3 mg/kg/day PO. Tx of classic
rheumatoid arthritis not responsive to other therapy. Adult: 1 mg/kg PO as single
dose or bid. May increase at 6–8 wk and thereafter by steps at 4-wk intervals; max,
2.5 mg/kg/day.
ADJUST DOSE Elderly pts, renal impairment
ADV EFF Carcinogenesis, hepatotoxicity, leukopenia, macrocytic anemia, n/v, serious
infection, thrombocytopenia
INTERACTIONS Allopurinol, NMJ blockers
NC/PT Switch to oral form as soon as possible; monitor blood counts carefully. Give w/
food if GI upset a problem. Protect from infection.

azilsartan medoxomil (Edarbi)

CLASS Antihypertensive, ARB
PREG/CONT D/NA

BBW Rule out pregnancy before starting tx. Suggest use of barrier contraceptives during
tx; fetal injury and death have been reported.
IND & DOSE Tx of hypertension, alone or w/ other antihypertensives. Adult:
80 mg/day PO. For pts on high-dose diuretics or who are volume-depleted, consider
starting dose of 40 mg/day; titrate if tolerated.
ADV EFF Diarrhea
INTERACTIONS NSAIDs
NC/PT Rule out pregnancy; suggest use of barrier contraceptives. Monitor in situations
that could lead to lower BP. Mark chart if pt is going to surgery; possible volume
problems after surgery. Not for use in pregnancy, breast-feeding.

azithromycin (AzaSite, Zithromax, Zmax)

CLASS Macrolide antibiotic
PREG/CONT B/NA

IND & DOSE Tx of mild to moderate acute bacterial exacerbations of COPD,

pneumonia, pharyngitis/tonsillitis (as second-line), uncomplicated skin and skin-
structure infections. Adult: 500 mg PO as single dose on first day, then 250 mg PO
daily on days 2–5 for total dose of 1.5 g or 500 mg/day PO for 3 days. Tx of
nongonococcal urethritis, genital ulcer disease, cervicitis due to Chlamydia
trachomatis. Adult: Single 1-g PO dose. Tx of gonococcal urethritis/cervicitis, mild to
moderate acute bacterial sinusitis, community-acquired pneumonia. Adult: Single
2-g PO dose. Child 6 mo and older: 10 mg/kg/day PO for 3 days. Disseminated MAC
infections. Adult: Prevention, 1,200 mg PO once wkly. Tx, 600 mg/day PO w/
ethambutol. Tx of acute sinusitis. Adult: 500 mg/day PO for 3 days or single 2-g dose
of Zmax. Tx of community-acquired pneumonia. Adult, child 16 yr and older: 500 mg IV
daily for at least 2 days, then 500 mg PO for 7–10 days. Child 6 mo–15 yr: 10 mg/kg PO
as single dose on first day, then 5 mg/kg PO on days 2–5, or 60 mg/kg Zmax as single
dose. Tx of mild community-acquired pneumonia. Adult: 500 mg PO on day 1, then
250 mg PO for 4 days. Tx of PID. Adult: 500 mg IV daily for 1–2 days, then 250 mg/day
PO for 7 days. Tx of otitis media. Child 6 mo and older: 10 mg/kg PO as single dose,
then 5 mg/kg PO on days 2–5, or 30 mg/kg PO as single dose, or 10 mg/kg/day PO for
3 days. Tx of pharyngitis/tonsillitis. Child 2 yr and older: 12 mg/kg/day PO on days 1–
5; max, 500 mg/day. Tx of bacterial conjunctivitis. Adult, child: 1 drop to affected eye
bid for 2 days; then 1 drop/day for 5 days.
ADV EFF Abd pain, angioedema, diarrhea, superinfections
INTERACTIONS Aluminum- and magnesium-containing antacids, QT-prolonging drugs,
theophylline, warfarin
NC/PT Culture before tx. Give on empty stomach 1 hr before or 2 hr after meals. Prepare
sol by adding 60 mL water to bottle and shaking well; pt should drink all at once. May
experience superinfections.

aztreonam (Azactam, Cayston)

CLASS Monobactam antibiotic
PREG/CONT B/NA

IND & DOSE Tx of UTIs. Adult: 500 mg–1 g IV or IM q 8–12 hr. Tx of moderately severe
systemic infection. Adult: 1–2 g IV or IM q 8–12 hr. Child 9 mo and older: 30 mg/kg IV
or IM q 8 hr. Tx of severe systemic infection. Adult: 2 g IV or IM q 6–8 hr. Child 9 mo
and older: 30 mg/kg IV or IM q 8 hr. Tx of cystic fibrosis pts w/ Pseudomonas
aeruginosa infections. Adult, child 7 yr and older: 75 mg inhalation using Altera
Nebulizer System tid for 28 days; space doses at least 4 hr apart. Then 28 days off.
ADJUST DOSE Renal impairment
ADV EFF Anaphylaxis, injection-site reactions, n/v/d, pruritus, rash
NC/PT Culture before tx. Discontinue, provide supportive tx if anaphylaxis occurs.
Monitor for injection-site reactions. Use inhaled form only with provided nebulizer
system.

bacitracin (Baci-IM)
CLASS Antibiotic
PREG/CONT C/NA

BBW Monitor renal function tests daily w/ IM tx; risk of serious renal toxicity.
IND & DOSE Pneumonia, empyema caused by susceptible strains of staphylococci in
infants. Over 2.5 kg: 1,000 units/kg/day IM in two to three divided doses. Under 2.5 kg:
900 units/kg/day IM in two to three divided doses. Px of minor skin abrasions; tx of
superficial skin infections. Adult, child: Apply topical ointment to affected area one to
three times/day; cover w/ sterile bandage if needed. Do not use longer than 1 wk.
Superficial infections of conjunctiva or cornea. Adult, child: Dose varies by product;
see package insert.
ADV EFF Contact dermatitis (topical), nephrotoxicity, pain at injection site,
superinfections
INTERACTIONS Aminoglycosides, NMJs
NC/PT Culture before tx. Reconstituted IM sol stable for 1 wk. Ensure adequate hydration.
Monitor renal function closely (IM).

baclofen (Gablofen, Lioresal)

 CLASSCentrally acting skeletal muscle relaxant
PREG/CONT C/NA

BBW Taper gradually to prevent rebound spasticity, hallucinations, possible psychosis,

rhabdomyolysis, other serious effects; abrupt discontinuation can cause serious
reactions.
IND & DOSE Alleviation of s&sx of spasticity from MS or spinal cord injuries
(intrathecal). Adult: Testing usually done w/ 50 mcg/mL injected into intrathecal space
over 1 min. Pt is observed for 4–8 hr, then 75 mcg/1.5 mL is given; pt is observed for 4–
8 hr; final screening bolus of 100 mcg/2 mL is given 24 hr later if response still
inadequate. Maint for spasticity of cerebral origin, 22–1,400 mcg/day; maint for
spasticity of spinal cord origin, 12–2,003 mcg/day. Spinal cord injuries, other spinal
cord diseases (oral). Adult: 5 mg PO tid for 3 days; 10 mg PO tid for 3 days; 15 mg PO
tid for 3 days; 20 mg PO tid for 3 days. Thereafter, additional increases may be needed.
Max, 80 mg/day.
ADJUST DOSE Elderly pts, renal impairment
ADV EFF Confusion, dizziness, drowsiness, fatigue, headache, hypotension, insomnia,
urinary frequency, weakness
INTERACTIONS CNS depressants
NC/PT Use caution if spasticity needed to stay upright. Monitor implantable intrathecal
delivery site, system. Taper slowly if discontinuing. Not for use in pregnancy. Pt should
avoid OTC sleeping drugs and alcohol.

balsalazide disodium (Colazal, Giazo)

CLASS Anti-inflammatory
PREG/CONT B/NA

IND & DOSE Tx of mildly to moderately active ulcerative colitis. Adult: Three 750-mg
capsules PO tid (total daily dose, 6.75 g) for up to 12 wk. Or, three 1.1-g tablets PO bid
(total daily dose 6.6 g) for up to 8 wk. Child 5–17 yr: Three 750-mg capsules PO tid (6.75
g/day) for 8 wk, or one 750-mg capsule PO tid (2.25 g/day) for up to 8 wk.
ADV EFF Abd pain, cramps, depression, fatigue, flatulence, flulike symptoms, n/v/d
NC/PT Serious effects; use extreme caution. Maintain hydration. Observe for worsening of
ulcerative colitis. Pt should take w/ meals, continue all restrictions and tx used for
ulcerative colitis. Drug is high in sodium; monitor sodium intake. Name confusion
between Colazal (balsalazide) and Clozaril (clozapine).

basiliximab (Simulect)
CLASS Immunosuppressant
PREG/CONT B/NA

BBW Only physicians experienced in immunosuppressive therapy and mgt of organ

transplant pts should prescribe. Pts should be managed in facilities equipped and staffed
w/ adequate laboratory and supportive medical resources.
IND & DOSE Px of acute rejection in renal transplant pts, w/ other
immunosuppressants. Adult: Two doses of 20 mg IV—first dose 2 hr before transplant,
second dose on day 4 posttransplant.
ADV EFF Abd pain, cramps, hypersensitivity reactions, hypertension, infections, n/v/d,
pain
NC/PT Not for use in pregnancy, breast-feeding. Monitor for hypersensitivity reactions;
protect pt from infections.

BCG intravesical (TheraCys, Tice BCG)

CLASS Antineoplastic
PREG/CONT C/NA

BBW Use precautions when handling. Contains live mycobacteria; infections can occur.
IND & DOSE Intravesical use in tx and px of carcinoma in situ of urinary bladder; px
of primary or recurrent stage Ta and/or T1 papillary tumors after transurethral
resection. Adult: 1 ampule in 50 mL diluent instilled via catheter into bladder by
gravity.
ADV EFF Bone marrow suppression, chills, cystitis, dysuria, hematuria, infections,
malaise, n/v, urinary urgency, UTI
INTERACTIONS Antibiotics, isoniazid
NC/PT Monitor for infection, local reactions. Pt should avoid fluids 4 hr before tx; empty
bladder before instillation; lie down for first hr (turning side to side), then upright for
1 hr; try to retain fluid in bladder for 2 hr; empty bladder trying not to splash liquid;
and increase fluid intake over next few hours.

beclomethasone dipropionate (OrbeShield, QNASL, QVAR), beclomethasone

dipropionate monohydrate (Beconase AQ)
CLASS Corticosteroid
PREG/CONT C/NA

IND & DOSE Maintenance, control, prophylactic tx of asthma. Adult, child 12 yr and
older: 40–160 mcg by inhalation bid; max, 320 mcg/bid. Titrate to response: “Low” dose:
80–240 mcg/day; “medium” dose: 240–480 mcg/day; “high” dose: Over 480 mcg/day.
Child 5–11 yr: 40 mcg bid; max, 80 mcg bid. Relief of s&sx of seasonal or perennial
and nonallergic rhinitis; prevention of recurrence of nasal polyps after surgical
removal. Adult, child 12 yr and older: 1–2 inhalations (42–84 mcg) in each nostril bid
(total, 168–336 mcg/day). Child 6–12 yr: 1 inhalation in each nostril bid (total,
168 mcg). Tx of GI acute radiation syndrome (OrbeShield). Adult: 2 tablets PO as
soon as possible after exposure.
ADV EFF Cushing’s syndrome, epistaxis, headache, local irritation, nausea rebound
congestion
NC/PT Taper oral steroids slowly in switching to inhaled forms. If using nasal spray, use
nose decongestant to facilitate penetration of drug. If using other inhalants, use several
min before using this drug. If using respiratory inhalant, allow at least 1 min between
puffs; pt should rinse mouth after each inhalation.

bedaquiline (Sirturo)
CLASS Antimycobacterial, antituberculosis drug
PREG/CONT B/NA

BBW Increased risk of death; reserve for pts resistant to other effective therapy.
Prolonged QT interval, risk of serious to fatal arrhythmias. Monitor ECG; avoid other
QT-prolonging drugs.
IND & DOSE Tx of adults w/ multidrug-resistant pulmonary TB, w/ other
antituberculosis drugs. Adult: 400 mg/day PO for 2 wk; then 200 mg/day PO three
times/wk for 22 wk, w/ other antituberculosis drugs.
ADJUST DOSE Hepatic impairment, severe renal impairment
ADV EFF Arthralgia, headache, hepatic impairment, nausea, prolonged QT interval
INTERACTIONS Ketoconazole, lopinavir, QT-prolonging drugs, rifampin, ritonavir
NC/PT Obtain baseline ECG; monitor periodically. Monitor LFTs. Ensure proper use of
drug and use w/ other antituberculosis drugs. Not for use in breast-feeding. Pt should
mark calendar for tx days; swallow capsule whole and not cut, crush, or chew it; ensure
also taking other drugs for TB; avoid alcohol; report urine/stool color changes,
abnormal heartbeat.

belatacept (Nulojix)
CLASS T-cell costimulation blocker
PREG/CONT C/NA

BBW Increased risk of posttransplant lymphoproliferative disorder involving CNS, more

likely without immunity to Epstein-Barr virus. Increased risk of cancers and serious
infections.
IND & DOSE Px of organ rejection in pts w/ renal transplants, w/ other
immunosuppressants. Adult: days 1 and 5, 10 mg/kg IV over 30 min; repeat end of wk
2, 4, 8, 12. Maint starting at wk 16 and q 4 wk thereafter, 5 mg/kg IV over 30 min.
ADV EFF Anemia, constipation, cough, edema, graft dysfx, headache, hyperkalemia,
hypokalemia, infections (potentially fatal), malignancies, posttransplant
lymphoproliferative disorder, progressive multifocal leukoencephalopathy, UTI
INTERACTIONS Live vaccines
NC/PT Not for use in liver transplants. Not for use in pregnancy, breast-feeding. Monitor
blood counts, s&sx of infection, orientation, mood. Protect from infection. Encourage
cancer screening exams.
 belimumab (Benlysta)
CLASS B-cell activating factor inhibitor
PREG/CONT C/NA

IND & DOSE Tx of pts w/ active, antibody-positive SLE, w/ standard therapy. Adult:
10 mg/kg IV over 1 hr at 2-wk intervals for first three doses, then at 4-wk intervals.
ADV EFF Bronchitis, death, depression/suicidality, hypersensitivity reactions,
malignancies, migraine, n/v/d, pain, pharyngitis, serious to fatal infections
INTERACTIONS Live vaccines
NC/PT Not for use in pregnancy, breast-feeding. Premedicate w/ antihistamines,
corticosteroids. Do not use w/ acute infection; monitor for infections. Encourage cancer
screening. Protect pt w/ suicidal thoughts.

benazepril hydrochloride (Lotensin)

CLASS ACE inhibitor, antihypertensive
PREG/CONT D/NA

BBW Rule out pregnancy; fetal abnormalities and death have occurred if used during
second or third trimester. Encourage contraceptive measures.
IND & DOSE Tx of hypertension, alone or as part of combination therapy. Adult:
10 mg PO daily. Maint, 20–40 mg/day PO; max, 80 mg/day. Child 6 yr and older: 0.1–
0.6 mg/kg/day; max, 40 mg/day.
ADJUST DOSE Renal impairment
ADV EFF Cough, Stevens-Johnson syndrome
INTERACTIONS Allopurinol, capsaicin, indomethacin, lithium, NSAIDs, potassium-sparing
diuretics
NC/PT Use caution before surgery; mark chart. Protect pt w/ decreased fluid volume. Not
for use in pregnancy. Cough may occur. Pt should change position slowly if dizzy, light-
headed.

DANGEROUS DRUG
bendamustine hydrochloride (Treanda)
CLASS Alkylating agent, antineoplastic
PREG/CONT D/NA

IND & DOSEChronic lymphocytic leukemia. Adult: 100 mg/m2 IV over 30 min on days 1
and 2 of 28-day cycle for up to six cycles. Non-Hodgkin lymphoma. Adult: 120 mg/m2
IV over 60 min on days 1 and 2 of 21-day cycle for up to eight cycles.
ADJUST DOSE Hepatic, renal impairment
ADV EFF Fatigue, fever, infections, infusion reaction, myelosuppression, n/v/d, rash to
toxic skin reactions, tumor lysis syndrome
INTERACTIONS Ciprofloxacin, fluvoxamine, nicotine, omeprazole
NC/PT Monitor blood counts closely. Protect pt from infection, bleeding. Monitor pt
closely during infusion. Premedicate w/ antihistamines, antipyretics, corticosteroids.
Assess skin regularly. Not for use in pregnancy, breast-feeding. Pt may feel very tired;
should plan activities accordingly.

benzonatate (Tessalon, Zonatuss)

CLASS Antitussive
PREG/CONT C/NA

IND & DOSE Symptomatic relief of nonproductive cough. Adult, child 10 yr and older:
100–200 mg PO tid; max, 600 mg/day.
ADV EFF Constipation, dizziness, headache, nausea, rash, sedation
NC/PT Pt should not cut, crush, or chew capsules; must swallow capsule whole. Use
caution if CNS effects occur.

benztropine mesylate (Cogentin)

CLASS Anticholinergic, antiparkinsonian
PREG/CONT C/NA

IND & DOSE Adjunct to tx of parkinsonism. Adult: Initially, 0.5–1 mg PO at bedtime;

total daily dose, 0.5–6 mg at bedtime or in two to four divided doses; may give IM or IV
at same dose. Control of drug-induced extrapyramidal disorders. Adult: 1–2 mg IM
(preferred) or IV to control condition, then 1–4 mg PO daily or bid to prevent
recurrences. Extrapyramidal disorders occurring early in neuroleptic tx. Adult: 2 mg
PO bid to tid. Withdraw drug after 1 or 2 wk to determine continued need.
ADJUST DOSE Elderly pts
ADV EFF Blurred vision, constipation, decreased sweating, dry mouth, urinary hesitancy,
urine retention
INTERACTIONS Alcohol, anticholinergics, haloperidol, phenothiazines, TCAs
NC/PT Pt should discontinue if dry mouth makes swallowing or speaking difficulty, use
caution in hot weather when decreased sweating could lead to heat prostration, avoid
alcohol and OTC drugs that could cause serious CNS effects, empty bladder before each
dose if urine retention a problem; use caution if CNS effects occur.

beractant (natural lung surfactant) (Survanta)

CLASS Lung surfactant
PREG/CONT Unkn/NA

IND & DOSEPx for infants at risk for RDS. Give first dose of 100 mg phospholipids/kg
birth weight (4 mL/kg) intratracheally soon after birth, preferably within 15 min. After
determining needed dose, inject ¼ of dose into endotracheal (ET) tube over 2–3 sec;
may repeat no sooner than 6 hr after dose. Rescue tx of premature infants w/ RDS.
Give 100 mg phospholipids/kg birth weight (4 mL/kg) intratracheally. Give first dose as
soon as possible within 8 hr of birth after RDS diagnosis is made and pt is on ventilator;
may repeat after 6 hr from previous dose.
ADV EFF Bradycardia, hypotension, intraventricular hemorrhage, nonpulmonary
infections, patent ductus arteriosus, sepsis
NC/PT Monitor ECG and O2 saturation continuously during and for at least 30 min after
administration. Ensure ET tube is correctly placed. Suction immediately before dosing;
do not suction for 1 hr after dosing.

betamethasone (generic), betamethasone dipropionate (Diprolene AF,

Maxivate), betamethasone sodium phosphate and acetate (Celestone
Soluspan), betamethasone valerate (Beta-Val, Luxiq)
CLASS Corticosteroid
PREG/CONT C/NA

IND & DOSE Tx of primary or secondary adrenocortical insufficiency; hypercalcemia

w/ cancer; short-term mgt of inflammatory and allergic disorders;
thrombocytopenia purpura; ulcerative colitis; MS exacerbations; trichinosis w/
neurological or cardiac involvement. Adult: Oral (betamethasone), initially, 0.6–
7.2 mg/day. IM (betamethasone sodium phosphate, betamethasone sodium phosphate
and acetate), initially, 0.5–9 mg/day. Intrabursal, intra-articular, intradermal,
intralesional (betamethasone sodium phosphate and acetate), 1.5–12 mg intra-articular
(depending on joint size), 0.2 mL/cm3 intradermally (max, 1 mL/wk); 0.25–1 mL at 3-
to 7-day intervals for foot disorders. Topical dermatologic cream, ointment
(betamethasone dipropionate), apply sparingly to affected area daily or bid.
ADV EFF Aggravation of infection, headache, immunosuppression, increased appetite,
local stinging and burning, masking of infection, vertigo, weight gain
INTERACTIONS Live vaccines
NC/PT Give oral dose at 9 a.m. Taper dosage when discontinuing. Pt should avoid
overusing joints after injection; be cautious w/ occlusive dressings; do not stop drug
suddenly; wear medical alert tag; apply sparingly if using topically; avoid exposure to
infection; monitor blood glucose with long-term use.

betaxolol hydrochloride valerate (Betoptic S, Kerlone)

CLASS Antiglaucoma drug, antihypertensive, beta-selective blocker
PREG/CONT C/NA

IND & DOSE Hypertension, used alone or w/ other antihypertensives. Adult: 10 mg PO

daily, alone or added to diuretic therapy. Tx of ocular hypertension and open-angle
glaucoma alone or w/ other antiglaucoma drugs. Adult: 1 or 2 drops ophthalmic sol
bid to affected eye(s).
ADJUST DOSE Elderly pts, severe renal impairment, dialysis pts
ADV EFF Allergic reactions, bradycardia, cardiac arrhythmias, decreased exercise
tolerance, dizziness, HF, n/v/d, ocular itching/tearing (ophthalmic)
INTERACTIONS Anticholinergics, aspirin, hormonal contraceptives, insulin, prazosin,
salicylates, verapamil
NC/PT Do not discontinue abruptly; taper over 2 wk. Protect eyes or joints from injury
after dosing. Give eyedrops as instructed to avoid systemic absorption.

bethanechol chloride (Urecholine)

CLASS Cholinergic, parasympathomimetic
PREG/CONT C/NA

IND & DOSEAcute postop and postpartum nonobstructive urine retention;

neurogenic atony of urinary bladder w/ retention. Adult: 10–50 mg PO three/four
times a day.
ADV EFF Abd discomfort, cardiac arrest, flushing, n/v/d, sweating
INTERACTIONS Cholinergics, ganglionic blockers
NC/PT Give on empty stomach 1 hr before or 2 hr after meals. Keep atropine on hand for
severe response. Safety precautions if CNS effects occur.

DANGEROUS DRUG
bevacizumab (Avastin)
CLASS Antineoplastic, monoclonal antibody
PREG/CONT C/NA

BBW GI perforation, wound healing impairment, severe to fatal hemorrhage possible;

monitor pt closely.
IND & DOSE Tx of metastatic cancer of colon/rectum, w/ 5-FU. Adult: 5–10 mg/kg IV q
14 days until progression; first infusion over 90 min, second over 60 min, then over
30 min. Tx of metastatic, unresectable or locally advanced nonsquamous, non-
small-cell lung cancer. Adult: 15 mg/kg IV q 3 wk. Tx of glioblastoma. Adult:
10 mg/kg IV q 2 wk. Tx of metastatic renal cell carcinoma. Adult: 10 mg/kg IV q
2 wk w/ interferon alfa.
ADV EFF Arterial thrombotic events, back pain, epistaxis, exfoliative dermatitis,
headache, hypertension, infusion reactions, non-GI fistula formation, proteinuria,
ovarian failure, rectal hemorrhage, RPLS, rhinitis
NC/PT Do not initiate within 28 days of major surgery and until surgical wound is
completely healed. Do not give as IV push or bolus. Monitor BP, wounds (for healing
issues), during infusion (for infusion reactions). Not for use in pregnancy, breast-
feeding. Pt should report rectal bleeding, high fever, changes in neurologic function.

DANGEROUS DRUG
 bexarotene (Targretin)
CLASS Antineoplastic
PREG/CONT X/NA

BBW Not for use in pregnancy; fetal harm can occur.

IND & DOSE Cutaneous manifestations of cutaneous T-cell lymphoma in pts
refractory to other tx. Adult: 300–400 mg/m2/day PO.
ADV EFF Abd pain, asthenia, dry skin, headache, hepatic impairment, hypothyroidism,
lipid abnormalities, nausea, pancreatitis, photosensitivity, rash
INTERACTIONS Atorvastatin, carboplatin, gemfibrozil, paclitaxel, tamoxifen
NC/PT Rule out pregnancy before start of tx; ensure pt is using contraceptives. Monitor
LFTs, amylase, lipids, thyroid function. Protect pt from exposure to sunlight. Pt should
swallow capsules whole, not cut, crush, or chew them. Not for use in breast-feeding.

DANGEROUS DRUG
bicalutamide (Casodex)
CLASS Antiandrogen
PREG/CONT X/NA

IND & DOSE Tx of stage D2 metastatic carcinoma of prostrate, w/ LHRH. Adult:

50 mg/day PO.
ADJUST DOSE Hepatic, renal impairment
ADV EFF Anemia, asthenia, constipation, diarrhea, dyspnea, edema, gynecomastia,
hematuria, hot flashes, nausea, nocturia, pain, severe hepatic injury to fatal hepatic
failure
INTERACTIONS Midazolam, warfarin
NC/PT Used w/ LHRH only. Monitor LFTs regularly, PSA levels, glucose levels. Not for
use in pregnancy. Pt should report trouble breathing, blood in urine, yellowing of eyes
or skin.

bismuth subsalicylate (Kaopectate, Pepto-Bismol, Pink Bismuth)

CLASS Antidiarrheal
PREG/CONT C (1st, 2nd trimesters); D (3rd trimester)/NA

IND & DOSE To control diarrhea, gas, upset stomach, indigestion, heartburn, nausea;
to reduce number of bowel movements and help firm stool. Adult, child 12 yr and
older: 2 tablets or 30 mL (524 mg) PO; repeat q 30 min–1 hr as needed (max, eight
doses/24 hr). Child 9–11 yr: 1 tablet or 15 mL PO. Child 6–8 yr: 2/3 tablet or 10 mL PO.
Child 3–5 yr: 1/3 tablet or 5 mL PO. Tx of traveler’s diarrhea. Adult, child 12 yr and
older: 1 oz (524 mg) PO q 30 min for total of eight doses.
ADV EFF Darkening of stool
INTERACTIONS Antidiabetics, aspirin, methotrexate, sulfinpyrazone, tetracyclines, valproic
acid
NC/PTShake liquid well. Have pt chew tablets (not swallow whole). Pt should not take
w/ drugs containing aspirin. Pt should report ringing in ears; stools may be dark.

bisoprolol fumarate (Zebeta)

CLASS Antihypertensive, beta-selective adrenergic blocker
PREG/CONT C/NA

IND & DOSE Mgt of hypertension, alone or w/ other antihypertensives. Adult: 5 mg

PO daily, alone or added to diuretic therapy; 2.5 mg may be appropriate. Max, 20 mg
PO daily.
ADJUST DOSE Renal, hepatic impairment
ADV EFF Bradycardia, bronchospasm, cardiac arrhythmias, constipation, decreased
exercise tolerance, ED, fatigue, flatulence, headache, n/v/d
INTERACTIONS Anticholinergics, hormonal contraceptives, insulin, NSAIDs, prazosin,
salicylates
NC/PT Do not discontinue abruptly; taper over 2 wk. Controversial need to stop before
surgery. If diabetic pt, monitor glucose levels regularly. Pt should avoid OTC drugs.
Name confusion between Zebeta (bisoprolol) and DiaBeta (glyburide).

DANGEROUS DRUG
bivalirudin (Angiomax)
CLASS Anticoagulant, thrombin inhibitor
PREG/CONT B/NA

IND & DOSE Pts w/ unstable angina undergoing PTCA. Adult: 0.75 mg/kg IV, then
1.75 mg/kg/hr during procedure. Tx or px of heparin-induced thrombocytopenia in
pts undergoing PTCA. Adult: 0.75 mg/kg IV, then 1.75 mg/kg/hr during procedure;
may continue for up to 4 hr, then 0.2 mg/kg/ hr for up to 20 hr if needed.
ADJUST DOSE Renal impairment
ADV EFF Bleeding, fever, headache, thrombocytopenia
INTERACTIONS Heparin, thrombolytics, warfarin
NC/PT Used w/ aspirin therapy. Monitor for bleeding; could indicate need to discontinue.

DANGEROUS DRUG
bleomycin sulfate (BLM)
CLASS Antibiotic, antineoplastic
PREG/CONT D/NA

BBW Monitor pulmonary function regularly and chest X-ray wkly or biwkly for onset of
pulmonary toxicity. Be alert for rare, severe idiosyncratic reaction, including fever,
chills, hypertension, in lymphoma pts.
IND & DOSE Palliative tx of squamous cell carcinoma, lymphomas, testicular
carcinoma, alone or w/ other drugs. Adult: 0.25–0.5 unit/kg IV, IM, or subcut once or
twice wkly. Tx of malignant pleural effusion. Adult: 60 units dissolved in 50–100 mL
NSS via thoracotomy tube.
ADJUST DOSE Renal impairment
ADV EFF Chills, dyspnea, fever, hair loss, hyperpigmentation, idiosyncratic reactions to
anaphylaxis, pneumonitis, pulmonary fibrosis, stomatitis, striae, vesiculation,
vomiting
INTERACTIONS Digoxin, oxygen, phenytoin
NC/PT Label reconstituted sol and use within 24 hr. Monitor LFTs, renal function tests,
pulmonary function regularly; consult physician immediately if s&sx of toxicity. Not for
use in pregnancy. Pt should mark calendar for injection dates, cover head w/ temp
extremes (hair loss possible).

boceprevir (Victrelis)
CLASS Antiviral, protease inhibitor
PREG/CONT X/NA

IND & DOSE Tx of chronic hepatitis C in pts w/ genotype 1 infection, w/

peginterferon alfa and ribavirin. Adult: 800 mg PO tid w/ food for 28–48 wk; given
w/ peginterferon alfa and ribavirin.
ADV EFF Anemia, dysgeusia, fatigue, headache, nausea, neutropenia
INTERACTIONS Alfuzosin, carbamazepine, dihydroergotamine, drospirenone, ergotamine,
lovastatin, methylergonovine, midazolam, phenobarbital, pimozide, sildenafil, triazolam
NC/PT Must use w/ peginterferon alfa, ribavirin; start these drugs 4 wk before starting
boceprevir. Interacts w/ many drugs; check full listing before administration. Protect
from infection. Not for use in pregnancy. Pt can still transmit disease; should use
precautions.

DANGEROUS DRUG
bortezomib (Velcade)
CLASS Antineoplastic, proteasome inhibitor
PREG/CONT D/NA

IND & DOSE Tx of multiple myeloma; tx of mantle cell lymphoma in pts who have
received at least one other therapy. Adult: 1.3 mg/m2 as 3–5 sec IV bolus or subcut
for nine 6-day cycles (days 1, 4, 8, 11, then 10 days of rest, then days 22, 25, 29, 32).
ADV EFF Anemia, anorexia, asthenia, constipation, hypotension, leukopenia, neutropenia,
n/v/d, peripheral neuropathies, pulmonary infiltrates
INTERACTIONS Ketoconazole, omeprazole, ritonavir, St John’s wort
NC/PT Monitor for neurologic changes. Monitor CBC. Try to maintain hydration if GI
effects are severe. Not for use in pregnancy, breast-feeding. Pt should use care when
driving or operating machinery until drug’s effects known.

bosentan (Tracleer)
CLASS Endothelin receptor antagonist, pulmonary antihypertensive
PREG/CONT X/NA

BBW Rule out pregnancy before starting tx; ensure pt is using two forms of
contraception during tx and for 1 mo after tx ends. Verify pregnancy status monthly.
Obtain baseline then monthly liver enzyme levels. Dose reduction or drug withdrawal
indicated if liver enzymes elevated; liver failure possible.
IND & DOSE Tx of pulmonary arterial hypertension in pts w/ WHO class II–IV
symptoms. Adult, child over 12 yr: 62.5 mg PO bid for 4 wk. Then, for pts 40 kg or more,
maint dose is 125 mg PO bid. For pts under 40 kg but over 12 yr, maint dose is 62.5 mg
PO bid.
ADJUST DOSE Hepatic impairment
ADV EFF Edema, flushing, headache, hypotension, liver injury, nasopharyngitis
INTERACTIONS Atazanavir, cyclosporine A, glyburide, hormonal contraceptives, ritonavir
(serious toxicity), statins
NC/PT Available only through restricted access program. Obtain baseline Hgb, at 1 and
3 mo, then q 3 mo. Monitor LFTs. Do not use w/ cyclosporine or glyburide. Taper if
discontinuing. Not for use in pregnancy (barrier contraceptives advised) or breast-
feeding. Pt should keep chart of activity tolerance to monitor drug’s effects.

bosutinib (Bosulif)
CLASS Antineoplastic, kinase inhibitor
PREG/CONT D/NA

IND & DOSE Tx of accelerated blast phase Philadelphia chromosome–positive CML

w/ resistance or intolerance to other tx. Adult: 500 mg/day PO, up to 600 mg/day.
ADJUST DOSE Hepatic impairment
ADV EFF Abd pain, anemia, fatigue, fever, fluid retention, GI toxicity, hepatotoxicity,
myelosuppression, n/v/d, rash
INTERACTIONS CYP3A inhibitors/inducers (carbamazepine, dexamethasone, ketoconazole,
phenobarbital, phenytoin, rifabutin, rifampin, rifapentine, St. John’s wort), P-
glycoprotein inhibitors; avoid these combinations. Proton pump inhibitors
NC/PT Monitor closely for bone marrow suppression, GI toxicity. Not for use in
pregnancy. Pt should take once a day, report s&sx of bleeding, severe GI effects,
urine/stool changes, swelling.

botulinum toxin type A (Botox, Botox Cosmetic, Dysport, Xeomin)

CLASS Neurotoxin
 PREG/CONT C/NA

BBW Drug not for tx of muscle spasticity; toxin may spread from injection area and
cause s&sx of botulism (CNS alterations, trouble speaking and swallowing, loss of
bladder control). Use only for approved indications.
IND & DOSE Improvement of glabellar lines. Adult: Total of 20 units (0.5 mL sol)
injected as divided doses of 0.1 mL into each of five sites—two in each corrugator
muscle, one in procerus muscle; repetition usually needed q 3–4 mo to maintain effect
(Botox). Or, 50 units in five equal injections q 4 mo (Dysport). Cervical dystonia. Adult:
236 units (range, 198–300 units) divided among affected muscles and injected into each
muscle in pts w/ known tolerance. In pts without prior use, 100 units or less, then adjust
dose based on pt response (Botox), 120 units IM (Xeomin), or 250–1,000 units IM q
12 wk (Dysport). Primary axillary hyperhidrosis. Adult: 50 units/axilla injected
intradermally 0.1–0.2 mL aliquots at multiple sites (10–15), about 1–2 cm apart. Repeat
as needed. Blepharospasm associated w/ dystonia. Adult: 1.25–2.5 units injected into
medial and lateral pretarsal orbicularis oculi of lower and upper lids. Repeat about q
3 mo. Strabismus associated w/ dystonia. Adult: 1.25–50 units injected in any one
muscle. Upper limb spasticity. Adult: Base dose on muscles affected and severity of
activity; electromyographic guidance recommended. Use no more than 50 units per site.
Chronic migraine. Adult: 155 units IM as 0.1 mL (5 units) at each site; divide into
seven head/neck muscle areas (Botox). Blepharospasm in previously treated pts.
Adult: 35 units per eye (Xeomin). Tx of urinary incontinence in pts w/ neurological
conditions (Botox). Adult: 200 units as 1-mL injection across 30 sites into detrusor
muscle. Tx of chronic migraines. Adult: 155 units IM as 0.1 mL at each of seven sites in
head/neck muscle area.
ADV EFF Anaphylactic reactions, dizziness, headache, local reactions, MI, spread of
toxin that can lead to death
INTERACTIONS Aminoglycosides, anticholinesterases, lincosamides, magnesium sulfate,
NMJ blockers, polymyxin, quinidine, succinylcholine
NC/PT Store in refrigerator. Have epinephrine available in case of anaphylactic
reactions. Effects may not appear for 1–2 days; will persist for 3–4 mo. Not for use in
pregnancy.

botulinum toxin type B (Myobloc)

CLASS Neurotoxin
PREG/CONT C/NA

BBW Drug not for tx of muscle spasticity; toxin may spread from injection area and
cause s&sx of botulism (CNS alterations, trouble speaking and swallowing, loss of
bladder control). Use only for approved indications.
IND & DOSE Tx of cervical dystonia to reduce severity of abnormal head position and
neck pain. Adult: 2,500–5,000 units IM injected locally into affected muscles.
ADV EFF Anaphylactic reactions, dry mouth, dyspepsia, dysphagia, spread of toxin
that can lead to death
INTERACTIONS Aminoglycosides, anticholinesterases, lincosamides, magnesium sulfate,
NMJ blockers, polymyxin, quinidine, succinylcholine
NC/PT Store in refrigerator. Have epinephrine on hand in case of anaphylactic reactions.
Do not inject in area of skin infection; effects may not appear for 1–2 days; will persist
for 3–4 mo. Not for use in pregnancy, breast-feeding. Pt should report difficulty
swallowing, breathing.

brentuximab (Adcetris)
CLASS Monoclonal antibody
PREG/CONT D/NA

BBW Risk of potentially fatal progressive multifocal leukoencephalopathy (PML).

IND & DOSE Tx of Hodgkin lymphoma after failure of autologous stem-cell
transplant; tx of systemic anaplastic large-cell lymphoma. Adult: 1.8 mg/kg IV over
30 min q 3 wk for max of 16 cycles.
ADV EFF Anaphylactic reactions, chills, cough, dyspnea, fever, infusion reactions,
nausea, neutropenia, peripheral neuropathy, PML, Stevens-Johnson syndrome
INTERACTIONS Bleomycin, ketoconazole, rifampin
NC/PT Monitor pt during infusion. Monitor neutrophil count; dose adjustment may be
needed. Protect pt w/ peripheral neuropathies. Not for use in pregnancy, breast-feeding.
Pt should report mood or behavior changes, changes in vision or walking, weakness.

bromocriptine mesylate (Cycloset, Parlodel)

CLASS Antidiabetic, antiparkinsonian, dopamine receptor agonist
PREG/CONT B/NA

IND & DOSE Tx of postencephalitic or idiopathic Parkinson’s disease. Adult, child 15 yr

and older: 11.25 mg PO bid. Assess q 2 wk, and adjust dose; max, 100 mg/day. Tx of
hyperprolactinemia. Adult, child 15 yr and older: 1.25–2.5 mg PO daily; range, 2.5–
15 mg/day. Tx of acromegaly. Adult, child 15 yr and older: 1.25–2.5 mg PO for 3 days at
bedtime; add 1.25–2.5 mg as tolerated q 3–7 days until optimal response. Range, 20–
30 mg/day. Tx of type 2 diabetes. Adult: 0.8 mg/day PO in a.m. within 2 hr of waking;
increase by 1 tablet/wk to max 6 tablets (4.8 mg) daily (Cycloset only).
ADV EFF Abd cramps, constipation, dyspnea, fatigue, n/v/d, orthostatic hypotension
INTERACTIONS Erythromycin, phenothiazines, sympathomimetics
NC/PT Ensure proper diagnosis before starting tx. Taper dose if used in parkinsonism.
Not for use in pregnancy, breast-feeding. Pt should take drug for diabetes once a day in
a.m., use safety precautions if dizziness, orthostatic hypotension occur.

brompheniramine maleate (BroveX, J-Tan, Lo-Hist 12, Respa-AR, VaZol)

 CLASSAntihistamine
PREG/CONT C/NA

IND & DOSE Relief of symptoms of seasonal rhinitis, common cold; tx of nonallergic
pruritic symptoms. Adult, child 12 yr and older: Products vary. ER tablets, 6–12 mg PO q
12 hr. Chewable tablets, 12–24 mg PO q 12 hr (max, 48 mg/day). ER capsules, 12–
24 mg/day PO. Oral suspension (BroveX), 5–10 mL (12–24 mg) PO q 12 hr (max,
48 mg/day). Oral liquid, 10 mL (4 mg) PO four times/day. Oral suspension 5 mL PO q
12 hr (max, two doses/day). Child 6–12 yr: ER tablets, 6 mg PO q 12 hr. Chewable
tablets, 6–12 mg PO q 12 hr (max, 24 mg/day). ER capsules, 12 mg/day PO. Oral liquid,
5 mL (2 mg) PO four times/day. Oral suspension (BroveX), 5 mL (12 mg) PO q 12 hr
(max, 24 mg/day). Oral suspension, 2.5 mL PO q 12 hr (max, 5 mL/day). Child 2–6 yr:
Chewable tablets, 6 mg PO q 12 hr (max, 12 mg/day). Oral liquid, 2.5 mL (1 mg) PO 4
times/day. Oral suspension (BroveX), 2.5 mL (6 mg) PO q 12 hr up (max, 12 mg/day).
Oral suspension 1.25 mL PO q 12 hr (max, 2.5 mg/day). Child 12 mo–2 yr: Oral
suspension, 1.25 mL (3 mg) PO q 12 hr (max, 2.5 mL [6 mg]/day). Oral liquid, Titrate
dose based on 0.5 mg/kg/day PO in equally divided doses four times/day.
ADJUST DOSE Elderly pts
ADV EFF Anaphylactic shock, disturbed coordination, dizziness, drowsiness, faintness,
thickening bronchial secretions
INTERACTIONS Alcohol, anticholinergics, CNS depressants
NC/PT Double-check dosages; products vary widely. Pt should not cut, crush, or chew ER
tablets; should avoid alcohol, take safety precautions if CNS effects occur.

budesonide (Entocort EC, Pulmicort, Rhinocort Aqua)

CLASS Corticosteroid
PREG/CONT B (inhalation); C (oral)/NA

IND & DOSE Nasal spray mgt of symptoms of allergic rhinitis. Adult, child 6 yr and
older: 64 mcg/day as 1 spray (32 mcg) in each nostril once daily. Max for pts over
12 yr, 256 mcg/ day as 4 sprays per nostril once daily. Max for pts 6 to under 12 yr,
128 mcg/day (given as 2 sprays per nostril once daily). Maint tx of asthma as
prophylactic therapy. Adult, child 12 yr and older: 360 mcg by inhalation bid; max,
720 mcg bid. “Low” dose, 180–600 mcg/day; “medium” dose, 600–1,200 mcg/day;
“high” dose, more than 1,200 mcg/day. Child 5–11 yr: 180 mcg by inhalation bid; max,
360 mcg bid. “Low” dose, 180–400 mcg/day; “medium” dose, 400–800 mcg/day; “high”
dose, over 800 mcg/day. Child 0–11 yr: 0.5–1 mg by inhalation once daily or in two
divided doses using jet nebulizer. Max, 1 mg/day. “Low” dose, 0.25–0.5 mg/day (0–
4 yr), 0.5 mg/day (5–11 yr); “medium” dose, 0.5–1 mg/day (0–4 yr), 1 mg/day (5–
11 yr); “high” dose, over 1 mg/day (0–4 yr), 2 mg/day (5–11 yr). Tx, maint of clinical
remission for up to 3 mo of mild to moderate active Crohn’s disease involving
ileum/ascending colon. Adult: 9 mg/day PO in a.m. for up to 8 wk. May retreat
recurrent episodes for 8-wk periods. Maint, 6 mg/day PO for up to 3 mo, then taper
until cessation complete.
ADJUST DOSE Hepatic impairment
ADV EFF Back pain, cough, dizziness, fatigue, headache, lethargy, nasal irritation,
pharyngitis
INTERACTIONS Erythromycin, grapefruit juice, indinavir, itraconazole, ketoconazole,
ritonavir, saquinavir
NC/PT Taper systemic steroids when switching to inhaled form. Ensure proper
administration technique for nasal spray, inhalation. Monitor for potential
hypercorticism. Pt should not cut, crush, or chew PO tablets.

bumetanide (generic)
CLASS Loop diuretic
PREG/CONT C/NA

BBW Monitor electrolytes, hydration, hepatic function w/ long-term tx; water and
electrolyte depletion possible.
IND & DOSE Tx of edema associated w/ HF, renal and hepatic diseases. Adult: Oral,
0.5–2 mg/day PO; may repeat at 4- to 5-hr intervals. Max, 10 mg/day. Intermittent
therapy, 3–4 days on, then 1–2 off. Parenteral, 0.5–1 mg IV/IM over 1–2 min; may
repeat in 2–3 hr; max, 10 mg/day.
ADJUST DOSE Elderly pts, renal impairment
ADV EFF Anorexia, asterixis, drowsiness, headache, hypokalemia, nocturia, n/v/d,
orthostatic hypotension, pain at injection site, polyuria
INTERACTIONS Aminoglycosides, cardiac glycosides, cisplatin, NSAIDs, probenecid
NC/PT Switch to PO as soon as possible. Monitor electrolytes. Give early in day to avoid
disrupting sleep. Pt should eat potassium-rich diet, check weight daily (report loss/gain
of over 3 lb/day).

DANGEROUS DRUG
buprenorphine hydrochloride (Buprenex, Butrans Transdermal)
CLASS Opioid agonist-antagonist analgesic
PREG/CONT C/C-III

IND & DOSERelief of moderate to severe pain (parenteral). Adult: 0.3 mg IM or by slow
(over 2 min) IV injection. May repeat once, 30–60 min after first dose; repeat q 6 hr.
Child 2–12 yr: 2–6 mcg/kg body weight IM or slow IV injection q 4–6 hr. Tx of opioid
dependence (oral). Adult: 8 mg on day 1, 16 mg on day 2 and subsequent
induction days (can be 3–4 days). Maint, 12–16 mg/day sublingually (Suboxone). Mgt
of moderate to severe chronic pain in pts needing continuous, around-the-clock
opioid analgesic for extended period (transdermal). Adult: Initially, 5 mcg/hr,
intended to be worn for 7 days; max, 20 mcg/hr.
ADJUST DOSE Elderly, debilitated pts
ADV EFF Dizziness, headache, hypotension, hypoventilation, miosis, n/v, sedation,
sweating, vertigo
INTERACTIONS Barbiturates, benzodiazepines, general anesthetics, opioid analgesics,
phenothiazines, sedatives
NC/PT Have opioid antagonists, facilities for assisted respiration on hand. Taper as part
of comprehensive tx plan. Not for use in pregnancy, breast-feeding. Pt should place
translingual tablet under tongue until dissolved, then swallow; apply transdermal patch
to clean, dry area, leave for 7 days. Remove old patch before applying new one. Safety
precautions if CNS effects occur.

DANGEROUS DRUG
buPROPion hydrobromide (Aplenzin), buPROPion hydrochloride (Wellbutrin,
Zyban)
CLASS Antidepressant, smoking deterrent
PREG/CONT C/NA

BBW Monitor response and behavior; suicide risk in depressed pts, children, adolescents,
young adults. Serious mental health events possible, including changes in behavior,
depression, and hostility. Aplenzin not indicated for smoking cessation; risk of serious
neuropsychiatric events, including suicide, when used for this purpose.
IND & DOSE Tx of major depressive disorder. Adult: 300 mg PO as 100 mg tid; max,
450 mg/day. SR, 150 mg PO bid. ER, 150 mg/day PO. Aplenza, 174–348 mg/day PO;
max, 522 mg/day. Smoking cessation. Adult: 150 mg (Zyban) PO daily for 3 days;
increase to 300 mg/day in two divided doses at least 8 hr apart. Treat for 7–12 wk. Tx
of seasonal affective disorder. Adult: 150 mg (Wellbutrin XL) PO daily in a.m.; max,
300 mg/day. Begin in autumn; taper off (150 mg/day for 2 wk before discontinuation)
in early spring.
ADJUST DOSE Renal, hepatic impairment
ADV EFF Agitation, constipation, depression, dry mouth, headache, migraine, suicidality,
tachycardia, tremor, weight loss
INTERACTIONS Alcohol, amantadine, cyclophosphamide, levodopa, MAOIs, paroxetine,
sertraline
NC/PT Check labels carefully; dose varies. Avoid use w/ hx of seizure disorder. Monitor
hepatic, renal function. Smoking cessation: Pt should quit smoking within 2 wk of tx.
May be used w/ transdermal nicotine. Pt should avoid alcohol, take safety precautions if
CNS effects occur, report thoughts of suicide.

busPIRone (generic)
CLASS Anxiolytic
PREG/CONT B/NA
IND & DOSEMgt of anxiety disorders; short-term relief of symptoms of anxiety. Adult:
15 mg/day PO; may increase slowly to optimum therapeutic effect. Max, 60 mg/day.
ADV EFF Abd distress, dizziness, dry mouth, headache, insomnia, light-headedness, n/v/d
INTERACTIONS Alcohol, CNS depressants, erythromycin, fluoxetine, grapefruit juice,
haloperidol, itraconazole, MAOIs
NC/PT Suggest sugarless lozenges for dry mouth, analgesic for headache. Pt should avoid
OTC sleeping drugs, alcohol, grapefruit juice take safety measures if CNS effects occur.

DANGEROUS DRUG
busulfan (Busulfex, Myleran)
CLASS Alkylating agent, antineoplastic
PREG/CONT D/NA

BBW Arrange for blood tests to evaluate bone marrow function before tx, wkly during,
and for at least 3 wk after tx ends. Severe bone marrow suppression possible.
IND & DOSE Palliative tx of chronic myelogenous leukemia; tx of other
myeloproliferative disorders, including severe thrombocytosis and polycythemia
vera, myelofibrosis; bone marrow transplantation (oral). Adult: Remission
induction, 4–8 mg or 60 mcg/kg PO. Maint, resume tx w/ induction dosage when WBC
count reaches 50,000/mm3; if remission shorter than 3 mo, maint of 1–3 mg PO daily
advised to control hematologic status. Child: May give 60–120 mcg/kg/day PO, or 1.8–
4.6 mg/m2/day PO for remission induction. With cyclophosphamide as conditioning
regimen before allogenic hematopoietic progenitor cell transplant for CML
(parenteral). Adult: 0.8 mg/kg IV of ideal body weight or actual body weight, whichever
is lower, as 2-hr infusion.
ADJUST DOSE Hepatic impairment
ADV EFF Amenorrhea, anemia, hyperpigmentation, leukopenia, menopausal symptoms,
n/v/d, ovarian suppression, pancytopenia, pulmonary dysplasia, Stevens-Johnson
syndrome
NC/PT Arrange for respiratory function test before and periodically during tx; monitor
CBC. Reduce dose w/ bone marrow suppression. Ensure pt is hydrated. Give IV through
central venous catheter. Premedicate for IV tx w/ phenytoin, antiemetics. Not for use in
pregnancy (barrier contraceptives advised) or breast-feeding. Pt should drink 10–12
glasses of fluid each day, report difficulty breathing, severe skin reactions.

DANGEROUS DRUG
butorphanol tartrate (Stadol)
CLASS Opioid agonist-antagonist analgesic
PREG/CONT C (pregnancy); D (labor & delivery)/C-IV

Relief of moderate to severe pain; preop or preanesthetic medication; to

IND & DOSE
supplement balanced anesthesia. Adult: 2 mg IM q 3–4 hr or 1 mg IV q 3–4 hr; range,
0.5–2 mg IV q 3–4 hr. During labor: 1–2 mg IV/IM at full term during early labor; repeat
q 4 hr. Relief of moderate to severe pain (nasal spray). 1 mg (1 spray/nostril); repeat
in 60–90 min if adequate relief not achieved; may repeat two-dose sequence q 3–4 hr.
ADJUST DOSE Elderly pts; hepatic, renal impairment
INTERACTIONS Barbiturate anesthetics
ADV EFF Nausea, sedation, slow shallow respirations
NC/PT Ensure ready access to respiratory assist devices when giving IV/IM. Protect from
falls; sedation, visual disturbances possible. Pt should not drive or perform other tasks
requiring alertness.

C1-inhibitor (human) (Cinryze)

CLASS Blood product, proteinase inhibitor
PREG/CONT C/NA

IND & DOSE Px against angioedema attacks in adults, adolescents w/ hereditary

angioedema. Adult, adolescent: 1,000 units IV at 10 mL/min q 3–4 days.
ADV EFF Blood-related infections, headache, hypersensitivity reactions, n/v, rash,
thrombotic events
NC/PT Have epinephrine available in case of severe hypersensitivity reactions. Slight risk
of blood-related diseases. Not for use in pregnancy, breast-feeding. Pt should report
difficulty breathing, hives, chest tightness.

cabazitaxel (Jevtana)
CLASS Antineoplastic, microtubular inhibitor
PREG/CONT D/NA

BBW  Severe hypersensitivity reactions possible; prepare to support pt. Severe

neutropenia, deaths have occurred; monitor blood counts closely. Not for use w/ hx of
severe reactions to cabazitaxel or polysorbate 80.
IND & DOSE With oral prednisone for tx of pts w/ hormone-refractory metastatic
prostate cancer previously treated w/ docetaxel. Adult: 25 mg/m2 IV over 1 hr q 3
wk.
ADJUST DOSE Hepatic impairment
ADV EFF Abd pain, alopecia, anorexia, arthralgia, asthenia, bone marrow suppression,
constipation, cough, dysgeusia, dyspnea, fever, hepatic impairment, hypersensitivity
reactions, n/v/d, neutropenia, renal failure
INTERACTIONS Strong CYP3A inhibitors, inducers
NC/PT Premedicate w/ antihistamine, corticosteroid, and H2 antagonist; antiemetic if
needed. Always give w/ oral prednisone. Monitor blood count; dose adjustment needed
based on neutrophil count. Monitor LFTs, renal function. Ensure hydration; tx w/
antidiarrheals may be needed. Not for use in pregnancy, breast-feeding. Pt should mark
calendar w/ dates for tx, try to maintain food and liquid intake, report difficulty
breathing, rash.
 cabozantinib (Cometriq)
CLASS Antineoplastic, kinase inhibitor
PREG/CONT D/NA

BBW Risk of GI perforation, fistulas; monitor pt. Severe to fatal hemorrhage has
occurred; monitor for s&sx of bleeding.
IND & DOSE Tx of progressive, metastatic medullary thyroid cancer. Adult: 140
mg/day PO.
ADJUST DOSE Hepatic impairment
ADV EFF Abd pain, anorexia, constipation, fatigue, hair color change, hypertension,
n/v/d, osteonecrosis of jaw, palmar-plantar erythrodysesthesia syndrome,
proteinuria, RPLS, thromboembolic events, weight loss, wound complications
INTERACTIONS Strong CYP3A4 inducers/inhibitors, grapefruit juice; avoid these
combinations
NC/PT Monitor for s&sx of bleeding, GI perforation, drug interactions. Not for use in
pregnancy, breast-feeding. Pt should take as directed on empty stomach, at least 2 hr
before or after food; swallow capsule whole and not cut, crush, or chew it; avoid
grapefruit juice; report s&sx of bleeding (bruising, coughing up blood, tarry stools,
bleeding that won’t stop); acute stomach pain; choking, difficulty swallowing; swelling
or pain in mouth or jaw; chest pain, acute leg pain, difficulty breathing.

caffeine (Caffedrine, Enerjets, NoDoz, Vivarin), caffeine citrate (Cafcit)

CLASS Analeptic, CNS stimulant, xanthine
PREG/CONT C/NA

IND & DOSEAid in staying awake; adjunct to analgesic preparations. Adult: 100–200
mg PO q 3–4 hr as needed. Tx of respiratory depression associated w/ overdose of
CNS depressants. Adult: 500 mg–1 g caffeine and sodium benzoate (250–500 mg
caffeine) IM; max, 2.5 g/day. May give IV in severe emergency. Short-term tx of
apnea of prematurity in infants between 28 and 33 wk gestation. Premature infants:
20 mg/kg IV over 30 min followed 24 hours later by 5 mg/kg/day IV over 10 min or PO
as maint (Cafcit).
ADV EFF Diuresis, excitement, insomnia, restlessness, tachycardia, withdrawal syndrome
(headache, anxiety, muscle tension)
INTERACTIONS Cimetidine, ciprofloxacin, clozapine, disulfiram, ephedra, guarana,
hormonal contraceptives, iron, ma huang, mexiletine, theophylline
NC/PT Pt should avoid foods high in caffeine; not stop abruptly because withdrawal
symptoms possible; avoid dangerous activities if CNS effects occur.

calcitonin, salmon (Calcimar, Miacalcin, Osteocalcin, Salmonine)

CLASS Calcium regulator, hormone
 PREG/CONT C/NA

IND & DOSETx of Paget’s disease. Adult: 100 units/day IM or subcut; maint, 50 units/day
or every other day. Tx of postmenopausal osteoporosis. Adult: 100 units every other
day IM or subcut or 200 units intranasally daily, alternating nostrils daily. Emergency
tx of hypercalcemia. Adult: 4 units/kg q 12 hr IM or subcut. If response unsatisfactory
after 1–2 days, increase to 8 units/kg q 12 hr; if response still unsatisfactory after 2
more days, increase to 8 units/kg q 6 hr.
ADV EFF Flushing of face or hands, local inflammatory reactions at injection site, n/v,
rash, urinary frequency
NC/PT Before use, give skin test to pt w/ hx of allergies; give w/ calcium carbonate (1.5
g/day) and vitamin D (400 units/day) when treating osteoporosis. Monitor serum
alkaline phosphatase and urinary hydroxyproline excretion before and during first 3 mo
of therapy, then q 3–6 mo. Inject doses of more than 2 mL IM, not subcut. Store nasal
spray in refrigerator until activated, then at room temperature. Alternate nostrils daily
when using nasal spray. If self-administering, learn proper technique and proper
disposal of needles, syringes.

calcium salts: calcium carbonate (Caltrate, Chooz, Tums), calcium chloride,

calcium glubionate (Calcionate, Calciquid), calcium gluconate (Cal-G), calcium
lactate (Cal-Lac)
CLASS Antacid, electrolyte
PREG/CONT C/NA

IND & DOSERDA (carbonate or lactate). Adult over 50 yr: 1,200 mg/day PO. Adult 19–50
yr: 1,000 mg/day PO. Child 14–18 yr: 1,300 mg/day PO. Child 9–13 yr: 1,300 mg/day
PO. Child 4–8 yr: 800 mg/day PO. Child 1–3 yr: 500 mg/day PO. Child 7–12 mo: 270
mg/day PO. Child 0–6 mo: 210 mg/ day PO. Pregnancy, breast-feeding, 19–50 yr: 1,000
mg/day PO. Pregnancy, breast-feeding, 14–18 yr: 1,300 mg/ day PO. Dietary
supplement (carbonate or lactate). Adult: 500 mg–2 g PO bid–qid. Antacid. Adult: 0.5–
2 g PO calcium carbonate as needed. Tx of hypocalcemic disorders. Adult: 500 mg–1 g
calcium chloride IV at intervals of 1–3 days. Child: 2.7–5 mg/kg or 0.027–0.05 mL/kg
calcium chloride IV q 4–6 hr, or 200–500 mg/day IV (2–5 mL of 10% sol); for infants, no
more than 200 mg IV (2 mL of 10% sol) in divided doses (calcium gluconate). Tx of
magnesium intoxication. Adult: 500 mg calcium chloride IV promptly. Cardiac
resuscitation. Adult: 500 mg–1 g IV or 200–800 mg calcium chloride into ventricular
cavity.
ADV EFF Anorexia, bradycardia, constipation, irritation at injection site, hypercalcemia,
hypotension, n/v, peripheral vasodilation, rebound hyperacidity, tingling
INTERACTIONS Fluoroquinolones, quinidine, salicylates, tetracyclines, thyroid hormone,
verapamil
NC/PT Do not give oral drugs within 1–2 hr of antacid. Avoid extravasation of IV fluid;
tissue necrosis possible. Monitor serum phosphate levels periodically. Monitor cardiac
response closely w/ parenteral tx. Pt should take drug between meals and at bedtime;
chew antacid tablets thoroughly before swallowing and follow w/ glass of water; not
take w/ other oral drugs; space at least 1–2 hr after antacid.

calfactant (natural lung surfactant) (Infasurf)

CLASS Lung surfactant
PREG/CONT Unkn/NA

IND & DOSE Prophylactic tx of infants at risk for developing RDS; rescue tx of
premature infants up to 72 hr of age who have developed RDS. Instill 3 mL/kg of
birth weight in two doses of 1.5 mL/kg each intratracheally. Repeat doses of 3 mL/kg
(to total of three doses) given 12 hr apart.
ADV EFF Bradycardia, hyperbilirubinemia, hypotension, intraventricular
hemorrhage, nonpulmonary infections, patent ductus arteriosus, sepsis
NC/PT Monitor ECG and O2 saturation continuously during and for at least 30 min after
administration. Ensure ET tube correctly placed; suction immediately before dosing. Do
not suction for 1 hr after dosing. Maintain appropriate interventions for critically ill
infant.

canagliflozin (Invokana)
CLASS Antidiabetic, sodium-glucose cotransporter 2 inhibitor
PREG/CONT C/NA

IND & DOSEW/ diet, exercise to improve glycemic control in type 2 diabetes. Adult:
100 mg/day w/ first meal of day; max, 300 mg/day.
ADJUST DOSE Severe renal impairment
ADV EFF Dehydration, genital yeast infections, hypoglycemia, hypotension, polyuria, UTI
INTERACTIONS Celery, coriander, dandelion root, digoxin, fenugreek, garlic, ginger,
juniper berries, phenobarbital, phenytoin, rifampin
NC/PT Not for use with type 1 diabetes, pregnancy, breast-feeding. Monitor blood
glucose, HbA1c, BP periodically; also monitor for UTI, genital infections. Pt should
continue diet/exercise program, other antidiabetics as ordered; take safety measures w/
dehydration; report sx of UTI, genital infections.

canakinumab (Ilaris)
CLASS Interleukin blocker
PREG/CONT C/NA

Tx of cryopyrin-associated periodic syndromes, including familial cold

IND & DOSE
autoinflammatory syndrome and Muckle-Wells syndrome; tx of juvenile
rheumatoid arthritis. Adult, child 4 yr and older: Over 40 kg, 150 mg subcut; 15 kg to
under 40 kg, 2 mg/kg subcut; 15–40 kg w/ inadequate response, 3 mg/kg subcut.
Injections given q 8 wk.
ADV EFF Diarrhea, flulike symptoms, headache, nasopharyngitis, nausea, serious
infections
INTERACTIONS Immunosuppressants, live vaccines
NC/PT Use extreme caution in pts w/ infections; monitor for infections. Not for use in
pregnancy, breast-feeding. Pt should report s&sx of infection.

candesartan cilexetil (Atacand)

CLASS Antihypertensive, ARB
PREG/CONT D/NA

BBW Rule out pregnancy before starting tx. Suggest barrier birth control; fetal injury
and deaths have occurred. If pregnancy detected, discontinue as soon as possible.
IND & DOSE Tx of hypertension. Adult: 16 mg PO daily; range, 8–32 mg/day. Child 6–
under 17 yr: Over 50 kg, 8–16 mg/day PO; range, 4–32 mg/day PO; under 50 kg, 4–8
mg/day PO; range, 4–16 mg/day PO. Child 1–under 6 yr: 0.20 mg/kg/day oral
suspension; range, 0.05–0.4 mg/kg/day. Tx of HF. Adult: 4 mg/day PO; may be doubled
at 2-wk intervals. Target dose, 32 mg/day PO as single dose.
ADJUST DOSE Volume depletion
ADV EFF Abd pain, diarrhea, dizziness, headache, URI symptoms
NC/PT If BP not controlled, can add other antihypertensives. Use caution if pt goes to
surgery; volume depletion possible. Not for use in pregnancy (barrier contraception
advised) or breast-feeding. Pt should use care in situations that could lead to fluid
volume loss; monitor fluid intake.

DANGEROUS DRUG
capecitabine (Xeloda)
CLASS Antimetabolite, antineoplastic
PREG/CONT D/NA

BBW Increased risk of excessive bleeding, even death, if combined w/ warfarin; avoid
this combination. If combination must be used, monitor INR and PT levels closely; adjust
anticoagulant dose as needed.
IND & DOSE Tx of breast and colorectal cancer. Adult: 2,500 mg/m2/day PO in two
divided doses 12 hr apart within 30 min after meal for 2 wk, followed by 1-wk rest
period. Given in 3-wk cycles. Adjuvant postsurgery Dukes C colon cancer. Adult:
1,250 mg/m2 PO bid, a.m. and p.m., within 30 min after meal for 2 wk, followed by 1
wk rest. Given as 3-wk cycles for eight cycles (24 wk).
ADJUST DOSE Elderly pts; hepatic, renal impairment
ADV EFF Anorexia, constipation, dermatitis, hand-and-foot syndrome, leukopenia, MI,
n/v, renal impairment, stomatitis
INTERACTIONS Antacids, docetaxel, leucovorin (risk of severe toxicity, death), phenytoin,
warfarin
NC/PT Obtain baseline and periodic renal function tests; monitor for s&sx of toxicity.
Monitor nutritional status, fluid intake. Give frequent mouth care. Not for use in
pregnancy (use of barrier contraceptives advised) or breast-feeding. Pt should mark
calendar for tx days; avoid exposure to infection; report s&sx of infection.

capreomycin (Capastat Sulfate)

CLASS Antibiotic, antituberculotic
PREG/CONT C/NA

BBW Arrange for audiometric testing and assessment of vestibular function, renal
function tests, and serum potassium before and regularly during tx; severe risk of renal
failure, auditory damage. Drug’s safety not established in children or pregnant women.
IND & DOSE Tx of pulmonary TB not responsive to first-line antituberculotics, as part
of combination therapy. Adult: 1 g daily (max, 20 mg/kg/day) IM or IV for 60–120
days, followed by 1 g IM two to three times/wk for 12–24 mo.
ADJUST DOSE Elderly pts, renal impairment
ADV EFF Nephrotoxicity, ototoxicity
INTERACTIONS Nephrotoxic drugs, NMJ blockers
NC/PT Culture and sensitivity before tx. Use w/ other antituberculotics. Give by deep IM
injection. Obtain audiometric testing regularly. Monitor renal function, potassium levels
regularly.

captopril (generic)
CLASS ACE inhibitor, antihypertensive
PREG/CONT D/NA

BBW Rule out pregnancy; fetal abnormalities and death have occurred if used during
second or third trimester. Encourage use of contraceptive measures.
IND & DOSE Tx of hypertension, alone or as part of combination therapy. Adult: 25
mg PO bid or tid. Range, 25–150 mg bid–tid; max, 450 mg/day. Tx of heart failure.
Adult: 6.25–12.5 mg PO tid. Maint, 50–100 mg PO tid; max, 450 mg/day. Left
ventricular dysfx after MI. Adult: 6.25 mg PO, then 12.5 mg PO tid; increase slowly to
50 mg PO tid starting as early as 3 days post-MI. Tx of diabetic nephropathy. Adult:
Reduce dosage; suggested dose, 25 mg PO tid.
ADJUST DOSE Elderly pts, renal impairment
ADV EFF Agranulocytosis, aphthous ulcers, cough, dysgeusia, HF, MI, pancytopenia,
proteinuria, rash, tachycardia
INTERACTIONS Allopurinol, indomethacin, lithium, probenecid
NC/PT Use caution before surgery; mark chart. Give 1 hr before meals. Protect pt in
situations of decreased fluid volume. Not for use in pregnancy. Cough may occur. Pt
should change position slowly if dizzy, light-headed; avoid OTC preparations; consult
prescriber before stopping drug.

carbamazepine (Carbatrol, Equetro, Tegretol)

CLASS Antiepileptic
PREG/CONT D/NA

BBW Risk of aplastic anemia and agranulocytosis; obtain CBC, including

platelet/reticulocyte counts, and serum iron determination before starting tx; repeat
wkly for first 3 mo and monthly thereafter for at least 2–3 yr. Discontinue if evidence of
marrow suppression. Increased risk of suicidality; monitor accordingly.
IND & DOSE Refractory seizure disorders. Adult: 200 mg PO bid on first day. Increase
gradually by up to 200 mg/day in divided doses q 6–8 hr, or 100 mg PO qid suspension;
range, 800–1,200 mg/day. Child 6–12 yr: 100 mg PO bid on first day. Increase gradually
by adding 100 mg/day at 6- to 8-hr intervals until best response achieved; max, 1,000
mg/day. Child under 6 yr: Optimal daily dose, less than 35 mg/kg/day PO. Tx of
trigeminal neuralgia. Adult: 100 mg PO bid on first day. May increase by up to 200
mg/day, using 100-mg increments q 12 hr as needed. Range, 200–1,200 mg/day; max,
1,200 mg/day. Tx of bipolar 1 disorder. Adult: 400 mg/day PO in divided doses; max,
1, 600 mg/day (Equetro only).
ADJUST DOSE Elderly pts
ADV EFF Bone marrow suppression, CV complications, dizziness, drowsiness, hepatic
cellular necrosis w/ total loss of liver tissue, hepatitis, HF, n/v, Stevens-Johnson
syndrome, unsteadiness
INTERACTIONS Barbiturates, charcoal, cimetidine, danazol, doxycycline, erythromycin,
isoniazid, lithium, MAOIs, NMJ blockers, phenytoin, primidone, valproic acid,
verapamil, warfarin
NC/PT Use only for indicated uses. Taper dose if withdrawing; abrupt removal can
precipitate seizures. Obtain baseline and frequent LFTs, monitor CBC; dose adjustment
made accordingly. Evaluate for therapeutic serum levels (usually 4–12 mcg/mL). Not for
use in pregnancy (barrier contraceptives advisable). Pt should swallow ER tablets
whole; wear medical alert tag; avoid CNS depressants (alcohol). May open Equetro
capsule and sprinkle over food.

carbinoxamine maleate (Karbinal ER)

CLASS Antihistamine
PREG/CONT C/NA

IND & DOSE Tx of seasonal/perennial allergic rhinitis; vasomotor rhinitis; allergic

conjunctivitis; allergic skin reactions; dermatographism; anaphylactic reactions;
allergic reactions to blood, blood products. Adult, child 12 yr and older: 6–16 mg PO q
12 hr. Child 6–11 yr: 6–12 mg PO q 12 hr. Child 4–5 yr: 3–8 mg PO q 12 hr. Child 2–3 yr:
3–4 mg PO q 12 hr.
ADV EFF Dizziness, drowsiness, dry mouth, epigastric distress, rash, thickened secretions,
urine retention
INTERACTIONS CNS depressants, MAOIs; avoid this combination
NC/PT Ensure pt can tolerate anticholinergic effects; suggest increased fluids, humidifier.
Not for use in pregnancy, breast-feeding. Pt should measure drug using mL measure
provided; take safety measures w/ CNS effects; use humidifier, increase fluid intake;
report difficulty breathing, fainting.

DANGEROUS DRUG
carboplatin (generic)
CLASS Alkylating agent, antineoplastic
PREG/CONT D/NA

BBW Evaluate bone marrow function before and periodically during tx; do not give next
dose if marked bone marrow depression. Consult physician for dosage. Ensure
epinephrine, corticosteroids, antihistamines readily available in case of anaphylactic
reactions, which may occur within min of administration.
IND & DOSE Initial, palliative tx of pts w/ advanced ovarian cancer. Adult: As single
agent, 360 mg/m2 IV over at least 15 min on day 1 q 4 wk; adjust dose based on blood
counts.
ADJUST DOSE Elderly pts, renal impairment
ADV EFF Abd pain, alopecia, asthenia, anaphylactic reactions, bone marrow
suppression, bronchospasm, cancer, constipation, electrolyte abnormalities, n/v/d,
peripheral neuropathies, renal impairment
INTERACTIONS Aluminum (in sol)
NC/PT Antiemetic may be needed. Obtain CBC regularly; dose adjustment may be
needed. Ensure emergency equipment available in case of anaphylactic reaction. Not for
use in pregnancy. Hair loss, GI effects possible.

carboprost tromethamine (Hemabate)

CLASS Abortifacient, prostaglandin
PREG/CONT C/NA

IND & DOSE Termination of pregnancy 13–20 wk from first day of last menstrual
period; evacuation of uterus in missed abortion or intrauterine fetal death. Adult:
250 mcg (1 mL) IM; give 250 mcg IM at 1.5- to 3.5-hr intervals. Max, 12 mg total dose.
Tx of postpartum hemorrhage. Adult: 250 mcg IM as one dose; may use multiple doses
at 15- to 90-min intervals. Max, 2 mg (eight doses).
ADV EFF Diarrhea, flushing, hypotension, nausea, perforated uterus, uterine rupture
NC/PT Pretreat w/ antiemetics and antidiarrheals. Give by deep IM injection. Ensure
abortion complete; monitor for infection. Ensure adequate hydration. Several IM
injections may be needed.

carfilzomib (Kyprolis)
CLASS Antineoplastic, proteasome inhibitor
PREG/CONT D/NA

IND & DOSE Tx of multiple myeloma in pts w/ disease progression after at least two
prior therapies. Adult: Cycle 1: 20 mg/m2/day IV over 2–10 min on two consecutive
days each wk for three wk (days 1, 2, 8, 9, 15, 16) followed by 12-day rest period. Cycle
2 and beyond: Increase to 27 mg/m2/day IV over 2–10 min, following same dosing-days
schedule.
ADV EFF Anemia, dyspnea, fatigue, fever, heart failure/ischemia, hepatotoxicity,
infusion reactions, liver failure, n/v/d, pulmonary complications, pulmonary
hypertension, thrombocytopenia, tumor lysis syndrome
NC/PT Premedicate w/ dexamethasone; hydrate before and after tx. Monitor for
potentially severe adverse reactions; arrange for supportive measures, dosage
adjustment. Not for use in pregnancy. Pt should mark calendar for tx days; report
difficulty breathing, swelling, urine/stool color changes, chest pain.

carglumic acid (Carbaglu)

CLASS Carbamoyl phosphate synthetase I activator
PREG/CONT C/NA

IND & DOSE Adjunctive/maint tx of acute hyperammonemia due to hepatic N-

acetylglutamate synthase deficiency. Adult, child: 100–250 mg/kg/day PO in divided
doses; may be made into sol and given through NG tube.
ADV EFF Abd pain, anemia, fever, headache, infections, nasopharyngitis, n/v/d
NC/PT Monitor ammonia levels during tx; dose adjustment may be needed. Restrict
protein intake until ammonia level regulated. Not for use in pregnancy, breast-feeding.
Store in refrigerator until opened, then room temp. Date bottle; discard after 1 mo.

carisoprodol (Soma)
CLASS Centrally acting skeletal muscle relaxant
PREG/CONT C/NA

IND & DOSE Relief of discomfort associated w/ acute, painful musculoskeletal

conditions, as adjunct. Adult, child over 16 yr: 250–350 mg PO tid–qid. Pt should take
last dose at bedtime for max of 2–3 wk.
ADJUST DOSE Hepatic, renal impairment
ADV EFF Allergic/idiosyncratic reaction, agitation, anaphylactoid shock, ataxia,
dizziness, drowsiness, irritability, tremor, vertigo
NC/PTMonitor for idiosyncratic reaction, most likely w/ first doses. Provide safety
measures w/ CNS effects. May become habit-forming; use caution. Pt should avoid other
CNS depressants.

DANGEROUS DRUG
carmustine (BCNU) (BiCNU, Gliadel)
CLASS Alkylating agent, antineoplastic
PREG/CONT D/NA

BBW Do not give more often than q 6 wk because of delayed bone marrow toxicity.
Evaluate hematopoietic function before, wkly during, and for at least 6 wk after tx to
monitor for bone marrow suppression. Monitor for pulmonary toxicity and delayed
toxicity, which can occur yrs after therapy; death possible. Cumulative doses of 1,400
mg/m2 increase risk.
IND & DOSE Palliative tx alone or w/ other agents (injection) for brain tumors,
Hodgkin lymphoma, non-Hodgkin lymphoma, multiple myeloma. Adult, child: 150–
200 mg/m2 IV q 6 wk as single dose or in divided daily injections (75–100 mg/m2 on 2
successive days); adjust dose based on CBC. Adjunct to surgery for tx of recurrent
glioblastoma as implantable wafer (w/ prednisone); tx of newly diagnosed high-
grade malignant glioma (wafer). Adult, child: Wafers implanted in resection cavity as
part of surgical procedure; up to 8 wafers at a time.
ADV EFF Bone marrow suppression (may be delayed 4–6 wk), cancer, hepatotoxicity,
local burning at injection site, pulmonary fibrosis, pulmonary infiltrates, renal
failure, stomatitis
INTERACTIONS Cimetidine, digoxin, mitomycin, phenytoin
NC/PT Monitor CBC before and wkly during tx. Do not give full dose within 2–3 wk of
radiation or other chemotherapy. Monitor pulmonary function; toxicity can be delayed.
Monitor LFTs, renal function, injection site for local reaction. Premedicate w/
antiemetic. Not for use in pregnancy. Pt should try to maintain fluid intake, nutrition.

carvedilol (Coreg)
CLASS Alpha and beta blocker, antihypertensive
PREG/CONT C/NA

IND & DOSE Converting to once-daily CR capsules. 3.125 mg bid, give 10 mg CR; 6.25
mg bid, give 20 mg CR; 12.5 mg bid, give 40 mg CR; 25 mg bid, give 80 mg CR. Mgt of
hypertension, alone or w/ other drugs. Adult: 6.25 mg PO bid; maintain for 7–14
days, then increase to 12.5 mg PO bid. Max, 50 mg/day. Tx of mild to severe HF.
Adult: 3.125 mg PO bid for 2 wk, then may increase to 6.25 mg PO bid. Max, 25 mg/day
if under 85 kg, 50 mg if over 85 kg. Tx of left ventricular dysfx after MI. Adult: 6.25
mg PO bid; increase after 3–10 days to 25 mg PO bid.
ADJUST DOSE Hepatic impairment
ADV EFF Bradycardia, constipation, fatigue, flatulence, diarrhea, dizziness, gastric pain,
hepatic injury, HF, hypotension, rhinitis, tinnitus, vertigo
INTERACTIONS Antidiabetics, clonidine, digoxin, diltiazem, rifampin, verapamil
NC/PT Do not discontinue abruptly; taper when discontinuing. Use caution if surgery
planned. Use care in conversion to CR capsules. Monitor for orthostatic hypotension.
Monitor LFTs. Provide safety measures. Pt should not cut, crush, or chew CR capsules;
change position slowly if lowered BP occurs; if diabetic, should use caution and monitor
glucose levels carefully.

caspofungin acetate (Cancidas)

CLASS Antifungal, echinocandin
PREG/CONT C/NA

IND & DOSE Tx of invasive aspergillosis; tx of esophageal candidiasis; tx of

candidemia and other Candida infections; empirical tx when fungal infection
suspected in neutropenic pts. Adult: Loading dose, 70 mg IV, then 50 mg/day IV
infusion for at least 14 days. Child 3 mo–17 yr: Loading dose, 70 mg/m2 IV, then
50 mg/m2 IV daily for 14 days.
ADJUST DOSE Hepatic impairment, concurrent rifampin or inducers of drug clearance
ADV EFF Decreased serum potassium, diarrhea, fever, hepatic damage, hypersensitivity
reactions, hypotension, increased liver enzymes
INTERACTIONS Cyclosporine, rifampin
NC/PT Monitor for IV complications. Monitor potassium levels; monitor LFTS before and
during tx. Not for use in pregnancy, breast-feeding.

cefaclor (Ceclor)
CLASS Cephalosporin
PREG/CONT B/NA

IND & DOSE Tx of lower respiratory infections, URI, skin infections, UTIs, otitis
media, pharyngitis caused by susceptible bacteria strains. Adult: 250 mg PO q 8 hr
or 375–500 mg q 12 hr for 7–10 days; max, 4 g/day. Child: 20 mg/kg/day PO in divided
doses q 8 hr; in severe cases, may give 40 mg/kg/day. Max, 1 g/day. For otitis
media/pharyngitis, may divide dose and give q 12 hr.
ADV EFF Abd pain, anaphylaxis, anorexia, colitis, flatulence, n/v/d, rash,
superinfections
INTERACTIONS Aminoglycosides, antacids, anticoagulants
NC/PT Culture before tx. Give w/ meals to decrease GI discomfort. Give oral vancomycin
for serious colitis. Refrigerate suspension. Pt should not cut, crush, or chew ER tablets;
complete full course of therapy; report diarrhea w/ blood or mucus.

cefadroxil (generic)
 CLASSCephalosporin
PREG/CONT B/NA

IND & DOSETx of pharyngitis/tonsillitis caused by susceptible bacteria strains. Adult:

1 g/day PO in single dose or two divided doses for 10 days. Child: 30 mg/kg/day PO in
single or two divided doses; continue for 10 days. Tx of UTIs caused by susceptible
bacteria strains. Adult: 1–2 g/day PO in single dose or two divided doses for
uncomplicated lower UTIs. For all other UTIs, 2 g/day in two divided doses. Child: 30
mg/kg/day PO in divided doses q 12 hr. Tx of skin, skin-structure infections caused
by susceptible bacteria strains. Adult: 1 g/day PO in single dose or two divided doses.
Child: 30 mg/kg/day PO in divided doses.
ADJUST DOSE Elderly pts, renal impairment
ADV EFF Abd pain, anaphylaxis, anorexia, bone marrow depression, colitis,
flatulence, n/v/d, rash, superinfections
INTERACTIONS Aminoglycosides, bacteriostatic agents, probenecid
NC/PT Culture before tx. Give w/ meals to decrease GI discomfort; give oral vancomycin
for serious colitis. Refrigerate suspension. Pt should not cut, crush, or chew ER tablets;
complete full course of therapy; report diarrhea w/ blood or mucus.

cefdinir (generic)
CLASS Cephalosporin
PREG/CONT B/NA

IND & DOSE Tx of community-acquired pneumonia, uncomplicated skin, skin-

structure infections. Adult, adolescent: 300 mg PO q 12 hr for 10 days. Tx of acute
exacerbation of chronic bronchitis, acute maxillary sinusitis, pharyngitis,
tonsillitis. Adult, adolescent: 300 mg PO q 12 hr for 10 days or 600 mg PO q 24 hr for
10 days. Tx of otitis media, acute maxillary sinusitis, pharyngitis, tonsillitis. Child
6 mo–12 yr: 7 mg/kg PO q 12 hr or 14 mg/kg PO q 24 hr for 10 days; max, 600 mg/day.
Tx of skin, skin-structure infections. Child 6 mo–12 yr: 7 mg/kg PO q 12 hr for 10
days.
ADJUST DOSE Renal impairment
ADV EFF Abd pain, anaphylaxis, anorexia, colitis, flatulence, n/v/d, rash,
superinfections
INTERACTIONS Aminoglycosides, antacids, oral anticoagulants
NC/PT Culture before tx. Give w/ meals to decrease GI discomfort; give oral vancomycin
for serious colitis. Arrange for tx of superinfections. Store suspension at room temp;
discard after 10 days. Pt should complete full course of therapy; report diarrhea w/
blood or mucus.

cefditoren pivoxil (Spectracef)

CLASS Cephalosporin
 PREG/CONT B/NA

IND & DOSE Tx of uncomplicated skin/skin-structure infections, pharyngitis,

tonsillitis caused by susceptible bacteria. Adult, child over 12 yr: 200 mg PO bid for
10 days. Tx of acute exacerbation of chronic bronchitis, community-acquired
pneumonia caused by susceptible bacteria strains. Adult, child over 12 yr: 400 mg PO
bid for 10 days (chronic bronchitis) or 14 days (pneumonia).
ADJUST DOSE Renal impairment
ADV EFF Abd pain, anaphylaxis, anorexia, colitis, flatulence, hepatotoxicity, n/v/d,
rash, superinfections
INTERACTIONS Antacids, oral anticoagulants
NC/PT Culture before tx. Do not give longer than 10 days; risk of carnitine deficiency.
Give w/ meals to decrease GI discomfort; give oral vancomycin for serious colitis.
Provide tx for superinfections. Not for pts w/ allergy to milk proteins. Pt should not take
w/ antacids; should complete full course of therapy; report diarrhea w/ blood or mucus.

cefepime hydrochloride (generic)

CLASS Cephalosporin
PREG/CONT B/NA

IND & DOSE Tx of mild to moderate UTI. Adult: 0.5–1 g IM or IV q 12 hr for 7–10 days.
Tx of severe UTI. Adult: 2 g IV q 12 hr for 10 days. Tx of moderate to severe
pneumonia. Adult: 1–2 g IV q 12 hr for 10 days. Tx of moderate to severe skin
infections. Adult: 2 g IV q 12 hr for 10 days. Empiric therapy for febrile neutropenic
pts. Adult: 2 g IV q 8 hr for 7 days. Tx of complicated intra-abdominal infections.
Adult: 2 g IV q 12 hr for 7–10 days. Children over 2 mo, under 40 kg: 50 mg/kg/day IV or
IM q 12 hr for 7–10 days depending on infection severity. If treating febrile
neutropenia, give q 8 hr (max, 2 g/day).
ADJUST DOSE Elderly pts, renal impairment
ADV EFF Abd pain, anaphylaxis, anorexia, colitis, disulfiram reaction w/ alcohol,
flatulence, hepatotoxicity, n/v/d, phlebitis, rash, superinfections
INTERACTIONS Alcohol, aminoglycosides, oral anticoagulants
NC/PT Culture before tx. Have vitamin K available if hypoprothrombinemia occurs. Pt
should avoid alcohol during and for 3 days after tx; report diarrhea w/ blood or and
mucus.

cefotaxime sodium (Claforan)

CLASS Cephalosporin
PREG/CONT B/NA

Tx of lower respiratory tract, skin, intra-abdominal, CNS, bone and joint

IND & DOSE
infections; UTIs; peritonitis caused by susceptible bacteria. Adult: 2–8 g/day IM or
IV in equally divided doses q 6–8 hr; max, 12 g/day. Child 1 mo–12 yr under 50 kg: 50–
180 mg/kg/day IV or IM in four to six divided doses. Child 1–4 wk: 50 mg/kg IV q 8 hr.
Child 0–1 wk: 50 mg/kg IV q 12 hr. Tx of gonorrhea. Adult: 0.5–1 g IM in single
injection. Disseminated infection. Adult: 1–2 g IV q 8 hr. Periop px. Adult: 1 g IV or
IM 30–90 min before surgery. Cesarean section. Adult: 1 g IV after cord is clamped,
then 1 g IV or IM at 6 and 12 hr.
ADJUST DOSE Elderly pts, renal impairment
ADV EFF Abd pain, anaphylaxis, anorexia, bone marrow depression, colitis, disulfiram
reaction w/ alcohol, flatulence, hepatotoxicity, n/v/d, phlebitis, rash, superinfections
INTERACTIONS Alcohol, aminoglycosides, oral anticoagulants
NC/PT Culture before tx. Give IV slowly. Pt should avoid alcohol during and for 3 days
after tx; report diarrhea w/ blood or mucus.

cefoxitin sodium (generic)

CLASS Cephalosporin
PREG/CONT B/NA

IND & DOSE Tx of lower respiratory tract, skin, intra-abdominal, CNS, bone and joint
infections; UTIs, peritonitis caused by susceptible bacteria. Adult: 2–8 g/day IM or
IV in equally divided doses q 6–8 hr. Child 3 mo and older: 80–160 mg/kg/day IM or IV
in divided doses q 4–6 hr. Max, 12 g/day. Tx of gonorrhea. Adult: 2 g IM w/ 1 g oral
probenecid. Uncomplicated lower respiratory tract infections, UTIs, skin
infections. Adult: 1 g q 6–8 hr IV. Moderate to severe infections. Adult:1 g q 4 hr IV
to 2 g q 6–8 hr IV. Severe infections. Adult: 2 g q 4 hr IV or 3 g q 6 hr IV. Periop px.
Adult: 2 g IV or IM 30–60 min before initial incision, q 6 hr for 24 hr after surgery.
Cesarean section. Adult: 2 g IV as soon as cord clamped, then 2 g IM or IV at 4 and 8
hr, then q 6 hr for up to 24 hr. Transurethral prostatectomy. Adult: 1 g before surgery,
then 1 g q 8 hr for up to 5 days.
ADJUST DOSE Elderly pts, renal impairment
ADV EFF Abd pain, anaphylaxis, anorexia, bone marrow depression, colitis, disulfiram
reaction w/ alcohol, flatulence, hepatotoxicity, n/v/d, phlebitis, rash, superinfections
INTERACTIONS Alcohol, aminoglycosides, oral anticoagulants
NC/PT Culture before tx. Give IV slowly. Have vitamin K available for
hypoprothrombinemia. Pt should avoid alcohol during and for 3 days after tx; report
diarrhea w/ blood or mucus.

cefpodoxime proxetil (generic)

CLASS Cephalosporin
PREG/CONT B/NA

IND & DOSE Tx of upper and lower respiratory tract infections, skin and skin-
structure infections, UTIs, otitis media caused by susceptible strains; STD caused
by Neisseria gonorrhoeae. Adult: 100–400 mg PO q 12 hr depending on infection
severity for 5–14 days. Child: 5 mg/kg/dose PO q 12 hr; max, 100–200 mg/dose for 10
days. Tx of acute otitis media. Child: 10 mg/kg/day PO divided q 12 hr; max, 400
mg/day for 5 days.
ADJUST DOSE Elderly pts, renal impairment
ADV EFF Abd pain, anaphylaxis, anorexia, bone marrow depression, colitis,
flatulence, hepatotoxicity, n/v/d, phlebitis, rash, superinfections
INTERACTIONS Aminoglycosides, oral anticoagulants
NC/PT Culture before tx. Refrigerate suspension. Give oral vancomycin for serious colitis.
Pt should take w/ food; complete full course of therapy; report diarrhea w/ blood or
mucus.

cefprozil (generic)
CLASS Cephalosporin
PREG/CONT B/NA

IND & DOSE Tx of upper and lower respiratory tract infections, skin and skin-
structure infections, otitis media, acute sinusitis caused by susceptible strains.
Adult: 250–500 mg PO q 12–24 hr for 10 days. Tx of acute otitis media, sinusitis. Child
6 mo–12 yr: 7.5–15 mg/kg PO q 12 hr for 10 days. Tx of pharyngitis, tonsillitis. Child
2–12 yr: 7.5 mg/kg PO q 12 hr for 10 days. Tx of skin and skin-structure infections.
Child 2–12 yr: 20 mg/kg PO once daily for 10 days.
ADJUST DOSE Elderly pts, renal impairment
ADV EFF Abd pain, anaphylaxis, anorexia, bone marrow depression, colitis,
flatulence, hepatotoxicity, n/v/d, phlebitis, rash, superinfections
INTERACTIONS Aminoglycosides, oral anticoagulants
NC/PT Culture before tx. Refrigerate suspension. Give oral vancomycin for serious colitis.
Pt should take w/ food; complete full course of therapy; report diarrhea w/ blood or
mucus.

ceftaroline fosamil (Teflaro)

CLASS Cephalosporin
PREG/CONT B/NA

IND & DOSE Tx of skin, skin-structure infections; community-acquired pneumonia

caused by susceptible strains. Adult: 600 mg by IV infusion over 1 hr q 12 hr for 5–
14 days (skin, skin-structure infections) or 5–7 days (community-acquired pneumonia).
ADJUST DOSE Renal impairment
ADV EFF Clostridium difficile–associated diarrhea, dizziness, hemolytic anemia,
hypersensitivity reactions, injection-site reactions, rash, renal failure
NC/PT Culture before tx. Small, frequent meals may help GI effects. Monitor injection
site, CBC. Not for use in pregnancy, breast-feeding. Pt should report severe diarrhea.

ceftazidime (Ceptaz, Fortaz, Tazicef)

CLASS Cephalosporin
PREG/CONT B/NA

IND & DOSE Tx of lower respiratory, skin and skin-structure, intra-abdominal, CNS,
bone and joint infections; UTIs, septicemia caused by susceptible strains,
gynecologic infections caused by Escherichia coli. Adult: Usual dose, 1 g (range,
250 mg–2 g) q 8–12 hr IM or IV; max, 6 g/day. Child 1 mo–12 yr: 30 mg/kg IV q 12 hr.
Child 0–4 wk: 30 mg/kg IV q 12 hr. Tx of UTIs caused by susceptible bacteria strains.
Adult: 250–500 mg IV or IM q 8–12 hr. Tx of pneumonia, skin and skin-structure
infections caused by susceptible bacteria strains. Adult: 500 mg–1 g IV or IM q 8 hr.
Tx of bone and joint infections caused by susceptible bacteria strains. Adult: 2 g IV
q 12 hr. Tx of gynecologic, intra-abdominal, life-threatening infections;
meningitis. Adult: 2 g IV q 8 hr.
ADJUST DOSE Elderly pts, renal impairment
ADV EFF Abd pain, anaphylaxis, anorexia, bone marrow depression, colitis,
disulfiram-like reaction w/ alcohol, flatulence, injection-site reactions, n/v/d, pain,
phlebitis, superinfections
INTERACTIONS Aminoglycosides, alcohol, oral anticoagulants
NC/PT Culture before tx. Do not mix in sol w/ aminoglycosides. Have vitamin K available
if hypoprothrombinemia occurs. Pt should avoid alcohol during and for 3 days after tx;
report diarrhea w/ blood or mucus.

ceftibuten (Cedax)
CLASS Cephalosporin
PREG/CONT B/NA

IND & DOSE Tx of acute bacterial exacerbations of chronic bronchitis, acute

bacterial otitis media, pharyngitis, tonsillitis caused by susceptible strains. Adult:
400 mg PO daily for 10 days. Child: 9 mg/kg/day PO for 10 days; max, 400 mg/day.
ADJUST DOSE Renal impairment
ADV EFF Abd pain, anaphylaxis, anorexia, bone marrow depression, colitis,
disulfiram-like reactions w/ alcohol, flatulence, hepatotoxicity, n/v/d, pain,
superinfections
INTERACTIONS Aminoglycosides, alcohol, oral anticoagulants
NC/PT Culture before tx. Give w/ meals. Refrigerate suspension; discard after 14 days.
Arrange tx for superinfections. Pt should avoid alcohol during and for 3 days after tx;
complete full course of therapy; report diarrhea w/ blood or mucus.

ceftriaxone sodium (Rocephin)

 CLASSCephalosporin
PREG/CONT B/NA

IND & DOSE Tx of lower respiratory tract, intra-abdominal, skin and skin-structure,
bone and joint infections; acute bacterial otitis media, UTIs, septicemia caused by
susceptible strains. Adult: 1–2 g/day IM or IV as one dose or in equal divided doses
bid; max, 4 g/day. Child: 50–75 mg/kg/day IV or IM in divided doses q 12 hr; max, 2
g/day. Tx of gonorrhea and PID caused by Neisseria gonorrhoeae. Adult: Single 250-
mg IM dose. Tx of meningitis. Adult: 1–2 g/day IM or IV as one dose or in equal
divided doses bid for 4–14 days; max, 4 g/day. Loading dose of 100 mg/kg may be used.
Periop px. Adult: 1 g IV 30–120 min before surgery.
ADV EFF Abd pain, anaphylaxis, anorexia, bone marrow depression, colitis,
disulfiram-like reactions w/ alcohol, flatulence, hepatotoxicity, n/v/d, pain,
superinfections
INTERACTIONS Aminoglycosides, alcohol, oral anticoagulants
NC/PT Culture before tx. Give w/ meals. Protect drug from light. Have vitamin K
available if hypoprothrombinemia occurs. Do not mix w/ other antimicrobials. Arrange
tx for superinfections. Pt should avoid alcohol during and for 3 days after tx; complete
full course of therapy; report diarrhea w/ blood or mucus.

cefuroxime axetil (Ceftin), cefuroxime sodium (Zinacef)

CLASS Cephalosporin
PREG/CONT B/NA

IND & DOSE Tx of upper respiratory tract, skin and skin-structure infections; acute
bacterial otitis media, uncomplicated gonorrhea, bacterial sinusitis, UTIs, early
Lyme disease caused by susceptible strains. Adult, child 12 yr and older: 250 mg PO
bid. For severe infections, may increase to 500 mg PO bid. Treat for up to 10 days. Or
750 mg–1.5 g IM or IV q 8 hr, depending on infection severity, for 5–10 days. Child over
3 mo: 50–100 mg/kg/day IM or IV in divided doses q 6–8 hr. Tx of acute otitis media.
Child 3 mo–12 yr: 250 mg PO bid for 10 days. Tx of pharyngitis/tonsillitis. Child 3 mo–
12 yr: 125 mg PO q 12 hr for 10 days Tx of acute sinusitis. Child 3 mo–12 yr: 250 mg
PO bid for 10 days. Tx of impetigo. Child 3 mo–12 yr: 30 mg/kg/day (max, 1 g/day) in
two divided doses for 10 days. Uncomplicated gonorrhea. Adult: 1.5 g IM (at two
different sites) w/ 1 g oral probenecid. Periop px. Adult: 1.5 g IV 30–60 min before
initial incision, then 750 mg IV or IM q 8 hr for 24 hr after surgery. Tx of bacterial
meningitis. Child: 200–240 mg/kg/day IV in divided doses q 6–8 hr.
ADJUST DOSE Elderly pts, impaired renal function
ADV EFF Abd pain, anaphylaxis, anorexia, bone marrow depression, colitis,
disulfiram-like reactions w/ alcohol, flatulence, hepatotoxicity, n/v/d, pain,
superinfections
INTERACTIONS Aminoglycosides, alcohol, oral anticoagulants
NC/PT Culture before tx. Give w/ meals. Have vitamin K available for
hypoprothrombinemia. Do not mix w/ other antimicrobials. Arrange for tx of
superinfections. Have suspension made for children who cannot swallow tablets. Pt
should avoid alcohol during and for 3 days after tx; complete full course of therapy;
report diarrhea w/ blood or mucus.

celecoxib (Celebrex)
CLASS Cox-2 specific inhibitor, NSAID
PREG/CONT C (1st, 2nd trimesters); D (3rd trimester)/NA

BBW Increased risk of CV events, GI bleeding; monitor accordingly.

IND & DOSE Tx of acute pain, dysmenorrhea; mgt of rheumatoid arthritis. Adult: 100
mg PO bid; may increase to 200 mg/day PO bid as needed. Tx of osteoarthritis. Adult:
200 mg/day PO. Tx of ankylosing spondylitis. Adult: 200 mg/day PO; after 6 wk, may
try 400 mg/day for 6 wk. Tx of juvenile rheumatoid arthritis. Child 2 yr and older:
Over 25 kg, 100 mg capsule PO bid. Ten kg to 25 kg or less, 50 mg capsule PO bid.
ADJUST DOSE Hepatic, renal impairment
ADV EFF Agranulocytosis, anaphylactoid reactions, dizziness, dyspepsia, headache,
insomnia, MI, rash, somnolence, stroke
INTERACTIONS Alcohol, lithium, nicotine, warfarin
NC/PT Give w/ food if GI upset occurs. Use comfort measures to help relieve pain, safety
measures if CNS effects occur. Name confusion w/ Celebrex (celecoxib), Celexa
(citalopram), Xanax (alprazolam), and Cerebyx (fosphenytoin); use caution.

cellulose sodium phosphate (CSP) (Calcibind)

CLASS Antilithic, resin exchange drug
PREG/CONT C/NA

IND & DOSE Tx of absorptive hypercalciuria type 1 (calcium oxalate and calcium
phosphate renal stones). Adult: 10–15 mg/day PO based on urine calcium level.
ADV EFF Abd discomfort, anorexia, dizziness, drowsiness, hypomagnesemia, muscle
spasm, n/v/d
INTERACTIONS Ascorbic acid, calcium-containing drugs, milk products, oxalate-containing
foods
NC/PT Suspend powder in water, soft drink, or fruit juice; give 1 hr before meal. Give w/
magnesium gluconate. Monitor serum calcium, magnesium, urine calcium, oxalate, PTH
levels. Not for use in pregnancy, breast-feeding. Push fluids. Pt should limit calcium
intake.

cephalexin (Keflex)
CLASS Cephalosporin
PREG/CONT B/NA
IND & DOSE Tx of respiratory tract infections, acute bacterial otitis media, bone
infections, UTIs caused by susceptible strains. Adult: 1–4 g/day in divided doses;
usual dose, 250 mg PO q 6 hr. Child: 25–50 mg/kg/day PO in divided doses. Tx of skin,
skin-structure infections, uncomplicated cystitis, streptococcal pharyngitis. Adult:
500 mg PO q 12 hr. May need larger doses in severe cases; max, 4 g/day. Child: Divide
usual daily dose; give q 12 hr. Tx of otitis media. Child: 75–100 mg/kg/day PO in four
divided doses.
ADV EFF Abd pain, anaphylaxis, anorexia, bone marrow depression, colitis,
disulfiram-like reactions w/ alcohol, flatulence, hepatotoxicity, n/v/d, pain,
superinfections
INTERACTIONS Aminoglycosides, alcohol, oral anticoagulants
NC/PT Culture before tx. Give w/ meal. Pt should avoid alcohol during and for 3 days
after tx; report diarrhea w/ blood or mucus.

certolizumab (Cimzia)
CLASS Immune modulator, TNF blocker
PREG/CONT C/NA

BBW Risk of serious infections, cancer, CNS demyelinating disorders. Prescreen for TB
and hepatitis B; monitor pt carefully.
IND & DOSE To reduce s&sx of Crohn’s disease; tx of moderately to severely active
rheumatoid arthritis. Adult: 400 mg subcut repeated at 2 wk and 4 wk; maint, 400 mg
q wk (Crohn’s), 200 mg q 4 wk (arthritis).
ADV EFF Anaphylaxis, lupus like syndrome, malignancies, serious to fatal
infections, rash, URIs, UTIs
INTERACTIONS Abatacept, anakinra, live vaccines, natalizumab, rituximab
NC/PT Monitor carefully for s&sx of allergic reaction, infection. Not for use in pregnancy.
Pt should report s&sx of infection.

cetirizine hydrochloride (Zyrtec)

CLASS Antihistamine
PREG/CONT B/NA

IND & DOSEMgt of seasonal and perennial allergic rhinitis; tx of chronic, idiopathic
urticaria. Adult, child 6 yr and older: 10 mg/day PO or 5 mg PO bid; max, 10 mg. Child
6–11 yr: 5 or 10 mg PO daily. Child 2–6 yr: 2.5 mg PO once daily; max,5 mg/day.
ADJUST DOSE Elderly pts; renal, hepatic impairment
ADV EFF Bronchospasm, sedation, somnolence
NC/PT Provide syrup or chewable tablets for children. Pt should maintain intake of fluids,
use humidifier if secretions thicken; take safety precautions if sedation occurs. Name
confusion between Zyrtec (cetirizine) and Zyprexa (olanzapine) and between Zyrtec
(cetirizine) and Zantac (ranitidine); use caution.

cetrorelix acetate (Cetrotide)

CLASS Fertility drug
PREG/CONT X/NA

IND & DOSE Inhibition of premature LH surges in women undergoing controlled

ovarian stimulation. Adult: 3 mg subcut. If HCG not given within 4 days, continue 0.25
mg/kg/day subcut until HCG is given.
ADV EFF Headache, hypersensitivity reactions, injection-site reactions, nausea, ovarian
overstimulation
NC/PT Part of comprehensive fertility program; many follow-up tests will be needed. Pt
should learn proper administration of drug and disposal of syringes, needles.

DANGEROUS DRUG
cetuximab (Erbitux)
CLASS Antineoplastic, monoclonal antibody
PREG/CONT C/NA

BBW Serious to fatal infusion reactions, cardiac arrest, and sudden death have occurred.
Closely monitor serum electrolytes during and after tx.
IND & DOSE Tx of advanced colorectal cancer, advanced squamous cell carcinoma of
head and neck w/ radiation or as monotherapy after failure of platinum therapy.
Adult: 400 mg/m2 IV loading dose over 120 min, then 250 mg/m2 IV over 60 min wkly.
ADV EFF Cardiac arrest, dermatological toxicity, diarrhea, headache,
hypomagnesemia, infections, infusion reactions, pulmonary toxicity, rash, pruritus
NC/PT Premedicate w/ H1 antagonist IV 30–60 min before first dose. Base future doses on
clinical response. Do not infuse faster than 10 mg/min. Have emergency equipment on
hand. Monitor electrolytes; assess lungs and skin for s&sx of toxicity. Males and females
should use contraception during and for 6 mo after tx; females should not breast-feed
during or for 2 mo after tx. Pt should report s&sx of infection, difficulty breathing, rash.

cevimeline hydrochloride (Evoxac)

CLASS Parasympathomimetic
PREG/CONT C/NA

IND & DOSE Tx of dry mouth in pts w/ Sjögren’s syndrome. Adult: 30 mg PO tid w/
food.
ADV EFFCardiac arrhythmias, bronchial narrowing, dehydration, dyspepsia, excessive
sweating, headache, n/v/d, URIs, visual blurring
INTERACTIONS Beta-adrenergic antagonists
NC/PT Give w/ meals. Monitor for dehydration. Pt should take safety precautions if
visual changes occur.

charcoal, activated (Actidose-Aqua, Liqui-Char)

CLASS Antidote
PREG/CONT C/NA

IND & DOSE Emergency tx in poisoning by most drugs and chemicals. Adult: 50–60 g
or 1 g/kg PO, or approximately 8–10 times by volume amount of poison ingested, as
oral suspension. Give as soon as possible after poisoning. With gastric dialysis, 20–40 g
PO q 6 hr for 1–2 days for severe poisonings; for optimum effect, give within 30 min of
poisoning. Child 1–12 yr: Over 32 kg, 50–60 g PO; 16–32 kg, 25–30 g PO; under 16 kg
and under 1 yr, not recommended.
ADV EFF Black stools, constipation, diarrhea, vomiting
INTERACTIONS Laxatives, milk products, oral medications
NC/PT For use w/ conscious pts only. Take steps to prevent aspiration; have life-support
equipment readily available. Pt should drink 6–8 glasses of liquid/day to avoid
constipation. Name confusion between Actidose (charcoal) and Actos (pioglitazone); use
caution.

chenodiol (Chenodal)
CLASS Gallstone solubilizer
PREG/CONT X/NA

BBW Highly toxic to liver. Reserve use for select pts where benefit clearly outweighs
risk.
IND & DOSE Tx of selected pts w/ radiolucent gallstones when surgery not an option.
Adult: 250 mg PO bid for 2 wk, then 13–16 mg/kg/day in 2 divided doses a.m. and p.m.
for up to 6–9 mo.
ADV EFF Colon cancer, diarrhea, hepatotoxicity, neutropenia
INTERACTIONS Clofibrate, warfarin
NC/PT Ensure correct selection of pt. Monitor LFTs carefully. Not for use in pregnancy
(barrier contraceptives advised). Long-term therapy requires frequent tests. Diarrhea
will occur.

DANGEROUS DRUG
chlorambucil (Leukeran)
CLASS Antineoplastic, nitrogen mustard
PREG/CONT D/NA

BBW Arrange for blood tests to evaluate hematopoietic function before and wkly during
tx. Severe bone marrow suppression possible. Drug is carcinogenic; monitor pt
regularly. Rule out pregnancy before starting tx. Encourage use of barrier
contraceptives; drug is teratogenic. May cause infertility.
IND & DOSE Palliative tx of chronic lymphocytic leukemia (CLL); malignant
lymphoma, including lymphosarcoma; giant follicular lymphoma; Hodgkin
lymphoma. Adult: Initial dose and short-course therapy, 0.1–0.2 mg/kg/day PO for 3–6
wk; may give single daily dose. CLL alternative regimen, 0.4 mg/kg PO q 2 wk,
increasing by 0.1 mg/kg w/ each dose until therapeutic or toxic effect occurs. Maint,
0.03–0.1 mg/kg/day PO; max, 0.1 mg/kg/day.
ADV EFF Acute leukemia, alopecia, bone marrow depression
NC/PT Monitor CBC regularly. Rule out pregnancy. Do not give full dose within 4 wk of
radiation or other chemotherapy. Divide dose w/ severe n/v; maintain hydration.
Sterility can occur. Name confusion w/ Leukeran (chlorambucil), Myleran (busulfan),
Alkeran (melphalan), and leucovorin; use caution.

chloramphenicol sodium succinate (generic)

CLASS Antibiotic
PREG/CONT C/NA

BBW Severe, sometimes fatal blood dyscrasias (in adults) and severe, sometimes fatal
gray syndrome (in newborns, premature infants) possible. Restrict use to situations in
which no other antibiotic effective. Monitor serum levels at least wkly to minimize
toxicity risk (therapeutic conc: peak, 10–20 mcg/mL; trough, 5–10 mcg/mL).
IND & DOSE Severe infections caused by susceptible strains. Adult: 50 mg/kg/day IV in
divided doses q 6 hr up to 100 mg/kg/day in severe cases. Severe infections and cystic
fibrosis regimen. Child: 50–100 mg/kg/day IV in divided doses q 6 hr. Neonates,
children w/ immature metabolic processes, 25 mg/kg/day IV; individualize doses at 6-hr
intervals.
ADJUST DOSE Elderly pts; hepatic, renal impairment
ADV EFF Anaphylaxis, bone marrow depression, gray baby syndrome, n/v/d,
superinfections
INTERACTIONS Bone marrow suppressants, glipizide, glyburide, phenytoins, tolazamide,
tolbutamide, vitamin B12, warfarin
NC/PT Culture before tx. Do not give IM. Monitor serum levels. Monitor CBC carefully.
Change to another antibiotic as soon as possible.

chlordiazepoxide (Librium)
CLASS Anxiolytic, benzodiazepine
PREG/CONT D/C-IV

IND & DOSEMgt of anxiety disorders. Adult: 5 or 10 mg PO, up to 20 or 25 mg, tid–qid.

Child over 6 yr: Initially, 5 mg PO bid–qid; may increase to 10 mg bid–tid. Preop
apprehension. Adult: 5–10 mg PO tid–qid on days preceding surgery. Alcohol
withdrawal. Adult: 50–100 mg PO, then repeated doses as needed (max, 300 mg/day).
ADJUST DOSE Elderly pts, debilitating disease
ADV EFF Apathy, confusion, constipation, CV collapse, depression, diarrhea,
disorientation, drowsiness, drug dependence w/ withdrawal, fatigue, incontinence,
lethargy, light-headedness, restlessness, urine retention
INTERACTIONS Alcohol, aminophylline, cimetidine, disulfiram, dyphylline, hormonal
contraceptives, smoking, theophylline
NC/PT Monitor LFTs, renal function, CBC periodically during long-term therapy. Taper
gradually after long-term use. Not for use in pregnancy (barrier contraceptives advised).
Pt should take safety precautions w/ CNS effects.

chloroquine phosphate (Aralen Phosphate)

CLASS Amebicide, 4-aminoquinoline, antimalarial
PREG/CONT C/NA

IND & DOSE Tx of extraintestinal amebiasis. Adult: 1 g (600 mg base)/day PO for 2

days, then 500 mg (300 mg base)/day for 2–3 wk. Px and tx of acute malaria attacks
caused by susceptible strains. Adult: Suppression, 300 mg base PO once a wk on same
day for 2 wk before exposure, continuing until 8 wk after exposure; acute attack, 600
mg base PO initially, then 300 mg 6–8 hr, 24 hr, and 48 hr after initial dose for total
dose of 1.5 g in 3 days. Child: Suppression, 5 mg base/kg PO once a wk on same day for
2 wk before exposure, continuing until 8 wk after exposure; acute attack, 10 mg base/kg
PO initially; then 5 mg base/kg 6 hr later; then third dose 18 hr later; then last dose 24
hr after third dose. Max, 10 mg base/kg/day or 300 mg/base/day.
ADV EFF N/v/d, visual distortion, permanent retinal changes
INTERACTIONS Cimetidine
NC/PT Double-check child doses; child very susceptible to overdose. Give w/ food if GI
effects occur. Arrange for ophthalmologic exam before and during long-term tx. Pt
should take safety measures if vision changes.

chlorothiazide (Diuril), chlorothiazide sodium (generic)

CLASS Thiazide diuretic
PREG/CONT C/NA

IND & DOSE Adjunctive tx for edema; tx of hypertension. Adult: 0.5–2 g daily PO or IV.
Child: Generally, 10–20 mg/kg/day PO in single dose or two divided doses. Child 2–12
yr: 375 mg–1 g PO in two divided doses. Child 6 mo–2 yr: 125–375 mg PO in two divided
doses. Child under 6 mo: Up to 30 mg/kg/day PO in two doses.
ADV EFF Agranulocytosis, anorexia, aplastic anemia, constipation, ED, n/v/d,
nocturia, polyuria, vertigo
INTERACTIONS Alcohol, antidiabetics, cholestyramine, corticosteroids, diazoxide, digoxin,
lithium, opioids
NC/PT Do not give IM or subcut. Monitor and record weight daily. Pt should take w/ food
if GI upset occurs, take early in day so sleep will not be disturbed. Increased urination
will occur; pt should plan day accordingly.

chlorpheniramine maleate (Aller-Chlor, Allergy, Chlor-Trimeton Allergy,

QDALL-AR)
CLASS Antihistamine
PREG/CONT C/NA

IND & DOSE Symptomatic relief of s&sx associated w/ perennial and seasonal
allergic rhinitis; vasomotor rhinitis; common cold; allergic conjunctivitis. Adult,
child over 12 yr: 4 mg PO q 4–6 hr; max, 24 mg in 24 hr (tablets, syrup). ER tablets, 16
mg w/ liquid PO q 24 hr. SR tablets, 8–12 mg PO at bedtime or q 8–12 hr during day. ER
capsules, 12 mg/day PO; max, 24 mg/day. Caplets, 8–12 mg/day PO q 12 hr. Child 6–12
yr: 2 mg q 4–6 hr PO; max, 12 mg in 24 hr (tablets, syrup).
ADJUST DOSE Elderly pts
ADV EFF Anaphylactic shock, aplastic anemia, bronchial secretion thickening,
disturbed coordination, dizziness, drowsiness, epigastric distress, sedation
INTERACTIONS Alcohol, CNS depressants
NC/PT Periodic CBC w/ long-term tx. Pt should take w/ food; not cut, crush, or chew
SR/ER forms; avoid alcohol; take safety precautions w/ CNS effects.

chlorproMAZINE hydrochloride (generic)

CLASS Antiemetic, antipsychotic, anxiolytic, dopamine blocker, phenothiazine
PREG/CONT C/NA

BBW Risk of death in elderly pts with dementia-related psychoses; not approved for this
use.
IND & DOSE Tx of excessive anxiety, agitation. Adult: 25 mg IM; may repeat in 1 hr w/
25–50 mg IM. Increase gradually in inpts, up to 400 mg q 4–6 hr. Switch to oral dose as
soon as possible, 10 mg PO tid–qid; increase to 25 mg PO bid–tid. 25–50 mg PO tid for
outpts; up to 2,000 mg/day PO for inpatients. Child 6 mo–12 yr, outpts: 0.5 mg/kg PO
q 4–6 hr; 1 mg/kg rectally q 6–8 hr; 0.55 mg/kg IM q 6–8 hr; max, 40 mg/day (up to 5
yr) or 75 mg/day (5–12 yr). Child, inpts: 50–100 mg/day PO; max, 40 mg/day IM (up to
5 yr), 75 mg/day IM (5–12 yr). Preop, postop anxiety. Adult: Preop, 25–50 mg PO 2–3
hr before surgery or 12.5–25 mg IM 1–2 hr before surgery; intraop, 12.5 mg IM repeated
in 30 min or 2 mg IV repeated q 2 min (up to 25 mg total) to control vomiting (if no
hypotension occurs); postop, 10–25 mg PO q 4–6 hr or 12.5–25 mg IM repeated in 1 hr
(if no hypotension occurs). Child 6 mo–12 yr: Preop, 0.55 mg/kg PO 2–3 hr before
surgery or 0.55 mg/kg IM 1–2 hr before surgery; intraop, 0.25 mg/kg IM or 1 mg
(diluted) IV, repeated at 2-min intervals up to total IM dose; postop, 0.55 mg/kg PO q
4–6 hr or 0.55 mg/kg IM, repeated in 1 hr (if no hypotension occurs). Tx of acute
intermittent porphyria. Adult: 25–50 mg PO or 25 mg IM tid–qid until pt can take oral
tx. Adjunct tx of tetanus. Adult: 25–50 mg IM tid–qid, usually w/ barbiturates, or 25–
50 mg IV diluted and infused at 1 mg/min. Child: 0.55 mg/kg IM q 6–8 hr or 0.5 mg/min
IV; max, 40 mg/day (up to 23 kg), 75 mg/day (23–45 kg). Antiemetic. Adult: 10–25 mg
PO q 4–6 hr, or 50–100 mg rectally q 6–8 hr, or 25 mg IM. If no hypotension, give 25–
50 mg q 3–4 hr. Switch to oral dose when vomiting ends. Child: 0.55 mg/kg PO q 4–6 hr,
or 0.55 mg/kg IM q 6–8 hr. Max IM dose, 40 mg/day (up to 5 yr), 75 mg/day (5–12 yr).
Tx of intractable hiccups. Adult: 25–50 mg PO tid–qid. If symptoms persist for 2–3
days, give 25–50 mg IM; if inadequate response, give 25–50 mg IV in 500–1,000 mL
saline.
ADJUST DOSE Elderly pts
ADV EFF Anaphylactoid reactions, aplastic anemia, blurred vision, bronchospasm,
cardiac arrest, cardiomegaly, drowsiness, dry mouth, extrapyramidal syndromes, HF,
hypotension, laryngospasm, n/v/d, NMS, orthostatic hypotension, photophobia,
pulmonary edema, urine retention, urticaria, vertigo
INTERACTIONS Alcohol, anticholinergics, barbiturate anesthetics, beta blockers,
epinephrine, meperidine, norepinephrine
NC/PT Do not give by subcut injection; give slowly by deep IM injection into upper outer
quadrant of buttock. If giving drug via continuous infusion for intractable hiccups, keep
pt flat in bed; avoid skin contact w/ parenteral drug sol; monitor renal function, CBC;
withdraw slowly after high-dose use. Aspiration risk w/ loss of cough reflex. Pt should
avoid alcohol, take safety measures if CNS effects occur, protect from sun exposure.
Name confusion between chlorpromazine, chlorpropamide, and clomipramine.

chlorproPAMIDE (generic)
CLASS Antidiabetic, sulfonylurea
PREG/CONT C/NA

IND & DOSE Tx of type 2 diabetes w/ diet and exercise. Adult: 100–250 mg/day PO;
max, 750 mg/day.
ADJUST DOSE Elderly pts
ADV EFF Anorexia, CV events, disulfiram reaction w/ alcohol, dizziness, headache,
hypoglycemia, n/v
INTERACTIONS Alcohol, beta blockers, MAOIs, miconazole, NSAIDs, salicylates, warfarin
NC/PT Monitor serum glucose; switch to insulin therapy in times of high stress. Not for
use in pregnancy. Pt should take w/ food; continue diet and exercise program, avoid
alcohol.

chlorthalidone (Thalitone)
CLASS Thiazide-like diuretic
PREG/CONT C/NA

IND & DOSE Adjunctive tx for edema. Adult: 50–100 mg/day PO or 100 mg every other
day; max, 200 mg/day. Tx of hypertension. Adult: 25 mg/day PO; if response
insufficient, increase to 50 mg/day. If needed, increase to 100 mg/day or add second
antihypertensive.
ADV EFF Agranulocytosis, anorexia, aplastic anemia, constipation, dizziness, dry
mouth, ED, nocturia, n/v/d, photophobia, polyuria, vertigo
INTERACTIONS Antidiabetics, cholestyramine, corticosteroids, diazoxide, digoxin, lithium
NC/PT Differentiate between Thalitone and other drugs; dosage varies. Monitor and
record weight daily. Pt should take w/ food if GI upset occurs, take early in day so sleep
will not be disturbed. Increased urination will occur; pt should plan day accordingly.

chlorzoxazone (Paraflex, Parafon Forte DSC, Remular-S)

CLASS Centrally acting skeletal muscle relaxant
PREG/CONT C/NA

IND & DOSE Relief of discomfort associated w/ acute, painful musculoskeletal

conditions as adjunct to rest, physical therapy, other measures. Adult: 250 mg PO
tid–qid; may need 500 mg PO tid–qid. Max, 750 mg tid–qid.
ADV EFF Anaphylaxis, dizziness, drowsiness, GI disturbances, hepatic impairment,
light-headedness, orange to red urine
INTERACTIONS Alcohol, CNS depressants
NC/PT Use other measures to help pain. Pt should avoid alcohol and sleep-inducing drugs,
take safety measures if CNS effects occur.

cholestyramine (Prevalite, Questran)

CLASS Bile acid sequestrant, antihyperlipidemic
PREG/CONT C/NA

IND & DOSE Adjunct to reduce elevated serum cholesterol in pts w/ primary
hypercholesterolemia; pruritus associated w/ partial biliary obstruction. Adult: 4
g PO once to twice a day; w/ constipation, start w/ 4 g once a day; maint, 8–16 g/day
divided into two doses. Max, 6 packets or scoopfuls (24 g/day). Child: 240 mg/kg/day
PO in two to three divided doses; max, 8 g/day.
ADV EFF Constipation to fecal impaction, hemorrhoid exacerbation, increased bleeding
tendencies
INTERACTIONS Corticosteroids, digitalis, diuretics, fat-soluble vitamins, thiazide
preparations, thyroid medication, warfarin
NC/PT Mix packet contents w/ water, milk, fruit juice, noncarbonated beverages, soup,
applesauce, pineapple; do not give in dry form. Monitor for constipation, which could
be severe. Pt should take w/ meals, take other oral drugs 1 hr before or 4–6 hr after this
drug.

choline magnesium trisalicylate (Tricosal)

 CLASSNSAID, salicylate
PREG/CONT C/NA

IND & DOSE Tx of osteoarthritis, rheumatoid arthritis. Adult: 1.5–2.5 g/day PO; max,
4.5 g/day in divided doses. Tx of pain/fever. Adult: 2–3 g/day PO in divided doses.
Child: 217.5–652.5 mg PO q 4 hr as needed.
ADV EFF Anaphylactoid reactions, dizziness, drowsiness, GI bleeding, headache,
heartburn, indigestion, n/v, sweating
INTERACTIONS ACE inhibitors, antidiabetics, carbonic anhydrase inhibitors, corticosteroids,
insulin, meglitinide, methotrexate, valproic acid
NC/PT Pt should take w/ full glass of water and not lie down for 30 min after taking;
take w/ food if GI effects are severe; use safety precautions if CNS effects occur.

chorionic gonadotropin (Novarel, Pregnyl)

CLASS Hormone
PREG/CONT X/NA

BBW Drug has no known effect on fat metabolism and is not for tx of obesity.
IND & DOSE Tx of prepubertal cryptorchidism not due to anatomic obstruction. Adult,
child over 4 yr: 4,000 USP units IM three times/wk for 3 wk; then 5,000 USP units IM
every second day for four injections; then 15 injections of 500–1,000 USP units over 6
wk; then 500 USP units three times/wk for 4–6 wk. If unsuccessful, start another course
1 mo later, giving 1,000 USP units/injection. Tx of hypogonadotropic hypogonadism
in males. Adult, child over 4 yr: 500–1,000 USP units IM three times/wk for 3 wk; then
same dose twice/wk for 3 wk; then 1,000–2,000 USP units IM three times/wk; then
4,000 USP units three times/wk for 6–9 mo. Reduce dose to 2,000 USP units three
times/wk for additional 3 mo. Induction of ovulation and pregnancy. Adult: 5,000–
10,000 units IM 1 day after last menotropins dose.
ADV EFF Gynecomastia, headache, irritability, ovarian cancer, ovarian
hyperstimulation, pain at injection site
NC/PT Must give IM. Prepare calendar of tx schedule. Discontinue if s&sx of ovarian
overstimulation. Provide comfort measures for headache, pain at injection site.

chorionic gonadotropin alfa (Ovidrel)

CLASS Fertility drug
PREG/CONT X/NA

IND & DOSEOvulation induction in infertile women. Adult: 250 mcg subcut 1 day after
last FSH dose.
ADV EFF Abd pain, injection-site pain, multiple births, n/v, ovarian enlargement, ovarian
hyperstimulation; pulmonary, vascular thromboembolic events
NC/PT Part of comprehensive fertility program. Inject into abdomen. Risk of multiple
births. Pt should report difficulty breathing, sudden abd or leg pain.

cidofovir (Vistide)
CLASS Antiviral
PREG/CONT C/NA

BBW Risk of severe renal impairment; monitor renal function closely. Risk of
neutropenia; monitor CBC closely. Cancer, impaired fertility, tetragenic effects reported.
IND & DOSE Tx of CMV retinitis in AIDS pts. Adult: 5 mg/kg IV over 1 hr for 2 wk, then 5
mg/kg IV q 2 wk.
ADV EFF Decreased IOP, dyspnea, fever, infection, n/v, neutropenia, pneumonia,
proteinuria, renal failure
NC/PT Use only for stated indication; not for other diseases. Give w/ PO probenecid (2 g
before each dose, then 1 g at 2 and 8 hr after each dose). Monitor renal function, CBC.
Protect pt from infection. Not for use in pregnancy, breast-feeding. Mark calendar for tx
days.

cilostazol (Pletal)
CLASS Antiplatelet
PREG/CONT C/NA

BBW Do not give to pts w/ HF; decreased survival reported.

IND & DOSE To reduce s&sx of intermittent claudication, allowing increased walking
distance. Adult: 100 mg PO bid at least 30 min before or 2 hr after breakfast and
dinner; may not notice response for 2–12 wk.
ADV EFF Bleeding, diarrhea, dizziness, dyspepsia, flatulence, headache, HF, nausea,
rhinitis
INTERACTIONS Azole antifungals, diltiazem, grapefruit juice, high-fat meal, macrolide
antibiotics, omeprazole, smoking
NC/PT Not for use in pregnancy (barrier contraceptives advised). Pt should take on
empty stomach 30 min before or 2 hr after breakfast and dinner, take safety precautions
to prevent injury, avoid grapefruit juice, continue tx for up to 12 wk to see results.

cimetidine (Tagamet)
CLASS Histamine2 antagonist
PREG/CONT B/NA

IND & DOSE Tx of heartburn, acid indigestion. Adult: 200 mg PO as s&sx occur; max,
400 mg/24 hr for max of 2 wk. Tx of active duodenal ulcer. Adult: 800 mg PO at
bedtime or 300 mg PO qid w/ meals and at bedtime or 400 mg PO bid; continue for 4–6
wk. Intractable ulcers, 300 mg IM or IV q 6–8 hr. Maint, 400 mg PO at bedtime. Tx of
active benign gastric ulcer. Adult: 300 mg PO qid w/ meals and at bedtime or 800 mg
at bedtime for 8 wk. Tx of pathologic hypersecretory syndrome. Adult: 300 mg PO
qid w/ meals and at bedtime or 300 mg IV or IM q 6 hr. Individualize doses as needed;
max, 2,400 mg/day. Tx of erosive GERD. Adult: 1,600 mg PO in divided doses bid–qid
for 12 wk. Prevention of upper GI bleeding. Adult: 50 mg/hr continuous IV infusion
for up to 7 days.
ADJUST DOSE Elderly pts, renal impairment
ADV EFF Cardiac arrhythmias, confusion, diarrhea, dizziness, hallucinations, ED
INTERACTIONS Alcohol, alkylating agents, benzodiazepines, beta-adrenergic blockers,
carbamazepine, chloroquine, lidocaine, nifedipine, pentoxifylline, phenytoin,
procainamide, quinidine, smoking, theophylline, TCAs
NC/PT Give w/ meals and at bedtime. Give IM undiluted into large muscle group. Pt
should report smoking so dose can be regulated.

cinacalcet hydrochloride (Sensipar)

CLASS Calcimimetic, calcium-lowering drug
PREG/CONT C/NA

IND & DOSE Tx of hypercalcemia associated w/ parathyroid carcinoma or severe

hypercalcemia in pts w/ primary hyperparathyroidism. Adult: Initially, 30 mg PO
bid to maintain calcium levels within normal range; adjust dose q 2–4 wk in sequential
doses of 60 mg bid, then 90 mg bid to max 90 mg tid–qid. Tx of secondary
hyperparathyroidism. Adult: 30 mg/day PO. Monitor serum calcium and phosphorus
levels within 1 wk; may increase dose 30 mg q 2–4 wk to max 180 mg/day. Target
intact parathyroid hormone levels, 150–300 pg/mL.
ADV EFF Dizziness, hallucinations, hypocalcemia, myalgia, n/v, seizures
INTERACTIONS Amitriptyline, erythromycin, flecainide, ketoconazole, itraconazole, TCAs,
thioridazine, vinblastine
NC/PT Monitor serum calcium levels before and regularly during tx. If pt on dialysis, also
give vitamin D and phosphate binders. Give w/ food. Not for use in breast-feeding. Pt
should not cut, crush, or chew tablets, should take safety measures if CNS effects occur.

ciprofloxacin (Ciloxan, Cipro)

CLASS Antibacterial, fluoroquinolone
PREG/CONT C/NA

BBW Risk of tendinitis and tendon rupture; risk higher in pts over 60 yr, those on
steroids, and those w/ renal, heart, or lung transplant. Avoid use in pts w/ hx of
myasthenia gravis; drug may exacerbate weakness.
IND & DOSE Tx of uncomplicated UTIs. Adult: 250 mg PO q 12 hr for 3 days or 500 mg
(ER tablets) PO daily for 3 days. Tx of mild to moderate UTIs. Adult: 250 mg PO q 12
hr for 7–14 days or 200 mg IV q 12 hr for 7–14 days. Tx of complicated UTIs. Adult:
500 mg PO q 12 hr for 7–14 days or 400 mg IV q 12 hr or 1,000 mg (ER tablets) PO
daily q 7–14 days. Tx of chronic bacterial prostatitis. Adult: 500 mg PO q 12 hr for 28
days or 400 mg IV q 12 hr for 28 days. Tx of infectious diarrhea. Adult: 500 mg PO q
12 hr for 5–7 days. Anthrax postexposure. Adult: 500 mg PO q 12 hr for 60 days or 400
mg IV q 12 hr for 60 days. Child: 15 mg/kg/dose PO q 12 hr for 60 days or 10
mg/kg/dose IV q 12 hr for 60 days; max, 500 mg/dose PO or 400 mg/dose IV. Tx of
respiratory infections. Adult: 500–750 mg PO q 12 hr or 400 mg IV q 8–12 hr for 7–14
days. Tx of acute sinusitis. Adult: 500 mg PO q 12 hr or 400 mg IV q 12 hr for 10 days.
Tx of acute uncomplicated pyelonephritis. Adult: 1,000 mg (ER tablets) PO daily q 7–
14 days. Tx of bone, joint, skin infections. 500–750 mg PO q 12 hr or 400 mg IV q 8–
12 hr for 4–6 wk. Tx of nosocomial pneumonia. Adult: 400 mg IV q 8 hr for 10–14
days. Tx of ophthalmic infections caused by susceptible organisms not responsive
to other tx. Adult: 1 or 2 drops q 2 hr in affected eye(s) while awake for 2 days or q 4
hr for 5 days; or ½-inch ribbon ointment into conjunctival sac tid on first 2 days, then
½-inch ribbon bid for next 5 days. Tx of acute otitis externa. Adult: 4 drops in infected
ear tid–qid, or 1 single-use container (0.25 mL) in infected ear bid for 7 days.
ADJUST DOSE Renal impairment
ADV EFF Headache, n/v/d, tendinitis, tendon rupture
INTERACTIONS Antacids, didanosine, foscarnet, St John’s wort, sucralfate, theophylline,
warfarin
NC/PT Avoid use in pts w/ hx of myasthenia gravis; may exacerbate weakness. Use
cautiously w/ children; increased incidence of joint/tissue injury. Culture before tx. Give
antacids at least 2 hr apart from dosing. Ensure hydration. Pt should not cut, crush, or
chew ER form.

DANGEROUS DRUG
cisplatin (CDDP) (generic)
CLASS Alkylating agent, antineoplastic, platinum agent
PREG/CONT D/NA

BBW Arrange for audiometric testing before starting tx and before subsequent doses. Do
not give if audiometric acuity outside normal limits. Monitor renal function; severe
toxicity related to dose possible. Have epinephrine, corticosteroids available for
anaphylaxis-like reactions.
IND & DOSE Tx of metastatic testicular tumors. Adult: Remission induction: Cisplatin, 20
mg/m2/day IV for 5 consecutive days (days 1–5) q 3 wk for three courses; bleomycin, 30
units IV wkly (day 2 of each wk) for 12 consecutive doses; vinblastine, 0.15–0.2 mg/kg
IV twice wkly (days 1 and 2) q 3 wk for four courses. Maint: Vinblastine, 0.3 mg/kg IV q
4 wk for 2 yr. Tx of metastatic ovarian tumors. Adult: 75–100 mg/m2 IV once q 4 wk.
For combination therapy, give sequentially: Cisplatin, 75–100 mg/m2 IV once q 3–4 wk;
cyclophosphamide, 600 mg/m2 IV once q 4 wk. Single dose: 100 mg/m2 IV once q 4 wk.
Tx of advanced bladder cancer. Adult: 50–70 mg/m2 IV once q 3–4 wk; in heavily
pretreated (radiotherapy or chemotherapy) pts, give initial dose of 50 mg/m2 repeated
q 4 wk. Do not give repeated courses until serum creatinine under 1.5 mg/dL, BUN
under 25 mg/dL, or platelets over 100,000/mm3 and WBCs over 4,000/mm3. Do not
give subsequent doses until audiometry indicates hearing within normal range.
ADJUST DOSE Renal impairment
ADV EFF Anaphylaxis-like reactions, anorexia, bone marrow suppression,
nephrotoxicity, n/v/d, ototoxicity
INTERACTIONS Aminoglycosides, bumetanide, ethacrynic acid, furosemide, phenytoins
NC/PT Monitor renal function before and regularly during tx. Monitor hearing. Maintain
hydration. Use antiemetics if needed. Monitor electrolytes regularly. Do not use needles
containing aluminum. Use gloves when preparing IV. Not for use in pregnancy. Pt
should report changes in hearing, difficulty breathing, unusual bleeding.

citalopram hydrobromide (Celexa)

CLASS Antidepressant, SSRI
PREG/CONT C/NA

BBW Increased risk of suicidality in children, adolescents, young adults; monitor

accordingly.
IND & DOSE Tx of depression. Adult: 20 mg/day PO as single daily dose. May increase to
40 mg/day; max, 40 mg/day.
ADJUST DOSE Elderly pts; renal, hepatic impairment
ADV EFF Dizziness, dry mouth, ejaculatory disorders, insomnia, nausea, prolonged QT
interval, somnolence, suicidality, tremor
INTERACTIONS Azole antifungals, beta blockers, citalopram, erythromycin, linezolid,
macrolide antibiotics, MAOIs, pimozide, QT-prolonging drugs, St. John’s wort, TCAs,
warfarin
NC/PT Avoid doses over 40 mg; increased risk of prolonged QT interval. Limit drug to
suicidal pts; monitor for suicidality. May take several wk to see effects. Not for use in
pregnancy, breast-feeding. Pt should avoid St. John’s wort, report thoughts of suicide.
Name confusion w/ Celexa (citalopram), Celebrex (celecoxib), Xanax (alprazolam), and
Cerebyx (fosphenytoin).

DANGEROUS DRUG
cladribine (generic)
CLASS Antimetabolite, antineoplastic, purine analogue
PREG/CONT D/NA

BBW Monitor complete hematologic profile, LFTs, renal function tests before and
frequently during tx. Consult physician at first sign of toxicity; consider delaying dose or
discontinuing if neurotoxicity or renal toxicity occurs.
IND & DOSE Tx of active hairy cell leukemia. Adult: Single course of 0.09–0.1 mg/kg/day
by continuous IV infusion for 7 days.
ADV EFF Abnormal breath sounds, anorexia, arthralgia, bone marrow suppression,
chills, cough, fatigue, fever, headache, hepatotoxicity, injection-site reactions,
nephrotoxicity, neurotoxicity, n/v/d
NC/PT Use gloves when handling drug. Must be given by continuous infusion for 7 days.
Monitor renal function, LFTs, CBC before and regularly during tx. Not for use in
pregnancy; pt should use contraception during and for several wk after tx ends. Pt
should report numbness, tingling, pain at injection site.

clarithromycin (Biaxin)
CLASS Macrolide antibiotic
PREG/CONT C/NA

IND & DOSETx of pharyngitis, tonsillitis; pneumonia; skin, skin-structure infections;

lower respiratory infections caused by susceptible strains. Adult: 250 mg PO q 12 hr
for 7–14 days. Child: 15 mg/kg/day PO divided q 12 hr for 10 days. Tx of acute
maxillary sinusitis, acute otitis media, lower respiratory infections caused by
susceptible strains. Adult: 500 mg PO q 12 hr for 14 days or 1,000 mg (ER tablets) PO
q 24 hr. Tx of mycobacterial infections. Adult: 500 mg PO bid. Child: 7.5 mg/kg PO
bid; max, 500 mg PO bid. Tx of duodenal ulcers. Adult: 500 mg PO tid plus omeprazole
40 mg PO q a.m. for 14 days, then omeprazole 20 mg PO q a.m. for 14 days. Tx of
community-acquired pneumonia. Adult: 250 mg PO q 12 hr for 7–14 days or 1,000 mg
(ER tablets) PO q 24 hr for 7 days.
ADJUST DOSE Elderly pts, renal impairment
ADV EFF Abd pain, diarrhea, superinfections
INTERACTIONS Carbamazepine, grapefruit juice, lovastatin, phenytoin, theophylline
NC/PT Culture before tx. Arrange for tx of superinfections. Do not refrigerate suspension.
Pt should take w/ food if GI upset occurs; avoid grapefruit juice; should not cut, crush,
or chew ER tablets.

clemastine fumarate (Dayhist-1, Tavist Allergy)

CLASS Antihistamine
PREG/CONT B/NA

IND & DOSE Symptomatic relief of s&sx of allergic rhinitis. Adult: 1.34 mg PO bid.
Max, 8.04 mg/day (syrup), 2.68 mg/day (tablets). Child 6–12 yr: (syrup only) 0.67 mg
PO bid; max, 4.02 mg/day. Tx of mild, uncomplicated urticaria and angioedema.
Adult: 2.68 mg PO daily–tid; max, 8.04 mg/day. Child 6–12 yr: (syrup only) 1.34 mg PO
bid; max, 4.02 mg/day.
ADJUST DOSE Elderly pts
ADV EFF Anaphylactic shock, bronchial secretion thickening, disturbed coordination,
dizziness, drowsiness, epigastric distress, sedation
INTERACTIONS Alcohol, CNS depressants, MAOIs
NC/PT Use syrup if pt cannot swallow tablets. Give w/ food if GI upset occurs. Pt should
drink plenty of fluids, use humidifier, avoid alcohol, report difficulty breathing/irregular
heartbeat.

clevidipine butyrate (Cleviprex)

CLASS Antihypertensive, calcium channel blocker
PREG/CONT C/NA

IND & DOSE To reduce BP when oral therapy not possible or desirable. Adult: 1–2
mg/hr IV infusion; titrate quickly by doubling dose q 90 sec to achieve desired BP;
maint, 4–6 mg/hr; max, 21 mg/hr/24-hr.
ADV EFF Headache, HF, n/v
NC/PT Continuously monitor BP, ECG during administration. Taper beta blockers before
use. Handle drug w/ strict aseptic technique. Use within 4 hr of puncturing stopper.
Rebound hypertension possible within 8 hr of stopping drug; switch to oral
antihypertensive as soon as possible.

clindamycin hydrochloride (Cleocin), clindamycin palmitate hydrochloride

(Cleocin Pediatric), clindamycin phosphate (Cleocin T, Clindagel, ClindaMax)
CLASS Lincosamide antibiotic
PREG/CONT B/NA

BBW Serious to fatal colitis, including Clostridium difficile–associated diarrhea, possibly

up to several wk after tx ends. Reserve use; monitor pt closely.
IND & DOSE Serious infections caused by susceptible bacteria strains. Reserve use for
penicillin-allergic pts or when penicillin inappropriate. Adult: 150–300 mg PO q 6 hr (up
to 300–450 mg PO q 6 hr in more severe infections) or 600–2,700 mg/day IV or IM in
two to four equal doses (up to 4.8 g/day IV or IM for life-threatening situations). Child:
Clindamycin hydrochloride, 8–16 mg/kg/day PO (serious infections) or 16–20 mg/kg/
day PO (more serious infections in three or four equal doses). Child under 10 kg: 37.5 mg
PO tid as min dose. Child older than 1 mo: 20–40 mg/kg/day IV or IM in three or four
equal doses or 350–450 mg/m2/day. Neonates: 15–20 mg/kg/day IV or IM in three or
four equal doses. Tx of bacterial vaginosis. Adult: 1 applicator (100 mg clindamycin
phosphate) intravaginally, preferably at bedtime for 7 consecutive days in pregnant
women and 3 or 7 days in nonpregnant women. Tx of acne vulgaris. Adult: Apply thin
film to affected area bid.
ADJUST DOSE Renal impairment
ADV EFF Abd pain, agranulocytosis, anaphylactic reactions, anorexia, cardiac arrest,
contact dermatitis, esophagitis, n/v/d, pain following injection, pseudomembranous
colitis, rash
INTERACTIONS Aluminum salts, kaolin, NMJ blockers
NC/PT Culture before tx. Give orally w/ full glass of water or food. Do not give IM
injection of more than 600 mg; inject deeply into muscle. Monitor LFTs, renal function.
Pt should avoid eye contact w/ topical sol, give intravaginally at bedtime, report severe
or watery diarrhea.

clobazam (Onfi)
CLASS Benzodiazepine, antiepileptic
PREG/CONT C/C-IV

IND & DOSE Adjunct tx of seizures associated w/ Lennox-Gastaut syndrome. Adult,

child 2 yr and older: Over 30 kg, initially 5 mg PO bid; increase to 10 mg PO bid starting
on day 7; increase to 20 mg PO bid starting on day 14. 30 kg or less, initially 5 mg/day
PO; increase to 5 mg PO bid starting on day 7; increase to 10 mg PO bid starting on day
14.
ADJUST DOSE Elderly pts, mild to moderate hepatic impairment, poor CYP2C19
metabolizers
ADV EFF Aggression, ataxia, constipation, drooling, dysarthria, fatigue, fever, insomnia,
sedation, somnolence, suicidality
INTERACTIONS Alcohol, fluconazole, fluvoxamine, hormonal contraceptives, omeprazole,
ticlopidine
NC/PT Taper drug after long-term use; dispense least amount feasible. Administer whole
or crush and mix in applesauce. Not for use in pregnancy, breast-feeding. Dizziness,
sleepiness possible. Pt should take bid, swallow whole or crush and take in applesauce,
avoid alcohol, report thoughts of suicide, increase in seizure activity.

clofarabine (Clolar)
CLASS Antimetabolite, antineoplastic
PREG/CONT D/NA

IND & DOSETx of pts w/ ALL who relapsed after at least two other regimens. Child 1–
21 yr: 52 mg/m2 IV over 2 hr daily for 5 consecutive days of 28-day cycle; repeat q 2–6
wk.
ADV EFF Anxiety, bone marrow suppression, capillary leak syndrome, fatigue,
flushing, headache, hepatotoxicity, hyperuricemia, infections, mucosal
inflammation, n/v/d, pruritus, rash, renal toxicity
NC/PT Premedicate w/ antiemetic. Monitor LFTs, renal function, CBC regularly; dose
adjustment may be needed. Protect pt from infection, injury. Not for use in pregnancy,
breast-feeding.

clomiPHENE citrate (Clomid, Serophene)

CLASS Fertility drug, hormone
PREG/CONT X/NA
IND & DOSE Tx of ovulatory failure in pts w/ normal liver function, normal
endogenous estrogen level. Adult: 50 mg/day PO for 5 days started anytime there has
been no recent uterine bleeding. If no ovulation occurs, 100 mg/day PO for 5 days as
early as 30 days after first. May repeat if no response.
ADV EFF Abd discomfort/distention, bloating, breast tenderness, flushing, multiple births,
n/v, ovarian enlargement, ovarian overstimulation, visual disturbances
NC/PT Perform pelvic exam, obtain urine estrogen and estriol levels before tx.
Discontinue if s&sx of ovarian overstimulation. Prepare calendar of tx days. Risk of
multiple births. Failure after three courses indicates tx not effective and will be
discontinued. Name confusion between Serophene (clomiphene) and Sarafem
(fluoxetine).

clomiPRAMINE hydrochloride (Anafranil)

CLASS Anxiolytic, TCA
PREG/CONT C/NA

BBW Increased risk of suicidality in children, adolescents, young adults; monitor pt

carefully.
IND & DOSE Tx of obsessions, compulsions in pts w/ OCD. Adult: Initially, 25 mg PO
daily. Increase as tolerated to approximately 100 mg during first 2 wk; max, 250
mg/day. Maint, adjust dose to maintain lowest effective dose; effectiveness after 10 wk
not documented. Child: Initially, 25 mg PO daily. Increase as tolerated during first 2 wk;
max, 3 mg/kg or 100 mg, whichever smaller. Maint, adjust dose to maintain lowest
effective dosage; effectiveness after 10 wk not documented.
ADV EFF Agranulocytosis, anticholinergic effects, confusion, constipation, disturbed
concentration, dry mouth, MI, nasal congestion, orthostatic hypotension,
photosensitivity, sedation, stroke
INTERACTIONS Anticholinergics, barbiturates, cimetidine, clonidine, disulfiram, ephedrine,
epinephrine, fluoxetine, furazolidone, hormonal contraceptives, levodopa, MAOIs,
methylphenidate, nicotine, norepinephrine, phenothiazines, QT-prolonging drugs, St.
John’s wort, thyroid medication
NC/PT Restrict drug access in depressed, suicidal pts. Give major portion at bedtime.
Obtain periodic CBC w/ long-term therapy. Pt should not mix w/ other sleep-inducing
drugs; avoid driving, etc, until drug’s effects known; avoid St. John’s wort, prolonged
exposure to sun and sunlamps; report thoughts of suicide. Name confusion between
clomipramine and chlorpromazine.

clonazepam (Klonopin)
CLASS Antiepileptic, benzodiazepine
PREG/CONT D/C-IV

IND & DOSE Tx of Lennox-Gastaut syndrome (petit mal variant); akinetic and
myoclonic seizures. Adult: 1.5 mg/day PO divided into three doses; increase in
increments of 0.5–1 mg PO q 3 days until seizures adequately controlled. Max, 20
mg/day. Child at least 10 yr or 30 kg: 0.01–0.03 mg/kg/ day PO. Max, 0.05 mg/kg/day
PO in two or three doses; maint, 0.1–0.2 mg/kg. Tx of panic disorder w/ or without
agoraphobia. Adult: Initially, 0.25 mg PO bid; gradually increase to target dose of 1
mg/day.
ADV EFF Agranulocytosis, apathy, confusion, constipation, CV collapse, depression,
diarrhea, disorientation, drowsiness, drug dependence w/ withdrawal, fatigue,
incontinence, lethargy, light-headedness, restlessness, urine retention
INTERACTIONS Alcohol, aminophylline, cimetidine, digoxin, disulfiram, dyphylline,
hormonal contraceptives, omeprazole, theophylline
NC/PT Monitor suicidal and addiction-prone pts closely. Monitor LFTs. Monitor for
therapeutic level (20–80 ng/mL). Taper gradually after long-term tx. Pt should avoid
alcohol, wear or carry medical alert notice, take safety precautions if CNS effects occur.
Name confusion between Klonopin (clonazepam) and clonidine.

clonidine hydrochloride (Catapres, Duraclon, Kapvay)

CLASS Antihypertensive, central analgesic, sympatholytic
PREG/CONT C/NA

BBW Epidural route not recommended for obstetric, postpartum, or periop pain because
of risk of hemodynamic instability.
IND & DOSE Tx of hypertension. Adult: 0.1 mg bid PO. For maint, increase in increments
of 0.1 or 0.2 mg to reach desired response; common range, 0.2–0.6 mg/day or 0.1-mg
transdermal system (releases 0.1 mg/ 24 hr). If, after 1–2 wk desired BP reduction not
achieved, add another 0.1-mg system or use larger system. More than two 0.3-mg
systems does not improve efficacy. Pain mgt. Adult: 30 mcg/hr by epidural infusion. Tx
of ADHD. Child 6–17 yr: 0.1 mg PO at bedtime; titrate at 0.1 mg/wk to total of 0.2 mg,
w/ 0.1 mg in a.m. and 0.1 mg in p.m., then 0.1 mg in a.m. and 0.2 mg in p.m. Maint,
0.2 mg in a.m. and 0.2 mg in p.m. (Kapvay only).
ADV EFF Constipation, dizziness, drowsiness, dry mouth, local reactions to transdermal
system
INTERACTIONS Alcohol, CNS depressants, propranolol, TCAs
NC/PT Taper when withdrawing to avoid rebound effects. Kapvay not interchangeable w/
other forms. Remove old patch before applying new to clean, dry skin; rotate skin sites.
Remove transdermal patch before defibrillation and MRI. Pt should avoid alcohol, take
safety precautions if CNS effects occur. Name confusion between clonidine and Klonopin
(clonazepam).

clopidogrel bisulfate (Plavix)

CLASS ADP receptor antagonist, antiplatelet
PREG/CONT B/NA
BBW Slow metabolizers may experience less effects, as drug is activated in liver by
CYP2C19. Genotype testing for poor metabolizers suggested before tx.
IND & DOSE Tx of pts at risk for ischemic events (recent MI, stroke, established
peripheral arterial disease). Adult: 75 mg/day PO. Tx of acute coronary syndrome.
Adult: 300 mg PO loading dose, then 75 mg/day PO w/ aspirin, at dose from 75–325 mg
once daily.
ADV EFF Bleeding risk, dizziness, GI bleed, headache, rash
INTERACTIONS NSAIDs, warfarin
NC/PT Genotype testing before tx. Monitor for bleeding. May give w/ meals. Pt should
report unusual bleeding.

clorazepate dipotassium bisulfate (Tranxene-T-tab)

CLASS Antiepileptic, anxiolytic, benzodiazepine
PREG/CONT D/C-IV

IND & DOSEMgt of anxiety disorders. Adult: 30 mg/day PO in divided doses tid. Adjunct
to antiepileptics. Adult: Max initial dose, 7.5 mg PO tid. Increase dose by no more than
7.5 mg q wk; max, 90 mg/day. Child 9–12 yr: Max initial dose, 7.5 mg PO bid. Increase
dose by no more than 7.5 mg q wk; max, 60 mg/day. Acute alcohol withdrawal.
Adult: Day 1, 30 mg PO initially, then 30–60 mg in divided doses. Day 2, 45–90 mg PO
in divided doses. Day 3, 22.5–45 mg PO in divided doses. Day 4, 15–30 mg PO in
divided doses. Thereafter, gradually reduce dose to 7.5–15 mg/day PO; stop as soon as
condition stable.
ADJUST DOSE Elderly pts, debilitating disease
ADV EFF Agranulocytosis, apathy, CV collapse, constipation, depression, diarrhea,
disorientation, dizziness, drowsiness, dry mouth, lethargy, light-headedness, mild
paradoxical excitatory reactions during first 2 wk
INTERACTIONS Alcohol, cimetidine, CNS depressants, digoxin, disulfiram, hormonal
contraceptives, kava, omeprazole, theophylline
NC/PT Taper gradually after long-term use. Monitor for suicidality. Encourage use of
medical alert tag. Not for use in pregnancy. Pt should avoid alcohol, take safety
precautions for CNS effects. Name confusion between clorazepate and clofibrate; use
caution.

clotrimazole (Cruex, Desenex, Gyne-Lotrimin, Lotrimin)

CLASS Antifungal
PREG/CONT B (topical/vaginal); C (oral)/NA

IND & DOSE Tx of oropharyngeal candidiasis; prevention of oropharyngeal

candidiasis in immunocompromised pts receiving radiation, chemotherapy,
steroid therapy (troche). Adult, child 2 yr and older: Dissolve slowly in mouth five times
daily for 14 days. For prevention, tid for duration of chemotherapy, radiation. Local tx
of vulvovaginal candidiasis (moniliasis). Adult, child 12 yr and older: 100-mg
suppository intravaginally at bedtime for 7 consecutive nights, or 200-mg suppository
for 3 consecutive nights, or 1 applicator (5 g/day) vaginal cream, preferably at bedtime
for 3–7 consecutive days. Topical tx of susceptible fungal infections. Adult, child 2 yr
and older: Gently massage into affected area and surrounding skin bid in a.m. and p.m.
for 14 days. Treat for 2–4 wk.
ADV EFF Abd cramps, abnormal LFTs, local reaction to topical forms, n/v, urinary
frequency
NC/PT Culture before tx. Dissolve troche in mouth. Insert vaginal suppository or cream
high into vagina using applicator; apply even during menstrual period. Apply topically
to clean, dry area. Pt should take full course of tx. Name confusion between clotrimazole
and co-trimoxazole; use caution.

clozapine (Clozaril, FazaClo)

CLASS Antipsychotic, dopaminergic blocker
PREG/CONT B/NA

BBW Use only when pt unresponsive to conventional antipsychotics. Risk of serious CV

and respiratory effects, including myocarditis. Monitor WBC count wkly during and for
4 wk after tx; dosage must be adjusted based on WBC count. Potentially fatal
agranulocytosis has occurred. Elderly pts w/ dementia-related psychosis are at increased
risk for death; drug not approved for these pts. Monitor for seizures; risk increases in pts
w/ hx of seizures and as dose increases.
IND & DOSE Mgt of severely ill schizophrenics unresponsive to standard
antipsychotics; to reduce risk of recurrent suicidal behavior in pts w/
schizophrenia. Adult: 12.5 mg PO daily or bid. Continue to 25 mg PO daily or bid, then
gradually increase w/ daily increments of 25–50 mg/day, if tolerated, to 300–450
mg/day by end of second wk; max, 900 mg/day. Maintain at lowest effective dose.
Withdraw slowly over 2–4 wk when discontinuing.
ADV EFF Agranulocytosis, constipation, dizziness, drowsiness, dry mouth, fever,
headache, hypotension, n/v, potentially fatal myocarditis, sedation, seizures,
syncope
INTERACTIONS Caffeine; cimetidine; CYP450 inducers, inhibitors; ethotoin; phenytoin
NC/PT Obtain through limited access program. Monitor WBC closely. Monitor temp;
report fever. Monitor for seizures. Ensure hydration in elderly pts. Not for use in
pregnancy. Pt should empty bladder before taking, use sugarless lozenges for dry mouth,
obtain wkly blood tests, report s&sx of infection. Name confusion between Clozaril
(clozapine) and Colazal (balsalazide); dangerous effects possible.

coagulation factor VIIa (recombinant) (NovoSeven RT)

CLASS Antihemophilic
 PREG/CONT C/NA

BBW Serious thrombotic events associated w/ off-label use. Use only for approved
indication.
IND & DOSE Tx of bleeding episodes in hemophilia A or B pts w/ inhibitors to factor
VIII or IX. Adult: 90 mcg/kg as IV bolus q 2 hr until bleeding controlled. Continue
dosing at 3- to 6-hr intervals after hemostasis in severe bleeds.
ADV EFF Arthralgia, edema, fever, headache, hemorrhage, hypersensitivity reactions,
hypertension, hypotension, injection-site reactions, n/v, rash, thromboembolic events
INTERACTIONS Do not mix in sol w/ other drugs.
NC/PT Use only for approved indication. Monitor for hypersensitivity reactions,
thrombotic events; alert pt to warning signs of each.

coagulation factor IX, recombinant (Rixubis)

CLASS Antihemophilic factor
PREG/CONT C/NA

IND & DOSE Control, prevention of bleeding w/ hemophilia B. Adult: International

units (IU) needed = body weight (kg) × desired factor IX increase (% of normal) ×
reciprocal of observed recovery (IU/kg per IU/dL). Routine px of hemophilia B. Adult:
40–60 international units/kg IV twice weekly.
ADV EFF Hypersensitivity reactions, nephrotic syndrome, neutralizing antibody
development, thrombotic events
NC/PT Ensure proper dx. Do not use with DIC, fibrinolysis, known hypersensitivity to
hamster proteins, pregnancy, breast-feeding. Pt should take safety measures to prevent
injury, blood loss; report difficulty breathing, rash, chest pain, increased bleeding.

DANGEROUS DRUG
codeine phosphate (generic)
CLASS Antitussive, opioid agonist analgesic
PREG/CONT C (pregnancy); D (labor)/C-II

IND & DOSE Relief of mild to moderate pain. Adult: 15–60 mg PO, IM, IV, or subcut q 4–
6 hr; max, 360 mg/ 24 hr. Child 1 yr and older: 0.5 mg/kg or 15 mg/m2 IM or subcut q 4
hr. Suppression of coughing induced by chemical or mechanical irritation. Adult:
10–20 mg PO q 4–6 hr; max, 120 mg/24 hr. Child 6–12 yr: 5–10 mg PO q 4–6 hr; max,
60 mg/24 hr. Child 2–6 yr: 2.5–5 mg PO q 4–6 hr; max, 12–18 mg/day.
ADJUST DOSE Elderly pts, impaired adults
ADV EFF Cardiac arrest, clamminess, confusion, constipation, dizziness, floating feeling,
lethargy, light-headedness, n/v, sedation, shock
INTERACTIONS Barbiturate anesthetics, CNS depressants
NC/PT Do not give IV in children. Ensure opioid antagonist available during parenteral
administration. Ensure perfusion of subcut area before injecting. Monitor bowel
function. Use of laxatives advised. Breast-feeding women should receive drug 4–6 hr
before next feeding and should monitor baby closely for signs of sedation or difficulty
breathing. Pt should take safety precautions for CNS effects. Name confusion between
codeine and Cardene (nicardipine); use caution.

DANGEROUS DRUG
colchicine (Colcrys)
CLASS Antigout drug
PREG/CONT C/NA

IND & DOSE Tx of acute gout flares. Adult: 1.2 mg PO at first sign of gout flare, then 0.6
mg 1 hr later; max, 1.8 mg over 1-hr period. Px of gout flares. Adult, child 16 yr and
older: 0.6 mg PO once or twice daily; max, 1.2 mg/day. Tx of familial Mediterranean
fever. Adult: 1.2–2.4 mg/day PO in one or two divided doses; increase or decrease in
0.3-mg increments as needed. Child older than 12 yr: Use adult dosage. Child 6–12 yr:
0.9–1.8 mg/day PO. Child 4–6 yr: 0.3–1.8 mg/day PO.
ADJUST DOSE Hepatic, renal impairment
ADV EFF Abd pain, bone marrow suppression, n/v/d, rash, rhabdomyolysis
INTERACTIONS Amprenavir, aprepitant, atazanavir, atorvastatin, clarithromycin,
cyclosporine, digoxin, diltiazem, erythromycin, fibrates, fluconazole, fluvastatin,
fosamprenavir, gemfibrozil, grapefruit juice, indinavir, itraconazole, ketoconazole,
nefazodone, nelfinavir, ranolazine, pravastatin, ritonavir, saquinavir, simvastatin,
telithromycin, verapamil
NC/PT Obtain baseline and periodic CBC, LFTs, renal function tests. Check complete drug
list; many drug interactions require dose adjustments. Monitor for pain relief. Fatal
overdoses have occurred; keep out of reach of children. Pt should avoid grapefruit juice,
report to all providers all drugs and herbs taken (many potentially serious drug
interactions possible), ensure protection from infection and injury, obtain periodic
medical exams.

colesevelam hydrochloride (WelChol)

CLASS Antihyperlipidemic, bile acid sequestrant
PREG/CONT B/NA

IND & DOSE Monotherapy for tx of hyperlipidemia. Adult: 3 tablets PO bid w/ meals or
6 tablets/day PO w/ meal; max, 7 tablets/day. To lower lipid levels, w/ HMG-CoA
inhibitor. Adult: 3 tablets PO bid w/ meals or 6 tablets PO once a day w/ meal; max, 6
tablets/day. To improve glycemic control in type 2 diabetes. Adult: 6 tablets/day PO
or 3 tablets PO bid. Tx of familial hypercholesterolemia. Child 10–17 yr: 1.8 g PO bid
or 3.7 g/day PO oral suspension.
ADV EFF Constipation to fecal impaction, flatulence, increased bleeding tendencies
INTERACTIONS Fat-soluble vitamins, oral drugs, verapamil
NC/PT Used w/ diet, exercise program. Give other oral drugs 1 hr before or 4–6 hr after
drug. Monitor blood lipid levels. Mix oral suspension in 4–8 oz water; do not use dry.
Establish bowel program for constipation. Pt should report unusual bleeding, severe
constipation.

colestipol hydrochloride (Colestid)

CLASS Antihyperlipidemic, bile acid sequestrant
PREG/CONT C/NA

IND & DOSE Adjunctive tx for primary hypercholesterolemia. Adult: 5–30 g/day PO
suspension once a day or in divided doses bid–qid. Start w/ 5 g PO daily or bid; increase
in 5-g/day increments at 1- to 2-mo intervals. For tablets, 2–16 g/day PO in one to two
divided doses; initially, 2 g once or twice daily, increasing in 2-g increments at 1- to 2-
mo intervals.
ADV EFF Constipation to fecal impaction, flatulence, headache, increased bleeding
tendencies
INTERACTIONS Digoxin, fat-soluble vitamins, oral drugs, thiazide diuretics
NC/PT Used w/ diet, exercise program. Give other oral drugs 1 hr before or 4-6 hr after
drug. Give before meals. Monitor blood lipid levels. Mix in liquids, soups, cereal,
carbonated beverages; do not give dry. Establish bowel program for constipation. Pt
should swallow tablets whole and not cut, crush, or chew them; report unusual bleeding,
severe constipation; use analgesic for headache.

collagenase clostridium histolyticum (Xiaflex)

CLASS Proteinase enzyme
PREG/CONT B/NA

IND & DOSE Tx of pts w/ Dupuytren’s contraction w/ palpable cord. Adult: 0.58 mg
injected into palpable cord; may repeat up to three times/cord at 4-wk intervals. Tx of
pts w/ Peyronie’s disease w/ penile curvature deformity of 30 degrees or more.
Adult: 2 injections into the collagen-containing structure followed by penile remodeling;
may repeat max of eight times.
ADV EFF Injection-site reactions, pain, severe allergic reactions, tendon rupture,
swelling in involved hand
INTERACTIONS Anticoagulants
NC/PT Be prepared for possible severe allergic reaction. Risk of bleeding if pt on
anticoagulants. Tendon rupture, damage to nerves and tissue of hand possible.

corticotropin (ACTH) (H.P. Acthar Gel)

CLASS Anterior pituitary hormone, diagnostic agent
PREG/CONT C/NA
IND & DOSE Tx of allergic states, glucocorticoid-sensitive disorders, nonsuppurative
thyroiditis, tuberculous meningitis, trichinosis w/ CNS and cardiac involvement;
rheumatic disorders; palliative mgt of leukemias, lymphomas. Adult: 40–80 units
IM or subcut q 24–72 hr. Tx of acute exacerbations of MS. Adult: 80–120 units/day IM
for 2–3 wk.
ADV EFF Acne, amenorrhea, anaphylactoid reactions, depression, ecchymoses,
euphoria, fluid and electrolyte disturbances, fragile skin, hypertension,
immunosuppression, impaired wound healing, infections, muscle weakness, petechiae
INTERACTIONS Anticholinesterases, antidiabetics, barbiturates, live vaccines
NC/PT Verify adrenal responsiveness before tx. Give only IM or subcut. Taper dose when
discontinuing after long-term use. Give rapidly acting corticosteroid in times of stress. Pt
should avoid exposure to infections, monitor blood glucose levels periodically, avoid
immunizations.

cosyntropin (Cortrosyn)
CLASS Diagnostic agent
PREG/CONT C/NA

IND & DOSE Diagnostic tests of adrenal function. Adult: 0.25-0.75 mg IV or IM or as IV

infusion at 0.04 mg/hr.
ADV EFF Anaphylactoid reactions, bradycardia, edema, hypertension, rash, seizures,
tachycardia
INTERACTIONS Diuretics
NC/PT Plasma cortisol levels usually peak within 45–60 min of injection. Normally,
expect doubling of baseline levels.

crizotinib (Xalkori)
CLASS Antineoplastic, kinase inhibitor
PREG/CONT D/NA

IND & DOSE Tx of locally advanced or metastatic non–small-cell lung cancer that is
anaplastic lymphoma kinase–positive as detected by Vysis ALK Break Apart FISH
Probe Kit. Adult: 250 mg PO bid without regard to food. Reduce to 200 mg PO bid based
on pt safety.
ADV EFF Constipation, hepatotoxicity, n/v/d, prolonged QT interval, serious to fatal
pneumonitis, vision changes including blurry vision, light sensitivity, floaters, flashes
of light
INTERACTIONS CYP3A inducers/inhibitors, QT-prolonging drugs
NC/PT Ensure pt has been tested for appropriate sensitivity. Monitor LFTs, pulmonary
function. Institute bowel program as needed; advise safety precautions with vision
changes. Pt should avoid pregnancy (contraceptives advised), breast feeding; driving,
operating machinery with vision changes. Pt should report difficulty breathing, color
changes of urine/stool.

crofelemer (Fulyzaq)
CLASS Antidiarrheal, calcium channel stimulator
PREG/CONT C/NA

IND & DOSERelief of noninfectious diarrhea in adults w/ HIV/AIDS on antiretroviral

therapy. Adult: 125 mg PO bid.
ADV EFF Bronchitis, cough, flatulence, possible URI
NC/PT Ensure cause of diarrhea is not infectious and pt also taking antiretroviral. Not for
use in pregnancy, breast-feeding. Monitor diarrhea. Pt should take as directed; swallow
capsule whole and not cut, crush, or chew it; report cough, increased diarrhea.

cromolyn sodium (Crolom)

CLASS Antiallergy drug
PREG/CONT C/NA

IND & DOSE Prevention, tx of allergic rhinitis. Adult, child 2 yr and older: 1 spray in each
nostril 3–6 times/day as needed. Tx of allergic eye disorders. Adult: 1 or 2 drops in
each eye 4–6 times/day as needed.
ADV EFF Allergic reaction, burning or stinging, shortness of breath, wheezing
NC/PT Eyedrops not for use w/ soft contact lenses. May take several days to 2 wk for
noticeable effects; pt should continue use. If pregnant or breast-feeding, consult
provider.

cyanocobalamin, intranasal (Nascobal)

CLASS Synthetic vitamin
PREG/CONT C/NA

IND & DOSE Maint of pts in hematologic remission after IM vitamin B12 tx for
pernicious anemia, inadequate secretion of intrinsic factor, dietary deficiency,
malabsorption, competition by intestinal bacteria or parasites, inadequate
utilization of vitamin B12; maint of effective therapeutic vitamin B12 levels in pts
w/ HIV infection, AIDS, MS, Crohn’s disease. Adult: 1 spray (500 mcg) in one nostril
once/wk
ADV EFF Headache, nasal congestion, rhinitis
INTERACTIONS Alcohol, antibiotics, colchicine, methotrexate, para-aminosalicylic acid
NC/PT Confirm diagnosis before tx. Monitor serum vitamin B12 levels before, at 1 mo,
then q 3–6 mo during tx. Do not give w/ nasal congestion, rhinitis, URI. Pt should take
drug 1 hr before or after ingesting hot foods or liquids, which can cause nasal
congestion.
 cyclizine (Marezine)
CLASS Anticholinergic, antiemetic, antihistamine, anti–motion sickness drug
PREG/CONT B/NA

IND & DOSE Prevention, tx of nausea, vomiting, dizziness associated w/ motion

sickness. Adult: 50 mg PO 30 min before exposure to motion. Repeat q 4–6 hr; max, 200
mg in 24 hr. Child 6–12 yr: 25 mg PO up to three times/day.
ADJUST DOSE Elderly pts
ADV EFF Anorexia, confusion, drowsiness, dry mouth, dysuria, nausea, urinary frequency
INTERACTIONS Alcohol, CNS depressants
NC/PT Monitor elderly pts carefully. Pt should use before motion sickness occurs, avoid
alcohol, take safety precautions w/ CNS effects.

cyclobenzaprine hydrochloride (Amrix, Flexeril)

CLASS Centrally acting skeletal muscle relaxant
PREG/CONT B/NA

IND & DOSE Relief of discomfort associated w/ acute, painful musculoskeletal

conditions, as adjunct to rest, physical therapy. Adult: 5 mg PO tid, up to 10 mg PO
tid. Do not use for longer than 2–3 wk. For ER capsules, 15 mg once/day PO.
ADJUST DOSE Elderly pts, hepatic impairment
ADV EFF Dizziness, drowsiness, dry mouth, MI
INTERACTIONS Alcohol, barbiturates, CNS depressants, MAOIs, TCAs, tramadol
NC/PT Give analgesics for headache. Monitor elderly pts closely. Pt should take safety
precautions for CNS effects, avoid alcohol.

DANGEROUS DRUG
cyclophosphamide (generic)
CLASS Alkylating agent, antineoplastic, nitrogen mustard
PREG/CONT D/NA

IND & DOSE Tx of malignant lymphoma, multiple myeloma, leukemias, mycosis

fungoides, neuroblastoma, adenocarcinoma of ovary, retinoblastoma, carcinoma
of breast; used concurrently or sequentially w/ other antineoplastics. Adult:
Induction, 40–50 mg/kg IV in divided doses over 2–5 days or 1–5 mg/kg/day PO for 2-5
days. Or, 1–5 mg/kg/day PO, 10–15 mg/kg IV q 7–10 days, or 3–5 mg/kg IV twice
wkly. Tx of minimal change nephrotic syndrome. Child: 2.5–3 mg/day PO for 60–90
days.
ADJUST DOSE Renal, hepatic impairment
ADV EFF Alopecia, anorexia, bone marrow suppression, hematuria to potentially fatal
hemorrhagic cystitis, interstitial pulmonary fibrosis, n/v/d, stomatitis
INTERACTIONS Allopurinol, anticoagulants, chloramphenicol, digoxin, doxorubicin,
grapefruit juice, succinylcholine
NC/PT Monitor CBC; dose adjustment may be needed. Do not give full dose within 4 wk
of radiation or chemotherapy. Ensure pt well hydrated. Pts should use contraceptive
measures; can cause fetal abnormalities. Pt should take oral drug on empty stomach,
wear protective gloves when handling drug, not drink grapefruit juice, cover head at
temperature extremes (hair loss may occur).

cycloSERINE (Seromycin Pulvules)

CLASS Antibiotic, antituberculotic
PREG/CONT C/NA

IND & DOSE Tx of active pulmonary, extrapulmonary (including renal) TB not

responsive to first-line antituberculotics, w/ other antituberculotics; UTIs caused
by susceptible bacteria. Adult: 250 mg PO bid at 12-hr intervals for first 2 wk. Max,
1 g/day; maint, 500 mg–1 g/day PO in divided doses.
ADV EFF Confusion, drowsiness, headache, HF, somnolence, tremor, vertigo
INTERACTIONS Alcohol, high-fat meals
NC/PT Culture before tx. Use only when other drugs have failed. Use w/ other anti-TB
agents. Pt should avoid alcohol, take safety precautions for CNS effects, should not take
w/ high-fat meal or discontinue drug without consulting prescriber. Name confusion w/
cycloserine, cyclosporine, and cyclophosphamide; use caution.

cycloSPORINE (Gengraf, Neoral, Sandimmune)

CLASS Immunosuppressant
PREG/CONT C/NA

BBW Monitor pts for infections, malignancies; risks increase. Monitor LFTs, renal
function tests before and during tx; marked decreases in function may require dose
adjustment or discontinuation. Monitor BP. Heart transplant pts may need concomitant
antihypertensive tx.
IND & DOSE Px and tx of organ rejection in pts w/ kidney, liver, heart transplants.
Adult: 15 mg/kg/day PO (Sandimmune) initially given 4–12 hr before transplantation;
continue dose postop for 1–2 wk, then taper by 5% per wk to maint level of 5–10
mg/kg/day. Or by IV infusion (Sandimmune) at 1/3 oral dose (ie, 5–6 mg/kg/day 4–12
hr before transplantation as slow infusion over 2–6 hr); continue this daily dose postop.
Switch to oral drug as soon as possible. Tx of rheumatoid arthritis. Adult: 2.5
mg/kg/day (Gengraf, Neoral) PO in divided doses bid; may increase up to 4 mg/kg/ day.
If no benefit after 16 wk, discontinue. Tx of recalcitrant plaque psoriasis. Adult: 2.5
mg/kg/day (Gengraf, Neoral) PO divided bid for 4 wk, then may increase up to 4
mg/kg/day. If response unsatisfactory after 6 wk at 4 mg/kg/day, discontinue.
ADV EFF Acne, diarrhea, gum hyperplasia, hirsutism, hyperkalemia, hypertension,
hypomagnesemia, renal impairment, tremors
INTERACTIONS Amiodarone, androgens, azole antifungals, carbamazepine, colchicine,
diltiazem, foscarnet, grapefruit juice, high-fat meal, HMG-CoA reductase inhibitors,
hormonal contraceptives, hydantoins, macrolides, metoclopramide, nephrotoxic agents,
nicardipine, orlistat, phenobarbital, rifampin, St. John’s wort, SSRIs
NC/PT Mix oral sol w/ milk, chocolate milk, orange juice at room temp; do not allow to
stand before drinking. Do not refrigerate. Use parenteral route only if pt cannot take
oral form. Monitor LFTs, renal function, CBC, BP carefully; toxicity possible. Not for use
in pregnancy (barrier contraceptives advised). Pt should avoid grapefruit juice, St John’s
wort, exposure to infection; should not take w/ high-fat meal or discontinue without
consulting prescriber. Interacts w/ many drugs; pt should inform all caregivers he is
taking drug. Name confusion w/ cyclosporine, cycloserine, and cyclophosphamide; use
caution.

cyproheptadine hydrochloride (generic)

CLASS Antihistamine
PREG/CONT B/NA

IND & DOSE Relief of s&sx associated w/ perennial, seasonal allergic rhinitis; other
allergic reactions; tx of cold urticaria. Adult: 4 mg PO tid. Maint, 4–20 mg/day in
three divided doses; max, 0.5 mg/kg/day. Child 7–14 yr: 4 mg PO bid–tid. Max, 16
mg/day. Child 2–6 yr: 2 mg PO bid. Max, 12 mg/day.
ADJUST DOSE Elderly pts
ADV EFF Agranulocytosis, anaphylactic shock, bronchial secretion thickening,
dizziness, drowsiness, epigastric distress, disturbed coordination, pancytopenia
INTERACTIONS Alcohol, anticholinergics, CNS depressants, fluoxetine, metyrapone, MAOIs
NC/PT Use syrup if pt cannot swallow tablets. Give w/ food. Monitor response.

DANGEROUS DRUG
cytarabine (cytosine arabinoside) (DepoCyt, Tarabine PFS)
CLASS Antimetabolite, antineoplastic
PREG/CONT D/NA

IND & DOSE AML, ALL induction, maint of remission. Adult: For induction, 100
mg/m2/day by continuous IV infusion (days 1–7) or 100 mg/m2 IV q 12 hr (days 1–7);
same dose for maint. Longer rest period may be needed. Child: Dose based on body
weight and surface area. Tx of meningeal leukemia. Adult: 5–75 mg/m2 IV once daily
for 4 days or once q 4 days. Most common dose, 30 mg/m2 q 4 days until CSF normal,
then one more tx. Tx of lymphomatous meningitis. Adult: 50 mg liposomal cytarabine
intrathecal q 14 days for two doses, then q 14 days for three doses. Repeat q 28 days for
four doses.
ADV EFF Alopecia, anorexia, bone marrow depression, fever, n/v/d, rash, stomatitis,
thrombophlebitis
INTERACTIONS Digoxin
NC/PT Monitor CBC; dose adjustment based on bone marrow response. Premedicate w/
antiemetics. Do not come in contact w/ liposomal forms. Provide mouth care, comfort
measures. Not for use in pregnancy. Pt should take safety measures w/ CNS effects,
avoid exposure to infection, cover head at temp extremes (hair loss possible).

dabigatran etexilate mesylate hydrochloride (Pradaxa)

CLASS Anticoagulant, direct thrombin inhibitor
PREG/CONT C/NA

BBW Increased risk of thrombotic events when discontinuing. Consider adding another
anticoagulant if stopping drug for any reason other than pathological bleeding.
IND & DOSE To reduce risk of stroke, systemic embolism in pts w/ nonvalvular atrial
fibrillation. Adult: 150 mg PO bid. Converting from warfarin: Stop warfarin and begin
dabigatran when INR is under 2. Converting from parenteral anticoagulant: Start
dabigatran 0–2 hr before next dose of parenteral drug would have been given, or at
discontinuation of continuous infusion of parenteral anticoagulant. If starting on
parenteral anticoagulant, wait 12 hr (if CrCl 30 mL/min or more) or 24 hr (if CrCl
under 30 mL/min) after last dose of dabigatran before starting parenteral drug.
ADJUST DOSE Renal impairment
ADV EFF Bleeding, dyspepsia, gastric hemorrhage, gastritis, gastritis-like symptoms,
rebound increased risk of thrombotic events w/ abrupt withdrawal, serious
hypersensitivity reactions
INTERACTIONS Aspirin, NSAIDs, platelet inhibitors, rifampin, warfarin
NC/PT Contraindicated in pts with artificial heart valves. Increased risk of bleeding; use
caution. Consider using another anticoagulant if stopping drug. Not for use in
pregnancy, breast-feeding. Pt should take at about same time each day; swallow capsule
whole and not cut, crush, or chew it; protect drug from moisture; keep in original
container or blister pack; mark container and use within 60 days; pt should alert all
health care providers he is taking drug; report unusual bleeding. Pt should not double-up
doses; should not stop drug suddenly (risk of thrombotic events).

dabrafenib (Tafinlar)
CLASS Antineoplastic, kinase inhibitor
PREG/CONT D/NA

IND & DOSE Tx of unresectable or metastatic melanoma w/ BRAF V600E mutations

alone or in combination w/ trametinib. Adult: 150 mg/day PO at least 1 hr before or
2 hr after meal.
ADV EFF Alopecia, arthralgia, cutaneous malignancies, fever, headache, hemolytic
anemia, hyperglycemia, hyperkeratosis, palmar-plantar erythrodysesthesia, tumor
promotion of wild-type BRAF melanoma, uveitis/iritis
INTERACTIONS CYP3A4/CYP2C8 inhibitors/inducers
NC/PT Ensure proper dx and appropriate BRAF mutation. Assess for other malignancies;
monitor CBC, blood glucose; have pt schedule eye exams. Pt should avoid pregnancy,
breast-feeding; use analgesics for headache; monitor skin; report vision changes, rash or
skin lesions, fever.

DANGEROUS DRUG
dacarbazine hydrochloride (DTIC-Dome)
CLASS Alkylating agent, antineoplastic
PREG/CONT C/NA

BBW Arrange for lab tests (LFTs; WBC, RBC, platelet count) before and frequently
during tx; serious bone marrow suppression, hepatotoxicity possible. Carcinogenic in
animals; monitor accordingly.
IND & DOSE Tx of metastatic malignant melanoma. Adult, child: 2–4.5 mg/kg/day IV
for 10 days, repeated at 4-wk intervals, or 250 mg/m2/day IV for 5 days, repeated q 3
wk. Second line tx of Hodgkin disease. Adult, child: 150 mg/m2/day IV for 5 days w/
other drugs, repeated q 4 wk, or 375 mg/m2 IV on day 1 w/ other drugs, repeated q 15
days.
ADV EFF Anaphylaxis, anorexia, bone marrow suppression, hepatic necrosis, local
tissue damage w/ extravasation, n/v/d, photosensitivity
NC/PT Monitor CBC, LFTs carefully; may limit dose. Give IV only; monitor site carefully.
Extravasation can cause serious local damage; apply hot packs if this occurs. Restrict
fluids and food for 4–6 hr before tx; may use antiemetics. Prepare calendar of tx days.
Pt should avoid exposure to infection, sun.

DANGEROUS DRUG
dactinomycin (Cosmegen)
CLASS Antibiotic, antineoplastic
PREG/CONT D/NA

BBW Use strict handling procedures; extremely toxic to skin and eyes. If extravasation,
burning, stinging occur at injection site, stop infusion immediately, apply cold
compresses to area, and restart in another vein. Local infiltration w/ injectable
corticosteroid and flushing w/ saline may lessen reaction.
IND & DOSE Tx of Wilms’ tumor, rhabdomyosarcoma, Ewing’s sarcoma, in
combination therapy; testicular cancer (metastatic nonseminomatous). Adult:
1,000 mcg/m2 IV on day 1 of combination regimen or daily for 5 days; max, 15
mcg/kg/day or 400–600 mcg/m2/day IV for 5 days. Child: 15 mcg/kg/day IV for 5 days;
max, 15 mcg/kg/day or 400–600 mcg/m2/day IV for 5 days. Tx of gestational
trophoblastic neoplasia. Adult: 12 mcg/kg/day IV for 5 days when used as
monotherapy; 500 mcg IV on days 1 and 2 in combination therapy. Palliative tx or
adjunct to tumor resection via isolation-perfusion technique for solid
malignancies. Adult: 50 mcg/kg for lower extremity or pelvis; 35 mcg/kg for upper
extremity.
ADV EFF Agranulocytosis, alopecia, anemia, aplastic anemia, bone marrow
suppression, cheilitis, dysphagia, esophagitis, fatigue, fever, hepatotoxicity, lethargy,
myalgia, skin eruptions, stomatitis, tissue necrosis w/ extravasation
NC/PT Use strict handling procedures; toxic to skin and eyes. Monitor CBC, LFTs
carefully; may limit dose. Give IV only. Monitor site carefully; extravasation can cause
serious local damage. Monitor for adverse effects, which may worsen 1–2 wk after tx.
Prepare calendar of tx days. Pt should cover head at temp extremes (hair loss possible).
Name confusion between dactinomycin and daptomycin; use caution.

dalfampridine (Ampyra)
CLASS Potassium channel blocker, MS drug
PREG/CONT C/NA

IND & DOSETo improve walking in pts w/ MS. Adult: 10 mg PO bid, 12 hr apart.
ADJUST DOSE Renal impairment, seizure disorder
ADV EFF Asthenia, back pain, balance disorder, constipation, dizziness, dyspepsia,
headache, insomnia, MS relapse, nasopharyngitis, nausea, paresthesia,
pharyngolaryngeal pain, UTIs
NC/PT Do not use w/ hx of seizure disorders, renal impairment. Not for use in pregnancy,
breast-feeding. Pt should swallow tablet whole and not cut, crush, or chew it; use safety
precautions w/ CNS effects.

DANGEROUS DRUG
dalteparin sodium (Fragmin)
CLASS Anticoagulant, low-molecular-weight heparin
PREG/CONT C/NA

BBW Carefully monitor pts w/ spinal epidural anesthesia for neurologic impairment;
risk of spinal hematoma and paralysis.
IND & DOSE Tx of unstable angina. Adult: 120 international units/kg subcut q 12 hr w/
aspirin therapy for 5–8 days; max, 10,000 international units q 12 hr. DVT px, abd
surgery. Adult: 2,500 international units subcut 1–2 hr before surgery, repeated once
daily for 5–10 days after surgery. High-risk pts, 5,000 international units subcut starting
evening before surgery, then daily for 5–10 days. DVT px w/ hip replacement
surgery. Adult: 5,000 international units subcut evening before surgery or 2,500
international units within 2 hr before surgery or 2,500 international units 4–8 hr after
surgery. Then, 5,000 international units subcut each day for 5–10 days or up to 14 days.
Extended tx of venous thromboembolism. Adult: Mo 1, 200 international
units/kg/day subcut; max, 18,000 international units/day. Mo 2–6, 150 international
units/kg/ day subcut; max, 18,000 international units/day.
ADJUST DOSE Thrombocytopenia, renal impairment
ADV EFF Bruising, chills, fever, hemorrhage, injection-site reaction
INTERACTIONS Antiplatelet drugs, chamomile, clopidogrel, garlic, ginger, ginkgo, ginseng,
heparin, high-dose vitamin E, oral anticoagulants, salicylates, ticlopidine
NC/PT Give 1–2 hr after abd surgery. Do not give IM. Give subcut, alternating left and
right abd wall. Cannot be interchanged w/ other heparin product. Do not mix w/ other
injection or infusion. Have protamine sulfate on hand as antidote. Teach proper
administration, disposal of needles, syringes. Pt should avoid injury, report excessive
bleeding.

dantrolene sodium (Dantrium)

CLASS Direct acting skeletal muscle relaxant
PREG/CONT C/NA

BBW Monitor LFTs periodically. Arrange to discontinue at first sign of abnormality;

early detection of liver abnormalities may permit reversion to normal function.
Hepatotoxicity possible.
IND & DOSE Control of clinical spasticity resulting from upper motor neuron
disorders. Adult: 25 mg PO daily. Increase to 25 mg PO tid for 7 days; then increase to
50 mg PO tid and to 100 mg PO tid if needed. Child over 5 yr: 0.5 mg/kg PO once daily
for 7 days, then 0.5 mg/kg PO tid for 7 days, then 1 mg/kg PO tid for 7 days, then
2 mg/kg PO tid if needed. Max, 100 mg PO qid. Preop px of malignant hyperthermia.
Adult, child: 4–8 mg/kg/day PO in three to four divided doses for 1–2 days before
surgery; give last dose about 3–4 hr before scheduled surgery. Or, for adult, child over 5
yr, 2.5 mg/kg IV 1¼ hr before surgery infused over 1 hr. Postcrisis follow-up. 4–
8 mg/kg/day PO in four divided doses for 1–3 days to prevent recurrence. Tx of
malignant hyperthermia. Adult, child over 5 yr: Discontinue all anesthetics as soon as
problem recognized. Give dantrolene by continuous rapid IV push beginning at
minimum of 1 mg/kg and continuing until sx subside or maximum cumulative dose of
10 mg/kg reached.
ADV EFF Aplastic anemia, diarrhea, dizziness, drowsiness, fatigue, hepatitis, HF,
malaise, weakness
INTERACTIONS Alcohol, verapamil
NC/PT Monitor baseline and periodic LFTs. Monitor IV site to prevent extravasation. Use
all appropriate support and tx for malignant hyperthermia. Establish tx goal w/ oral
drug; stop occasionally to assess spasticity. Discontinue if diarrhea is severe. Pt should
take safety precautions, avoid alcohol.

dapagliflozin (Farxiga)
CLASS Antidiabetic, sodium-glucose cotransporter 2 inhibitor
 PREG/CONT C/NA

IND & DOSE Adjunct to diet/exercise to improve glycemic control in type 2 diabetes.
Adult: 5 mg/day PO in a.m.; max, 10 mg/day.
ADJUST DOSE Severe renal impairment
ADV EFF Bladder cancer, genital mycotic infections, hypoglycemia, hyponatremia,
increased LDLs, renal impairment, UTI
INTERACTIONS Celery, coriander, dandelion root, digoxin, fenugreek, garlic, ginger,
juniper berries, phenobarbital, phenytoin, rifampin
NC/PT Not for use w/ type 1 diabetes. Monitor blood glucose, HbA1c, BP periodically.
Not for use in pregnancy, breast-feeding. Pt should continue diet/exercise program,
other antidiabetics as ordered; take safety measures w/ dehydration; monitor for UTI,
genital infections.

dapsone (generic)
CLASS Leprostatic
PREG/CONT C/NA

IND & DOSE Tx of leprosy. Adult, child: 50–100 mg/day PO. Adults may need up to
300 mg/day; max in children, 100 mg/day PO. Tx of dermatitis herpetiformis. Adult:
50–300 mg/day PO. Smaller doses in children; max, 100 mg/day.
ADV EFF Blurred vision, headache, hepatic impairment, insomnia, n/v/d,
photosensitivity, ringing in ears, severe allergic reactions, tinnitus
INTERACTIONS Probenecid, rifampin, trimethoprim
NC/PT Obtain baseline, periodic LFTs. Not for use in pregnancy, breast-feeding. Pt should
complete full course of therapy, avoid sun exposure, take safety precautions w/ vision
changes.

daptomycin (Cubicin)
CLASS Cyclic-lipopeptide antibiotic
PREG/CONT B/NA

IND & DOSE Tx of complicated skin, skin-structure infections caused by susceptible

strains of gram-positive bacteria. Adult: 4 mg/kg IV over 30 min or as IV injection
over 2 min in normal saline injection q 24 hr for 7–14 days. Tx of Staphylococcus
aureus bacteremia. Adult: 6 mg/kg/day IV over 30 min or as IV injection over 2 min
for 2–6 wk or longer.
ADJUST DOSE Renal impairment
ADV EFF Constipation, dizziness, eosinophilic pneumonia, injection-site reactions,
insomnia, myopathy, n/v/d, pseudomembranous colitis, superinfections
INTERACTIONS HMG-CoA inhibitors, oral anticoagulants, tobramycin
NC/PT Culture before tx. Monitor CPK for myopathy. Discontinue and give support for
pseudomembranous colitis. Discontinue if signs of eosinophilic pneumonia. Treat
superinfections. Name confusion between dactinomycin and daptomycin; use caution.

darbepoetin alfa (Aranesp)

CLASS Erythropoiesis-stimulating hormone
PREG/CONT C/NA

BBW Increased risk of death and serious CV events if Hgb target exceeds 11 g/dL. Use
lowest level of drugs needed to increase Hgb to lowest level needed to avoid transfusion.
Risk of DVT is higher in pts receiving erythropoietin-stimulating agents preop to
decrease need for transfusion; note darbepoetin not approved for this use. Increased risk
of death or tumor progression when drug used in cancer pts w/ Hgb target range
exceeding 11 g/dL; monitor Hgb closely in these pts.
IND & DOSE Tx of anemia associated w/ chronic renal failure, including during
dialysis. Adult: 0.45 mcg/kg IV or subcut once/wk. Target Hgb level, 12 g/dL. Tx of
chemotherapy-induced anemia in pts w/ nonmyeloid malignancies. 2.25 mcg/kg
subcut once/wk; adjust to maintain acceptable Hgb levels. Or 500 mcg by subcut
injection once q 3 wk; adjust to maintain Hgb level no higher than 12 g/dL.
ADJUST DOSE Chronic renal failure
ADV EFF Abd pain, arthralgia, asthenia, cough, development of anti-erythropoietin
antibodies w/ subsequent pure red cell aplasia and extreme anemia, diarrhea,
dizziness, dyspnea, edema, fatigue, headache, hypotension, hypertension, MI, myalgias,
n/v/d, rapid cancer growth, seizure, stroke, URI
NC/PT Ensure correct diagnosis; not substitute for emergency transfusion. Monitor Hgb
levels closely; max, 12 g/dL. Monitor preop pt for increased risk of DVTs. Do not give in
sol w/ other drugs. Evaluate iron stores before and periodically during tx. Frequent
blood tests will be needed. Teach pt proper administration and disposal of needles and
syringes. Pt should take safety precautions for CNS effects, mark calendar for injection
dates.

darifenacin hydrobromide (Enablex)

CLASS Urinary antispasmodic, muscarinic receptor antagonist
PREG/CONT C/NA

IND & DOSE Tx of overactive bladder. Adult: 7.5 mg/day PO w/ liquid and swallowed
whole. May increase to 15 mg/day PO as early as wk 2.
ADJUST DOSE Hepatic impairment
ADV EFF Constipation, dry mouth, glaucoma, urine retention
INTERACTIONS Anticholinergics, clarithromycin, flecainide, itraconazole, ketoconazole,
nefazodone, nelfinavir, ritonavir, thioridazine, TCAs
NC/PT Ensure correct diagnosis; rule out underlying medical issues. Monitor IOP. Not for
use in pregnancy, breast-feeding. Pt should swallow tablet whole and not cut, crush, or
chew it; use sugarless lozenges for dry mouth.

darunavir (Prezista)
CLASS Antiviral/protease inhibitor
PREG/CONT C/NA

IND & DOSE Tx of pts w/ HIV infection that has progressed following standard tx.
Adult: 600 mg PO bid w/ ritonavir 100 mg PO bid w/ food (tx-experienced) 800 mg PO
bid w/ ritonavir 100 mg PO bid (tx-naïve). Child 3–under 18 yr, 10 kg or more: Base dose
on weight and surface area (see manufacturer’s guidelines).
ADJUST DOSE Hepatic impairment
ADV EFF Abd pain, diabetes, headache, hepatitis, increased bleeding w/ hemophilia,
n/v/d, rash to Stevens Johnson syndrome, redistribution of body fat
INTERACTIONS Alfuzosin, cisapride, dihydroergotamine, ergotamine, lovastatin,
methylergonovine, pimozide, oral midazolam, rifampin, St. John’s wort, sildenafil,
simvastatin, triazolam
NC/PT Contraindicated for use w/ many other drugs; check complete drug list before tx.
Monitor LFTs regularly; not for use w/ severe hepatic impairment. Not for use in
children under 3; fatalities have occurred. Monitor blood glucose. Not for use in
pregnancy, breast-feeding. Pt should report rash, changes in color of urine or stool.

DANGEROUS DRUG
dasatinib (Sprycel)
CLASS Antineoplastic, kinase inhibitor
PREG/CONT D/NA

IND & DOSE Tx of adults w/ all stages of CML; newly diagnosed or resistant
Philadelphia chromosome–positive ALL. Adult: Chronic CML, 100 mg/day PO.
ALL/other phases of CML, 140 mg/day PO.
ADV EFF Bone marrow suppression, diarrhea, dyspnea, fatigue, fluid retention,
hemorrhage, HF, nausea, pulmonary artery hypertension, QT prolongation, rash
INTERACTIONS Antacids; CYP3A4 inducers, inhibitors; grapefruit juice
NC/PT Obtain baseline and periodic ECG. Monitor CBC closely; dose adjustment may be
needed. Not for use in pregnancy, breast-feeding. Men should not father a child during
tx. Pt should swallow tablets whole and not cut, crush, or chew them; avoid grapefruit
juice; avoid exposure to infection, injury; report severe swelling, bleeding.

DANGEROUS DRUG
DAUNOrubicin citrate (DaunoXome)
CLASS Antineoplastic
PREG/CONT D/NA
BBW Cardiac toxicity possible; monitor ECG, enzymes (dose adjustment may be needed).
Serious bone marrow depression possible; monitor CBC (dose adjustment may be
needed).
IND & DOSE Tx of advanced HIV-associated Kaposi’s sarcoma. Adult: 400 mg/m2 IV
over 1hr q 2 wk.
ADJUST DOSE Renal, hepatic impairment
ADV EFF Abd pain, anorexia, bone marrow suppression, cancer, cardiac toxicity,
fatigue, fever, headache, hepatotoxicity, n/v/d
INTERACTIONS Cyclophosphamide, hepatotoxic drugs, myelosuppressants
NC/PT Obtain baseline and periodic ECG, enzymes. Monitor CBC closely; dose adjustment
may be needed. Monitor injection site; extravasation can cause serious damage. Not for
use in pregnancy, breast-feeding.

DANGEROUS DRUG
decitabine (Dacogen)
CLASS Antineoplastic antibiotic
PREG/CONT D/NA

IND & DOSE Tx of pts w/ myelodysplastic syndromes. Adult: 15 mg/m2 IV over 3 hr q

8 hr for 3 days; repeat q 6 wk.
ADJUST DOSE Renal, hepatic impairment
ADV EFF Anemia, constipation, cough, diarrhea, fatigue, hyperglycemia, nausea,
neutrophilia, petechiae, pyrexia, thrombocytopenia
NC/PT Monitor CBC closely; dose adjustment may be needed. Premedicate w/ antiemetic.
Not for use in pregnancy (contraceptive use during and for 1 mo after tx), breast-
feeding. Men should not father a child during and for 2 mo after tx. Pt should avoid
exposure to infection, injury.

deferasirox (Exjade)
CLASS Chelate
PREG/CONT C/NA

BBW May cause potentially fatal renal, hepatic reactions; monitor closely.
IND & DOSE Tx of chronic iron overload from blood transfusions; tx of iron overload
related to thalassemia in pts 10 yr and older. Adult, child 2 yr and older (10 yr and
older w/ thalassemia): 20 mg/kg/day PO; max, 30 mg/kg/day. Adjust dose based on
serum ferritin levels.
ADJUST DOSE Renal impairment
ADV EFF Abd pain; hepatic, renal impairment; n/v/d; rash; hearing, vision changes
INTERACTIONS Bisphosphonates, iron chelating agents
NC/PT Monitor LFTs, renal function before, wkly for 2 wk, then monthly during tx. Dose
adjusted based on serum ferritin levels. Pt should take safety precautions for CNS
effects.

deferoxamine mesylate (Desferal)

CLASS Chelate
PREG/CONT C/NA

IND & DOSE Tx of chronic iron overload. Adult, child 2 yr and older: 0.5–1 g IM qid; 2 g
IV w/ each unit of blood, or 2,040 mg/kg/day as continuous subcut infusion over 8–
24 hr. IM preferred. Tx of acute iron toxicity. Adult, child: 1 g IM or IV, then 0.5 g q
4 hr for two doses, then q 4–12 hr based on pt response. Max for child, 6 g/day.
ADV EFF Abd pain, hearing/vision changes, infections, injection-site reactions, n/v/d,
respiratory distress syndrome, rash, discolored urine
NC/PT Not for use in primary hemochromatosis. Monitor hearing, vision, lung function.
Caution in pregnancy, breast-feeding. Urine may be discolored. Pt should take safety
measures for CNS effects.

degarelix (generic)
CLASS Antineoplastic
PREG/CONT X/NA

IND & DOSE Tx of advanced prostate cancer. Adult: 240 mg subcut as two 120-mg
injections, then maint of 80 mg subcut q 28 days.
ADV EFF Hot flashes, injection-site reaction, loss of libido, QT prolongation, weight gain
INTERACTIONS QT-prolonging drugs
NC/PT Obtain baseline and periodic ECG. Monitor injection sites for reaction. Alert pt
that flushing, hot flashes, changes in libido possible.

delavirdine mesylate (Rescriptor)

CLASS Antiviral, nonnucleoside reverse transcriptase inhibitor
PREG/CONT C/NA

BBW Give concurrently w/ appropriate antiretrovirals; not for monotherapy.

IND & DOSE Tx of HIV-1 infection w/ other appropriate antiretrovirals. Adult, child
over 16 yr: 400 mg PO tid w/ appropriate antiretrovirals.
ADV EFF Diarrhea, flulike symptoms, headache, nausea, rash
INTERACTIONS Antacids, antiarrhythmics, benzodiazepines, calcium channel blockers,
clarithromycin, dapsone, ergot derivatives, indinavir, quinidine, rifabutin, saquinavir,
St. John’s wort, warfarin
NC/PT Must give w/ other antiretrovirals. Monitor T cells, LFTs. Monitor for
opportunistic infections. Disperse 100-mg tablets in water before giving; let stand. Stir
to form uniform dispersion. Have pt drink, rinse glass, and drink the rinse. Pt should use
appropriate precautions (drug not a cure); consult all health care providers (drug
interacts w/ many drugs); avoid St. John’s wort.

demeclocycline hydrochloride (generic)

CLASS Tetracycline
PREG/CONT D/NA

IND & DOSE Tx of infections caused by susceptible bacteria strains; when penicillin
contraindicated. Adult: General guidelines, 150 mg PO qid or 300 mg PO bid. Child 8 yr
and older: 3–6 mg/lb/day (6.6–13.2 mg/kg/day) PO in two to four divided doses. Tx of
gonococcal infections. Adult: 600 mg PO, then 300 mg q 12 hr for 4 days to total 3 g.
Tx of streptococcal infections. Adult: 150 mg PO qid for 10 days.
ADV EFF Anemia; anorexia; discoloration, inadequate calcification of fetal primary teeth
if used in pregnancy; discoloration, inadequate calcification of permanent teeth if used
during dental development; eosinophilia; glossitis; hemolytic thrombocytopenia;
leukocytosis; leukopenia; liver failure; neutropenia; n/v/d; phototoxic reaction;
rash
INTERACTIONS Antacids, dairy products, digoxin, hormonal contraceptives, iron,
magnesium, penicillin
NC/PT Not for use in pregnancy (use of barrier contraceptives advised), breast-feeding. Pt
should take on empty stomach w/ full glass of water, not take w/ iron or dairy
products, avoid sun exposure.

denileukin diftitox (Ontak)

CLASS Biological protein
PREG/CONT D/NA

BBW Severe hypersensitivity reactions possible; have life support equipment on hand.
Capillary leak syndrome possible; pt may lose visual acuity, color vision.
IND & DOSE Tx of cutaneous T-cell lymphoma in pts who express CD25 component of
IL-2 receptor. Adult: 9 or 18 mcg/kg/day IV over 15 min for 5 consecutive days q 21
days.
ADV EFF Cough, diarrhea, dyspnea, fatigue, headache, n/v, peripheral edema, pruritus,
pyrexia, rigors
NC/PT Premedicate w/ antihistamine and acetaminophen. Have emergency equipment
available for hypersensitivity reactions. Warn pt of potential vision loss. Caution in
pregnancy; not for use in breast-feeding. Pt should report sudden weight gain, rash,
difficulty breathing, vision changes.
 denosumab (Prolia, Xgeva)
CLASS RANK ligand inhibitor
PREG/CONT D (Xgeva), X (Prolia)/NA

IND & DOSE Tx of postmenopausal osteoporosis in women at high risk for fracture;
tx of bone loss in breast cancer pts receiving aromatase inhibitors; tx of bone loss
in prostate cancer pts receiving androgen deprivation therapy. Adult: 60 mg by
subcut injection in upper arm, thigh, or abdomen q 6 mo (Prolia only). Px of skeletal-
related events in pts w/ bone metastases from solid tumors. Adult: 120 mg by
subcut injection q 4 wk (Xgeva only). Tx of unresectable giant cell tumor of the bone
(Xgeva). Adult, adolescent: 120 mg subcut q 4 wk w/ additional 120 mg subcut on days
8, 15 of first month, w/ calcium, vitamin D.
ADJUST DOSE Renal impairment
ADV EFF Back pain, cancer, constipation, cystitis, hypercholesterolemia, hypocalcemia,
infection (serious to life-threatening), osteonecrosis of jaw
NC/PT Obtain baseline serum calcium levels; repeat regularly. Give subcut into abdomen,
upper thigh, or upper arm; rotate injection sites. Not for use in pregnancy, breast-
feeding. Pt should take 1,000 mg/day calcium and 400 units/day vitamin D, have
regular cancer screening, avoid exposure to infection, report signs of infection, get
regular dental care to prevent jaw problems.

desipramine hydrochloride (Norpramin)

CLASS Antidepressant, TCA
PREG/CONT C/NA

BBW Risk of suicidality in children, adolescents, young adults. Monitor pt; inform
caregivers.
IND & DOSE Relief of depression sx. Adult: 100–200 mg/day PO as single dose or in
divided doses; max, 300 mg/day.
ADJUST DOSE Adolescents, elderly pts
ADV EFF Agranulocytosis, anticholinergic effects, confusion, constipation, disturbed
concentration, dry mouth, MI, nasal congestion, orthostatic hypotension,
photosensitivity, sedation, stroke, urine retention, withdrawal symptoms after
prolonged use
INTERACTIONS Anticholinergics, cimetidine, clonidine, fluoxetine, MAOIs, oral
anticoagulants, quinolones, sympathomimetics
NC/PT Give major portion of dose at bedtime. Monitor elderly pts for increased adverse
effects. Obtain CBC if fever, signs of infection occur. Pt should avoid alcohol, sun
exposure; use sugarless lozenges for dry mouth; take safety precautions w/ CNS effects;
report difficulty urinating, fever, thoughts of suicide.
 DANGEROUS DRUG
desirudin (Iprivask)
CLASS Anticoagulant, thrombin inhibitor
PREG/CONT C/NA

BBW Risk of epidural, spinal hematoma w/ resultant long-term or permanent paralysis.

Weigh risks before using epidural or spinal anesthesia, spinal puncture.
IND & DOSE PX of DVT in pts undergoing elective hip replacement. Adult: 15 mg
subcut q 12 hr for 9–12 days. Give initial dose 5–15 min before surgery after induction
of anesthesia.
ADJUST DOSE Renal impairment
ADV EFF Hemorrhage, injection-site reactions
INTERACTIONS Drugs that prolong bleeding
NC/PT Give by deep subcut injection; alternate sites. Monitor blood clotting tests
carefully. Protect pt from injury.

desloratadine (Clarinex, Clarinex Reditabs)

CLASS Antihistamine
PREG/CONT C/NA

IND & DOSE Relief of nasal and nonnasal sx of seasonal allergic rhinitis in pts 2 yr
and older; tx of chronic idiopathic urticaria and perennial allergies caused by
indoor and outdoor allergens in pts 6 mo and older. Adult, child 12 yr and older:
5 mg/day PO or 2 tsp (5 mg/10 mL) syrup/day PO. Child 6–11 yr: 1 tsp syrup (2.5 mg/5
mL)/day PO, or 2.5-mg rapidly disintegrating tablet/day PO. Child 12 mo–5yr: 1/2 tsp
syrup/day (1.25 mg/2.5 mL) PO. Child 6–11 mo: 2 mL syrup/day (1 mg) PO.
ADJUST DOSE Renal, hepatic impairment
ADV EFF Dry mouth, dry throat, dizziness
NC/PT Do not use Clarinex Reditabs w/ phenylketonuria. Pt should use humidifier if
dryness a problem, suck sugarless lozenges for dry mouth, take safety precautions if
dizzy.

desmopressin acetate (DDAVP, Stimate)

CLASS Hormone
PREG/CONT B/NA

IND & DOSE Tx of neurogenic diabetes insipidus. Adult: 0.1–0.4 mL/day intranasally as
single dose or divided into two to three doses, or 0.5–1 mL/day subcut or IV divided into
two doses, or 0.05 mg PO bid; adjust according to water turnover pattern (DDAVP
only). Child 3 mo–12 yr: 0.05–0.3 mL/day intranasally as single dose or divided into two
doses, or 0.05 mg PO daily; adjust according to water turnover pattern (DDAVP only).
Tx of hemophilia A, von Willebrand disease (type I). Adult: 0.3 mcg/kg diluted in 50
mL sterile physiologic saline; infuse IV slowly over 15–30 min 30 min preop; intranasal,
1 spray/nostril 2 hr preop for total dose of 300 mcg. Child 11 mo and older: 1
spray/nostril (150 mcg); total dose, 300 mcg. Less than 50 kg, 150 mcg as single spray.
ADV EFF Local redness, swelling, burning at injection site; water intoxication
INTERACTIONS Carbamazepine, chlorpropamide, SSRIs, TCAs
NC/PT Refrigerate sol, injection. Use rhinal tube to deposit deep into nasal cavity; use
air-filled syringe or blow into tube. Monitor nasal passages. Monitor for hyponatremia.
Monitor pts w/ CV disorders. Individualize dose to establish diurnal water turnover
patterns to allow sleep.

desvenlafaxine succinate (Pristiq)

CLASS Antidepressant, serotonin-norepinephrine reuptake inhibitor
PREG/CONT C/NA

BBW High risk of suicidality in children, adolescents, young adults; monitor for suicidal
ideation, especially when beginning tx or changing dose. Not approved for children.
IND & DOSE Tx of major depressive disorders. Adult: 50 mg/day PO w/ or without food;
range, 50–400 mg/day.
ADJUST DOSE Severe renal impairment
ADV EFF Constipation, decreased appetite, dizziness, dry mouth, eosinophilic
pneumonia, fatigue, glaucoma, headache, hyperhidrosis, interstitial lung disease,
n/v/d, suicidal ideation
INTERACTIONS Alcohol, aspirin, CNS depressants, MAOIs, NSAIDs, SSRIs, St. John’s wort,
venlafaxine, warfarin
NC/PT Limit access in suicidal pts. Do not give within 14 days of MAOIs. Taper gradually
when stopping. Monitor IOP periodically. Not for use in pregnancy, breast-feeding. May
take several wks to see effects. Tablet matrix may appear in stool. Pt should swallow
tablet whole and not cut, crush, or chew it; report thoughts of suicide.

dexamethasone (Aerosorb-Dex, DexPak TaperPak), dexamethasone sodium

phosphate (generic)
CLASS Glucocorticoid, hormone
PREG/CONT C/NA

IND & DOSE Short-term tx of various inflammatory, allergic disorders. Adult: 0.75–
9 mg/day PO, or 0.5–9 mg/day IM or IV. Child: Base dose on formulas for child dosing
using age, body weight. Tx of cerebral edema. Adult: 10 mg IV, then 4 mg IM q 6 hr
until cerebral edema sx subside. Change to oral therapy, 1–3 mg tid, as soon as possible;
taper over 5–7 days. Tx of unresponsive shock. Child: 1–6 mg/kg as single IV injection
(as much as 20 mg initially; repeated injections q 2–6 hr have been used). Intra-
articular or soft-tissue administration for tx of arthritis, psoriatic plaques. Adult:
0.2–6 mg (depending on joint or soft-tissue injection site). Control of bronchial
asthma requiring corticosteroids. Adult: 3 inhalations tid–qid; max, 12
inhalations/day. Child: 2 inhalations tid–qid; max, 8 inhalations/day. Relief of
seasonal or perennial rhinitis sx. Adult: 2 sprays (168 mcg) into each nostril bid–tid;
max, 12 sprays (1,008 mcg)/day. Child: 1 or 2 sprays (84–168 mcg) into each nostril bid,
depending on age; max, 8 sprays (672 mcg)/day. Tx of inflammation of eyelid,
conjunctiva, cornea, globe. Adult, child: Instill 1 or 2 drops into conjunctival sac q hr
during day and q 2 hr during night; taper as 1 drop q 4 hr, then 1 drop tid–qid. For
ointment, apply thin coating in lower conjunctival sac tid–qid; reduce dose to bid, then
once daily. Relief of inflammatory and pruritic manifestations of dermatoses.
Adult, child: Apply sparingly to affected area bid–qid.
ADV EFF Acne, amenorrhea, depression, euphoria, fluid/electrolyte disturbances,
headache, HPA suppression, hyperglycemia, hypertension, immunosuppression,
impaired wound healing, infection, insomnia, irregular menses, local irritation, muscle
weakness, secondary adrenal suppression, seizures, vertigo
INTERACTIONS Corticotropin, live vaccines, phenobarbital, phenytoin, rifampin, salicylates
NC/PT Give daily doses before 9 a.m. to mimic normal peak corticosteroid blood levels.
Taper dose w/ high doses or long-term use. Monitor serum glucose. Protect pt from
exposure to infection; do not give to pt w/ active infection. Not for use in breast-
feeding. Apply topical drug sparingly to intact skin. Pt should not overuse joints after
intra-articular injection.

dexchlorpheniramine maleate (generic)

CLASS Antihistamine
PREG/CONT B/NA

IND & DOSE Relief of sx associated w/ perennial, seasonal allergic rhinitis;

vasomotor rhinitis; allergic conjunctivitis; mild, uncomplicated urticaria,
angioedema; amelioration of allergic reactions to blood or plasma;
dermatographism; adjunct tx in anaphylactic reactions. Adult, child older than 12 yr:
4–6 mg PO at bedtime or q 8–10 hr during day. Child 6–12 yr: 4 mg PO once daily at
bedtime (syrup only).
ADJUST DOSE Elderly pts
ADV EFF Agranulocytosis, anaphylactic shock, disturbed coordination, dizziness,
drowsiness, epigastric distress, pancytopenia, sedation, thickening of bronchial
secretions, thrombocytopenia
INTERACTIONS Alcohol, CNS depressants
NC/PT Adjust dose to lowest possible to manage sx. Pt should swallow tablet whole and
not cut, crush, or chew it; avoid alcohol; take safety precautions for CNS effects.

dexlansoprazole (Dexilant)
CLASS Antisecretory, proton pump inhibitor
 PREG/CONT B/NA

IND & DOSE Healing, maint of healing of erosive esophagitis. Adult: 60 mg/day PO for
up to 8 wk, then 30 mg/day PO. Tx of heartburn, GERD. Adult: 30 mg/day PO for up
to 4 wk.
ADV EFF N/v/d, possible increase in Clostridium difficile diarrhea, possible loss of bone
density
INTERACTIONS Ampicillin, atazanavir, digoxin, iron salts, ketoconazole, warfarin
NC/PT Not for use in breast-feeding. May be opened, contents sprinkled over 1 tbsp
applesauce, and swallowed immediately. Pt should swallow capsule whole and not cut,
crush, or chew it; report severe diarrhea.

DANGEROUS DRUG
dexmedetomidine hydrochloride (Precedex)
CLASS Sedative/hypnotic
PREG/CONT C/NA

IND & DOSE ICU sedation of mechanically ventilated pts. Adult: 1 mcg/kg IV over 10
min, then 0.2–0.7 mcg/kg/hr using IV infusion pump.
ADJUST DOSE Elderly pts
ADV EFF Agitation, bradycardia, dry mouth, hypotension, respiratory failure
INTERACTIONS Anesthetics, CNS depressants, opioids
NC/PT Not for use in pregnancy, breast-feeding. Monitor pt continuously during tx. Do
not use for longer than 24 hr.

dexmethylphenidate hydrochloride (Focalin, Focalin XR)

CLASS CNS stimulant
PREG/CONT C/C-II

BBW Use caution w/ hx of substance dependence or alcoholism. Dependence, severe

depression, psychotic reactions possible w/ withdrawal.
IND & DOSE Tx of ADHD as part of total tx program. Adult, child 6 yr and older: 2.5 mg
PO bid; may increase as needed in 2.5- to 5-mg increments to max 10 mg PO bid. ER
capsules: Initially 5 mg/day PO for children; increase in 5-mg increments to 30 mg/day.
Start adults at 10 mg/day PO; increase in 10-mg increments to 20 mg/day. Already on
methylphenidate: Start at one-half methylphenidate dose w/ max of 10 mg PO bid.
ADV EFF Abd pain, anorexia, dizziness, insomnia, nausea, nervousness, tachycardia
INTERACTIONS Alcohol, antihypertensives, dopamine, epinephrine, MAOIs, phenobarbital,
phenytoin, primidone, SSRIs, TCAs, warfarin
NC/PT Ensure proper diagnosis before use; interrupt periodically to reevaluate. Do not
give within 14 days of MAOIs. Controlled substance; secure storage. May sprinkle
contents on applesauce; pt should take immediately. Pt should swallow ER capsules
whole and not cut, crush, or chew them; take as part of comprehensive tx program; take
early in day to avoid interrupting sleep; avoid alcohol and OTC products.

dexpanthenol (Panthoderm)
CLASS Emollient, GI stimulant
PREG/CONT C/NA

IND & DOSE Prevention of postoperative adynamic ileus. Adult: 250–500 mg IM or IV

diluted in sol; repeat in 2 hr, then q 6 hr until danger of adynamic ileus has passed. Tx
of adynamic ileus. Adult: 500 mg IM or IV diluted in sol; repeat in 2 hr, then q 6 hr as
needed. Topical tx of mild eczema, dermatosis, bee stings, diaper rash, chafing.
Adult, child: Apply once or twice daily to affected areas.
ADV EFF Abd pain, anorexia, dizziness, insomnia, nausea, nervousness, tachycardia
INTERACTIONS Intestinal colic, n/v/d, slight hypotension
NC/PT Monitor BP w/ IV use. Intestinal colic possible.

dexrazoxane (Totect)
CLASS Lyophilizate
PREG/CONT D/NA

IND & DOSE Tx of extravasation of IV anthracycline chemotherapy. Adult: Days 1, 2:

1,000 mg/m2 IV; max, 2,000 mg IV. Day 3: 500 mg/m2 IV; max, 1,000 mg infused over
2 hr.
ADJUST DOSE Renal impairment
ADV EFF Bone marrow suppression, injection-site pain, n/v/d, pyrexia
NC/PT Available in emergency kit. Monitor bone marrow. Not for use in pregnancy,
breast-feeding. Use pain-relief measures for extravasation site.

dextran, high-molecular-weight (Dextran 70, Gentran 70, Macrodex)

CLASS Plasma volume expander
PREG/CONT C/NA

IND & DOSE Adjunct tx for shock or impending shock when blood or blood products
are not available. Adult: 500–1,000 mL IV at 20–40 mL/min as emergency procedure;
max, 20 mL/kg first 24 hr of tx. Child: Base dose on body weight or surface area; max,
20 mL/kg IV total dose.
ADJUST DOSE Renal impairment
ADV EFF Anaphylactoid reaction, coagulation problems, HF, hypervolemia, injection-
site reactions, rash
NC/PT Give IV only. Use clear sols only. Monitor for hypervolemia, HF. Pt should report
difficulty breathing.
 dextran, low-molecular-weight (Dextran 40, Gentran 40, 10% LMD,
Rheomacrodex)
CLASS Plasma volume expander
PREG/CONT C/NA

IND & DOSE Adjunct tx of shock or impending shock when blood or blood products
are not available. Adult, child: Total dose of 20 mL/kg IV in first 24 hr; max, 10 mL/kg
beyond 24 hr. Discontinue after 5 days. Hemodiluent in extracorporeal circulation.
Adult: 10–20 mL/kg added to perfusion circuit; max, 20 mL/kg. Px for DVT, PE in pts
undergoing procedures w/ high risk of thromboembolic events. Adult: 500–1,000
mL IV on day of surgery. Continue at 500 mL/day IV for additional 2–3 days.
Thereafter, may give 500 mL q second to third day for up to 2 wk.
ADV EFF Hypotension, hypervolemia, injection-site reactions, rash
NC/PT Give IV only. Use clear sols only. Monitor for hypervolemia. Monitor urine output.
Pt should report difficulty breathing.

dextroamphetamine sulfate (Dexedrine Spansule)

CLASS Amphetamine, CNS stimulant
PREG/CONT C/C-II

BBW High abuse potential. Avoid prolonged use; prescribe sparingly. Misuse may cause
sudden death or serious CV events. Increased risk w/ heart problems or structural heart
anomalies.
IND & DOSE Tx of narcolepsy. Adult, child over 12 yr: 10 mg/day PO in divided doses.
Increase in 10-mg/day increments at wkly intervals; range, 5–60 mg/day PO in divided
doses. Child 6–12 yr: 5 mg/day PO. Increase in 5-mg increments at wkly intervals until
optimal response obtained. Adjunct tx for abnormal behavioral syndrome (ADHD
hyperkinetic syndrome). Adult: 5 mg PO once or twice daily; max, 40 mg/day. Child 6
yr and older: 5 mg PO daily–bid. Increase in 5-mg/day increments at wkly intervals;
max, 40 mg/day. Child 3–5 yr: 2.5 mg/day PO. Increase in 2.5-mg/day increments at
wkly intervals.
ADV EFF Diarrhea, dizziness, dry mouth, hypertension, insomnia, overstimulation,
palpitations, restlessness, tachycardia, unpleasant taste
INTERACTIONS Acetazolamide, antihypertensives, furazolidone, MAOIs, sodium
bicarbonate, urinary acidifiers
NC/PT Baseline ECG recommended. Ensure proper diagnosis. Do not give within 14 days
of MAOIs. Incorporate into comprehensive social and behavioral tx plan. Controlled
substance; store securely. Give early in day. Provide periodic drug breaks. Monitor BP,
growth in children. Not for use in pregnancy. Pt should swallow ER capsules whole and
not cut, crush, or chew them.

dextromethorphan hydrobromide (Creo-Terpin, Delsym, DexAlone, Hold DM,

 etc)
CLASSNonopioid antitussive
PREG/CONT C/NA

IND & DOSEControl of nonproductive cough. Adult, child 12 yr and older: Gelcaps, 30 mg
PO q 6–8 hr; max, 120 mg/day. Lozenges, 5–15 mg PO q 1–4 hr; max, 120 mg/day.
Liquid, syrup, strips, 10–20 mg PO q 4 hr or 30 mg q 6–8 hr; max, 120 mg/day. ER
suspension, 60 mg PO q 12 hr; max, 120 mg/day. Child 6–11 yr: Lozenges, 5–10 mg PO q
1–4 hr; max, 60 mg/day. Liquid, syrup, strips, 15 mg PO q 6–8 hr; max, 60 mg/day.
Freezer pops, 2 pops q 6–8 hr. Child 2–6 yr: Liquid, syrup, 7.5 mg PO q 6–8 hr; max,
30 mg/day. Freezer pops, 1 pop q 6–8 hr.
ADV EFF Respiratory depression (w/ overdose)
INTERACTIONS MAOIs
NC/PT Ensure proper use and advisability of suppressing cough. Do not use within 14
days of MAOIs. Pt should avoid OTC products w/ same ingredients, report persistent
cough w/ fever.

diazepam (Diastat AcuDial, Valium)

CLASS Antiepileptic, anxiolytic, benzodiazepine
PREG/CONT D/C-IV

IND & DOSE Tx of anxiety disorders, skeletal muscle spasm, seizure disorders. Adult:
2–10 mg PO bid–qid, or 0.2 mg/kg rectally. Treat no more than one episode q 5 days.
May give second dose in 4–12 hr. Child 6–11 yr: 0.3 mg/kg rectally. Child 2–5 yr:
0.5 mg/kg rectally. Child over 6 mo: 1–2.5 mg PO tid–qid initially. Tx of anxiety. Adult:
2–10 mg IM or IV; repeat in 3–4 hr if needed. Alcohol withdrawal. Adult: 10 mg IM or
IV initially, then 5–10 mg in 3–4 hr if needed. Endoscopic procedures. Adult: 10 mg or
less (up to 20 mg) IV just before procedure or 5–10 mg IM 30 min before procedure.
Relief of muscle spasm. Adult: 5–10 mg IM or IV initially, then 5–10 mg in 3–4 hr if
needed. Status epilepticus. Adult: 5–10 mg preferably by slow IV. May repeat q 5–10
min to total dose of 30 mg. May repeat in 2–4 hr. Child 5 yr and older: 1 mg IV q 2–5
min to max of 10 mg; may repeat in 2–4 hr. Child over 1 mo–under 5 yr: 0.2–0.5 mg
slowly IV q 2–5 min to max of 5 mg. Preoperative anxiety. Adult: 10 mg IM.
Cardioversion. Adult: 5–15 mg IV 5–10 min before procedure. Tx of tetanus. Child 5 yr
and older: 5–10 mg IV q 3–4 hr. Child over 1 mo–under 5 yr: 1–2 mg IM or IV slowly q 3–
4 hr as needed.
ADJUST DOSE Elderly pts, debilitating diseases
ADV EFF Apathy, bradycardia, confusion, constipation, CV collapse, depression, diarrhea,
disorientation, fatigue, incontinence, lethargy, libido changes, light-headedness,
paradoxical excitement, tachycardia, urine retention
INTERACTIONS Alcohol, cimetidine, disulfiram, hormonal contraceptives, omeprazole,
ranitidine, theophylline
NC/PT Do not give intra-arterially; change to oral route as soon as possible. Monitor
carefully w/ IV route. Keep pt in bed for 3 hr; do not allow pt to drive after injection.
Taper dose after long-term use. Suggest medical alert ID. Not for use in pregnancy
(barrier contraceptives advised). Pt should take safety precautions w/ CNS effects.

diazoxide (Proglycem)
CLASS Glucose-elevating drug
PREG/CONT C/NA

IND & DOSEMgt of hypoglycemia due to hyperinsulinism in infants and children and
to inoperable pancreatic islet cell malignancies. Adult, child: 3–8 mg/kg/day PO in
two to three divided doses q 8–12 hr. Infant, newborn: 8–15 mg/kg/day PO in two to
three doses q 8–12 hr.
ADJUST DOSE Renal impairment
ADV EFF Anxiety, hirsutism, hyperglycemia, hypotension, HF, n/v, thrombocytopenia
INTERACTIONS Chlorpropamide, glipizide, glyburide, hydantoins, tolazamide, tolbutamide,
thiazides
NC/PT Check serum glucose, daily weight to monitor fluid retention. Protect suspension
from light; have insulin on hand if hyperglycemia occurs. Excessive hair growth will end
when drug stopped. Pt should report weight gain of more than 3 lb/day.

diclofenac epolamine (Flector, Solaraze, Voltaren), diclofenac potassium

(Cambia, Cataflam, Zipsor), diclofenac sodium (Solaraze)
CLASS Analgesic
PREG/CONT C (1st, 2nd trimesters); D (3rd trimester)/NA

BBW Possible increased risk of CV events, GI bleed, renal insufficiency; monitor

accordingly.
IND & DOSE Tx of pain, including dysmenorrhea. Adult: 50 mg PO tid or 1 transdermal
patch (Flector) applied to most painful area bid.
TX OF OSTEOARTHRITIS Adult: 100–150 mg/day PO in divided doses (Voltaren), or
50 mg bid–tid PO (Cataflam). For upper extremities, apply 2 g gel to affected area qid;
for lower extremities, apply 4 g gel to affected area qid (Voltaren). Tx of rheumatoid
arthritis. Adult: 150–200 mg/day PO in divided doses (Voltaren), or 50 mg bid–tid PO
(Cataflam). Tx of ankylosing spondylitis. Adult: 100–125 mg/day PO. Give as 25 mg
qid, w/ extra 25-mg dose at bedtime (Voltaren), or 25 mg qid PO w/ additional 25 mg at
bedtime if needed (Cataflam). Tx of acute migraine. 50-mg packet mixed in 30–60 mL
water PO as single dose at onset of headache (Cambia). Tx of mild to moderate pain.
Adult: 25 mg liquid-filled capsule PO qid (Zipsor; not interchangeable w/ other forms of
diclofenac). Tx of actinic keratosis. Adult: Cover lesion w/ topical gel, smooth into
skin; do not cover w/ dressings or cosmetics (Solaraze). Relief of postop inflammation
from cataract extraction. Adult: 1 drop to affected eye qid starting 24 hr after surgery
for 2 wk.
ADV EFF Anaphylactoid reactions to fatal anaphylactic shock, constipation, diarrhea,
dizziness, CV events, dyspepsia, GI pain, headache, nausea
INTERACTIONS Anticoagulants, lithium
NC/PT Give w/ meals if GI upset occurs. Add packets for oral suspension to 30–60 mL
water. Remove old transdermal patch before applying new one to intact, dry skin.
Institute emergency procedures if overdose occurs. Pt should swallow tablets whole and
not cut, crush, or chew them; avoid sun if using topical gel; take safety precautions for
CNS effects.

dicyclomine hydrochloride (Bentyl)

CLASS Anticholinergic, antispasmodic, parasympatholytic
PREG/CONT B/NA

IND & DOSE Tx of functional bowel or IBS. Adult: 160 mg/day PO divided into four equal
doses or 80 mg/day IM in four divided doses; do not give IV.
ADJUST DOSE Elderly pts
ADV EFF Altered taste perception, blurred vision, decreased sweating, dry mouth,
dysphagia, irritation at injection site, n/v/d, urinary hesitancy, urine retention
INTERACTIONS Amantadine, antipsychotics, atenolol, digoxin, TCAs
NC/PT IM use is only temporary; switch to oral form as soon as possible. Ensure
hydration, temp control. Pt should avoid hot environments, empty bladder before taking
if urine retention occurs, perform mouth care for dry mouth.

didanosine (ddI, dideoxyinosine) (Videx, Videx EC)

CLASS Antiviral
PREG/CONT B/NA

BBW Monitor for pancreatitis (abd pain, elevated enzymes, n/v). Stop drug; resume
only if pancreatitis ruled out. Monitor pts w/ hepatic impairment; decrease may be
needed if toxicity occurs. Fatal liver toxicity w/ lactic acidosis possible. Noncirrhotic
portal hypertension, sometimes fatal, has occurred.
IND & DOSE Tx of pts w/ HIV infection w/ other antiretrovirals. Adult, child: DR
capsules: 60 kg or more, 400 mg/day PO; 25–60 kg, 250 mg/day PO; 20–25 kg,
200 mg/day PO. Oral sol: 60 kg or more, 200 mg PO bid or 400 mg/day PO; under 60
kg, 125 mg PO bid or 250 mg/day PO. Child over 8 mo: Pediatric powder, 120 mg/m2 PO
bid. Child 2 wk–8 mo: 100 mg/m2 PO bid.
ADJUST DOSE Renal, hepatic impairment
ADV EFF Abd pain, headache, hemopoietic depression, hepatotoxicity, lactic acidosis,
n/v, pancreatitis
INTERACTIONS Antifungals, allopurinol, fluoroquinolones, ganciclovir, methadone,
tetracyclines
NC/PT Monitor CBC, pancreatic enzymes, LFTs. Give on empty stomach 1 hr before or
2 hr after meals. Pediatric sol can be made by pharmacists; refrigerate. Pt should not
cut, crush, or chew ER forms.

diflunisal (generic)
CLASS Analgesic, anti-inflammatory, antipyretic, NSAIDs
PREG/CONT C/NA

BBW Possible increased risk of CV events, GI bleeding; monitor accordingly. Do not use
to treat periop pain after CABG surgery.
IND & DOSE Tx of mild to moderate pain. Adult, child over 12 yr: 1,000 mg PO initially,
then 500 mg q 8–12 hr PO. Tx of osteoarthritis, rheumatoid arthritis. Adult, child over
12 yr: 500–1,000 mg/day PO in two divided doses; maint, no more than 1,500 mg/day.
ADV EFF Anaphylactoid reactions to anaphylactic shock, CV event, diarrhea,
dizziness, dyspepsia, GI pain, headache, insomnia, nausea, rash
INTERACTIONS Acetaminophen, antacids, aspirin
NC/PT Give w/ food if GI upset. Pt should swallow tablets whole and not cut, crush, or
chew them; take safety precautions for CNS effects; report unusual bleeding.

DANGEROUS DRUG
digoxin (Lanoxin)
CLASS Cardiac glycoside
PREG/CONT C/NA

IND & DOSE Tx of HF, atrial fibrillation. Adult: Loading dose, 0.25 mg/day IV or PO for
pts under 70 yr w/ good renal function; 0.125 mg/day PO or IV for pts over 70 yr or w/
impaired renal function; 0.0625 mg/day PO or IV w/ marked renal impairment. Maint,
0.125–0.5 mg/day PO. Child: Premature, 20 mcg/kg PO or 15–25 mcg/kg IV; neonate,
30 mcg/kg PO or 20–30 mcg/kg IV; 1–24 mo, 40–50 mcg/kg PO or 30–50 mcg/kg IV; 2–
10 yr, 30–40 mcg/kg PO or 25–35 mcg/kg IV; over 10 yr, 10–15 mcg/kg PO or 8–12
mcg/kg IV as loading dose. Maint, 25%–35% of loading dose in divided doses; range,
0.125–0.5 mg/day PO.
ADJUST DOSE Elderly pts, impaired renal function
ADV EFF Arrhythmias, GI upset, headache, weakness, yellow vision
INTERACTIONS Amiodarone, bleomycin, charcoal, cholestyramine, colestipol,
cyclophosphamide, cyclosporine, dobutamine in sol, erythromycin, ginseng, hawthorn,
licorice, loop diuretics, metoclopramide, methotrexate, oral aminoglycosides,
penicillamine, psyllium, quinidine, St. John’s wort, tetracyclines, thiazide diuretics,
thyroid hormone, verapamil
NC/PT Monitor apical pulse; withhold if under 60 in adults, under 90 in children. Check
dose carefully. Do not give IM. Give on empty stomach. Monitor for therapeutic drug
levels: 0.5–2 ng/mL. Pt should learn to take pulse, weigh self daily, consult prescriber
before taking OTC drugs or herbs, avoid St. John’s wort, report slow or irregular pulse,
yellow vision.

digoxin immune fab (DigiFab)

CLASS Antidote
PREG/CONT C/NA

IND & DOSE Tx of potentially life-threatening digoxin toxicity (serum digoxin over
10 ng/mL, serum potassium over 5 mEq/L in setting of digoxin toxicity). Adult,
child: Dose determined by serum digoxin level or estimate of amount of digoxin ingested.
If no estimate possible and serum digoxin level unavailable, use 800 mg IV (20 vials
DigiFab) See manufacturer’s details; dose varies by digoxin level.
ADV EFF Anaphylaxis, HF, low cardiac output, hypokalemia
NC/PT Ensure no sheep allergies. Monitor serum digoxin before tx. Have life-support
equipment on hand. Do not redigitalize until drug has cleared (several days to a wk).
Serum digoxin levels unreliable for up to 3 days after administration. Pt should report
difficulty breathing.

dihydroergotamine mesylate (D.H.E. 45, Migranal)

CLASS Antimigraine, ergot
PREG/CONT X/NA

BBW Serious to life-threatening ischemia if taken w/ potent CYP3A4 inhibitors,

including protease inhibitors, macrolide antibiotics; concurrent use contraindicated.
IND & DOSE Tx of migraine w/ or without aura; acute tx of cluster headaches. Adult:
1 mg IM, IV, or subcut at first sign of headache; may repeat at 1-hr intervals. Max,
3 mg, or 1 intranasal spray (0.5 mg) in each nostril followed in 15 min by another spray
in each nostril (max, 3 mg).
ADV EFF CV events, nausea, numbness, rhinitis, tingling
INTERACTIONS CYP3A4 inhibitors, peripheral vasoconstrictors, sumatriptan
NC/PT Not for use in pregnancy, breast-feeding. May give antiemetic if nausea severe.
Monitor BP; look for signs of vasospasm. Pt should prime pump four times before use
(nasal spray), report numbness or tingling, chest pain.

diltiazem hydrochloride (Cardizem, Diltzac)

CLASS Antianginal, antihypertensive, calcium channel blocker
PREG/CONT C/NA

IND & DOSETx of angina pectoris. Adult: Initially, 30 mg PO qid before meals and at
bedtime; gradually increase at 1- to 2-day intervals to 180–360 mg PO in three to four
divided doses. Or, 120–360 mg/day (ER, SR forms) PO, depending on brand. Tx of
essential hypertension. Adult: 180–240 mg PO daily (Cardizem CD, Cartia XT). 120–
540 mg PO daily (Cardizem LA). 180–240 mg PO daily (Diltia XT, Dilt-CD, Dilt-XR). 120–
240 mg PO daily (Tiazac, Taztia XT). Tx of supraventricular tachycardia, atrial
fibrillation, atrial flutter. Adult: Direct IV bolus, 0.25 mg/kg over 2 min; second bolus
of 0.35 mg/kg over 2 min after 15 min if response inadequate. Or, 5–10 mg/hr by
continuous IV infusion w/ increases up to 15 mg/hr; may continue for up to 24 hr.
ADV EFF Asthenia, asystole, bradycardia, dizziness, edema, flushing, light-headedness,
nausea
INTERACTIONS Beta blockers, cyclosporine, grapefruit juice
NC/PT Monitor closely while establishing dose. Pt should swallow ER/SR tablets whole
and not cut, crush, or chew them; avoid grapefruit juice; report irregular heart beat,
swelling.

dimenhyDRINATE (Dimetabs, Dramanate, Dymenate)

CLASS Anticholinergic, antihistamine, anti–motion sickness drug
PREG/CONT B/NA

IND & DOSE Px, tx of n/v or vertigo of motion sickness. Adult: 50–100 mg PO q 4–6 hr;
for px, pt should take first dose 30 min before exposure to motion. Max, 400 mg/24 hr.
Or, 50 mg IM as needed, or 50 mg in 10 mL sodium chloride injection IV over 2 min.
Child 6–12 yr: 25–50 mg PO q 6–8 hr; max, 150 mg/day.
ADJUST DOSE Elderly pts
ADV EFF Anaphylaxis. confusion, dizziness, drowsiness, headache, heaviness/weakness of
hands, lassitude, nervousness, restlessness, vertigo
INTERACTIONS Alcohol, CNS depressants
NC/PT Have epinephrine on hand during IV use. Pt should use 30 min before motion
sickness–inducing event, avoid alcohol, take safety precautions w/ CNS effects.

dimercaprol (BAL in Oil)

CLASS Antidote, chelate
PREG/CONT C/NA

IND & DOSETx of arsenic, gold poisoning Adult, child: 25 mg/kg deep IM four times/day
for 2 days, two times/day on third day, then once daily for 10 days. Tx of mercury
poisoning. Adult, child: 5 mg/kg IM, then 2.5 mg/kg once daily or bid for 10 days. Tx
of lead poisoning w/ edetate calcium. Adult, child: 4 mg/kg IM for first dose, then at
4-hr intervals w/ edetate calcium for 2–7 days.
ADJUST DOSE Hepatic impairment
ADV EFF Abd pain, burning sensation in lips/mouth, constricted feeling in throat/chest,
headache, nausea, sweating
INTERACTIONS Alcohol, CNS depressants
NC/PT Use extreme caution w/ peanut allergy. Use deep IM injection. Pt should report
constricted feeling in throat/chest, difficulty breathing.

dimethyl fumarate (Tecfidera)

CLASS MS drug, nicotinic receptor agonist
PREG/CONT C/NA

IND & DOSETx of relapsing MS. Adult: 120 mg PO bid for 7 days; then 240 mg PO bid.
ADV EFF Abd pain, dizziness, dyspepsia, flushing, lymphopenia, n/v/d, rash
NC/PT Obtain baseline and periodic CBC, LFTs; withhold w/ serious infection. Use
cautiously w/ pregnancy, breast-feeding. Pt should swallow capsule whole and not cut,
crush, or chew it (may open and sprinkle on food); avoid infections; dress in layers if
flushing occurs; report continued n/v/d, severe rash, worsening of MS sx.

dinoprostone (Cervidil, Prepidil, Prostin E2)

CLASS Abortifacient, prostaglandin
PREG/CONT C/NA

IND & DOSE Termination of pregnancy 12–20 wk from first day of last menstrual
period; evacuation of uterus in mgt of missed abortion. Adult: 1 suppository
(20 mg) high into vagina; keep pt supine for 10 min after insertion. May give additional
suppositories at 3- to 5-hr intervals, based on uterine response and tolerance, for up to 2
days. Initiation of cervical ripening before labor induction. Adult: 0.5 mg gel via
provided cervical catheter w/ pt in dorsal position and cervix visualized using speculum.
May repeat dose if no response in 6 hr. Wait 6–12 hr before beginning oxytocin IV to
initiate labor. For insert: Place 1 insert transversely in posterior fornix of vagina. Keep
pt supine for 2 hr (1 insert delivers 0.3 mg/hr over 12 hr). Remove, using retrieval
system, at onset of active labor or 12 hr after insertion.
ADV EFF Dizziness, headache, hypotension, n/v/d, perforated uterus
NC/PT Store suppositories in freezer; bring to room temp before insertion. Keep pt supine
after vaginal insertion. Ensure abortion complete. Give antiemetics, antidiarrheals if
needed. Monitor for uterine tone, bleeding. Give support, encouragement for
procedure/progressing labor. Name confusion among Prostin VR Pediatric (alprostadil),
Prostin FZ (dinoprost), Prostin E2 (dinoprostone), Prostin 15 (carboprost in Europe); use
extreme caution.

diphenhydrAMINE hydrochloride (Benadryl Allergy, Diphen AF, Diphenhist)

CLASS Antihistamine, anti–motion sickness, antiparkinsonian, sedative
PREG/CONT B/NA

IND & DOSERelief of sx of various allergic reactions, motion sickness. Adult: 25–
50 mg PO q 4–6 hr; max, 300 mg/24 hr. Or, 10–50 mg IV or deep IM or up to 100 mg if
needed; max, 400 mg/day. Child 6–12 yr: 12.5–25 mg PO tid–qid, or 5 mg/kg/day PO,
or 150 mg/m2/day PO; max, 150 mg/day. Or, 5 mg/kg/day or 150 mg/m2/day IV or
deep IM injection. Max, 300 mg/day divided into four doses. Nighttime sleep aid.
Adult: 50 mg PO at bedtime. Cough suppression. Adult: 25 mg PO q 4 hr; max,
150 mg/day (syrup). Child 6–12 yr: 12.5 mg PO q 4 hr. Max, 75 mg/24 hr (syrup).
ADJUST DOSE Elderly pts
ADV EFF Agranulocytosis, anaphylactic shock, bronchial secretion thickening,
disturbed coordination, dizziness, drowsiness, epigastric distress, hemolytic anemia,
hypoplastic anemia, leukopenia, pancytopenia, thrombocytopenia
INTERACTIONS Alcohol, CNS depressants, MAOIs
NC/PT Monitor response; use smallest dose possible. Use syrup if swallowing tablets
difficult. Pt should avoid alcohol, take safety precautions w/ CNS effects.

dipyridamole (Persantine)
CLASS Antianginal, antiplatelet, diagnostic agent
PREG/CONT B/NA

IND & DOSE Px of thromboembolism in pts w/ artificial heart valves, w/ warfarin.

Adult: 75–100 mg PO qid. Diagnostic aid to assess CAD in pts unable to exercise.
Adult: 0.142 mg/kg/min IV over 4 min.
ADV EFF Abd distress, dizziness, headache
INTERACTIONS Adenosine
NC/PT Monitor continually w/ IV use. Give oral drug at least 1 hr before meals. Pt should
take safety precautions for light-headedness.

disopyramide phosphate (Norpace, Norpace CR)

CLASS Antiarrhythmic
PREG/CONT C/NA

BBW Monitor for possible refractory arrhythmias that can be life-threatening; reserve
use for life-threatening arrhythmias.
IND & DOSE Tx of life-threatening ventricular arrhythmias. Adult, child: 400–
800 mg/day PO in divided doses q 6 hr, or q 12 hr if using CR forms. Rapid control of
ventricular arrhythmias. Adult: 300 mg (immediate-release) PO. If no response within
6 hr, 200 mg PO q 6 hr; may increase to 250–300 mg q 6 hr if no response in 48 hr. For
pts w/ cardiomyopathy, no loading dose; 100 mg (immediate-release) PO q 6–8 hr.
ADJUST DOSE Renal, hepatic failure
ADV EFF Blurred vision, constipation, dry nose/eye/throat, HF, itching, malaise, muscle
aches and pains, urinary hesitancy, urine retention
INTERACTIONS Antiarrhythmics, erythromycin, phenytoin, quinidine
NC/PT Monitor ECG carefully. Make pediatric suspension (1–10 mg/mL) by adding
contents of immediate-release capsule to cherry syrup, if desired. Store in amber glass
bottle; refrigerate up to 1 mo. Evaluate pt for safe, effective serum levels (2–8 mcg/mL).
Pt should swallow CR forms whole and not cut, crush, or chew them; not stop taking
without consulting prescriber; maintain hydration, empty bladder before taking.

disulfiram (Antabuse)
CLASS Antialcoholic, enzyme inhibitor
PREG/CONT C/NA

BBW Never give to intoxicated pt or without pt’s knowledge. Do not give until pt has
abstained from alcohol for at least 12 hr.
IND & DOSE Aid in mgt of selected chronic alcoholics who want to remain in state of
enforced sobriety. Adult: 500 mg/day PO in single dose for 1–2 wk. If sedative effect
occurs, give at bedtime or decrease dose. Maint, 125–500 mg/day PO; max,
500 mg/day.
ADV EFF Dizziness, fatigue, headache, metal- or garlic-like aftertaste, skin eruptions; if
taken w/ alcohol, arrhythmias, CV collapse, death, HF, MI
INTERACTIONS Alcohol, caffeine, chlordiazepoxide, diazepam, metronidazole, oral
anticoagulants, theophyllines
NC/PT Do not give until pt has abstained from alcohol for at least 12 hr. Monitor LFTs,
CBC before and q 6 mo of tx. May crush tablets and mix w/ liquid beverages. Institute
supportive measures if pt drinks alcohol during tx. Pt should abstain from all forms of
alcohol (serious to fatal reactions possible if combined), wear/carry medical ID, take
safety precautions for CNS effects.

DANGEROUS DRUG
DOBUTamine hydrochloride (generic)
CLASS Beta 1-selective adrenergic agonist, sympathomimetic
PREG/CONT B/NA

IND & DOSE Short-term tx of cardiac decompensation. Adult: Usual rate, 2–20
mcg/kg/min IV to increase cardiac output; rarely, rates up to 40 mcg/kg/min. Child:
0.5–1 mcg/kg/min as continuous IV infusion. Maint, 2–20 mcg/kg/min.
ADV EFF Headache, hypertension, nausea, PVCs, tachycardia
INTERACTIONS Methyldopa, TCAs
NC/PT Monitor urine flow, cardiac output, pulmonary wedge pressure, ECG, BP closely
during infusion; adjust dose, rate accordingly. Arrange to digitalize pt w/ atrial
fibrillation w/ rapid ventricular rate before giving dobutamine (dobutamine facilitates
AV conduction). Name confusion between dobutamine and dopamine; use caution.

DANGEROUS DRUG
docetaxel (Docefrez, Taxotere)
CLASS Antineoplastic
 PREG/CONT D/NA

BBW Do not give unless blood counts are within acceptable range (neutrophils over
1,500 cells/m2). Do not give w/ hepatic impairment; increased risk of toxicity and
death. Monitor LFTs carefully. Monitor for hypersensitivity reactions, possibly severe.
Do not give w/ hx of hypersensitivity. Monitor carefully for fluid retention; treat
accordingly.
IND & DOSE Tx of breast cancer. Adult: 60–100 mg/m2 IV infused over 1 hr q 3 wk. Tx of
non-small-cell lung cancer. Adult: 75 mg/m2 IV over 1 hr q 3 wk. First-line tx of
non-small-cell lung cancer. Adult: 75 mg/m2 over 1 hr, then 75 mg/m2 cisplatin IV
over 30–60 min q 3 wk. Tx of androgen-independent metastatic prostate cancer.
Adult: 75 mg/m2 IV q 3 wk as 1-hr infusion w/ 5 mg prednisone PO bid constantly
throughout tx. Reduce dose to 60 mg/m2 if febrile neutropenia, severe or cumulative
cutaneous reactions, moderate neurosensory s&sx, or neutrophil count under 500/mm3
occurs for longer than 1 wk. Stop tx if reactions continue w/ reduced dose. Tx of
operable node-positive breast cancer. Adult: 75 mg/m2 IV 1 hr after doxorubicin
50 mg/m2 and cyclophosphamide 500 mg/m2 q 3 wk for 6 courses. Induction for
squamous cell cancer of head and neck before radiotherapy. Adult: 75 mg/m2 as 1-
hr IV infusion, then cisplatin 75 mg/m2 IV over 1 hr on day 1, then 5-FU
750 mg/m2/day IV for 5 days. Repeat q 3 wk for four cycles before radiotherapy starts.
Induction for squamous cell cancer of head and neck before chemoradiotherapy.
Adult: 75 mg/m2 as 1-hr IV infusion, then cisplatin 100 mg/m2 as 30-min–3-hr infusion,
then 5-FU 1,000 mg/m2/day as continuous infusion on days 1–4. Give q 3 wk for three
cycles before chemoradiotherapy starts. Tx of advanced gastric adenocarcinoma.
Adult: 75 mg/m2 IV as 1-hr infusion, then cisplatin 75 mg/m2 IV as 1–3-hr infusion (both
on day 1), then 5-FU 750 mg/m2/day IV as 24-hr infusion for 5 days. Repeat cycle q 3
wk.
ADJUST DOSE Hepatic impairment
ADV EFF Alopecia, arthralgia, asthenia, bone marrow suppression, fluid retention,
hypersensitivity reactions, infection, myalgia, n/v/d, stomatitis
INTERACTIONS Cyclosporine, erythromycin, immunosuppressants, ketoconazole
NC/PT Handle drug carefully. Premedicate w/ oral corticosteroids to reduce fluid
retention. Monitor CBC before each dose; adjust dose as needed. Monitor LFTs; do not
give w/ hepatic impairment. Monitor for fluid retention; treat accordingly. Protect from
infection. Give antiemetics if needed. Pt should cover head at temp extremes (hair loss
possible), mark calendar for tx days, take safety precautions for CNS effects. Name
confusion between Taxotere (docetaxel) and Taxol (paclitaxel); use extreme caution.

dofetilide (Tikosyn)
CLASS Antiarrhythmic
PREG/CONT C/NA
BBW Monitor ECG before and periodically during administration. Monitor pt
continually for at least 3 days. May adjust dose based on maint of sinus rhythm. Risk of
induced arrhythmias.
IND & DOSE Conversion of atrial fibrillation (AF) or flutter to normal sinus rhythm;
maint of sinus rhythm after conversion from AF. Adult: Dose based on ECG response
and CrCl. CrCl over 60 mL/min, 500 mcg PO bid; CrCl 40–60 mL/min, 250 mcg PO bid;
CrCl 20–under 40 mL/min, 125 mcg PO bid; CrCl under 20 mL/min, use
contraindicated.
ADJUST DOSE Renal impairment
ADV EFF Fatigue, dizziness, headache, ventricular arrhythmias
INTERACTIONS Antihistamines, cimetidine, ketoconazole, phenothiazines, TCAs,
trimethoprim, verapamil; contraindicated w/ amiodarone, disopyramide, procainamide,
quinidine, sotalol
NC/PT Determine time of arrhythmia onset. Monitor ECG before and periodically during
tx. Monitor serum creatinine before and q 3 mo during tx. Do not attempt cardioversion
within 24 hr of starting tx. Pt should take bid at about same time each day, keep follow-
up appointments, take safety precautions w/ CNS effects.

dolasetron mesylate (Anzemet)

CLASS Antiemetic, serotonin receptor blocker
PREG/CONT B/NA

IND & DOSE Px, tx of n/v associated w/ emetogenic chemotherapy (oral only). Adult:
100 mg PO within 1 hr before chemotherapy. Child 2–16 yr: 1.8 mg/kg PO tablets or
injection diluted in apple or apple-grape juice within 1 hr before chemotherapy. Px, tx
of postop n/v. Adult: 100 mg PO within 2 hr before surgery, or 12.5 mg IV about 15
min before stopping anesthesia for px, or 12.5 mg IV as soon as needed for tx. Child 2–
16 yr: 1.2 mg/kg PO tablets or injection diluted in apple or apple-grape juice within 2 hr
before surgery, or 0.35 mg/kg IV about 15 min before stopping anesthesia for px, or
0.35 mg/kg IV as soon as needed for tx. Max, 12.5 mg/dose.
ADV EFF Fatigue, diarrhea, dizziness, headache, prolonged QT, tachycardia
INTERACTIONS Anthracycline, QT-prolonging drugs, rifampin
NC/PT Do not use IV for chemotherapy-induced n/v. Monitor ECG before and regularly
during tx. Pt should perform proper mouth care, use sugarless lozenges, use analgesics
for headache, take safety precautions w/ CNS effects.

dolutegravir (Tivicay)
CLASS Antiviral, integrase inhibitor
PREG/CONT B/NA

IND & DOSE Tx of HIV-1 infection in combination w/ other antiretrovirals. Adult, child
12 yr and older weighing at least 40 kg: 50 mg/day PO; w/ efavirenz,
fosamprenavir/ritonavir, tipranavir/ritonavir, rifampin, or suspected resistance, 50 mg
PO bid.
ADV EFF Abd pain, diarrhea, fat redistribution, headache, hepatotoxicity in pts with
hepatitis B or C, insomnia, nausea
INTERACTIONS Antacids, buffered drugs, calcium supplements, efavirenz,
fosamprenavir/ritonavir, iron supplements, laxatives, rifampin, sucralfate,
tipranavir/ritonavir
NC/PT Screen for hepatitis B or C before tx. Must be given w/ other antiretrovirals; give
cation-containing drugs at least 2 hr before or 6 hr after dolutegravir. Pt should continue
other HIV drugs; space antacids apart from dosing; avoid pregnancy, breast-feeding;
take precautions to avoid spread; not run out of prescription; report sx of infection,
difficulty breathing, changes in urine/ stool color.

donepezil hydrochloride (Aricept, Aricept ODT)

CLASS Alzheimer drug, anticholinesterase inhibitor
PREG/CONT C/NA

IND & DOSE Tx of Alzheimer-type dementia, including severe dementia. Adult:

5 mg/day PO at bedtime; may increase to 10 mg daily after 4–6 wk; 10 mg PO daily for
severe disease. May use 23 mg/day after 10 mg/day for at least 3 mo.
ADV EFF Abd pain, anorexia, dyspepsia, fatigue, hepatotoxicity, insomnia, muscle
cramps, n/v/d, rash
INTERACTIONS Anticholinergics, cholinesterase inhibitors, NSAIDs, theophylline
NC/PT Monitor hepatic function. Give at bedtime. Pt should place disintegrating tablet on
tongue, allow to dissolve, then drink water; take safety precautions; report severe
n/v/d. Name confusion between Aricept (donepezil) and Aciphex (rabeprazole); use
caution.

DANGEROUS DRUG
DOPamine hydrochloride (generic)
CLASS Dopaminergic, sympathomimetic
PREG/CONT C/NA

BBW To prevent sloughing/necrosis after extravasation, infiltrate area w/ 10–15 mL

saline containing 5–10 mg phentolamine as soon as possible after extravasation.
IND & DOSE Correction of hemodynamic imbalance, low cardiac output,
hypotension. Adult: Pts likely to respond to modest increments of cardiac contractility
and renal perfusion, 2–5 mcg/kg/min IV initially. More seriously ill pts, 5 mcg/kg/min
IV initially. Increase in increments of 5–10 mcg/kg/min to rate of 20–50 mcg/kg/min.
ADV EFF Angina, dyspnea, ectopic beats, hypotension, n/v, palpitations, tachycardia
INTERACTIONS MAOIs, methyldopa, phenytoin, TCAs; do not mix in IV sol w/ other drugs
NC/PT Use extreme caution in calculating doses. Base dosing on pt response. Give in
large vein; avoid extravasation. Monitor urine output, cardiac output, BP during
infusion. Name confusion between dopamine and dobutamine; use caution.

doripenem (Doribax)
CLASS Carbapenem antibiotic
PREG/CONT B/NA

IND & DOSE Tx of complicated intra-abdominal infections, UTIs caused by

susceptible bacteria strains. Adult: 500 mg IV over 1 hr q 8 hr for 5–14 days (intra-
abdominal infection) or 10 days (UTI, pyelonephritis).
ADJUST DOSE Renal impairment
ADV EFF Diarrhea including Clostridium difficile diarrhea, headache, nausea, phlebitis, rash
INTERACTIONS Probenecid, valproic acid
NC/PT Culture, sensitivity before tx. Monitor injection site for phlebitis. Not for use in
pregnancy (barrier contraceptives advised), breast-feeding. Monitor for C. difficile
diarrhea. Provide supportive tx for up to 2 mo after tx ends.

dornase alfa (Pulmozyme)

CLASS Cystic fibrosis drug
PREG/CONT B/NA

IND & DOSE Mgt of cystic fibrosis to improve pulmonary function, w/ other drugs.
Adult, child: 2.5 mg inhaled through recommended nebulizer; bid use beneficial to some.
ADV EFF Chest pain, laryngitis, pharyngitis, rash, rhinitis
NC/PT Assess respiratory function regularly. Store in refrigerator; not stable after 24 hr
at room temp. Do not mix in nebulizer w/ other drugs; review proper use of nebulizer.
Pt should continue other drugs for cystic fibrosis.

doxapram hydrochloride (Dopram)

CLASS Analeptic, respiratory stimulant
PREG/CONT B/NA

IND & DOSE Stimulation of respiration in pts w/ drug-induced postanesthesia

respiratory depression. Adult: Single injection of 0.5–1 mg/kg IV; max, 1.5 mg/kg as
total single injection or 2 mg/kg when given as multiple injections at 5-min intervals.
Tx of COPD associated acute hypercapnia. Adult: Mix 400 mg in 180 mL IV infusion;
start infusion at 1–2 mg/min (0.5–1 mL/min); no longer than 2 hr. Max, 3 mg/min. Mgt
of drug-induced CNS depression. 1–2 mg/kg IV; repeat in 5 min. Repeat q 1–2 hr until
pt awakens. Or, priming dose of 1–2 mg/kg IV; if no response, infuse 250 mg in 250 mL
dextrose or saline sol at rate of 1–3 mg/min, discontinue after 2 hr if pt awakens; repeat
in 30 min–2 hr if relapse occurs. Max, 3 g/day.
ADV EFF Bronchospasm, cough, hypertension, increased reflexes, seizures
INTERACTIONS Aminophylline, enflurane, halothane, MAOIs, muscle relaxants,
sympathomimetics, theophylline
NC/PT Give IV only. Monitor for extravasation. Continuously monitor pt until fully
awake. Discontinue if sudden hypotension, deterioration occur.

doxazosin mesylate (Cardura, Cardura XL)

CLASS Antihypertensive, alpha-adrenergic blocker
PREG/CONT C/NA

IND & DOSE Tx of mild to moderate hypertension. Adult: 1 mg PO daily; maint, 2, 4, 8,

or 16 mg PO daily. May increase q 2 wk. Do not use ER tablets. Tx of BPH. Adult: 1 mg
PO daily; maint, 2, 4, 8 mg daily. Or, ER tablets, 4 mg PO once daily at breakfast. Max,
8 mg/day PO.
ADV EFF Diarrhea, dizziness, dyspepsia, edema, fatigue, headache, lethargy, nausea,
orthostatic hypotension, palpitations, sexual dysfx, tachycardia
INTERACTIONS Alcohol, antihypertensives, nitrates, sildenafil
NC/PT Monitor pt carefully w/ first dose; chance of orthostatic hypotension, dizziness,
syncope greatest w/ first dose. Monitor for edema, BPH s&sx. Pt should swallow ER
tablets whole and not cut, crush, or chew them, take safety precautions.

doxepin hydrochloride (Prudoxin, Silenor, Sinequan, Zonalon)

CLASS Antidepressant, TCA
PREG/CONT C/NA

BBW Increased risk of suicidality in children, adolescents, young adults; monitor

carefully.
IND & DOSE Tx of mild to moderate anxiety, depression. Adult: 25 mg PO tid.
Individualize dose; range, 75–150 mg/day. Tx of more severe anxiety, depression.
Adult: 50 mg PO tid; max, 300 mg/day. Tx of mild symptoms or emotional symptoms
accompanying organic disease. Adult: 25–50 mg PO. Tx of pruritus. Adult: Apply
cream four times/day at least 3–4 hr apart for 8 days. Do not cover dressing. Tx of
insomnia w/ difficulty in sleep maintenance (Silenor). Adult: 3–6 mg PO 30 min
before bed.
ADV EFF Anticholinergic effects, confusion, constipation, disturbed concentration, dry
mouth, MI, orthostatic hypotension, photosensitivity, sedation, stroke, urine retention,
withdrawal symptoms w/ prolonged use
INTERACTIONS Alcohol, anticholinergics, barbiturates, cimetidine, clonidine, disulfiram,
ephedrine, epinephrine, fluoxetine, furazolidone, hormonal contraceptives, levodopa,
MAOIs, methylphenidate, nicotine, norepinephrine, phenothiazines, QT-prolonging
drugs, thyroid medication
NC/PT Restrict drug access in depressed, suicidal pts. Give major portion at bedtime.
Dilute oral concentrate w/ approximately 120 mL water, milk, fruit juice just before
administration. Pt should be aware of sedative effects (avoid driving, etc); not mix w/
other sleep-inducing drugs, alcohol; avoid prolonged exposure to sun, sunlamps; report
thoughts of suicide. Name confusion between Sinequan and saquinavir; use caution.

doxercalciferol (Hectorol)
CLASS Vitamin D analogue
PREG/CONT B/NA

IND & DOSE To reduce parathyroid hormone in mgt of secondary

hyperparathyroidism in pts undergoing chronic renal dialysis; secondary
hyperparathyroidism in pts w/ stage 3, 4 chronic kidney disease without dialysis.
Adult: 10 mcg PO three times/wk at dialysis; max, 20 mcg three times/wk. Without
dialysis, 1 mcg/day PO; max, 3.5 mcg/day.
ADV EFF Dizziness, dyspnea, edema, headache, malaise, n/v
INTERACTIONS Cholestyramine, magnesium-containing antacids, mineral oil,
phenothiazines, QT-prolonging drugs, thyroid medication
NC/PT Monitor for vitamin D toxicity. Give w/ non-aluminum-containing phosphate
binders. Monitor vitamin D levels predialysis.

DANGEROUS DRUG
DOXOrubicin hydrochloride (Doxil)
CLASS Antineoplastic
PREG/CONT D/NA

BBW Accidental substitution of liposomal form for conventional form has caused serious
adverse reactions; check carefully before giving. Monitor for extravasation, burning,
stinging. If these occur, discontinue; restart in another vein. For local subcut
extravasation, local infiltration w/ corticosteroid may be ordered. Flood area w/ normal
saline; apply cold compress. If ulceration, arrange consult w/ plastic surgeon. Monitor
pt’s response often at start of tx: serum uric acid, cardiac output (listen for S3). CBC
changes may require dose decrease; consult physician. Risk of HF, myelosuppression,
liver damage. Record doses given to monitor total dosage; toxic effects often dose-
related, as total dose approaches 550 mg/m2.
IND & DOSE To produce regression in ALL, AML; Wilms’ tumor; neuroblastoma; soft-
tissue, bone sarcoma; breast, ovarian carcinoma; transitional cell bladder
carcinoma; thyroid carcinoma; Hodgkin, non-Hodgkin lymphoma; bronchogenic
carcinoma. Adult: 60–75 mg/m2 as single IV injection given at 21-day intervals.
Alternate schedule: 30 mg/m2 IV on each of 3 successive days, repeated q 4 wk. Tx of
AIDS-related Kaposi sarcoma (liposomal form). Adult: 20 mg/m2 IV q 3 wk starting
w/ initial rate of 1 mg/min. Tx of ovarian cancer that has progressed or recurred
after platinum-based chemotherapy. Adult: 50 mg/m2 IV at 1 mg/min; if no adverse
effects, complete infusion in 1 hr. Repeat q 4 wk.
ADJUST DOSE Elevated bilirubin
ADV EFF Anaphylaxis, cardiac toxicity, complete but reversible alopecia, mucositis,
myelosuppression, n/v, red urine
INTERACTIONS Digoxin
NC/PT Do not give IM or subcut. Monitor for extravasation. Ensure hydration. Not for use
in pregnancy. Name confusion between conventional doxorubicin and liposomal
doxorubicin; use caution.

doxycycline (Atridox, Doryx, Doxy 100, Oracea, Vibramycin)

CLASS Tetracycline
PREG/CONT D/NA

IND & DOSE Tx of infections caused by susceptible bacteria strains; tx of infections

when penicillin contraindicated. Adult, child over 8 yr, over 45 kg: 200 mg IV in one or
two infusions (each over 1–4 hr) on first tx day, then 100–200 mg/day IV, depending on
infection severity. Or, 200 mg PO on day 1, then 100 mg/day PO. Child over 8 yr, under
45 kg:. 4.4 mg/kg IV in one or two infusions, then 2.2–4.4 mg/kg/day IV in one or two
infusions. Or, 4.4 mg/kg PO in two divided doses on first tx day, then 2.2–
4.4 mg/kg/day on subsequent days. Tx of rosacea. Adult: 40 mg/day PO in a.m. on
empty stomach w/ full glass of water for up to 9 mo. Tx of primary or secondary
syphilis. Adult, child over 8 yr, over 45 kg: 100 mg PO bid for 14 days. Tx of acute
gonococcal infection. Adult, child over 8 yr, over 45 kg: 100 mg PO, then 100 mg at
bedtime, then 100 mg bid for 3 days. Or, 300 mg PO, then 300 mg in 1 hr. Px of
traveler’s diarrhea. Adult, child over 8 yr, over 45 kg: 100 mg/day PO. Px of malaria.
Adult, child over 8 yr, over 45 kg 100 mg PO daily. Child over 8 yr, under 45 kg:
2 mg/kg/day PO; max, 100 mg/day. Px of anthrax. Adult, child over 8 yr, over 45 kg:
100 mg PO bid for 60 days. Child over 8 yr, under 45 kg: 2.2 mg/kg PO bid for 60 days.
CDC recommendations for STDs. Adult, child over 8 yr, over 45 kg: 100 mg PO bid for
7–28 days depending on disease. Periodontal disease. Adult, child over 8 yr, over 45 kg:
20 mg PO bid, after scaling, root planing. Tx of Lyme disease. Child over 8 yr, less than
45 kg: 2.2 mg/kg PO bid for 60 days or 100 mg PO bid for 14–21 days.
ADJUST DOSE Elderly pts, renal impairment
ADV EFF Anorexia, bone marrow suppression, discoloring of teeth/inadequate bone
calcification (of fetus when used during pregnancy, of child when used if under 8 yr),
exfoliative dermatitis, glossitis, hepatic failure, n/v/d, phototoxic reactions, rash,
superinfections
INTERACTIONS Alkali, antacids, barbiturates, carbamazepine, dairy foods, digoxin, iron,
penicillins, phenytoins
NC/PT Culture before tx. Give w/ food if GI upset severe. Not for use in pregnancy,
breast-feeding. Pt should complete full course of therapy, avoid sun exposure.

dronabinol (delta-9-tetrahydrocannabinol, delta-9-THC) (Marinol)

 CLASSAntiemetic, appetite suppressant
PREG/CONT C/C-III

IND & DOSE Tx of n/v associated w/ cancer chemotherapy. Adult, child: 5 mg/m2 PO 1–
3 hr before chemotherapy administration. Repeat q 2–4 hr after chemotherapy, for total
of four to six doses/day. If 5 mg/m2 ineffective and no significant side effects, increase
by 2.5-mg/m2 increments to max, 15 mg/m2/dose. Tx of anorexia associated w/
weight loss in pts w/ AIDS. Adult, child: 2.5 mg PO bid before lunch and dinner. May
reduce to 2.5 mg/day as single evening or bedtime dose; max, 10 mg PO bid (max not
recommended for children).
ADV EFF Dependence w/ use over 30 days, depression, dry mouth, dizziness, drowsiness,
hallucinations, headache, heightened awareness, impaired coordination, irritability,
sluggishness, unsteadiness, visual disturbances
INTERACTIONS Alcohol, anticholinergics, antihistamines, CNS depressants, dofetilide,
ritonavir, TCAs
NC/PT Store capsules in refrigerator. Supervise pt during first use to evaluate CNS effects.
Discontinue if psychotic reactions; warn pt about CNS effects. Pt should avoid marijuana
(drug contains same active ingredient), take safety precautions for CNS effects, avoid
alcohol and OTC sleeping aids.

dronedarone (Multaq)
CLASS Antiarrhythmic
PREG/CONT X/NA

BBW Contraindicated in pts w/ symptomatic HF or recent hospitalization for HF; double

risk of death. Contraindicated in pts with AF who cannot be cardioverted; double risk of
death, stroke.
IND & DOSE To reduce risk of CV hospitalization in pts w/ paroxysmal or persistent
AF or atrial flutter w/ recent episode of either and associated CV risk factors who
are in sinus rhythm or will be cardioverted. Adult: 400 mg PO bid w/ a.m. and p.m.
meal.
ADV EFF Asthenia, HF, n/v/d, QT prolongation, rash, serious hepatotoxicity, stroke
INTERACTIONS Antiarrhythmics, beta blockers, calcium channel blockers, CYP3A
inhibitors/inducers, digoxin, grapefruit juice, sirolimus, statins, St. John’s wort,
tacrolimus
NC/PT Obtain baseline, periodic ECG. Do not use in pt w/ permanent AF or serious HF.
Monitor LFTs during tx. Not for use in pregnancy, breast-feeding. Pt should avoid
grapefruit juice, St. John’s wort; keep complete list of all drugs and report use to all
health care providers; comply w/ frequent ECG monitoring; not make up missed doses;
report difficulty breathing, rapid weight gain, extreme fatigue.

droperidol (generic)
 CLASSGeneral anesthetic
PREG/CONT C/NA

BBW May prolong QT interval; reserve use for pts unresponsive to other tx. Monitor pt
carefully.
IND & DOSE To reduce n/v associated w/ surgical procedures. Adult: 2.5 mg IM or IV.
May use additional 1.2 mg w/ caution. Child 2–12 yr: 0.1 mg/kg IM or IV.
ADJUST DOSE Renal, hepatic impairment
ADV EFF Chills, drowsiness, hallucinations, hypotension, prolonged QT w/ potentially
fatal arrhythmias, tachycardia
INTERACTIONS CNS depressants, opioids, QT-prolonging drugs
NC/PT Reserve use. Monitor ECG continually during tx and recovery. Pt should take
safety precautions for CNS effects.

droxidopa (Northera)
CLASS Norepinephrine precursor
PREG/CONT C/NA

BBW Risk of supine hypertension. Raise head of bed to lessen effects; lower dose or
discontinue drug if supine hypertension cannot be managed.
IND & DOSE Tx of orthostatic hypotension in adults w/ neurogenic orthostatic
hypotension caused by autonomic failure. Adult: 100 mg PO tid; titrate in 100-mg-tid
segments to max 600 mg PO tid. Effectiveness beyond 2 wk is unknown.
ADJUST DOSE Renal impairment
ADV EFF Confusion, dizziness, exacerbation of ischemic heart disease, fatigue, fever,
headache, hypertension, nausea, supine hypertension
INTERACTIONS Carbidopa, levodopa
NC/PT Monitor BP carefully; raise head of bed to decrease supine hypertension.
Administer last dose at least 3 hr before bedtime. Pt should avoid breast-feeding; take
safety precautions w/ CNS changes; report drugs used for tx of Parkinson’s disease,
severe headache, chest pain, palpitations.

duloxetine hydrochloride (Cymbalta)

CLASS Antidepressant, serotonin/norepinephrine reuptake inhibitor
PREG/CONT C/NA

BBW Monitor for increased depression (agitation, irritability, increased suicidality),

especially at start of tx and dose change. Most likely in children, adolescents, young
adults. Provide appropriate interventions, protection. Drug not approved for children.
IND & DOSE Tx of major depressive disorder. Adult: 20 mg PO bid; max, 120 mg/day.
Allow at least 14 days if switching from MAOI, 5 days if switching to MAOI. Tx of
generalized anxiety disorder. Adult: 60 mg/day PO; max, 120 mg/day. Tx of diabetic
neuropathic pain. Adult: 60 mg/day PO as single dose. Tx of fibromyalgia; chronic
musculoskeletal pain. Adult: 30 mg/day PO for 1 wk; then increase to 60 mg/day.
ADV EFF Constipation, diarrhea, dizziness, dry mouth, fatigue, hepatotoxicity, sweating
INTERACTIONS Alcohol, aspirin, flecainide, fluvoxamine, linezolid, lithium, MAOIs, NSAIDs,
phenothiazines, propafenone, quinidine, SSRIs, St. John’s wort, tramadol, TCAs,
triptans, warfarin
NC/PT Not for use in pregnancy, breast-feeding. Taper when discontinuing. Pt should
swallow capsules whole and not cut, crush, or chew them; avoid alcohol, St John’s wort;
report thoughts of suicide; take safety precautions w/ dizziness.

dutasteride (Avodart)
CLASS BPH drug. androgen hormone inhibitor
PREG/CONT X/NA

IND & DOSE Tx of symptomatic BPH in men w/ an enlarged prostate gland Adult:
0.5 mg/day PO. W/ tamsulosin, 0.5 mg/day PO w/ tamsulosin 0.4. mg/day PO.
ADV EFF Decreased libido, enlarged breasts, GI upset
INTERACTIONS Cimetidine, ciprofloxacin, diltiazem, ketoconazole, ritonavir, saw palmetto,
verapamil
NC/PT Assess to ensure BPH dx. Monitor prostate periodically. Pt should not father child
and will not be able to donate blood during and for 6 mo after tx. Pregnant women
should not handle capsule. Pt should swallow capsule whole and not cut, crush, or chew
it; avoid saw palmetto.

dyphylline (Lufyllin, Lufyllin-400)

CLASS Bronchodilator, xanthine
PREG/CONT C/NA

IND & DOSE Symptomatic relief or px of bronchial asthma, reversible bronchospasm

associated w/ chronic bronchitis, emphysema. Adult: Up to 15 mg/kg PO q 6 hr.
ADJUST DOSE Elderly, impaired pts
ADV EFF Headache, insomnia, n/v/d, seizures
INTERACTIONS Benzodiazepines, beta blockers, caffeine, halothane, mexiletine, NMJs,
probenecid
NC/PT Have diazepam on hand for seizures. Give around the clock. Pt should avoid
excessive intake of caffeine-containing beverages, take w/ food if GI effects severe.

ecallantide (Kalbitor)
CLASS Plasma kallikrein inhibitor
PREG/CONT C/NA
BBW Risk of severe anaphylaxis; have medical support on hand.
IND & DOSE Tx of acute attacks of hereditary angioedema. Adult, child 16 yr and older:
30 mg subcut as three 10-mg injections; may repeat once in 24 hr.
ADV EFF Anaphylaxis, fever, headache, injection-site reactions, nasopharyngitis, n/v/d
NC/PT Give only when able to provide medical support for anaphylaxis. Not for use in
pregnancy, breast-feeding. Pt should report difficulty breathing.

eculizumab (Soliris)
CLASS Complement inhibitor, monoclonal antibody
PREG/CONT C/NA

BBW Pt must have received meningococcal vaccine at least 2 wk before tx. Drug
increases risk of infection serious to fatal meningococcal infections have occurred.
IND & DOSE Tx of pts w/ paroxysmal nocturnal hemoglobinuria to reduce hemolysis.
Adult: 600 mg IV over 35 min q 7 days for first 4 wk, then 900 mg IV as fifth dose 7 days
later, then 900 mg IV q 14 days. Child under 18 yr: Base dose on body weight; see
manufacturer’s recommendations. Tx of pts w/ atypical hemolytic uremic syndrome
to inhibit complement-mediated thrombotic microangiopathy. Adult: 900 mg IV
over 35 min for first 4 wk, then 1,200 mg IV for fifth dose 1 wk later, then 1,200 mg IV
q 2 wk.
ADV EFF Back pain, headache, hemolysis, hypertension, meningococcal infections,
nasopharyngitis, n/v/d, UTI
NC/PT Monitor for s&sx of meningococcal infection. Stopping drug can cause serious
hemolysis. Must monitor pt for 8 wk after stopping; inform pt of risk for meningococcal
infections. Not for use in pregnancy, breast-feeding. Pt should wear medical alert tag.

edetate calcium disodium (Calcium Disodium Versenate)

CLASS Antidote
PREG/CONT B/NA

BBW Reserve use for serious conditions requiring aggressive therapy; serious toxicity
possible.
IND & DOSE Tx of acute/chronic lead poisoning, lead encephalopathy. Adult, child: For
blood levels 20–70 mcg/dL, 1,000 mg/m2/day IV or IM for 5 days. Interrupt tx for 2–4
days; follow w/ another 5 days of tx if indicated. For blood levels higher than 70
mcg/dL, combine w/ dimercaprol.
ADV EFF Electrolyte imbalance, headache, n/v/d, orthostatic hypotension
INTERACTIONS Zinc insulin
NC/PT Give IM or IV. Avoid excess fluids w/ encephalopathy. Establish urine flow by IV
infusion before tx. Monitor BUN, electrolytes. Keep pt supine for short period after tx to
prevent orthostatic hypotension. Pt should prepare calendar of tx days.
 edrophonium chloride (Enlon, Reversol)
CLASS Anticholinesterase, antidote, diagnostic agent, muscle stimulant
PREG/CONT C/NA

IND & DOSE Differential dx, adjunct in evaluating myasthenia gravis tx. Adult: Inject
10 mg IM. May retest w/ 2 mg IM after 30 min to rule out false-negative results. Or,
10 mg drawn into tuberculin syringe w/ IV needle. Inject 2 mg IV in 15–30 sec; leave
needle in vein. If no reaction after 45 sec, inject remaining 8 mg. May repeat test after
30 min. Child over 34 kg: 2 mg IV or 5 mg IM. Child 34 kg or less: 1 mg IV or 2 mg IM.
Infants: 0.5 mg IV. Evaluation of myasthenia gravis tx. Adult: 1–2 mg IV 1 hr after
oral intake of edrophonium. Response determines effectiveness of tx. Edrophonium
test in crisis. Adult: Secure controlled respiration immediately if pt apneic, then give
test. If pt in cholinergic crisis, giving edrophonium will increase oropharyngeal
secretions and further weaken respiratory muscles. If crisis myasthenic, giving
edrophonium will improve respiration, and pt can be treated w/ longer-acting IV
anticholinesterases. To give test, draw up no more than 2 mg into syringe. Give 1 mg IV
initially. Carefully observe cardiac response. If after 1 min dose does not further impair
pt, inject remaining 1 mg. If after 2-mg dose no clear improvement in respiration,
discontinue all anticholinesterases; control ventilation by tracheostomy, assisted
respiration. Antidote for NMJ blockers. Adult: 10 mg IV slowly over 30–45 sec so that
onset of cholinergic reaction can be detected; repeat when necessary. Max, 40 mg.
ADV EFF Abd cramps; anaphylaxis; bradycardia; cardiac arrest; cardiac arrhythmias;
dysphagia; increased lacrimation, pharyngeal/tracheobronchial secretions, salivation;
miosis; urinary frequency/incontinence
INTERACTIONS Corticosteroids, succinylcholine
NC/PT Give slowly IV; have atropine sulfate on hand as antidote and antagonist to severe
reaction. Testing can frighten pt; offer support, explain procedure.

efavirenz (Sustiva)
CLASS Antiviral, nonnucleoside reverse transcriptase inhibitor
PREG/CONT D/NA

IND & DOSE Tx of HIV/AIDS w/ other antiretrovirals. Adult: 600 mg/day PO w/

protease inhibitor or other nucleoside reverse transcriptase inhibitor. In combination w/
voriconazole 400 mg PO q 12 hr: 300 mg/day efavirenz PO. Child 3 mo and older: 40 kg
or more, 600 mg/day PO; 32.5–under 40 kg, 400 mg/day PO; 25–under 32.5 kg,
350 mg/day PO; 20–under 25 kg, 300 mg/day PO; 15–under 20 kg, 250 mg/day PO; 10–
under 15 kg, 200 m/day P; 5–under 10 kg, 150 mg/day PO; 3.5–under 5 kg, 100 mg/day
PO.
ADV EFF Asthenia, dizziness, drowsiness, headache, n/v/d, rash
INTERACTIONS Alcohol, cisapride, ergot derivatives, hepatotoxic drugs, indinavir,
methadone, midazolam, pimozide, rifabutin, rifampin, ritonavir, saquinavir, St. John’s
wort, triazolam, voriconazole
NC/PT Blood test needed q 2 wk. Ensure drug part of combination therapy. Give at
bedtime for first 2–4 wk to minimize CNS effects. Not for use in pregnancy, breast-
feeding. Not a cure; pt should use precautions. Pt should swallow forms whole and not
cut, crush, or chew them; avoid alcohol, report all drugs, herbals taken (including St.
John’s wort) to health care provider; seek regular medical care.

eletriptan hydrobromide (Relpax)

CLASS Antimigraine, triptan
PREG/CONT C/NA

IND & DOSE Tx of acute migraine w/ or without aura. Adult: 20–40 mg PO. If headache
improves, then returns, may give second dose after at least 2 hr. Max, 80 mg/day.
ADV EFF Hypertonia, hypoesthesia, MI, pharyngitis, sweating, vertigo
INTERACTIONS Clarithromycin, ergots, itraconazole, ketoconazole, nefazodone, nelfinavir,
ritonavir, SSRIs, other triptans
NC/PT Tx only; not for migraine px. No more than two doses in 24 hr. Closely monitor BP
w/ known CAD; discontinue if s&sx of angina. Not for use in pregnancy. Pt should take
safety precautions for CNS effects, maintain usual measures for migraine relief.

elosulfase alfa (Vimizim)

CLASS Enzyme
PREG/CONT C/NA

BBW Risk of life-threatening anaphylaxis, hypersensitivity reaction. Monitor pt closely;

be prepared to deal w/ anaphylaxis. Pts w/ acute respiratory illness at risk for life-
threatening pulmonary complications; delay use with respiratory illness.
IND & DOSE Tx of mucopolysaccharidosis type IVA (Morquio A syndrome). Adult, child
5 yr and over: 2 mg/kg IV infused over 3.5–4.5 hr once a wk.
ADV EFF Abd pain, chills, fatigue, fever, headache, hypersensitivity reaction, vomiting
NC/PT Pretreat w/ antihistamines, antipyretic 30–60 min before infusion. Slow or stop
infusion if sx of hypersensitivity reaction. Use cautiously in pregnancy, breast-feeding.
Pt should report difficulty breathing, cough, rash, chest pain.

eltrombopag (Promacta)
CLASS Thrombopoietin receptor agonist
PREG/CONT C/NA

BBW Risk of severe to fatal hepatotoxicity. Monitor LFTs closely; adjust dose or
discontinue as needed.
IND & DOSE Tx of chronic immune idiopathic thrombocytopenic purpura in pts
unresponsive to usual tx. Adult: 50–75 mg/day PO. Start Eastern Asian pts at
25 mg/day.
ADJUST DOSE Moderate hepatic failure
ADV EFF Back pain, bone marrow fibrosis, cataracts, headache, hepatotoxicity, n/v/d,
pharyngitis, thrombotic events, URI, UTI
INTERACTIONS Antacids, dairy products, oral anticoagulants, statins
NC/PT Do not give within 4 hr of antacids, dairy products. Monitor CBC, LFTs regularly
for safety, dose adjustment. Not for use w/ blood cancers; worsening possible. Monitor
for cataracts or vision changes. Not for use in pregnancy, breast-feeding. Pt should
report chest pain, bleeding, yellowing of eyes, skin.

emtricitabine (Emtriva)
CLASS Antiviral, nucleoside reverse transcriptase inhibitor
PREG/CONT B/NA

BBW Use caution w/ current/suspected hepatitis B; serious disease resurgence possible.

Withdraw drug, monitor pt w/ sx of lactic acidosis or hepatotoxicity, including
hepatomegaly, steatosis.
IND & DOSE Tx of HIV-1 infection w/ other antiretrovirals. Adult: 200 mg/day PO or
240 mg (24 mL) oral sol/day PO. Child 3 mo–17 yr: 6 mg/kg/day PO to max 240 mg (24
mL) oral sol. For child over 33 kg able to swallow capsule, one 200-mg capsule/day PO.
Child under 3 mo: 3 mg/kg/day oral sol PO.
ADJUST DOSE Renal impairment
ADV EFF Abd pain, asthenia, cough, dizziness, headache, insomnia, lactic acidosis,
n/v/d, rash, redistribution of body fat, rhinitis, severe hepatomegaly w/ steatosis
INTERACTIONS Atripla, lamivudine, Truvada; contraindicated
NC/PT HIV antibody testing before tx. Monitor LFTs, renal function regularly. Ensure use
w/ other antiretrovirals. Not for use in pregnancy, breast-feeding. Not a cure; pt should
use safety precautions. Pt should try to maintain nutrition, hydration (GI effects will
occur).

enalapril maleate (Epaned, Vasotec), enalaprilat (Vasotec I.V.)

CLASS ACE inhibitor, antihypertensive
PREG/CONT D/NA

BBW Possible serious fetal injury or death if used in second, third trimesters; advise
contraceptive use.
IND & DOSE Tx of hypertension. Adult: Initially, 5 mg/day PO; range, 10–40 mg/day.
Discontinue diuretics for 2–3 days before tx; if not possible, start w/ 2.5 mg/day PO or
1.25 mg IV q 6 hr; monitor pt response. If on diuretics, 0.625 mg IV over 5 min; repeat
in 1 hr if needed, then 1.25 mg IV q 6 hr. Child 2 mo–16 yr: 0.08 mg/kg PO once daily;
max, 5 mg. Tx of HF. Adult: 2.5 mg/day PO or bid w/ diuretics, digitalis; max,
40 mg/day. Tx of asymptomatic left ventricular dysfx. Adult: 2.5 mg PO bid; target
dose, 20 mg/day in two divided doses.
ADJUST DOSE Elderly pts, renal impairment, HF
ADV EFF Cough; decreased Hct, Hgb; diarrhea; dizziness; fatigue; renal failure
INTERACTIONS Indomethacin, NSAIDs, rifampin
NC/PT Adjust dose if pt also on diuretic. Peak effect may not occur for 4 hr. Monitor BP
before giving second dose; monitor closely in situations that might lead to BP drop.
Mark chart if surgery required; pt may need fluid support. Not for use in pregnancy
(contraceptives advised). Pt should take safety precautions w/ CNS effects.

enfuvirtide (Fuzeon)
CLASS Anti-HIV drug, fusion inhibitor
PREG/CONT B/NA

IND & DOSE Tx of HIV-1 infection in tx-experienced pts w/ evidence of HIV-1

replication despite ongoing tx, w/ other antiretrovirals. Adult: 90 mg bid by subcut
injection into upper arm, anterior thigh, or abdomen. Child 6–16 yr: 2 mg/kg bid by
subcut injection; max, 90 mg/dose into upper arm, anterior thigh, or abdomen.
ADV EFF Dizziness, injection-site reactions, n/v/d, pneumonia
NC/PT Ensure pt also on other antiretrovirals; rotate injection sites (upper arm, anterior
thigh, abdomen). Refrigerate reconstituted sol; use within 24 hr. Not for use in
pregnancy, breast-feeding. Not a cure; pt should use safety precautions. Teach pt proper
administration and disposal of syringes, needles.

DANGEROUS DRUG
enoxaparin (Lovenox)
CLASS Low-molecular-weight heparin
PREG/CONT B/NA

BBW Increased risk of spinal hematoma, neurologic damage if used w/ spinal/epidural

anesthesia. If must be used, monitor pt closely.
IND & DOSE Px of DVT after hip, knee replacement surgery. Adult: 30 mg subcut bid, w/
initial dose 12–24 hr after surgery. Continue for 7–10 days; then may give 40 mg daily
subcut for up to 3 wk. Px of DVT after abd surgery. Adult: 40 mg/day subcut begun
within 2 hr before surgery, continued for 7–10 days. Px of DVT in high-risk pts.
40 mg/day subcut for 6–11 days; has been used up to 14 days. Px of ischemic
complications of unstable angina and non-Q-wave MI. Adult: 1 mg/kg subcut q
12 hr for 2–8 days. Tx of DVT. Adult: 1 mg/kg subcut q 12 hr (for outpts);
1.5 mg/kg/day subcut or 1 mg/kg subcut q 12 hr (for inpts). Tx of MI. Adult: 75 yr and
older, 0.75 mg/kg subcut q 12 hr (max, 75 mg for first two doses only). Under 75 yr, 30-
mg IV bolus plus 1 mg/kg subcut followed by 1 mg/kg subcut q 12 hr w/ aspirin (max,
100 mg for first two doses only).
ADJUST DOSE Renal impairment
ADV EFF Bruising, chills, fever, hemorrhage, injection-site reactions
INTERACTIONS Aspirin, cephalosporins, chamomile, garlic, ginger, ginkgo, ginseng, high-
dose vitamin E, NSAIDs, penicillins, oral anticoagulants, salicylates
NC/PT Give as soon as possible after hip surgery, within 12 hr of knee surgery, and
within 2 hr preop for abd surgery. Use deep subcut injection, not IM; alternate sites. Do
not mix w/ other injections or sols. Store at room temp. Have protamine sulfate on hand
as antidote. Check for s&sx of bleeding; protect pt from injury. Teach pt proper
administration and disposal of syringes, needles.

entacapone (Comtan)
CLASS Antiparkinsonian
PREG/CONT C/NA

IND & DOSE Adjunct w/ levodopa/carbidopa in tx of s&sx of idiopathic Parkinson’s

disease in pts experiencing “wearing off” of drug effects. Adult: 200 mg PO
concomitantly w/ levodopa/carbidopa; max, eight times/day.
ADV EFF Confusion, disorientation, dizziness, dry mouth, dyskinesia, fever,
hallucinations, hyperkinesia, hypotension, n/v, orthostatic hypotension,
rhabdomyolysis
INTERACTIONS Ampicillin, apomorphine, chloramphenicol, cholestyramine, dobutamine,
dopamine, epinephrine, erythromycin, isoetharine, isoproterenol, MAOIs, methyldopa,
norepinephrine, rifampin
NC/PT Give only w/ levodopa/carbidopa; do not give within 14 days of MAOIs. Not for
use in pregnancy (contraceptives advised), breast-feeding. Pt should use sugarless
lozenges for dry mouth, take safety precautions w/ CNS effects.

entecavir (Baraclude)
CLASS Antiviral, nucleoside analogue
PREG/CONT C/NA

BBW Withdraw drug, monitor pt if s&sx of lactic acidosis or hepatotoxicity, including

hepatomegaly and steatosis. Do not use in pts w/ HIV unless pt receiving highly active
antiretroviral tx, because of high risk of HIV resistance. Offer HIV testing to all pts
before starting entecavir. Severe, acute hepatitis B exacerbations have occurred in pts
who discontinue antihepatitis tx. Monitor pts for several mo after drug cessation;
restarting antihepatitis tx may be warranted.
IND & DOSE Tx of chronic hepatitis B infection in pts w/ evidence of active viral
replication and active disease. Adult, child 16 yr and older w/ no previous nucleoside tx:
0.5 mg/day PO on empty stomach at least 2 hr after meal or 2 hr before next meal.
Adult, child 16 yr and older w/ hx of viremia also receiving lamivudine or w/ known
resistance mutations: 1 mg/day PO on empty stomach at least 2 hr after meal or 2 hr
before next meal.
ADJUST DOSE Renal impairment
ADV EFF Acute exacerbation of hepatitis B when discontinuing, dizziness, fatigue,
headache, nausea
INTERACTIONS Nephrotoxic drugs
NC/PT Assess renal function regularly. Give on empty stomach at least 2 hr after meal or
2 hr before next meal. Not a cure; pt should take precautions. Not for use in pregnancy,
breast-feeding. Pt should not run out of or stop drug suddenly (severe hepatitis
possible), should take safety precautions w/ dizziness, report unusual muscle pain.

enzalutamide (Xtandi)
CLASS Androgen receptor inhibitor, antineoplastic
PREG/CONT X/NA

IND & DOSE Tx of metastatic castration-resistant prostate cancer in pts previously

on docetaxel. Adult: 160 mg/day PO once daily.
ADV EFF Arthralgia, asthenia, anxiety, back pain, diarrhea, dizziness, edema, flushing,
headache, hematuria, hypertension, paresthesia, seizures, weakness
INTERACTIONS Midazolam, omeprazole, pioglitazone, warfarin; avoid concurrent use.
Gemfibrozil
NC/PT Monitor for CNS reactions; provide safety precautions. Not for use in pregnancy.
Pt should swallow capsule whole and not cut, crush, or chew it; use caution w/ CNS
effects; report falls, severe headache, problems thinking clearly.

DANGEROUS DRUG
ephedrine sulfate (generic)
CLASS Bronchodilator, sympathomimetic, vasopressor
PREG/CONT C/NA

IND & DOSE Tx of hypotensive episodes, allergic disorders. Adult: 25–50 mg IM (fast
absorption) or subcut (slower absorption), or 5–25 mg IV slowly; may repeat in 5–10
min. Child: 0.5 mg/kg or 16.7 mg/m2 IM or subcut q 4–6 hr. Tx of acute asthma,
allergic disorders. Adult: 12.5–25 mg PO q 4 hr.
ADJUST DOSE Elderly pts
ADV EFF Anxiety, CV collapse w/ hypotension, dizziness, dysuria, fear, hypertension
resulting in intracranial hemorrhage, pallor, palpitations, precordial pain in pts
w/ ischemic heart disease, restlessness, tachycardia, tenseness
INTERACTIONS Caffeine, ephedra, guarana, ma huang, MAOIs, methyldopa, TCAs, urinary
acidifiers/alkalinizers
NC/PT Protect sol from light. Give only if sol clear; discard unused portion. Monitor CV
status, urine output. Avoid prolonged systemic use. Pt should avoid OTC products w/
similar action, take safety precautions w/ CNS effects.
 DANGEROUS DRUG
epinephrine bitartrate (Primatene Mist), epinephrine hydrochloride
(Adrenaclick, AsthmaNefrin, EpiPen Auto-Injector)
CLASS Antiasthmatic, cardiac stimulant, sympathomimetic, vasopressor
PREG/CONT C/NA

IND & DOSE Tx in cardiac arrest. Adult: 0.5–1 mg (5–10 mL of 1:10,000 sol) IV during
resuscitation, 0.5 mg q 5 min. Intracardiac injection into left ventricular chamber, 0.3–
0.5 mg (3–5 mL of 1:10,000 sol). Hypersensitivity, bronchospasm. Adult: 0.1–0.25 mg
(1–2.5 mL of 1:10,000 sol) injected slowly IV or 0.2–1 mL of 1:1,000 sol subcut or IM, or
0.1–0.3 mL (0.5–1.5 mg) of 1:200 sol subcut. Child: 1:1,000 sol, 0.01 mg/kg or 0.3
mL/m2 (0.01 mg/kg or 0.3 mg/m2) subcut. Repeat q 4 hr if needed; max, 0.5 mL
(0.5 mg) in single dose. For neonates, 0.01 mg/kg subcut; for infants, 0.05 mg subcut as
initial dose. Repeat q 20–30 min as needed. Child 30 kg or less: 1:10,000 sol, 0.15 mg or
0.01 mg/kg by autoinjector. Temporary relief from acute attacks of bronchial
asthma, COPD. Adult, child 4 yr and older: 1 inhalation, wait 1 min, then may use once
more. Do not repeat for at least 3 hr. Or, place not more than 10 drops into nebulizer
reservoir, place nebulizer nozzle into partially opened mouth, have pt inhale deeply
while bulb is squeezed one to three times (not more than q 3 hr).
ADJUST DOSE Elderly pts
ADV EFF Anxiety, CV collapse w/ hypotension, dizziness, dysuria, fear, hypertension
resulting in intracranial hemorrhage, pallor, palpitations, precordial pain in pts
w/ ischemic heart disease, restlessness, tachycardia, tenseness
INTERACTIONS Beta blockers, chlorpromazine, ephedra, guarana, ma huang, methyldopa,
propranolol, TCAs
NC/PT Use extreme caution when calculating doses; small margin of safety. Protect sol
from light, heat. Rotate subcut injection sites. Have alpha-adrenergic blocker on hand
for hypertensive crises/pulmonary edema, beta blocker on hand for cardiac
arrhythmias. Do not exceed recommended dose of inhalants. Pt should take safety
precautions w/ CNS effects.

DANGEROUS DRUG
epirubicin hydrochloride (Ellence)
CLASS Antineoplastic antibiotic
PREG/CONT D/NA

BBW Cardiac toxicity possible; monitor ECG closely. Severe tissue necrosis w/
extravasation. Secondary acute myelogenous leukemia possible. Reduce dose in hepatic
impairment. Monitor for severe bone marrow suppression.
IND & DOSE Adjunct tx in pts w/ evidence of axillary node tumor involvement after
resection of primary breast cancer. Adult: 100–120 mg/m2 IV in repeated 3- to 4-wk
cycles, all on day 1; given w/ cyclophosphamide and 5-FU.
ADJUST DOSE Elderly pts; hepatic, severe renal impairment
ADV EFF Alopecia, bone marrow suppression, HF, infection, leukemia, local injection-
site toxicity/rash, n/v/d, renal toxicity, thromboembolic events
INTERACTIONS Cardiotoxic drugs, cimetidine, live vaccines
NC/PT Monitor baseline and periodic ECG to evaluate for toxicity. Premedicate w/
antiemetic. Monitor injection site carefully. Monitor CBC regularly; dose adjustment
may be needed. Not for use in pregnancy, breast-feeding. Pt should mark calendar of tx
dates.

eplerenone (Inspra)
CLASS Aldosterone receptor blocker, antihypertensive
PREG/CONT B/NA

IND & DOSE Tx of hypertension. Adult: 50 mg/day PO as single dose; may increase to
50 mg PO bid after minimum 4-wk trial period. Max, 100 mg/day. Tx of HF post-MI.
Adult: Initially, 25 mg/day PO; titrate to 50 mg/day over 4 wk. If serum potassium
lower than 5, increase dose; if 5–5.4, no adjustment needed; if 5.5–5.9, decrease dose; if
6 or higher, withhold dose.
ADV EFF Dizziness, gynecomastia, headache, hyperkalemia, MI
INTERACTIONS ACE inhibitors, amiloride, ARBs, NSAIDs, spironolactone, triamterene;
serious reactions w/ erythromycin, fluconazole, itraconazole, ketoconazole, lithium,
saquinavir, verapamil
NC/PT Monitor potassium, renal function; suggest limiting potassium-rich foods. Not for
use in pregnancy, breast-feeding. Pt should avoid OTC drugs that might interact, weigh
self daily, report changes of 3 lb or more/day.

epoetin alfa (EPO, erythropoietin) (Epogen, Procrit)

CLASS Recombinant human erythropoietin
PREG/CONT C/NA

BBW Increased risk of death, serious CV events if Hgb target is over 11 g/dL. Use lowest
levels of drug needed to increase Hgb to lowest level needed to avoid transfusion.
Incidence of DVT higher in pts receiving erythropoietin-stimulating agents preop to
reduce need for transfusion; consider antithrombotic px if used for this purpose. Pts w/
cancer at risk for more rapid tumor progression, shortened survival, death when Hgb
target is over 12 g/dL. Increased risk of death in cancer pts not receiving radiation or
chemotherapy.
IND & DOSE Tx of anemia of chronic renal failure. Adult: 50–100 units/kg three
times/wk IV for dialysis pts, IV or subcut for nondialysis pts. Maint, 75–100 units/kg
three times/wk. If on dialysis, median dose is 75 units/kg three times/wk. Target Hgb
range, 10–11 g/dL. Child 1 mo–16 yr: 50 units/kg IV or subcut three times/wk. Tx of
anemia in HIV-infected pts on AZT therapy. Adult: For pts receiving AZT dose of
4,200 mg/wk or less w/ serum erythropoietin levels of 500 milliunits/mL or less, 100
units/kg IV or subcut three times/wk for 8 wk. Tx of anemia in cancer pts on
chemotherapy (Procrit only). Adult: 150 units/kg subcut three times/wk or 40,000 units
subcut wkly. After 8 wk, can increase to 300 units/kg or 60,000 units subcut wkly. Child
1 mo–16 yr: 600 units/kg per wk IV; max, 60,000 units/dose in child 5 yr and older. To
reduce allogenic blood transfusions in surgery. Adult: 300 units/kg/day subcut for
10 days before surgery, on day of surgery, and 4 days after surgery. Or,
600 units/kg/day subcut 21, 14, and 7 days before surgery and on day of surgery. Tx of
anemia of prematurity. Child: 25–100 units/kg/dose IV three times/wk.
ADV EFF Arthralgia, asthenia, chest pain, development of anti-erythropoietin
antibodies, dizziness, edema, fatigue, headache, hypertension, n/v/d, seizures, stroke,
tumor progression/shortened survival (w/ cancers)
NC/PT Confirm nature of anemia. Do not give in sol w/ other drugs. Monitor access lines
for clotting. Monitor Hgb (target range, 10–11 g/dL; max, 11 g/dL). Evaluate iron stores
before and periodically during tx; supplemental iron may be needed. Monitor for sudden
loss of response and severe anemia w/ low reticulocyte count; withhold drug and check
for anti-erythropoietin antibodies. Must give subcut three times/wk. Pt should keep
blood test appointments to monitor response to drug, report difficulty breathing, chest
pain, severe headache.

epoprostenol sodium (Flolan, Veletri)

CLASS Prostaglandin
PREG/CONT B/NA

IND & DOSE Tx of primary pulmonary hypertension in pts unresponsive to standard

tx. Adult: 2 ng/kg/min IV w/ increases of 2 ng/kg as tolerated through infusion pump
using central line; 20–40 ng/kg/min common range after 6 mo
ADV EFF Anxiety, agitation, chest pain, flushing, headache, hypotension, muscle aches,
n/v/d, pain; rebound pulmonary hypertension (w/ sudden stopping)
INTERACTIONS Antihypertensives, diuretics, vasodilators
NC/PT Must deliver through continuous infusion pump. Use caution in pregnancy, breast-
feeding. Teach pt, significant other maint and use of pump. Do not stop suddenly; taper
if discontinuing. Pt should use analgesics for headache, muscle aches.

eprosartan mesylate (Teveten)

CLASS Antihypertensive, ARB
PREG/CONT D/NA

BBW Rule out pregnancy before starting tx. Suggest barrier birth control; fetal injury,
deaths have occurred. If pregnancy detected, discontinue as soon as possible.
IND & DOSE Tx of hypertension. Adult: 600 mg PO daily. Can give in divided doses bid w/
target dose of 400–800 mg/day.
ADJUST DOSE Renal impairment
ADV EFF Abd pain, diarrhea, dizziness, headache, URI symptoms
INTERACTIONS Potassium-elevating drugs
NC/PT If BP not controlled, may add other antihypertensives. Monitor fluid intake. Use
caution if pt goes to surgery; volume depletion possible. Not for use in pregnancy
(barrier contraception advised), breast-feeding. Pt should use care in situations that
could lead to volume depletion.

DANGEROUS DRUG
eptifibatide (Integrelin)
CLASS Antiplatelet, glycoprotein IIb/IIIa receptor agonist
PREG/CONT B/NA

IND & DOSE Tx of acute coronary syndrome. Adult:180 mcg/kg IV (max, 22.6 mg) over
1–2 min as soon as possible after dx, then 2 mcg/kg/min (max, 15 mg/hr) by continuous
IV infusion for up to 72 hr. If pt is to undergo percutaneous coronary intervention (PCI),
continue for 18–24 hr after procedure, up to 96 hr of tx. Px of ischemia w/ PCI.
180 mcg/kg IV as bolus immediately before PCI, then 2 mcg/kg/min by continuous IV
infusion for 18–24 hr. May give second bolus of 180 mcg/kg 10 min.
ADJUST DOSE Renal impairment
ADV EFF Bleeding, dizziness, headache, hypotension, rash
INTERACTIONS Anticoagulants, clopidogrel, dipyridamole, NSAIDs, thrombolytics,
ticlopidine
NC/PT Used w/ aspirin, heparin. Arrange for baseline and periodic CBC, PT, aPTT, active
clotting time; maintain aPTT of 50–70 sec and active clotting time of 300–350 sec. Avoid
invasive procedures. Ensure compression of sites. Pt should use analgesics for headache,
take safety precautions for dizziness.

ergotamine tartrate (Ergomar)

CLASS Antimigraine, ergot
PREG/CONT X/NA

IND & DOSE Px, tx of vascular headaches. Adult: 2 mg under tongue at first sign of
headache. May repeat at 30-min intervals; max, 6 mg/day or 10 mg/wk.
ADV EFF Cyanosis, gangrene, headache, hypertension, ischemia, itching, n/v, pulmonary
fibrosis, tachycardia
INTERACTIONS Beta blockers, epinephrine, macrolide antibiotics, nicotine, protease
inhibitors, sympathomimetics
NC/PT Not for use in pregnancy, breast-feeding. Pt should take at first sign of headache;
not take more than 3 tablets in 24 hr; report difficulty breathing, numbness or tingling,
chest pain.

eribulin mesylate (Halaven)

CLASS Antineoplastic, microtubular inhibitor
PREG/CONT D/NA

IND & DOSE Tx of metastatic breast cancer in pts previously treated w/ at least two
chemotherapeutic regimens. Adult:1.4 mg/m2 IV over 2–5 min on days 1 and 8 of 21-
day cycle.
ADJUST DOSE Hepatic, renal impairment
ADV EFF Alopecia, asthenia, bone marrow suppression, constipation, nausea, QT
prolongation, peripheral neuropathy
INTERACTIONS Dextrose-containing solutions, QT-prolonging drugs
NC/PT Obtain baseline ECG; monitor QT interval. Monitor for bone marrow suppression,
(adjust dose accordingly), peripheral neuropathy (dose adjustment may be needed). Not
for use in pregnancy, breast-feeding. Protect from infection. Hair loss possible. Pt should
cover head at extremes of temp; report fever, chills, cough, burning on urination.

erlotinib (Tarceva)
CLASS Antineoplastic, monoclonal antibody
PREG/CONT D/NA

IND & DOSE Tx of locally advanced or metastatic non-small-cell lung cancer after
failure of other chemotherapy. Adult: 150 mg/day PO on empty stomach. Tx of
locally advanced, unresectable or metastatic pancreatic cancer, w/ gemcitabine.
Adult: 100 mg/day PO w/ IV gemcitabine.
ADJUST DOSE Hepatic, renal impairment; lung dysfx
ADV EFF Abd pain, anorexia, bleeding, corneal ulcerations, cough, dyspnea,
exfoliative skin disorders, fatigue, GI perforation, hepatic failure, hemolytic
anemia, interstitial pulmonary disease, MI, n/v/d, rash, renal failure
INTERACTIONS Antacids, cigarette smoking, CYP3A4 inducers/inhibitors, midazolam
NC/PT Monitor LFTs, renal function regularly. Monitor pulmonary status. Assess cornea
before and periodically during tx. Provide skin care, including sunscreen, alcohol-free
emollient cream. Not for use in pregnancy, breast-feeding. Pt should report severe
diarrhea, difficulty breathing, worsening rash, vision changes.

ertapenem (Invanz)
CLASS Carbapenem antibiotic
PREG/CONT B/NA

IND & DOSETx of community-acquired pneumonia; skin, skin-structure infections,

including diabetic foot infections; complicated GU, intra-abdominal infections;
acute pelvic infections caused by susceptible bacteria strains; px of surgical-site
infection after colorectal surgery. Adult, child 13 yr and older: 1 g IM or IV each day.
Length of tx varies w/ infection: intra-abdominal, 5–14 days; urinary tract, 10–14 days;
skin, skin-structure, 7–14 days; community-acquired pneumonia, 10–14 days; acute
pelvic, 3–10 days. Child 3 mo–12 yr: 15 mg/kg IV or IM bid for 3–14 days; max, 1 g/day.
ADJUST DOSE Renal impairment
ADV EFF Anaphylaxis, headache, hypersensitivity reaction, local pain/phlebitis at
injection site; n/v/d, pseudomembranous colitis, superinfections
NC/PT Culture before tx. Give by deep IM injection; have emergency equipment on hand
for hypersensitivity reactions. Monitor injection site for reaction. Treat superinfections.
Pt should report severe or bloody diarrhea, pain at injection site. Name confusion
between Avinza (ER morphine) and Invanz (ertapenem); use extreme caution.

erythromycin salts (Eryderm, Eryped, Erythrocin)

CLASS Macrolide antibiotic
PREG/CONT B/NA

IND & DOSE Tx of infections caused by susceptible bacteria. Adult: General guidelines,
15–20 mg/kg/day by continuous IV infusion or up to 4 g/day in divided doses q 6 hr; or
250 mg (400 mg ethylsuccinate) PO q 6 hr or 500 mg PO q 12 hr or 333 mg PO q 8 hr,
up to 4 g/day, depending on infection severity. Child: General guidelines, 30–
50 mg/kg/day PO in divided doses. Specific dose determined by infection severity, age,
weight. Tx of streptococcal infections. Adult: 250 mg PO q 6 hr or 500 mg PO q 12 hr
(for group A beta-hemolytic streptococcal infections, continue tx for at least 10 days).
Tx of Legionnaires’ disease. Adult: 1–4 g/day PO or IV in divided doses for 10–
21 days. Tx of dysenteric amebiasis. Adult: 250 mg PO q 6 hr or 333 mg PO q 8 hr for
10–14 days. Child: 30–50 mg/kg/day PO in divided doses for 10–14 days. Tx of acute
PID (Neisseria gonorrhoeae). Adult: 500 mg IV q 6 hr for 3 days, then 250 mg PO q 6 hr or
333 mg PO q 8 hr or 500 mg PO q 12 hr for 7 days. Tx of chlamydial infections. Adult:
Urogenital infections during pregnancy, 500 mg PO qid or 666 mg PO q 8 hr for at least
7 days; ½ this dose q 8 hr for at least 14 days if intolerant to first regimen. Urethritis in
males, 800 mg ethylsuccinate PO tid for 7 days. Child: 50 mg/kg/day PO in divided
doses, for at least 2 (conjunctivitis of newborn) or 3 (pneumonia of infancy) wk. Tx of
primary syphilis. Adult: 30–40 g PO in divided doses over 10–15 days. CDC
recommendations for STDs. Adult: 500 mg PO qid for 7–30 days, depending on
infection. Tx of pertussis. Child: 40–50 mg/kg/day PO in divided doses for 14 days. Tx
of superficial ocular infections caused by susceptible strains. Adult, child: ½-inch
ribbon instilled into conjunctival sac of affected eye two to six times/day, depending on
infection severity. Tx of acne (dermatologic sol). Adult, child: Apply to affected areas
a.m. and p.m. Tx of skin infections caused by susceptible bacteria. Adult, child:
Apply flexible hydroactive dressings and granules; keep in place for 1–7 days.
ADV EFF Abd pain, anaphylaxis, anorexia, local irritation w/ topical use; n/v/d,
pseudomembranous colitis, superinfections
INTERACTIONS Calcium channel blockers, carbamazepine, corticosteroids, cyclosporine,
digoxin, disopyramide, ergots, grapefruit juice, midazolam, oral anticoagulants, proton
pump inhibitors, quinidine, statins, theophylline
NC/PT Culture before tx. Give oral drug on empty stomach round the clock for best
results. Monitor LFTs w/ long-term use. Apply topical form to clean, dry area. Pt should
avoid grapefruit juice, report severe or bloody diarrhea.

escitalopram oxalate (Lexapro)

CLASS Antidepressant, SSRI
PREG/CONT C/NA

BBW Monitor for suicidality, especially when starting tx or altering dose. Increased risk
in children, adolescents, young adults.
IND & DOSE Tx of major depressive disorder. Adult: 10 mg/day PO as single dose; may
increase to 20 mg/day after minimum of 1-wk trial period. Maint, 10–20 mg/day PO.
Child 12–17 yr: 10 mg/day PO as single dose; max, 20 mg/day. Tx of generalized
anxiety disorder. Adult: 10 mg/day PO; may increase to 20 mg/day after 1 wk if
needed.
ADJUST DOSE Elderly pts, hepatic impairment
ADV EFF Anaphylaxis, angioedema, dizziness, ejaculatory disorders, nausea,
somnolence, suicidality
INTERACTIONS Alcohol, carbamazepine, citalopram, lithium, MAOIs, SSRIs, St. John’s wort
NC/PT Limit supply in suicidal pts. Do not use within 14 days of MAOIs. Taper after long-
term use. Not for use in pregnancy, breast-feeding. Use safety precautions. May need 4
wk to see effects. Pt should not stop drug suddenly; avoid alcohol, St John’s wort; report
thoughts of suicide. Name confusion between escitalopram and citalopram and Lexapro
(escitalopram) and Loxitane (loxapine); use caution.

eslicarbazepine acetate (Aptiom)

CLASS Antiepileptic, sodium channel blocker
PREG/CONT C/NA

IND & DOSE Adjunct tx for partial-onset seizures. Adult: 400 mg/day PO; after 1 wk,
increase to 800 mg/day PO. Max, 1,200 mg/day.
ADJUST DOSE Severe renal impairment (not recommended)
ADV EFF Anaphylaxis, dizziness, double vision, drowsiness, fatigue, headache,
hyponatremia, liver damage, n/v, suicidality
INTERACTIONS Carbamazepine, hormonal contraceptives, phenobarbital, phenytoin,
primidone
NC/PT Ensure proper dx. Monitor LFTs, serum electrolytes; ensure safety precautions w/
CNS effects. Pt should avoid pregnancy, breastfeeding; take safety precautions with CNS
effects; report thoughts of suicide, difficulty breathing, changes in color of urine/stool.

DANGEROUS DRUG
esmolol hydrochloride (Brevibloc)
CLASS Antiarrhythmic, beta-selective adrenergic blocker
PREG/CONT C/NA

IND & DOSE Tx of supraventricular tachycardia; noncompensatory tachycardia;

intraop, postop tachycardia and hypertension. Adult: Initial loading dose,
500 mcg/kg/min IV for 1 min, then maint of 50 mcg/kg/min for 4 min. If response
inadequate after 5 min, repeat loading dose and follow w/ maint infusion of
100 mcg/kg/min. Repeat titration as needed, increasing rate of maint dose in 50-
mcg/kg/min increments. As desired heart rate or safe endpoint is approached, omit
loading infusion and decrease incremental dose in maint infusion to 25 mcg/kg/min (or
less), or increase interval between titration steps from 5 to 10 min. Usual range, 50–
200 mcg/kg/min. Up to 24-hr infusions have been used; up to 48 hr may be well
tolerated. Individualize dose based on pt response; max, 300 mcg/kg/min.
ADV EFF Hypotension, inflammation at injection site, light-headedness, midscapular pain,
rigors, weakness
INTERACTIONS Ibuprofen, indomethacin, piroxicam, verapamil
NC/PT Do not give undiluted. Do not mix in sol w/ sodium bicarbonate, diazepam,
furosemide, thiopental. Not for long-term use. Closely monitor BP, ECG.

esomeprazole magnesium (Nexium)

CLASS Antisecretory, proton pump inhibitor
PREG/CONT B/NA

IND & DOSE Healing of erosive esophagitis. Adult: 20–40 mg PO daily for 4–8 wk.
Maint, 20 mg PO daily. Child 1–11 yr: 20 kg or more, 10–20 mg/day PO for up to 8 wk;
under 20 kg, 10 mg/day PO for up to 8 wk. Tx of symptomatic GERD. Adult: 20 mg PO
daily for 4 wk. Can use additional 4-wk course. Child 12–17 yr: 20–40 mg/day PO for up
to 8 wk. Child 1–11 yr: 10 mg/day PO for up to 8 wk. Tx of duodenal ulcer. Adult:
40 mg/day PO for 10 days w/ 1,000 mg PO bid amoxicillin and 500 mg PO bid
clarithromycin. Reduction of risk of gastric ulcers w/ NSAID use. Adult: 20–40 mg PO
daily for 6 mo. Short-term tx of GERD when oral therapy not possible. Adult, child 1
mo–17 yr: 20–40 mg IV by injection over at least 3 min or IV infusion over 10–30 min.
ADJUST DOSE Severe hepatic impairment
ADV EFF Abd pain, bone loss w/ long-term use, Clostridium difficile diarrhea,
dizziness, headache, hypomagnesemia, n/v/d, pneumonia, sinusitis, URI
INTERACTIONS Atazanavir, benzodiazepines, digoxin, iron salts, ketoconazole
NC/PT Give at least 1 hr before meals; may give through NG tube. Monitor LFTs
periodically. Limit IV use to max 10 days. Pt should swallow capsules whole and not cut,
crush, or chew them; take safety precautions w/ CNS effects.; report diarrhea, difficulty
breathing. Name confusion between esomeprazole and omeprazole, Nexium
(esomeprazole) and Nexavar (sorafenib); use caution.

estazolam (generic)
CLASS Benzodiazepine, sedative-hypnotic
PREG/CONT X/C-IV

IND & DOSETx of insomnia, recurring insomnia, acute or chronic medical conditions
requiring restful sleep. Adult: 1 mg PO before bedtime; may need up to 2 mg.
ADJUST DOSE Elderly pts, debilitating disease,
ADV EFF Anaphylaxis, angioedema, apathy, bradycardia, constipation, CV collapse,
depression, diarrhea, disorientation, drowsiness, drug dependence w/ withdrawal
syndrome, dyspepsia, lethargy, light-headedness, tachycardia, urine retention
INTERACTIONS Alcohol, aminophylline, barbiturates, opioids, phenothiazines, rifampin,
TCAs, theophylline
NC/PT Monitor LFTs, renal function. Taper after long-term use. Pt should avoid alcohol,
use only as needed (can be habit-forming), take safety precautions w/ CNS effects.

estradiol, estradiol acetate, estradiol cypionate, estradiol hemihydrate,

estradiol valerate (Delestrogen, Estrace, Estring, Evamist, Femring, Vagifem)
CLASS Estrogen
PREG/CONT X/NA

BBW Arrange for pretreatment and periodic (at least annual) hx and physical; should
include BP, breasts, abdomen, pelvic organs, Pap test. May increase risk of endometrial
cancer. Do not use to prevent CV events, dementia; may increase risks, including
thrombophlebitis, PE, stroke, MI. Caution pt of risks of estrogen use. Stress need for
pregnancy prevention during tx, frequent medical follow-up, periodic rests from tx.
IND & DOSE Relief of moderate to severe vasomotor symptoms, atrophic vaginitis,
kraurosis vulvae associated w/ menopause. Adult: 1–2 mg/day PO. Adjust dose to
control symptoms. For gel, 0.25 g 0.1% gel applied to right or left upper thigh on
alternating days; may increase to 0.5 or 1 g/day to control symptoms. For topical spray
(Evamist), 1 spray once daily to forearm; may increase to 2–3 sprays daily. Cyclic
therapy (3 wk on/1 wk off) recommended, especially in women w/ no hysterectomy. 1–
5 mg estradiol cypionate in oil IM q 3–4 wk. 10–20 mg estradiol valerate in oil IM q 4
wk. 0.014- to 0.05-mg system applied to skin wkly or twice wkly. If oral estrogens have
been used, start transdermal system 1 wk after withdrawal of oral form. Given on cyclic
schedule (3 wk on/1 wk off). Attempt to taper or discontinue q 3–6 mo. Vaginal cream:
2–4 g intravaginally daily for 1–2 wk, then reduce to ½ dose for similar period followed
by maint of 1 g one to three times/wk thereafter. Discontinue or taper at 3- to 6-mo
intervals. Vaginal ring: Insert one ring high into vagina. Replace q 90 days. Vaginal
tablet: 1 tablet inserted vaginally daily for 2 wk, then twice wkly. Emulsion: Apply
lotion to legs, thighs, or calves once daily. Apply gel to one arm once daily. Tx of
female hypogonadism, female castration, primary ovarian failure. Adult: 1–
2 mg/day PO. Adjust to control symptoms. Cyclic therapy (3 wk on/1 wk off)
recommended. 1.5–2 mg estradiol cypionate in oil IM at monthly intervals. 10–20 mg
estradiol valerate in oil IM q 4 wk. 0.05-mg system applied to skin twice wkly as above.
Tx of prostate cancer (inoperable). Adult: 1–2 mg PO tid; give long-term. 30 mg or
more estradiol valerate in oil IM q 1–2 wk. Tx of breast cancer (inoperable,
progressing). Adult: 10 mg tid PO for at least 3 mo. Prevention of postpartum breast
engorgement. Adult: 10–25 mg estradiol valerate in oil IM as single injection at end of
first stage of labor. Px of osteoporosis. Adult: 0.5 mg/day PO cyclically (23 days on,
5 days rest) starting as soon after menopause as possible.
ADV EFF Acute pancreatitis, abd cramps, bloating, cancer, chloasma, cholestatic
jaundice, colitis, dysmenorrhea, edema, hepatic adenoma, menstrual flow changes,
n/v/d, pain at injection site, photosensitivity, premenstrual syndrome, thrombotic
events
INTERACTIONS Barbiturates, carbamazepine, corticosteroids, phenytoins, rifampin
NC/PT Give cyclically for short-term use. Give w/ progestin for women w/ intact uterus.
Review proper administration for each drug type. Potentially serious adverse effects.
Not for use in pregnancy, breast-feeding. Pt should get regular pelvic exams, avoid sun
exposure, report pain in calves/chest, lumps in breast, vision or speech changes.

estrogens, conjugated (Cenestin, Enjuvia, Premarin)

CLASS Estrogen
PREG/CONT X/NA

BBW Arrange for pretreatment and periodic (at least annual) hx and physical; should
include BP, breasts, abdomen, pelvic organs, Pap test. May increase risk of endometrial
cancer. Do not use to prevent CV events, dementia; may increase risks, including
thrombophlebitis, PE, stroke, MI. Caution pt of risks of estrogen use. Stress need for
pregnancy prevention during tx, frequent medical follow-up, periodic rests from tx.
IND & DOSE Relief of moderate to severe vasomotor symptoms associated w/
menopause: Adult: 0.3–0.625 mg/day PO. Tx of atrophic vaginitis, kraurosis vulvae
associated w/ menopause. Adult: 0.5–2 g vaginal cream daily intravaginally or
topically, depending on severity. Taper or discontinue at 3- to 6-mo intervals. Or,
0.3 mg/day PO continually. Tx of female hypogonadism. Adult: 0.3–0.625 mg/day PO
for 3 wk, then 1 wk rest. Tx of female castration, primary ovarian failure. Adult:
1.25 mg/day PO. Tx of prostate cancer (inoperable). Adult: 1.25–2.5 mg PO tid. Tx of
osteoporosis. Adult: 0.3 mg/day PO continuously or cyclically (25 days on/5 days off).
Breast cancer (inoperable, progressing). Adult: 10 mg PO tid for at least 3 mo.
Abnormal uterine bleeding due to hormonal imbalance. 25 mg IV or IM. Repeat in
6–12 hr as needed. More rapid response w/ IV route.
ADV EFF Acute pancreatitis, abd cramps, bloating, cancer, chloasma, cholestatic
jaundice, colitis, dysmenorrhea, edema, headache, hepatic adenoma, menstrual flow
changes, n/v/d, pain at injection site, photosensitivity, premenstrual syndrome,
thrombotic events
INTERACTIONS Barbiturates, carbamazepine, corticosteroids, phenytoins, rifampin
NC/PT Give cyclically for short-term use. Give w/ progestin for women w/ intact uterus.
Review proper administration for each drug type. Potentially serious adverse effects.
Not for use in pregnancy, breast-feeding. Pt should get regular pelvic exams, avoid sun
exposure, report pain in calves/chest, lumps in breast, vision or speech changes.

estrogens, esterified (Menest)

CLASS Estrogen
PREG/CONT X/NA

BBW Arrange for pretreatment and periodic (at least annual) hx and physical; should
include BP, breasts, abdomen, pelvic organs, Pap test. May increase risk of endometrial
cancer. Do not use to prevent CV events or dementia; may increase risks, including
thrombophlebitis, PE, stroke, MI. Caution pt of risks of estrogen use. Stress need for
pregnancy prevention during tx, frequent medical follow-up, periodic rests from drug tx.
Give cyclically for short-term only when treating postmenopausal conditions because of
endometrial neoplasm risk. Taper to lowest effective dose; provide drug-free wk each
mo.
IND & DOSE Relief of moderate to severe vasomotor symptoms, atrophic vaginitis,
kraurosis vulvae associated w/ menopause. Adult: 0.3–1.25 mg/day PO given
cyclically (3 wk on/1 wk off). Use lowest possible dose. Tx of female hypogonadism.
Adult: 2.5–7.5 mg/day PO in divided doses for 20 days on/10 days off. Female
castration, primary ovarian failure. Adult: 1.25 mg/day PO given cyclically. Prostate
cancer (inoperable). Adult: 1.25–2.5 mg PO tid. Inoperable, progressing breast
cancer. Adult: 10 mg PO tid for at least 3 mo.
ADV EFF Acute pancreatitis, abd cramps, bloating, cancer, chloasma, cholestatic
jaundice, colitis, dysmenorrhea, edema, headache, hepatic adenoma, menstrual flow
changes, n/v/d, pain at injection site, photosensitivity, premenstrual syndrome,
thrombotic events
INTERACTIONS Barbiturates, carbamazepine, corticosteroids, phenytoins, rifampin
NC/PT Give cyclically for short-term use. Give w/ progestin for women w/ intact uterus.
Review proper administration for each drug type. Potentially serious adverse effects.
Not for use in pregnancy, breast-feeding. Pt should get regular pelvic exams, avoid sun
exposure, report pain in calves/chest, lumps in breast, vision or speech changes.

estropipate (generic)
CLASS Estrogen
 PREG/CONT X/NA

BBW Arrange for pretreatment and periodic (at least annual) hx and physical; should
include BP, breasts, abdomen, pelvic organs, Pap test. May increase risk of endometrial
cancer. Do not use to prevent CV events or dementia; may increase risks, including
thrombophlebitis, PE, stroke, MI. Caution pt of risks of estrogen use. Stress need for
pregnancy prevention during tx, frequent medical follow-up, periodic rests from drug tx.
Give cyclically for short term only when treating postmenopausal conditions because of
endometrial neoplasm risk. Taper to lowest effective dose; provide drug-free wk each
mo.
IND & DOSE Relief of moderate to severe vasomotor sx, atrophic vaginitis, kraurosis
vulvae associated w/ menopause. Adult: 0.75–6 mg/day PO given cyclically (3 wk
on/1 wk off). Use lowest possible dose. Tx of female hypogonadism, female
castration, primary ovarian failure. Adult: 1.5–9 mg/day PO for first 3 wk, then rest
period of 8–10 days. Repeat if no bleeding at end of rest period. Px of osteoporosis.
Adult: 0.75 mg/day PO for 25 days of 31-day cycle/mo.
ADV EFF Acute pancreatitis, abd cramps, bloating, cancer, chloasma, cholestatic
jaundice, colitis, dysmenorrhea, edema, headache, hepatic adenoma, menstrual flow
changes, n/v/d, pain at injection site, photosensitivity, premenstrual syndrome,
thrombotic events
INTERACTIONS Barbiturates, carbamazepine, corticosteroids, phenytoins, rifampin
NC/PT Give cyclically for short-term use. Give w/ progestin for women w/ intact uterus.
Review proper administration for each drug type. Potentially serious adverse effects.
Not for use in pregnancy, breast-feeding. Pt should get regular pelvic exams, avoid sun
exposure, report pain in calves/chest, lumps in breast, vision or speech changes.

eszopiclone (Lunesta)
CLASS Nonbenzodiazepine hypnotic, sedative-hypnotic
PREG/CONT C/C-IV

IND & DOSE Tx of insomnia. Adult: 2 mg PO immediately before bedtime. May increase to
3 mg PO.
ADJUST DOSE CYP3A4 inhibitor use, elderly pts, severe hepatic impairment
ADV EFF Anaphylaxis, angioedema, dizziness, headache, nervousness, somnolence,
suicidality
INTERACTIONS Alcohol, clarithromycin, itraconazole, ketoconazole, nefazodone, nelfinavir,
rifampin, ritonavir
NC/PT Not for use in pregnancy, breast-feeding. Pt should swallow tablet whole and not
cut, crush, or chew it; take only if in bed and able to stay in bed for up to 8 hr; avoid
alcohol; not take w/ high-fat meal; report thoughts of suicide.

etanercept (Enbrel)
 CLASSAntiarthritic, disease-modifying antirheumatic drug
PREG/CONT B/NA

BBW Monitor for infection s&sx; discontinue if infection occurs. Risk of serious infections
(including TB), death. Increased risk of lymphoma, other cancers in children taking for
juvenile rheumatoid arthritis, Crohn’s disease, other inflammatory conditions; monitor
accordingly.
IND & DOSE To reduce s&sx of ankylosing spondylitis, rheumatoid arthritis, psoriatic
arthritis. Adult: 50 mg/wk subcut. Child 2–17 yr: 0.8 mg/kg/wk subcut; max, 50 mg/wk.
To reduce s&sx of plaque psoriasis. Adult: 50 mg/dose subcut twice wkly 3 or 4 days
apart for 3 mo; maint, 50 mg/wk subcut.
ADV EFF Bone marrow suppression, demyelinating disorders (MS, myelitis, optic
neuritis), cancers, increased risk of serious infections, dizziness, headache, irritation
at injection site, URIs
INTERACTIONS Immunosuppressants, vaccines
NC/PT Obtain baseline and periodic CBC, neurologic function tests. Rotate injection sites
(abdomen, thigh, upper arm). Monitor for infection. Do regular cancer screening. Teach
proper administration, disposal of syringes, needles. Pt should avoid exposure to
infection, maintain other tx for rheumatoid disorder (drug not a cure).

ethacrynic acid (Edecrin)

CLASS Loop diuretic
PREG/CONT B/NA

IND & DOSE To reduce edema associated w/ systemic diseases. Adult: 50–200 mg/day
PO; may give IV as 50 mg slowly to max, 100 mg. Child: 25 mg/day PO; adjust in 25-
mg/day increments if needed.
ADV EFF Abd pain, agranulocytosis, dehydration, dysphagia, fatigue, headache, hepatic
impairment, hypokalemia, n/v/d, vertigo, weakness
INTERACTIONS Diuretics
NC/PT Switch to oral form as soon as possible. Give w/ food if GI upset. Monitor
potassium; supplement as needed. Not for use in breast-feeding. Pt should weigh self
daily; report changes of 3 lb/day or more.

ethambutol hydrochloride (Myambutol)

CLASS Antituberculotic
PREG/CONT C/NA

Tx of pulmonary TB w/ at least one other antituberculotic. Adult, child 13

IND & DOSE
yr and older: 15 mg/kg/day PO as single oral dose. Continue until bacteriologic
conversion permanent and max clinical improvement has occurred. Retreatment:
25 mg/kg/day as single oral dose. After 60 days, reduce to 15 mg/kg/day as single dose.
ADV EFF Anorexia, fever, headache, malaise, n/v/d, optic neuritis, toxic epidermal
necrolysis, thrombocytopenia
INTERACTIONS Aluminum salts
NC/PT Ensure use w/ other antituberculotics. Give w/ food. Monitor CBC, LFTs, renal
function, ophthalmic exam. Pt should not stop suddenly; have regular medical checkups;
report changes in vision, color perception; take safety precautions w/ CNS effects.

ethionamide (Trecator)
CLASS Antituberculotic
PREG/CONT C/NA

IND & DOSE Tx of pulmonary TB unresponsive to first-line tx, w/ at least one other
antituberculotic. Adult: 15–20 mg/kg/day PO to max 1 g/day. Child: 10–20 mg/kg/day
PO in two or three divided doses after meals (max, 1 g/day), or 15 mg/kg/24 hr as
single dose.
ADV EFF Alopecia, asthenia, depression, drowsiness, hepatitis, metallic taste, n/v/d,
orthostatic hypotension, peripheral neuritis
NC/PT Ensure use w/ other antituberculotics. Concomitant use of pyridoxine
recommended to prevent or minimize s&sx of peripheral neuritis. Give w/ food. Monitor
LFTs before tx and q 2–4 wk during tx. Not for use in pregnancy. Pt should not stop
suddenly, have regular medical checkups, take safety precautions w/ CNS effects.

ethosuximide (Zarontin)
CLASS Antiepileptic, succinimide
PREG/CONT C/NA

IND & DOSE Control of absence (petit mal) seizures. Adult, child 6 yr and older:
500 mg/day PO. Increase by small increments to maint level; increase by 250 mg q 4–
7 days until control achieved. Child 3–6 yr: 250 mg/day PO. Increase in small increments
until optimal 20 mg/kg/day in one dose or two divided doses.
ADV EFF Abd pain, agranulocytosis, aplastic anemia, ataxia, blurred vision,
constipation, cramps, dizziness, drowsiness, eosinophilia, generalized tonic-clonic
seizures, granulocytopenia, irritability, leukopenia, monocytosis, nervousness,
n/v/d, pancytopenia, Stevens-Johnson syndrome
INTERACTIONS Alcohol, CNS depressants, primidone
NC/PT Reduce dose, discontinue, or substitute other antiepileptic gradually. Taper when
discontinuing. Monitor CBC. Stop drug at signs of rash. Evaluate for therapeutic serum
level (40–100 mcg/mL). Not for use in pregnancy (contraceptives advised). Pt should
avoid alcohol, wear medical ID, avoid exposure to infection, take safety precautions w/
CNS effects.

ethotoin (Peganone)
 CLASSAntiepileptic, hydantoin
PREG/CONT D/NA

IND & DOSE Control of tonic-clonic, complex partial (psychomotor) seizures. Adult:
1 g/day PO in four to six divided doses; increase gradually over several days. Usual
maint dose, 2–3 g/day PO in four to six divided doses. Child 1 yr and older: 750 mg/day
PO in four to six divided doses; maint range, 500 mg/day to 1 g/day PO in four to six
divided doses.
ADV EFF Abd pain, agranulocytosis, aplastic anemia, ataxia, blurred vision, confusion,
constipation, cramps, dizziness, drowsiness, eosinophilia, epidermal necrolysis,
fatigue, granulocytopenia, gum dysplasia, hepatotoxicity, irritability, leukopenia,
lymphoma, monocytosis, nervousness, n/v/d, nystagmus, pancytopenia, pulmonary
fibrosis, Stevens-Johnson syndrome
INTERACTIONS Acetaminophen, amiodarone, antineoplastics, carbamazepine,
chloramphenicol, cimetidine, corticosteroids, cyclosporine, diazoxide, disopyramide,
disulfiram, doxycycline, estrogens, fluconazole, folic acid, hormonal contraceptives,
isoniazid, levodopa, methadone, metyrapone, mexiletine, phenacemide,
phenylbutazone, primidone, rifampin, sulfonamides, theophyllines, trimethoprim,
valproic acid
NC/PT May use w/ other antiepileptics. Reduce dosage, discontinue, or substitute other
antiepileptic gradually. Taper when discontinuing. Monitor CBC. Stop drug at signs of
rash. Monitor LFTs. Give w/ food to enhance absorption. Evaluate for therapeutic serum
levels (15–50 mcg/mL). Not for use in pregnancy (contraceptives advised). Evaluate
lymph node enlargement during tx. Frequent medical follow-up needed. Pt should avoid
alcohol, wear medical ID, avoid exposure to infection, take safety precautions w/ CNS
effects, use good dental care to limit gum hyperplasia.

etidronate disodium (Didronel)

CLASS Bisphosphonate, calcium regulator
PREG/CONT C/NA

IND & DOSE Tx of Paget’s disease. Adult: 5–10 mg/kg/day PO for up to 6 mo; or 11–
20 mg/kg/day PO for up to 3 mo. If retreatment needed, wait at least 90 days between
tx regimens. Tx of heterotopic ossification. Adult: 20 mg/kg/day PO for 2 wk, then
10 mg/kg/day PO for 10 wk (after spinal cord injury); 20 mg/kg/day PO for 1 mo
preop (if total hip replacement), then 20 mg/kg/day PO for 3 mo postop.
ADJUST DOSE Renal impairment
ADV EFF Bone pain, headache, n/v/d
INTERACTIONS Antacids, aspirin, food
NC/PT For Paget’s disease, ensure 3 mo rest periods between tx. Monitor serum calcium
level. Pt should take w/ full glass of water 2 hr before meals, take calcium and vitamin
D as needed, report muscle twitching.
 etodolac (generic)
CLASS Analgesic, NSAID
PREG/CONT C/NA

BBW Increased risk of CV events, GI bleeding; monitor accordingly.

IND & DOSE Mgt of s&sx of osteoarthritis, rheumatoid arthritis. Adult: 600–
1,000 mg/day PO in divided doses. Maint range, 600–1,200 mg/day in divided doses;
max, 1,200 mg/day (20 mg/kg for pts under 60 kg). ER, 400–1,000 mg/day PO; max,
1,200 mg/day. Mgt of s&sx of juvenile rheumatoid arthritis (ER tablets). Child 6–16
yr: Over 60 kg, 1,000 mg/day PO as 500 mg PO bid; 46–60 kg, 800 mg/day PO as
400 mg PO bid; 31–45 kg, 600 mg/day PO; 20–30 kg, 400 mg/day PO. Analgesia,
acute pain. Adult: 200–400 mg PO q 6–8 hr; max, 1,200 mg/day.
ADV EFF Anaphylactoid reactions, bleeding, blurred vision, constipation, CV events,
diarrhea, dizziness, dyspepsia, GI pain, hepatic failure, renal impairment
INTERACTIONS Anticoagulants, antihypertensives, antiplatelets
NC/PT Pt should take w/ meals, use safety precautions w/ CNS effects.

DANGEROUS DRUG
etoposide (VP-16) (Etopophos, Toposar)
CLASS Antineoplastic, mitotic inhibitor
PREG/CONT D/NA

BBW Obtain platelet count, Hgb, Hct, WBC count w/ differential before tx and each
dose. If severe response, discontinue; consult physician. Severe myelosuppression
possible. Monitor for severe hypersensitivity reaction; arrange supportive care.
IND & DOSE Tx of testicular cancer. Adult: 50–100 mg/m2/day IV on days 1 to 5, or
100 mg/m2/day IV on days 1, 3, 5 q 3–4 wk w/ other chemotherapeutics. Tx of small-
cell lung cancer. Adult: 35 mg/m2/day IV for 4 days to 50 mg/m2/day for 5 days;
repeat q 3–4 wk after recovery from toxicity or switch to oral form (two times IV dose
rounded to nearest 50 mg).
ADJUST DOSE Renal impairment
ADV EFF Alopecia, anaphylactoid reactions, anorexia, fatigue, hypotension,
myelotoxicity, n/v/d, somnolence
INTERACTIONS Anticoagulants, antihypertensives, antiplatelets
NC/PT Avoid skin contact; use rubber gloves. If contact occurs, immediately wash w/
soap, water. Do not give IM, subcut. Monitor BP during infusion. Give antiemetic if
nausea severe. Not for use in pregnancy (contraceptives advised). Pt should cover head
at temp extremes (hair loss possible), mark calendar of tx days, avoid exposure to
infection, have blood tests regularly.

etravirine (Intelence)
 CLASSAntiviral, nonnucleoside reverse transcriptase inhibitor
PREG/CONT B/NA

IND & DOSE Tx of HIV-1 infection in tx-experienced pts w/ evidence of viral

replication and HIV-1 strains resistant to nonnucleoside reverse transcriptase
inhibitors and other antiretrovirals, w/ other drugs. Adult: 200 mg PO bid after
meal. Child 6–under 18 yr: 30 kg or more, 200 mg PO bid; 25 to under 30 kg, 150 mg PO
bid; 20 to under 25 mg, 125 mg PO bid; 16–under 20 kg, 100 mg PO bid.
ADV EFF Altered fat distribution, diarrhea, fatigue, headache, severe hypersensitivity
reactions
INTERACTIONS Antiarrhythmics, atazanavir, azole, carbamazepine, clarithromycin,
clopidogrel, delavirdine, fosamprenavir, indinavir, maraviroc, nelfinavir, nevirapine,
phenobarbital, phenytoin, rifabutin, rifampin, rifapentine, ritonavir, St. John’s wort,
tipranavir, warfarin
NC/PT Always give w/ other antivirals. Stop at first sign of severe skin reaction. Pt
should swallow tablets whole and not cut, crush, or chew them. If pt cannot swallow,
put tablets in glass of water, stir; when water is milky, have pt drink whole glass, rinse
several times, and drink rinse each time to get full dose. Not for use in breast-feeding. Pt
should not use w/ St. John’s wort, take precautions to prevent transmission (drug not a
cure), have blood tests regularly.

everolimus (Afinitor, Zortress)

CLASS Antineoplastic, kinase inhibitor
PREG/CONT D/NA

BBW Zortress only: Risk of serious infections, cancer development; risk of venous
thrombosis, kidney loss; risk of nephrotoxicity w/ cyclosporine. Increased mortality if
used w/ heart transplant; not approved for this use.
IND & DOSE Tx of advanced renal carcinoma after failure w/ sunitinib, sorafenib; tx
of subependymal giant-cell astrocytoma in pts not candidates for surgery. Adult:
5–10 mg/day PO w/ food. Tx of pts 1 yr and older with tuberous sclerosis complex
who have developed brain tumor. Adult, child: 4.5 mg/m2 PO once/day with food. Px
of organ rejection in adult at low to moderate risk receiving kidney transplant
(Zortress). Adult: 0.75 mg PO bid w/ cyclosporine starting as soon as possible after
transplant.
ADJUST DOSE Hepatic impairment
ADV EFF Elevated blood glucose, lipids, serum creatinine; oral ulcerations, pneumonitis,
serious to fatal infections, stomatitis
INTERACTIONS Live vaccines, strong CYP3A4 inducers (increase everolimus dose to
20 mg/day), CYP3A4 inhibitors
NC/PT Give w/ food. Provide oral care. Monitor respiratory status; protect from
infections. Not for use in pregnancy, breast-feeding. Pt should report difficulty
breathing, fever.

exemestane (Aromasin)
CLASS Antineoplastic
PREG/CONT X/NA

IND & DOSE Tx of advanced breast cancer in postmenopausal women whose disease
has progressed after tamoxifen; adjunct tx of postmenopausal women w/
estrogen receptor–positive early breast cancer who have received 2–3 yr of
tamoxifen; switch to exemestane to finish 5-yr course. Adult: 25 mg/day PO w/
meal.
ADV EFF Anxiety, decreased bone marrow density, depression, GI upset, headache, hot
flashes, nausea, sweating
INTERACTIONS CYP3A4 inducers/inhibitors, estrogens, St. John’s wort
NC/PT Monitor LFTs, renal function. Give supportive therapy for adverse effects. Not for
use in pregnancy, breast-feeding. Pt should not use St. John’s wort.

exenatide (Bydureon, Byetta)

CLASS Antidiabetic, incretin mimetic drug
PREG/CONT C/NA

BBW ER form increases risk of thyroid C-cell tumors; contraindicated w/

personal/family hx of medullary thyroid cancer and in pts w/ multiple endocrine
neoplasia syndrome.
IND & DOSE Adjunct to diet, exercise for tx of type 2 diabetes; as add-on tx w/
insulin glargine, metformin to improve glycemic control in type 2 diabetes. Adult:
5–10 mcg by subcut injection bid at any time within 60 min before a.m. and p.m. meals
or two main meals of day, approximately 6 hr apart. ER form, 2 mg by subcut injection
once q 7 days.
ADJUST DOSE Renal impairment
ADV EFF Dizziness, hypoglycemia, injection-site reaction, hemorrhagic or necrotizing
pancreatitis, nausea
INTERACTIONS Alcohol, antibiotics, oral contraceptives, warfarin
NC/PT Maintain diet, exercise, other drugs used to tx diabetes. Monitor serum glucose.
Monitor for pancreatitis. Rotate injection sites (thigh, abdomen, upper arm). Give
within 1 hr of meal; if pt not going to eat, do not give. Use caution w/ pregnancy,
breast-feeding. Review hypoglycemia s&sx.

ezetimibe (Zetia)
CLASS Cholesterol-absorption inhibitor, cholesterol-lowering drug
PREG/CONT C/NA
IND & DOSE Adjunct to diet, exercise to lower cholesterol. Adult, child over 10 yr:
10 mg/day PO without regard to food. May give at same time as HMG-CoA reductase
inhibitor, fenofibrate. If combined w/ bile acid sequestrant, give at least 2 hr before or
4 hr after bile acid sequestrant.
ADV EFF Abd pain, diarrhea, dizziness, headache, URI
INTERACTIONS Cholestyramine, cyclosporine, fenofibrate, gemfibrozil
NC/PT Ensure use of diet, exercise program. Monitor serum lipid profile. Not for use in
pregnancy, breast-feeding. Frequent blood tests needed. Pt should use safety precautions
w/ CNS effects, continue other lipid-lowering drugs if prescribed.

ezogabine (Potiga)
CLASS Antiepileptic, neuronal potassium channel opener
PREG/CONT C/NA

BBW Risk of suicidal ideation/suicidality; monitor accordingly.

IND & DOSE Adjunct to tx of partial seizures when other measures have failed. Adult:
100 mg PO tid for 1 wk; maint, 200-400 mg PO tid, w/ other antiepileptics.
ADV EFF Abnormal coordination, aphasia, asthenia, blurred vision, confused state,
dizziness, fatigue, prolonged QT, somnolence, tremor, urine retention, suicidal ideation,
vertigo
INTERACTIONS Alcohol, carbamazepine, digoxin, phenytoin
NC/PT Obtain baseline ECG; review QT interval periodically. Taper slowly when
withdrawing. Not for use in pregnancy, breast-feeding. Pt should empty bladder before
taking, continue other tx for seizures as prescribed, avoid alcohol, use safety precautions
w/ CNS effects, report thoughts of suicide.

factor IX concentrates (AlphaNine SD, Bebulin VH, BeneFix, Mononine)

CLASS Antihemophilic
PREG/CONT C/NA

IND & DOSE Control of bleeding w/ factor IX deficiency (hemophilia B, Christmas

disease). Adult: Base dose on factor IX levels. Guidelines: BeneFix, 1.3 units/kg × body
weight (kg) × desired increase (% of normal) IV daily to bid for up to 7 days; Bebulin
VH, body weight (kg) × desired increase (% of normal) × 1.2 units/kg IV daily to bid
for up top 10 days. Others: 1 international unit/kg × body weight (kg) × desired
increase (% of normal) IV daily to bid. Px of factor IX deficiency. Adult, child: 20–30
units/kg IV once or twice/wk; increase if surgery planned.
ADV EFF AIDS, Creutzfeldt-Jakob disease, headache, infusion reaction, nausea,
thrombotic events
NC/PT Must give IV; infuse slowly. Monitor for infusion reaction; slow infusion. Regular
blood tests of clotting factors needed. Review s&sx of thrombotic events. Pt should wear
medical ID.
 factor XIII concentrate (human) (Corifact)
CLASS Clotting factor
PREG/CONT C/NA

IND & DOSE Routine px of congenital factor XIII deficiency. Adult, child: 40 units/kg IV
over not less than 4 mL/min, then base dose on pt response. Repeat q 28 days,
maintaining trough activity level of 5%–20%.
ADV EFF Anaphylaxis, arthralgia, blood-transferred diseases, chills, factor XIII
antibody formation, fever, headache, hepatic impairment, thrombotic events
NC/PT Alert pt to risk of blood-related disease. Teach pt s&sx of thrombotic events,
allergic reaction, immune reaction (break-through bleeding).

famciclovir sodium (Famvir)

CLASS Antiviral
PREG/CONT B/NA

IND & DOSE Mgt of herpes zoster. Adult: 500 mg PO q 8 hr for 7 days. Tx of genital
herpes, first episode in immunocompetent pts. Adult: 250 mg PO tid for 7–10 days.
Tx of recurrent genital herpes. Adult: 125 mg PO bid for 5 days, or 1,000 mg PO bid
for 1 day. Chronic suppression of recurrent genital herpes. Adult: 250 mg PO bid for
up to 1 yr. Tx of recurrent orolabial or genital herpes simplex infection in HIV-
infected pts. Adult: 500 mg PO q 12 hr for 7 days. Tx of recurrent herpes labialis.
Adult: 1,500 mg PO as single dose.
ADJUST DOSE Renal impairment
ADV EFF Cancer, diarrhea, fever, granulocytopenia, headache, rash,
thrombocytopenia
INTERACTIONS Cimetidine, digoxin
NC/PT Monitor CBC before, q 2 days during, at least wkly after tx. Pt should continue
precautions to prevent transmission (drug not a cure), avoid exposure to infection, take
analgesics for headache.

famotidine (Pepcid)
CLASS Histamine-2 receptor antagonist
PREG/CONT B/NA

IND & DOSEAcute tx of active duodenal ulcer. Adult: 40 mg PO or IV at bedtime, or

20 mg PO or IV bid; discontinue after 6–8 wk. Child 1–12 yr: 0.5 mg/kg/day PO at
bedtime or divided into two doses (up to 40 mg/day), or 0.25 mg/kg IV q 12 hr (up to
40 mg/day) if unable to take orally. Maint tx of duodenal ulcer. Adult: 20 mg PO at
bedtime. Benign gastric ulcer. Adult: 40 mg PO daily at bedtime. Tx of
hypersecretory syndrome. Adult: Initially, 20 mg PO q 6 hr. Taper; up to 160 mg PO q
6 hr has been used. Or, 20 mg IV q 12 hr in pts unable to take orally. Children 1–12 yr:
0.25 mg/kg IV q 12 hr (up to 40 mg/day) if unable to take orally. Tx of GERD. Adult:
20 mg PO bid for up to 6 wk. For GERD w/ esophagitis, 20–40 mg PO bid for up to 12
wk. Child 1–12 yr: 1 mg/kg/day PO divided into two doses (up to 40 mg bid). Child 3
mo–1 yr: 0.5 mg /kg PO bid for up to 8 wk. Under 3 mo: 0.5 mg/kg/dose oral suspension
once daily for up to 8 wk. Px, relief of heartburn, acid indigestion. Adult: 10–20 mg
PO for relief; 10–20 mg PO 15–60 min before eating for prevention. Max, 20 mg/24 hr.
ADJUST DOSE Renal impairment
ADV EFF Constipation, diarrhea, headache
NC/PT Reserve IV use for pts unable to take orally; switch to oral as soon as possible.
Give at bedtime. May use concurrent antacid to relieve pain. Pt should place rapidly
disintegrating tablet on tongue; swallow w/ or without water.

fat emulsion, intravenous (Intralipid, Liposyn)

CLASS Caloric drug, nutritional drug
PREG/CONT C/NA

BBW Give to preterm infants only if benefit clearly outweighs risk; deaths have
occurred.
IND & DOSE Parenteral nutrition. Adult: Should not constitute more than 60% of total
calorie intake. 10%: Infuse IV at 1 mL/min for first 15–30 min; may increase to 2
mL/min. Infuse only 500 mL first day; increase following day. Max, 2.5 g/kg/day. 20%:
Infuse at 0.5 mL/min for first 15–30 min. Infuse only 250 mL Liposyn II or 500 mL
Intralipid first day; increase following day. Max, 3 g/kg/day. 30%: Infuse at 1 mL/min
(0.1 g fat/min) for first 15–30 min; max, 2.5 g/kg/day. Child: Should not constitute
more than 60% of total calorie intake. 10%: Initial IV infusion rate, 0.1 mL/min for first
10–15 min. 20%: Initial infusion rate, 0.05 mL/min for first 10–15 min. If no untoward
reactions, increase rate to 1 g/kg in 4 hr; max, 3 g/kg/day. 30%: Initial infusion rate,
0.1 mL/min (0.01 g fat/min) for first 10–15 min; max, 3 g/kg/day. Tx of essential
fatty acid deficiency. Supply 8%–10% of caloric intake by IV fat emulsion.
ADV EFF Headache, leukopenia, nausea, sepsis, thrombocytopenia, thrombophlebitis
NC/PT Supplied in single-dose containers. Do not store partially used bottles or resterilize
for later use. Do not use w/ filters. Do not use bottle in which there appears to be
separation from emulsion. Monitor closely for fluid, fat overload. Monitor lipid profile,
nitrogen balance closely; monitor for thrombotic events, sepsis. Pt should report pain at
injection site.

febuxostat (Uloric)
CLASS Antigout drug, xanthine oxidase inhibitor
PREG/CONT C/NA

IND & DOSE Long-term mgt of hyperuricemia in pts w/ gout. Adult: 40 mg/day PO; if
serum uric acid level not under 6 mg/dL in 2 wk, may increase to 80 mg/day PO.
ADJUST DOSE Hepatic, renal impairment
ADV EFF Gout flares, MI, nausea, stroke
INTERACTIONS Azathioprine, mercaptopurine theophyllines (use contraindicated)
NC/PT Obtain baseline, periodic uric acid levels. May use w/ antacids, other drugs to
control gout. Store at room temp, protected from light. Use caution in pregnancy,
breast-feeding. Pt should report chest pain, numbness, tingling.

felodipine (Plendil)
CLASS Antihypertensive, calcium channel blocker
PREG/CONT C/NA

IND & DOSE Tx of essential hypertension. Adult: 5 mg/day PO; range, 2.5–10 mg/day
PO.
ADJUST DOSE Elderly pts, hepatic impairment
ADV EFF Dizziness, fatigue, flushing, headache, lethargy, light-headedness, nausea,
peripheral edema
INTERACTIONS Antifungals, barbiturates, carbamazepine, cimetidine, grapefruit juice,
hydantoins, ranitidine
NC/PT Monitor cardiac rhythm, BP carefully during dose adjustment. Pt should swallow
tablet whole and not cut, crush, or chew it; avoid grapefruit juice; report swelling in
hands, feet.

fenofibrate (Antara, Fenoglide, Lofibra, Lipofen, TriCor, Triglide, Trilipix)

CLASS Antihyperlipidemic
PREG/CONT C/NA

IND & DOSE Adjunct to diet, exercise for tx of hypertriglyceridemia. Adult: 48–145 mg
(TriCor) PO, or 67–200 mg (Lofibra) PO w/ meal, or 50–160 mg/day (Triglide) PO daily,
or 43–130 mg/day PO (Antara), or 50–150 mg/day PO (Lipofen), or 40–120 mg/day PO
(Fenoglide), or 45–135 mg/day PO (Trilipix). Adjunct to diet, exerciser for tx of
primary hypercholesterolemia, mixed dyslipidemia. Adult: 145 mg/day PO (TriCor),
or 200 mg/day (Lofibra) PO w/ meal, or 160 mg/day (Triglide), or 130 mg/day PO
(Antara), or 150 mg/day PO (Lipofen), or 120 mg/day PO (Fenoglide), or 135 mg/day PO
(Trilipix); if combined w/ statin, 135 mg/day PO (Trilipix).
ADJUST DOSE Elderly pts, renal impairment
ADV EFF Decreased libido, ED, flulike symptoms, myalgia, nausea, pancreatitis, rash
INTERACTIONS Anticoagulants, bile acid sequestrants, immunosuppressants, nephrotoxic
drugs, statins
NC/PT Obtain baseline, periodic lipid profile, LFTs, CBC w/ long-term therapy.
Differentiate between brand names; doses vary. Balance timing of administration if used
w/ other lipid-lowering drugs. Use caution in pregnancy; not for use in breast-feeding.
Pt should swallow DR capsules whole and not cut, crush, or chew them; continue
exercise, diet programs; report muscle weakness, aches.

fenoprofen calcium (Nalfon)

CLASS Analgesic, NSAID
PREG/CONT B (1st, 2nd trimesters); D (3rd trimester)/NA

BBW Increased risk of CV events, GI bleeding; monitor accordingly.

IND & DOSE Tx of rheumatoid arthritis, osteoarthritis. Adult: 400–600 mg PO tid or qid.
May need 2–3 wk before improvement seen. Tx of mild to moderate pain. Adult:
200 mg PO q 4–6 hr as needed.
ADJUST DOSE Renal impairment
ADV EFF Agranulocytosis, anaphylactoid reactions to fatal anaphylactic shock,
aplastic anemia, dizziness, dyspepsia, eosinophilia, GI pain, granulocytopenia,
headache, impaired vision, insomnia, leukopenia, nausea, neutropenia,
pancytopenia, rash, somnolence, thrombocytopenia
INTERACTIONS ACE inhibitors, anticoagulants, antiplatelets, aspirin, phenobarbital
NC/PT Not for use in pregnancy (contraceptives advised). Pt should take w/ meals, use
safety precautions w/ CNS effects, report bleeding, tarry stools, vision changes.

DANGEROUS DRUG
fentanyl (Abstral, Actiq, Duragesic, Fentora, Lazanda, Onsolis, SUBSYS)
CLASS Opioid agonist analgesic
PREG/CONT C/C-II

BBW Ensure appropriate use because drug potentially dangerous; respiratory

depression, death possible. Have opioid antagonist, facilities for assisted or controlled
respiration on hand during parenteral administration. Use caution when switching
between forms; doses vary. Transdermal, nasal forms not for use in opioid–nontolerant
pts. Not for acute or postop pain. Do not substitute for other fentanyl product. Keep out
of children’s reach; can be fatal. Potentiation of effects possible when given w/
macrolide antibiotics, ketoconazole, itraconazole, protease inhibitors; potentially fatal
respiratory depression possible.
IND & DOSE Analgesic adjunct for anesthesia. Adult: Premedication, 50–100 mcg IM 30–
60 min before surgery. Adjunct to general anesthesia, initially, 2–20 mcg/kg; maint, 2–
50 mcg IV or IM. 25–100 mcg IV or IM when vital sign changes indicate surgical stress,
lightening of analgesia. W/ oxygen for anesthesia, total high dose, 50–100 mcg/kg IV.
Adjunct to regional anesthesia, 50–100 mcg IM or slowly IV over 1–2 min. Child 2–12 yr:
2–3 mcg/kg IV as vital signs indicate. Control of postop pain, tachypnea, emergence
delirium. Adult: 50–100 mcg IM; repeat in 1–2 hr if needed. Mgt of chronic pain in
pts requiring continuous opioid analgesia over extended period. Adult: 25 mcg/hr
transdermal system; may need replacement in 72 hr if pain has not subsided. Do not use
torn, damaged systems; serious overdose possible. Children 2–12 yr: 25 mcg/hr
transdermal system; pts should be opioid-tolerant and receiving at least 60 mg oral
morphine equivalents/day. Tx of breakthrough pain in cancer pts treated w/ and
tolerant to opioids. Adult: Place unit (Actiq) in mouth between cheek, lower gum. Start
w/ 200 mcg; may start redosing 15 min after previous lozenge completed. No more than
two lozenges/breakthrough pain episode. For buccal tablets, initially 100-mcg tablet
between cheek, gum for 14–25 min; may repeat in 30 min. For buccal soluble film,
remove film, place inside cheek; will dissolve within 5–30 min. For sublingual tablets,
initially 100 mcg sublingually; wait at least 2 hr between doses. For nasal spray, 100
mcg as single spray in one nostril. Max, 800 mcg as single spray in one nostril or single
spray in each nostril/episode. Wait at least 2 hr before treating new episode. No more
than four doses in 24 hr.
ADV EFF Apnea, cardiac arrest, clamminess, confusion, constipation, dizziness, floating
feeling, headache, lethargy, light-headedness, local irritation, n/v, sedation, shock,
sweating, vertigo
INTERACTIONS Alcohol, barbiturates, CNS depressants, grapefruit juice, itraconazole,
ketoconazole, macrolide antibiotics, MAOIs, protease inhibitors
NC/PT Adjust dose as needed, tolerated for pain relief. Apply transdermal system to
nonirritated, nonirradiated skin on flat surface of upper torso. Clip, do not shave, hair.
May need 12 hr for full effect. Do not use torn, damaged transdermal systems; serious
overdose possible. Give to breast-feeding women 4–6 hr before next scheduled feeding.
Buccal soluble film, nasal spray only available through restricted access program. Pt
should avoid grapefruit juice, remove old transdermal patch before applying new one,
take safety precautions w/ CNS effects, report difficulty breathing. Name confusion
between fentanyl and sufentanil; use extreme caution.

ferrous salts (ferrous aspartate, ferrous fumarate, ferrous gluconate, ferrous

sulfate, ferrous sulfate exsiccated) (Femiron, Feosol, Fer-In-Sol, Ferro-Sequels,
Slow Fe, Slow Release Iron)
CLASS Iron preparation
PREG/CONT A/NA

BBW Warn pt to keep out of reach of children; leading cause of fatal poisoning in child
under 6 yr.
IND & DOSE Dietary iron supplement. Adult: Men, 8–11 mg/day PO; women, 8–
18 mg/day PO. Pregnant, breast-feeding women, 9–27 mg/day PO. Child: 7–11 mg/day
PO. Px, tx of iron deficiency anemia. Adult: 150–300 mg/day (6 mg/kg/day) PO for
approximately 6–10 mo. Child: 3–6 mg/kg/day PO.
ADV EFF Anorexia; coma, death w/ overdose; constipation; GI upset; n/v
INTERACTIONS Antacids, chloramphenicol, cimetidine, ciprofloxacin, coffee, eggs,
levodopa, levothyroxine, milk, norfloxacin, ofloxacin, tea, tetracycline
NC/PT Establish correct diagnosis. Regularly monitor Hct, Hgb. Use straw for liquid forms
(may stain teeth). Give w/ food if GI upset severe. Stool may be green to black; tx may
take several mo. Laxative may be needed. Pt should avoid eggs, milk, coffee, tea; keep
out of reach of children (serious to fatal toxicity possible).

ferumoxytol (Feraheme)
CLASS Iron preparation
PREG/CONT C/NA

IND & DOSE Tx of iron deficiency anemia in pts w/ chronic renal failure. Adult:
510 mg IV as undiluted sol at 30 mg/sec, then 510 mg IV in 3–8 days.
ADV EFF Constipation, diarrhea, dizziness, hypersensitivity reactions, hypotension,
iron overload, nausea, peripheral edema
NC/PT Alters MRI results for up to 3 mo after use; will not alter CT scans or X-rays. Do
not give if iron overload. Monitor for hypersensitivity reaction up to 30 min after
infusion; have life support available. Monitor BP during and for 30 min after
administration. Use caution in pregnancy; not for use in breast-feeding. Pt should take
safety precautions w/ CNS effects, report difficulty breathing, itching, swelling.

fesoterodine fumarate (Toviaz)

CLASS Antimuscarinic
PREG/CONT C/NA

IND & DOSE Tx of overactive bladder. Adult: 4 mg/day PO; may increase to max
8 mg/day.
ADJUST DOSE Renal impairment; hepatic impairment (not recommended)
ADV EFF Blurred vision, constipation, decreased sweating, dry eyes, dry mouth, increased
IOP, urine retention
INTERACTIONS Alcohol, clarithromycin, itraconazole, ketoconazole
NC/PT Monitor IOP before, periodically during tx. Pt should swallow tablet whole and
not cut, crush, or chew it; use sugarless lozenges, mouth care for dry mouth; take safety
precautions for vision changes; stay hydrated in heat conditions (decreased ability to
sweat); avoid alcohol.

fexofenadine hydrochloride (Allegra)

CLASS Antihistamine
PREG/CONT C/NA

IND & DOSE Symptomatic relief of sx associated w/ seasonal allergic rhinitis. Adult,
child 12 yr and older: 60 mg PO bid or 180 mg PO once daily; or 10 mL suspension PO
bid. Child 6–12 yr: 30 mg orally disintegrating tablet (ODT) PO bid, or 5 mL suspension
PO bid. Child 2–12 yr: 5 mL suspension PO bid. Chronic idiopathic urticaria. Adult,
child 12 yr and older: 60 mg PO bid or 180 mg PO once daily. Child 6–12 yr: 30 mg ODT
PO bid, or 5 mL suspension PO bid. Child 2–12 yr: 5 mL suspension PO bid..
ADJUST DOSE Elderly pts, renal impairment
ADV EFF Drowsiness, fatigue, nausea
INTERACTIONS Antacids, erythromycin, itraconazole ketoconazole
NC/PT Arrange for humidifier if nasal dryness, thickened secretions a problem; encourage
hydration. Pt should use in a.m. before exposure to allergens, take safety precautions w/
CNS effects.

fibrinogen concentrate, human (RiaSTAP)

CLASS Coagulation factor
PREG/CONT C/NA

IND & DOSE Tx of acute bleeding episodes in pts w/ congenital fibrinogen deficiency.
Adult, child: 70 mg/kg by slow IV injection not over 5 mL/min; adjust dose to target
fibrinogen level of 100 mg/dL.
ADJUST DOSE Elderly pts, renal impairment
ADV EFF Anaphylactic reactions, arterial thrombosis, blood-transmitted diseases,
chills, DVT, fever, MI, n/v, PE, rash
NC/PT Made from human blood; risk of blood-transmitted diseases. Risk of
thromboembolic events, severe hypersensitivity reactions. Pt should report chest/leg
pain, chest tightness, difficulty breathing, continued fever.

fidaxomicin (Dificid)
CLASS Macrolide antibiotic
PREG/CONT B/NA

IND & DOSETx of Clostridium difficile diarrhea. Adult: 200 mg PO bid for 10 days.
ADV EFF Abd pain, dyspepsia, gastric hemorrhage, n/v
NC/PT Culture stool before tx. Not for systemic infections; specific to C. difficile diarrhea.
Pt should complete full course of tx, report severe vomiting, bloody diarrhea.

filgrastim (Neupogen)
CLASS Colony-stimulating factor
PREG/CONT C/NA

IND & DOSETo decrease incidence of infection in pts w/ nonmyeloid malignancies

receiving myelosuppressive anticancer drugs; to reduce time to neutrophil
recovery, duration of fever after induction or consolidation chemotherapy tx of
acute myeloid leukemia. Adult: 5 mcg/kg/day subcut or IV as single daily injection.
May increase in increments of 5 mcg/kg for each chemotherapy cycle; range, 4–8
mcg/kg/day. To reduce duration of neutropenia after bone marrow transplant.
Adult: 10 mcg/kg/day IV or continuous subcut infusion. Tx of severe chronic
neutropenia. Adult: 6 mcg/kg subcut bid (congenital neutropenia); 5 mcg/kg/day
subcut as single injection (idiopathic, cyclic neutropenia). To mobilize hematopoietic
progenitor cells into blood for leukapheresis collection. Adult: 10 mcg/kg/day
subcut at least 4 days before first leukapheresis; continue to last leukapheresis.
ADV EFF Alopecia, bone pain, n/v/d
NC/PT Obtain CBC, platelet count before and twice wkly during tx. Do not give within
24 hr of chemotherapy. Give daily for up to 2 wk or neutrophils are 10,000/mm3. Store
in refrigerator. Do not shake vial; do not reuse vial, needles, syringes. Teach pt proper
administration, disposal of needles, syringes. Pt should avoid exposure to infection,
cover head at temp extremes (hair loss possible).

finasteride (Propecia, Proscar)

CLASS Androgen hormone inhibitor
PREG/CONT X/NA

IND & DOSETx of symptomatic BPH. Adult: 5 mg daily PO w/ or without meal; may take
6–12 mo for response (Proscar). Px of male-pattern baldness. Adult: 1 mg/day PO for 3
mo or more before benefit seen (Propecia).
ADV EFF Decreased libido, ED, gynecomastia
NC/PT Confirm dx of BPH. Protect from light. Pregnant women should not touch tablet.
Pt may not donate blood during and for 6 mo after tx. Pt should monitor urine flow for
improvement; may experience loss of libido

fingolimod (Gilenya)
CLASS MS drug
PREG/CONT C/NA

IND & DOSE Tx of relapsing forms of MS. Adult: 0.5 mg/day PO.
ADV EFF Back pain, bradycardia, cough, decreased lung capacity, depression, diarrhea,
dyspnea, headache, increased liver enzymes, infections, macular edema
INTERACTIONS Amiodarone, antineoplastics, beta blockers, calcium channel blockers,
immunomodulators, immunosuppressants, ketoconazole, live vaccines. procainamide,
quinidine, sotalol
NC/PT Use caution w/ hypertension or hx of CAD. Obtain baseline, periodic ophthalmic
evaluation because of macular edema risk. Monitor for bradycardia for at least 6 hr
after first dose. Obtain spirometry studies if dyspnea occurs. Not for use in pregnancy
(contraceptives advised during and for 2 mo after tx), breast-feeding. Pt should avoid
exposure to infection, take safety precautions w/ CNS effects, report difficulty
breathing.

flavoxate hydrochloride (generic)

 CLASSParasympathetic blocker, urinary antispasmodic
PREG/CONT B/NA

IND & DOSE Symptomatic relief of dysuria, urgency, nocturia, suprapubic pain,
frequency/incontinence due to cystitis, prostatitis, urethritis, urethrocystitis,
urethrotrigonitis. Adult, child 12 yr and older: 100–200 mg PO tid or qid. Reduce dose
when symptoms improve. Use max 1,200 mg/day in severe urinary urgency after pelvic
radiotherapy.
ADV EFF Blurred vision, drowsiness, dry mouth, eosinophilia, headache, leukopenia,
nervousness, n/v, vertigo
INTERACTIONS Anticholinergics, cholinergics
NC/PT Treat for underlying problem leading to s&sx. Obtain eye exam before, during tx.
Pt should use sugarless lozenges for dry mouth, report blurred vision.

flecainide acetate (Tambocor)

CLASS Antiarrhythmic
PREG/CONT C/NA

BBW Increased risk of nonfatal cardiac arrest, death in pts w/ recent MI, chronic atrial
fibrillation. Monitor cardiac rhythm carefully; risk of potentially fatal proarrhythmias.
IND & DOSE Px, tx of life-threatening ventricular arrhythmias. Adult: 100 mg PO q
12 hr. Increase in 50-mg increments bid q fourth day until efficacy achieved; max,
400 mg/day. Px of paroxysmal atrial fibrillation/flutter associated w/ symptoms
and paroxysmal supraventricular tachycardias. Adult: 50 mg PO q 12 hr; may
increase in 50-mg increments bid q 4 days until efficacy achieved; max, 300 mg/day.
Transfer to flecainide. Allow at least 2–4 plasma half-lives to elapse after other
antiarrhythmics discontinued before starting flecainide.
ADJUST DOSE Elderly pts; renal, hepatic impairment
ADV EFF Abd pain, arrhythmias, chest pain, constipation, dizziness, drowsiness,
dyspnea, fatigue, headache, leukopenia, n/v, visual changes
INTERACTIONS Amiodarone, cimetidine, disopyramide (avoid marked drop in cardiac
output), propranolol
NC/PT Check serum potassium before starting tx; evaluate for therapeutic serum levels
(0.2–1 mcg/mL). Monitor response closely; have life support equipment on hand. Pt
should take q 12 hr (arrange timing to avoid interrupting sleep), use safety precautions
w/ CNS effects, report chest pain, palpitations.

floxuridine (FUDR)
CLASS Antimetabolite, antineoplastic
PREG/CONT D/NA

IND & DOSE Palliative mgt of GI adenocarcinoma metastatic to liver. Adult: 0.1–
0.6 mg/kg/day via intra-arterial infusion.
ADV EFF Bone marrow suppression, infections, gastric ulceration, glossitis, hepatic
impairment, n/v/d, renal impairment, stomatitis
INTERACTIONS Immunosuppressants, live vaccines
NC/PT Obtain baseline, periodic CBC. Check for mouth ulcerations, dental infections;
mouth care essential. Protect from exposure to infections. Not for use in pregnancy,
breast-feeding. Pt should report severe GI pain, bloody diarrhea.

fluconazole (Diflucan)
CLASS Antifungal
PREG/CONT D/NA

IND & DOSE Tx of oropharyngeal candidiasis: Adult: 200 mg PO or IV on first day, then
100 mg/day for at least 2 wk. Child: 6 mg/kg PO or IV on first day, then 3 mg/kg once
daily for at least 2 wk. Tx of esophageal candidiasis. Adult: 200 mg PO or IV on first
day, then 100 mg/day, up to 400 mg/day for minimum of 3 wk, at least 2 wk after
resolution. Child: 6 mg/kg PO or IV on first day, then 3 mg/kg/day for 3 wk, at least 2
wk after resolution. Tx of vaginal candidiasis. Adult: 150 mg PO as single dose. Tx of
systemic candidiasis. Adult: 400 mg PO or IV daily. Child: 6–12 mg/kg/day PO or IV.
Tx of candidal UTI/peritonitis. Adult: 50–200 mg/day PO. Tx of cryptococcal
meningitis. Adult: 400 mg PO or IV on first day, then 200 mg/day up to 400 mg/day
for 10–12 wk after cultures of CSF become negative. Child: 12 mg/kg PO or IV on first
day, then 6 mg/kg/day for 10–12 wk after cultures of CSF become negative.
Suppression of cryptococcal meningitis in AIDS pts. Adult: 200 mg PO or IV daily.
Child: 6 mg/kg PO or IV daily. Px of candidiasis in bone marrow transplants. Adult:
400 mg PO daily for several days before onset of neutropenia and for 7 days after
neutrophil count above 1,000/mm3.
ADJUST DOSE Renal impairment
ADV EFF Abd pain, headache, n/v/d, renal toxicity
INTERACTIONS Benzodiazepines, cimetidine, cyclosporine, oral hypoglycemics, phenytoin,
rifampin, warfarin anticoagulants, zidovudine
NC/PT Culture before tx. For IV, oral use only. Monitor renal function wkly. Frequent
medical follow-up needed. Pt should take hygiene measures to prevent infection spread,
use analgesics for headache.

flucytosine (Ancobon)
CLASS Antifungal
PREG/CONT C/NA

BBW Monitor serum flucytosine levels in pts w/ renal impairment (levels over 100
mcg/mL associated w/ toxicity).
IND & DOSE Tx of serious infections caused by susceptible Candida, Cryptococcus
strains. Adult: 50–150 mg/kg/ day PO at 6-hr intervals.
ADJUST DOSE Renal impairment
ADV EFF Anemia, cardiac arrest, confusion, dizziness, leukopenia, n/v/d, rash,
respiratory arrest, thrombocytopenia
NC/PT Give capsules few at a time over 15-min to decrease GI upset, diarrhea. Monitor
LFTs, renal/hematologic function periodically during tx. Pt should take safety
precautions w/ CNS effects; report fever, difficulty breathing.

DANGEROUS DRUG
fludarabine phosphate (generic)
CLASS Antimetabolite, antineoplastic
PREG/CONT D/NA

BBW Stop tx if s&sx of toxicity (CNS complaints, stomatitis, esophagopharyngitis,

rapidly falling WBC count, intractable vomiting, diarrhea, GI ulceration/bleeding,
thrombocytopenia, hemorrhage, hemolytic anemia); serious to life-threatening
infections possible. Consult physician.
IND & DOSE Chronic lymphocytic leukemia (CLL); unresponsive B-cell CLL. Adult:
40 mg/m2 PO or 25 mg/m2 IV over 30 min for 5 consecutive days. Begin each 5-day
course q 28 days.
ADJUST DOSE Renal impairment
ADV EFF Anorexia, autoimmune hemolytic anemia, bone marrow toxicity, chills, CNS
toxicity (including blindness, coma, death), cough, dyspnea, edema, fatigue, fever,
headache, infection, n/v/d, pneumonia, pruritus, pulmonary toxicity, stomatitis,
tumor lysis syndrome, visual disturbances, weakness
INTERACTIONS Pentostatin
NC/PT Obtain CBC before tx, each dose. Monitor pulmonary function regularly. Not for
use in pregnancy (contraceptives advised). Pt should not crush tablets; avoid contact w/
skin, mucous membranes; mark calendar of tx days; take safety precautions for CNS
effects; avoid exposure to infections; report bruising, excess bleeding, black stools,
difficulty breathing.

fludrocortisone acetate (Florinef Acetate)

CLASS Corticosteroid
PREG/CONT C/NA

IND & DOSE Partial replacement tx in adrenocortical insufficiency. Adult: 0.05–

0.1 mg/day PO. Tx of salt-losing adrenogenital syndrome. Adult: 0.1–0.2 mg/day
PO.
ADJUST DOSE Elderly pts; hepatic, renal impairment
ADV EFF Anxiety, cardiac enlargement, depression, edema, HF, hypertension,
hypokalemic acidosis, infection, weakness
INTERACTIONS Amphotericin B, anabolic steroids, antidiabetics, aspirin, barbiturates,
digitalis, diuretics, hormonal contraceptives, phenytoin, rifampin, warfarin
NC/PT Monitor BP, serum electrolytes, blood glucose before, periodically during tx.
Protect from infection. Frequent medical follow-up, blood tests needed. Use caution in
pregnancy, breast-feeding. Pt should wear medical ID, report all drugs used to health
care provider (many drug interactions possible).

flumazenil (Romazicon)
CLASS Antidote, benzodiazepine receptor antagonist
PREG/CONT C/NA

BBW Possible increased risk of seizures, especially in pts on long-term benzodiazepine tx

and pts w/ serious cyclic antidepressant overdose; take appropriate precautions.
IND & DOSE Reversal of conscious sedation or in general anesthesia. Adult: 0.2 mg (2
mL) IV over 15 sec, wait 45 sec; if ineffectual, repeat at 60-sec intervals. Max
cumulative dose, 1 mg (10 mL). Children over 1 yr: 0.01 mg/kg (up to 0.2 mg) IV over 15
sec; wait 45 sec. Repeat at 60-sec intervals. Max cumulative dose, 0.05 mg/kg or 1 mg,
whichever lowest. Mgt of suspected benzodiazepine overdose. Adult: 0.2 mg IV over
30 sec; repeat w/ 0.3 mg IV q 30 sec. May give further doses of 0.5 mg over 30 sec at 1-
min intervals. Max cumulative dose, 3 mg.
ADV EFF Amnesia, dizziness, increased sweating, n/v, pain at injection site, seizures,
vertigo
INTERACTIONS Alcohol, CNS depressants, food
NC/PT IV use only, into running IV in large vein. Have emergency equipment on hand;
continually monitor response. Provide safety measures for CNS effects for at least 18–
24 hr after use. Give pt written information (amnesia may be prolonged). Pt should
avoid alcohol for 18–24 hr after administration.

flunisolide (Aerospan HFA)

CLASS Corticosteroid
PREG/CONT C/NA

BBW Taper systemic steroids carefully during transfer to inhalational steroids; deaths
from adrenal insufficiency have occurred.
IND & DOSE Intranasal relief/mgt of nasal sx of seasonal, perennial allergic rhinitis.
Adult: 2 sprays (50 mcg) in each nostril bid; may increase to 2 sprays in each nostril tid
(total dose, 300 mcg/day). Max, 400 mcg/day. Child 6–14 yr: 1 spray in each nostril tid
or 2 sprays in each nostril bid (total dose, 150–200 mcg/day). Max, 200 mcg/day.
Inhalation maint tx of asthma. Adult: 2 inhalations by mouth bid. Max, 640 mcg/day.
Child 12 yr and older: Adult dosage. Child 6–11 yr: 1 inhalation bid. Max, 160 mcg bid.
ADV EFF Epistaxis, fungal infection, headache, nasal irritation, rebound congestion
NC/PT May use decongestant drops to facilitate penetration if needed. Not for acute
asthma attack. Pt should not stop suddenly, rinse mouth after each use of inhaler.

DANGEROUS DRUG
fluorouracil (Adrucil, Carac, Efudex, Fluoroplex)
CLASS Antimetabolite, antineoplastic
PREG/CONT D/NA

BBW Stop tx at s&sx of toxicity (stomatitis, esophagopharyngitis, rapidly falling WBC

count, intractable vomiting, diarrhea, GI ulceration/bleeding, thrombocytopenia,
hemorrhage); serious to life-threatening reactions have occurred. Consult physician.
IND & DOSE Palliative mgt of carcinoma of colon, rectum, breast, stomach, pancreas
in selected pts considered incurable by surgery or other means. Adult:
12 mg/kg/day IV for 4 successive days, infused slowly over 24 hr; max, 800 mg/day. If
no toxicity, 6 mg/kg IV on days 6, 8, 10, 12, w/ no drug tx on days 5, 7, 9, 11. Stop tx
at end of day 12. If no toxicity, repeat q 30 days. If toxicity, 10–15 mg/kg/wk IV as
single dose after s&sx of toxicity subside; max, 1 g/wk. Adjust dose based on response; tx
may be prolonged (12–60 mo). Tx of actinic or solar keratoses. Adult: Apply bid to
cover lesions. 0.5% and 1% used on head, neck, chest; 2% and 5% used on hands.
Continue until inflammatory response reaches erosion, necrosis, and ulceration stage,
then stop. Usual tx course, 2–4 wk. Complete healing may not occur for 1–2 mo after tx
stops. Tx of superficial basal cell carcinoma. Adult: 5% strength bid in amount
sufficient to cover lesions, for at least 3–6 wk. Tx may be needed for 10–12 wk.
ADJUST DOSE Poor risk, undernourished pts
ADV EFF Alopecia, anorexia, cramps, dermatitis, duodenal ulcer, duodenitis, enteritis,
gastritis, glossitis, lethargy, leukopenia, local irritation w/ topical use, malaise, n/v/d,
photosensitivity, rash, stomatitis, thrombocytopenia
NC/PT Obtain CBC before and regularly during tx. Ensure dx of topical lesions.
Thoroughly wash hands after applying topical form; avoid occlusive dressings w/
topical form. Stop tx at s&sx of toxicity. Frequent medical follow-up needed. Pt should
mark calendar for tx days; cover head at temp extremes (hair loss possible); avoid
exposure to sun, infections; report black tarry stools, unusual bleeding or bruising.

fluoxetine hydrochloride (Prozac, Sarafem)

CLASS Antidepressant, SSRI
PREG/CONT C/NA

BBW Establish suicide precautions for severely depressed pts. Limit quantity dispensed;
high risk of suicidality in children, adolescents, young adults.
IND & DOSE Tx of depression. Adult: 20 mg/day PO in a.m.; max, 80 mg/day. Once
stabilized, may switch to 90-mg DR capsules PO once/wk. Child 8–18 yr: 10 mg/day PO;
may increase to 20 mg/day after 1 wk or after several wk for low-weight children. Tx of
depressive episodes of bipolar I disorder. Adult: 20 mg/day PO w/ 5 mg olanzapine.
Tx of tx-resistant depression. Adult: 20–50 mg/day PO w/ 5–20 mg olanzapine. Tx of
OCD. Adult: 20 mg/day PO; range, 20–60 mg/day PO. May need up to 5 wk for
effectiveness. Max, 80 mg/day. Adolescent, higher-weight child: 10 mg/day PO; range, 20–
60 mg/day PO. Adolescent, lower-weight child: 10 mg/day PO; range, 20–30 mg/day. Tx
of bulimia. Adult: 60 mg/day PO in a.m. Tx of panic disorder. Adult: 10 mg/day PO
for first wk; max, 60 mg/day. Tx of PMDD (Sarafem). Adult: 20 mg/day PO. Or
20 mg/day PO starting 14 days before anticipated beginning of menses, continuing
through first full day of menses; then no drug until 14 days before next menses. Max,
80 mg/day.
ADJUST DOSE Elderly pts, hepatic impairment
ADV EFF Anorexia, anxiety, asthenia, constipation, dizziness, drowsiness, dry mouth,
dyspepsia, fever, headache, insomnia, light-headedness, nervousness, n/v/d, painful
menstruation, pharyngitis, pruritus, rash, seizures, sexual dysfx, sweating, URI, urinary
frequency, weight changes
INTERACTIONS Alcohol, benzodiazepines, ED drugs, linezolid, lithium, MAOIs, opioids,
serotoninergic drugs, St. John’s wort, TCAs, thioridazine
NC/PT Do not use within 14 days of MAOIs. Give in a.m. Full antidepressant effect may
not occur for up to 4–6 wk. Taper when stopping. Not for use in pregnancy. Pt should
avoid alcohol, St. John’s wort; take safety precautions w/ CNS effects; report thoughts of
suicide. Name confusion between Sarafem (fluoxetine) and Serophene (clomiphene); use
caution.

fluphenazine decanoate, fluphenazine hydrochloride (generic)

CLASS Antipsychotic, dopaminergic blocker, phenothiazine
PREG/CONT C/NA

BBW Establish suicide precautions for severely depressed pts. Limit quantity dispensed;
high risk of suicidality in children, adolescents, young adults.
IND & DOSE Mgt of manifestations of psychotic disorders. Adult: 2.5–10 mg/day PO in
divided doses q 6–8 hr; usual maint dose, 1–5 mg/day. Or, 1.25 mg/day IM (range, 2.5–
10 mg) divided and given q 6–8 hr; parenteral dose is ⅓ to ½ oral dose (fluphenazine
hydrochloride). Long-term or parenteral neuroleptic therapy. Adult: 12.5–25 mg IM
or subcut; max, 100 mg/dose (fluphenazine decanoate).
ADJUST DOSE Elderly pts
ADV EFF Akathisia, anemia, aplastic anemia, autonomic disturbances, bronchospasm,
cardiac arrest, dystonias, eosinophilia, hemolytic anemia, hyperthermia,
hypoglycemia, laryngospasm, leukocytosis, leukopenia, NMS, photosensitivity,
pseudoparkinsonism, refractory arrhythmias, seizures, sudden death related to
asphyxia; tardive dyskinesia, thrombocytopenic or nonthrombocytopenic purpura
INTERACTIONS Alcohol, anticholinergics, barbiturates, CNS depressants, metrizamide
NC/PT Dilute oral concentrate in 60 mL suitable diluent not containing caffeine, tannic
acid (tea), pectinates (apple juice). Monitor CBC, renal function, LFTs; adjust dose
accordingly. Pt should take safety precautions w/ CNS effects; avoid exposure to sun,
infection; maintain hydration; report unusual bleeding.

flurazepam hydrochloride (generic)

CLASS Benzodiazepine, sedative-hypnotic
PREG/CONT X/C-IV

IND & DOSE Tx of insomnia. Adult: 15–30 mg PO at bedtime.

ADJUST DOSE Elderly pts, debilitating disease
ADV EFF Anaphylaxis, angioedema, apathy, bradycardia, confusion, constipation, CV
collapse, depression, diarrhea, disorientation, drowsiness, drug dependence w/
withdrawal, fatigue, gynecomastia, lethargy, light-headedness, restlessness, tachycardia,
urine retention
INTERACTIONS Alcohol, aminophylline, barbiturates, cimetidine, disulfiram, hormonal
contraceptives, opioids, phenothiazines, rifampin, SSRIs, theophylline, TCAs
NC/PT Monitor LFTs, renal function. Taper gradually after long-term use. Not for use in
pregnancy (barrier contraceptives advised). Pt should take safety precautions w/ CNS
effects, report worsening depression, difficulty breathing, edema.

flurbiprofen (Ansaid, Ocufen)

CLASS Analgesic, NSAID
PREG/CONT B (oral); C (ophthalmic)/NA

BBW Increased risk of CV events, GI bleeding; monitor accordingly. Contraindicated for

tx of periop CABG pain.
IND & DOSE Acute or long-term tx of s&sx of rheumatoid arthritis, osteoarthritis;
relief of moderate to mild pain. Adult: 200–300 mg PO in divided doses bid, tid, or
qid. Max, 100 mg/dose. Inhibition of intraop miosis. Adult: 1 drop ophthalmic sol
approximately q 30 min, starting 2 hr before surgery (total, 4 drops).
ADV EFF Agranulocytosis, aplastic anemia, bleeding, bone marrow depression,
bronchospasm, dizziness, dyspepsia, eosinophilia, fatal anaphylactic shock, fatigue,
gastric ulcer, GI pain, granulocytopenia, headache, insomnia, leukopenia, nausea,
neutropenia, pancytopenia, renal impairment, somnolence, thrombocytopenia,
transient local stinging/burning w/ ophthalmic sol
NC/PT Give w/ food if GI upset severe. Not for use in pregnancy (barrier contraceptives
advised). Pt should take safety precautions w/ CNS effects; report fever, rash, black
stools, swelling in ankles/fingers.

DANGEROUS DRUG
flutamide (generic)
CLASS Antiandrogen, antineoplastic
PREG/CONT D/NA
BBW Arrange for periodic monitoring of LFTs during long-term tx; severe hepatotoxicity
possible.
IND & DOSE Tx of locally advanced, metastatic prostatic carcinoma. Adult: 250 mg PO
tid. Begin tx at same time as initiation of LH-RH analogue.
ADV EFF Anemia, dizziness, drowsiness, ED, GI disturbances, gynecomastia, hepatic
necrosis, hepatitis, hot flashes, leukopenia, loss of libido, n/v/d, photosensitivity, rash
NC/PT Give w/ other drugs used for medical castration. Monitor LFTs regularly. Periodic
blood tests will be needed. Pt should take safety precautions w/ CNS effects, avoid
exposure to sunlight.

fluvastatin sodium (Lescol)

CLASS Antihyperlipidemic, statin
PREG/CONT X/NA

IND & DOSE Adjunct to diet, exercise to lower cholesterol, LDL; to slow progression
of CAD, reduce risk of need for revascularization w/CAD. Adult: 40 mg/day PO.
Maint, 20–80 mg/day PO; give 80 mg/day as two 40-mg doses, or use 80-mg ER form.
Tx of heterozygous familial hypercholesterolemia. Child 9–16 yr: 20 mg/day PO.
Adjust q 6 wk to max 40 mg bid or 80 mg ER form PO once/day.
ADV EFF Abd pain, blurred vision, cataracts, constipation, cramps, flatulence, headache,
rhabdomyolysis
INTERACTIONS Azole antifungals, cyclosporine, erythromycin, gemfibrozil, grapefruit juice,
niacin, other statins, phenytoin, warfarin
NC/PT Give in evening. Periodic ophthalmic exams will be needed. Not for use in
pregnancy (barrier contraceptives advised). Pt should swallow ER form whole and not
cut, crush, or chew it; continue diet, exercise program; avoid grapefruit juice; report
muscle pain w/ fever, changes in vision.

fluvoxamine maleate (Luvox)

CLASS Antidepressant, SSRI
PREG/CONT C/NA

BBW Establish suicide precautions for severely depressed pts. Limit quantity dispensed.
Increased risk of suicidal ideation, behavior in children, adolescents, young adults.
IND & DOSE Tx of OCD, social anxiety disorders. Adult: 50 mg PO at bedtime; range,
100–300 mg/day. Or, 100–300 mg/day CR capsules PO. Child 8–17 yr: 25 mg PO at
bedtime. Divide doses over 50 mg/day; give larger dose at bedtime. Max for child up to
11 yr, 200 mg/day.
ADJUST DOSE Elderly pts, hepatic impairment
ADV EFF Anorexia, anxiety, asthenia, constipation, dizziness, drowsiness, dry mouth,
dyspepsia, fever, headache, insomnia, light-headedness, nervousness, n/v/d, painful
menstruation, pharyngitis, pruritus, rash, seizures, sexual dysfx, sweating, URI, urinary
frequency, weight changes
INTERACTIONS Alprazolam, beta blockers, carbamazepine, cigarette smoking, clozapine,
diltiazem, MAOIs, methadone, quetiapine, statins, St. John’s wort, TCAs, theophylline,
triazolam, warfarin
NC/PT Give in evening. Monitor for serotonin syndrome. Taper when stopping. Pt should
swallow CR capsule whole and not cut, crush, or chew it; take safety precautions w/
CNS effects; report thoughts of suicide.

folic acid (Folvite)

CLASS Folic acid, vitamin supplement
PREG/CONT A/NA

IND & DOSE Tx of megaloblastic anemias due to sprue, nutritional deficiency,

pregnancy; anemias of infancy, childhood. Adult: 1 mg/day PO, IM, IV, subcut;
maint, 0.4 mg/day. In pregnancy/breast-feeding, 0.8 mg/day PO. Child (maint): Over 4
yr, 0.4 mg/day PO; under 4 yr, up to 0.3 mg/day PO; infants, 0.1 mg/day
ADV EFF Pain, discomfort at injection site
INTERACTIONS Aminosalicylic acid, phenytoin, sulfasalazine
NC/PT Ensure correct anemia dx. Give orally if possible. Monitor for hypersensitivity
reactions. Pt should report pain at injection site, difficulty breathing.

follitropin alfa (Gonal-F)

CLASS Fertility drug
PREG/CONT X/NA

IND & DOSE Induction of ovulation. Adult: 75 international units/day subcut. Increase by
37.5 international units/day after 14 days; may increase again after 7 days. Do not use
for longer than 35 days. Stimulation of multiple follicles for in vitro fertilization.
Adult: 150 international units/day subcut on days 2, 3 of cycle; continue for 10 days.
Adjust based on response. Max, 450 international units subut; then 5,000–10,000
international units HCG. Promotion of spermatogenesis. Adult: 150–300 international
units subcut two to three times/wk w/ HCG. May use for up to 18 mo.
ADV EFF Multiple births, nausea, ovarian cyst, ovarian hyperstimulation,
pulmonary/vascular complications, URI
NC/PT Ensure uterine health. Monitor regularly; monitor for thrombotic events. Alert pt
to risk of multiple births. Teach proper administration, disposal of needles, syringes.

follitropin beta (Follistim AQ)

CLASS Fertility drug
PREG/CONT X/NA
IND & DOSEInduction of ovulation. Adult: 75 international units/day subcut. Increase by
37.5 international units/day after 14 days; may increase again after 7 days. Do not use
for longer than 35 days. Stimulation of multiple follicles for in vitro fertilization.
Adult: 150–225 international units/day subcut or IM for at least 4 days; adjust based on
response. Follow w/ HCG.
ADV EFF Multiple births, nausea, ovarian cyst, ovarian hyperstimulation,
pulmonary/vascular complications, URI
NC/PT Ensure uterine health. Give subcut in navel or abdomen. Monitor regularly;
monitor for thrombotic events. Alert pt to risk of multiple births. Teach proper
administration, disposal of needles, syringes.

fomepizole (Antizol)
CLASS Antidote
PREG/CONT C/NA

IND & DOSE Antidote for antifreeze, methanol poisoning. Adult: 15 mg/kg loading dose
IV, then 10 mg/kg IV q 12 hr for 12 doses by slow IV infusion over 30 min.
ADV EFF Acidosis, bradycardia, dizziness, electrolyte disturbances, headache, hypotension,
injection-site reaction, lymphangitis, multiorgan failure, nausea, nystagmus, phlebitis,
seizures, shock
INTERACTIONS Alcohol
NC/PT Monitor ECG, electrolytes, renal function, LFTs, BP. Monitor injection site. May be
used w/hemodialysis if needed to clear toxins. Give q 4 hr during dialysis. Pt should take
safety precautions w/ CNS effects.

DANGEROUS DRUG
fondaparinux (Arixtra)
CLASS Antithrombotic, low-molecular-weight heparin
PREG/CONT C/NA

BBW Carefully monitor pts receiving spinal/epidural anesthesia; risk of spinal

hematoma, neurologic damage.
IND & DOSE Px of venous thrombotic events in pts undergoing surgery for hip
fracture, hip or knee replacement; in pts undergoing abd surgery; extended px of
DVT that may lead to PE after hip surgery. Adult: 2.5 mg/day subcut starting 6–8 hr
after surgical closure and continuing for 5–9 days. May add 24 days after initial course
for pts undergoing hip fracture surgery. Tx of DVT, acute PE, w/ warfarin. Adult: Over
100 kg, 10 mg/day subcut for 5–9 days; begin warfarin within 72 hr. 50–100 kg,
7.5 mg/day subcut for 5–9 days. Under 50 kg, 5 mg/day subcut for 5–9 days.
ADJUST DOSE Elderly pts, renal impairment
ADV EFF Anemia, bruising, fever, hemorrhage, local reaction at injection site, nausea
INTERACTIONS Cephalosporins, garlic, ginkgo, NSAIDs, oral anticoagulants, penicillins,
salicylates, vitamin E
NC/PT Give drug 6–8 hr after surgical closure. Give by deep subcut injections; do not give
IM. Store at room temp. Do not mix w/ other sols or massage injection site. Rotate
injection sites. Provide safety measures to prevent bleeding. Teach proper technique for
injection, disposal of needles/syringes. Pt should avoid NSAIDs, report bleeding, black
tarry stools, severe headache.

formoterol fumarate (Foradil Aerolizer, Perforomist)

CLASS Antiasthmatic, beta agonist
PREG/CONT C/NA

BBW Long-acting beta agonists may increase risk of asthma-related deaths; use only if
clearly warranted. Use without concomitant inhaled corticosteroid contraindicated.
IND & DOSE Maintenance tx of COPD. Adult: Oral inhalation of contents of 1 capsule (12
mcg) using Aerolizer inhaler q 12 hr; max, 24 mcg daily. Or, one 20-mcg/2 mL vial by
oral inhalation using jet nebulizer connected to air compressor bid (a.m. and p.m.);
max, 40 mcg/day. Prevention of exercise-induced bronchospasm. Adult, child 12 yr
and older: Oral inhalation of contents of 1 capsule (12 mcg) using Aerolizer inhaler 15
min before exercise. Maintenance tx of asthma. Adult, child 5 yr and older: Oral
inhalation of contents of 1 capsule (12 mcg) using Aerolizer inhaler q 12 hr; max, 1
capsule q 12 hr.
ADV EFF Headache, nervousness, prolonged QT interval, throat/mouth irritation, tremors,
viral infections
INTERACTIONS Beta blockers, QT-prolonging drugs
NC/PT Teach proper use of inhaler, nebulizer; periodically monitor use. Provide safety
precautions for tremors, analgesics for headache. Ensure continued use of other drugs
for COPD, bronchospasm. Pt should use 15 min before activity if used for exercise-
induced asthma. Name confusion between Foradil (formoterol) and Toradol (ketorolac);
use extreme caution.

fosamprenavir (Lexiva)
CLASS Antiviral, protease inhibitor
PREG/CONT C/NA

IND & DOSE Tx of HIV infection w/ other antiretrovirals. Adult: 1,400 mg PO bid. W/
ritonavir: 1,400 mg/day PO plus ritonavir 100 mg/day PO, or 1,400 mg/day PO plus
ritonavir 200 mg/day PO, or 700 mg PO bid w/ ritonavir 100 mg PO bid. In protease-
experienced pts: 700 mg PO bid w/ ritonavir 100 mg PO bid. Child 2–5 yr (tx-naïve):
30 mg/kg oral suspension PO bid; max, 1,400 mg bid. Child 6 yr and older (tx-naïve):
30 mg/kg oral suspension PO bid; max, 1,400 mg bid. Or, 18 mg/kg oral suspension PO
w/ ritonavir 3 mg/kg PO bid; max, 700 mg fosamprenavir plus 100 mg ritonavir bid.
Child 6 yr and older (tx-experienced): 18 mg/kg oral suspension w/ 3 mg/kg ritonavir PO
bid; max, 700 mg fosamprenavir w/ 100 mg ritonavir bid.
ADJUST DOSE Hepatic impairment
ADV EFF Depression, headache, hyperglycemia, MI, n/v/d, redistribution of body fat,
Stevens-Johnson syndrome
INTERACTIONS Dihydroergotamine, ergotamine, flecainide, lovastatin, methylergonovine,
midazolam, pimozide, piroxicam, propafenone, rifabutin, simvastatin, triazolam—do
not use w/ any of preceding drugs. Amiodarone, amitriptyline, amlodipine,
carbamazepine, cyclosporine, delavirdine, diltiazem, efavirenz, felodipine, hormonal
contraceptives, imipramine, isradipine, itraconazole, ketoconazole, lidocaine,
lopinavir/ritonavir, nevirapine, nicardipine, nifedipine, nimodipine, nisoldipine,
phenobarbital, phenytoin, quinidine, rifampin, saquinavir, sildenafil, St. John’s wort,
tacrolimus, vardenafil, verapamil
NC/PT Carefully check other drugs being used; interacts w/ many drugs. Give w/ other
antiretrovirals. Monitor LFTs, blood glucose. Monitor for rash. Not for use in pregnancy
(barrier contraceptives advised). Pt should monitor glucose carefully if diabetic; avoid
St. John’s wort; tell all health care providers about all drugs, herbs being taken; report
rash, chest pain.

fosfomycin tromethamine (Monurol)

CLASS Antibacterial, urinary tract anti-infective
PREG/CONT B/NA

IND & DOSE Tx of uncomplicated UTIs in women caused by susceptible strains. Adult,
child 12 yr and older: 1 packet dissolved in water PO as single dose.
ADV EFF Dizziness, headache, nausea, rash
INTERACTIONS Metoclopramide
NC/PT Culture before tx. Do not give dry. Mix in 90–120 mL water (not hot); stir to
dissolve. Pt should contact prescriber if no improvement, take safety precautions if
dizziness occurs.

fosinopril sodium (Monopril)

CLASS ACE inhibitor, antihypertensive
PREG/CONT D/NA

BBW Pt should avoid pregnancy (suggest contraceptive); fetal damage possible if used in
second, third trimesters. Switch to different drug if pregnancy occurs.
IND & DOSE Tx of hypertension. Adult: 10 mg/day PO. Range, 20–40 mg/day PO; max,
80 mg. Adjunct tx of HF. Adult: 10 mg/day PO; observe for 2 hr for hypotension. For pt
w/ moderate to severe renal failure, 5 mg/day PO; max, 40 mg/day.
ADV EFF Angioedema, cough, nausea, orthostatic hypotension, rash
INTERACTIONS Antacids, indomethacin, lithium, NSAIDs, potassium-sparing diuretics
NC/PT Alert surgeon about use; postop fluid replacement may be needed. Not for use in
pregnancy (barrier contraceptives advised). Pt should use care in situations that might
lead to BP drop, change positions slowly if light-headedness occurs. Name confusion
between fosinopril and lisinopril; use caution.

fosphenytoin sodium (Cerebyx)

CLASS Antiepileptic, hydantoin
PREG/CONT D/NA

BBW Pt should avoid pregnancy; fetal damage possible. Suggest use of contraceptive.
IND & DOSE Short-term control of status epilepticus. Adult: Loading dose, 15–20 mg
PE/kg at 100–150 mg PE/min IV. Px, tx of seizures during or after neurosurgery.
Adult: Loading dose, 10–20 mg PE/kg IM or IV; maint, 4–6 mg PE/kg/day. Substitution
for oral phenytoin therapy. Adult: Substitute IM or IV at same total daily dose as
phenytoin; for short-term use only.
ADJUST DOSE Hepatic, renal impairment
ADV EFF Ataxia, dizziness, drowsiness, hypotension, nausea, pruritus, twitching
INTERACTIONS Acetaminophen, amiodarone, antineoplastics, carbamazepine,
chloramphenicol, cimetidine, corticosteroids, cyclosporine, diazoxide, disopyramide,
disulfiram, doxycycline, estrogens, fluconazole, folic acid, hormonal contraceptives,
isoniazid, levodopa, methadone, metyrapone, mexiletine, phenacemide,
phenylbutazone, primidone, rifampin, sulfonamides, theophyllines, trimethoprim,
valproic acid
NC/PT Give IV slowly to prevent severe hypotension. Monitor infusion site carefully; sols
are very alkaline, irritating. For short-term use only (up to 5 days); switch to oral
phenytoin as soon as possible. Not for use in pregnancy (contraceptives advised). Pt
should take safety precautions w/ CNS effects. Name confusion w/ Cerebyx
(fosphenytoin), Celebrex (celecoxib), Celexa (citalopram), and Xanax (alprazolam); use
caution.

frovatriptan succinate (Frova)

CLASS Antimigraine, triptan
PREG/CONT C/NA

IND & DOSE Tx of acute migraine w/ or without aura. Adult: 2.5 mg PO as single dose
at first sign of migraine; may repeat after 2 hr. Max, 3 doses/24 hr.
ADV EFF Cerebrovascular events, dizziness, headache, MI, n/v, tingling, ventricular
arrhythmias
INTERACTIONS Ergots, SSRIs
NC/PT Ensure proper dx of migraine. For tx, not px. Ensure no ergots taken within 24 hr.
Ensure 2 hr between doses, no more than three doses/day. Monitor BP. Not for use in
pregnancy. Pt should take safety precautions w/ CNS effects, report chest pain/pressure.
 DANGEROUS DRUG
fulvestrant (Faslodex)
CLASS Antineoplastic, estrogen receptor antagonist
PREG/CONT D/NA

IND & DOSE Tx of hormone receptor–positive breast cancer in postmenopausal

women w/ disease progression after antiestrogen tx. Adult: 500 mg IM on days 1,
15, 29, then monthly as two concomitant 5-mL injections, one in each buttock.
ADJUST DOSE Hepatic impairment
ADV EFF Abd pain, anemia, arthritis, asthenia, back pain, bone pain, dizziness, dyspnea,
hot flashes, increased cough/sweating, n/v/d, pelvic pain
INTERACTIONS Oral anticoagulants
NC/PT Rule out pregnancy; suggest contraceptives. Handle cautiously. Give by slow IM
injection over 1–2 min. Hot flashes possible. Teach proper administration, disposal of
syringes, needles. Pt should mark calendar of tx days, take safety precautions w/ CNS
effects.

furosemide (Lasix)
CLASS Loop diuretic
PREG/CONT C/NA

BBW Profound diuresis w/ water, electrolyte depletion possible; careful medical

supervision needed.
IND & DOSE Edema associated w/ systemic disease. Adult: 20–80 mg/day PO as single
dose; max, 600 mg/day. Or, 20–40 mg IM or IV (slow IV injection over 1–2 min); max,
4 mg/min. Child: 2 mg/kg/day PO; max, 6 mg/kg/day (1 mg/kg/day in preterm
infants). Tx of acute pulmonary edema. Adult: 40 mg IV over 1–2 min. May increase
to 80 mg IV over 1–2 min if response unsatisfactory after 1 hr. Child: 1 mg/kg IV or IM.
May increase by 1 mg/kg in 2 hr until desired effect achieved. Max, 6 mg/kg. Tx of
hypertension. Adult: 40 mg bid PO.
ADJUST DOSE Renal impairment
ADV EFF Anemia, anorexia, dizziness, hypokalemia, leukopenia, muscle cramps, n/v,
orthostatic hypotension, paresthesia, photosensitivity, pruritus, thrombocytopenia,
urticaria, xanthopsia
INTERACTIONS Aminoglycosides, charcoal, cisplatin, digitalis, ibuprofen, indomethacin,
NSAIDs, oral antidiabetics, phenytoin
NC/PT Give early in day so diuresis will not affect sleep. Do not expose to light. Record
weight daily. Arrange for potassium replacement or potassium-rich diet. Pt should avoid
sun exposure, report loss or gain of more than 3 lb/day, take safety precautions w/ CNS
effects. Name confusion between furosemide and torsemide; use caution.
 gabapentin (Neurontin, Gralise, Horizant)
CLASS Antiepileptic
PREG/CONT C/NA

IND & DOSE Adjunct tx of partial seizures. Adult: 300 mg PO tid. Maint, 900–
1,800 mg/day PO tid in divided doses; max of 2,400–3,600 mg/day has been used. Max
interval between doses, 12 hr. Child 3–12 yr: 10–15 mg/kg/day PO in three divided
doses. Range, 25–35 mg/kg/day in three divided doses (child 5 yr and older) and up to
40 mg/kg/day in three divided doses (child 3–4 yr). Tx of postherpetic neuralgia.
Adult: 300 mg/day PO; 300 mg PO bid on day 2; 300 mg PO tid on day 3. Or,
1,800 mg/day PO w/ evening meal (Gralise). Tx of moderate to severe restless legs
syndrome. Adult: 600–800 mg/day PO w/ food around 5 p.m.; max, 2,400 mg/day
(Horizant).
ADJUST DOSE Elderly pts, renal impairment
ADV EFF Ataxia, dizziness, insomnia, suicidal ideation, tremor, weight gain
INTERACTIONS Antacids
NC/PT Gralise not interchangeable w/ other forms of gabapentin. Do not cut, crush, or
allow pt to chew ER forms. Taper ER forms after long-term use. Pt may be at increased
risk for suicidality; monitor. Suggest medical ID. Pt should take safety precautions for
CNS effects.

gadobutrol (Gadavist)
CLASS Contrast agent
PREG/CONT C/NA

BBW Risk of nephrogenic systemic fibrosis, more common w/ higher-than-normal dosing

or repeated dosing; monitor total dose.
IND & DOSE Detection, visualization of areas w/ disrupted blood-brain barrier
and/or abnormal CNS vascularity. Adult, child 2 yr and older: Dosage based on body
weight: 0.1 mL/ kg, given as IV bolus at 2 mL/sec; flush line w/ NSS after injection.
ADV EFF Dysgeusia, feeling hot, headache, hypersensitivity reaction, injection-site
reaction, nausea, nephrogenic systemic fibrosis
NC/PT Evaluate GFR before starting tx. Monitor total dose exposure; monitor for
nephrogenic systemic fibrosis. Not for use in pregnancy. Pt should report all exposure to
contrast agents, itching, swelling or tightening, red or dark patches on skin, joint
stiffness, muscle weakness, bone pain.

galantamine hydrobromide (Razadyne)

CLASS Alzheimer drug, cholinesterase inhibitor
PREG/CONT B/NA
IND & DOSE Tx of mild to moderate dementia of Alzheimer type. Adult: 4 mg PO bid;
after 4 wk, increase to 8 mg PO bid; after 4 more wk, increase to 12 mg PO bid. Range,
16–32 mg/day in two divided doses. ER capsules, 8 mg/day PO; titrate to 16–24 mg/day
PO.
ADJUST DOSE Hepatic, renal impairment
ADV EFF Abd pain, anorexia, diarrhea, dizziness, dyspepsia, n/v/d, insomnia, weight loss
INTERACTIONS Bethanechol, cimetidine, erythromycin, ketoconazole, paroxetine, potent
CYP2D6/CYP3A4 inhibitors, succinylcholine
NC/PT Does not cure disease; may slow degeneration. Establish baseline functional
profile. Mix sol w/ water, fruit juice, or soda. Do not cut, crush, or allow pt to chew ER
form; have pt swallow whole. Antiemetics may be helpful for GI upset. Pt should take
safety measures for CNS effects. Because of name confusion, manufacturer has changed
name from Reminyl to Razadyne.

galsulfase (Naglazyme)
CLASS Enzyme
PREG/CONT B/NA

IND & DOSE Tx of pts w/ mucopolysaccharidosis VI to improve walking and stair

climbing capacity. Adult: 1 mg/kg/wk by IV infusion, diluted and infused over 4 hr.
ADJUST DOSE Hepatic, renal impairment
ADV EFF Abd pain, anaphylaxis and allergic reactions, cardiorespiratory failure,
chills, dyspnea, fever, headache, immune reactions, infusion reactions, n/v, pruritus,
rash, urticaria
NC/PT Establish baseline activity. Pretreat w/ antihistamines and antipyretics; consider
adding corticosteroids. Monitor continually during infusion; consider lowering dose or
discontinuing w/ severe reactions.

ganciclovir sodium (Cytovene, Vitrasert, Zirgan)

CLASS Antiviral
PREG/CONT C/NA

BBW Obtain CBC before tx, q 2 days during daily dosing, and at least wkly thereafter.
Consult physician and arrange for reduced dose if WBC or platelet count falls. IV
therapy is only for tx of CMV retinitis in immunocompromised pts and for px of CMV
disease in transplant pts at risk for CMV.
IND & DOSE Tx of CMV retinitis. Adult: 5 mg/kg IV at constant rate over 1 hr q 12 hr for
14–21 days; maint, 5 mg/kg by IV infusion over 1 hr once daily 7 days/wk or 6 mg/kg
once daily 5 days/wk. Or 1,000 mg PO tid w/ food or 500 mg PO six times/day q 3 hr
w/ food while awake. Implant surgically placed in affected eye q 5–8 mo. Child 2 yr and
older: Ophthalmic gel, 1 drop in affected eye(s) five times daily (approximately q 3 hr
while awake) until ulcer heals. Maint, 1 drop three times daily for 7 days. Prevention
of CMV disease in transplant recipients: Adult: 5 mg/kg IV over 1 hr q 12 hr for 7–
14 days; then 5 mg/kg/day PO once daily for 7 days/wk, or 6 mg/kg/day once daily for
5 days/wk. Prophylactic oral dose is 1,000 mg tid. Prevention of CMV disease w/
advanced AIDS: Adult: 1,000 mg PO tid.
ADJUST DOSE Renal impairment
ADV EFF Anemia, bone marrow suppression, cancer, fever, granulocytopenia, hepatic
changes, inflammation at injection site, pain, rash, thrombocytopenia
INTERACTIONS Bone marrow suppressants, imipenem-cilastatin, probenecid, zidovudine
NC/PT Avoid contact w/ sol; proper disposal necessary. Do not give IM or subcut; give
oral drug w/ food. Monitor CBC before and periodically during tx. Not for use in
pregnancy (contraceptives for men and women advised). Tell pt surgical implant will
need to be replaced q 5–8 mo; periodic eye exams, frequent blood tests will be needed.

ganirelix acetate (Antagon)

CLASS Fertility drug
PREG/CONT X/NA

IND & DOSEInhibition of premature LH surges in women in fertility programs. Adult:

250 mcg/day subcut starting on day 2 or 3 of cycle.
ADV EFF Abd pain, headache, injection-site reaction, n/v, ovarian hyperstimulation,
vaginal bleeding
NC/PT Drug part of comprehensive fertility program. Show pt proper administration
technique and proper disposal of needles and syringes. Pt should report swelling,
shortness of breath, severe n/v, low urine output.

DANGEROUS DRUG
gemcitabine hydrochloride (Gemzar)
CLASS Antimetabolite, antineoplastic
PREG/CONT D/NA

IND & DOSE Tx of pancreatic cancer after 5-FU tx. Adult: 1,000 mg/m2 IV over 30 min
once wkly for up to 7 wk. Subsequent cycles of once wkly for 3 out of 4 consecutive wk
can be given after 1-wk rest from tx. First-line tx of inoperable, locally advanced or
metastatic non-small-cell lung cancer: Adult: 1,000 mg/m2 IV over 30 min, days 1, 8,
and 15 of each 28-day cycle, w/ 100 mg/m2 cisplatin on day 1 after gemcitabine
infusion, or 1,250 mg/m2 IV over 30 min, days 1 and 8 of each 21-day cycle, w/
100 mg/m2 cisplatin on day 1 after gemcitabine infusion. First-line therapy for
metastatic breast cancer after failure of other adjuvant chemotherapy. Adult:
1,250 mg/m2 IV over 30 min, days 1 and 8 of each 21-day cycle, w/ 175 mg/m2
paclitaxel IV as 3-hr infusion before gemcitabine on day 1 of cycle. Tx of advanced
ovarian cancer that has relapsed at least 6 mo after completion of platinum-
based therapy. Adult: 1,000 mg/m2 IV over 30 min, days 1 and 8 of each 21-day cycle.
Carboplatin given on day 1 after gemcitabine.
ADV EFF Alopecia, bone marrow depression, edema, fever, flulike symptoms,
interstitial pneumonitis, n/v, pain, rash
NC/PT Monitor CBC, renal function, LFTS carefully; dose adjustment may be needed.
Infuse over 30 min; longer infusions cause increased half-life/greater toxicity.
Premedicate for n/v. Pt should avoid exposure to infection, protect head in temp
extremes (hair loss possible).

gemfibrozil (Lopid)
CLASS Antihyperlipidemic
PREG/CONT C/NA

IND & DOSE Adjunct to diet, exercise for tx of hypertriglyceridemia in pts w/ very
high triglycerides; reduction of CAD in pts unresponsive to traditional therapies.
Adult: 1,200 mg/day PO in two divided doses 30 min before morning and evening
meals.
ADJUST DOSE Hepatic, renal impairment
ADV EFF Abd pain, blurred vision, cataract development, dizziness, dyspepsia, eczema,
epigastric pain, eosinophilia, fatigue, headache, leukopenia, n/v/d, rhabdomyolysis
INTERACTIONS Anticoagulants, repaglinide, statins, sulfonylureas
NC/PT Use only if strongly indicated and lipid studies show a definite response; hepatic
tumorigenicity occurs in lab animals. Pt should take w/ meals; continue diet, exercise
program; take safety precautions w/ CNS effects; report muscle pain w/ fever.

gemifloxacin mesylate (Factive)

CLASS Fluoroquinolone antibiotic
PREG/CONT C/NA

BBW Risk of tendinitis and tendon rupture. Risk increases in pts over 60 yr, w/
concurrent corticosteroid use, and w/ kidney, heart, or lung transplant; monitor these
pts accordingly. Risk of exacerbation of muscle weakness and potential crisis in pts w/
myasthenia gravis; contraindicated for use in pts w/ hx of myasthenia gravis.
IND & DOSE Tx of acute bacterial exacerbations of chronic bronchitis caused by
susceptible strains. Adult: 320 mg/day PO for 5 days. Tx of community-acquired
pneumonia caused by susceptible strains. Adult: 320 mg/day PO for 5 days; 7 days
for resistant strains.
ADJUST DOSE Renal impairment
ADV EFF Abd pain, blurred vision, dizziness, n/v/d, photosensitivity, prolonged QT
interval, ulcerative colitis, sulfonylureas
INTERACTIONS Aluminum- or potassium-containing antacids, amiodarone, antidepressants,
antipsychotics, calcium, didanosine, erythromycin, iron, procainamide, quinidine,
sotalol, sucralfate
NC/PT Culture before tx. Not for use in breast-feeding. Pt should take 3 hr before or 2 hr
after taking antacids; swallow tablet whole and not cut, crush, or chew it; drink plenty
of fluids; report acute pain or tenderness in muscle or tendon, bloody diarrhea,
palpitations, fainting.

gentamicin sulfate (Gentak, Pediatric Gentamicin Sulfate)

CLASS Fluoroquinolone antibiotic
PREG/CONT D (systemic); C (ophthalmic)/NA

BBW Monitor hearing w/ long-term tx; ototoxicity possible. Monitor renal function,
CBC, serum drug levels during long-term tx; carefully monitor pt if combined w/ other
neurotoxic or nephrotoxic drugs.
IND & DOSE Tx of serious infections caused by susceptible bacteria strains or when
causative organisms not known. Adult: 320 mg/day PO for 5 days. Tx of community-
acquired pneumonia caused by susceptible strains. Adult: 3 mg/kg/day IM or IV in
three equal doses q 8 hr. Up to 5 mg/kg/day in three to four equal doses in severe
infections, usually for 7–10 days. For IV use, may infuse loading dose of 1–2 mg/kg over
30–60 min. Child: 2–2.5 mg/kg IM or IV q 8 hr. Infants, neonates: 2.5 mg/kg IM or IV q
8 hr. Preterm, full-term neonates 1 wk or younger: 2.5 mg/kg IM or IV q 12 hr. Preterm
neonates under 32 wk gestational age: 2.5 mg/kg IM or IV q 18 hr or 3 mg/kg q 24 hr. Tx
of PID. Adult: 2 mg/kg IV, then 1.5 mg/kg IV tid plus clindamycin 600 mg IV qid.
Continue for at least 4 days and at least 48 hr after pt improves, then continue
clindamycin 450 mg PO qid for 10–14 days total tx. Tx of superficial ocular infections
due to susceptible microorganism strains. Adult, child: 1–2 drops in affected eye(s) q
4 hr; use up to 2 drops hrly in severe infections or apply about ½″ ointment to affected
eye bid–tid. Infection px in minor skin abrasions, tx of superficial skin infections.
Adult, child: Apply tid–qid. May cover w/ sterile bandage.
ADJUST DOSE Elderly pts, renal failure
ADV EFF Anorexia, apnea, arachnoiditis at IM injection sites, bone marrow
suppression, dizziness, local irritation, n/v/d, nephrotoxicity, neuromuscular
blockade, ototoxicity, pain, purpura, rash, seizures, superinfections, tinnitus
INTERACTIONS Aminoglycosides, anesthetics, beta-lactam–type antibiotics, carbenicillin,
cephalosporins, citrate-anticoagulated blood, diuretics (potent), enflurane,
methoxyflurane, nondepolarizing NMJ blockers, penicillins, succinylcholine, ticarcillin,
vancomycin
NC/PT Culture before tx. Give by deep IM injection if possible. Avoid long-term use.
Monitor serum levels. Max peak levels, 12 mcg/mL (6–8 mcg/mL usually adequate for
most infections); max trough levels, 2 mcg/mL. Monitor CBC, renal function, hearing.
Teach proper administration of ophthalmic and topical preparations. Pt should take
safety precautions w/ CNS effects; avoid exposure to infection; report severe headache,
loss of hearing, difficult breathing.
 glatiramer acetate (Copaxone)
CLASS MS drug
PREG/CONT B/NA

IND & DOSE To reduce frequency of relapses in pts w/ relapsing-remitting MS,

including pts who have experienced a first clinical episode and have MRI features
consistent w/ MS. Adult: 20 mg/day subcut.
ADV EFF Anxiety, asthenia, back pain, chest pain, infections, injection-site reactions
(including lipoatrophy, skin necrosis), nausea, post-injection reaction, rash
NC/PT Rotate injection sites; do not use same site within a wk. Teach proper
administration technique and disposal of needles and syringes. Monitor for infections.
Pt should report severe injection-site reactions, chest pain w/ sweating, trouble
breathing.

DANGEROUS DRUG
glimepiride (Amaryl)
CLASS Antidiabetic, sulfonylurea
PREG/CONT C/NA

IND & DOSE Adjunct to diet to lower blood glucose in pts w/ type 2 diabetes mellitus.
Adult: 1–2 mg PO once daily w/ breakfast or first meal of day. Range, 1–4 mg PO once
daily; max, 8 mg/day. W/ metformin or insulin to better control glucose as adjunct
to diet, exercise in pts w/ type 2 diabetes mellitus. Adult: 8 mg PO daily w/ first
meal of day w/ low-dose insulin or metformin.
ADJUST DOSE Adrenal or pituitary insufficiency; debilitated, elderly, malnourished pts;
hepatic, renal impairment
ADV EFF Allergic skin reactions, anorexia, CV mortality, diarrhea, epigastric distress,
eosinophilia, hypoglycemia
INTERACTIONS Alcohol, androgens, anticoagulants, azole antifungals, beta blockers,
calcium channel blockers, celery, cholestyramine, chloramphenicol, clofibrate,
coriander, corticosteroids, dandelion root, diazoxide, estrogens, fenugreek, fluconazole,
garlic, gemfibrozil, ginseng, histamine-2 blockers, hormonal contraceptives, hydantoins,
isoniazid, juniper berries, magnesium salts, MAOIs, methyldopa, nicotinic acid,
phenothiazines, probenecid, rifampin, salicylates, sulfinpyrazone, sulfonamides,
sympathomimetics, TCAs, thiazides, thyroid drugs, urinary acidifiers/alkalinizers
NC/PT Monitor blood glucose. Transfer to insulin temporarily in times of stress. Ensure
diet, exercise program Arrange for complete diabetic teaching program. Not for use in
pregnancy. Pt should avoid alcohol.

DANGEROUS DRUG
glipiZIDE (Glucotrol)
 CLASSAntidiabetic, sulfonylurea
PREG/CONT C/NA

IND & DOSE Adjunct to diet to lower blood glucose in pts w/ type 2 diabetes mellitus.
Adult: 5 mg PO before breakfast. Adjust dose in increments of 2.5–5 mg as determined
by blood glucose response; max, 15 mg/dose. ER tablets, 5 mg/day PO; may increase to
10 mg/day after 3 mo.
ADJUST DOSE Elderly pts
ADV EFF Allergic skin reactions, anorexia, bone marrow suppression, CV mortality,
diarrhea, epigastric distress, eosinophilia, hypoglycemia
INTERACTIONS Alcohol, beta blockers, chloramphenicol, clofibrate, coriander, dandelion
root, diazoxide, fenugreek, garlic, gemfibrozil, ginseng, juniper berries, phenothiazines,
rifampin, salicylates, sulfonamides
NC/PT Monitor blood glucose. Transfer to insulin temporarily in times of stress. Give 30
min before breakfast. Ensure diet, exercise program. Arrange for complete diabetic
teaching program. Not for use in pregnancy. Pt should swallow ER tablets whole and
not cut, crush, or chew them; avoid alcohol.

glucagon (GlucaGen Diagnostic Kit, GlucaGen HypoKit, Glucagon Emergency

Kit)
CLASS Diagnostic agent, glucose-elevating drug
PREG/CONT B/NA

IND & DOSE Tx of hypoglycemia. Adult, child over 20 kg: 0.5–1 mg IV, IM, or subcut;
severe hypoglycemia, 1 mL IV, IM, or subcut. Use IV if possible. Child under 20 kg:
0.5 mg IM, IV, or subcut, or dose equivalent to 20–30 mcg/kg. Diagnostic aid in
radiologic examination of stomach, duodenum, small bowel, colon. Adult, child
over 20 kg: Usual dose, 0.25–2 mg IV or 1–2 mg IM.
ADV EFF Hypokalemia, hypotension, n/v, respiratory distress
INTERACTIONS Oral anticoagulants
NC/PT Arouse pt as soon as possible. Provide supplemental carbohydrates. Evaluate
insulin dose in pts w/ insulin overdose. Teach pt and significant other proper
administration and disposal of needles and syringes.

glucarpidase (Voraxaze)
CLASS Carboxypeptidase enzyme
PREG/CONT C/NA

IND & DOSE Tx of pts w/ toxic plasma methotrexate concentrations w/ delayed

methotrexate clearance due to impaired renal function. Adult, child: 50 units/kg as
single IV injection.
ADV EFF Flushing, headache, hypotension, n/v, paresthesia, serious allergic reactions
INTERACTIONS Folate, folate antimetabolites, leucovorin
NC/PT Continue hydration, alkalinization of urine. Do not administer within 2 hr of
leucovorin. Monitor closely for allergic reaction during and directly after injection. Tell
pt blood levels will be monitored repeatedly during tx. Pt should report fever, chills,
rash, difficulty breathing, numbness/tingling, headache.

DANGEROUS DRUG
glyBURIDE (DiaBeta, Glynase)
CLASS Antidiabetic, sulfonylurea
PREG/CONT B (Glynase); C (DiaBeta)/NA

IND & DOSE Adjunct to diet to lower blood glucose in pts w/ type 2 diabetes mellitus.
Adult: 2.5–5 mg PO w/ breakfast (DiaBeta); 1.5–3 mg/day PO (Glynase); maint, 1.25–
20 mg/day PO.
ADJUST DOSE Debilitated, elderly, malnourished pts
ADV EFF Allergic skin reactions, anorexia, blurred vision, bone marrow suppression, CV
mortality, diarrhea, epigastric distress, hypoglycemia
INTERACTIONS Alcohol, beta blockers, chloramphenicol, clofibrate, coriander, dandelion
root, diazoxide, fenugreek, garlic, gemfibrozil, ginseng, juniper berries, phenothiazines,
rifampin, salicylates, sulfonamides
NC/PT Note dosage difference between two forms; use w/ care. Monitor blood glucose.
Transfer to insulin temporarily in times of stress. Give before breakfast. Ensure diet,
exercise program. Arrange for complete diabetic teaching program. Not for use in
pregnancy. Pt should avoid alcohol. Name confusion between DiaBeta (glyburide) and
Zebeta (bisoprolol); use caution.

glycerol phenylbutyrate (Ravicti)

CLASS Nitrogen-binding agent
PREG/CONT C/NA

IND & DOSE Long-term mgt of urea cycle disorders not managed by diet/amino acid
supplementation. Adult, child 2 yr and older: 4.5–11.2 mL/m2/day PO divided into three
equal doses, rounded to nearest 0.5 mL, w/ food; max, 17.5 mL/day.
ADJUST DOSE Hepatic impairment
ADV EFF Diarrhea, flatulence, headache, neurotoxicity
INTERACTIONS Corticosteroids, haloperidol, probenecid, valproic acid
NC/PT Must give w/ protein-restricted diet; monitor ammonia levels; adjust dose as
needed. Not for not use in pregnancy, breast-feeding. Pt should take with food, report
disorientation, confusion, impaired memory.

glycopyrrolate (Cuvposa, Robinul)

CLASS Anticholinergic, antispasmodic, parasympatholytic
 PREG/CONT B/NA

IND & DOSEAdjunct tx for peptic ulcer. Adult: 1 mg PO tid or 2 mg bid–tid. Maint, 1 mg
bid; max, 8 mg/day. Tx of chronic, severe drooling caused by neurologic disorders.
Child: 3–16 yr: 0.02 mg/kg PO tid; titrate in 0.02-mg increments q 5–7 days. Max,
0.1 mg/kg PO tid; do not exceed 1.5–3 mg/dose. Tx of peptic ulcer. Adult: 0.1–0.2 mg
IM or IV tid–qid. Preanesthetic medication. Adult: 0.004 mg/kg IM 30–60 min before
anesthesia. Child 2 yr–under 12 yr: 0.004 mg/kg IM 30 min–1 hr before anesthesia. Child
1 mo–2 yr: Up to 0.009 mg/kg IM may be needed. Intraop to decrease vagal traction
reflexes. Adult: 0.1 mg IV; repeat as needed at 2- to 3-min intervals. Child over 1 mo:
0.004 mg/kg IV, not to exceed 0.1 mg in single dose. May repeat at 2- to 3-min
intervals. Reversal of neuromuscular blockade. Adult, child over 1 mo: W/
neostigmine, pyridostigmine, 0.2 mg IV for each 1 mg neostigmine or 5 mg
pyridostigmine; give IV simultaneously.
ADV EFF Altered taste perception, blurred vision, decreased sweating, dry mouth,
dysphagia, irritation at injection site, n/v, photosensitivity, urinary hesitancy, urine
retention
INTERACTIONS Amantadine, anticholinergics, digitalis, haloperidol, phenothiazines
NC/PT Check dose carefully. Ensure adequate hydration. Pt should empty bladder before
each dose, avoid hot environments (may be subject to heat stroke) and sun exposure,
suck sugarless lozenges, perform mouth care for dry mouth.

gold sodium thiomalate (Aurolate)

CLASS Antirheumatic, gold compound
PREG/CONT C/NA

BBW Monitor lung, renal function; obtain CBC regularly. Discontinue at first sign of
toxicity; can cause serious to fatal bone marrow suppression and renal toxicity.
IND & DOSE Tx of selected, early cases of adult and juvenile rheumatoid arthritis.
Adult: 10 mg IM wk 1; 25 mg IM wk 2 and 3; then 25–50 mg IM to total dose of 1 g.
Maint, 25–50 mg IM q other wk for 2–30 wk. Child: 10 mg IM as test dose, then
1 mg/kg/wk IM; max, 50 mg/dose.
ADV EFF Abd pain, bone marrow suppression, diarrhea, fainting, fever, grey-blue skin,
hair loss, headache, infection, injection-site reactions, photosensitivity, rash, seizures,
stomatitis
INTERACTIONS ACE inhibitors, chloroquine immunosuppressants, phenylbutazone,
phenytoin, primaquine
NC/PT Monitor closely. Rotate injection sites; local reactions common. May use
corticosteroids for severe reactions. Give analgesics as needed. Use cautiously in
pregnancy. Pt should avoid exposure to infection and sunlight.

golimumab (Simponi)
 CLASSMonoclonal antibody, TNF inhibitor
PREG/CONT B/NA

BBW Serious infections possible, including TB, sepsis, invasive fungal infections.
Discontinue if infection or sepsis develops. Perform TB test before tx. If TB present, start
TB tx and monitor pt carefully throughout tx. Increased risk of lymphoma and other
cancers in children and adolescents; monitor accordingly.
IND & DOSE Tx of active rheumatoid arthritis, active psoriatic arthritis, ankylosing
spondylitis. Adult: 50 mg/mo subcut or 2 mg/kg IV over 30 min wk 0, 4, then q 8 wk.
ADV EFF Dizziness, increased risk of demyelinating disorders, infections, injection-
site reactions, nasopharyngitis
INTERACTIONS Abatacept, anakinra, adalimumab, certolizumab, etanercept, infliximab,
live vaccines, rituximab
NC/PT TB test before tx. Store in refrigerator; bring to room temp before use. Rotate
injection sites. For IV, use inline filter; do not infuse w/ other drugs. Monitor for CNS
changes, infection. Not for use in breast-feeding. Teach proper administration and
disposal of needles and syringes. Pt should avoid live vaccines, take safety precautions
for dizziness, have regular medical follow-up; report fever, numbness and tingling,
worsening of arthritis.

DANGEROUS DRUG
goserelin acetate (Zoladex)
CLASS Antineoplastic, hormone
PREG/CONT X; D (w/ breast cancer)/NA

IND & DOSE Palliative tx of advanced prostate or breast cancer. Adult: 3.6 mg q
28 days subcut (long-term use). Mgt of endometriosis. Adult: 3.6 mg subcut q 28 days
for 6 mo. Endometrial thinning before ablation. Adult: One to two 3.6-mg subcut
depots 4 wk apart; surgery should be done 4 wk after first dose (within 2–4 wk after
second depot if two are used). Tx of stage B2–C prostate cancer. Adult: Start tx 8 wk
before start of radiation therapy and continue during radiation therapy; 3.6-mg depot 8
wk before radiation, then one 10.8-mg depot 28 days later. Or, four injections of 3.6-mg
depot at 28-day intervals, two depots preceding and two during radiotherapy.
ADV EFF Cancer, decreased erections, dizziness, dysmenorrhea, edema. gynecomastia, hot
flashes, lower urinary tract symptoms, sexual dysfunction, vaginitis
NC/PT Implant in upper abdomen q 28 days or q 3 mo. Mark calendar for injection dates.
Not for use in pregnancy (contraceptives advised), breast-feeding. Pt should report pain
at injection site, discuss sexual dysfx w/ health care provider.

granisetron hydrochloride (Kytril, Sancuso)

CLASS Antiemetic, 5-HT3 receptor antagonist
PREG/CONT B/NA
IND & DOSE Tx, px of chemotherapy-induced n/v. Adult, child over 2 yr: 10 mcg/kg IV
over 5 min starting within 30 min of chemotherapy, only on days of chemotherapy. Or
1 mg PO bid or 2 mg/day PO as 1 dose, beginning up to 1 hr before chemotherapy and
second dose 12 hr after chemotherapy, only on days of chemotherapy. Or, for adults,
apply 1 patch to clean, dry skin on upper, outer arm 24–48 hr before chemotherapy.
Keep patch in place minimum of 24 hr after completion of chemotherapy, then remove;
may be left in place for up to 7 days. Tx, px of radiation induced n/v. Adult, child over
2 yr: 2 mg PO once daily 1 hr before radiation. Px, tx of postop n/v. Adult, child over 2
yr: 1 mg IV over 30 sec before induction or reversal of anesthesia.
ADV EFF Asthenia, chills, decreased appetite, fever, headache
NC/PT Use only as directed. Apply transdermal patch to clean, dry skin; leave in place up
to 7 days. Pt should perform mouth care, use sugarless lozenges to help relieve nausea,
report sever headache.

guaifenesin (Altarussin, Diabetic Tussin, Mucinex, Siltussin)

CLASS Expectorant
PREG/CONT C/NA

IND & DOSE Symptomatic relief of respiratory conditions characterized by dry,

nonproductive cough; mucus in respiratory tract. Adult, child over 12 yr: 200–400 mg
PO q 4 hr; max, 2.4 g/day. Or 1–2 tablets PO (600-mg ER tablets) q 12 hr; max, 2.4
g/day. Child 6–12 yr: 100–200 mg PO q 4 hr; max, 1.2 g/day or 600 mg (ER) PO q 12 hr.
Child 2–6 yr: 50–100 mg PO q 4 hr; max, 600 mg/day.
ADV EFF Dizziness, headache, n/v
NC/PT Pt should swallow ER tablet whole and not cut, crush, or chew it, use for no longer
than 1 wk, consult prescriber if cough persists, take safety precautions for dizziness.
Name confusion between Mucinex (guaifenesin) and Mucomyst (acetylcysteine); use
caution.

guanfacine hydrochloride (Intuniv, Tenex)

CLASS Antihypertensive, sympatholytic
PREG/CONT B/NA

IND & DOSEMgt of hypertension. Adult, child over 12 yr: 1 mg/day PO at bedtime. Tx of
ADHD. Adult, child 6 yr and older: 1 mg/day PO; titrate at increments of 1 mg/wk to
range of 1–4 mg/day (Intuniv).
ADJUST DOSE Elderly pts; hepatic, renal impairment
ADV EFF Constipation, dizziness, dry mouth, ED, sedation, weakness
NC/PT Taper when stopping; decrease by no more than 1 mg q 3–7 days. Pt should
swallow ER form whole and not cut, crush, or chew it, take immediate-release form at
bedtime, continue tx program for ADHD, take safety precautions for CNS effects, use
sugarless lozenges for dry mouth.

haloperidol, haloperidol decanoate, haloperidol lactate (Haldol)

CLASS Antipsychotic, dopaminergic blocker
PREG/CONT C/NA

BBW Increased risk of death in elderly pts w/ dementia-related psychosis; drug not
approved for this use.
IND & DOSE Tx of psychiatric disorders, Tourette syndrome. Adult: 0.5–2 mg PO bid–tid
w/ moderate symptoms; 3–5 mg PO bid–tid for more resistant pts. Or IM dose 10–
15 times daily oral dose in elderly pts stabilized on 10 mg/day or less; 20 times daily
oral dose in pts stabilized on high doses and tolerant to oral haloperidol. Max,
3 mL/injection site; repeat at 4-wk intervals. Prompt control of acutely agitated pts
w/ severe symptoms. Adult: 2–5 mg (up to 10–30 mg) q 60 min or q 4–8 hr IM as
necessary. Tx of psychiatric disorders. Child 3–12 yr or 15–40 kg: 0.5 mg/day (25–
50 mcg/kg/day) PO; may increase in increments of 0.5 mg q 5–7 days as needed in
general, then 0.05–0.15 kg/day PO bid–tid. Nonpsychotic and Tourette syndromes,
behavioral disorders, hyperactivity. Child 3–12 yr or 15–40 kg: 0.05–0.075 mg/kg/day
PO bid–tid.
ADJUST DOSE Elderly pts
ADV EFF Akathisia, anemia, aplastic anemia, autonomic disturbances, bronchospasm,
cardiac arrest, dry mouth, dystonia, eosinophilia, hemolytic anemia, hyperthermia,
hypoglycemia, laryngospasm, leukocytosis, leukopenia, NMS, photosensitivity,
pseudoparkinsonism, refractory arrhythmias, seizures, sudden death related to
asphyxia, tardive dyskinesia, thrombocytopenic or nonthrombocytopenic purpura
INTERACTIONS Anticholinergics, carbamazepine, ginkgo, lithium
NC/PT Do not use IM in children. Do not give IV. Gradually withdraw after maint tx.
Monitor for renal toxicity. Urine may be pink to brown. Pt should take safety
precautions for CNS effects, avoid sun exposure, maintain fluid intake, use sugarless
lozenges for dry mouth.

DANGEROUS DRUG
heparin sodium (generic)
CLASS Anticoagulant
PREG/CONT C/NA

IND & DOSE Px, tx of venous thrombotic events. Adult: IV loading dose, 5,000 units; then
10,000–20,000 units subcut followed by 8,000–10,000 units subcut q 8 hr or 15,000–
20,000 units q 12 hr. Or initial dose, 10,000 units IV, then 5,000–10,000 units IV q 4–
6 hr. Or loading dose, 5,000 units IV, then 20,000–40,000 units/day by IV infusion.
Child: IV bolus of 50 units/kg, then 100 units/kg IV q 4 hr, or 20,000 units/m2/24 hr by
continuous IV infusion. Px of postop thromboembolism. Adult: 5,000 units by deep
subcut injection 2 hr before surgery and q 8–12 hr thereafter for 7 days or until pt fully
ambulatory. Surgery of heart and blood vessels for pts undergoing total body
perfusion. Adult: Not less than 150 units/kg IV. IV often-used guideline: 300 units/kg
for procedures less than 60 min, 400 units/kg for longer procedures. Add 400–600 units
to 100 mL whole blood. Clot prevention in blood samples. Adult: 70–150 units/ 10–
20 mL whole blood.
ADV EFF Bleeding, bruising, chills, fever, hemorrhage, injection-site reactions, hair loss,
liver enzyme changes, white clot syndrome
INTERACTIONS Aspirin, cephalosporins, chamomile, garlic, ginger, ginkgo, ginseng, high-
dose vitamin E, NSAIDs, penicillins, oral anticoagulants, salicylates
NC/PT Adjust dose based on coagulation tests; target aPTT, 1.5–2.5 times control.
Incompatible in sol w/many drugs; check before combining. Give by deep subcut
injection; do not give IM. Apply pressure to all injection sites; check for signs of
bleeding. Have protamine sulfate on hand as antidote. Pt should protect from injury,
report bleeding gums, black or tarry stools, severe headache.

hetastarch (Hespan, Voluven)

CLASS Plasma expander
PREG/CONT C/NA

IND & DOSE Adjunct tx for plasma volume expansion in shock due to hemorrhage,
burns, surgery, sepsis, trauma. Adult: 500–1,000 mL IV; max, 1,500 mL/day. In acute
hemorrhagic shock, rates approaching 20 mL/kg/hr IV often needed (Hespan); up to
50 mL/kg/day IV Voluven injection. Adjunct tx in leukapheresis to improve
harvesting, increase yield of granulocytes. Adult: 250–700 mL infused at constant
fixed ratio of 1:8 to 1:13 to venous whole blood. Safety of up to two procedures/wk and
total of seven to ten procedures using hetastarch have been established.
ADV EFF Bleeding, chills, headache, itching, mild influenza-like reactions, submaxillary
and parotid gland enlargement, n/v
NC/PT Do not mix in sol w/ other drugs. Have emergency support on hand. Pt should
report difficulty breathing, severe headache.

histrelin implant (Vantas)

CLASS Antineoplastic, GNRH
PREG/CONT X/NA

IND & DOSE Palliative tx of advanced prostate cancer. Adult: 1 implant inserted subcut
and left for 12 mo. May be removed after 12 mo and new implant inserted.
ADV EFF Diabetes, fatigue, hot flashes, hyperglycemia, injection-site reactions MI, renal
impairment, spinal cord compression, stroke, testicular atrophy
NC/PT Monitor serum glucose, renal function, injection site. Pt should report chest pain,
numbness or tingling, injection-site reactions.
 hyaluronic acid derivatives (Euflexxa, Hyalgan, Synvisc)
CLASS Glucosamine polysaccharide
PREG/CONT C/NA

IND & DOSE Tx of pain in osteoarthritis of knee in pts unresponsive to traditional

therapy. Adult: 2 mL/wk by intra-articular injection in knee for total of three to five
injections.
ADV EFF Headache, joint swelling, pain at injection site
NC/PT Avoid strenuous exercise and prolonged weight bearing for 48 hr after injection.
Headache may occur. Pt should report severe joint swelling, loss of movement.

hyaluronidase (Amphadase, Hylenex, Vitrase)

CLASS Enzyme
PREG/CONT C/NA

IND & DOSE To increase absorption of injected drugs. Adult, child: Add 150 units to
injection sol. Hypodermoclysis. Adult: 150 units injected under skin close to clysis. Child
under 3 yr: Limit total dose to 200 mL/clysis. Premature infants: Max, 25 mL/kg at rate of
no more than 2 mL/min. Adjunct to subcut urography. Adult: 75 units subcut over
each scapula followed by injection of contrast media at same sites.
ADV EFF Chills, dizziness, edema, hypotension, injection-site reactions, n/v
INTERACTIONS Benzodiazepines, furosemide, phenytoin
NC/PT Do not use w/ dopamine or alpha-adrenergic drugs or in inflamed or infected
areas. Do not apply to cornea or use for insect bites or stings; monitor injection site.

hydrALAZINE hydrochloride (Apresoline)

CLASS Antihypertensive, vasodilator
PREG/CONT C/NA

IND & DOSE Tx of essential hypertension. Adult: 10 mg PO qid for first 2–4 days;
increase to 25 mg PO qid for first wk. Second and subsequent wks: 50 mg PO qid. Or 20–
40 mg IM or IV, repeated as necessary if unable to take orally. Child: 0.75 mg/kg/day
PO in divided doses q 6 hr (max, 7.5 mg/kg/day PO in four divided doses, or
200 mg/day PO). Or 1.7–3.5 mg/kg IM or IV divided into four to six doses if unable to
take orally. Tx of eclampsia. Adult: 5–10 mg q 20 min by IV bolus. If no response after
20 mg, try another drug.
ADV EFF Angina, anorexia, blood dyscrasias, dizziness, headache, n/v/d, orthostatic
hypotension, palpitations, peripheral neuritis, rash, tachycardia
INTERACTIONS Adrenergic blockers
NC/PT Use parenteral drug immediately after opening ampule. Withdraw drug gradually,
especially in pts who have experienced marked BP reduction. Pt should take safety
precautions w/ orthostatic hypotension, CNS effects; take w/ food; report chest pain,
numbness or tingling, fever.

hydrochlorothiazide (HydroDIURIL, Hydro-Par, Microzide Capsules)

CLASS Thiazide diuretic
PREG/CONT B/NA

IND & DOSE Adjunct tx of edema from systemic disease. Adult: 25–100 mg PO daily
until dry weight attained. Then, 25–100 mg/day PO or intermittently, up to
200 mg/day. Child: 1–2 mg/kg/day PO in one or two doses. Max, 100 mg/day in two
doses (2–12 yr), 37.5 mg/day in two doses (6 mo–2 yr), up to 3 mg/kg/day in two doses
(under 6 mo). Tx of hypertension. Adult: 12.5–50 mg PO; max, 50 mg/day.
ADJUST DOSE Elderly pts
ADV EFF Anorexia, dizziness, drowsiness, dry mouth, muscle cramps, n/v, nocturia,
photosensitivity, polyuria, vertigo
INTERACTIONS Amphotericin B, antidiabetics, cholestyramine, colestipol, corticosteroids,
lithium, loop diuretics, NMJ blockers
NC/PT Monitor BP; reduced dose of other antihypertensives may be needed. Give w/
food. Mark calendar for intermittent therapy. Pt should measure weight daily, take
early in day so sleep not interrupted, use safety precautions for CNS effects, avoid sun
exposure, report weight changes of 3 lb/day.

DANGEROUS DRUG
hydrocodone bitartrate (Zohydro ER)
CLASS Opioid agonist analgesic
PREG/CONT C/C-II

BBW Risks of addiction, severe to fatal respiratory depression, death w/ accidental

consumption by children, life-threatening neonatal withdrawal if used in pregnancy,
fatal plasma levels if combined w/ alcohol.
IND & DOSE Mgt of pain requiring continuous analgesic for prolonged period. Adult:
Initially, 10 mg PO q 12 hr for opioid-naïve or opioid-nontolerant pts; increase as
needed in 10-mg increments q 12 hr q 3–7 days.
ADJUST DOSE Elderly, impaired pts; severe renal, hepatic impairment
ADV EFF Abd pain, back pain, confusion, constipation, dizziness, dry mouth, fatigue,
headache, n/v/d, pruritus, respiratory depression
INTERACTIONS Alcohol, anticholinergics, barbiturate anesthetics, CNS depressants, CYP3A4
inhibitors, MAOIs, other opioids, protease inhibitors
NC/PT Monitor pt carefully; ensure appropriate use of drug. Ensure opioid antagonist
and emergency equipment readily available. Safety issues w/ CNS changes. Taper when
discontinuing. Pt should swallow capsule whole, not cut, crush, or chew it; discontinue
slowly; avoid pregnancy, breast-feeding, alcohol; take safety precautions w/ CNS
changes; report difficulty breathing, severe constipation, pain unrelieved by drug.

hydrocortisone salts (Cortaid, Pandel, Solu-Cortef, Westcort)

CLASS Corticosteroid
PREG/CONT C/NA

IND & DOSE Replacement tx in adrenal cortical insufficiency, allergic states,

inflammatory disorders, hematologic disorders, trichinosis, ulcerative colitis, MS.
Adult, child: 5–200 mg/day PO based on severity and pt response, or 100–500 mg IM or
IV q 2, 4, or 6 hr. Retention enema for tx of ulcerative colitis, proctitis. Adult, child:
100 mg nightly for 21 days. Anorectal cream, suppositories to relieve discomfort of
hemorrhoids, perianal itching or irritation. Adult, child: 1 applicator daily or bid for
2 or 3 wk and q second day thereafter. Dermatologic preparations to relieve
inflammatory and pruritic manifestations of dermatoses. Adult, child: Apply
sparingly to affected area bid–qid. Tx of acute/chronic ophthalmic inflammatory
conditions. Adult, child: 1–2 drops per eye one to two times/day.
ADV EFF Anaphylactoid reactions, amenorrhea, ecchymoses, fluid retention, headache,
HF, hypokalemia, hypotension, immunosuppression, infection, irregular menses, local
pain or irritation at application site, muscle weakness, pancreatitis, peptic ulcer, striae,
vertigo
INTERACTIONS Anticoagulants, anticholinesterases, cholestyramine, estrogen, hormonal
contraceptives, ketoconazole, live vaccines, phenobarbital, phenytoin, rifampin,
salicylates
NC/PT Give daily before 9 a.m. to mimic normal peak diurnal corticosteroid levels and
minimize HPA suppression. Rotate IM injection sites. Use minimal doses for minimal
duration to minimize adverse effects. Taper doses when discontinuing high-dose or long-
term tx; arrange for increased dose when pt is subject to unusual stress. W/ topical use,
use caution w/ occlusive dressings; tight or plastic diapers over affected area can
increase systemic absorption. Suggest medical ID. Pt should protect from infection;
report swelling, difficulty breathing.

DANGEROUS DRUG
hydromorphone hydrochloride (Dilaudid, Dilaudid-HP, Exalgo)
CLASS Opioid agonist analgesic
PREG/CONT C; D (Labor & delivery)/C-II

BBW Monitor dose and intended use; vary w/ form. Serious effects, abuse, misuse
possible. Extended-release form for opioid-tolerant pts only; fatal respiratory depression
possible. Extended-release form not for use w/ acute or postop pain or as an as-needed
drug. Pt must swallow extended-release tablets whole; broken, chewed, or crushed
tablets allow rapid release of drug and could cause fatal overdose.
IND & DOSE Relief of moderate to severe pain; acute and chronic pain. Adult: 2–4 mg
PO q 4–6 hr. Liquid, 2.5–10 mg PO q 3–6 hr. ER tablets, 8–64 mg/day PO. Or 1–2 mg
IM/subcut q 4–6 hr as needed, or by slow IV injection over 2–3 min, or 3 mg rectally q
6–8 hr.
ADJUST DOSE Elderly pts; hepatic, renal impairment
ADV EFF Apnea, cardiac arrest, circulatory depression, constipation, dizziness,
flushing, light-headedness, n/v, respiratory arrest, respiratory depression, sedation,
shock, sweating, visual disturbances
INTERACTIONS Alcohol, anticholinergics, antihistamines, barbiturate anesthetics, MAOIs,
opioid agonist/antagonists
NC/PT Ensure opioid antagonist and facilities for assisted or controlled respiration are
readily available during parenteral administration. Breast-feeding pts should take 4–
6 hr before scheduled feeding. Refrigerate rectal suppositories. Pt should swallow ER
tablets whole, and not cut, crush, or chew them; avoid alcohol, antihistamines; take
laxative for constipation; use safety precautions for CNS effects; report chest pain,
difficulty breathing.

hydroxocobalamin (Cyanokit)
CLASS Antidote
PREG/CONT C/NA

IND & DOSETx of known or suspected cyanide poisoning. Adult: 5 g by IV infusion over
15 min; may give second dose over 15–120 min by IV infusion.
ADV EFF Anaphylaxis, chest tightness, dyspnea, edema, hypertension, injection-site
reactions, nausea, photosensitivity, rash, red skin and mucous membranes (up to 2 wk),
red urine (up to 5 wk)
NC/PT Support pt during acute poisoning. Run in separate IV line; do not mix w/ other
drugs. Monitor BP. Not for use in pregnancy, breast-feeding. Tell pt urine may be red
for up to 5 wk, skin and mucous membranes may be red for 2 wk. Pt should avoid
exposure to sunlight during that period, report difficulty breathing.

hydroxyprogesterone caproate (Makena)

CLASS Progestin
PREG/CONT B/NA

IND & DOSE To reduce risk of preterm birth in women w/ singleton pregnancy and
hx of singleton spontaneous preterm birth. Adult: 250 mg IM once wkly, beginning
between 16 wk, 0 days’ and 20 wk, 6 days’ gestation. Continue wkly injections until wk
37 of gestation, or until delivery, whichever comes first.
ADV EFF Depression, fluid retention, glucose intolerance, injection-site reactions, nausea,
pruritus, thromboembolic events, urticaria
NC/PT IM injection into upper outer area of buttocks once/wk. Vial stable for 5 wk at
room temp; protect from light. Monitor injection sites; periodically check serum glucose.
Mark calendar for injection days. Pt should report leg, chest pain.

DANGEROUS DRUG
hydroxyurea (Droxia, Hydrea)
CLASS Antineoplastic
PREG/CONT D/NA

IND & DOSE Tx of melanoma; recurrent, metastatic, or inoperable ovarian cancer.

Adult: 80 mg/kg PO as single dose q third day or 20–30 mg/kg PO as single daily dose
(Hydrea). Concomitant therapy w/ irradiation for primary squamous cell
carcinoma of head and neck. Adult: 80 mg/kg PO as single daily dose q third day.
Begin 7 days before irradiation; continue during and for a prolonged period after
radiation therapy (Hydrea). Tx of resistant chronic myelocytic leukemia. Adult: 20–
30 mg/kg PO as single daily dose (Hydrea). To reduce sickle cell anemia crises
(Droxia). Adult: 15 mg/kg/day PO as single dose; may increase by 5 mg/kg/day q 12 wk
until max of 35 mg/kg/day reached. If blood levels become toxic, stop drug and resume
at 2.5 mg/kg/day less than dose that resulted in toxicity when blood levels return to
normal; increase q 12 wk in 2.5-mg/kg/day intervals if blood levels remain acceptable.
ADJUST DOSE Renal impairment
ADV EFF Anorexia, bone marrow depression, cancer, dizziness, headache, n/v,
stomatitis
INTERACTIONS Uricosuric agents
NC/PT Handle w/ extreme care; may cause cancer. Use gloves when handling capsule.
Monitor CBC before and q 2 wk during tx. Capsule should not be cut, crushed, or
chewed; have pt swallow whole. If pt unable to swallow capsule, may empty into glass
of water; pt should swallow immediately. Not for use in pregnancy (barrier
contraceptives advised). Pt should drink 10–12 glasses of fluid each day, take safety
precautions for CNS effects, protect from exposure to infections, report unusual
bleeding.

hydrOXYzine hydrochloride, hydrOXYzine pamoate (Vistaril)

CLASS Antiemetic, antihistamine, anxiolytic
PREG/CONT C/NA

IND & DOSE Symptomatic relief of anxiety. Adult, child over 6 yr: 50–100 mg PO qid.
Child under 6 yr: 50 mg/day PO in divided doses. Mgt of pruritus. Adult: 25 mg PO or
IM tid–qid. Sedation, antiemetic (preop/postop). Adult: 50–100 mg PO or IM. Child:
0.6 mg/kg PO or IM. Psychiatric and emotional emergencies. 50–100 mg IM
immediately and q 4–6 hr as needed.
ADV EFF Constipation, dizziness, drowsiness, dry mouth, hypersensitivity reactions,
sedation, tremors, urine retention
INTERACTIONS Alcohol, barbiturates, CNS depressants, opioids
NC/PT Do not give parenteral sol subcut, IV, or intra-arterially; tissue necrosis has
occurred. Give IM injections deep into upper outer quadrant of buttocks or midlateral
thigh (adults) or midlateral thigh muscles (children). Pt should take safety precautions
w/ CNS effects, use sugarless lozenges for dry mouth, avoid alcohol.

hyoscyamine sulfate (IB-Stat, Levbid, Levsin/SL, Symax)

CLASS Anticholinergic, antispasmodic, belladonna alkaloid
PREG/CONT C/NA

IND & DOSE Adjunct tx in IBS, peptic ulcer, spastic or functional GI disorders,
cystitis, neurogenic bladder or bowel disorders, parkinsonism, biliary or renal
colic, rhinitis. Adult: 0.125–0.25 mg PO q 4 hr or as needed. Or 1–2 mL oral sol q 4 hr
as needed (max, 12 mL/day). Or 1–2 oral sprays q 4 hr as needed (max, 12 sprays/day).
Or ½–1 orally disintegrating tablet 3–4 times/day 30 min–1 hr before meals and at
bedtime. Or 1–2 tsp elixir PO q 4 hr as needed (max, 12 tsp/day). Or 0.375–0.75 mg ER
tablet PO q 12 hr; may give q 8 hr if needed (max, 4 capsules/day). Or 0.25–0.5 mg
subcut, IM, or IV 2–4 times/day at 4-hr intervals as needed. Child 12 yr and older: 1–2
tablets PO q 4 hr as needed (max, 12 tablets in 24 hr). Or ½–1 orally disintegrating
tablets PO tid–qid 30 min–1 hr before meals and at bedtime. Or 1–2 mL oral sol PO q
4 hr or as needed (max, 12 mL in 24 hr). Or 1–2 ER capsules PO q 12 hr; adjust to 1
capsule q 8 hr if needed (max, 4 capsules in 24 hr). Or 1–2 tsp elixir PO q 4 hr or as
needed (max, 12 tsp in 24 hr). Or 1–2 oral sprays q 4 hr as needed. Child 2 yr–under 12
yr: ½–1 tablet PO q 4 hr as needed (max, 6 tablets in 24 hr). Or 0.25–1 mL oral sol PO q
4 hr or as needed (max, 6 mL in 24 hr). Or may give elixir, dose based on weight. To
reduce secretions preanesthetic. Adult: 0.005 mg/kg IV or IM 30–60 min before
induction. Child over 2 yr: 5 mcg/kg IV 30–60 min before anesthesia. Tx of drug-
induced bradycardia. Adult, child over 2 yr: 0.125 mg (0.25 mL) IV. Repeat as needed.
Reversal of neuromuscular blockade. Adult, child over 2 yr: 0.2 mg IV, IM, or subcut
for q 1 mg neostigmine.
ADV EFF Anaphylaxis, decreased sweating, dizziness, drowsiness, dry mouth, fever,
nausea, palpitations, urinary hesitancy, urticaria
INTERACTIONS Antacids, amantadine, anticholinergics, antihistamines, haloperidol,
MAOIs, phenothiazines, TCAs
NC/PT Ensure adequate hydration. Pt should empty bladder before each dose, swallow
whole (not cut, crush, or chew ER forms), take safety precautions for CNS effects, use
sugarless lozenges for dry mouth, take 30–60 min before meals; report difficulty
breathing, fainting, palpitations.
 ibandronate sodium (Boniva)
CLASS Bisphosphonate, calcium regulator
PREG/CONT C/NA

IND & DOSE Tx, px of osteoporosis in postmenopausal women. Adult: 2.5 mg/day PO,
or 150-mg tablet PO once/mo, or 3 mg IV over 15–30 sec q 3 mo.
ADJUST DOSE Renal impairment
ADV EFF Abd/back pain, bronchitis, diarrhea, dizziness, dyspepsia, headache,
hypertension, jaw osteonecrosis, myalgia, pneumonia
INTERACTIONS Aluminum, iron, magnesium antacids; food, milk
NC/PT Monitor serum calcium levels. Ensure adequate intake of vitamin D/calcium. Use
caution in pregnancy; not for use in breast-feeding. Obtain periodic bone density exams.
Pt should take in a.m. w/ full glass of water at least 60 min before first beverage, food,
or medication of day; stay upright for 60 min after taking to avoid potentially serious
esophageal erosion; mark calendar for once/mo or q-3-mo tx; report difficulty
swallowing, pain/burning in esophagus.

DANGEROUS DRUG
ibritumomab (Zevalin)
CLASS Antineoplastic, monoclonal antibody
PREG/CONT D/NA

BBW Risk of serious to fatal infusion reactions, prolonged bone marrow suppression,
cutaneous/mucocutaneous reactions; monitor, support pt accordingly. Max, 32 mCi total
dose.
IND & DOSE Tx of relapsed or refractory low-grade follicular transformed B-cell non-
Hodgkin lymphoma; previously treated follicular non-Hodgkin lymphoma w/
relapse after first-line tx. Adult: 250 mg/m2 IV rituximab, then 5 mCi/kg as 10-min IV
push. Repeat in 7–9 days.
ADV EFF Abd pain, asthenia, cough, fatigue, fever, infusion reactions, leukemia,
nasopharyngitis, n/v/d, prolonged bone marrow suppression, severe
cutaneous/mucocutaneous reactions
INTERACTIONS Live vaccines, platelet inhibitors
NC/PT Premedicate w/ acetaminophen, diphenhydramine before each infusion. Monitor
for extravasation; move to other limb if this occurs. Not for use in pregnancy (barrier
contraceptives advised), breast-feeding. Pt should avoid exposure to infection; report
bleeding, fever or s&sx of infection, rash, mouth sores.

ibrutinib (Imbruvica)
CLASS Antineoplastic, kinase inhibitor
PREG/CONT PREG/CONT D/NA
IND & DOSETx of mantle cell lymphoma when at least one other tx has been tried.
Adult: 560 mg PO once daily.
ADJUST DOSE Hepatic impairment (contraindicated)
ADV EFF Abd pain, anemia, bone marrow suppression, bruising, constipation, dyspnea,
edema, fatigue, n/v/d, renal toxicity, secondary malignancies, URI
INTERACTIONS CYP3A inducers/inhibitors
NC/PT Ensure proper dx. Monitor renal function; screen for secondary malignancies. Not
for use in pregnancy (contraceptive use advised), breast-feeding. Pt must swallow
capsule whole, not cut, crush, or chew it. Pt should avoid exposure to infection; report
color changes in urine/stool, severe diarrhea, fever, bleeding, sx of infection.

ibuprofen (Advil, Caldolor, Motrin)

CLASS Analgesic, NSAID
PREG/CONT B (1st, 2nd trimesters); D (3rd trimester)/NA

BBW Increased risk of CV events, GI bleeding; monitor accordingly. Contraindicated for

tx of periop pain after CABG.
IND & DOSE Tx of mild to moderate pain, fever, migraine headache, primary
dysmenorrhea. Adult, child 12 yr and older: 400 mg PO q 4–6 hr; max, 3,200/day. Or,
400–800 mg IV over 30 min q 6 hr for pain. Or, 400 mg IV over 30 min for fever; may
follow with 400 mg IV q 4–6 hr or 100–200 mg IV q 4 hr to control fever. Child 6 mo–11
yr: Base dose on weight, given q 6–8 hr. 32–42 kg, 300 mg PO; 27–31 kg, 250 mg PO;
22–26 kg, 200 mg PO; 16–21 kg, 150 mg PO; 11–15 kg, 100 mg PO; 8–10 kg, 75 mg PO;
5–7 kg, 50 mg. Oral drops: 9–11 kg or 12–23 mo, 1.875 mL (75 mg) PO; 5–8 kg or 6–11
mo, 1.25 mL (50 mg) PO. Tx of osteoarthritis, rheumatoid arthritis. Adult: 1,200–
3,200 mg/day PO (300 mg qid or 400, 600, 800 mg tid or qid; individualize dose). Tx of
juvenile arthritis. Child 6 mo–11 yr: 30–50 mg/kg/day PO in three to four divided
doses; 20 mg/kg/day for milder disease.
ADV EFF Agranulocytosis, anaphylactoid reactions to anaphylactic shock,
bronchospasm, dizziness, dyspepsia, edema, eye changes, headache, GI bleeding, GI
pain, HF, insomnia, nausea, pancytopenia, rash, somnolence, stomatitis
INTERACTIONS ACE inhibitors, anticoagulants, beta blockers, bisphosphonates,
bumetanide, ethacrynic acid, furosemide, ginkgo, lithium
NC/PT Ensure hydration w/ IV use. Stop if eye changes, renal or hepatic impairment.
Give w/ food if GI upset. Pt should avoid OTC products that may contain ibuprofen,
take safety precautions w/ CNS effects, report ankle swelling, black tarry stool, vision
changes.

DANGEROUS DRUG
ibutilide fumarate (Corvert)
CLASS Antiarrhythmic
PREG/CONT C/NA
BBW Have emergency equipment on hand during and for at least 4 hr after
administration; can cause potentially life-threatening arrhythmias. Use caution when
selecting pts for tx.
IND & DOSE Rapid conversion of atrial fibrillation (AF)/flutter of recent onset to
sinus rhythm. Adult: 60 kg or more, 1 vial (1 mg) IV over 10 min; may repeat after 10
min if arrhythmia not terminated; under 60 kg, 0.1 mL/kg (0.01 mg/kg) IV over 10 min;
may repeat after 10 min if arrhythmia not terminated.
ADV EFF Dizziness, headache, nausea, numbness/tingling in arms, ventricular
arrhythmias
INTERACTIONS Amiodarone, antihistamines, digoxin, disopyramide, quinidine,
phenothiazines, procainamide, sotalol, TCAs
NC/PT Determine time of arrhythmia onset; most effective if less than 90 days. Ensure pt
anticoagulated for at least 2 wk if AF lasts more than 2 days. Have emergency
equipment on hand. Provide follow-up for medical evaluation. Pt should report chest
pain, difficulty breathing.

icatibant (Firazyr)
CLASS Bradykinin receptor antagonist
PREG/CONT C/NA

IND & DOSE Tx of acute attacks of hereditary angioedema. Adult: 30 mg subcut in

abdomen; may repeat after at least 6 hr. Max, 3 injections/day.
ADV EFF Dizziness, drowsiness, fever, injection-site reaction, rash
INTERACTIONS ACE inhibitors
NC/PT Teach proper administration, disposal of needles, syringes. Rotate injection sites;
do not inject into scars, inflamed/infected areas. Use caution in pregnancy, breast-
feeding. Pt should take safety precautions w/ CNS effects, go to emergency department
after injecting if laryngeal attack occurs.

icosapent ethyl (Vascepa)

CLASS Antithypertriglyceridemic, ethyl ester
PREG/CONT C/NA

IND & DOSE Adjunct to diet to reduce triglyceride levels in adults with severe
(500 mg/dL or higher) hypertriglyceridemia. Adult: 2 g PO bid w/ food.
ADV EFF Arthralgia, bleeding, hepatic impairment, hypersensitivity reaction
INTERACTIONS Anticoagulants, platelet inhibitors
NC/PT Monitor LFTs carefully; use caution w/ known fish/shellfish allergy. Pt should
swallow capsule whole and not cut, crush, or chew it; continue diet/exercise program.

DANGEROUS DRUG
 idarubicin hydrochloride (Idamycin PFS)
CLASS Antineoplastic antibiotic
PREG/CONT D/NA

BBW Do not give IM, subcut because of severe local reaction, tissue necrosis; give IV
only. Risk of myocardial toxicity; monitor accordingly. Monitor response to tx
frequently at start of tx. Monitor serum uric acid level, CBC, cardiac output (listen for
S3), LFTs. Changes in uric acid levels may need dose decrease; consult physician.
IND & DOSE Tx of AML w/ other drugs. Adult: 12 mg/m2/day for 3 days by slow IV
injection (10–15 min) w/ cytarabine. May give cytarabine as 100 mg/m2/day by
continuous IV infusion for 7 days or as 25-mg/m2 IV bolus, then 200 mg/m2/day IV for
5 days by continuous infusion. May give second course when toxicity has subsided, if
needed, at 25% dose reduction.
ADJUST DOSE Hepatic, renal impairment
ADV EFF Alopecia, anaphylaxis, anorexia, cancer, cardiac toxicity, headache, HF,
injection-site reactions, myelosuppression, mucositis, n/v
NC/PT Monitor injection site for extravasation. Monitor CBC, LFTs, renal function,
cardiac output frequently during tx. Ensure adequate hydration. Not for use in
pregnancy (barrier contraceptives advised). Pt should cover head at temp extremes (hair
loss possible), get regular medical follow-up, report swelling, chest pain, difficulty
breathing.

idursulfase (Elaprase)
CLASS Enzyme
PREG/CONT C/NA

BBW Risk of severe to life-threatening anaphylactic reactions during infusion; have

emergency equipment on hand. Monitor closely.
IND & DOSE Tx of Hunter’s syndrome. Adult, child over 5 yr: 0.5 mg/kg IV infused over 1–
3 hr q wk.
ADV EFF Anaphylaxis, fever, hypertension, rash, respiratory impairment
NC/PT Start first infusion slowly to monitor for infusion reaction (8 mL/min for first 15
min, then increase by 8 mL/min at 15-min intervals; max, 100 mL/hr). Do not infuse w/
other products in same line. Use caution in pregnancy, breast-feeding. Pt should report
difficulty breathing, rash.

DANGEROUS DRUG
ifosfamide (Ifex)
CLASS Alkylating agent, antineoplastic, nitrogen mustard
PREG/CONT D/NA

BBW Arrange for blood tests to evaluate hematopoietic function before starting tx and
wkly during tx; serious hemorrhagic toxicities have occurred. Provide extensive
hydration consisting of at least 2 L oral or IV fluid/day to prevent bladder toxicity.
Arrange to give protector, such as mesna, to prevent hemorrhagic cystitis.
IND & DOSE Third-line chemotherapy of germ-cell testicular cancer w/ other drugs;
third-line tx of bone, soft-tissue sarcomas. Adult: 1.2 g/m2/day IV over at least 30
min for 5 consecutive days; repeat q 3 wk, or after recovery from hematologic toxicity.
For px of bladder toxicity, give more than 2 L fluid/day IV or PO. Use mesna IV to
prevent hemorrhagic cystitis.
ADJUST DOSE Renal impairment
ADV EFF Alopecia, anorexia, confusion, hallucinations, immunosuppression, leukopenia,
n/v, potentially fatal hemorrhagic cystitis, somnolence
INTERACTIONS Grapefruit juice
NC/PT For px of bladder toxicity, give more than 2 L fluid/day IV or PO. Use mesna IV to
prevent hemorrhagic cystitis. Maintain hydration (at least 10–12 glasses fluid/day). Can
cause fetal harm; contraceptives advised (for men/women) during and for few wks after
tx. Pt should avoid grapefruit juice, cover head at temp extremes (hair loss possible),
report painful urination, blood in urine.

iloperidone (Fanapt)
CLASS Atypical antipsychotic
PREG/CONT C/NA

BBW Increased risk of death if used in elderly pts w/ dementia-related psychosis. Do not
use for these pts; not approved for this use.
IND & DOSE Acute tx of schizophrenia. Adult: Range, 12–24 mg/day PO; titrate based on
orthostatic hypotension tolerance. Initially, 1 mg PO bid; then 2, 4, 6, 8, 10, 12 mg PO
bid on days 2, 3, 4, 5, 6, 7 respectively.
ADJUST DOSE Hepatic impairment
ADV EFF Dizziness, fatigue, hyperglycemia, nausea, NMS, orthostatic hypotension, QT
prolongation, weight gain
INTERACTIONS Alcohol, antihypertensives, CNS depressants, fluoxetine, itraconazole,
ketoconazole, other QT-prolonging drugs, paroxetine, St. John’s wort
NC/PT Obtain baseline ECG; periodically monitor QT interval. Titrate over first wk to
decrease orthostatic hypotension. Monitor serum glucose. Use caution in pregnancy; not
for use in breast-feeding. Pt should take safety measures w/ CNS effects, avoid
alcohol/St. John’s wort; change positions carefully, report fever, thoughts of suicide,
fainting.

iloprost (Ventavis)
CLASS Vasodilator
PREG/CONT C/NA
IND & DOSE Tx of pulmonary artery hypertension in pts w/ NY Heart Association
Class II to IV symptoms. Adult: 2.5–5 mcg inhaled 6–9 times/day while awake; max,
45 mcg/day.
ADV EFF Back pain, bronchospasm, cough, dizziness, headache, hypotension, insomnia,
light-headedness, muscle cramps, n/v, palpitations, pulmonary hypotension, syncope
INTERACTIONS Anticoagulants, antihypertensives, vasodilators
NC/PT Review proper use of inhaler. Use caution in pregnancy; not for use in breast-
feeding. Pt should take safety measures w/ CNS effects, report difficulty breathing,
fainting.

DANGEROUS DRUG
imatinib mesylate (Gleevec)
CLASS Antineoplastic, protein tyrosine kinase inhibitor
PREG/CONT D/NA

IND & DOSE Tx of chronic phase CML. Adult: 400 mg/day PO as once-a-day dose; may
consider 600 mg/day. Child over 2 yr: 260 mg/m2/day PO as one dose, or divided a.m.
and p.m. Tx of accelerated phase or blast crisis CML. Adult: 600 mg/day PO as single
dose; may consider 400 mg PO bid. Tx of newly diagnosed CML. Child over 2 yr:
340 mg/m2 PO; max, 600 mg/day. Tx of ALL. Adult: 600 mg/day PO. Tx of aggressive
systemic mastocytosis (ASM), hypereosinophilic syndrome/chronic eosinophilic
leukemia, myelodysplastic/ myeloproliferative diseases, metastatic malignant GI
stromal tumors; adjunct tx after surgical resection of Kit-positive GI stromal
tumors. Adult: 400 mg/day PO. Tx of ASM w/ eosinophilia. Adult: 100 mg/day PO. Tx
of unresectable, recurrent, or metastatic dermatofibrosarcoma protuberans. Adult:
800 mg/day PO.
ADJUST DOSE Hepatic, renal impairment
ADV EFF Bone marrow suppression, fluid retention, headache, left ventricular dysfx,
n/v/d, rash, severe HF
INTERACTIONS Azithromycin, carbamazepine, clarithromycin, cyclosporine,
dexamethasone, grapefruit juice, itraconazole, ketoconazole, levothyroxine, pimozide,
phenobarbital, phenytoin, rifampin, simvastatin, St. John’s wort, warfarin
NC/PT Monitor CBC. Not for use in pregnancy (barrier contraceptives advised). Monitor
child for growth retardation. Give w/ meals. May disperse in glass of water or apple
juice; give immediately using 50 mL for 10-mg tablet, 200 mL for 400-mg tablet. Pt
should not cut or crush tablet, take analgesics for headache, avoid grapefruit juice/St.
John’s wort, report sudden fluid retention.

imipramine hydrochloride, imipramine pamoate (Tofranil)

CLASS Antidepressant, TCA
PREG/CONT C/NA
BBW Limit drug access for depressed, potentially suicidal pts. Increased risk of
suicidality, especially in children, adolescents, young adults; monitor accordingly.
IND & DOSE Tx of depression. Adult: Hospitalized pts, 100–150 mg/day PO in divided
doses; may increase to 200 mg/day. After 2 wk, may increase to 250–300 mg/day.
Outpts, 75 mg/day PO, increasing to 150 mg/day. Max, 200 mg/day; range, 50–
150 mg/day. Adolescent: 30–40 mg/day PO. Tx of childhood enuresis. Child 6 yr and
older: 25 mg/day PO 1 hr before bedtime. May increase to 75 mg PO nightly in child
over 12 yr, 50 mg PO nightly in child under 12 yr. Max, 2.5 mg/kg/day.
ADJUST DOSE Elderly pts
ADV EFF Anticholinergic effects, arrhythmias, bone marrow depression, confusion,
constipation, disturbed concentration, dry mouth, MI, nervousness, orthostatic
hypotension, photosensitivity, sedation, stroke, urine retention, withdrawal symptoms
after prolonged use
INTERACTIONS Anticholinergics, clonidine, MAOIs, oral anticoagulants, St. John’s wort,
sympathomimetics
NC/PT Give major portion at bedtime. Consider dose change w/ adverse effects. Not for
use in pregnancy, breast-feeding. Pt should avoid sun exposure, take safety measures w/
CNS effects, report thoughts of suicide, excessive sedation.

indacaterol (Arcapta Neohaler)

CLASS Bronchodilator, long-acting beta agonist
PREG/CONT C/NA

BBW Increased risk of asthma-related deaths; not indicated for tx of asthma.

IND & DOSE Long-term maint bronchodilator tx for pts w/ COPD: Adult: 75 mcg/day
inhaled w/ Arcapta Neohaler.
ADV EFF Arrhythmias, asthma-related deaths, bronchospasm, cough, headache,
hypertension, nausea, nasopharyngitis, pharyngeal pain, seizures
INTERACTIONS Adrenergic drugs, beta blockers, corticosteroids, diuretics, MAOIs, QT-
prolonging drugs, TCAs, xanthines
NC/PT Not for acute or deteriorating situations. Do not exceed recommended dose. Should
be used with inhaled corticosteroid. Review proper use of inhaler. Pt should report
worsening of condition, chest pain, severe difficulty breathing.

indapamide (generic)
CLASS Thiazide-like diuretic
PREG/CONT B/NA

IND & DOSE Tx of edema associated w/ HF. Adult: 2.5–5 mg/day PO. Tx of
hypertension. Adult: 1.25–2.5 mg/day PO. Consider adding another drug if control not
achieved.
ADV EFF Agranulocytosis, anorexia, aplastic anemia, dizziness, dry mouth,
hypotension, n/v, photosensitivity, vertigo
INTERACTIONS Antidiabetics, cholestyramine, colestipol, lithium, thiazide diuretics
NC/PT Give w/ food if GI upset occurs. Give early in a.m. Pt should weigh self daily and
record, report weight change of 3 lb/day, take safety precautions w/ CNS effects, use
sugarless lozenges for dry mouth, avoid sun exposure.

indinavir sulfate (Crixivan)

CLASS Antiviral, protease inhibitor
PREG/CONT C/NA

IND & DOSE Tx of HIV infection w/ other drugs. Adult, child 12 yr and older: 800 mg PO
q 8 hr. W/ delavirdine, 600 mg PO q 8 hr; w/ delavirdine, 400 mg PO tid; w/
didanosine, give more than 1 hr apart on empty stomach; w/ itraconazole, 600 mg PO q
8 hr; w/ itraconazole, 200 mg PO bid; w/ ketoconazole, 600 mg PO q 8 hr; w/ rifabutin,
1,000 mg PO q 8 hr (reduce rifabutin by 50%).
ADJUST DOSE Hepatic impairment
ADV EFF Dry skin, flulike symptoms, headache, hyperbilirubinemia, n/v/d
INTERACTIONS Ergots, midazolam, pimozide, triazolam; do not use w/ preceding drugs.
Atazanavir, azole antifungals, benzodiazepines, carbamazepine, delavirdine, efavirenz,
fentanyl, grapefruit juice, interleukins, nelfinavir, nevirapine, phenobarbital,
phenytoin, rifabutin, rifampin, rifamycin, ritonavir, sildenafil, St. John’s wort,
venlafaxine
NC/PT Protect capsules from moisture; store in container provided and keep desiccant in
bottle. Give drug q 8 hr around clock. Maintain hydration. Check all drugs pt taking;
many interactions possible. Not a cure for disease; advise pt to use precautions. Pt
should avoid grapefruit juice, St. John’s wort; continue other HIV drugs; drink at least
1.5 L of water/day; report severe diarrhea.

indomethacin, indomethacin sodium trihydrate (Indocin)

CLASS NSAID
PREG/CONT B (1st, 2nd trimesters); D (3rd trimester)/NA

BBW Increased risk of CV events, GI bleeding; monitor accordingly. Adverse reactions

dose-related; use lowest effective dose.
IND & DOSE Relief of s&sx of osteoarthritis, rheumatoid arthritis, ankylosing
spondylitis. Adult: 25 mg PO bid or tid; may use total daily dose of 150–200 mg/day
PO. Tx of acute painful shoulder. Adult: 75–150 mg/day PO in three or four divided
doses for 7–14 days. Tx of acute gouty arthritis. Adult: 50 mg PO tid until pain
tolerable; then decrease until not needed (within 3–5 days). Do not use SR form.
Closure of hemodynamically significant patent ductus arteriosus in preterm
infants 500–1,750 g. Infant: 3 IV doses at 12- to 24-hr intervals. 2–7 days old:
0.2 mg/kg IV for all three doses. Under 48 hr old: 0.2 mg/kg IV, then 0.1 mg/kg, then
0.1 mg/kg.
ADV EFF Anaphylactoid reactions to anaphylactic shock. aplastic anemia, apnea w/
IV use, bleeding ulcer, bone marrow suppression, dizziness, drowsiness, eye changes,
headache, insomnia, n/v, pulmonary hemorrhage w/ IV use, rash
INTERACTIONS ACE inhibitors, adrenergic blockers, ARBs, bisphosphonates, lithium, loop
diuretics, potassium-sparing diuretics
NC/PT Do not use SR form for gouty arthritic. Give w/ food. Monitor eyes w/ long-term
therapy. Monitor LFTs, renal function. Pt should avoid OTC drugs without first checking
w/ prescriber. Take safety precautions w/ CNS effects, report black or tarry stools,
bleeding.

infliximab (Remicade)
CLASS Monoclonal antibody
PREG/CONT B/NA

BBW Risk of serious to life-threatening infections, activation of TB, malignancies,

including fatal hepatosplenic T-cell lymphoma. Monitor pt; reserve for approved uses.
IND & DOSE Tx of Crohn’s disease, ulcerative colitis, ankylosing spondylitis,
psoriatic arthritis, plaque psoriasis. Adult, child: 5 mg IV at 0, 2, 6 wk; maint,
5 mg/kg IV q 8 wk (q 6 wk for ankylosing spondylitis). Tx of rheumatoid arthritis.
Adult: 3 mg IV at 0, 2, 6 wk; maint, 3 mg/kg IV q 8 wk.
ADV EFF Abd pain, bone marrow suppression, cancer, demyelinating diseases,
headache, hepatitis B reactivation, hepatotoxicity, HF, infusion reactions, serious to
fatal infections
INTERACTIONS TNF blockers, tocilizumab, methotrexate, immunosuppressants
NC/PT Obtain TB test before starting tx. Monitor CBC before each dose; adjustment may
be needed. Monitor LFTs. Assess for s&sx of infection. Pt should get routine cancer
screening, report edema, chest pain, fever, signs of infection.

insoluble Prussian blue (Radiogardase)

CLASS Ferric hexacyanoferrate
PREG/CONT C/NA

IND & DOSE Tx of pts w/ known or suspected internal contamination w/ radioactive

cesium and/or radioactive or nonradioactive thallium. Adult: 3 g PO tid. Child 2–12
yr: 1 g PO tid.
ADV EFF Constipation
NC/PT Monitor radioactivity levels. Take appropriate precautions to avoid exposure.
Treat for constipation if indicated. Excreted in urine, feces; pt should flush toilet several
times, clean up spilled urine, feces.

DANGEROUS DRUG
 insulin, insulin lispro (Humalog), insulin aspart (Novolog), insulin detemir
(Levemir), insulin glargine (Lantus), insulin glulisine (Apidra), isophane
insulin
CLASS Hormone
PREG/CONT B; C (aspart, glargine, glulisine)/NA

IND & DOSE Tx of type 1 diabetes, severe ketoacidosis, diabetic coma; short-course tx
when glucose control needed. Adult, child: 0.5–1 unit/kg/day subcut. Base adjustment
on serum glucose levels, pt response. Can give regular and glulisine IV. Tx of type 2
diabetes when glucose control cannot be maintained. Adult: 10 mg/day subcut;
range, 2–100 units/day (Lantus) or 0.1–0.2 units/kg subcut or 10 units/day or bid subcut
(Levemir). See Insulin pharmacokinetics.
ADV EFF Anaphylaxis or angioedema, hypoglycemia, injection-site reactions,
ketoacidosis, rash
INTERACTIONS Alcohol, atypical antipsychotics, beta blockers, celery, coriander,
corticosteroids, dandelion root, diuretics, fenugreek, garlic, ginseng, juniper berries,
MAOIs, salicylates
NC/PT Double-check doses for child. Use caution when mixing two types of insulin;
always draw regular insulin into syringe first. If mixing w/ lispro, draw lispro first. Use
mixtures of regular and NPH or regular and lente within 5–15 min of combining. Do not
mix Lantus (glargine), Levemir (detemir) in sol w/ other drugs, including other insulins.
Usage based on onset, peak, duration; varies among insulins. Do not freeze; protect
from heat extremes. Monitor serum glucose frequently. Monitor, rotate injections sites.
Ensure total diabetic teaching, including diet, exercise, hygiene measures, recognition of
hypo-, hyperglycemia. Pt should avoid alcohol; if using herbs, check w/ prescriber for
insulin dose adjustment; wear medical ID; always eat when using insulin; report
uncontrolled serum glucose.

INSULIN PHARMACOKINETICS
 DANGEROUS DRUG
interferon alfa-2b (Intron-A)
CLASS Antineoplastic
PREG/CONT C/NA

BBW Risk of serious to life-threatening reactions. Monitor for severe reactions (including
hypersensitivity reactions), neuropsychiatric, autoimmune, ischemic, infectious
disorders. Notify physician immediately if these occur; dose reduction/discontinuation
may be needed.
IND & DOSE Tx of hairy cell leukemia. Adult: 2 million international units/m2 subcut or
IM three times/wk for up to 6 mo. Tx of condylomata acuminata. Adult: 1 million
international units/lesion intralesionally three times/wk for 3 wk; can treat up to five
lesions at one time. May repeat in 12–16 wk. Tx of chronic hepatitis C. Adult: 3
million international units subcut or IM three times/wk for 18–24 mo. Tx of AIDS-
related Kaposi sarcoma. Adult: 30 million international units/m2 subcut or IM three
times/wk. Tx of chronic hepatitis B. Adult: 30–35 million international units/wk
subcut or IM either as 5 million international units daily or 10 million international
units three times/wk for 16 wk. Child: 3 million international units/m2 subcut three
times/wk for first wk, then 6 million international units/m2 subcut three times/wk for
total of 16–24 wk (max, 10 million international units three times/wk). Tx of follicular
lymphoma. Adult: 5 million international units subcut three times/wk for 18 mo w/
other chemotherapy. Tx of malignant melanoma. Adult: 20 million international
units/m2 IV over 20 min on 5 consecutive days/wk for 4 wk; maint, 10 million
international units/m2 IV three times/wk for 48 wk.
ADV EFF Anorexia, bone marrow suppression, confusion, dizziness, flulike symptoms,
n/v, rash
NC/PT Obtain baseline, periodic CBC, LFTs. Do not give IV. Pt should mark calendar of
tx days, get blood tests regularly, take safety precautions w/ CNS effects, report
bleeding, signs of infection.

DANGEROUS DRUG
interferon alfacon-1 (Infergen)
CLASS Immunomodulator
PREG/CONT C/NA

BBW Severe to life-threatening neuropsychiatric, autoimmune, ischemic, infectious

disorders possible; monitor pt accordingly.
IND & DOSE Tx of chronic hepatitis C in pts w/ compensated liver disease and anti–
hepatitis C antibodies. Adult: 9 mcg subcut three times/wk for 24 wk; at least 48 hr
between doses. If used w/ ribavirin, 15 mcg daily as single subcut injection w/ weight-
based ribavirin at 1,200 mg (75 kg and over), 1,000 mg (under 75 kg) PO in two divided
doses for up to 48 wk.
ADJUST DOSE Hepatic, renal impairment
ADV EFF Abd pain, arthralgia, back/body pain, bone marrow suppression, fatigue,
fever, flulike symptoms, hepatic failure, myalgia, nausea, neuropsychiatric
disorders, neutropenia, ophthalmic disorders, pancreatitis, peripheral neuropathy,
pulmonary failure, renal failure, rigor
INTERACTIONS Bone marrow suppressants
NC/PT Obtain baseline, periodic CBC, LFTs, renal function tests. Monitor for eye changes.
Not for use in pregnancy (barrier contraceptives advised), breast-feeding. Give
antiemetics if needed. Teach learn proper administration, disposal of needles, syringes.
Pt should use precautions to prevent disease spread (drug not a cure), report personality
changes, thoughts of suicide, signs of infection, unusual bleeding, difficulty breathing.

interferon beta-1a (Avonex, Rebif)

CLASS Immunomodulator, MS drug
PREG/CONT C/NA

IND & DOSE Tx of relapsing forms of MS to slow accumulation of physical disability,

decrease frequency of clinical exacerbations. Adult: 30 mcg IM once/wk (Avonex).
Or, 22–44 mcg subcut three times per wk (Rebif); start w/ 8.8 mcg three times/wk;
titrate up over 5 wk to full dose of 22–44 mcg.
ADV EFF Anorexia, bone marrow suppression, confusion, depression, dizziness, flulike
symptoms, nausea, photosensitivity
NC/PT Obtain baseline, periodic CBC, LFTs. Rotate injection sites. Teach proper
administration, disposal of needles, syringes. Maintain hydration. Pt should mark
calendar of tx days; avoid exposure to infections, sun; report infection, unusual
bleeding, thoughts of suicide.

interferon beta-1b (Betaseron, Extavia)

CLASS Immunomodulator, MS drug
PREG/CONT C/NA

IND & DOSE Tx of relapsing forms of MS to slow accumulation of physical disability,

decrease frequency of clinical exacerbations. Adult: 0.25 mg subcut q other day
(target); discontinue if disease unremitting for more than 6 mo. Initially, 0.0625 mg
subcut q other day, wks 1–2; then 0.125 mg subcut q other day, wks 3–4; then
0.1875 mg subcut q other day, wks 5–6; target 0.25 mg subcut q other day by wk 7.
ADV EFF Anorexia, bone marrow suppression, confusion, depression, dizziness, flulike
symptoms, nausea, photosensitivity
NC/PT Obtain baseline, periodic CBC, LFTs. Rotate injection sites. Not for use in
pregnancy (barrier contraceptives advised). Maintain hydration. Teach proper
administration, disposal of needles, syringes. Pt should mark calendar of tx day; avoid
exposure to infection, sun; report infection, unusual bleeding, thoughts of suicide.
 interferon gamma-1b (Actimmune)
CLASS Immunomodulator
PREG/CONT C/NA

IND & DOSE To reduce frequency/severity of serious infections associated w/ chronic

granulomatous disease; to delay time to disease progression in pts w/ severe,
malignant osteopetrosis; tx of renal cell carcinoma. Adult: 50 mcg/m2 (1 million
international units/m2) subcut three times/wk in pts w/ body surface area (BSA) over
0.5 m2; 1.5 mcg/kg/dose in pts w/ BSA of 0.5 m2 or less subcut three times/wk. For
severe reactions, withhold or reduce dose by 50%.
ADV EFF Anorexia, confusion, depression, dizziness, flulike symptoms, nausea
NC/PT Obtain baseline, periodic CBC, LFTs. Store in refrigerator. Give at night if flulike
symptoms a problem. Rotate injection sites. Teach proper administration, disposal of
needles, syringes. Not for use in pregnancy (barrier contraceptives advised). Maintain
hydration. Pt should mark calendar of tx day; avoid exposure to infection, sun; report
infection, unusual bleeding, thoughts of suicide.

iodine thyroid products (Iosat, Lugol’s Solution, Pima, SSKI, Strong Iodine
Solution, ThyroSafe, ThyroShield)
CLASS Thyroid suppressant
PREG/CONT D/NA

IND & DOSE Tx of hyperthyroidism in preparation for surgery; thyrotoxic crisis:

Adult, child over 1 yr: RDA, 150 mcg/day PO. Tx, 0.3 mL PO tid (Strong Iodine Solution,
Lugol’s Solution); range, 0.1–0.9 mL/day PO. Thyroid blocking in radiation
emergency. Adult, child over 12 yr, 68 kg or more: 130 mg PO q 24 hr (Iosat, ThyroSafe,
ThyroShield). Child 3–18 yr, under 68 kg: 65 mg/day PO. Child 1 mo–3 yr: 32.5 mg/day
PO. Child birth–1 mo: 16.25 mg/day PO.
ADV EFF Iodism, rash, swelling of salivary glands
INTERACTIONS Lithium
NC/PT Dilute strong iodine sol w/ fruit juice/water to improve taste. Crush tablets for
small child. Discontinue if iodine toxicity.

iodoquinol (Yodoxin)
CLASS Amebicide
PREG/CONT C/NA

IND & DOSE Tx of acute, chronic intestinal amebiasis. Adult: 650 mg PO tid after meals
for 20 days. Child: 10–13.3 mg/kg/day PO in three divided doses for 20 days; max,
650 mg/dose (do not exceed 1.95 g in 24 hr for 20 days).
ADV EFF Blurred vision, n/v/d, rash
INTERACTIONSLithium
NC/PT Give after meals. Maintain nutrition. Pt should report severe GI upset, unusual
fatigue.

ipilimumab (Yervoy)
CLASS Cytotoxic T-cell antigen 4–blocking antibody
PREG/CONT C/NA

BBW Severe to fatal immune-mediated reactions involving many organs possible; may
occur during tx or wks to mos after tx ends. Permanently stop drug, treat w/ high-dose
systemic corticosteroids if s&sx of immune reactions appear.
IND & DOSE Tx of unresectable or metastatic melanoma. Adult: 3 mg/kg IV over 90 min
q 3 wk; total, four doses.
ADV EFF Colitis, diarrhea, endocrinopathies, fatigue, hepatitis, pruritus, rash
NC/PT Establish baseline LFTs, thyroid/endocrine/GI function, skin condition; assess
regularly for changes. Not for use in pregnancy, breast-feeding. Pt should mark calendar
for tx days, report severe diarrhea, increased thirst, unusual fatigue.

ipratropium bromide (Atrovent)

CLASS Anticholinergic, bronchodilator
PREG/CONT B/NA

IND & DOSE Maint tx of bronchospasm associated w/ COPD (sol, aerosol), chronic
bronchitis, emphysema. Adult, child 12 yr and older: 500 mcg tid–qid via nebulizer, w/
doses 6–8 hr apart. Symptomatic relief of rhinorrhea associated w/ common cold.
Adult, child 12 yr and older: 2 sprays 0.06%/nostril tid–qid. Child 5–11 yr: 2 sprays
0.06%/nostril tid. Symptomatic relief of rhinitis. Adult, child 6 yr and older: 2 sprays
0.03%/nostril bid–tid. Relief of rhinorrhea in seasonal allergic rhinitis. Adult, child
over 5 yr: 2 sprays 0.06%/nostril qid for 3 wk.
ADV EFF Cough, dizziness, dry mouth, headache, nervousness, nausea, urine retention
NC/PT Do not use w/ peanut, soy allergies. Protect sol from light. May mix in nebulizer
w/ albuterol for up to 1 hr. Review proper use of nebulizer. Ensure hydration. Pt should
empty bladder before using, take safety precautions w/ CNS effects, report vision
changes, rash.

irbesartan (Avapro)
CLASS Antihypertensive, ARB
PREG/CONT D/NA

BBW Rule out pregnancy before beginning tx. Suggest barrier contraceptives during tx;
fetal injury, deaths have occurred.
IND & DOSE Tx of hypertension. Adult, child 13–16 yr: 150 mg/day PO; max, 300 mg/day.
Child 6–12 y: 75 mg/day PO; max, 150 mg/day. To slow progression of nephropathy
in pts w/ hypertension, type 2 diabetes. Adult: 300 mg/day PO.
ADJUST DOSE Volume or salt depletion
ADV EFF Abd pain, angioedema, cough, dizziness, fatigue, headache, n/v/d, URI
INTERACTIONS CYP2C9-metabolized drugs
NC/PT Use caution w/ surgery; volume expansion may be needed. Monitor closely when
decreased BP secondary to fluid volume loss possible. May give w/ meals. Not for use in
pregnancy (barrier contraceptives advised), breast-feeding. Pt should take safety
precautions w/ CNS effects; report fever, chills.

irinotecan hydrochloride (Camptosar)

CLASS Antineoplastic, DNA topoisomerase inhibitor
PREG/CONT D/NA

BBW Obtain CBC before each infusion. Do not give when baseline neutrophil count
under 1,500 /mm2. Severe bone marrow depression possible; consult physician for dose
reduction or withholding if bone marrow depression evident. Monitor for diarrhea;
assess hydration. Arrange to reduce dose if 4–6 stools/day; omit dose if 7–9 stools/day.
If 10 or more stools/day, consult physician. May prevent or ameliorate early diarrhea
w/ atropine 0.25–1 mg IV or subcut. Treat late diarrhea lasting more than 24 hr w/
loperamide; late diarrhea can be severe to life-threatening.
IND & DOSE First-line tx w/ 5-FU, leucovorin for pts w/ metastatic colon, rectal
carcinomas. Adult: 125 mg/m2 IV over 90 min days 1, 8, 15, 22 w/ leucovorin
20 mg/m2 IV bolus days 1, 8, 15, 22 and 5-FU 500 mg/m2 IV days 1, 8, 15, 22. Restart
cycle on day 43. Or, 180 mg/m2 IV over 90 min days 1, 15, 29 w/ leucovorin
200 mg/m2 IV over 2 hr days 1, 2, 15, 16, 29, 30 and 5-FU 400 mg/m2 as IV bolus days
1, 2, 15, 16, 29, 30 followed by 5-FU 600 mg/m2 IV infusion over 22 hr on days 1, 2, 15,
16, 29, 30. Restart cycle on day 43. Tx of pts w/ metastatic colon, rectal cancer
whose disease has recurred or progressed after 5-FU therapy. Adult: 125 mg/m2 IV
over 90 min once wkly for 4 wk, then 2-wk rest; repeat 6-wk regimen, or 350 mg/m2 IV
over 90 min once q 3 wk.
ADV EFF Alopecia, anorexia, bone marrow suppression, dizziness, dyspnea, fatigue,
mucositis, n/v/d
INTERACTIONS Diuretics, ketoconazole, other antineoplastics, St. John’s wort
NC/PT Monitor CBC; dose adjustment based on bone marrow response. Monitor IV site
for extravasation. Not for use in pregnancy (barrier contraceptives advised). Pt should
mark calendar for tx days, cover head at temp extremes (hair loss possible), avoid
exposure to infections, report pain at injection site, signs of infection, severe/bloody
diarrhea.

iron dextran (Dexferrum, INFeD)

CLASS Iron preparation
 PREG/CONT C/NA

BBW Monitor for hypersensitivity reactions; test dose highly recommended. Have
epinephrine on hand for severe hypersensitivity reaction.
IND & DOSE Tx of iron deficiency anemia only when PO route not possible. Adult,
child: 0.5 mL IM or IV test dose before tx; base dose on hematologic response w/
frequent Hgb determinations. Over 25 kg: Dose (mL) = [0.0442 (desired Hgb–observed
Hgb) × LBW] + (0.26 × LBW), where Hgb = Hgb in g/dL and LBW = lean body
weight, IV or IM. Child over 4 mo, 5–15 kg: Dose (mL) = 0.0442 (desired Hgb–observed
Hgb) × W + (0.26 × W), where W = actual weight in kg, IV or IM. Iron replacement
for blood loss. Adult, child: Replacement iron (in mg) = blood loss (in mL) × Hct.
ADV EFF Anaphylaxis, arthritic reactivation, cardiac arrest, discoloration/pain at
injection site, local phlebitis, lymphadenopathy, n/v
INTERACTIONS Chloramphenicol
NC/PT Ensure actual iron deficiency. Perform test dose at least 5 min before tx. Inject IM
only into upper outer quadrant of buttocks using Z-track technique. Monitor serum
ferritin. Pt should avoid oral iron or vitamins w/ iron added, report pain at injection
site, difficulty breathing.

iron sucrose (Venofer)

CLASS Iron preparation
PREG/CONT B/NA

IND & DOSE Tx of iron deficiency anemia in chronic kidney disease. Adult: On dialysis,
100 mg IV injection over 2–5 min or 100 mg diluted IV infusion over at least 15 min.
Not on dialysis, 200 mg IV injection over 2–5 min. Peritoneal dialysis, 300 mg over
1.5 hr on two occasions 14 days apart, then single infusion of 400 mg over 2.5 hr.
ADV EFF Anaphylaxis, arthralgia, chest pain, dizziness, headache, hypotension,
injection-site reactions, iron overload, muscle cramps, n/v/d
NC/PT Ensure actual iron deficiency. Pt should avoid oral iron or vitamins w/ iron added,
take safety precautions w/ CNS effects, report pain at injection site, difficulty breathing.

isocarboxazid (Marplan)
CLASS MAOI
PREG/CONT C/NA

BBW Increased risk of suicidality in children, adolescents, young adults; monitor

accordingly.
IND & DOSE Tx of depression (not a first choice). Adult: Up to 40 mg/day PO.
ADJUST DOSE Hepatic, severe renal impairment
ADV EFF Constipation, CV events, drowsiness, dry mouth
INTERACTIONS Anesthetics, antihypertensives, buspirone, caffeine, CNS depressants,
dextromethorphan, meperidine, SSRIs, sympathomimetics, TCAs, tyramine-containing
foods
NC/PT Do not use w/ known cerebrovascular disorders, pheochromocytoma. Check
complete drug list before giving; many interactions. Pt should avoid foods high in
tyramine, use sugarless lozenges for dry mouth, report thoughts of suicide.

isoniazid (Nydrazid)
CLASS Antituberculotic
PREG/CONT C/NA

BBW Risk of serious to fatal hepatitis; monitor liver enzymes monthly.

IND & DOSE Tx of active TB. Adult: 5 mg/kg/day (max, 300 mg) PO or IM in single dose
w/ other effective drugs. Or, 15 mg/kg (max, 900 mg) PO two or three times/wk. Child:
10–15 mg/kg/day (max, 300 mg) PO or IM in single dose w/ other effective drugs. Or,
20–40 mg/kg (max, 900 mg/day) two or three times/wk. Px for TB. Adult: 300 mg/day
PO in single dose. Child: 10 mg/kg/day (max, 300 mg) PO in single dose.
ADV EFF Epigastric distress, fever, gynecomastia, hepatitis, injection-site reactions,
peripheral neuropathy, thrombocytopenia
INTERACTIONS Acetaminophen, alcohol, carbamazepine, enflurane, phenytoin, rifampin,
tyramine-containing foods
NC/PT Concomitant administration of 10–50 mg/day pyridoxine recommended for pts
who are malnourished or predisposed to neuropathy (alcoholics, diabetics). Pt should
take on empty stomach; avoid alcohol, foods high in tyramine; get regular medical
checkups; take safety precautions to avoid injury (loss of sensation possible).

DANGEROUS DRUG
isoproterenol hydrochloride (Isuprel)
CLASS Antiasthmatic, beta agonist, bronchodilator, vasopressor
PREG/CONT C/NA

IND & DOSE Mgt of bronchospasm during anesthesia. Adult: 0.01–0.02 mg (0.5–1 mL
diluted sol) by IV bolus; repeat when needed. Child 7–19 yr: 0.05–0.17 mcg/kg/min by
IV bolus. Max, 1.3–2.7 mcg/kg/min. Vasopressor as adjunct tx of shock. Adult: 0.5–
5 mcg/ min; infuse IV at adjusted rate based on hr, CVP, systemic BP, urine flow. Tx of
cardiac standstill, arrhythmias. Adult: 0.02–0.06 mg IV injection using diluted sol. Or,
5 mcg/min IV infusion using diluted sol.
ADJUST DOSE Elderly pts
ADV EFF Anxiety, apprehension, bronchospasm, cardiac arrhythmias, cough, dyspnea,
fear, pallor, palpitations, pulmonary edema, respiratory difficulties, sweating
INTERACTIONS Antiarrhythmics, ergots, halogenated hydrocarbon anesthetics, oxytocics,
TCAs
NC/PT Protect from light. Give smallest dose for minimum period. Have beta blocker on
hand to reverse effects. Pt should report chest pain, tremor.

isosorbide dinitrate (Dilatrate SR, Isochron, Isordil Titradose), isosorbide

mononitrate (Imdur, ISMO, Monoket)
CLASS Antianginal, nitrate
PREG/CONT C; B (Imdur, Monoket)/NA

IND & DOSE Tx of angina (dinitrate). Adult: 2.5–5 mg sublingual or 5- to 20-mg oral
tablets; maint, 10–40 mg PO q 6 hr or tid (oral tablets/capsules). SR or ER: Initially,
40 mg, then 40–80 mg PO q 8–12 hr. Px of angina (mononitrate). Adult: 20 mg PO bid
7 hr apart. ER tablets: 30–60 mg/day PO; may increase to 120 mg/day. Acute px of
angina (dinitrate). Adult: 2.5–5 mg sublingual q 2–3 hr. Give 15 min before activity that
may cause angina.
ADV EFF Apprehension, collapse, dizziness, headache, hypotension, orthostatic
hypotension, rebound hypertension, restlessness, tachycardia, weakness
INTERACTIONS Ergots
NC/PT Reduce dose gradually when stopping. Headache possible. Pt should place
sublingual form under tongue or in buccal pouch, try not to swallow; take orally on
empty stomach; take safety precautions w/ CNS effects, orthostatic hypotension; report
blurred vision, severe headache, more frequent anginal attacks. Name confusion Isordil
(isosorbide) and Plendil (felodipine); use caution.

isotretinoin (Amnesteem, Claravis, Sotret)

CLASS Acne product, retinoid
PREG/CONT X/NA

BBW Ensure pt reads, signs consent form; place form in pt’s permanent record. Rule out
pregnancy before tx; test for pregnancy within 2 wk of starting tx. Advise use of two
forms of contraception starting 1 mo before tx until 1 mo after tx ends. Pharmacists
must register pts in iPLEDGE program before dispensing drug. Pt may obtain no more
than 30-day supply.
IND & DOSE Tx of severe recalcitrant nodular acne unresponsive to conventional tx.
Adult, child 12 yr and older: 0.5–1 mg/kg/day PO; range, 0.5–2 mg/kg/day divided into
two doses for 15–20 wk. Max daily dose, 2 mg/kg. If second course needed, allow rest
period of at least 8 wk between courses.
ADV EFF Abd pain, bronchospasm, cheilitis, conjunctivitis, dizziness, dry nose/skin,
epistaxis, eye irritation, fatigue, headache, hematuria, insomnia, lethargy, lipid changes,
n/v, papilledema, skin irritation, suicidality, visual changes
INTERACTIONS Corticosteroids, phenytoin, tetracycline, vitamin A
NC/PT Ensure pt has read, signed consent form. Rule out pregnancy; ensure pt using
contraception. Allow 8 wk between tx cycles. Only 1 mo prescription can be given. Pt
may be unable to wear contact lenses. Give w/ food to improve absorption. Pt should
swallow capsules whole and not cut, crush, or chew them; avoid donating blood; avoid
vitamin supplements; take safety precautions w/CNS effects; report visual changes,
thoughts of suicide.

isradipine (DynaCirc CR)

CLASS Antihypertensive, calcium channel blocker
PREG/CONT C/NA

IND & DOSE Mgt of hypertension. Adult: 2.5 mg PO bid; max, 20 mg/day. CR, 5–
10 mg/day PO.
ADJUST DOSE Elderly pts; hepatic, renal impairment
ADV EFF Dizziness, edema, headache, hypotension, nausea
INTERACTIONS Antifungals, atracurium, beta blockers, calcium, carbamazepine, digoxin,
fentanyl, H2 antagonists, pancuronium, prazosin, quinidine, rifampin, tubocurarine,
vecuronium
NC/PT Monitor BP; other antihypertensives may be added as needed. Monitor BP, cardiac
rhythm closely when determining dose. Pt should swallow CR tablet whole and not cut,
crush, or chew it; take safety precautions w/ CNS effects; treat for headache; report
swelling, palpitations.

itraconazole (Sporanox)
CLASS Antifungal
PREG/CONT C/NA

BBW Risk of severe HF; do not give if evidence of cardiac dysfunction, HF. Potential for
serious CV events (including ventricular tachycardia, death) w/ lovastatin, simvastatin,
triazolam, midazolam, pimozide, dofetilide, quinidine due to significant CYP450
inhibition; avoid these combinations.
IND & DOSE Tx of empiric febrile neutropenia. Adult: 200 mg PO bid until clinically
significant neutropenia resolves. Tx of candidiasis. Adult: 200 mg/day PO (oral sol
only) for 1–2 wk (oropharyngeal); 100 mg/day PO for at least 3 wk (esophageal);
200 mg/day PO in AIDS/neutropenic pts. Tx of blastomycosis, chronic
histoplasmosis. Adult: 200 mg/day PO for at least 3 mo; max, 400 mg/day. Tx of
systemic mycoses. Adult: 100–200 mg/day PO for 3–6 mo. Tx of dermatophytoses.
Adult: 100–200 mg/day PO to bid for 7–28 days. Tx of fingernail onychomycosis.
Adult: 200 mg bid PO for 1 wk, then 3-wk rest period; repeat. Tx of toenail
onychomycosis. Adult: 200 mg/day PO for 12 wk. Tx of aspergillosis. Adult: 200–
400 mg/day PO.
ADJUST DOSE Renal impairment
ADV EFF Abd pain, edema, headache, HF, hepatotoxicity, n/v/d, rash
INTERACTIONS Antacids, benzodiazepines, buspirone, carbamazepine, colas, cyclosporine,
digoxin, grapefruit juice, histamine2 antagonists, isoniazid, lovastatin, macrolide
antibiotics, nevirapine, oral hypoglycemics, phenobarbital, phenytoin, protease
inhibitors, proton pump inhibitors, rifampin, warfarin anticoagulants
NC/PT Culture before tx. Monitor LFTs; stop if s&sx of active liver disease. Check all
drugs being used; many interactions possible. Not for use in pregnancy (contraceptives
advised). Give capsules w/ food. For oral sol, give 100–200 mg (10–20 mL), have pt
rinse and hold, then swallow sol daily for 1–3 wk. Pt should avoid grapefruit juice,
colas; report difficulty breathing, stool/urine changes.

ivacaftor (Kalydeco)
CLASS Cystic fibrosis transmembrane conductance regulator potentiator
PREG/CONT B/NA

IND & DOSETx of cystic fibrosis (CF) in pts 6 yr and older w/ G551D mutation of CF
gene. Adult, child 6 yr and older: 150 mg PO q 12 hr w/ fat-containing food.
ADJUST DOSE Moderate to severe hepatic impairment
ADV EFF Abd pain, congestion, dizziness, headache, hepatic impairment,
nasopharyngitis, n/v, rash, URI
INTERACTIONS Grapefruit juice, moderate to strong CYP3A inhibitors, St. John’s wort
NC/PT Monitor LFTs before and q 3 mo during first yr, then yearly. Give w/ fat-
containing food; use safety precautions if dizziness occurs. Pt should take q 12 hr w/ fat-
containing food; use caution w/ dizziness; avoid grapefruit juice, St. John’s wort; report
yellowing of eyes or skin, urine/stool color changes.

ivermectin (Stromectol)
CLASS Anthelmintic
PREG/CONT C/NA

IND & DOSETx of intestinal strongyloidiasis. Adult: 200 mcg/kg PO as single dose. Tx of
onchocerciasis. Adult: 150 mcg/kg PO as single dose; may repeat in 3–12 mo.
ADV EFF Abd pain, dizziness, nausea, rash
NC/PT Culture before tx. Not for use in breast-feeding. Pt should take on empty stomach
w/ water; will need repeat stool cultures; may need repeat tx.

ixabepilone (Ixempra)
CLASS Antineoplastic, microtubular inhibitor
PREG/CONT D/NA

BBW Risk of severe liver failure, severe bone marrow suppression, neurotoxicities,
cardiotoxicities; select pt carefully, monitor closely.
IND & DOSE Tx of metastatic or locally advanced breast cancer in pts who have
failed on anthracycline, taxane. Adult: 40 mg/m2 IV over 3 hr q 3 wk; may combine
w/ capecitabine.
ADV EFF Alopecia, anorexia, asthenia, bone marrow suppression, fatigue, n/v/d,
peripheral neuropathy, severe hypersensitivity reactions, stomatitis
INTERACTIONS CYP3A4 inducers/inhibitors
NC/PT Follow CBC, LFTs closely. Premedicate w/ corticosteroids. Not for use in
pregnancy (barrier contraceptives advised). Pt should mark calendar for tx days; cover
head at temp extremes (hair loss possible); avoid exposure to infections; perform mouth
care (for stomatitis); take safety precautions (for neuropathies); report chest pain,
palpitations, difficulty breathing, numbness/tingling.

DANGEROUS DRUG
ketamine (Ketalar)
CLASS Nonbarbiturate anesthetic
PREG/CONT B/C-III

BBW Emergence reaction (confusion, hallucinations, delirium) possible; lessened with

smallest effective dose and use of tactile, verbal, or visual stimuli. Severe cases require
small dose of short-acting barbiturate.
IND & DOSE Induction of anesthesia. Adult: 1–4.5 mg/kg IV slowly or 1–2 mg/kg IV at
0.5 mg/kg/min, or 6.5–13 mg/kg IM (10 mg/kg IM produces 12–25 min anesthesia).
Induction of anesthesia in cardiac surgery. Adult: 0.5–1.5 mg/kg IV at 20 mg q 10
sec. Maintenance of general anesthesia. Adult: Repeat dose in increments of ½ to full
induction dose.
ADV EFF Anorexia, confusion, diplopia, dreamlike state, emergence reaction,
hallucinations, hypertension, nausea, pain at injection site, vomiting
INTERACTIONS Halothane, NMJ blockers, other sedative/hypnotics, thyroid hormones
NC/PT Administered by anesthesia specialist. Ensure oxygen, oximetry, cardiac
monitoring; have emergency equipment nearby. Warn pt about sedative effect: Pt
should avoid driving after receiving drug, tasks requiring mental alertness/coordination,
making important decisions. Pt should report difficulty breathing, pain at injection site,
changes in thinking.

ketoconazole (Extina, Nizoral A-D, Xolegel)

CLASS Antifungal
PREG/CONT C/NA

BBW Risk of serious to fatal hepatotoxicity; monitor closely.

IND & DOSE Tx of susceptible, systemic fungal infections; recalcitrant
dermatophytosis. Adult: 200 mg PO daily; for severe infections, 400 mg/day PO for 1
wk–6 mo. Child over 2 yr: 3.3–6.6 mg/kg/day PO as single dose. To reduce scaling due
to dandruff. Adult, child: Moisten hair, scalp thoroughly w/ water; apply sufficient
shampoo to produce lather; leave on for 5 min. Shampoo twice/wk for 4 wk with at
least 3 days between shampooing. Topical tx of tinea pedis, corporis, cruris;
cutaneous candidiasis. Adult, child over 12 yr: Apply thin film of gel, foam, cream once
daily to affected area for 2 wk; do not wash area for 3 hr after applying. Wait 20 min
before applying makeup, sunscreen. May need 6 wk of tx. Tx of seborrheic dermatitis.
Adult, child over 12 yr: Apply foam bid for 4 wk.
ADV EFF Anaphylaxis, dizziness, hepatotoxicity, local stinging on application, n/v,
pruritus
INTERACTIONS Antacids, corticosteroids, cyclosporine, histamine2 blockers, proton pump
inhibitors, rifampin, tacrolimus, warfarin
NC/PT Culture before tx. Have epinephrine on hand for anaphylaxis. Monitor LFTs
closely. Review proper administration. Pt may need long-term tx. Pt should use proper
hygiene to prevent infection spread, avoid drugs that alter stomach acid level (if
needed, pt should take ketoconazole at least 2 hr after these drugs), take safety
precautions w/ CNS effects, report stool/urine changes, unusual bleeding.

ketoprofen (generic)
CLASS NSAID
PREG/CONT C (1st, 2nd trimesters); D (3rd trimester)/NA

BBW Increased risk of CV events, GI bleeding; monitor accordingly. Contraindicated for

tx of perioperative pain after CABG surgery; serious adverse effects have occurred.
IND & DOSE Relief of pain from rheumatoid arthritis, osteoarthritis. Adult: 75 mg PO
tid or 50 mg PO qid. Maint, 150–300 mg PO in three or four divided doses; max,
300 mg/day. ER form, 200 mg/day PO; or max, 200 mg/day ER. Tx of mild to
moderate pain, primary dysmenorrhea: Adult: 25–50 mg PO q 6–8 hr as needed.
ADJUST DOSE Elderly pts; hepatic, renal impairment
ADV EFF Anaphylaxis, dizziness, dyspepsia, edema, gastric/duodenal ulcer, GI pain,
headache, insomnia, nausea, renal impairment
INTERACTIONS Aminoglycosides, aspirin, cyclosporine, diuretics, warfarin
NC/PT Monitor renal function. Give w/ food. Not for use in pregnancy. Pt should avoid
OTC products that might contain NSAIDs, report swelling, difficulty breathing, black
tarry stools.

ketorolac tromethamine (Acular LS, Acuvail, Sprix)

CLASS Antipyretic, NSAID
PREG/CONT C (1st, 2nd trimesters); D (3rd trimester)/NA

BBW Increased risk of CV events, GI bleeding; monitor accordingly. Do not use during
labor/delivery or in breast-feeding; serious adverse effects in fetus/baby possible. May
increase risk of bleeding; do not use w/ high risk of bleeding or as px before surgery.
Increased risk of severe hypersensitivity with known hypersensitivity to aspirin, NSAIDs.
IND & DOSE Short-term pain mgt (up to 5 days). Adult: 60 mg IM or 30 mg IV as single
dose, or 30 mg IM or IV q 6 hr to max 120 mg/day. Or, 1 spray in one nostril q 6–8 hr;
max, 63 mg/day (over 65 yr); 1 spray (15.75 mg) in each nostril q 6–8 hr; max,
126 mg/day (under 65 yr). Transfer to oral: 20 mg PO as first dose for pts who received
60 mg IM or 30 mg IV as single dose or 30-mg multiple dose, then 10 mg PO q 4–6 hr;
max, 40 mg/24 hr. Child 2–16 yr: 1 mg/kg IM to max 30 mg, or 0.5 mg/kg IV to max
15 mg as single dose. Relief of itching of allergic conjunctivitis. Adult: 1 drop in
affected eye(s) qid. Relief of cataract postop pain, inflammation. Adult: Dose varies
by product; check manufacturer info.
ADJUST DOSE Elderly pts, renal impairment, weight under 50 kg
ADV EFF Anaphylaxis, dizziness, dyspepsia, edema, gastric/duodenal ulcer, GI pain,
headache, insomnia, nausea, renal impairment
INTERACTIONS Aminoglycosides, aspirin, cyclosporine, diuretics, NSAIDs, warfarin
NC/PT Protect vials from light. Monitor renal function. Give to maintain serum levels,
control pain. Not for use in pregnancy. Do not use ophthalmic drops w/ contact lenses.
Pt should take w/ food, use safety precautions w/ CNS effects, avoid OTC products that
might contain NSAIDs, report swelling, difficulty breathing, black tarry stools.

DANGEROUS DRUG
labetalol hydrochloride (Trandate)
CLASS Antihypertensive, sympathetic blocker
PREG/CONT C/NA

IND & DOSETx of hypertension. Adult: 100 mg PO bid; maint, 200–400 mg bid PO; up to
2,400 mg/day has been used. Tx of severe hypertension. Adult: 20 mg (0.25 mg/kg) IV
injection slowly over 2 min; can give additional doses of 40 or 80 mg at 10-min
intervals until desired BP achieved or 300-mg dose has been injected. Transfer to oral
therapy as soon as possible.
ADJUST DOSE Elderly pts
ADV EFF Bronchospasm, constipation, cough, dizziness, dyspnea, ED, flatulence, gastric
pain, HF, n/v/d, stroke, vertigo
INTERACTIONS Calcium channel blockers, enflurane, isoflurane, nitroglycerin
NC/PT Taper after long-term tx. Keep pt supine during infusion. Pt should not stop taking
suddenly, take w/ meals, use safety precautions w/ CNS effects, report difficulty
breathing, swelling.

lacosamide (Vimpat)
CLASS Antiepileptic
PREG/CONT C/NA

BBW Increased risk of suicidal ideation in children, adolescents, young adults; monitor
accordingly.
IND & DOSEAdjunct tx for partial-onset seizures. Adult, child 17 yr and older: 50 mg PO
bid; range, 200–400 mg/day PO. IV dosing is same as oral; for short-term use if oral not
possible.
ADJUST DOSE Hepatic, renal impairment
ADV EFF Ataxia, prolonged PR interval, diplopia, dizziness, n/v
INTERACTIONS Other PR-prolonging drugs
NC/PT Taper after long-term tx. Not for use in pregnancy (barrier contraceptives
advised), breast-feeding. Pt should not stop taking suddenly, take safety precautions w/
CNS effects, report thoughts of suicide, personality changes.

lactulose (Cephulac, Chronulac, Constilac, Enulose)

CLASS Ammonia-reducing drug, laxative
PREG/CONT B/NA

IND & DOSE Tx of portal-systemic encephalopathy. 30–45 mL (20–30 g) PO tid or qid.

Adjust q 1–2 days to produce two or three soft stools/day. May use 30–45 mL/hr PO if
needed. Or, 300 mL (20 g) lactulose mixed w/ 700 mL water or physiologic saline as
retention enema retained for 30–60 min; may repeat q 4–6 hr. Child: 2.5–10 mL/day PO
in divided dose for small child or 40–90 mL/day for older child suggested. Goal: Two or
three soft stools daily. Laxative. Adult: 15–30 mL/day (10–20 g) PO; up to 60 mL/day
has been used.
ADV EFF Belching, distention, intestinal cramping, transient flatulence
NC/PT Give laxative syrup orally w/ fruit juice, water, milk to increase palatability.
Monitor serum ammonia levels. Monitor for electrolyte imbalance w/ long-term tx. Pt
should not use other laxatives, not use as laxative for longer than 1 wk unless
prescribed, have ready access to bathroom facilities, report diarrhea.

lamivudine (Epivir, Epivir-HBV)

CLASS Antiviral, reverse transcriptase inhibitor
PREG/CONT C/NA

BBW Monitor hematologic indices, LFTs q 2 wk during tx; severe hepatomegaly w/

steatosis, lactic acidosis possible. Counsel, periodically test pts receiving Epivir-HBV;
severe, acute hepatitis B virus (HBV) exacerbations have occurred in pts w/ both HIV
and HBV infection who stop taking lamivudine.
IND & DOSE Tx of chronic hepatitis B. Adult: 100 mg PO daily. Child 2–17 yr: 3 mg/kg PO
daily; max, 100 mg daily. Tx of HIV, w/ other drugs. Adult, child 16 yr and older:
150 mg PO bid or 300 mg/day PO as single dose. Child 3 mo–16 yr: 4 mg/kg PO bid;
max, 150 mg bid. Over 30 kg: 150 mg PO bid. Over 21 kg but under 30 kg: 75 mg PO in
am and 150 mg PO in pm. 14–21 kg: 75 mg PO bid.
ADJUST DOSE Renal impairment
ADV EFF Agranulocytosis, asthenia, diarrhea, GI pain, headache, hepatomegaly w/
lactic acidosis, nasal s&sx, nausea, pancreatitis, steatosis
INTERACTIONS Trimethoprim-sulfamethoxazole, zalcitabine
NC/PT Give w/ other antiretrovirals for HIV. Monitor for s&sx of pancreatitis; stop
immediately if evident. Monitor for opportunistic infections. Not for use in pregnancy.
Pt should use protection to prevent transmission (drug not a cure), get frequent blood
tests, report severe headache, severe n/v.

lamotrigine (Lamictal)
CLASS Antiepileptic
PREG/CONT C/NA

BBW Risk of serious, life-threatening rash; monitor accordingly. Stop immediately if rash
appears; have appropriate life support on hand.
IND & DOSE Tx of partial-onset seizures, primary generalized tonic-clonic seizures,
Lennox-Gastaut syndrome. Adult taking enzyme-inducing antiepileptics (ie,
carbamazepine, phenobarbital, phenytoin) but not valproic acid: 50 mg PO daily for 2 wk,
then 100 mg PO daily in two divided doses for 2 wk. Then may increase by 100 mg/day
q wk to maint of 300–500 mg/day PO in two divided doses. ER form: wk 1–2,
50 mg/day PO; wk 3–4, 100 mg/day PO; wk 5, 200 mg/day PO; wk 6, 300 mg/day PO;
wk 7, 400 mg/day PO. Range, 400–600 mg/day. Adult, child over 12 yr taking enzyme-
inducing antiepileptics and valproic acid: 25 mg PO q other day for 2 wk, then 25 mg PO
daily for 2 wk. Then may increase by 25–50 mg q 1–2 wk to maint 100–400 mg/day PO
in two divided doses. Child 2–12 yr taking non-enzyme-inducing antiepileptics and valproic
acid: 0.15 mg/kg/day PO in one to two divided doses for 2 wk. Then 0.3 mg/kg/day PO
in one to two divided doses, rounded down to nearest 5 mg for 2 wk. Maint, 1–
5 mg/kg/day in one to two divided doses to max of 200 mg/day. Child 2–12 yr taking
single enzyme-inducing antiepileptic without valproic acid: 0.6 mg/kg/day PO in two
divided doses for 2 wk, then 1.2 mg/kg/day PO in two divided doses for 2 wk. Maint, 5–
15 mg/kg/day in two divided doses to max 400 mg/day. Tx of bipolar I disorder. Adult
taking valproic acid: 25 mg PO q other day for 2 wk, then 25 mg PO once daily for 2 wk.
After 4 wk, may double dose at wkly intervals to target 100 mg/day. Adult taking
enzyme-inducing antiepileptics but not valproic acid: 50 mg/day PO for 2 wk; then 100 mg
PO daily in two divided doses for 2 wk. After 4 wk, may increase dose in 100-mg
increments at wkly intervals to target maint of 400 mg/day PO in two divided doses.
Adult taking neither enzyme-inducing antiepileptics nor valproic acid: 25 mg/day PO for 2
wk, then 50 mg PO daily for 2 wk. After 4 wk, may double dose at wkly intervals to
maint of 200 mg/day.
ADV EFF Aseptic meningitis, ataxia, dizziness, hepatotoxicity, nausea, rash, Stevens-
Johnson syndrome, toxic epidermal necrosis w/ multiorgan failure
INTERACTIONS Carbamazepine, phenobarbital, phenytoin, primidone, valproic acid
NC/PT Monitor LFTs, renal function closely. Monitor for aseptic meningitis. Monitor for
rash; stop if rash evident. Taper slowly over 2 wk when stopping. Ensure pt swallows
ER tablets whole and does not cut, crush, or chew them. Pt should wear medical ID, take
safety precautions w/ CNS effects, report rash, stool/urine changes. Name confusion
between Lamictal (lamotrigine) and Lamisil (terbinafine); use caution.

lanreotide acetate (Somatuline Depot)

CLASS Growth hormone (GH) inhibitor
PREG/CONT C/NA

IND & DOSE Long-term tx of acromegaly in pts unresponsive to other tx. Adult: 60–
120 mg subcut q 4 wk for 3 mo.
ADJUST DOSE Hepatic, renal impairment
ADV EFF Abd pain, cholelithiasis, diarrhea, flatulence, hyperglycemia, hypoglycemia,
injection-site reactions, sinus bradycardia, thyroid dysfx
INTERACTIONS Antidiabetics, beta blockers, cyclosporine, insulin
NC/PT Drug injected into buttocks, alternating left and right; monitor for injection-site
reactions. Monitor GH, insulin growth factor-1. Monitor serum glucose, thyroid function;
intervene as indicated. Monitor for bradycardia. Not for use in breast-feeding. Pt should
mark calendar of tx days, keep frequent follow-up appointments.

lansoprazole (Prevacid, Prevacid 24 hr)

CLASS Proton pump inhibitor
PREG/CONT B/NA

IND & DOSE Tx of active duodenal ulcer. Adult: 15 mg PO daily for 4 wk; maint,
15 mg/day PO. Tx of gastric ulcer. Adult: 30 mg/day PO for up to 8 wk. To reduce
risk of gastric ulcer w/ NSAIDs. Adult: 15 mg/day PO for up to 12 wk. Tx of
duodenal ulcers associated w/ Helicobacter pylori. Adult: 30 mg lansoprazole,
500 mg clarithromycin, 1 g amoxicillin, all PO bid for 10–14 days; or 30 mg
lansoprazole, 1 g amoxicillin PO tid for 14 days. GERD. Adult, child 12–17 yr: 15 mg/day
PO for up to 8 wk. Child 1–11 yr: Over 30 kg, 30 mg/day PO for up to 12 wk. 30 kg or
less, 15 mg/day PO for up to 12 wk. Tx of erosive esophagitis, poorly responsive
GERD. Adult, child 12–17 yr: 30 mg/day PO daily for up to 8 wk. Additional 8-wk course
may be helpful for pts not healed after 8-wk tx. Maint, 15 mg/day PO. Tx of
pathological hypersecretory conditions. Adult: 60 mg/day PO; up to 90 mg bid have
been used. Short-term tx of erosive esophagitis (all grades). Adult: 30 mg/day IV
over 30 min for up to 7 days; switch to oral form as soon as possible for total of 8 wk.
Tx of heartburn. Adult: 1 capsule Prevacid 24 hr PO w/ full glass of water in a.m. before
eating for 14 days; may repeat 14-day course q 4 mo.
ADJUST DOSE Hepatic impairment
ADV EFF Abd pain, bone loss, dizziness, headache, n/v/d, rash, URI
INTERACTIONS Ketoconazole, sucralfate, theophylline
NC/PT Give w/ meals. May open capsule, sprinkle on applesauce, Ensure, yogurt, cottage
cheese, strained pears. For NG tube, place 15- or 30-mg tablet in syringe, draw up 4 or
10 mL water; shake gently for quick dispersal. After dispersal, inject through NG tube
into stomach within 15 min. If using capsules w/ NG tube, mix granules from capsule w/
40 mL apple juice, inject through tube, then flush tube w/ more apple juice. For orally
disintegrating tablet, place on tongue, follow w/ water after it dissolves. For IV, switch
to oral form as soon as feasible. Arrange for further evaluation if no symptom
improvement. Pt should swallow capsule whole and not cut, crush, or chew it; take
safety precautions w/ CNS effects; report severe diarrhea.

lanthanum carbonate (Fosrenol)

CLASS Phosphate binder
PREG/CONT C/NA

IND & DOSE To reduce serum phosphate level in pts w/ end-stage renal disease.
Adult: 1,500–3,000 mg/day PO w/ meals; base dose on serum phosphate level.
ADJUST DOSE Hepatic impairment
ADV EFF Abd pain, allergic skin reactions, dyspepsia, GI obstruction, n/v/d, tooth injury
INTERACTIONS Antacids, levothyroxine, quinolone antibiotics
NC/PT Monitor serum phosphate level (target, 6 mg/dL or lower). Pt should chew or
crush tablets, not swallow whole; take w/ meals; separate from other oral drugs by 2 hr;
report severe abd pain, constipation.

DANGEROUS DRUG
lapatinib (Tykerb)
CLASS Antineoplastic, kinase inhibitor
PREG/CONT D/NA

BBW Severe to fatal hepatotoxicity has occurred; monitor LFTs closely.

IND & DOSE Tx of advanced/metastatic breast cancer w/ tumors that overexpress
HER2 in women who have received other tx. Adult: 1,250 mg/day PO on days 1–21
w/ capecitabine 2,000 mg/m2/day PO on days 1–14, given 12 hr apart. Repeat 21-day
cycle. Tx of HER2-positive metastatic breast cancer. Adult: 1,500 mg/day PO w/
letrozole 2.5 mg/day PO.
ADJUST DOSE Cardiotoxicities, concomitant CYP3A4 inducers/inhibitors, hepatic
impairment
ADV EFF Anaphylaxis, decreased left ventricular function, diarrhea, fatigue,
hepatotoxicity, interstitial pneumonitis, n/v, prolonged QT interval
INTERACTIONS Antacids, carbamazepine, digoxin, grapefruit juice, ketoconazole,
midazolam, paclitaxel, QT-prolonging drugs, St. John’s wort
NC/PT Monitor LFTs before and regularly during tx. Monitor cardiac/respiratory
function; evaluate lungs for pneumonitis. Not for use in pregnancy (contraceptives
advised). Pt should take 1 hr before or after meals; avoid grapefruit juice, St. John’s
wort, antacids; report difficulty breathing, swelling, dizziness, color change of
urine/stool.

laronidase (Aldurazyme)
CLASS Enzyme
PREG/CONT C/NA

BBW Life-threatening anaphylaxis has occurred; have medical support on hand.

IND & DOSE Tx of pts w/ Hurler, Hurler-Scheie forms of mucopolysaccharidosis 1;
Scheie forms w/ moderate to severe symptoms. Adult, child 6 yr and older:
0.58 mg/kg IV infused over 3–4 hr once/wk.
ADV EFF Anaphylaxis, fever, hyperreflexia, hypertension, injection- site reactions,
paresthesia, tachycardia, UTI
NC/PT Pretreat w/ antipyretics, antihistamines; monitor continually during infusion.
Have emergency equipment on hand. Pt should mark calendar of tx days; report
injection-site pain/swelling, difficulty breathing.

leflunomide (Arava)
CLASS Antiarthritic, pyrimidine, synthesis inhibitor
PREG/CONT X/NA

BBW Advise women of childbearing age of risks of pregnancy; provide counseling for
appropriate contraceptive use during tx. If pt decides to become pregnant, withdrawal
program to rid body of leflunomide recommended. May use cholestyramine to rapidly
decrease serum level if unplanned pregnancy occurs. Risk of severe liver injury; monitor
LFTs before, periodically during tx. Not recommended w/ preexisting liver disease or
liver enzymes over two times upper limit of normal (ULN). Use caution w/ other drugs
that cause liver injury; start cholestyramine washout if ALT increases to three times
ULN.
IND & DOSE Tx of active rheumatoid arthritis (RA); to relieve s&sx, improve
functioning. Adult: Loading dose, 100 mg/day PO for 3 days; maint, 20 mg/day PO.
May reduce to 10 mg/day PO.
ADJUST DOSE Hepatic impairment
ADV EFF Alopecia, drowsiness, diarrhea, erythematous rashes, headache, hepatotoxicity
INTERACTIONS Charcoal, cholestyramine, hepatotoxic drugs, rifampin
NC/PT Monitor LFTs. If ALT rise between two and three times ULN, monitor closely if
continued tx desired. If ALT three times or more ULN, cholestyramine may decrease
absorption; consider stopping. Not for use in pregnancy (barrier contraceptives
advised). Pt should continue other RA tx, get regular medical follow-up, cover head at
temp extremes (hair loss possible), take safety precautions w/ CNS effects.

lenalidomide (Revlimid)
 CLASSAntianemic, immunomodulator
PREG/CONT X/NA

BBW Thalidomide derivative associated w/ birth defects; rule out pregnancy before tx.
Available under limited access program. Can cause significant bone marrow
suppression. Increased risk of DVT, PE.
IND & DOSE Tx of multiple myeloma, w/ dexamethasone. Adult: 25 mg/day PO days 1–
21 of repeated 28-day cycle. Tx of transfusion-dependent anemia due to low or
intermediate risk myelodysplastic syndromes. Adult: 10 mg/day PO. Tx of mantle
cell lymphoma in pts who progress after two prior therapies. Adult: 25 mg/day PO
on days 1–21 of repeated 28-day cycle.
ADJUST DOSE Renal impairment
ADV EFF Anemia, back pain, bone marrow suppression, cancer, constipation, diarrhea,
dizziness, dyspnea, edema, fatigue, fever, nausea, rash, thrombocytopenia, tumor lysis
syndrome, URI
INTERACTIONS Digoxin, erythropoietin-stimulating tx, estrogens
NC/PT Monitor CBC; adjust dose as needed. Rule out pregnancy; ensure contraceptive
use. Not for use in breast-feeding. Pt should take safety precautions w/ CNS effects;
avoid exposure to infection; get cancer screening; report s&sx of infection, unusual
bleeding, muscle pain, difficulty breathing.

lepirudin (Refludan)
CLASS Anticoagulant
PREG/CONT B/NA

IND & DOSETx of heparin-induced thrombocytopenia associated w/ thromboembolic

disease. Adult: 0.4 mg/kg IV bolus, then 0.15 mg/kg IV for 2–10 days.
ADJUST DOSE Renal impairment
ADV EFF Allergic skin reactions, bleeding, fever, injection-site reactions, liver changes,
pneumonia
INTERACTIONS Other anticoagulants, thrombolytics
NC/PT Monitor aPTT ratio (target, 1.5–2.5). Monitor for signs of bleeding. Not for use in
pregnancy, breast-feeding. Pt should report pain at injection site, bleeding.

letrozole (Femara)
CLASS Antiestrogen, antineoplastic, aromatase inhibitor
PREG/CONT D/NA

IND & DOSETx of advanced breast cancer in postmenopausal women progressing

after antiestrogen tx; adjuvant tx of early receptor-positive breast cancer;
extended adjuvant tx of breast cancer in postmenopausal women who have had 5
yr of tamoxifen. Adult: 2.5 mg/day PO; continue until tumor progression evident.
ADJUST DOSE Hepatic impairment
ADV EFF GI upset, headache, hot flashes, nausea, thromboembolic events
NC/PT Not for use in pregnancy (contraceptives advised). Give comfort measures for
adverse effects. Pt should report urine/stool color changes.

leucovorin calcium (generic)

CLASS Folic acid derivative
PREG/CONT C/NA

IND & DOSELeucovorin rescue, after high-dose methotrexate. Adult: Start within 24 hr
of methotrexate dose; 10 mg/m2 PO q 6 hr for 10 doses or until methotrexate level less
than 0.05 micromolar. If serum creatinine is 100% greater than pretreatment level 24 hr
after methotrexate dose, or based on methotrexate levels, increase leucovorin to 150 mg
IV q 3 hr until serum methotrexate less than 1.0 micromolar; then 15 mg IV q 3 hr until
methotrexate is under 0.05 micromolar. Tx of megaloblastic anemia. Adult: 1 mg/day
IM; max, 1 mg/day. Palliative tx of metastatic colon cancer. Adult: 200 mg/m2 by
slow IV injection over 3 min, then 5-FU 370 mg/m2 IV. Or, 20 mg/m2 IV, then 5-FU
425 mg/m2 IV. Repeat daily for 5 days; may repeat at 4-wk intervals.
ADV EFF Hypersensitivity reactions, pain/discomfort at injection site
INTERACTIONS 5-FU
NC/PT Give orally if possible. Monitor for hypersensitivity reactions; have emergency
support on hand. Do not use intrathecally. Pt should report rash, difficulty breathing.
Name confusion between Leukeran (chlorambucil) and leucovorin; use care.

leuprolide acetate (Eligard, Lupron)

CLASS GnRH analogue
PREG/CONT X/NA

IND & DOSE Tx of advanced prostate cancer. Adult: 1 mg/day subcut, or depot 7.5 mg
IM monthly (q 28–33 days), or 22.5 mg depot IM or subcut q 3 mo (84 days), or 30 mg
depot IM or subcut q 4 mo, or 45 mg depot subcut q 6 mo. Tx of endometriosis. Adult:
3.75 mg as single monthly IM injection, or 11.25 mg IM q 3 mo. Continue for 6 mo. Tx
of uterine leiomyomata. Adult: 3.75 mg as single monthly injection for 3 mo, or
11.25 mg IM once; give w/ concomitant iron tx. Tx of central precocious puberty.
Child: 50 mcg/kg/day subcut; may increase by 10-mcg/kg/day increments. Or,
0.3 mg/kg IM depot q 4 wk. Round to nearest depot size; minimum, 7.5 mg.
ADV EFF Anorexia, constipation, dizziness, headache, hematuria, hot flashes, injection-site
reactions, MI, n/v, peripheral edema, sweating
NC/PT Give only w/ syringe provided. Give depot injections deep into muscle. Obtain
periodic tests of testosterone, PSA. Not for use in pregnancy (contraceptives advised).
Stop if precocious puberty before 11 yr (girls), 12 yr (boys). Teach proper
administration, disposal of needles, syringes. Pt should take safety precautions w/ CNS
effects, report injection-site reaction, chest pain.

levalbuterol hydrochloride (Xopenex), levalbuterol tartrate (Xopenex HFA)

CLASS Antiasthmatic, beta agonist, bronchodilator
PREG/CONT C/NA

IND & DOSE Tx, px of bronchospasm. Adult, child 12 yr and older (Xopenex): 0.63 mg tid,
q 6–8 hr by nebulization; may increase up to 1.25 mg tid by nebulization. Child 6–11 yr
(Xopenex): 0.31 mg tid by nebulization; max, 0.63 mg tid.: Adult, child 4 yr and older
(Xopenex HFA): 2 inhalations (90 mcg) repeated q 4–6 hr; some pts may respond to 1
inhalation (45 mcg) q 4 hr.
ADV EFF Anxiety, apprehension, BP changes, bronchospasm, CNS stimulation, fear,
headache, nausea
INTERACTIONS Aminophylline, beta blockers, MAOIs, sympathomimetics, theophylline
NC/PT Keep unopened drug in foil pouch until ready to use; protect from heat, light.
Once foil pouch open, use vial within 2 wk, protected from heat, light. Once vial is
removed from pouch, use immediately. If not used, protect from light, use within 1 wk.
Discard vial if sol not colorless. Teach proper use of inhaler/nebulizer. Pt should take
safety precautions w/ CNS effects, not exceed recommended dose, report chest pain,
difficulty breathing, worsening of condition.

levetiracetam (Keppra)
CLASS Antiepileptic
PREG/CONT C/NA

IND & DOSE Tx of partial-onset seizures. Adult, child over 16 yr: 500 mg PO or IV bid;
max, 3,000 mg/day. ER tablets: 1,000 mg/day PO; max, 3,000 mg/day. Child 4–16 yr:
10 mg/kg PO bid (500–1,000 mg/day); may increase q 2 wk in 20-mg/kg increments to
30 mg/kg bid (1,500–3,000 mg/day). Daily dose of oral sol: total dose (mL/day) =
daily dose (mg/kg/day) × pt weight (kg) ÷ 100 mg/mL PO. Tx of generalized tonic-
clonic seizures. Adult, child over 16 yr: 500 mg PO bid; increase by 1,000 mg/day q
2 wk to recommended 3,000 mg/day. Child 6–15 yr: 10 mg/kg PO bid; increase q 2 wk
by 20-mg/kg increments to recommended 60 mg/kg/day given as 30 mg/kg bid. Tx of
myoclonic seizures. Adult, child 12 yr and older: 500 mg PO bid; slowly increase to
recommended max, 3,000 mg/day.
ADJUST DOSE Renal impairment
ADV EFF Dizziness, dyspepsia, headache, suicidality, vertigo, vision changes
NC/PT Taper when stopping. Give w/ food. Not for use in pregnancy (barrier
contraceptives advised). Pt should swallow ER tablet whole and not cut, crush, or chew
it; take safety precautions w/ CNS effects; wear medical ID; report severe headache,
thoughts of suicide. Name confusion between Keppra (levetiracetam) and Kaletra
(lopinavir/ritonavir); use caution.
 levocetirizine dihydrochloride (Xyzal)
CLASS Antihistamine
PREG/CONT B/NA

IND & DOSE Symptom relief of seasonal, perennial allergic rhinitis in pts 6 mo and
older; tx of uncomplicated skin effects in chronic idiopathic urticaria in pts 2 yr
and older. Adult, child 12 yr and older: 5 mg/day PO in evening. Child 6–11 yr:
2.5 mg/day PO in evening. Child 6 mo–5 yr: 1.25 mg (½ tsp oral sol) PO once daily in
evening.
ADJUST DOSE Renal impairment
ADV EFF Dry mouth, fatigue, mental alertness changes, nasopharyngitis, somnolence
INTERACTIONS Alcohol, CNS depressants
NC/PT Encourage humidifiers, adequate fluid intake to help prevent severe dryness of
mucous membranes; skin care for urticaria. Not for use in pregnancy, breast-feeding. Pt
should take in evening, use safety precautions w/ CNS effects.

levodopa (generic)
CLASS Antiparkinsonism
PREG/CONT C/NA

IND & DOSE Tx of parkinsonism. Adult: 1 g/day PO in two or more doses w/ food;
increase gradually in increments not exceeding 0.75 g/day q 3–7 days as tolerated. Max,
8 g/day. Only available in combination products.
ADV EFF Abd pain, adventitious movements, anorexia, ataxia, dizziness, drowsiness, dry
mouth, n/v, numbness, suicidality, weakness
INTERACTIONS Benzodiazepines, MAOIs, papaverine, phenytoin, pyridoxine, TCAs
NC/PT Ensure 14 days free of MAOIs before use. Give w/ meals. Decreased dose needed if
tx interrupted. Observe for suicidal tendencies. Limit vitamin B6 intake; check
multivitamin use. Pt should take safety precautions w/ CNS effects, use sugarless
lozenges for dry mouth, report uncontrollable movements, difficulty urinating.

levofloxacin (Levaquin)
CLASS Fluoroquinolone antibiotic
PREG/CONT C/NA

BBW Risk of tendinitis, tendon rupture. Risk increased in pts older than 60 yr, w/
concurrent corticosteroids use, and w/ kidney, heart, lung transplant. Risk of
exacerbation of myasthenia gravis w/ serious muscle weakness; do not use w/ hx of
myasthenia gravis.
IND & DOSE Tx of community-acquired pneumonia. Adults: 500 mg/day PO or IV for 7–
14 days. Tx of sinusitis. Adult: 500 mg/day PO or IV for 10–14 days, or 750 mg/day PO
or IV for 5 days. Tx of chronic bronchitis. Adult: 500 mg/day PO or IV for 7 days. Tx
of skin infection. Adult: 500–750 mg/day PO or IV for 7–14 days. Tx of UTIs,
pyelonephritis. Adults: 250 mg daily PO or IV for 3–10 days; complicated, 750 mg/day
PO or IV for 5 days. Tx of nosocomial pneumonia. Adult: 750 mg/day PO or IV for 7–
14 days. Tx of chronic prostatitis. Adults: 500 mg/day PO for 28 days, or 500 mg/day
by slow IV infusion over 60 min for 28 days. Postexposure anthrax. Adult: 500 mg/day
PO or IV for 60 days. Child 6 mo or older over 50 kg: 500 mg/day PO for 60 days. Child 6
mo or older under 50 kg: 8 mg/kg q 12 hr PO for 60 days. Max, 250 mg/dose. Tx, px of
plague due to Yersinia pestis. Adult, child over 50 kg: 500 mg/day PO for 10–14 days.
Child 6 mo and older but less than 50 kg: 8 mg/kg PO q 12 hr for 10–14 days; max,
250 mg.
ADJUST DOSE Renal impairment
ADV EFF Diarrhea, dizziness, headache, insomnia, muscle/joint tenderness,
photosensitivity, prolonged QT interval, rash, renal impairment, tendon rupture
INTERACTIONS Antacids, iron salts, magnesium, NSAIDs, QT-prolonging drugs, St. John’s
wort, sucralfate, zinc
NC/PT Culture before starting tx. Ensure hydration. Stop if hypersensitivity reaction.
Separate from antacids by at least 2 hr. Pt should avoid sun exposure, avoid St John’s
wort, take safety precautions w/ CNS effects, report muscle/tendon pain, weakness.

levoleucovorin (Fusilev)
CLASS Folate analogue
PREG/CONT C/NA

IND & DOSE Rescue after high-dose methotrexate; to diminish toxicity from impaired
methotrexate elimination. Adult: 7.5 mg IV q 6 hr for 10 doses, starting 24 hr after
start of methotrexate infusion. Palliative tx of advanced metastatic colorectal
cancer, w/ 5-FU. Adult: 100 mg/m2 by IV injection over at least 3 min, then 5-FU
370 mg/m2 by IV injection. Or, or 10 mg/m2 by IV injection, then 5-FU 425 mg/m2 by
IV injection.
ADV EFF N/v/d, stomatitis
INTERACTIONS 5-FU, phenobarbital, phenytoin, primidone, trimethoprim-sulfamethoxazole
NC/PT Inject slowly IV, no faster than 160 mg/min because of high calcium content. Give
antiemetics if needed, mouth care for stomatitis.

levomilnacipran (Fetzima)
CLASS Antidepressant, serotonin/norepinephrine reuptake inhibitor
PREG/CONT C/NA

BBW Increased risk of suicidality in children, adolescents, young adults; monitor closely.
IND & DOSE Tx of major depressive disorder. Adult: 20 mg/day PO for 2 days; then
40 mg/day PO. May increase in increments of 40 mg/day every 2 days as needed. Max,
120 mg/day.
ADJUST DOSE Severe renal impairment
ADV EFF Activation of mania, bradycardia, constipation, discontinuation syndrome, ED,
hyponatremia, hypertension, n/v, palpitations, serotonin syndrome, sweating, urinary
retention
INTERACTIONS Azole antifungals, buspirone, clarithromycin, diuretics, fentanyl, linezolid,
lithium, methylene blue (IV), NSAIDs, St. John’s wort, tramadol, tryptophan
NC/PT Monitor for hypomania, BP periodically, IOP in pts w/ glaucoma, serotonin
syndrome, discontinuation syndrome. Not for use in pregnancy, breast-feeding. Pt
should swallow capsule whole, not cut, crush, or chew it. Pt should avoid St. John’s
wort; empty bladder before taking drug; take safety precautions w/ CNS effects; report
thoughts of suicide, hallucinations, continued rapid heart rate, hallucinations.

DANGEROUS DRUG
levorphanol tartrate (generic)
CLASS Opioid agonist analgesic
PREG/CONT C/C-II

IND & DOSE Relief of moderate to severe pain. Adult: 2 mg PO q 3–6 hr; range, 8–
16 mg/day.
ADJUST DOSE Elderly pts, impaired adults
ADV EFF Bronchospasm, cardiac arrest, constipation, dizziness, drowsiness,
laryngospasm, light-headedness, n/v, respiratory arrest, shock, sweating
INTERACTIONS Alcohol, antihistamines, barbiturate anesthetics, CNS depressants
NC/PT Monitor closely w/ first dose. Pt should take safety precautions w/ CNS effects,
use laxative for constipation, take 4–6 hr before next feeding if breast-feeding, report
difficulty breathing.

levothyroxine sodium (Levothroid, Levoxine, Levoxyl, Synthroid, Thyro-Tabs)

CLASS Thyroid hormone
PREG/CONT A/NA

BBW Do not use for weight loss; possible serious adverse effects w/ large doses.
IND & DOSE Replacement tx in hypothyroidism. Adult: 12.5–25 mcg PO, w/ increasing
increments of 25 mcg PO q 2–4 wk; maint, up to 200 mcg/day. Can substitute IV or IM
injection for oral form when oral route not possible. Usual IV dose is 50% of oral dose.
Start at 25 mcg/day or less in pts w/ long-standing hypothyroidism, known cardiac
disease. Usual replacement, 1.7 mcg/kg/day. Tx of myxedema coma without severe
heart disease. Adult: Initially, 200–500 mcg IV. May give additional 100–300 mcg or
more second day if needed. Thyroid suppression tx. Adult: 2.6 mcg/kg/day PO for 7–
10 days. TSH suppression in thyroid cancer, nodules, euthyroid goiters.
Individualize dose based on specific disease and pt; larger amounts than used for normal
suppression. Tx of congenital hypothyroidism. Child: Over 12 yr, 2–3 mcg/kg/day PO;
6–12 yr, 4–5 mcg/kg/day PO; 1–5 yr, 5–6 mcg/kg/day PO; 6–12 mo, 6–8 mcg/kg/day
PO; 3–6 mo, 8–10 mcg/kg/day PO; 0–3 mo, 10–15 mcg/kg/day PO.
ADJUST DOSE Elderly pts
ADV EFF Cardiac arrest, esophageal atresia, n/v/d, tremors
INTERACTIONS Aluminum- and magnesium-containing antacids, cholestyramine, colestipol,
digoxin, iron, sucralfate, theophylline, warfarin
NC/PT Monitor thyroid function. Do not add IV form to other IV fluids. Replaces normal
hormone; adverse effects should not occur. Pt should swallow whole w/ full glass of
water, wear medical ID, report chest pain, unusual sweating.

DANGEROUS DRUG
lidocaine hydrochloride (Anestacon, Numby Stuff, Otocaine, Xylocaine)
CLASS Antiarrhythmic, local anesthetic
PREG/CONT B/NA

IND & DOSE Tx of ventricular arrhythmias. Adult: Use 10% sol for IM injection: 300 mg
in deltoid or thigh muscle; may repeat in 60–90 min. Switch to IV or oral form as soon
as possible. Or, 1–4 mg/min (20–50 mcg/kg/min) IV; decrease as soon as cardiac
rhythm stabilizes. Child: Safety/efficacy not established. AHA recommends bolus of 0.5–
1 mg/kg IV, then 30 mcg/kg/min w/ caution. Local anesthetic. Adult, child: Conc,
diluent should be appropriate to particular local anesthetic use: 5% sol w/ glucose for
spinal anesthesia, 1.5% sol w/ dextrose for low spinal or saddle block anesthesia. Dose
varies w/ area to be anesthetized and reason for anesthesia; use lowest dose needed to
achieve results. Topical analgesia. Adult, child: Up to 3 transdermal patches to area of
pain for up to 12 hr within 24-hr period, or apply cream, ointment, gel, sol, oral patch,
spray as directed 1–3 times/day.
ADJUST DOSE Elderly, debilitated pts; HF; hepatic, renal impairment
ADV EFF Anaphylactoid reactions, back pain, cardiac arrest, cardiac arrhythmias,
dizziness, drowsiness, fatigue, headache, hypotension, light-headedness, respiratory
arrest, seizures, urine retention
INTERACTIONS Beta blockers, cimetidine, succinylcholine
NC/PT Have life support equipment on hand; continually monitor pt response. Check
conc carefully; varies by product. Monitor for safe, effective serum conc
(antiarrhythmic: 1–5 mcg/ mL); conc of 6 or more mcg/mL usually toxic. Pt should take
safety precautions w/ CNS effects, report difficulty speaking/breathing, numbness, pain
at injection site.

linaclotide (Linzess)
CLASS Guanylate cyclase-C agonist, IBS drug
PREG/CONT C/NA
BBW Contraindicated in child up to 6 yr; avoid use in child 6–17 yr; caused deaths in
juvenile mice.
IND & DOSE Tx of IBS w/ constipation. Adult: 290 mcg/day PO. Tx of chronic
idiopathic constipation. Adult: 145 mcg/day PO.
ADV EFF Abd pain, diarrhea, distention, flatulence, severe diarrhea
NC/PT Ensure constipation is main complaint. Give on empty stomach. Have pt swallow
capsule whole and not cut, crush, or chew it. Ensure pt is not under 6 yr. Pt should
swallow capsule whole and not cut, crush, or chew it; take on empty stomach; store in
original container protected from moisture; not give to child under 17 yr; report severe
diarrhea, severe abd pain.

linagliptin (Tradjenta)
CLASS Antidiabetic, DPP-4 inhibitor
PREG/CONT B/NA

IND & DOSE Adjunct to diet, exercise to improve glycemic control in pts w/ type 2
diabetes; tx of type 2 diabetes in pts w/ severe renal impairment w/ insulin; add
on tx to insulin, diet, exercise to achieve glycemic control in pts w/ type 2
diabetes. Adult: 5 mg PO once/day.
ADV EFF Hypoglycemia, nasopharyngitis, pancreatitis
INTERACTIONS Celery, coriander, dandelion root, fenugreek, garlic, ginger, juniper berries,
potent CYP3A inhibitors
NC/PT Monitor blood glucose, HbA1c before, periodically during tx. Ensure pt continues
diet, exercise, other drugs for diabetes control. Use caution in pregnancy, breast-feeding.
Arrange for thorough diabetic teaching program. Report OTC/herbal use that could alter
blood glucose, s&sx of infection, uncontrolled glucose level.

lincomycin hydrochloride (Lincocin)

CLASS Lincosamide antibiotic
PREG/CONT C/NA

BBW Risk of Clostridium difficile diarrhea, pseudomembranous colitis; monitor closely.

IND & DOSE Tx of serious infections caused by susceptible bacteria strains. Adult:
500 mg/day PO q 6–8 hr, or 600 mg IM q 12–24 hr, or 600 mg–1 g IV q 8–12 hr. Child:
30–60 mg/kg/day PO, or 10 mg/kg IM q 12–24 hr, or 10–20 mg/kg/day IV in divided
doses.
ADJUST DOSE Renal impairment
ADV EFF Abd pain, agranulocytosis, anaphylactic reactions, anorexia, cardiac arrest,
contact dermatitis, esophagitis, n/v/d, pain after injection, pseudomembranous
colitis, rash
INTERACTIONS Aluminum salts, kaolin, NMJ blockers
NC/PT Culture before tx. Give orally w/ full glass of water or food. Do not give IM
injection of more than 600 mg; inject deeply into muscle. Monitor LFTs, renal function.
Pt should report severe, watery diarrhea.

linezolid (Zyvox)
CLASS Oxazolidinone antibiotic
PREG/CONT C/NA

IND & DOSE Tx of VREF, MRSA, pneumonia, complicated skin/skin-structure

infections, including diabetic foot ulcers without osteomyelitis. Adult, child 12 yr
and older: 600 mg IV or PO q 12 hr for 10–28 days. Child 11 yr and under: 10 mg/kg IV
or PO q 8 hr for 10–14 days. Tx of uncomplicated skin/skin-structure infections.
Adult, child 12 yr and older: 400 mg PO q 12 hr for 10–14 days. Child 5–11 yr: 10 mg/kg
PO q 12 hr for 10–14 days.
ADV EFF Diarrhea, dizziness, insomnia, nausea, pseudomembranous colitis, rash
INTERACTIONS Aspirin, dipyridamole, MAOIs, NSAIDs, pseudoephedrine, SSRIs, St. John’s
wort, sympathomimetics, tyramine-containing foods
NC/PT Culture before tx. Do not mix IV solution with other solutions. Monitor platelets,
BP w/ long-term use. Pt should complete full course; avoid foods high in tyramine;
report all OTC and herbal use; report severe GI problems, bloody diarrhea. Name
confusion between Zyvox (linezolid) and Zovirax (acyclovir); use caution.

liothyronine (Cytomel, Triostat)

CLASS Thyroid hormone
PREG/CONT A/NA

BBW Do not use for weight loss; serious adverse effects w/ large doses possible.
IND & DOSE Replacement tx in hypothyroidism. Adult: 25 mcg PO; maint, 25–
75 mcg/day. Tx of myxedema. 5 mcg/day PO; maint, 50–100 mcg/day. Tx of
myxedema coma, precoma. Adult: 25–50 mcg IV q 4–12 hr; do not give IM or subcut.
Start at 10–20 mcg IV w/ heart disease. Max, 100 mcg/24 hr. Tx of simple goiter.
Adult: 5 mcg/day PO; maint, 75 mcg/day. Thyroid suppression tx. Adult: 75–
100 mcg/day PO for 7 days. Repeat I131 uptake test; unaffected w/ hyperthyroidism,
decreased by 50% w/ euthyroidism. Tx of congenital hypothyroidism. Child: Birth,
5 mcg/day PO. Usual maint, 20 mcg/day up to 1 yr; 50 mcg/day PO for 1–3 yr, adult
dose over 3 yr.
ADJUST DOSE Elderly pts
ADV EFF Cardiac arrest, esophageal atresia, hyperthyroidism, n/v/d, tremors
INTERACTIONS Aluminum-, magnesium-containing antacids, cholestyramine, colestipol,
digoxin, iron, sucralfate, theophylline, warfarin
NC/PT Monitor thyroid function. Do not add IV form to other IV fluids. Replaces normal
hormone; adverse effects should not occur. Pt should swallow whole w/ full glass of
water, wear medical ID, report chest pain, unusual sweating.

liotrix (Thyrolar)
CLASS Thyroid hormone
PREG/CONT A/NA

BBW Do not use for weight loss; serious adverse effects w/ large doses possible.
IND & DOSE Replacement tx in hypothyroidism. Adult: 30 mg/day PO; Maint, 60–
120 mg/day PO (thyroid equivalent). Mgt of goiter, thyroid cancer. Use larger doses
than needed for replacement surgery. Dx of thyroid function. 1.56 mcg/kg/day PO for
7–10 days. Tx of congenital hypothyroidism. Child: Over 12 yr, 90 mg/day PO; 6–12
yr, 60–90 mg/day PO; 1–5 yr, 45–60 mg/day PO; 6–12 mo, 30–45 mg/day PO; 0–6 mo,
15–30 mg/day PO.
ADV EFF Cardiac arrest, esophageal atresia, hyperthyroidism, n/v/d, tremors
INTERACTIONS Aluminum-, magnesium-containing antacids, cholestyramine, colestipol,
digoxin, iron, sucralfate, theophylline, warfarin
NC/PT Monitor thyroid function. Replaces normal hormone; adverse effects should not
occur. Pt should swallow whole w/ full glass of water, wear medical ID, report chest
pain, unusual sweating.

DANGEROUS DRUG
liraglutide (Victoza)
CLASS Antidiabetic, glucagon-like peptide receptor agonist
PREG/CONT C/NA

BBW Causes thyroid medullary cancer in rodents. Not for use w/ personal, family hx of
thyroid medullary cancer, multiple endocrine neoplasia syndrome type 2; monitor
closely.
IND & DOSE Adjunct to diet, exercise to improve glycemic control in type 2 diabetes.
Adults: 0.6 mg/day by subcut injection; max, 1.8 mg/day.
ADV EFF Dizziness, headache, n/v/d, pancreatitis, papillary thyroid carcinoma
INTERACTIONS Antidiabetic secretagogues, celery, coriander, dandelion root, drugs that
delay GI emptying, garlic, ginseng, fenugreek, juniper berries
NC/PT Monitor blood glucose, HbA1c before, periodically during tx. Ensure pt continues
diet, exercise, other drugs for diabetes. Provide complete diabetic teaching program.
Teach proper administration, disposal of needles, syringes. Use caution in pregnancy,
breast-feeding. Pt should report OTC/herbal use, difficulty swallowing, lump in throat,
severe abd pain radiating to back.

lisdexamfetamine dimesylate (Vyvanse)

CLASS Amphetamine, CNS stimulant
PREG/CONT C/C-II
BBW High risk of abuse; could lead to drug dependence. Amphetamine misuse has
caused serious CV events, sudden death.
IND & DOSE Tx of ADHD as part of integrated tx plan. Adult, child 6 yr and older:
30 mg/day PO in a.m.; may increase at wkly intervals in increments of 10–20 mg/day.
Max, 70 mg/day.
ADV EFF Abd pain, cardiac events, decreased appetite, fever, headache, insomnia,
irritability, n/v/d, sudden death, weight loss
INTERACTIONS Chlorpromazine, haloperidol, MAOIs, meperidine, methenamine,
norepinephrine, sympathomimetics, TCAs, urine acidifiers
NC/PT Ensure proper dx. Part of comprehensive tx plan. Monitor growth in child. If pt
cannot swallow whole, empty contents into glass of water, have pt drink right away.
Stop periodically to validate use. Pt should avoid MAOI use within 14 days, take in a.m.
to prevent insomnia, store in dry place, secure drug (controlled substance), report vision
changes, manic symptoms, marked weight loss.

lisinopril (Prinivil, Zestril)

CLASS ACE inhibitor, antihypertensive
PREG/CONT D/NA

BBW Contraceptives advised. If pregnancy occurs, stop drug as soon as possible; fetal
injury/death possible.
IND & DOSE Tx of hypertension. Adults: 10 mg/day PO; range, 20–40 mg/day. If also
taking diuretic, start at 5 mg/day; monitor BP. Child 6 yr and older: 0.07 mg/kg/day PO;
max, 5 mg/day. Adjunct tx of HF. Adults: 5 mg/day PO w/ diuretics, digitalis. Effective
range, 5–20 mg/day (Prinivil), 5–40 mg/day (Zestril). To improve survival post-MI.
Adults: Start within 24 hr of MI; 5 mg PO, then 5 mg PO in 24 hr; 10 mg PO after 48 hr;
then 10 mg/day PO for 6 wk.
ADJUST DOSE Elderly pts, renal impairment
ADV EFF Airway obstruction, angioedema, cough, dizziness, fatigue, gastric irritation,
headache, insomnia, n/v/d, orthostatic hypotension, pancytopenia
INTERACTIONS Capsaicin, NSAIDs
NC/PT Mark chart if surgery scheduled; fluid replacement may be needed postop. Monitor
BP; use care in situations that may lead to decreased BP. Maintain hydration. Not for
use in pregnancy (contraceptives advised). Pt should take safety precautions w/ CNS
effects, report swelling, difficulty breathing. Name confusion between lisinopril and
fosinopril; use caution.

lithium carbonate, lithium citrate (Lithobid, Lithonate, Lithotabs)

CLASS Antimanic drug
PREG/CONT D/NA
BBW Monitor clinical status closely, especially during initial tx stages. Monitor for
therapeutic serum level (0.6–1.2 mEq/L); toxicity closely related to serum level.
IND & DOSE Tx of manic episodes of bipolar disorder. Adults: 600 mg PO tid or 900 mg
SR form PO bid to produce effective serum level between 1 and 1.5 mEq/L. Maint,
300 mg PO tid–qid to produce serum level of 0.6–1.2 mEq/L. Determine serum level at
least q 2 mo in samples drawn immediately before dose (at least 8–12 hr after previous
dose).
ADJUST DOSE Elderly pts, renal impairment
ADV EFF Related to serum levels: Death, lethargy, muscle weakness, pulmonary
complications, slurred speech, tremor progressing to CV collapse. Other: Dizziness,
drowsiness, GI upset, thirst, tremor
INTERACTIONS Antacids, carbamazepine, dandelion root, diuretics, haloperidol,
indomethacin, iodide salts, juniper, NSAIDs, SSRIs, tromethamine, urinary alkalinizers
NC/PT Monitor serum level regularly; therapeutic range, 0.6–1.2 mEq/L. Maintain salt,
fluid intake. Not for use in pregnancy (contraceptives advised). Teach toxicity warning
signs. Pt should take w/ food, milk; take safety precautions w/ CNS effects; report
diarrhea, unsteady walking, slurred speech.

DANGEROUS DRUG
lomitapide (Juxtapid)
CLASS Antitriglyceride
PREG/CONT X/NA

BBW Increased transaminase elevations; monitor LFTs closely. Stop drug at s&sx of
hepatotoxicity; risk of hepatic steatosis, cirrhosis.
IND & DOSE Adjunct to low-fat diet, other lipid-lowering tx to reduce LDL, total
cholesterol, apolipoprotein B, non-HDL cholesterol in pts w/ homozygous familial
hypercholesterolemia. Adult: Initially 5 mg/day PO; increase after 2 wk to 10 mg/day
PO, then at 4-wk intervals to 20, 40, and 60 mg/day PO.
ADJUST DOSE Hepatic, renal impairment
ADV EFF Abd pain, dyspepsia, hepatotoxicity, n/v/d
INTERACTIONS Bile acid sequestrants, lovastatin, simvastatin, strong or moderate CYP3A4
inhibitors, warfarin
NC/PT Available only through restricted access program. Ensure negative pregnancy test
before tx and continued use of low-fat diet other lipid-lowering agents. Monitor LFTs
regularly. Consider supplemental vitamin E, and fatty acids, tx for severe GI effects. Not
for use in pregnancy (barrier contraceptives advised), breast-feeding. Pt should take as
prescribed (dosage will be slowly increased); take w/ water (not food) in evening;
swallow capsule whole and not cut, crush, or chew it; continue low-fat diet, other lipid-
lowering drugs; take vitamin E, fatty acids if prescribed; report severe GI complaints,
urine/stool color changes, extreme fatigue.
 DANGEROUS DRUG
lomustine (CeeNU)
CLASS Alkylating agent, antineoplastic
PREG/CONT D/NA

BBW Arrange for blood tests to evaluate hematopoietic function before tx, then wkly for
at least 6 wk; severe bone marrow suppression possible. Delayed suppression at or
beyond 6 wk also possible.
IND & DOSE Tx of primary/metastatic brain tumors, secondary tx of Hodgkin disease
in pts who relapse after primary tx w/ other drugs. Adult, child: 130 mg/m2 PO as
single dose q 6 wk. Must make adjustments w/ bone marrow suppression: Initially,
reduce to 100 mg/m2 PO q 6 wk; do not give repeat dose until platelets over
100,000/mm2 and leukocytes over 4,000/mm2.
ADV EFF Alopecia, ataxia, bone marrow suppression, n/v, pulmonary fibrosis, renal
toxicity
NC/PT Monitor CBC, respiratory function. Do not give full dose within 2–3 wk of
radiation therapy. Not for use in pregnancy (barrier contraceptives advised).
Antiemetics may be ordered. Pt should avoid exposure to infection, report unusual
bleeding, difficulty breathing, s&sx of infection.

loperamide hydrochloride (Imodium, Pepto Diarrhea Control)

CLASS Antidiarrheal
PREG/CONT B/NA

IND & DOSE Tx of acute/chronic diarrhea, traveler’s diarrhea. Adult: 4 mg PO, then
2 mg after each unformed stool; max, 16 mg/day. Child: 8–12 yr (over 30 kg): 2 mg PO
tid; 6–8 yr (20–30 kg): 2 mg PO bid; 2–5 yr (13–20 kg): 1 mg PO tid. For traveler’s
diarrhea, 6–11 yr (22–43 kg): 2 mg PO after loose stool, then 1 mg w/ each subsequent
stool; max, 4 mg/day PO (6–8 yr) or 6 mg/day PO (9–11 yr) for 2 days.
ADV EFF Abd pain, constipation, distention, dry mouth, nausea, pulmonary infiltrates,
toxic megacolon
NC/PT Pt should take drug after each stool; stop if no response in 48 hr; drink clear fluids
to prevent dehydration; report fever, continued diarrhea, abd pain and distention.

lopinavir (lopinavir/ritonavir) (Kaletra)

CLASS Antiviral, protease inhibitor
PREG/CONT C/NA

IND & DOSE Note: Doses for child under 12 yr based on weight. See manufacturer’s details
for specific doses. Tx of HIV infection w/ other antiretrovirals in tx-naive pts. Adult,
child 12 yr and older, over 40 kg: 800 mg lopinavir, 200 mg ritonavir (four tablets or
10 mL)/day PO. Children 6 mo–12 yr: over 40 kg, adult dose; 15–under 40 kg, 10 mg/kg
PO bid; 7–under 15 kg, 12 mg/kg PO bid. Child 6 mo–12 yr using oral solution: over 40
kg, adult dose; over 35–40 kg, 4.75 mL PO bid; over 30–35 kg, 4 mL PO bid; over 25–30
kg, 3.5 mL PO bid; over 20–25 kg, 2.75 mL PO bid; 15–20 kg, 2.25 mL PO bid; over 10–
15 kg, 1.75 mL PO bid; 7–10 kg, 1.2 mL PO bid. Tx of HIV infection w/ other
antiretrovirals in tx-experienced pts. Adult, child 12 yr and older, over 40 kg: 400 mg
lopinavir, 100 mg ritonavir (two tablets or 5 mL) PO bid. Tx of HIV infection w/
efavirenz, nevirapine, fosamprenavir without ritonavir, or nelfinavir. Adult, child
12 yr and older, over 40 kg: 600 mg lopinavir, 150 mg ritonavir (three tablets) PO bid for
tx-experienced pts. No adjustment needed for tx-naive pts. Child 6 mo-12 yr: 7–15 kg,
13 mg/kg PO bid; 15–40 kg, 11 mg/kg PO bid; over 45 kg, adult dose. Tx of HIV
infection using oral sol w/ efavirenz, nevirapine, amprenavir, or nelfinavir. Adult,
child 12 yr and older, over 40 kg: Adjust dose to 533 mg lopinavir, 133 mg ritonavir
(6.5 mL) bid PO w/ food. Child 6 mo–12 yr: over 45 kg, adult dose; over 40–45 kg,
5.75 mL PO bid; over 35–40 kg, 5 mL PO bid; over 30–35 kg, 4.5 mL PO bid; over 25–30
kg, 4 mL PO bid; over 25–30 kg, 3.25 mL PO bid; over 20–25 kg, 2.5 mL PO bid; 15–20
kg, 2. 5 mL PO bid; over 10–15 kg, 2 mL PO bid; 7–10 kg, 1. 5 mL PO bid.
ADV EFF Abd pain, anorexia, asthenia, lipid abnormalities, n/v/d, paresthesia, rash
INTERACTIONS Hormonal contraceptives, sildenafil, St. John’s wort, tadalafil, vardenafil.
Fatal reactions possible; do not give w/ amiodarone, bepridil, bupropion, clozapine,
encainide, flecainide, meperidine, piroxicam, propafenone, quinidine, rifabutin.
Extreme sedation/respiratory depression possible; do not give w/ alprazolam,
clonazepam, diazepam, estazolam, flurazepam, midazolam, triazolam, zolpidem.
NC/PT Obtain baseline lipid profile. Store sol in refrigerator; protect from light, heat. Do
not use in preterm infants. Give didanosine 1 hr before or 2 hr after lopinavir sol. May
make hormonal contraceptives ineffective (barrier contraceptives advised). Pt should
swallow tablet whole and not cut, crush, or chew it; use precautions to prevent spread
(drug not a cure); avoid other prescription drugs, OTC/herbs until checking w/
prescriber; avoid St John’s wort; report severe abd pain, numbness/tingling. Name
confusion between Kaletra (lopinavir/ritonavir) and Keppra (levetiracetam).

loratadine (Alavert, Claritin)

CLASS Antihistamine
PREG/CONT B/NA

IND & DOSE Symptomatic relief of allergic rhinitis; tx of rhinitis, urticaria. Adult,
child 6 yr and over: 10 mg/day PO. Child 2–5 yr: 5 mg PO daily (syrup, chewable tablets).
ADJUST DOSE Elderly pts; hepatic, renal impairment
ADV EFF Bronchospasm, dizziness, headache, increased appetite, nervousness, thickened
bronchial secretions, weight gain
INTERACTIONS Alcohol, CNS depressants
NC/PT Pt should place orally disintegrating tablet on tongue, swallow after it dissolves;
avoid alcohol; use humidifier for dry mucous membranes; take safety precautions w/
CNS effects.

lorazepam (Ativan)
CLASS Anxiolytic, benzodiazepine, sedative-hypnotic
PREG/CONT D/C-IV

IND & DOSEMgt of anxiety disorders; short-term relief of anxiety symptoms. Adults:
2–6 mg/day PO; range, 1–10 mg/day in divided doses w/ largest dose at bedtime.
Insomnia due to transient stress. Adult: 2–4 mg PO at bedtime. Preanesthetic
sedation, anxiolytic. Adult: 0.05 mg/kg IM; max, 4 mg at least 2 hr before procedure.
Or, 2 mg total IV or 0.044 mg/kg, whichever smaller; may give doses as high as
0.05 mg/kg to total of 4 mg 15–20 min before procedure. Tx of status epilepticus.
Adult: 4 mg slowly IV at 2 mg/min. May give another 4 mg IV after 10–15 min if
needed.
ADJUST DOSE Hepatic, renal impairment
ADV EFF Apathy, confusion, depression, disorientation, drowsiness, dry mouth, CV
collapse, gynecomastia, hostility, light-headedness, nausea, restlessness
INTERACTIONS Alcohol, CNS depressants, kava, probenecid, theophyllines
NC/PT Do not give intra-arterially. Give IM injection deep into muscle. Protect sol from
light. May mix oral sol w/ water, juice, soda, applesauce, pudding. Taper gradually
after long-term tx. Pt should take safety precautions w/ CNS effects, report vision
changes, chest pain, fainting. Name confusion between lorazepam and alprazolam; use
caution.

lorcaserin hydrochloride (Belviq)

CLASS Serotonin receptor agonist, weight-loss drug
PREG/CONT X/NA

IND & DOSEAdjunct to diet, exercise for long-term weight management in adults w/
initial body mass index of 30 kg/m2 or more or 27 kg/m2 or more w/ at least one
weight-related condition. Adult: 10 mg PO bid.
ADV EFF Back pain, cognitive changes, constipation, dizziness, dry mouth, fatigue,
headache, hypoglycemia, NMS, pulmonary hypertension, suicidality, valvular heart
disease
INTERACTIONS Bupropion, dextromethorphan, linezolid, lithium, MAOIs, selected serotonin
norepinephrine reuptake inhibitors, SSRIs, St. John’s wort, TCAs, tramadol, tryptophan;
avoid these combinations
NC/PT Ensure appropriate use of drug; if 5% of body weight is not lost within 12 wk,
stop drug. Be aware of risk of cognitive changes, suicidality; monitor for s&sx of
valvular heart disease, NMS. Not for use in pregnancy, breast-feeding. Pt should take
drug bid, and not change dosage; continue diet, exercise program; avoid combining w/
other weight-loss drugs; avoid St. John’s wort; use safety precautions w/ dizziness,
sugarless candy for dry mouth; watch for slowed thinking, sleepiness; report thoughts of
suicide, changes in heart rate, mental status.

losartan potassium (Cozaar)

CLASS Antihypertensive, ARB
PREG/CONT D/NA

BBW Rule out pregnancy before starting tx. Suggest barrier contraceptives during tx;
fetal injury/death have occurred.
IND & DOSE Tx of hypertension. Adult: 50 mg/day PO; range, 25–100 mg/day PO once or
bid. Child 6 yr and over: 0.7 mg/kg/day PO; max, 50 mg/day. Tx of diabetic
nephropathy. Adult: 50 mg/day PO; may increase to 100 mg/day based on BP
response. Tx of hypertension w/ left ventricular hypertrophy. Adult: 50–100 mg/day
PO w/ 12.5–25 mg/day hydrochlorothiazide.
ADV EFF Abd pain, cough, diarrhea, dizziness, drowsiness, nausea, URI
INTERACTIONS Fluconazole, indomethacin, ketoconazole, phenobarbital, rifamycin
NC/PT If surgery needed, alert surgeon to drug use; volume replacement may be needed.
Not for use in pregnancy (barrier contraceptives advised), breast-feeding. Pt should use
caution in situations that could lead to fluid loss, maintain hydration, take safety
precautions w/ CNS effects.

lovastatin (Altoprev, Mevacor)

CLASS Antihyperlipidemic, statin
PREG/CONT X/NA

IND & DOSETx of familial hypercholesterolemia, type II hyperlipidemia (ER only); to

slow progression of atherosclerosis in pts w/ CAD; tx of primary
hypercholesterolemia. Adult: 20 mg/day PO in evening w/ meals. Maint, 10–
80 mg/day PO; max, 80 mg/day. For ER tablets, 10–60 mg/day PO single dose in
evening. As adjunct to diet to reduce total cholesterol, LDLs, apolipoprotein B in
heterozygous familial hypercholesterolemia. Adolescent boy, postmenarchal girl, 10–
17 yr: 10–40 mg/day PO; may increase to max 40 mg/day.
ADJUST DOSE Renal impairment
ADV EFF Abd pain, cataracts, cramps, constipation, flatulence, headache, nausea,
rhabdomyolysis
INTERACTIONS Amiodarone, azole antifungals, cyclosporine, gemfibrozil, grapefruit juice,
itraconazole, ketoconazole, other statins, verapamil
NC/PT Monitor LFTs. Not for use in pregnancy (barrier contraceptives advised). Pt should
not cut, crush, or chew ER tablets; take in evening for best effects; continue diet,
exercise program; get periodic eye exams; report muscle pain w/ fever, unusual
bleeding.
 loxapine hydrochloride, loxapine succinate (Adasuve, Loxitane)
CLASS Antipsychotic, dopaminergic blocker
PREG/CONT C/NA

BBW Increased risk of mortality when antipsychotics used in elderly pts w/ dementia-
related psychosis. Avoid this use; not approved for this use. Increased risk of potentially
fatal bronchospasm w/ inhaled form; available only through limited release program;
monitor pt closely.
IND & DOSE Tx of schizophrenia. Adult: 10 mg PO bid; max, 50 mg/day. Increase fairly
rapidly over first 7–10 days until symptoms controlled; range, 60–100 mg/day PO.
Dosage over 250 mg/day PO not recommended. For maint: range, 20–60 mg/day PO.
Acute tx of agitation associated w/ schizophrenia, bipolar disorder. Adult:
10 mg/24 hr by oral inhalation using inhaler.
ADJUST DOSE Elderly pts
ADV EFF Bone marrow suppression, bronchospasm, drowsiness, dry mouth,
extrapyramidal symptoms, gynecomastia, laryngospasm, photosensitivity, rash,
refractory arrhythmias
INTERACTIONS CNS drugs, drugs that affect airway disease (inhaled form)
NC/PT Ensure hydration of elderly pts. Monitor CBC; stop if suppressed. Screen
pulmonary hx and examine pt before using inhaled form; inhaled form available only
through restricted access program. Pt should take safety precautions w/ CNS effects,
avoid sun exposure, report unusual bleeding, infections, palpitations. Name confusion
w/ Loxitane (loxapine), Lexapro (escitalopram), Soriatane (acitretin); use caution.

lucinactant (Surfaxin)
CLASS Lung surfactant
PREG/CONT Unkn/NA

IND & DOSE Px of RDS in premature infants at high risk for RDS. Infant: 5.8 mL/kg
birth weight intratracheally. Up to four doses within first 48 hr of life; space no less
than 16 hr.
ADV EFF Acute change in lung compliance, ET tube obstruction, ET tube reflux,
oxygen desaturation
NC/PT Ensure proper placement of ET tube. Warm vial, shake vigorously before use;
discard after 2 hr. Do not suction for 1 hr after dosing. Monitor color, breath sounds,
oximetry, blood gases continually. Incorporate teaching into parents’ comprehensive
teaching plan for premature infant.

lurasidone hydrochloride (Latuda)

CLASS Atypical antipsychotic
PREG/CONT B/NA
BBW Increased risk of mortality when antipsychotics used in elderly pts w/ dementia-
related psychosis. Avoid this use; not approved for this use. Increased risk of suicidality
in child, adolescent, young adult; monitor accordingly.
IND & DOSE Tx of schizophrenia. Adult: 40 mg/day PO w/ food; may titrate to max
80 mg/day PO.
ADJUST DOSE Hepatic, renal impairment
ADV EFF Akathisia, dystonia, hyperglycemia, NMS, n/v/d, parkinsonism, suicidality,
weight gain
INTERACTIONS Alcohol, grapefruit juice, strong CYP3A4 inducers/inhibitors
NC/PT Dispense least amount possible to suicidal pts. Not for use in breast-feeding. Pt
should take safety measures w/ CNS effects, monitor serum glucose/weight gain, avoid
alcohol, report increased thirst/appetite, thoughts of suicide.

macitentan (Opsumit)
CLASS Endothelin receptor blocker, pulmonary hypertension drug
PREG/CONT X/NA

BBW Known teratogen; life-threatening birth defects possible. Available by limited

access program for women. Monthly pregnancy tests required.
IND & DOSE Tx of pulmonary artery hypertension. Adult: 10 mg/day PO.
ADV EFF Anemia, bronchitis, decreased Hgb, headache, hepatotoxicity, nasopharyngitis,
pulmonary edema, reduced sperm count, UTI
INTERACTIONS Ketoconazole, rifampin, ritonavir; avoid these combinations
NC/PT Ensure proper dx, negative monthly pregnancy test for women. Monitor LFTs,
Hgb, respiratory status. Female pt should avoid pregnancy (contraceptives required),
breast-feeding; males should be aware of reduced sperm count. Pt should monitor
activity tolerance; report difficulty breathing, color changes in urine/stool, extreme
fatigue.

magnesium salts, magnesia, magnesium citrate (Citroma), magnesium

hydroxide (Milk of Magnesia), magnesium oxide (Mag-Ox)
CLASS Antacid, laxative
PREG/CONT C; A (antacids); B (laxative)/NA

IND & DOSELaxative. Adult: 300 mL (citrate) PO w/ full glass of water, or 15–60 mL
(hydroxide) PO w/ liquid. Child 12 and older: 30–60 mL (400 mg/ 5 mL) (hydroxide) PO
w/ water or 15–30 mL/day (800 mg/5 mL) PO once daily at bedtime, or eight 311-mg
tablets PO once daily at bedtime or in divided doses. Child 6–11 yr: 15–30 mL
(400 mg/5 mL) (hydroxide) PO once daily at bedtime, or 7.5–15 mL/day (800 mg/5 mL)
PO once daily at bedtime, or four 311-mg tablets/day PO at bedtime. Child 2–5 yr: 5–
15 mL (400 mg/5 mL) (hydroxide) PO once daily at bedtime, or two 311-mg tablets/day
PO at bedtime. Antacid. Adult: 5–15 mL (hydroxide) liquid or 622–1,244-mg tablets PO
qid (adult, pt over 12 yr). Supplemental magnesium replacement. Adult: Magnesium
oxide capsules, 140 mg PO tid–qid. Tablets, 400–800 mg/day PO.
ADV EFF Dizziness, hypermagnesemia, n/v/d, perianal irritation
INTERACTIONS Fluoroquinolones, ketoconazole, nitrofurantoin, penicillamine, tetracyclines
NC/PT Pt should avoid other oral drugs within 1–2 hr of antacids, take between meals
and at bedtime, chew antacid tablet thoroughly, avoid long-term laxative use, avoid
laxatives if abd pain, n/v occur, maintain hydration, report rectal bleeding, weakness.

DANGEROUS DRUG
magnesium sulfate (generic)
CLASS Antiepileptic, electrolyte, laxative
PREG/CONT A; B (laxative)/NA

IND & DOSE Control of hypertension w/ acute nephritis. Child: 100 mg/kg (0.8 mEq/kg
or 0.2 mL/kg of 50% sol) IM q 4–6 hr as needed. Or, 20–40 mg/kg (0.16–0.32 mEq/kg
or 0.1–0.2 mL/kg of 20% sol) IM. Or, for severe symptoms, 100–200 mg/kg of 1%–3%
sol IV over 1 hr w/ half of dose given in first 15–20 min (seizure control). Laxative.
Adult: 10–30 g/day PO. Child 6–11 yr: 5–10 g/day PO; 15–30 mL/day PO. Child 2–5 yr:
2.5–5 g/day PO; 5–15 mL/day PO. Tx of arrhythmias. Adult: 3–4 g IV over several min;
then 3–20 mg/min continuous infusion for 5–48 hr. Tx of eclampsia, severe
preeclampsia. Adult: 10–14 g IV. May infuse 4–5 g in 250 mL 5% dextrose injection or
normal saline while giving IM doses up to 10 g (5 g or 10 mL of undiluted 50% sol in
each buttock). Or, may give initial 4 g IV by diluting 50% sol to 10% or 20%; may inject
diluted fluid (40 mL of 10% or 20 mL of 20% sol) IV over 3–4 min. Then inject 4–5 g (8–
10 mL of 50% sol) IM into alternate buttocks q 4 hr as needed depending on patellar
reflex, respiratory function. Or, after initial IV dose, may give 1–2 g/hr by constant IV
infusion. Continue until paroxysms stop. To control seizures, optimal serum magnesium
level is 6 mg/100 mL; max, 30–40 g/24 hr. Correction of hypomagnesemia. Adult: 1 g
IM or IV q 6 hr for four doses (32.5 mEq/24 hr); up to 246 mg/kg IM within 4 hr or 5 g
(40 mEq)/1,000 mL D5W or normal saline IV infused over 3 hr for severe cases.
Parenteral nutrition. Adult: 8–24 mEq/day IV.
ADJUST DOSE Renal impairment
ADV EFF Dizziness, excessive bowel activity, fainting, magnesium intoxication, perianal
irritation, weakness
INTERACTIONS Alcohol, aminoglycosides, amphotericin B, cisplatin, cyclosporine, digoxin,
diuretics, NMJ blockers
NC/PT Monitor serum magnesium level during parenteral tx; normal limits, 1.5–3 mEq/L.
Save IV use in eclampsia for life-threatening situations. Monitor knee-jerk reflex before
repeated parenteral administration. If knee-jerk reflex suppressed, do not give. Use as
temporary relief of constipation; stop if diarrhea occurs.

mannitol (Osmitrol)
 CLASSDiagnostic agent, osmotic diuretic, urinary irrigant
PREG/CONT B/NA

IND & DOSE Px of oliguria in renal failure. Adult: 50–100 g IV as 5%–25% sol. Tx of
oliguria in renal failure. Adult: 50–100 g IV as 15%–25% sol. To reduce intracranial
pressure, cerebral edema. Adult: 1.5–2 g/kg IV as 15%–25% sol over 30–60 min.
Reduced pressure should be evident in 15 min. Reduction of IOP. Adult: 1.5–2 g/kg IV
infusion as 25%, 20%, or 15% sol over 30 min. If used preop, give 60–90 min before
surgery for max effect. Adjunct tx to promote diuresis in intoxication. Adult: Max
200 g IV mannitol w/ other fluids, electrolytes. To measure GFR. Adult: Dilute 100 mL
of 20% sol w/ 180 mL sodium chloride injection. Infuse this 280 mL of 7.2% sol IV at
20 mL/min. Collect urine w/ catheter for specified time to measure mannitol excreted
in mg/min. Draw blood at start and end of time for mannitol measurement in mg/mL
plasma. Test dose of mannitol in pts w/ inadequate renal function. Adult: 0.2 g/kg
IV (about 50 mL of 25% sol, 75 mL of 20% sol) in 3–5 min to produce urine flow of 30–
50 mL/hr. If urine flow not increased, repeat dose. If no response to second dose,
reevaluate situation.
ADV EFF Anorexia, diuresis, dizziness, dry mouth, n/v, seizures, thirst
NC/PT Do not give electrolyte-free mannitol w/ blood. If blood must be given, add at
least 20 mEq sodium chloride to each liter mannitol sol; use filter. Monitor serum
electrolytes periodically. Pt should use sugarless lozenges for dry mouth, take safety
precautions w/ CNS effects.

maprotiline hydrochloride (generic)

CLASS TCA
PREG/CONT B/NA

BBW Increased risk of suicidal thinking, behavior in children, adolescents, young adults;
monitor accordingly.
IND & DOSE Tx of mild to moderate depression. Adult: 75 mg/day PO in outpts; after 2
wk may increase gradually in 25-mg increments. Usual dose, 150 mg/day. Tx of severe
depression. Adult: 100–150 mg/day PO in inpts; may gradually increase to
225 mg/day. Maint tx of depression. Adult: Use lowest effective dose, usually 75–
150 mg/day PO.
ADJUST DOSE Elderly pts
ADV EFF Confusion, constipation, disturbed conc, dry mouth, gynecomastia, MI,
orthostatic hypotension, peripheral neuropathy, photosensitivity, rash, restlessness,
sedation, stroke, urine retention
INTERACTIONS Alcohol, anticholinergics, phenothiazines, sympathomimetics, thyroid
medication
NC/PT Limit access to depressed/potentially suicidal pts. Expect clinical response in 3 wk.
Give at bedtime if orthostatic hypotension occurs. Not for use in pregnancy (barrier
contraceptives advised). Pt should avoid alcohol, sun exposure; report
numbness/tingling, chest pain, thoughts of suicide.

maraviroc (Selzentry)
CLASS Antiviral, CCR5 coreceptor antagonist
PREG/CONT B/NA

BBW Risk of severe hepatotoxicity, possibly preceded by systemic allergic reaction (rash,
eosinophilia, elevated IgE level). Immediately evaluate, support pt w/ s&sx of hepatitis,
allergic reaction.
IND & DOSE Combination antiretroviral tx of pts infected only w/ detectable CCR5-
tropic HIV-1. Adult, child over 16 yr: W/ strong CYP3A inhibitors, protease inhibitors
(except tipranavir/ritonavir), delavirdine, 150 mg PO bid. W/ tipranavir/ritonavir,
nevirapine, enfuvirtide, nucleoside reverse transcriptase inhibitors, other drugs that are
not strong CYP3A inhibitors, 300 mg PO bid. W/ efavirenz, rifampin, carbamazepine,
phenobarbital, phenytoin, 600 mg PO bid.
ADJUST DOSE Renal impairment
ADV EFF Abd pain, cough, dizziness, fever, headache, hepatotoxicity, musculoskeletal
symptoms, rash
INTERACTIONS CYP3A inducers/inhibitors, St. John’s wort
NC/PT Give w/ other antiretrovirals. Monitor LFTs, CD4. Use caution in pregnancy; not
for use in breast-feeding. Pt should swallow tablet whole and not cut, crush, or chew it;
take precautions to prevent spread (drug not a cure); avoid St. John’s wort; take safety
precautions w/ CNS effects.

mecasermin (Increlex)
CLASS Insulin-like growth factor-1
PREG/CONT C/NA

IND & DOSE Long-term tx of growth failure in child w/ severe primary insulin
growth factor-1 deficiency or w/ growth hormone gene deletion who has
developed neutralizing antibodies to growth hormone. Child 2 yr and over: Initially,
0.04–0.08 mg/kg (40–80 mcg/kg) bid by subcut injection shortly before meal or snack;
may be increased by 0.04 mg/kg/dose to max of 0.12 mg/kg bid.
ADV EFF Hypersensitivity reactions, hypoglycemia, intracranial hypertension,
progression of scoliosis, slipped capital femoral epiphysis, tonsillar hypertrophy
NC/PT Monitor blood glucose, tonsils. Ensure given just before meal or snack. Pt should
avoid pregnancy, breast-feeding; learn proper administration/disposal of needles,
syringes; report difficulty breathing/swallowing, sudden limb or hip/knee pain,
injection site pain, rash.

DANGEROUS DRUG
 mechlorethamine hydrochloride (Mustargen, Valchlor)
CLASS Alkylating agent, antineoplastic, nitrogen mustard
PREG/CONT D/NA

BBW Handle drug with caution; use chemo-safe nonpermeable gloves. Drug highly toxic
and a vesicant. Avoid inhaling dust, vapors; avoid contact w/ skin, mucous membranes
(especially eyes). If eye contact, immediately irrigate w/ copious amount of ophthalmic
irrigating sol, get ophthalmologic consultation. If skin contact, irrigate w/ copious
amount of water for 15 min, then apply 2% sodium thiosulfate. Monitor injection site
for extravasation. Painful inflammation/induration, skin sloughing possible. If leakage,
promptly infiltrate w/ sterile isotonic sodium thiosulfate (1/6M), apply ice compress for
6–12 hr. Notify physician.
IND & DOSE Palliative tx of bronchogenic carcinoma, Hodgkin disease,
lymphosarcoma, CML, chronic lymphocytic leukemia, mycosis fungoides,
polycythemia vera. Adult: Total 0.4 mg/kg IV for each course as single dose or in two
to four divided doses of 0.1–0.2 mg/kg/day. Give at night if sedation needed for side
effects. Interval between courses usually 3–6 wk. Palliative tx of effusion secondary
to metastatic carcinoma. Adult: Dose, preparation for intracavity use vary greatly;
usual dose, 0.2–0.4 mg/kg. Tx of stage 1A, 1B mycosis fungoides–type T-cell
lymphoma after direct skin tx. Adult: Apply thin film to affected areas of skin; avoid
eyes and mucous membranes.
ADV EFF Anorexia, bone marrow suppression, dizziness, drowsiness, impaired fertility,
n/v/d, thrombophlebitis, weakness
INTERACTIONS Adalimumab, denosumab, infliximab, leflunomide, natalizumab,
pimecrolimus, roflumilast
NC/PT Avoid skin contact w/ powder for injection. Premedicate w/ antiemetics,
sedatives. Monitor CBC closely, injection site for extravasation. Maintain hydration. Not
for use in pregnancy (contraceptives advised). Pt should take safety precautions w/ CNS
changes; avoid smoking, open flames when using topical gel until gel dries (very
flammable); report burning at IV site, fever.

meclizine hydrochloride (Antivert, Bonine, Dramamine)

CLASS Anticholinergic, antiemetic, antihistamine, anti–motion sickness
PREG/CONT B/NA

IND & DOSE Px, tx of motion sickness. Adult, child over 12 yr: 25–50 mg/day PO 1 hr
before travel. Tx of vertigo. Adult, child over 12 yr: 25–100 mg/day PO.
ADJUST DOSE Elderly pts
ADV EFF Anorexia, confusion, drowsiness, dry mouth, nausea, respiratory depression to
death, urinary difficulty/frequency
INTERACTIONS Alcohol, CNS depressants
NC/PT For anti–motion sickness, works best if used before motion. Pt should avoid
alcohol, take safety precautions w/ CNS depression, use sugarless lozenges for dry
mouth, report difficulty breathing.

DANGEROUS DRUG
medroxyPROGESTERone acetate (Depo-Provera, depo-subQ provera 104,
Provera)
CLASS Antineoplastic, contraceptive, hormone, progestin
PREG/CONT X/NA

BBW Before tx, rule out pregnancy; caution pt to avoid pregnancy and have frequent
medical follow-up. Alert pt using contraceptive injections that drug does not protect
from HIV, other STDs, and to take precautions. Depo-Provera use may result in
significant bone density loss; drug should not be used for longer than 2 yr unless no
other contraception form is adequate.
IND & DOSE Contraception. Adult: 150 mg IM q 3 mo. For depo-subQ provera: 104 mg
subcut into thigh or abdomen q 12–14 wk. Tx of secondary amenorrhea. Adult: 5–
10 mg/day PO for 5–10 days. Tx of abnormal uterine bleeding. Adult: 5–10 mg/day
PO for 5–10 days, starting on 16th or 21st day of menstrual cycle. Tx of endometrial,
renal carcinoma. Adult: 400–1,000 mg/ wk IM. To reduce endometrial hyperplasia.
Adult: 5–10 mg/day PO for 12–14 consecutive days/mo. Start on 1st or 16th day of cycle.
Mgt of endometriosis-associated pain. Adult: 104 mg subcut (depo-subQ Provera) into
anterior thigh or abdomen q 12–14 wk for no longer than 2 yr.
ADV EFF Amenorrhea, breakthrough bleeding, edema, fluid retention, menstrual flow
changes, rash, thromboembolic events, vision changes, weight changes
NC/PT Arrange for pretreatment, periodic (at least annual) complete hx, physical. Not for
use in pregnancy. Pt should know drug does not protect against STDs, HIV; protection is
still required. Pt should mark calendar for tx days, report sudden vision loss, swelling,
severe headache.

mefenamic acid (Ponstel)

CLASS NSAID
PREG/CONT C/NA

BBW Increased risk of CV events, GI bleeding; monitor accordingly. Do not use for
periop pain in CABG surgery.
IND & DOSE Tx of acute pain. Adult, child over 14 yr: 500 mg PO, then 250 mg q hr as
needed for up to 1 wk. Tx of primary dysmenorrhea. Adult, child over 14 yr: 500 mg
PO, then 250 mg q 6 hr starting w/ bleeding onset. Can initiate at start of menses, then
for 2–3 days.
ADJUST DOSE Elderly pts, renal impairment (not recommended)
ADV EFF Anaphylactoid reactions to anaphylactic shock, bone marrow suppression,
constipation, diarrhea, dizziness, dyspepsia, edema, GI pain, headache, nausea, rash,
renal impairment
INTERACTIONS ASA, anticoagulants, methotrexate, NSAIDs
NC/PT Pt should take w/ food, use safety precautions w/ CNS effects, stop drug and
report rash, diarrhea, black tarry stools.

DANGEROUS DRUG
(AS ANTINEOPLASTIC)
megestrol acetate (Megace)
CLASS Antineoplastic, hormone, progestin
PREG/CONT X (suspension); D (tablets)/NA

BBW Caution pt not to use if pregnant; fetal risks. Advise barrier contraceptives. Risk of
thromboembolic events, stop drug at sx of thrombosis.
IND & DOSE Palliative tx of breast cancer. Adult: 160 mg/day PO (40 mg qid).
Palliative tx of endometrial cancer. Adult: 40–320 mg/day PO. Tx of cachexia w/
HIV. Adult: 800 mg/day PO; range, 400–800 mg/day (suspension only) or 625 mg/day
PO (ES suspension).
ADV EFF Amenorrhea, breakthrough bleeding, dizziness, edema, fluid retention, menstrual
flow changes, photosensitivity, rash, somnolence, thromboembolic events, vision
changes, weight changes
NC/PT Stop if thromboembolic events. Store suspension in cool place; shake well before
use. Not for use in pregnancy (barrier contraceptives advised). Pt should avoid sun
exposure; take safety precautions w/ CNS effects; report chest/leg pain, swelling,
numbness/tingling, severe headache.

meloxicam (Mobic)
CLASS NSAID
PREG/CONT C (1st, 2nd trimesters); D (3rd trimester)/NA

BBW Increased risk of CV events, GI bleeding; monitor accordingly. Do not use for
periop pain in CABG surgery.
IND & DOSE Relief of s&sx of osteoarthritis, rheumatoid arthritis. Adult: 7.5 mg/day
PO. Max, 15 mg/day. Relief of s&sx of pauciarticular/polyarticular course juvenile
rheumatoid arthritis. Child 2 yr and older: 0.125 mg/kg/day PO; max, 7.5 mg (oral
suspension).
ADV EFF Anaphylactic shock, bone marrow suppression, diarrhea, dizziness,
dyspepsia, edema, GI pain, headache, insomnia, nausea, rash
INTERACTIONS ACE inhibitors, aspirin, anticoagulants, diuretics, lithium, methotrexate,
oral corticosteroids
NC/PT Pt should take w/ food, use safety precautions w/ CNS effects, report difficulty
breathing, swelling, black tarry stools.
 DANGEROUS DRUG
melphalan (Alkeran)
CLASS Alkylating agent, antineoplastic, nitrogen mustard
PREG/CONT D/NA

BBW Arrange for blood tests to evaluate hematopoietic function before and wkly during
tx; severe bone marrow suppression possible. Caution pt to avoid pregnancy during tx;
drug considered mutagenic.
IND & DOSE Tx of multiple myeloma. Adult: 6 mg/day PO. After 2–3 wk, stop for up to 4
wk, monitor blood counts. When counts rising, start maint of 2 mg/day PO. Or,
16 mg/m2 as single IV infusion over 15–20 min at 2-wk intervals for four doses, then at
4-wk intervals. Tx of epithelial ovarian carcinoma. Adult: 0.2 mg/kg/ day PO for
5 days as single course. Repeat courses q 4–5 wk.
ADJUST DOSE Renal impairment
ADV EFF Alopecia, amenorrhea, anaphylaxis, bone marrow suppression, cancer, n/v,
pulmonary fibrosis, rash
NC/PT Refrigerate tablets in glass bottle. Monitor CBC regularly; dose adjustment may be
needed. Maintain hydration. Give antiemetics for severe nausea. Not for use in
pregnancy (barrier contraceptives advised). Pt should cover head at temp extremes (hair
loss possible), avoid exposure to infection, report bleeding, signs of infection.

memantine hydrochloride (Namenda)

CLASS Alzheimer drug; N-methyl-D-aspartate receptor antagonist
PREG/CONT B/NA

IND & DOSE Tx of moderate to severe Alzheimer-type dementia. Adult: 5 mg/day PO.
Increase at wkly intervals to 5 mg PO bid (10 mg/day), 15 mg/day PO (5-mg and 10-mg
doses) w/ at least 1 wk between increases. Target, 20 mg/day (10 mg bid). ER form:
7 mg/day PO; may increase by 7 mg/day after at least 1 wk. Maint, 28 mg/day
ADJUST DOSE Renal impairment
ADV EFF Confusion, constipation, cough, dizziness, fatigue, headache
INTERACTIONS Amantadine, carbonic anhydrase inhibitors, dextromethorphan, ketamine,
sodium bicarbonate, urine alkalinizers
NC/PT Obtain baseline functional profile. Not a cure; medical follow-up needed. Pt should
swallow ER tablet whole and not cut, crush, or chew it; take safety precaution w/ CNS
effects; report lack of improvement, swelling, respiratory problems.

menotropins (Menopur, Repronex)

CLASS Fertility drug, hormone
PREG/CONT X/NA
IND & DOSE To induce ovulation in anovulatory women, w/ HCG. Adult: 225 units IM;
then 75–150 units/day subcut to max 450 units/day for no longer than 12 days
(Repronex) or 20 days (Menopur). Or, pts who have received GnRH agonists or pituitary
suppression: 150 international units/day subcut or IM (Repronex) for first 5 days; max,
450 international units/day. Use no longer than 12 days.
ADV EFF Dizziness, febrile reactions, multiple births, ovarian enlargement, ovarian
overstimulation, thromboembolic events
NC/PT Must follow w/ HCG when clinical evidence shows sufficient follicular maturation
based on urine excretion of estrogens. Dissolve contents of 1–6 vials in 1–2 mL sterile
saline; give immediately. Monitor for ovarian overstimulation; admit pt to hosp for tx.
Risk of multiple births. Teach proper administration, disposal of needles, syringes. Pt
should mark calendar of tx days, report severe abd pain, fever.

DANGEROUS DRUG
meperidine hydrochloride (Demerol, Meperitab)
CLASS Opioid agonist analgesic
PREG/CONT B; D (long-term use)/NA

IND & DOSE Relief of moderate to severe acute pain. Adult: 50–150 mg IM, subcut, or
PO q 3–4 hr as needed. May give diluted sol by slow IV injection. IM route preferred for
repeated injections. Child: 1.1–1.75 mg/kg IM, subcut, or PO up to adult dose q 3–4 hr
as needed. Preop medication. Adult: 50–100 mg IM or subcut 30–90 min before
anesthesia. Child: 1.1–2.2 mg/kg IM or subcut, up to adult dose, 30–90 min before
anesthesia. Anesthesia support. Adult: Dilute to 10 mg/mL; give repeated doses by
slow IV injection. Or, dilute to 1 mg/mL; infuse continuously. Obstetric analgesia.
Adult: When contractions regular, 50–100 mg IM or subcut; repeat q 1–3 hr.
ADJUST DOSE Elderly, debilitated pts; hepatic, renal impairment
ADV EFF Apnea, cardiac arrest, circulatory depression, constipation, dizziness, light-
headedness, n/v, respiratory arrest/depression, shock, sweating
INTERACTIONS Alcohol, barbiturate anesthetics, CNS depressants, MAOIs, phenothiazines.
Incompatible w/ sols of barbiturates, aminophylline, heparin, iodide, morphine sulfate,
methicillin, phenytoin, sodium bicarbonate, sulfadiazine, sulfisoxazole
NC/PT Contraindicated in preterm infants. May give diluted sol by slow IV injection. IM
route preferred for repeated injections. Have opioid antagonist, facilities for assisted or
controlled respiration on hand during parenteral administration. Pt should take safety
precautions w/ CNS effects; use laxative if constipated; take drug 4–6 hr before next
feeding if breast-feeding; report difficulty breathing.

meprobamate (generic)
CLASS Anxiolytic
PREG/CONT D/C-IV
IND & DOSE Mgt of anxiety disorders. Adult: 1,200–1,600 mg/day PO in three or four
divided doses. Max, 2,400 mg/day. Child 6–12 yr: 100–200 mg PO bid–tid.
ADJUST DOSE Elderly pts
ADV EFF Ataxia, bone marrow suppression, dependence w/ withdrawal reactions,
dizziness, drowsiness, headache, impaired vision, hypotensive crisis, n/v/d, rash,
suicidality, vertigo
INTERACTIONS Alcohol, CNS depressants, barbiturates, opioids
NC/PT Dispense least amount possible to depressed/addiction-prone pts. Withdraw
gradually over 2 wk after long-term use. Not for use in pregnancy (barrier
contraceptives advised). Pt should avoid alcohol, take safety precautions w/ CNS effects,
report thoughts of suicide.

DANGEROUS DRUG
mercaptopurine (Purinethol)
CLASS Antimetabolite, antineoplastic
PREG/CONT D/NA

BBW Reserve for pts w/ established dx of acute lymphatic leukemia; serious adverse
effects possible.
IND & DOSE Maint tx of acute leukemia (lymphocytic, lymphoblastic). Adult, child:
Induction, 2.5 mg/kg/day PO (about 100–200 mg in adult, 50 mg in average 5-yr-old);
may increase to 5 mg/kg/day. Maint tx after complete hematologic remission, 1.5–
2.5 mg/kg/ day PO as single daily dose.
ADJUST DOSE Renal impairment
ADV EFF Bone marrow depression, hepatosplenic T-cell lymphoma, hepatotoxicity,
hyperuricemia, immunosuppression, n/v, stomatitis
INTERACTIONS Allopurinol, TNF blockers
NC/PT Monitor CBC regularly; dose adjustment may be needed. Not for use in pregnancy
(barrier contraceptives advised), breast-feeding. Maintain hydration. Pt should get
regular checkups, report night sweats, fever, abd pain, weight loss. Name confusion
between Purinethol (mercaptopurine) and propylthiouracil; use caution.

meropenem (Merrem IV)

CLASS Carbapenem antibiotic
PREG/CONT B/NA

IND & DOSE Tx of meningitis, intra-abdominal infections caused by susceptible

strains. Adult: 1 g IV q 8 hr. Child 3 mo and older: For meningitis: Over 50 kg, 2 g IV q
8 hr; under 50 kg, 40 mg/kg IV q 8 hr. For intra-abdominal infections: Over 50 kg, 1 g
IV q 8 hr; under 50 kg, 20 mg/kg IV q 8 hr. Tx of skin/skin-structure infections
caused by susceptible strains. Adult: 500 mg IV q 8 hr. Child 3 mo and older: Over 50
kg, 500 mg IV q 8 hr; under 50 kg, 10 mg/kg IV q 8 hr.
ADJUST DOSE Renal impairment
ADV EFF Abd pain, anorexia, flatulence, headache, n/v/d, phlebitis, pseudomembranous
colitis, rash, superinfections
INTERACTIONS Probenecid, valproic acid
NC/PT Culture before tx. Do not mix in sol w/ other drugs. Stop if s&sx of colitis. Pt
should report severe diarrhea, pain at injection site.

mesalamine (Apriso, Asacol, Lialda, Pentasa, Rowasa)

CLASS Anti-inflammatory
PREG/CONT B/NA

IND & DOSETx of active mild to moderate ulcerative colitis. Adult: 2–4 1.2-g tablets PO
once daily w/ food for total 2.4–4.8 g (Lialda). Or, 1.5 g/day PO (4 capsules) in a.m. for
up to 6 mo (Apriso). Or, 1 g PO qid for total daily dose of 4 g for up to 8 wk (Pentasa).
Or, 1.6 g/day PO in divided doses (Asacol). Or, 800 mg PO tid for 6 wk (Asacol HD). Tx
of active, distal, mild to moderate ulcerative colitis/proctitis, proctosigmoiditis.
Adult: 60-mL units in 1 rectal instillation (4 g) once/day, preferably at bedtime, retained
for approximately 8 hr for 3–6 wk. Effects may occur within 3–21 days. Or, 1 g (1
suppository) bid retained for 1–3 hr or longer. Usual course, 3–6 wk.
ADV EFF Abd pain, cramps, fatigue, fever, flatulence, flulike sx, gas, headache, malaise
NC/PT Products vary; use caution to differentiate doses. Teach proper rectal suppository,
retention enema administration. Pt should swallow tablet whole and not cut, crush, or
chew it; report severe abd pain, difficulty breathing. Name confusion w/ mesalamine,
methenamine, memantine; use caution.

mesna (Mesnex)
CLASS Cytoprotective
PREG/CONT B/NA

IND & DOSEPx to reduce incidence of ifosfamide-induced hemorrhagic cystitis. Adult:

20% ifosfamide dose IV at time of ifosfamide infusion and at 4 and 8 hr after; timing
must be exact.
ADV EFF Abd pain, alopecia, anemia, anorexia, constipation, fatigue, fever, n/v,
thrombocytopenia
NC/PT Helps prevent chemotherapy complications. Timing critical to balance
chemotherapy effects. May give antiemetics. Pt should report severe abd pain.

metaproterenol sulfate (generic)

CLASS Antiasthmatic, beta 2-selective agonist, bronchodilator
PREG/CONT C/NA

IND & DOSE Px, tx of bronchial asthma, reversible bronchospasm. Adult, child 12 yr
and older: 20 mg PO tid to qid. Child over 9–under 12 yr, over 27 kg: 20 mg PO tid to qid.
Child 6–9 yr, under 27 kg: 10 mg PO tid to qid.
ADJUST DOSE Elderly pts
ADV EFF Anxiety, apprehension, CNS stimulation, fear, flushing, heartburn, n/v, pallor,
sweating, tachycardia
NC/PT Switch to syrup if swallowing difficult. Protect tablets from moisture. Do not
exceed recommended dose. Pt should take safety precautions w/ CNS effects, report
chest pain, difficulty breathing.

metaxalone (Skelaxin)
CLASS Skeletal muscle relaxant (centrally acting)
PREG/CONT C/NA

IND & DOSEAdjunct for relief of discomfort associated w/ acute, painful

musculoskeletal disorders. Adult, child 12 yr and older: 800 mg PO tid to qid.
ADV EFF Dizziness, drowsiness, hemolytic anemia, leukopenia, light-headedness,
nausea
INTERACTIONS Alcohol, CNS depressants
NC/PT Arrange for other tx for muscle spasm relief. Pt should take safety precautions w/
CNS effects, avoid alcohol, report rash, yellowing of skin/eyes.

DANGEROUS DRUG
metformin hydrochloride (Fortamet, Glucophage, Glumetza, Riomet)
CLASS Antidiabetic
PREG/CONT B/NA

BBW Risk of severe lactic acidosis. Monitor pt; treat if suspicion of lactic acidosis.
IND & DOSE Adjunct to diet to lower blood glucose in type 2 diabetes, alone or w/
sulfonylurea. Adult: 500 mg PO bid or 850 mg PO once daily; max, 2,550 mg/day in
divided doses. ER tablet: 1,000 mg/day PO w/ evening meal; max, 2,000 mg/day
(2,500 mg Fortamet). Child 10–16 yr: 500 mg bid w/ meals. Max, 2,000 mg/day in
divided doses. ER form not recommended for child.
ADJUST DOSE Elderly pts, renal impairment
ADV EFF Allergic skin reactions, anorexia, gastric discomfort, heartburn, hypoglycemia,
lactic acidosis, n/v/d
INTERACTIONS Alcohol, amiloride, celery, cimetidine, coriander, dandelion root, digoxin,
fenugreek, furosemide, garlic, ginseng, iodinated contrast media, juniper berries,
sulfonylureas, vancomycin
NC/PT Monitor serum glucose frequently to determine drug effectiveness, dose. Arrange
for transfer to insulin during high-stress periods. Not for use in pregnancy. Pt should
swallow ER tablet whole and not cut, crush, or chew it; take at night if GI problems;
avoid alcohol; continue diet, exercise program; report all herbs used (so dose adjustment
can be made), hypoglycemic episodes, urine/stool color changes.

DANGEROUS DRUG
methadone hydrochloride (Dolophine, Methadose)
CLASS Opioid agonist analgesic
PREG/CONT C/C-II

BBW Use for opioid addiction should be part of approved program; deaths have occurred
during start of tx for opioid dependence. Carefully determine all drugs pt taking. Have
emergency services on standby. Monitor for prolonged QT interval, especially at higher
doses.
IND & DOSE Relief of severe pain unresponsive to nonopioid analgesics. Adult: 2.5–
10 mg IM, subcut, or PO q 8–12 hr as needed. Detoxification, temporary maint tx of
opioid addiction. Adult: 20–30 mg PO or parenteral; PO preferred. Increase to suppress
withdrawal s&sx; 40 mg/day in single or divided doses is usual stabilizing dose.
Continue stabilizing doses for 2–3 days, then gradually decrease q 1 or 2 days. Provide
sufficient amount to keep withdrawal sx tolerable. Max, 21 days’ tx; do not repeat
earlier than 4 wk after completion of previous course. For maint tx: For heavy heroin
users up until hospital admission, initially 20 mg PO 4–8 hr after heroin stopped or
40 mg PO in single dose; may give additional 10-mg doses if needed to suppress
withdrawal syndrome. Adjust dose to max 120 mg/day PO.
ADJUST DOSE Elderly pts, impaired adults
ADV EFF Apnea, cardiac arrest, circulatory depression, constipation, dizziness, light-
headedness, n/v, prolonged QT interval, respiratory arrest, respiratory depression,
shock, sweating
INTERACTIONS Barbiturate anesthetics, HIV antiretrovirals, hydantoins, protease
inhibitors, QT-prolonging drugs, rifampin, urine acidifiers
NC/PT Have opioid antagonist, equipment for assisted or controlled respiration on hand
during parenteral administration. Not for use in pregnancy (barrier contraceptives
advised). Pt should take drug 4–6 hr before next feeding if breast-feeding, avoid alcohol,
take safety precautions w/ CNS effects, report difficulty breathing, severe n/v.

methazolamide (generic)
CLASS Carbonic anhydrase inhibitor, glaucoma drug
PREG/CONT C/NA

IND & DOSE Tx of ocular conditions where lowering IOP is beneficial. Adult: 50–
100 mg PO bid-tid.
ADJUST DOSE Hepatic, renal impairment
ADV EFF Anorexia, bone marrow suppression, dizziness, drowsiness, fatigue, GI
disturbances, kidney stones, photosensitivity, Stevens-Johnson syndrome, taste
alteration, tingling, tinnitus
INTERACTIONS Aspirin, corticosteroids
NC/PT Monitor IOP regularly. Pt should take safety precautions w/ CNS effects; avoid
exposure sun, infection; report fever, rash.

methenamine (generic), methenamine hippurate (Hiprex, Urex)

CLASS Antibacterial, urinary tract anti-infective
PREG/CONT C/NA

IND & DOSE To suppress, eliminate bacteriuria associated w/ UTIs. Adult: 1 g

methenamine PO qid after meals and at bedtime, or 1 g hippurate PO bid. Child 6–12 yr:
500 mg methenamine PO qid, or 0.5–1 g hippurate PO bid. Child under 6 yr:
50 mg/kg/day PO methenamine divided into three doses.
ADV EFF Bladder irritation, dysuria, hepatotoxicity (hippurate), nausea, rash
NC/PT Culture before tx. Maintain hydration. Monitor LFTs w/ hippurate form. Use
additional measures for UTIs. Pt should take w/ food, report rash, stool/urine color
changes. Name confusion between methimazole and mesalamine; use caution.

methimazole (Tapazole)
CLASS Antithyroid drug
PREG/CONT D/NA

IND & DOSE Tx of hyperthyroidism; palliation in certain thyroid cancers. Adult: 15–
60 mg/day PO in three equal doses q 8 hr. Maint, 5–15 mg/day PO. Child:
0.4 mg/kg/day PO, then maint of approximately ½ initial dose. Or, initially, 0.5–
0.7 mg/kg/day or 15–20 mg/m2/day PO in three divided doses, then maint of ⅓–⅔
initial dose, starting when pt becomes euthyroid. Max, 30 mg/24 hr.
ADV EFF Bone marrow suppression, dizziness, neuritis, paresthesia, rash, vertigo,
weakness
INTERACTIONS Cardiac glycosides, metoprolol, oral anticoagulants, propranolol,
theophylline
NC/PT Monitor CBC, thyroid function. Tx will be long-term. Not for use in pregnancy
(barrier contraceptives advised), breast-feeding. Pt should take safety precautions w/
CNS effects, report unusual bleeding/bruising, signs of infection.

methocarbamol (Robaxin)
CLASS Skeletal muscle relaxant
PREG/CONT C/NA

IND & DOSE Relief of discomfort associated w/ acute, painful musculoskeletal

conditions. Adult: 1.5 g PO qid. For first 48–72 hr, 6 g/day or up to 8 g/day
recommended. Maint, 1 g PO qid, or 750 mg q 4 hr, or 1.5 g tid for total 4–4.5 g/day.
Or, 1 g IM or IV; may need 2–3 g in severe cases. Do not use 3 g/day for more than
3 days. Control of neuromuscular manifestations of tetanus. Adult: Up to 24 g/day
PO or 1 g IM or IV; may need 2–3 g for no longer than 3 days. Child: 15 mg/kg IV
repeated q 6 hr as needed.
ADV EFF Bradycardia, discolored urine, dizziness, drowsiness, headache, nausea, urticaria
NC/PT Have pt remain recumbent during and for at least 15 min after IV injection. For
IM, do not inject more than 5 mL into each gluteal region; repeat at 8-hr intervals.
Switch from parenteral to oral route as soon as possible. Not for use in pregnancy.
Urine may darken to green, brown, black on standing. Pt should take safety precautions
w/ CNS effects, avoid alcohol. Name confusion between methocarbamol and
mephobarbital; use caution.

DANGEROUS DRUG
methotrexate (Rheumatrex, Trexall)
CLASS Antimetabolite, antineoplastic, antipsoriatic, antirheumatic
PREG/CONT X/NA

BBW Arrange for CBC, urinalysis, LFTs/renal function tests, chest X-ray before, during,
and for several wk after tx; severe toxicity possible. Rule out pregnancy before starting
tx; counsel pt on severe risks of fetal abnormalities. Reserve use for life-threatening
neoplastic diseases, severe psoriasis/rheumatoid arthritis unresponsive to other tx.
Monitor LFTs carefully w/ long-term use; serious hepatotoxicity possible. High risk of
serious opportunistic infections; monitor closely during tx. Use cautiously w/ malignant
lymphomas, rapidly growing tumors; worsening of malignancy possible.
IND & DOSE Tx of choriocarcinoma, other trophoblastic diseases. Adult: 15–30 mg PO
or IM daily for 5-day course. Repeat course three to five times w/ rest periods of 1 wk or
longer between courses until toxic symptoms subside. Tx of leukemia. Adult: Induction:
3.3 mg/m2 methotrexate PO or IM w/ 60 mg/m2 prednisone daily for 4–6 wk. Maint,
30 mg/m2 methotrexate PO or IM twice wkly or 2.5 mg/kg IV q 14 days. Tx of
meningeal leukemia. Adult: Give methotrexate intrathecally as px in lymphocytic
leukemia. 12 mg/m2 (max, 15 mg) intrathecally at intervals of 2–5 days; repeat until
CSF cell count normal, then give one additional dose. Child: 3 yr or older, 12 mg
intrathecally q 2–5 days. 2–3 yr, 10 mg intrathecally q 2–5 days. 1–2 yr, 8 mg
intrathecally q 2–5 days. Under 1 yr, 6 mg intrathecally q 2–5 days. Tx of lymphomas.
Adult: Burkitt tumor (stages I, II), 10–25 mg/day PO for 4–8 days. Stage III, use w/
other neoplastic drugs. All usually require several courses of tx w/ 7- to 10-day rest
periods between doses. Tx of mycosis fungoides. Adult: 2.5–10 mg/day PO for wks or
mos, or 50 mg IM once wkly, or 25 mg IM twice wkly. Can also give IV w/ combination
chemotherapy regimens in advanced disease. Tx of osteosarcoma. Adult: 12 g/m2 or up
to 15 g/m2 IV to give peak serum conc of 1,000 micromol. Must use as part of cytotoxic
regimen w/ leucovorin rescue. Tx of severe psoriasis. Adult: 10–25 mg/wk PO, IM, or
IV as single wkly dose; max, 30 mg/wk. Or, 2.5 mg PO at 12-hr intervals for three doses
each wk. Tx of severe rheumatoid arthritis. Adult: Single doses of 7.5 mg/wk PO or
divided dose of 2.5 mg PO at 12-hr intervals for three doses as a course once wkly. Max,
20 mg/wk. Tx of polyarticular course juvenile rheumatoid arthritis. Child 2–16 yr:
10 mg/m2 PO wkly; max, 20 mg/m2/wk.
ADV EFF Alopecia, anaphylaxis, blurred vision, chills, dizziness, fatigue, fertility
alterations, fever, interstitial pneumonitis, n/v/d, rash, renal failure, severe bone
marrow depression, sudden death, ulcerative stomatitis
INTERACTIONS Alcohol, digoxin, NSAIDs (serious to fatal reactions), phenytoin,
probenecid, salicylates, sulfonamides, theophylline
NC/PT Monitor CBC, LFTs, renal/pulmonary function regularly. Have leucovorin or
levoleucovorin on hand as antidote for methotrexate overdose or when large doses used.
Not for use in pregnancy (men, women should use contraceptives during, for 3 mo after
tx). Give antiemetic for n/v. Pt should avoid alcohol, NSAIDs; cover head at temp
extremes (hair loss possible); perform frequent mouth care; take safety precautions w/
CNS effects; report urine changes, abd pain, black tarry stools, unusual bleeding.

methoxsalen (8-MOP, Oxsoralen, Uvadex)

CLASS Psoralen
PREG/CONT C/NA

BBW Reserve use for severe/disabling disorders unresponsive to traditional tx; risk of
eye/skin damage, melanoma. Brand names not interchangeable; use extreme caution.
IND & DOSE Tx of disabling psoriasis; repigmentation of vitiliginous skin; cutaneous
T-cell lymphoma. Adult: Dose varies by weight. Must time tx w/ UV exposure; see
manufacturer’s details.
ADV EFF Depression, dizziness, headache, itching, leg cramps, melanoma, ocular/skin
damage, swelling
INTERACTIONS Anthralin, coal tar/coal tar derivatives, fluoroquinolones, griseofulvin,
methylene blue, nalidixic acid, phenothiazines, sulfonamides, tetracyclines,
thiazides/certain organic staining dyes
NC/PT Do not use w/ actinic degeneration; basal cell carcinomas; radiation, arsenic tx;
hepatic, cardiac disease. Alert pt to adverse effects, including ocular damage,
melanoma. Must time tx w/ UV light exposure. Pt should mark calendar for tx days,
take safety precautions if dizzy, report vision changes.

methscopolamine bromide (Pamine)

CLASS Anticholinergic, antispasmodic
PREG/CONT C/NA

IND & DOSEAdjunct tx of peptic ulcer. Adult: 2.5 mg PO 30 min before meals, 2.5–5 mg
PO at bedtime.
ADV EFF Altered taste perception, blurred vision, decreased sweating, dry mouth,
dysphagia, n/v, urinary hesitancy, urine retention
INTERACTIONS Anticholinergics, antipsychotics, haloperidol, TCAs
NC/PT Pt should maintain adequate hydration, empty bladder before each dose, avoid hot
environments, use sugarless lozenges for dry mouth, take safety precautions w/ vision
changes, report difficulty swallowing, palpitations.

methsuximide (Celontin)
CLASS Antiepileptic, succinimide
PREG/CONT C/NA

IND & DOSE Control of absence seizures. Adult: 300 mg/day PO for first wk; titrate to
max 1.2 g/day.
ADV EFF Aggression, ataxia, blood dyscrasias, blurred vision, dizziness, drowsiness,
headache, nervousness hepatotoxicity, n/v/d, SLE, Stevens-Johnson syndrome,
suicidality
INTERACTIONS Other antiepileptics
NC/PT Monitor CBC, LFTs w/ long-term tx. Not for use in pregnancy (barrier
contraceptives advised). Pt should take safety precaution w/ CNS effects, report rash,
stool/urine color changes, thoughts of suicide.

methyldopa, methyldopate hydrochloride (generic)

CLASS Antihypertensive, sympatholytic
PREG/CONT B (oral); C (IV)/NA

IND & DOSETx of hypertension. Adult: 250 mg PO bid–tid in first 48 hr; maint, 500 mg–2
g/day PO in two to four doses. If given w/ other antihypertensives, limit initial dose to
500 mg/day in divided doses. Child: 10 mg/kg/day PO in two to four doses. Max,
65 mg/kg/day PO or 3 g/day PO, whichever less. Tx of hypertensive crisis. Adult: 250–
500 mg IV q 6 hr as needed; max, 1 g q 6 hr. Switch to oral tx as soon as control
attained. Child: 20–40 mg/kg/day IV in divided doses q 6 hr. Max, 65 mg/kg or 3 g/day,
whichever less.
ADJUST DOSE Elderly pts, renal impairment
ADV EFF Asthenia, bradycardia, constipation, decreased mental acuity, distention,
headache, hemolytic anemia, hepatotoxicity, HF, myocarditis, n/v, rash, sedation,
weakness
INTERACTIONS General anesthetics, levodopa, lithium, sympathomimetics
NC/PT Give IV slowly over 30–60 min; monitor injection site. Monitor CBC, LFTs
periodically. Monitor BP carefully when stopping; hypertension usually returns within
48 hr. Pt should take safety precautions w/ CNS effects, report urine/stool color
changes, rash, unusual tiredness.

methylene blue (Methblue 65)

 CLASSAntidote, diagnostic agent, urinary tract anti-infective
PREG/CONT C/NA

IND & DOSE Tx of cyanide poisoning, drug-induced methemoglobinemia; GU

antiseptic for cystitis, urethritis Adult, child: 65–130 mg PO tid w/ full glass of water.
Or, 1–2 mg/kg IV or 25–50 mg/m2 IV injected over several min. May repeat after 1 hr.
ADV EFF Blue-green stool, confusion, discolored urine, dizziness, n/v
INTERACTIONS SSRIs
NC/PT Give IV slowly over several min; do not give subcut or intrathecally. Contact w/
skin will dye skin blue; may remove stain w/ hypochlorite sol. Use other measures to
decrease UTI incidence. Urine, stool may turn blue-green. Pt should take safety
measures w/ CNS effects, report severe n/v.

methylergonovine maleate (generic)

CLASS Ergot derivative, oxytocic
PREG/CONT C/NA

IND & DOSE Routine mgt after delivery of placenta; tx of postpartum atony,
hemorrhage; subinvolution of uterus; uterine stimulation during second stage of
labor after delivery of anterior shoulder. Adult: 0.2 mg IM or IV slowly over at least
60 sec, after delivery of placenta/anterior shoulder, or during puerperium. May repeat q
2–4 hr, then 0.2 mg PO three or four times/day in puerperium for up to 1 wk.
ADV EFF Dizziness, headache, hypertension, nausea
INTERACTIONS CYP3A4 inhibitors, ergot alkaloids, vasoconstrictors
NC/PT Reserve IV use for emergency; monitor BP/bleeding postpartum; use for no longer
than 1 wk. Pt should report increased vaginal bleeding, numb/cold extremities.

methylnaltrexone bromide (Relistor)

CLASS Opioid receptor antagonist, laxative
PREG/CONT B/NA

IND & DOSE Tx of opioid-induced constipation in pts in palliative care in whom

other laxatives do not work. Adult: 62–114 kg, 12 mg subcut q other day; 38–under 62
kg, 8 mg subcut q other day. If weight not in above range, 0.15 mg/kg subcut q other
day.
ADJUST DOSE Renal impairment
ADV EFF Abd pain, diarrhea, dizziness, flatulence, GI perforation, hyperhidrosis, nausea
NC/PT Teach proper administration, disposal of needles, syringes. Use caution in
pregnancy, breast-feeding. Pt should take safety precautions w/ dizziness, report acute
abd pain, severe diarrhea.

methylphenidate hydrochloride (Concerta, Daytrana, Metadate, Methylin,

 Ritalin)
CLASS CNS stimulant
PREG/CONT C/C-II

BBW Potential for abuse; use caution w/ emotionally unstable pts.

IND & DOSE Tx of narcolepsy (Ritalin, Ritalin SR, Metadate ER, Methylin); tx of
attention-deficit disorders, hyperkinetic syndrome, minimal brain dysfunction in
child, adult w/ behavioral syndrome. Adult: Range, 10–60 mg/day PO. ER:
18 mg/day PO in a.m. May increase by 18 mg/day at 1-wk intervals; max, 54 mg/day
(Concerta). Or, 10- to 20-mg/day increments to max 60 mg/day (Metadate CD, Ritalin
LA). Child 13–17 yr: 18 mg/day PO in a.m. Titrate to max 72 mg/day PO; do not exceed
2 mg/kg/day. Or, 10–30 mg/day transdermal patch; apply 2 hr before effect needed,
remove after 9 hr. Child 6–12 yr: 5 mg PO before breakfast, lunch w/ gradual increments
of 5–10 mg wkly; max, 60 mg/day. ER: Use adult dose up to max 54 mg/day PO. Or,
10–30 mg/day transdermal patch; apply 2 hr before effect needed, remove after 9 hr.
ADV EFF Abd pain, angina, anorexia, cardiac arrhythmias, changes in P/BP, growth
changes, insomnia, nausea, nervousness, rash
INTERACTIONS Alcohol, MAOIs, oral anticoagulants, phenytoin, SSRIs, TCAs
NC/PT Ensure proper dx; rule out underlying cardiac problems. Baseline ECG
recommended. Stop tx periodically to evaluate sx. Monitor growth in children. Monitor
BP frequently when starting tx. Pt should swallow ER tablet whole and not cut, crush, or
chew it; take before 6 p.m. to avoid sleep disturbances; apply patch to clean, dry area of
hip (remove old patch before applying new one); avoid heating pads on patch; keep in
secure place; report chest pain, nervousness, insomnia.

methyLPREDNISolone (Medrol), methyLPREDNISolone acetate (Depo-Medrol),

methyLPREDNISolone sodium succinate (Solu-Medrol)
CLASS Corticosteroid, hormone
PREG/CONT C/NA

IND & DOSE Short-term mgt of inflammatory/allergic disorders, thrombocytopenic

purpura, erythroblastopenia, ulcerative colitis, acute exacerbations of MS,
trichinosis w/ neurologic/cardiac involvement; px of n/v w/ chemotherapy. Adult:
4–48 mg/day PO. Alternate-day tx: twice usual dose q other a.m. Or, 10–40 mg IV over
several min. Or, high-dose tx: 30 mg/kg IV infused over 10–30 min; repeat q 4–6 hr but
not longer than 72 hr. Child: Minimum dose, 0.5 mg/kg/day PO; base dose on actual
response. Maint tx of rheumatoid arthritis. Adult: 40–120 mg/wk IM. Adrenogenital
syndrome. Adult: 40 mg IM q 2 wk. Dermatologic lesions. Adult: 40–120 mg/wk IM
for 1–4 wk. Asthma, allergic rhinitis. Adult: 80–120 mg IM. Intralesional. Adult: 20–
60 mg. Intra-articular. Adult: dose depends on site of injection: 4–10 mg (small joints);
10–40 mg (medium); 20–80 mg (large).
ADV EFF Aggravation of infections, amenorrhea, anaphylactic reactions, edema, fluid
retention, headache, hyperglycemia, hypotension, immunosuppression, impaired
healing, increased appetite, shock, vertigo
INTERACTIONS Azole antifungals, edrophonium, erythromycin, live vaccines, neostigmine,
phenytoin, pyridostigmine, rifampin, salicylates, troleandomycin
NC/PT Individualize dose based on severity, response. Give daily dose before 9 a.m. to
minimize adrenal suppression. For maint, reduce initial dose in small increments at
intervals until lowest satisfactory clinical dose reached. If long-term tx needed, consider
alternate-day therapy w/ short-acting corticosteroid. After long-term tx, withdraw
slowly to prevent adrenal insufficiency. Monitor serum glucose. Pt should avoid
exposure to infections, report signs of infection, black tarry stools.

metoclopramide (Reglan)
CLASS Antiemetic, dopaminergic, GI stimulant
PREG/CONT B/NA

BBW Long-term tx associated w/ permanent tardive dyskinesia; risk increases w/ pts

over 60 yr, especially women. Use smallest dose possible. Max, 3 mo of tx.
IND & DOSE Relief of sx of gastroparesis. Adult: 10 mg PO 30 min before each meal and
at bedtime for 2–8 wk; severe, 10 mg IM or IV for up to 10 days until sx subside. Tx of
symptomatic gastroesophageal reflux. Adult: 10–15 mg PO up to four times/day 30
min before meals and at bedtime for max 12 wk. Px of postop n/v. Adult: 10–20 mg IM
at end of surgery. Px of chemotherapy-induced vomiting. Adult: IV infusion over at
least 15 min. First dose 30 min before chemotherapy; repeat q 2 hr for two doses, then q
3 hr for three doses. For highly emetogenic drugs (cisplatin, dacarbazine), initial two
doses, 1–2 mg/kg. If extrapyramidal symptoms, give 50 mg diphenhydramine IM.
Facilitation of small-bowel intubation, gastric emptying. Adult: 10 mg (2 mL) by
direct IV injection over 1–2 min. Child 6–14 yr: 2.5–5 mg by direct IV injection over 1–2
min. Child under 6 yr: 0.1 mg/kg by direct IV injection over 1–2 min.
ADV EFF Diarrhea, drowsiness, extrapyramidal reactions, fatigue, lassitude, nausea,
restlessness
INTERACTIONS Alcohol, CNS depressants, cyclosporine, digoxin, succinylcholine
NC/PT Monitor BP w/ IV use. Give diphenhydramine for extrapyramidal reactions. Pt
should take safety precautions w/ CNS effects, report involuntary movements, severe
diarrhea.

metolazone (Zaroxolyn)
CLASS Thiazide diuretic
PREG/CONT B/NA

BBW Do not interchange Zaroxolyn w/ other formulations; not therapeutically

equivalent.
IND & DOSE Tx of hypertension. Adult: 2.5–5 mg/day PO. Tx of edema from systemic
disease. Adult: 5–20 mg/day PO.
ADV EFF Anorexia, bone marrow depression, dizziness, dry mouth, nocturia, n/v/d,
orthostatic hypotension, photophobia, polyuria, vertigo
INTERACTIONS Antidiabetics, cholestyramine, colestipol, diazoxide, dofetilide, lithium
NC/PT Withdraw drug 2–3 days before elective surgery; for emergency surgery, reduce
preanesthetic/anesthetic dose. Pt should take early in day to avoid sleep interruption;
avoid sun exposure; weigh self daily, report changes of 3 lb or more/day; report unusual
bleeding.

DANGEROUS DRUG
metoprolol, metoprolol succinate, metoprolol tartrate (Lopressor)
CLASS Antihypertensive, selective beta blocker
PREG/CONT C/NA

BBW Do not stop abruptly after long-term tx (hypersensitivity to catecholamines

possible, causing angina exacerbation, MI, ventricular arrhythmias). Taper gradually
over 2 wk w/ monitoring. Pts w/ bronchospastic diseases should not, in general, receive
beta blockers. Use w/ caution only in pts unresponsive to or intolerant of other
antihypertensives.
IND & DOSE Tx of hypertension. Adult: 100 mg/day PO; maint, 100–450 mg/day. Or, 25–
100 mg/day ER tablet PO; max, 400 mg/day. Tx of angina pectoris. Adult:
100 mg/day PO in two divided doses; range, 100–400 mg/day. Or, 100 mg/day ER
tablet PO. Early tx of MI. Adult: 3 IV boluses of 5 mg each at 2-min intervals, then
50 mg PO 15 min after last IV dose and q 6 hr for 48 hr. Then maint of 100 mg PO bid.
Late tx of MI. Adult: 100 mg PO bid as soon as possible after infarct, continuing for at
least 3 mo–3 yr. Tx of HF. Adult: 12.5–25 mg/day ER tablet PO for 2 wk; max,
200 mg/day.
ADV EFF ANA development, bronchospasm, cardiac arrhythmias, constipation, decreased
exercise tolerance/libido, dizziness, ED, flatulence, gastric pain, HF, laryngospasm,
n/v/d, paresthesia
INTERACTIONS Barbiturates, cimetidine, clonidine, epinephrine, hydralazine, lidocaine,
methimazole, NSAIDs, prazosin, propylthiouracil, rifampin, verapamil
NC/PT Monitor cardiac function w/ IV use. Pt should swallow ER tablet whole and not
cut, crush, or chew it; take safety precautions w/ CNS effects; report difficulty breathing,
swelling.

metreleptin (Myalept)
CLASS Leptin analogue
PREG/CONT C/NA

BBW Risk of development of anti-metreleptin antibodies, w/ loss of drug efficacy and

worsening metabolic issues, severe infections; test for antibodies in pts with severe
infection or loss of efficacy. Risk of T-cell lymphoma; assess risk in pts with hematologic
abnormalities and/or acquired generalized lipodystrophy.
IND & DOSE Adjunct to diet as replacement tx in leptin deficiency in pts w/
congenital or acquired lipodystrophy. Adult, child 40 kg or less: 0.06 mg/kg/day
subcut; max, 0.13 mg/kg. Males over 40 kg: 2.5 mg/day subcut; max 10 mg/day. Females
over 40 kg: 5 mg/day subcut; max 10 mg/day.
ADV EFF Abd pain, autoimmune disorder progression, benzyl alcohol toxicity, headache,
hypersensitivity reactions, hypoglycemia, T-cell lymphoma, weight loss
NC/PT Ensure proper use of drug; only use for approved indication. Monitor for
infections; test for antibody development. Dilute with Bacteriostatic Water for Injection
or Sterile Water for Injection; avoid benzyl alcohol when using drug in neonates,
infants. Pt should learn proper reconstitution, subcut administration, proper disposal of
syringes; avoid pregnancy, breast-feeding; report difficulty breathing, dizziness, fever,
sx of infection.

metronidazole (Flagyl, MetroCream, MetroGel)

CLASS Amebicide, antibiotic, antiprotozoal
PREG/CONT B/NA

BBW Avoid use unless needed; possibly carcinogenic.

IND & DOSE Tx of amebiasis. Adult: 750 mg PO tid for 5–10 days. Child: 35–50 mg/kg/day
PO in three divided doses for 10 days. Tx of antibiotic-associated
pseudomembranous colitis. Adult: 1–2 g/day PO in three to four divided doses for 7–
10 days. Tx of gardnerella vaginalis. Adult: 500 mg PO bid for 7 days. Tx of
giardiasis. Adult: 250 mg PO tid for 7 days. Tx of trichomoniasis. Adult: 2 g PO in 1
day (1-day tx) or 250 mg PO tid for 7 days. Bacterial vaginosis. Nonpregnant women,
750 mg PO daily for 7 days, or 1 applicator intravaginally one to two times/day for
5 days. Pregnant women, 750 mg/day PO for 7 days; avoid in first trimester. Tx of
anaerobic bacterial infection. Adult: 15 mg/kg IV infused over 1 hr, then 7.5 mg/kg
infused over 1 hr q 6 hr for 7–10 days; max, 4 g/day. Preop, intraop, postop px for pts
undergoing colorectal surgery. Adult: 15 mg/kg infused IV over 30–60 min, completed
about 1 hr before surgery; then 7.5 mg/kg infused over 30–60 min at 6- to 12-hr
intervals after initial dose during day of surgery only. Tx of inflammatory papules,
pustules, erythema of rosacea. Apply, rub in thin film bid (a.m. and p.m.) to entire
affected areas after washing; for 9 wk.
ADV EFF Anorexia, ataxia, darkened urine, dizziness, dry mouth, headache, injection-site
reactions, n/v/d, superinfections, unpleasant metallic taste
INTERACTIONS Alcohol, barbiturates, disulfiram, oral anticoagulants
NC/PT Urine may darken. Pt should take full course; take orally w/ food; avoid alcohol or
alcohol-containing preparations during and for 24–72 after tx (severe reactions
possible); use sugarless lozenges for dry mouth/metallic taste; report severe GI
problems, fever.
 metyrosine (Demser)
CLASS Enzyme inhibitor
PREG/CONT C/NA

IND & DOSE Mgt of pheochromocytoma. Adult, child over 12 yr: 250–500 mg PO qid.
Preop preparation for pheochromocytoma surgery. Adult, child over 12 yr: 2–3 g/day
PO for 5–7 days; max, 4 g/day.
ADV EFF Anxiety, diarrhea, dysuria, extrapyramidal effects, gynecomastia, hypotension,
insomnia, sedation
INTERACTIONS Alcohol, CNS depressants, haloperidol, phenothiazines
NC/PT Maintain hydration. Antidiarrheals may be needed. Give supportive care
throughout surgery. Monitor for hypotension. Pt should avoid alcohol.

DANGEROUS DRUG
mexiletine hydrochloride (Mexitil)
CLASS Antiarrhythmic
PREG/CONT C/NA

BBW Reserve for life-threatening arrhythmias; possible serious proarrhythmic effects.

IND & DOSE Tx of documented life-threatening ventricular arrhythmias. Adult:
200 mg PO q 8 hr. Increase in 50- to 100-mg increments q 2–3 days until desired
antiarrhythmic effect. Max, 1,200 mg/day PO. Rapid control, 400 mg loading dose, then
200 mg PO q 8 hr. Transferring from other antiarrhythmics: Lidocaine, stop lidocaine
w/ first mexiletine dose; leave IV line open until adequate arrhythmia suppression
ensured. Quinidine sulfate, initially 200 mg PO 6–12 hr after last quinidine dose.
Procainamide, initially 200 mg PO 3–6 hr after last procainamide dose. Disopyramide,
200 mg PO 6–12 hr after last disopyramide dose.
ADV EFF Cardiac arrhythmias, chest pain, coordination difficulties, dizziness, dyspnea,
headache, heartburn, light-headedness, n/v, rash, tremors, visual disturbances
INTERACTIONS Hydantoins, propafenone, rifampin, theophylline
NC/PT Monitor for safe, effective serum level (0.5–2 mcg/mL); monitor cardiac rhythm
frequently. Pt should not stop without consulting prescriber, take safety precautions w/
CNS effects, report chest pain, excessive tremors, lack of coordination.

DANGEROUS DRUG
micafungin sodium (Mycamine)
CLASS Antifungal, echinocandin
PREG/CONT C/NA

IND & DOSETx of esophageal candidiasis. Adult: 150 mg/day by IV infusion over 1 hr
for 10–30 days. Px of candidal infections in pts undergoing hematopoietic stem-
cell transplantation. Adult: 50 mg/day by IV infusion over 1 hr for about 19 days. Tx
of systemic candidal infections. Adult: 100 mg/day by IV infusion over 1 hr for 10–
47 days based on infection.
ADV EFF Headache, hemolytic anemia, hepatotoxicity, nausea, phlebitis, renal
toxicity, serious hypersensitivity reaction
INTERACTIONS Nifedipine, sirolimus
NC/PT Obtain baseline, periodic CBC, LFTs, renal function tests. Monitor injection site for
phlebitis. Not for use in pregnancy (contraceptives advised), breast-feeding. Pt should
get periodic blood tests, report difficulty breathing, urine/stool color changes, pain at IV
site.

DANGEROUS DRUG
miconazole nitrate (Breeze Mist, Fungoid Tincture, Lotrimin AF, Monistat)
CLASS Antifungal
PREG/CONT B/NA

IND & DOSE Local tx of vulvovaginal candidiasis (moniliasis). Adult: 1 suppository

intravaginally once daily at bedtime for 3 days (Monistat). Or, 1 applicator cream or 1
suppository intravaginally daily at bedtime for 7 days (Monistat 7). Repeat course if
needed. Alternatively, one 1,200-mg vaginal suppository at bedtime for 1 dose. Topical
tx of susceptible fungal infections. Adult, child over 2 yr: Cream/lotion, cover affected
areas a.m. and p.m. Powder, spray or sprinkle powder liberally over affected area a.m.
and p.m.
ADV EFF Local irritation/burning, nausea, rash
NC/PT Culture before tx. Monitor response. Pt should take full tx course; insert vaginal
suppositories high into vagina; practice good hygiene to prevent spread, reinfection;
report rash, pelvic pain.

DANGEROUS DRUG
midazolam hydrochloride (generic)
CLASS Benzodiazepine, CNS depressant
PREG/CONT D/C-IV

BBW Only personnel trained in general anesthesia should give. Have equipment for
maintaining airway, resuscitation on hand; respiratory depression/arrest possible. Give
IV w/ continuous monitoring of respiratory, CV function. Individualize dose; use lower
dose in elderly/debilitated pts. Adjust according to other premedication use.
IND & DOSE Preop sedation, anxiety, amnesia. Adult: Over 60 yr or debilitated, 20–
50 mcg/kg IM 1 hr before surgery; usual dose, 1–3 mg. Under 60 yr, 70–80 mcg/kg IM
1 hr before surgery; usual dose, 5 mg. Child 6 mo–16 yr: 0.1–0.15 mg/kg IM; max,
10 mg/dose. Conscious sedation for short procedures. Adult: Over 60 yr, 1–1.5 mg IV
initially. Maint, 25% initial dose; total dose, 3.5 mg. Under 60 yr, 1–2.5 mg IV initially.
Maint, 25% of initial dose; total dose, 5 mg. Child over 12 yr: 1–2.5 mg IV; maint, 25%
of initial dose. Conscious sedation for short procedures before anesthesia. Child 6–
12 yr: Initially, 25–50 mcg/kg IV. May give up to 400 mcg/kg; max, 10 mg/dose. 6 mo–
5 yr: 50–100 mcg/kg IV; max, 6 mg total dose. Induction of anesthesia. Adult: Over 55
yr, 150–300 mcg/kg IV as initial dose. Under 55 yr, 300–350 mcg/kg IV (to total
600 mcg/kg). Debilitated adult, 200–250 mcg/kg IV as initial dose. Sedation in critical
care areas. Adult: 10–50 mcg/kg (0.5–4 mg usual dose) as loading dose. May repeat q
10–15 min; continuous infusion of 20–100 mcg/kg/hr to sustain effect. Sedation in
critical care areas for intubated child. Neonates over 32 wks’ gestation: 60 mcg/kg/hr
IV. Neonates under 32 wks’ gestation: 30 mcg/kg/hr IV.
ADV EFF Amnesia, bradycardia, confusion, disorientation, drowsiness, sedation,
incontinence, injection-site reactions, n/v/d, rash, respiratory depression, slurred
speech
INTERACTIONS Alcohol, antihistamines, carbamazepine, CNS depressants, grapefruit juice,
opioids, phenobarbital, phenytoin, protease inhibitors, rifabutin, rifampin
NC/PT Do not give intra-arterially; may cause arteriospasm, gangrene. Keep resuscitative
facilities on hand; have flumazenil available as antidote if overdose. Monitor P, BP, R
during administration. Monitor level of consciousness for 2–6 hr after use. Do not let pt
drive after use. Provide written information (amnesia likely). Pt should take safety
precautions w/ CNS effects, avoid alcohol, grapefruit juice before receiving drug; report
visual/hearing disturbances, persistent drowsiness.

midodrine (generic)
CLASS Antihypotensive, alpha agonist
PREG/CONT C/NA

BBW Use only w/ firm dx of orthostatic hypotension that interferes w/ daily activities;
systolic pressure increase can cause serious problems.
IND & DOSE Tx of severe orthostatic hypotension. Adult: 10 mg PO tid while upright.
ADJUST DOSE Renal impairment
ADV EFF Bradycardia, dizziness, increased IOP, paresthesia, pruritus, supine hypertension,
syncope, urine retention
INTERACTIONS Corticosteroids, digoxin, sympathomimetics, vasoconstrictors
NC/PT Monitor BP, orthostatic BP carefully. Monitor IOP w/ long term use. Pt should
take safety precautions w/ CNS effects, empty bladder before taking, avoid OTC
cold/allergy remedies, report headache, fainting, numbness/tingling.

mifepristone (Korlym, Mifeprex)

CLASS Abortifacient
PREG/CONT X/NA

BBW Serious, fatal infection possible after abortion; monitor for sustained fever,
prolonged heavy bleeding, severe abd pain. Urge pt to seek emergency medical help if
these occur. Rule out pregnancy before tx and if tx stopped for 14 days or longer (with
Korlym).
IND & DOSE Pregnancy termination through 49 days gestational age. Adult: Day 1,
600 mg (3 tablets) PO as single dose. Day 3, if termination not confirmed, 400 mcg PO
(2 tablets) misoprostol (Cytotec). Day 14, evaluate for termination; if unsuccessful,
surgical intervention suggested. To control hyperglycemia secondary to
hypercortisolism in adults w/ Cushing’s syndrome and type 2 diabetes or glucose
intolerance who have failed other tx and are not candidates for surgery. Adult:
300 mg/day PO with meal; max, 1,200 mg/day (Korlym).
ADV EFF Abd pain, dizziness, headache, n/v/d, potentially serious to fatal infection,
heavy uterine bleeding
NC/PT Alert pt that menses usually begins within 5 days of tx and lasts for 1–2 wk;
arrange to follow drug within 48 hr w/ prostaglandin (Cytotec) as appropriate. Ensure
abortion complete or that other measures are used to complete abortion if drug effects
insufficient. Give analgesic, antiemetic as needed for comfort. Ensure pt follow-up;
serious to fatal infections possible. Pt treated for hyperglycemia should take w/ meals;
continue other tx for Cushing’s syndrome. Not for use in pregnancy with this indication
(contraceptives advised). Pt should swallow tablet whole, and not cut, crush, or chew it;
immediately report sustained fever, severe abd pain, prolonged heavy bleeding,
dizziness on arising, persistent malaise. Name confusion between mifepristone and
misoprostol, Mifeprex and Mirapex (pramipexole); use caution.

DANGEROUS DRUG
miglitol (Glyset)
CLASS Alpha-glucosidase inhibitor, antidiabetic
PREG/CONT B/NA

IND & DOSE Adjunct to diet, exercise to lower blood glucose in type 2 diabetes as
monotherapy or w/ sulfonylurea. Adult: 25 mg PO tid at first bite of each meal. After
4–8 wk, start maint: 50 mg PO tid at first bite of each meal. Max, 100 mg PO tid. If
combined w/ sulfonylurea, monitor blood glucose; adjust doses accordingly.
ADV EFF Abd pain, anorexia, flatulence, hypoglycemia, n/v/d
INTERACTIONS Celery, charcoal, coriander, dandelion root, digestive enzymes, fenugreek,
garlic, ginseng, juniper berries, propranolol, ranitidine
NC/PT Ensure thorough diabetic teaching, diet/exercise program. Pt should take w/ first
bite of each meal, monitor blood glucose, report severe abd pain.

miglustat (Zavesca)
CLASS Enzyme inhibitor
PREG/CONT X/NA
IND & DOSE Tx of mild to moderate type 1 Gaucher disease. Adult: 100 mg PO tid.
ADJUST DOSE Elderly pts, renal impairment
ADV EFF Diarrhea, GI complaints, male infertility, peripheral neuropathy, reduced
platelet count, tremor, weight loss
NC/PT Not for use in pregnancy, breast-feeding; men should use barrier contraceptives
during tx. Pt should use antidiarrheals for severe diarrhea, report unusual bleeding,
increasing tremors.

milnacipran (Savella)
CLASS Selective serotonin and norepinephrine reuptake inhibitor
PREG/CONT C/NA

BBW Increased risk of suicidality; monitor accordingly.

IND & DOSE Mgt of fibromyalgia. Adult: 12.5 mg/day PO; increase over 1 wk to target
50 mg PO bid.
ADJUST DOSE Elderly pts, renal impairment
ADV EFF Bleeding, constipation, dizziness, dry mouth, headache, hypertension, insomnia,
nausea, NMS, palpitations, seizures, serotonin syndrome
INTERACTIONS Alcohol, clonidine, digoxin, epinephrine, MAOIs, norepinephrine, tramadol,
triptans
NC/PT Do not use w/ uncontrolled narrow-angle glaucoma. Not for use in breast-feeding.
Taper when stopping to avoid withdrawal reactions. Pt should avoid alcohol, take safety
precautions w/ CNS effects, report bleeding, rapid heart rate, thoughts of suicide.

DANGEROUS DRUG
milrinone lactate (generic)
CLASS Inotropic
PREG/CONT C/NA

IND & DOSE Short-term mgt of pts w/ acute decompensated HF. Adult: 50 mcg/kg IV
bolus over 10 min. Maint infusion, 0.375–0.75 mcg/kg/min IV. Max, 1.13 mg/kg/day.
ADJUST DOSE Renal impairment
ADV EFF Headache, hypotension, death, ventricular arrhythmias
INTERACTIONS Furosemide in sol
NC/PT Do not mix in sol w/ other drugs. Monitor rhythm, BP, P, I & O, electrolytes
carefully. Pt should report pain at injection site, chest pain.

minocycline hydrochloride (Arestin, Dynacin, Minocin)

CLASS Tetracycline
PREG/CONT D/NA
IND & DOSE Infections caused by susceptible bacteria. Adult: Initially, 200 mg PO or IV,
then 100 mg q 12 hr PO or IV. Or, 100–200 mg PO initially, then 50 mg PO qid. Adult
(ER): 91–136 kg, 135 mg/day PO; 60–90 kg, 90 mg/day PO; 45–59 kg, 45 mg/day PO.
Child over 8 yr: 4 mg/kg PO, then 2 mg/kg PO q 12 hr. Tx of syphilis. Adult: 100 mg PO
q 12 hr for 10–15 days. Tx of urethral, endocervical, rectal infections. Adult: 100 mg
PO q 12 hr for 7 days. Tx of gonococcal urethritis in men. Adult: 100 mg PO bid for
5 days. Tx of gonorrhea. Adult: 200 mg PO, then 100 mg q 12 hr for 4 days. Obtain
post-tx cultures within 2–3 days. Tx of meningococcal carrier state. Adult: 100 mg PO
q 12 hr for 5 days. Tx of periodontitis. Adult: Unit dose cartridge discharged in
subgingival area. Tx of moderate to severe acne vulgaris. Adult, child 12 yr and older:
1 mg/kg/ day PO for up to 12 wk (ER form).
ADJUST DOSE Elderly pts, renal impairment
ADV EFF Anorexia; bone marrow depression; discoloring/inadequate calcification of
primary teeth of fetus if used by pregnant women, of permanent teeth if used during
dental development; glossitis; liver failure; n/v/d; phototoxic reactions; rash;
superinfections
INTERACTIONS Alkali, antacids, dairy products, food, digoxin, hormonal contraceptives,
iron, penicillin
NC/PT Culture before tx. Give w/ food for GI upset. Use IV only if oral not possible;
switch to oral as soon as feasible. Additional form of contraception advised; hormonal
contraceptives may be ineffective. Pt should avoid sun exposure, report rash, urine/stool
color changes, watery diarrhea.

minoxidil (Rogaine)
CLASS Antihypertensive, vasodilator
PREG/CONT C/NA

BBW Arrange for echocardiographic evaluation of possible pericardial effusion if using

oral drug; more vigorous diuretic therapy, dialysis, other tx (including minoxidil
withdrawal) may be needed. Increased risk of exacerbation of angina, malignant
hypertension. When first administering, hospitalize pt, monitor closely; use w/ beta
blocker and/or diuretic to decrease risk.
IND & DOSE Tx of severe hypertension. Adult, child 12 yr and older: 5 mg/day PO as
single dose. Range, usually 10–40 mg/day PO; max, 100 mg/day. Concomitant therapy
w/ diuretics: Add hydrochlorothiazide 50 mg PO bid, or chlorthalidone 50–100 mg/day
PO, or furosemide 40 mg PO bid. Concomitant therapy w/ beta-adrenergic blockers,
other sympatholytics: Add propranolol 80–160 mg/day PO; other beta blockers (dose
equivalent to above); methyldopa 250–750 mg PO bid (start methyldopa at least 24 hr
before minoxidil); clonidine 0.1–0.2 mg PO bid. Child under 12 yr: General guidelines:
0.2 mg/kg/day PO as single dose. Range, 0.25–1 mg/kg/day; max, 50 mg/day. Topical
tx of alopecia areata, male-pattern alopecia. Adult: 1 mL to total affected scalp areas
bid. Total daily max, 2 mL. May need 4 mo of tx to see results; balding returns if
untreated 3–4 mo.
ADJUST DOSE Elderly pts, renal impairment
ADV EFF Bronchitis, dry scalp, eczema, edema, fatigue, headache, hypertrichosis, local
irritation, pruritus, Stevens-Johnson syndrome, tachycardia, URI
NC/PT Monitor pt closely. Withdraw slowly. Do not apply other topical drugs to topically
treated area. Enhanced/darkening of body, facial hair possible. Twice daily use will be
needed to maintain hair growth; baldness will return if drug stopped. Pt should take P,
report increase over 20 beats above normal; report weight gain of more than 3 lb in one
day; wash hands thoroughly after applying topical form; avoid applying more than
prescribed, not apply to inflamed or broken skin.

mipomersen sodium (Kynamro)

CLASS Lipid-lowering drug, oligonucleotide inhibitor
PREG/CONT B/NA

BBW May cause transaminase increases, hepatotoxicity, hepatic steatosis; available only
through restricted access program.
IND & DOSE Adjunct to other lipid-lowering drugs, diet to reduce LDL, total
cholesterol, non-HDL cholesterol in pts with familial hypercholesterolemia. Adult:
200 mg/wk subcut.
ADJUST DOSE Hepatic impairment
ADV EFF Arthralgia, chills, fatigue, flulike illness, injection-site reactions, hepatotoxicity,
malaise, myalgia
NC/PT Available only through limited access program. Monitor LFTs before and
frequently during therapy. Rotate injection sites; ensure continued diet, exercise, other
drugs to lower lipids. Not for use in pregnancy (contraceptives advised), breast-feeding.
Pt should learn proper injection technique, disposal of syringes; rotate injection sites;
refrigerate drug, protect from light; report urine/stool color changes, extreme fatigue.

mirabegron (Myrbetriq)
CLASS Beta-adrenergic agonist
PREG/CONT C/NA

IND & DOSETx of overactive bladder. Adult: 25 mg/day PO; max, 50 mg/day.
ADJUST DOSE Hepatic, renal impairment
ADV EFF Dizziness, headache, hypertension, nasopharyngitis, UTI
INTERACTIONS Anticholinergics, desipramine, digoxin, flecainamide, metoprolol,
propafenone
NC/PT Ensure dx; rule out obstruction, infection. Monitor BP; check for urine retention.
Not for use in breast-feeding. Pt should swallow tablet whole and not cut, crush, or chew
it; take w/ full glass of water; use safety precautions w/ dizziness; report urinary tract
sx, fever, persistent headache.

mirtazapine (Remeron)
CLASS Antidepressant
PREG/CONT C/NA

BBW Ensure depressed/potentially suicidal pts have access only to limited quantities.
Increased risk of suicidality in children, adolescents, young adults. Observe for clinical
worsening of depressive disorders, suicidality, unusual changes in behavior, especially
when starting tx or changing dose.
IND & DOSE Tx of major depressive disorder. Adult: 15 mg/day PO as single dose in
evening. May increase up to 45 mg/day as needed. Change dose only at intervals of
more than 1–2 wk. Continue tx for up to 6 mo for acute episodes.
ADJUST DOSE Elderly pts; hepatic, renal impairment
ADV EFF Agranulocytosis, confusion, constipation, dry mouth, disturbed concentration,
dizziness, dysphagia, gynecomastia, heart block, increased appetite, MI, neutropenia,
photosensitivity, stroke, urine retention, weight gain
INTERACTIONS Alcohol, CNS depressants, MAOIs
NC/PT Do not give within 14 days of MAOIs; serious reactions possible. CBC needed if
fever, signs of infection. Pt should take safety precautions w/ CNS effects; avoid alcohol,
sun exposure; use sugarless lozenges for dry mouth; report signs of infection, chest pain,
thoughts of suicide.

misoprostol (Cytotec)
CLASS Prostaglandin
PREG/CONT X/NA

BBW Arrange for serum pregnancy test for women of childbearing age. Women must
have negative test within 2 wk of starting tx; drug possible abortifacient.
IND & DOSE Px of NSAID (including aspirin)-induced gastric ulcers in pts at high risk
for gastric ulcer complications. Adult: 100–200 mcg PO four times/day w/ food.
ADJUST DOSE Elderly pts, renal impairment
ADV EFF Abd pain, dysmenorrhea, flatulence, miscarriage, n/v/d
NC/PT Explain high risk of miscarriage if used in pregnancy (contraceptives advised). Pt
should take drug w/ NSAID, not share drug w/ others, report severe diarrhea,
pregnancy. Name confusion between misoprostol and mifepristone; use caution.

DANGEROUS DRUG
mitomycin (generic)
CLASS Antineoplastic antibiotic
PREG/CONT D/NA
BBW Monitor CBC, renal/pulmonary function tests frequently at start of tx; risk of bone
marrow suppression, hemolytic uremic syndrome w/ renal failure. Adverse effects may
require decreased dose or drug stoppage; consult physician.
IND & DOSE Palliative tx of disseminated adenocarcinoma of stomach, pancreas.
Adult: 20 mg/m2 IV as single dose q 6 to 8 wk; adjust according to hematologic profile.
ADV EFF Acute respiratory distress syndrome, alopecia, anorexia, bone marrow
toxicity, confusion, drowsiness, fatigue, hemolytic uremic syndrome, injection-site
reactions, n/v/d, pulmonary toxicity
NC/PT Do not give IM, subcut. Monitor injection site for extravasation. Not for use in
pregnancy (barrier contraceptives advised). Pt should mark calendar for tx days, cover
head at temp extremes (hair loss possible), take safety precautions w/ CNS effects,
report difficulty breathing, unusual bleeding.

mitotane (Lysodren)
CLASS Antineoplastic
PREG/CONT C/NA

BBW Stop temporarily during stress; adrenal hormone replacement may be needed.
IND & DOSE Tx of inoperable adrenocortical carcinoma. Adult: 2–6 g/day PO in divided
doses; gradually increase to target 9–10 g/day.
ADV EFF Anorexia, dizziness, lethargy, n/v, orthostatic hypotension, rash, somnolence,
visual disturbances
INTERACTIONS Warfarin
NC/PT Give antiemetics if needed. Pt should take safety precautions w/ CNS effects.

DANGEROUS DRUG
mitoxantrone hydrochloride (generic)
CLASS Antineoplastic, MS drug
PREG/CONT D/NA

BBW Monitor CBC and LFTs carefully before and frequently during tx; dose adjustment
possible if myelosuppression severe. Monitor IV site for extravasation; if extravasation
occurs, stop and immediately restart at another site. Evaluate left ventricular ejection
fraction (LVEF) before each dose when treating MS. Evaluate yearly after tx ends to
detect late cardiac toxic effects; decreased LVEF, frank HF possible. Monitor BP, P,
cardiac output regularly during tx; start supportive care for HF at first sign of failure.
IND & DOSE Tx of acute nonlymphocytic leukemia as part of comb tx. Adult:
12 mg/m2/day IV on days 1–3, w/ 100 mg/m2 cytarabine for 7 days as continuous
infusion on days 1–7. Consolidation tx: Mitoxantrone 12 mg/m2 IV on days 1, 2, w/
cytarabine 100 mg/m2 as continuous 24-hr infusion on days 1–5. First course given 6 wk
after induction tx if needed. Second course generally given 4 wk after first course. Tx of
pain in advanced prostate cancer. Adult: 12–14 mg/m2 as short IV infusion q 21 days.
Tx of MS. Adult: 12 mg/m2 IV over 5–15 min q 3 mo; max cumulative lifetime dose,
140 mg/m2.
ADV EFF Alopecia, bone marrow depression, cough, fever, headache, HF,
hyperuricemia, n/v/d
NC/PT Handle drug w/ great care; gloves, gowns, goggles recommended. If drug contacts
skin, wash immediately w/ warm water. Clean spills w/ calcium hypochlorite sol.
Monitor CBC, uric acid level, LFTs. Not for use in pregnancy (barrier contraceptives
advised). Urine, whites of eyes may appear blue; should pass w/ time. Pt should avoid
exposure to infection, mark calendar for tx days, cover head at temp extremes (hair loss
possible), report swelling, signs of infection, unusual bleeding.

modafinil (Provigil)
CLASS CNS stimulant, narcolepsy drug
PREG/CONT C/C-IV

IND & DOSE Tx of narcolepsy; improvement in wakefulness in pts w/ obstructive

sleep apnea/hypopnea syndrome. Adult: 200 mg/day PO. Max, 400 mg/day. Tx of
shift-work sleep disorder. Adult: 200 mg/day PO 1 hr before start of shift.
ADJUST DOSE Elderly pts, hepatic impairment
ADV EFF Anorexia, anxiety, dry mouth, headache, insomnia, nervousness, Stevens-
Johnson syndrome
INTERACTIONS Hormonal contraceptives, phenytoin, TCAs, triazolam, warfarin
NC/PT Ensure accurate dx. Distribute least feasible amount of drug at any time to
decrease risk of overdose. Monitor LFTs. Not for use in pregnancy (barrier
contraceptives advised); pt using hormonal contraceptives should use second method
(drug affects hormonal contraceptives). Pt should take safety precautions w/ CNS
effects, report rash.

moexipril (Univasc)
CLASS ACE inhibitor, antihypertensive
PREG/CONT D/NA

BBW Do not give during pregnancy; serious fetal injury or death possible.
IND & DOSE Tx of hypertension. Adult: 7.5 mg/day PO 1 hr before meal; maint, 7.5–
30 mg/day PO 1 hr before meals. If pt receiving diuretic, stop diuretic for 2 or 3 days
before starting moexepril. If diuretic cannot be stopped, start w/ 3.75 mg; monitor for
symptomatic hypotension.
ADJUST DOSE Elderly pts, renal impairment
ADV EFF Aphthous ulcers, cough, diarrhea, dizziness, dysgeusia, flulike syndrome,
flushing, gastric irritation, MI, pancytopenia, peptic ulcers, proteinuria, pruritus, rash
INTERACTIONS Diuretics, lithium, potassium supplements
NC/PT Alert surgeon if surgery required; volume support may be needed. Monitor for BP
fall w/ drop in fluid volume. Not for use in pregnancy (barrier contraceptives advised).
Pt should perform mouth care for mouth ulcers, take safety precautions w/ CNS effects,
report chest pain, signs of infection.

montelukast sodium (Singulair)

CLASS Antiasthmatic, leukotriene receptor antagonist
PREG/CONT B/NA

IND & DOSE Px, long-term tx of asthma in pts 12 mo and older; relief of seasonal
allergic rhinitis sx in pts 2 yr and older; relief of perennial allergic rhinitis sx in
pts 6 mo and older; px of exercise-induced bronchoconstriction in pts 6 yr and
older. Adult, child 15 yr and older: 10 mg/day PO in p.m. For exercise-induced
bronchoconstriction, dose taken 2 hr before exercise, not repeated for at least 24 hr.
Child 6–14 yr: 5 mg/day chewable tablet PO in p.m. Child 2–5 yr: 4 mg/day chewable
tablet PO in p.m. Child 6–23 mo: 1 packet (4 mg)/day PO. For asthma only, 4 mg
granules/day PO in p.m.
ADV EFF Abd pain, behavior/mood changes, dizziness, fatigue, headache, nausea, URI
INTERACTIONS Phenobarbital
NC/PT Give in p.m. continually for best results. Not for acute asthma attacks. Pt should
have rescue medication for acute asthma, take safety precautions w/ CNS effects, report
increased incidence of acute attacks, changes in behavior/mood.

DANGEROUS DRUG
morphine sulfate (Avinza, DepoDur, Duramorph, Infumorph, Kadian, MS
Contin, Roxanol)
CLASS Opioid agonist analgesic
PREG/CONT C/C-II

BBW Caution pt not to chew, crush CR, ER, SR forms; ensure appropriate use of forms.
Do not substitute Infumorph for Duramorph; conc differs significantly, serious overdose
possible. Ensure pt observed for at least 24 hr in fully equipped, staffed environment if
given by epidural, intrathecal route; risk of serious adverse effects. Liposome
preparation for lumbar epidural injection only; do not give liposome intrathecally, IV,
IM.
IND & DOSE Relief of moderate to severe pain; analgesic adjunct during anesthesia;
preop medication. Adult: 5–30 mg PO q 4 hr. CR, ER, SR: 30 mg q 8–12 hr PO or as
directed by physician. Kadian, 20–100 mg/day PO. MS Contin, 200 mg PO q 12 hr.
Avinza, 30 mg/day PO; if opioid-naive, increase by 30-mg (or lower) increments q
4 days. Or, 10 mg (range, 5–20 mg) IM or subcut q 4 hr. Or, 10 mg IV q 4 hr (range, 5–
15 mg); usual daily dose, 12–120 mg. Or, 10–20 mg rectally q 4 hr. Child: 0.1–0.2 mg/kg
(max, 15 mg/dose) IM or subcut q 4 hr. Or, 0.05 to 0.1 mg/kg (max, 10 mg/dose) slowly
IV. Relief of intractable pain. Adult: 5 mg injected in lumbar region provides relief for
up to 24 hr; max, 10 mg/24 hr. For continuous infusion, initial dose of 2–4 mg/24 hr
recommended. Or, intrathecally, w/ dosage 1/10 epidural dosage; single injection of
0.2–1 mg may provide satisfactory relief for up to 24 hr. Do not inject more than 2 mL
of 5 mg/10-mL ampule or more than 1 mL of 10 mg/10-mL ampule. Use only in lumbar
area. Repeated intrathecal injections not recommended. Tx of pain after major
surgery. Adult: 10–15 mg liposome injection by lumbar epidural injection using catheter
or needle before major surgery or after clamping umbilical cord during cesarean birth.
ADJUST DOSE Elderly pts, impaired adults
ADV EFF Apnea, bronchospasm, cardiac arrest, circulatory depression, dizziness,
drowsiness, impaired mental capacity, injection-site irritation, laryngospasm, light-
headedness, n/v, respiratory arrest/depression, sedation, shock, sweating
INTERACTIONS Alcohol, barbiturate anesthetics
NC/PT Have opioid antagonist, facilities for assisted or controlled respiration on hand
during IV administration. Pt should lie down during IV use. Use caution when injecting
IM, subcut into chilled areas and in pts w/ hypotension, shock; impaired perfusion may
delay absorption. Excessive amount may be absorbed w/ repeated doses when
circulation restored. Pt should swallow CR, ER, SR forms whole and not cut, crush, or
chew them; store in secure place; take safety precautions w/ CNS effects, report
difficulty breathing.

moxifloxacin hydrochloride (Avelox, Moxeza, Vigamox)

CLASS Fluoroquinolone
PREG/CONT C/NA

BBW Increased risk of tendonitis, tendon rupture, especially in pts over 60 yr, pts taking
corticosteroids, pts w/ kidney, heart, lung transplant. Risk of exacerbated weakness in
pts w/ myasthenia gravis; avoid use w/ hx of myasthenia gravis.
IND & DOSE Tx of bacterial infections in adults caused by susceptible strains.
Pneumonia: 400 mg/day PO, IV for 7–14 days. Sinusitis: 400 mg/day PO, IV for 10 days.
Acute exacerbation of chronic bronchitis: 400 mg/day PO, IV for 5 days. Uncomplicated
skin, skin-structure infections: 400 mg/day PO for 7 days. Complicated skin, skin-structure
infections: 400 mg/day PO, IV for 7–21 days. Complicated intra-abdominal infections:
400 mg PO, IV for 5–14 days.
ADV EFF Bone marrow suppression, cough, dizziness, drowsiness, headache, insomnia,
n/v/d, photosensitivity, prolonged QT interval, rash, vision changes
INTERACTIONS Risk of prolonged QT w/ amiodarone, phenothiazines, procainamide,
quinidine, sotalol; do not combine. Antacids, didanosine, NSAIDs, sucralfate
NC/PT Culture before tx. Pt should take oral drug 4 hr before or 8 hr after antacids; stop
if severe diarrhea, rash; take safety precautions w/ CNS effects; avoid sun exposure;
report rash, unusual bleeding, severe GI problems.

mycophenolate mofetil (CellCept), mycophenolate sodium (Myfortic)

 CLASSImmunosuppressant
PREG/CONT D/NA

BBW Risk of serious to life-threatening infection. Protect from exposure to infections;

maintain sterile technique for invasive procedures. Monitor for possible lymphoma
development related to drug action.
IND & DOSE Px of organ rejection in allogeneic transplants. Renal. Adult: 1 g bid PO,
IV (over at least 2 hr) as soon as possible after transplant. Or, 720 mg PO bid on empty
stomach (Myfortic). Child: 600 mg/m2 oral suspension PO bid; max daily dose, 2
g/10 mL. Or, 400 mg/m2 PO bid; max, 720 mg bid (Myfortic). Cardiac. Adult: 1.5 g PO
bid, or IV (over at least 2 hr). Hepatic. Adult: l g IV bid over at least 2 hr, or 1.5 g PO
bid.
ADJUST DOSE Elderly pts; hepatic, renal impairment; cardiac dysfx
ADV EFF Anorexia, bone marrow suppression, constipation, headache, hepatotoxicity,
hypertension, infection, insomnia, n/v/d, photosensitivity, renal impairment
INTERACTIONS Antacids, cholestyramine, phenytoin, theophylline
NC/PT Intended for use w/ corticosteroids, cyclosporine. Do not mix w/ other drugs in
infusion. Monitor LFTs, renal function regularly. Do not confuse two brand names; not
interchangeable. Not for use in pregnancy (barrier contraceptives advised). Pt should
swallow DR form whole and not cut, crush, or chew it; avoid exposure to sun, infection;
get cancer screening; report signs of infection, unusual bleeding.

nabilone (Cesamet)
CLASS Antiemetic, cannabinoid
PREG/CONT C/C-II

IND & DOSE Tx of n/v associated w/ chemotherapy in pts unresponsive to

conventional antiemetics. Adult: 1–2 mg PO bid. Give initial dose 1–3 hr before
chemotherapy. Max, 6 mg/day PO divided tid. May give daily during each
chemotherapy cycle and for 48 hr after last dose in cycle, if needed. Risk of altered
mental state; supervise pt closely.
ADV EFF Ataxia, concentration difficulties, drowsiness, dry mouth, euphoria, orthostatic
hypotension, vertigo
INTERACTIONS Alcohol, amitriptyline, amoxapine, amphetamines, anticholinergics,
antihistamines, atropine, barbiturates, benzodiazepines, buspirone, CNS depressants,
cocaine, desipramine, lithium, muscle relaxants, opioids, scopolamine,
sympathomimetics, TCAs
NC/PT Risk of altered mental state; supervise pt closely; stop w/ sx of psychotic reaction.
Use caution in pregnancy, breast-feeding. Warn pt possible altered mental state may
persist for 2–3 days after use. Pt should take safety measures w/ CNS effects, avoid
alcohol, report all drugs used (interactions possible), chest pain, psychotic episodes.

nabumetone (generic)
CLASS NSAID
PREG/CONT C (1st, 2nd trimesters); D (3rd trimester)/NA

BBW Increased risk of CV events, GI bleeding; monitor accordingly. Not for use for
periop pain after CABG surgery.
IND & DOSE Tx of s&sx of rheumatoid arthritis, osteoarthritis. Adult: 1,000 mg PO as
single dose w/ or without food; 1,500–2,000 mg/day has been used.
ADJUST DOSE Renal impairment
ADV EFF Anaphylactic shock, bone marrow suppression, bronchospasm, dizziness,
dyspepsia, GI pain, headache, insomnia, n/v/d, rash, renal impairment
INTERACTIONS Aspirin, warfarin
NC/PT Pt should take w/ food, take safety precautions w/ CNS effects, report swelling,
signs of infection, difficulty breathing.

nadolol (Corgard)
CLASS Antianginal, antihypertensive, beta blocker
PREG/CONT C/NA

IND & DOSE Tx of hypertension; mgt of angina. Adult: 40 mg/day PO; gradually
increase in 40- to 80-mg increments. Maint, 40–80 mg/day.
ADJUST DOSE Elderly pts, renal failure
ADV EFF Cardiac arrhythmias, constipation, decreased exercise tolerance/libido, diarrhea,
dizziness, ED, flatulence, gastric pain, HF, laryngospasm, n/v/d, pulmonary edema,
stroke
INTERACTIONS Alpha-adrenergic blockers, clonidine, dihydroergotamine, epinephrine,
ergotamine, lidocaine, NSAIDs, theophylline, verapamil
NC/PT To discontinue, reduce gradually over 1–2 wk. Alert surgeon if surgery required;
volume replacement may be needed. Pt should take safety precautions w/ CNS effects,
report difficulty breathing, numbness, confusion.

nafarelin acetate (Synarel)

CLASS GnRH
PREG/CONT X/NA

IND & DOSE Tx of endometriosis. Adult: 400 mcg/day: One spray (200 mcg) into one
nostril in a.m., 1 spray into other nostril in p.m. Start tx between days 2, 4 of menstrual
cycle. May give 800-mcg dose as 1 spray into each nostril in a.m. (total of 2 sprays) and
again in p.m. for pts w/ persistent regular menstruation after 2 mo of tx. Tx for 6 mo
recommended. Retreatment not recommended. Tx of central precocious puberty.
Child: 1,600 mcg/day: Two sprays (400 mcg) in each nostril in a.m., 2 sprays in each
nostril in p.m.; may increase to 1,800 mcg/day. If 1,800 mcg needed, give 3 sprays into
alternating nostrils three times/day. Continue until resumption of puberty desired.
ADV EFF Androgenic effects, dizziness, headache, hypoestrogenic effects, nasal irritation,
rash
NC/PT Rule out pregnancy before tx. Store upright, protected from light. Begin
endometriosis tx during menstrual period, between days 2, 4. Advise barrier
contraceptives. Low estrogen effects, masculinizing effects possible (some may not be
reversible). If nasal decongestant used, use at least 2 hr before dose. Pt should not
interrupt tx; report nasal irritation, unusual bleeding.

DANGEROUS DRUG
nalbuphine hydrochloride (Nubain)
CLASS Opioid agonist-antagonist analgesic
PREG/CONT B; D (long-term use, high doses)/NA

IND & DOSERelief of moderate to severe pain. Adult, 70 kg: 10 mg IM, IV, subcut q 3–
6 hr as needed. Supplement to anesthesia. Adult: Induction, 0.3–3 mg/kg IV over 10–
15 min; maint, 0.25–0.5 mg/kg IV.
ADJUST DOSE Hepatic, renal impairment
ADV EFF Bradycardia, dizziness, drowsiness, dry mouth, headache, hypotension, n/v,
respiratory depression, sweating, vertigo
INTERACTIONS Barbiturate anesthetics
NC/PT Taper when stopping after prolonged use to avoid withdrawal symptoms. Have
opioid antagonist, facilities for assisted or controlled respiration on hand for respiratory
depression. Pt should take safety precautions w/ CNS effects, report difficulty breathing.

naloxone hydrochloride (generic)

CLASS Diagnostic agent, opioid antagonist
PREG/CONT C/NA

IND & DOSE Complete, partial reversal of opioid depression from opioid overdose.
Adult: 0.4–2 mg IV; may repeat at 2- to 3-min intervals. If no response after 10 mg,
question dx. May use IM, subcut if IV route unavailable. Child: 0.01 mg/kg IV, IM,
subcut. May give subsequent 0.1 mg/kg if needed. Reversal of postop opioid
depression. Adult: 0.1–0.2 mg IV at 2- to 3-min intervals until desired degree of
reversal. Child: Inject in increments of 0.005–0.01 mg IV at 2- to 3-min intervals to
desired degree of reversal.
ADV EFF Hypertension, hypotension, n/v, pulmonary edema, sweating, tachycardia,
tremors, ventricular fibrillation
NC/PT Monitor continually after use. Maintain open airway, provide life support as
needed. Pt should report sweating, tremors.

naltrexone hydrochloride (ReVia, Vivitrol)

CLASS Opioid antagonist
PREG/CONT C/NA

BBW Obtain periodic LFTs during tx; stop tx if increasing hepatic impairment (risk of
hepatocellular injury).
IND & DOSE Naloxone challenge. Adult: Draw 2 mL (0.8 mg) into syringe; inject 0.5 mL
(0.2 mg) IV. Leave needle in vein; observe for 30 sec. If no withdrawal s&sx, inject
remaining 1.5 mL (0.6 mg); observe for 20 min for withdrawal s&sx. Or, 2 mL (0.8 mg)
naloxone subcut; observe for withdrawal s&sx for 20 min. If withdrawal s&sx occur or if
any doubt pt opioid free, do not administer naltrexone. Adjunct to tx of
alcohol/opioid dependence. Adult: 50 mg/day PO. Or, 380 mg IM q 4 wk into upper
outer quadrant of gluteal muscle (Vivitrol); alternate buttock w/ each dose. Px of
relapse to opioid dependence after opioid detoxification. Adult: 25 mg PO. Observe
for 1 hr. If no s&sx, complete dose w/ 25 mg; maint, 50 mg/24 hr PO. Can use flexible
dosing schedule w/ 100 mg q other day or 150 mg q third day.
ADV EFF Abd pain, anxiety, chills, delayed ejaculation, joint/muscle pain, headache,
hepatocellular injury, increased thirst, insomnia, n/v, nervousness
INTERACTIONS Opioid-containing products
NC/PT Do not use until pt opioid free for 7–10 days; check urine opioid levels. Do not
give until pt has passed naloxone challenge. Ensure active participation in
comprehensive tx program. Large opioid doses may overcome blocking effect but could
cause serious injury, death. Pt should wear medical ID, take safety precautions w/ CNS
effects, report unusual bleeding, urine/stool color changes.

naproxen (Naprelan, Naprosyn), naproxen sodium (Aleve, Anaprox)

CLASS Analgesic, NSAID
PREG/CONT C/NA

BBW Increased risk of CV events, GI bleeding; monitor accordingly. Contraindicated for

periop pain after CABG surgery; serious complications possible.
IND & DOSE Tx of rheumatoid arthritis, osteoarthritis, ankylosing spondylitis. Adult:
375–500 mg DR tablet PO bid; or 750–1,000 mg/day CR tablet PO; or 275–550 mg
naproxen sodium PO bid (may increase to 1.65 g/day for limited time); or 250–500 mg
naproxen PO bid; or 250 mg (10 mL), 375 mg (15 mL), 500 mg (20 mL) naproxen
suspension PO bid. Tx of acute gout. Adult: 1,000–1,500 mg/day CR tablet PO; or
825 mg naproxen sodium PO then 275 mg q 8 hr until attack subsides; or 750 mg
naproxen PO then 250 mg q 8 hr until attack subsides. Tx of mild to moderate pain.
Adult: 1,000 mg/day CR tablet PO; or 550 mg naproxen sodium PO then 275 mg q 6–
8 hr; or 500 mg naproxen PO then 500 mg q 12 hr; or 250 mg naproxen PO q 6–8 hr; or
OTC products 200 mg PO q 8–12 hr w/ full glass of liquid while sx persist (max, 600
mg/24 hr). Tx of juvenile arthritis. Child: 10 mg/kg/day naproxen PO in two divided
doses.
ADJUST DOSE Elderly pts
ADV EFF Anaphylactoid reactions to anaphylactic shock, bone marrow suppression,
bronchospasm, dizziness, dyspepsia, GI pain, headache, insomnia, nausea, somnolence
INTERACTIONS Lithium
NC/PT Pt should not cut, crush, or chew DR, CR forms; take w/ food for GI upset; take
safety precautions w/ CNS effects; report difficulty breathing, swelling, black tarry
stools.

naratriptan (Amerge)
CLASS Antimigraine, triptan
PREG/CONT C/NA

IND & DOSE Tx of acute migraine attacks. Adult: 1 or 2.5 mg PO; may repeat in 4 hr if
needed. Max, 5 mg/24 hr.
ADJUST DOSE Hepatic, renal impairment
ADV EFF Chest pain, CV events, dizziness, drowsiness, headache, neck/throat/jaw
discomfort
INTERACTIONS Ergots, hormonal contraceptives, SSRIs
NC/PT For acute attack only; not for px. Monitor BP w/ known CAD. Not for use in
pregnancy (barrier contraceptives advised). Pt should take safety measures w/ CNS
effects, continue usual migraine measures, report chest pain, visual changes, severe
pain.

natalizumab (Tysabri)
CLASS Monoclonal antibody, MS drug
PREG/CONT C/NA

BBW Increased risk of possibly fatal progressive multifocal leukoencephalopathy (PML).

Monitor closely for PML; stop drug immediately if signs occur. Drug available only to
prescribers and pts in TOUCH prescribing program; pts must understand risks, need for
close monitoring. Risk increases w/ number of infusions. Risk of immune reconstitution
inflammatory syndrome in pts who developed PML and stopped drug.
IND & DOSE Tx of relapsing MS; tx of Crohn’s disease in pts unresponsive to other tx.
Adult: 300 mg by IV infusion over 1 hr q 4 wk.
ADV EFF Abd pain, anaphylactic reactions, arthralgia, depression, diarrhea, dizziness,
fatigue, gastroenteritis, hepatotoxicity, increased WBCs, lower respiratory tract
infections, PML
INTERACTIONSCorticosteroids, TNF blockers
NC/PT Withhold drug at s&sx of PML. Ensure pt not immune-suppressed or taking
immunosuppressants. Refrigerate vials, protect from light. Monitor continually during
infusion. Not for use in pregnancy (barrier contraceptives advised), breast-feeding. Pt
should mark calendar of tx days, avoid exposure to infection, report signs of infection,
changes in eyesight/thinking.

DANGEROUS DRUG
nateglinide (Starlix)
CLASS Antidiabetic, meglitinide
PREG/CONT C/NA

IND & DOSEAdjunct to diet, exercise to lower blood glucose in type 2 diabetes, alone
or w/ metformin, thiazolidinedione. Adult: 120 mg PO tid 1–30 min before meals;
may try 60 mg PO tid if pt near HbA1c goal.
ADV EFF Dizziness, headache, hypoglycemia, nausea, URI
INTERACTIONS Beta blockers, MAOIs, NSAIDs, salicylates
NC/PT Monitor serum glucose, HbA1c frequently to determine effectiveness of drug, dose
being used. Arrange for thorough diabetic teaching program; ensure diet, exercise
protocols. Pt should report unusual bleeding, severe abd pain.

nebivolol (Bystolic)
CLASS Antihypertensive, beta blocker
PREG/CONT C/NA

IND & DOSE Tx of hypertension. Adult: 5 mg/day PO; may increase at 2-wk intervals to
max 40 mg/day PO
ADJUST DOSE Hepatic, renal impairment
ADV EFF Bradycardia, chest pain, dizziness, dyspnea, headache, hypotension
INTERACTIONS Antiarrhythmics, beta blockers, catecholamine-depleting drugs, clonidine,
CYP2D6 inducers/inhibitors, digoxin, diltiazem, verapamil
NC/PT Do not stop abruptly after long-term tx; taper gradually over 2 wk while
monitoring pt. Use caution in pregnancy; not for use in breast-feeding. Pt should take
safety precautions w/ CNS effects, report difficulty breathing, fainting.

nefazodone (generic)
CLASS Antidepressant
PREG/CONT C/NA

BBW Increased risk of suicidality in children, adolescents, young adults; monitor

accordingly. Risk of severe to fatal liver failure; do not use if s&sx of hepatic
impairment. Monitor closely; stop at first sign of liver failure.
IND & DOSE Tx of depression. Adult: 200 mg/day PO in divided doses; range, 300–
600 mg/day.
ADJUST DOSE Elderly pts, hepatic impairment
ADV EFF Abnormal vision, agitation, asthenia, confusion, constipation, dizziness, dry
mouth, hepatic failure, insomnia, light-headedness, mania, nausea, orthostatic
hypotension, priapism, seizures, suicidality
INTERACTIONS MAOIs, triazolam. Contraindicated w/ astemizole, carbamazepine,
cisapride, pimozide, terfenadine.
NC/PT Monitor LFTs before, regularly during tx. Ensure no MAOI use within 14 days. Use
caution in pregnancy, breast-feeding. Pt should avoid antihistamines, take safety
precautions w/ CNS effects, report all drugs being used, urine/stool color changes,
thoughts of suicide.

DANGEROUS DRUG
nelarabine (Arranon)
CLASS Antimitotic, antineoplastic
PREG/CONT D/NA

BBW Monitor for neurologic toxicity including neuropathies, demyelinating disorders.

Stop if neurotoxicity; effects may not be reversible.
IND & DOSE Tx of T-cell acute lymphoblastic anemia, T-cell lymphoblastic
lymphoma. Adult: 1,500 mg/m2 IV over 2 hr on days 1, 3, 5; repeat q 21 days. Child:
650 mg/m2/day IV over 1 hr for 5 consecutive days; repeat q 21 days.
ADJUST DOSE Hepatic, renal impairment
ADV EFF Bone marrow suppression, constipation, cough, dizziness, fatigue, fever,
neurotoxicity, n/v/d, somnolence
INTERACTIONS Live vaccines
NC/PT Monitor neuro function before, regularly during tx; stop if sign of neurotoxicity.
Not for use in pregnancy (barrier contraceptives advised). Pt should avoid exposure to
infection, take safety precautions w/ CNS effects, report numbness/tingling, unusual
bleeding, signs of infection.

nelfinavir mesylate (Viracept)

CLASS Antiviral, protease inhibitor
PREG/CONT B/NA

IND & DOSETx of HIV infection w/ other drugs. Adult, child over 13 yr: 750 mg PO tid, or
1,250 mg PO bid. Max, 2,500 mg/day. Child 2–13 yr: 45–55 mg/kg PO bid, or 25–35
mg/kg PO tid.
ADV EFF Anorexia, anxiety, diarrhea, dizziness, GI pain, nausea, seizures, sexual dysfx
INTERACTIONS Carbamazepine, dexamethasone, grapefruit juice, hormonal contraceptives,
phenobarbital, phenytoin, rifabutin, St. John’s wort. Avoid use w/ amiodarone, ergot
derivatives, lovastatin, midazolam, pimozide, rifampin, quinidine, simvastatin,
triazolam.
NC/PT Given w/ other antivirals. Interferes w/ hormonal contraceptives (barrier
contraceptives advised). Pt should take w/ light meal, snack; avoid grapefruit juice, St.
John’s wort; take safety precautions w/ CNS effects; use precautions to avoid infections,
prevent transmission (drug not a cure). Name confusion between Viracept (nelfinavir)
and Viramune (nevirapine); use caution.

neomycin sulfate (Mycifradin, Neo-fradin, Neo-Tabs)

CLASS Aminoglycoside
PREG/CONT D/NA

IND & DOSE Preop suppression of GI bacteria for colorectal surgery. Adult: See
manufacturer’s recommendations for complex 3-day regimen that includes oral
erythromycin, bisacodyl, magnesium sulfate, enemas, dietary restrictions. Adjunct tx in
hepatic coma to reduce ammonia-forming bacteria in GI tract. Adult: 12 g/day PO
in divided doses for 5–6 days as adjunct to protein-free diet, supportive tx. Child: 50–100
mg/kg/day PO in divided doses for 5–6 days as adjunct to protein-free diet, supportive
tx.
ADJUST DOSE Elderly pts, renal failure
ADV EFF Anorexia, leukemoid reaction, n/v, ototoxicity, pain, rash, superinfection
INTERACTIONS Beta-lactam antibiotics, citrate-anticoagulated blood, carbenicillin,
cephalosporins, digoxin, diuretics, NMJ blockers, other aminoglycosides, penicillins,
succinylcholine, ticarcillin
NC/PT Ensure hydration. Pt should report hearing changes, dizziness.

neostigmine bromide (generic), neostigmine methylsulfate (Prostigmin)

CLASS Antidote, parasympathomimetic, urinary tract drug
PREG/CONT C/NA

IND & DOSE Px of postop distention, urine retention. Adult: 0.25 mg methylsulfate
subcut, IM as soon as possible postop. Repeat q 4–6 hr for 2–3 days. Tx of postop
distention. Adult: 1 mL 1:2,000 sol (0.5 mg) methylsulfate subcut, IM. Tx of urine
retention. Adult: 1 mL 1:2,000 sol (0.5 mg) methylsulfate subcut, IM. After bladder
emptied, continue 0.5-mg injections q 3 hr for at least five injections. Symptomatic
control of myasthenia gravis. Adult: 1 mL 1:2,000 sol (0.5 mg) subcut, IM. Use w/
atropine to counteract adverse muscarinic effects. Or, 15–375 mg/day tablets PO;
average dose, 150 mg/day. Child: 0.01–0.04 mg/kg per dose IM, IV, subcut q 2–3 hr as
needed. Or, 2 mg/kg/day tablets PO q 3–4 hr as needed. Antidote for NMJ blockers.
Adult: 0.6–1.2 mg atropine IV several min before slow neostigmine IV injection of 0.5–2
mg. Repeat as needed. Max, 5 mg. Child: 0.008–0.025 mg/kg atropine IV several min
before slow neostigmine IV injection of 0.025–0.08 mg/kg.
ADV EFF Abd cramps, bronchospasm, cardiac arrest, cardiac arrhythmias, dizziness,
drowsiness, dysphagia, increased peristalsis, increased pharyngeal/tracheobronchial
secretions, increased salivation/lacrimation, laryngospasm, miosis, nausea, urinary
frequency/incontinence, vomiting
INTERACTIONS Aminoglycosides, corticosteroids, succinylcholine
NC/PT Have atropine sulfate on hand as antidote and antagonist in case of cholinergic
crisis, hypersensitivity reaction. Stop drug, consult physician for excessive salivation,
emesis, frequent urination, diarrhea. Give IV slowly. Pt should take safety precautions
w/ CNS effects, report excessive sweating/salivation, difficulty breathing, muscle
weakness.

nesiritide (Natrecor)
CLASS Human B-type natriuretic peptide, vasodilator
PREG/CONT C/NA

IND & DOSE Tx of acutely decompensated HF. Adult: 2 mcg/kg IV bolus, then
0.01 mcg/kg/min IV infusion for no longer than 48 hr.
ADV EFF Azotemia, headache, hypotension, tachycardia
INTERACTIONS ACE inhibitors
NC/PT Replace reconstituted drug q 24 hr. Monitor continuously during administration.
Monitor renal function regularly. Maintain hydration.

nevirapine (Viramune)
CLASS Antiviral, nonnucleoside reverse transcriptase inhibitor
PREG/CONT B/NA

BBW Monitor LFTs, renal function before, during tx. Stop if s&sx of hepatic impairment;
severe to life-threatening hepatotoxicity possible (greatest risk at 6–18 wk of tx).
Monitor closely. Do not give if severe rash occurs, especially w/ fever, blisters, lesions,
swelling, general malaise; stop if rash recurs on rechallenge. Severe to life-threatening
reactions possible; risk greatest at 6–18 wk of tx.
IND & DOSE Tx of HIV-1 infection w/ other drugs. Adult: 200 mg/day PO for 14 days; if
no rash, then 200 mg PO bid. Or, 400 mg/day PO ER tablet. Max, 400 mg/day. Child
15 days and over: 150 mg/m2 PO once daily for 14 days, then 150 mg/m2 PO bid.
ADV EFF Fat redistribution, headache, hepatic impairment including hepatitis, hepatic
necrosis, n/v/d, rash, Stevens-Johnson syndrome, toxic epidermal necrolysis
INTERACTIONS Clarithromycin, hormonal contraceptives, itraconazole, ketoconazole,
protease inhibitors, rifampin, St. John’s wort
NC/PT Give w/ nucleoside analogues. Do not switch to ER form until pt stabilized on
immediate-release form (14 days). Shake suspension gently before use; rinse oral dosing
cup and have pt drink rinse. Not for use in pregnancy (barrier contraceptives advised).
Pt should swallow ER tablet whole and not cut, crush, or chew it; be aware drug not a
cure, continue preventive measures, other drugs for HIV; report rash, urine/stool color
changes. Name confusion between Viramune (nevirapine) and Viracept (nelfinavir); use
caution.

niacin (Niacor, Niaspan, Slo-Niacin)

CLASS Antihyperlipidemic, vitamin
PREG/CONT C/NA

IND & DOSE Tx of dyslipidemias. Adult, child over 16 yr: 100 mg PO tid, increased to
1,000 mg PO tid (immediate-release form); 500 mg/day PO at bedtime for 4 wk, then
1,000 mg/day PO at bedtime for another 4 wk (ER form); titrate to pt response,
tolerance. Max, 2,000 mg/day; 1,000–2,000 mg/day PO (SR form). Child under 16 yr:
100–250 mg/day PO in three divided doses w/ meals; may increase at 2- to 3-wk
intervals to max 10 mg/kg/day (immediate-release form). Tx of CAD, post MI. Adult:
500 mg/day PO at bedtime, titrated at 4-wk intervals to max 1,000–2,000 mg/day. Tx
of pellagra. Adult, child: 50–100 mg PO tid to max 500 mg/day.
ADV EFF Flushing, GI upset, glucose intolerance, hyperuricemia, n/v/d, rash
INTERACTIONS Anticoagulants, antihypertensives, bile acid sequestrants, statins,
vasoactive drugs
NC/PT Do not substitute ER form for immediate-release form at equivalent doses; severe
hepatotoxicity possible. ASA 325 mg 30 min before dose may help flushing. Pt should
take at bedtime, avoid hot foods/beverages, alcohol around dose time to decrease
flushing; maintain diet, exercise program; report rash, unusual bleeding/bruising.

niCARdipine hydrochloride (Cardene)

CLASS Antianginal, antihypertensive, calcium channel blocker
PREG/CONT C/NA

IND & DOSETx of chronic, stable angina. Adult: Immediate-release only, 20 mg PO tid;
range, 20–40 mg PO tid. Tx of hypertension. Adult: Immediate-release, 20 mg PO tid;
range, 20–40 mg tid. SR, 30 mg PO bid; range, 30–60 mg bid. Or, 5 mg/hr IV. Increase
by 2.5 mg/hr IV q 15 min to max 15 mg/hr. For rapid reduction, begin infusion at 5
mg/hr; switch to oral form as soon as possible.
ADJUST DOSE Hepatic, renal impairment
ADV EFF Asthenia, bradycardia, dizziness, flushing, headache, heart block, light-
headedness, nausea
INTERACTIONS Cyclosporine, nitrates
NC/PT Monitor closely when titrating to therapeutic dose. Pt should have small, frequent
meals for GI complaints; take safety precautions w/ CNS effects; report irregular
heartbeat, shortness of breath.
 nicotine (Nicoderm, Nicotrol)
CLASS Smoking deterrent
PREG/CONT D/NA

IND & DOSE Temporary aid to give up cigarette smoking. Adult: Apply transdermal
system, 5–21 mg, q 24 hr. Nicoderm: 21 mg/day for first 6 wk; 14 mg/day for next 2 wk;
7 mg/day for next 2 wk. Nicotrol: 15 mg/day for first 6 wk; 10 mg/day for next 2 wk;
5 mg/day for last 2 wk. Or nasal spray, 1 spray in each nostril as needed, one to two
doses/hr; max, five doses/hr, 40 doses/day. Or nasal inhaler, 1 spray in each nostril,
one to two doses/hr. Max, 5 doses/hr, 40 doses/day; use for no longer than 6 mo. Treat
for 12 wk, then wean over next 6–12 wk.
ADV EFF Cough, dizziness, GI upset, headache, insomnia, light-headedness, local reaction
to patch
INTERACTIONS Adrenergic agonists, adrenergic blockers, caffeine, furosemide, imipramine,
pentazocine, theophylline
NC/PT Ensure pt has stopped smoking, is using behavioral modification program. Protect
dermal system from heat. Apply to nonhairy, clean, dry skin. Remove old system before
applying new one; rotate sites. Wrap old system in foil pouch, fold over, dispose of
immediately. If nasal spray contacts skin, flush immediately. Dispose of bottle w/ cap
on. Pt should take safety precautions w/ CNS effects, report burning/swelling at dermal
system site, chest pain.

nicotine polacrilex (Nicorette, Nicotine Gum)

CLASS Smoking deterrent
PREG/CONT C/NA

IND & DOSE Temporary aid to give up cigarette smoking. Adult: Chewing gum—under
25 cigarettes/day, 2 mg; over 25 cigarettes/day, 4 mg. Have pt chew one piece when
urge to smoke occurs; 10 pieces daily often needed during first month. Max, 24
pieces/day no longer than 4 mo. Lozenge—2 mg if first cigarette over 30 min after
waking; 4 mg if first cigarette within 30 min of waking. Wk 1–6, 1 lozenge q 1–2 hr; wk
7–9, 1 lozenge q 2–4 hr; wk 10–12, 1 lozenge q 4–8 hr. Max, 5 lozenges in 6 hr or
20/day.
ADV EFF Dizziness, GI upset, headache, hiccups, light-headedness, mouth/throat soreness,
n/v
INTERACTIONS Adrenergic agonists, adrenergic blockers, caffeine, furosemide, imipramine,
pentazocine, theophylline
NC/PT For gum, have pt chew each piece slowly until it tingles, then place between cheek
and gum. When tingle gone, have pt chew again, repeat process. Gum usually lasts for
about 30 min to promote even, slow, buccal absorption of nicotine. For lozenge, have pt
place in mouth, let dissolve over 20–30 min. Pt should avoid eating, drinking anything
but water for 15 min before use. Taper use at 3 mo. Pt should not smoke (behavioral tx
program advised), take safety precautions w/ CNS effects, report hearing/vision
changes, chest pain.

NIFEdipine (Adalat, Nifediac, Procardia)

CLASS Antianginal, antihypertensive, calcium channel blocker
PREG/CONT C/NA

IND & DOSE Tx of angina. Adult: 10 mg PO tid; range, 10–20 mg tid. Max, 180 mg/day.
Tx of hypertension. Adult: 30–60 mg/day ER tablet PO; max, 90–120 mg/day.
ADV EFF Angina, asthenia, AV block, constipation, cough, dizziness, fatigue, flushing,
headache, light-headedness, mood changes, nasal congestion, nervousness, n/v,
peripheral edema, tremor, weakness
INTERACTIONS Cimetidine, grapefruit juice
NC/PT Monitor closely while adjusting dose. Pt should swallow ER tablet whole and not
cut, crush, or chew it; avoid grapefruit juice; take safety precautions w/ CNS effects;
report irregular heartbeat, swelling of hands/feet.

nilotinib (Tasigna)
CLASS Antineoplastic, kinase inhibitor
PREG/CONT D/NA

BBW Risk of prolonged QT interval, sudden death. Increased risk w/ hypokalemia,

hypomagnesemia, known prolonged QT interval, use of strong CYP3A4 inhibitors.
IND & DOSE Tx of Philadelphia chromosome–positive CML. Adult: 300–400 mg PO bid
12 hr apart on empty stomach.
ADJUST DOSE Hepatic impairment
ADV EFF Abd pain, anorexia, bone marrow suppression, constipation, fatigue,
headache, hepatic dysfx, nasopharyngitis, n/v/d, pain, prolonged QT, rash, sudden
death, tumor lysis syndrome
INTERACTIONS Proton pump inhibitors, QT-prolonging drugs, strong CYP3A4
inducers/inhibitors, St. John’s wort
NC/PT Obtain baseline, periodic ECG, QT measurement. Not for use in pregnancy
(barrier contraceptives advised), breast-feeding, long-term tx. Pt should avoid exposure
to infection; report all drugs/herbs being used, urine/stool color changes, signs of
infection, unusual bleeding.

nimodipine (Nymalize)
CLASS Calcium channel blocker
PREG/CONT C/NA

BBW Do not give parenterally; serious to fatal reactions have occurred.

IND & DOSE To improve neurologic outcomes after subarachnoid hemorrhage from
ruptured aneurysm. Adult: 60 mg PO q 4 hr for 21 days.
ADJUST DOSE Hepatic impairment
ADV EFF Bradycardia, hypotension, diarrhea
INTERACTIONS Antihypertensives, CYP3A4 inducers/inhibitors
NC/PT If pt unable to swallow capsule, may extract drug from capsule using syringe, give
through NG or PEG tube, then flush w/ normal saline. Do not give parenterally. Monitor
carefully; provide life support as needed.

nisoldipine (Sular)
CLASS Antihypertensive, calcium channel blocker
PREG/CONT C/NA

IND & DOSETx of hypertension. Adult: 17 mg/day PO; increase in wkly increments of 8.5
mg/wk until BP controlled; range, 17–34 mg/day PO Max, 34 mg/day.
ADJUST DOSE Elderly pts, hepatic impairment
ADV EFF Angina, asthenia, dizziness, edema, fatigue, headache, high-fat meals, light-
headedness, MI, nausea
INTERACTIONS Cimetidine, cyclosporine, grapefruit juice, quinidine
NC/PT Monitor closely when titrating to therapeutic dose. Pt should swallow tablet whole
and not cut, crush, or chew it; take w/ meals; avoid grapefruit juice, high-fat meals;
report chest pain, shortness of breath.

nitazoxanide (Alinia)
CLASS Antiprotozoal
PREG/CONT B/NA

IND & DOSE Tx of diarrhea caused by Giardia lamblia. Adult, child 12 yr and older:
500 mg PO q 12 hr w/ food, or 25 mL (500 mg) suspension PO q 12 hr w/ food. Child 4–
11 yr: 10 mL (200 mg) suspension PO q 12 hr w/ food. Child 1–3 yr: 5 mL (100 mg)
suspension PO q 12 hr w/ food. Tx of diarrhea caused by Cryptosporidium parvum.
Child 4–11 yr: 10 mL (200 mg) PO q 12 hr w/ food. Child 1–3 yr: 5 mL (100 mg)
suspension PO q 12 hr w/ food.
ADV EFF Abd pain, diarrhea, headache, vomiting
NC/PT Culture before tx. Ensure hydration. Pt should take w/ food, report continued
diarrhea, vomiting.

nitrofurantoin (Macrobid, Macrodantin)

CLASS Antibacterial, urinary tract anti-infective
PREG/CONT B/NA

IND & DOSE Tx of UTIs. Adult: 50–100 mg PO qid for 10–14 days, or 100 mg PO bid for 7
days (Macrobid). Max, 400 mg/day. Child over 1 mo: 5–7 mg/kg/day in four divided
doses PO. Long-term suppression of UTIs. Adult: 50–100 mg PO at bedtime. Child: 1
mg/kg/day PO in one or two doses.
ADV EFF Abd pain, bone marrow suppression, dizziness, drowsiness, hepatotoxicity,
n/v/d, pulmonary hypersensitivity, rash, Stevens-Johnson syndrome,
superinfections
NC/PT Culture before tx. Monitor CBC, LFTs regularly. Monitor pulmonary function.
Urine may be brown or yellow-green. Pt should take w/ food or milk, complete full
course, take safety precautions w/ CNS effects, report difficulty breathing.

nitroglycerin (Minitran, Nitrek, Nitro-Bid, Nitro-Dur, Nitrolingual Pumpspray,

Nitrostat, Nitro-Time, Rectiv)
CLASS Antianginal, nitrate
PREG/CONT C/NA

IND & DOSE Tx of acute anginal attack. Adult: 1 sublingual tablet under tongue or in
buccal pouch at first sign of anginal attack, let dissolve; repeat q 5 min until relief
obtained. No more than 3 tablets/15 min. Or, for translingual spray: Spray preparation
delivers 0.4 mg/metered dose. At onset of attack, one to two metered doses sprayed into
oral mucosa; no more than three doses/15 min. Px of angina attacks. Adult:
Sublingual, 1 tablet 5–10 min before activities that might precipitate attack. Buccal, 1
tablet between lip, gum; allow to dissolve over 3–5 min. Tablet should not be
chewed/swallowed. Initial dose, 1 mg q 5 hr while awake; maint, 2 mg tid. SR tablet,
2.5–9 mg q 12 hr; max, 26 mg qid. Topical, ½ inch q 8 hr. Increase by ½ inch to achieve
desired results. Usual dose, 1–2 inches q 8 hr; max 4–5 inches q 4 hr has been used.
1 inch ½ 15 mg nitroglycerin. Transdermal, one patch applied each day. Translingual
spray, one to two metered doses sprayed into oral mucosa 5–10 min before activity that
might precipitate attack. Tx of moderate to severe pain associated w/ anal fissure.
Adult: 1 inch ointment intra-anally q 12 hr for 3 wk (Rectiv). Tx of periop
hypertension, HF associated w/ MI, angina unresponsive to nitrates, beta
blockers. Adult: 5 mcg/min IV through infusion pump. Increase by 5-mcg/min
increments q 3–5 min as needed. If no response at 20 mcg/min, increase increments to
10–20 mcg/min.
ADV EFF Abd pain, angina, apprehension, faintness, headache, hypotension, local
reaction to topical use, n/v, rash
INTERACTIONS Ergots, heparin, sildenafil, tadalafil, vardenafil
NC/PT Review proper administration of each form. Sublingual should “fizzle” under
tongue; replace q 6 mo. Withdraw gradually after long-term use. Pt may relieve
headache by lying down. Pt should not cut, crush, or chew SR tablet; apply topical to
clean, dry, hair-free area (remove old patch before applying new one); take safety
precautions w/ CNS effects; report unrelieved chest pain, severe headache. Name
confusion between NitroBid (nitroglycerin) and Nicotrol (nicotine), nitroglycerin and
nitroprusside; use caution.

nitroprusside sodium (Nitropress)

CLASS Antihypertensive, vasodilator
PREG/CONT C/NA

BBW Monitor BP closely. Do not let BP drop too rapidly; do not lower systolic BP below
60 mm Hg. Monitor blood acid-base balance (metabolic acidosis early sign of cyanide
toxicity), serum thiocyanate level daily during prolonged tx, especially w/ renal
impairment.
IND & DOSE Tx of hypertensive crises; controlled hypotension during anesthesia; tx
of acute HF. Adult, child: Not on antihypertensive: Average dose, 3 mcg/kg/min IV;
range, 0.3–10 mcg/kg/min. At this rate, diastolic BP usually lowered by 30%–40%
below pretreatment diastolic level. Use smaller doses in pts on antihypertensive. Max
infusion rate, 10 mcg/kg/min. If this rate does not reduce BP within 10 min, stop drug.
ADJUST DOSE Elderly pts, renal impairment
ADV EFF Abd pain, apprehension, cyanide toxicity, diaphoresis, faintness, headache,
hypotension, muscle twitching, n/v, restlessness
NC/PT Do not mix in sol w/ other drugs. Monitor BP, IV frequently. Have amyl nitrate
inhalation, materials to make 3% sodium nitrite sol, sodium thiosulfate on hand for
nitroprusside overdose and depletion of body stores of sulfur, leading to cyanide
toxicity. Pt should report chest pain, pain at injection site.

nizatidine (Axid)
CLASS Histamine-2 antagonist
PREG/CONT B/NA

IND & DOSE Short-term tx of active duodenal ulcer, benign gastric ulcer. Adult:
300 mg PO daily at bedtime. Maint tx of healed duodenal ulcer; tx of GERD. Adult:
150 mg PO daily at bedtime. Px of heartburn, acid indigestion. Adult: 75 mg PO w/
water 30–60 min before problematic food, beverages.
ADJUST DOSE Elderly pts; hepatic, renal impairment
ADV EFF Bone marrow suppression, cardiac arrest, confusion, diarrhea, dizziness, ED,
gynecomastia, hallucinations, headache, hepatic dysfx, somnolence
INTERACTIONS Aspirin
NC/PT Monitor LFTs, renal function, CBC w/ long-term use. Switch to oral sol if
swallowing difficult. Pt should take drug at bedtime; avoid OTC drugs that may contain
same ingredients; have regular medical follow-up; report unusual bleeding, dark tarry
stools.

DANGEROUS DRUG
norepinephrine bitartrate (Levophed)
 CLASSCardiac stimulant, sympathomimetic, vasopressor
PREG/CONT C/NA

BBW Have phentolamine on standby for extravasation (5–10 mg phentolamine in 10–15

mL saline to infiltrate affected area).
IND & DOSE To restore BP in controlling certain acute hypotensive states; adjunct in
cardiac arrest. Adult: Add 4 mL sol (1 mg/mL) to 1,000 mL 5% dextrose sol for conc of
4 mcg base/mL. Give 8–12 mcg base/min IV. Adjust gradually to maintain desired BP
(usually 80–100 mm Hg systolic). Average maint, 2–4 mcg base/min.
ADV EFF Bradycardia, headache, hypertension
INTERACTIONS Methyldopa, phenothiazines, reserpine, TCAs
NC/PT Give whole blood, plasma separately, if indicated. Give IV infusions into large
vein, preferably antecubital fossa, to prevent extravasation. Monitor BP q 2 min from
start of infusion until desired BP achieved, then monitor q 5 min if infusion continued.
Do not give pink, brown sols. Monitor for extravasation.

norethindrone acetate (Aygestin)

CLASS Progestin
PREG/CONT X/NA

IND & DOSETx of amenorrhea; abnormal uterine bleeding. Adult: 2.5–10 mg PO for 5–
10 days during second half of theoretical menstrual cycle. Tx of endometriosis. Adult:
5 mg/day PO for 2 wk; increase in increments of 2.5 mg/day q 2 wk to max 15 mg/day.
ADV EFF Acne, amenorrhea, breakthrough bleeding/spotting, dizziness, edema, insomnia,
menstrual changes, PE, photosensitivity, rash, thromboembolic disorders, vision
changes/blindness, weight increase
NC/PT Stop if sudden vision loss, s&sx of thromboembolic event. Pt should mark calendar
of tx days, avoid sun exposure, take safety precautions w/ CNS effects, report calf
swelling/pain, chest pain, vision changes, difficulty breathing.

norfloxacin (Noroxin)
CLASS Fluoroquinolone, urinary tract anti-infective
PREG/CONT C/NA

BBW Increased risk of tendonitis, tendon rupture, especially in pts over 60 yr, those
taking corticosteroids, kidney/heart/lung transplant pts. Risk of severe muscle weakness
if used w/ myasthenia gravis; do not use w/ hx of myasthenia gravis.
IND & DOSE Tx of infections in adults caused by susceptible bacteria. Uncomplicated
UTI: 400 mg PO q 12 hr for 7–10 days; max, 800 mg/day. Uncomplicated cystitis: 400 mg
PO q 12 hr for 3 days. Complicated UTI: 400 mg PO q 12 hr for 10–21 days.
Uncomplicated gonorrhea: 800 mg PO as single dose. Prostatitis: 400 mg PO q 12 hr for 28
days.
ADJUST DOSE Elderly pts, renal impairment
ADV EFF Bone marrow suppression, dizziness, drowsiness, dry mouth, fatigue, fever,
headache, hepatic impairment, nausea, photosensitivity, prolonged QT interval, rash
INTERACTIONS Antacids, cyclosporine, iron salts, QT-prolonging drugs, St. John’s wort,
sucralfate, theophyllines
NC/PT Culture before tx. Ensure hydration. Pt should take on empty stomach 1 hr before
or 2 hr after meals, milk, dairy; avoid antacids within 2 hr of dose; avoid St. John’s
wort; take safety precautions w/ CNS effects, report tendon pain, signs of infection.
Name confusion between Noroxin and Neurontin (gabapentin); use caution.

norgestrel (generic)
CLASS Hormonal contraceptive, progestin
PREG/CONT X/NA

IND & DOSE To prevent pregnancy. 1 tablet PO daily, starting on first day of
menstruation, at same time each day, q day of year. For one missed dose, 1 tablet as
soon as pt remembers, then next tablet at usual time. For two consecutive missed doses,
pt takes one of missed tablets, discards other, takes daily tablet at usual time. For three
consecutive missed doses, pt should discontinue immediately, use additional form of
birth control until menses, or pregnancy ruled out.
ADV EFF Breakthrough bleeding/spotting, breast tenderness, cerebral hemorrhage,
corneal curvature changes, edema, menstrual changes, migraine, MI, PE,
thrombophlebitis
INTERACTIONS Barbiturates, carbamazepine, griseofulvin, hydantoins, penicillins,
rifampin, St. John’s wort, tetracyclines
NC/PT Arrange for pretreatment, periodic complete physical, Pap test. Start no earlier
than 4 wk postpartum. Stop if s&sx of thrombotic event, sudden vision loss. Not for use
in pregnancy. Review all drugs pt taking; additional contraceptive measure may be
needed. Pt should avoid sun exposure, St John’s wort; take safety precautions w/ CNS
effects; report calf swelling/pain, vision loss, difficulty breathing.

nortriptyline hydrochloride (Aventyl, Pamelor)

CLASS TCA
PREG/CONT D/NA

BBW Limit access in depressed, potentially suicidal pts. Risk of suicidality in children,
adolescents, young adults; monitor accordingly.
IND & DOSE Tx of depression. Adult: 25 PO mg tid–qid. Max, 150 mg/day. Child 12 yr and
over: 30–50 mg/day PO in divided doses.
ADJUST DOSE Elderly pts
ADV EFF Atropine-like effects, bone marrow depression, constipation, disturbed
concentration, dry mouth, glossitis, gynecomastia, hyperglycemia, orthostatic
hypotension, photosensitivity, seizures, stroke, urine retention
INTERACTIONS Alcohol, cimetidine, clonidine, fluoxetine, MAOIs, sympathomimetics
NC/PT Monitor CBC. Pt should take at bedtime if drowsiness an issue; avoid sun
exposure, alcohol; take safety precautions w/ CNS effects; use sugarless lozenges for dry
mouth; report thoughts of suicide.

nystatin (Mycostatin, Nilstat, NySert)

CLASS Antifungal
PREG/CONT C/NA

IND & DOSE Local tx of vaginal candidiasis (moniliasis). Adult: 1 tablet (100,000 units)
or 1 applicator cream (100,000 units) vaginally daily–bid for 2 wk. Tx of
cutaneous/mucocutaneous mycotic infections caused by Candida albicans, other
Candida sp. Adult: Apply to affected area two to three times daily until healing
complete. For fungal foot infection, dust powder on feet, in shoes/socks. Tx of
oropharyngeal candidiasis. Adult, child over 1 yr: 500,000–1,000,000 units PO tid for
at least 48 hr after clinical cure, or 400,000–600,000 units suspension four times/day for
14 days and for at least 48 hr after sx subside.
ADV EFF GI distress, local reactions at application site, n/v/d
NC/PT Culture before tx. Pt should complete full course of tx; hold suspension in mouth as
long as possible (can be made into popsicle for longer retention); clean affected area
before topical application; use appropriate hygiene to prevent reinfection; report
worsening of condition.

obinutuzumab (Gazyva)
CLASS Antineoplastic, monoclonal antibody
PREG/CONT C/NA

BBW Risk of reactivation of hepatitis B, fulminant hepatitis, progressive multifocal

leukoencephalopathy (PML), death. Monitor closely.
IND & DOSE Tx of previously untreated chronic lymphocytic leukemia, w/
chlorambucil. Adult: 6-day cycle: 100 mg IV on day 1, cycle 1; 900 mg IV on day 2,
cycle 1; 1,000 mg IV on day 8 and 15, cycle 1; 1,000 mg IV on day 1 of cycles 2–6.
ADV EFF Cough, bone marrow suppression, fever, hepatotoxicity, infusion reactions,
n/v/d, PML, tumor lysis syndrome
NC/PT Premedicate with glucocorticoids, acetaminophen, antihistamine. For pt with large
tumor load, premedicate w/ antihyperuricemics, ensure adequate hydration. Dilute and
administer as IV infusion, not IV push or bolus. Do not give live vaccines before or
during tx. Monitor LFTS; stop drug w/ sx of hepatotoxicity. Monitor CBC; watch for
PML. Pt should avoid pregnancy during and for 12 mo after tx; avoid breast-feeding;
take safety measures w/ drug reaction; report color changes in urine/stool, severe
n/v/d, fever, dizziness, CNS changes.
 octreotide acetate (Sandostatin)
CLASS Antidiarrheal, hormone
PREG/CONT B/NA

IND & DOSE Symptomatic tx of carcinoid tumors. Adult: First 2 wk: 100–600 mcg/day
subcut in two to four divided doses; mean daily dose, 300 mcg. Tx of watery diarrhea
of VI-Pomas. Adult: 200–300 mcg subcut in two to four divided doses during first 2 wk
to control symptoms. Depot injection, 20 mg IM q 4 wk. Child: 1–10 mcg/kg/day subcut.
Range, 150–750 mcg subcut. Tx of acromegaly. Adult: 50 mcg tid subcut, adjusted up to
100–500 mcg tid. Withdraw for 4 wk once yrly. Depot injection: 20 mg IM intragluteally
q 4 wk.
ADV EFF Abd pain, asthenia, anxiety, bradycardia, cholelithiasis, dizziness, fatigue,
flushing, injection-site pain, hyperglycemia, hypoglycemia, light-headedness, n/v/d
NC/PT Give subcut; rotate sites. Give depot injections deep IM; avoid deltoid region.
Arrange to withdraw for 4 wk (8 wk for depot injection) once yrly for acromegaly.
Monitor blood glucose, gallbladder ultrasound. Pt should take safety precautions w/ CNS
effects, report severe abd pain, severe pain at injection site. Name confusion between
Sandostatin (octreotide) and Sandimmune (cyclosporine); use caution.

ofatumumab (Arzerra)
CLASS Antineoplastic, cytotoxic
PREG/CONT C/NA

IND & DOSE Tx of chronic lymphocytic leukemia refractory to standard tx. Adult: 12
doses total, 300 mg IV then, in 1 wk, 2,000 mg/wk IV for 7 doses, then, in 4 wk,
2,000 mg IV q 4 wk for 4 doses.
ADV EFF Anemia, ataxia, bone marrow suppression, bronchitis, cough, diarrhea,
dizziness, dyspnea, fatigue, fever, hepatitis B reactivation, infusion reactions,
intestinal obstruction, nausea, progressive multifocal leukoencephalopathy, URI,
vision problems
INTERACTIONS Live vaccines
NC/PT Premedicate w/ acetaminophen, IV antihistamine, IV corticosteroids. Monitor CBC
regularly. Not for use in pregnancy (contraceptives advised). Pt should avoid exposure
to infection, take safety precautions w/ CNS effects, report difficulty breathing, unusual
bleeding, signs of infection.

ofloxacin (Floxin, Ocuflox)

CLASS Fluoroquinolone
PREG/CONT C/NA

BBW Increased risk of tendinitis, tendon rupture. Risk higher in pts over 60 yr, women,
pts w/ kidney/heart/lung transplant. Risk of exacerbated muscle weakness, sometimes
severe, w/ myasthenia gravis; do not give w/ hx of myasthenia gravis.
IND & DOSE Tx of infections caused by susceptible bacteria strains. Uncomplicated
UTIs: Adult: 200 mg q 12 hr PO for 3–7 days. Complicated UTIs: Adult: 200 mg PO bid
for 10 days. Bacterial exacerbations of COPD, community-acquired pneumonia,
mild to moderate skin infections. Adult: 400 mg PO q 12 hr for 10 days. Prostatitis.
Adult: 300 mg PO q 12 hr for 6 wk. Acute, uncomplicated gonorrhea. Adult: 400 mg
PO as single dose. Cervicitis, urethritis. Adult: 300 mg PO q 12 hr for 7 days. Ocular
infections. Adult: 1–2 drops/eye as indicated. Otic infections. Adult, child over 12 yr: 10
drops in affected ear tid for 10–14 days. Child 1–12 yr w/ tympanostomy tubes: 5 drops in
affected ear bid for 10 days. Swimmer’s ear. Adult: 10 drops/day (1.5 mg) in affected
ear for 7 days. Child 12 yr and older: 10 drops in affected ear bid for 10 days. Child 6 mo–
under 12 yr: 5 drops in affected ear bid for 10 day. Chronic suppurative otitis media.
Adult, child: 10 drops in affected ear bid for 14 days.
ADJUST DOSE Elderly pts, renal impairment
ADV EFF Bone marrow suppression, dizziness, drowsiness, headache, hepatic
impairment, insomnia, n/v/d, photosensitivity, prolonged QT, tendinitis, tendon
rupture
INTERACTIONS Antacids, iron salts, QT-prolonging drugs, St. John’s wort, sucralfate, zinc
NC/PT Culture before tx. Teach proper administration of eye/eardrops. Pt should take
oral drug 1 hr before or 2 hr after meals on empty stomach; avoid antacids within 2 hr
of ofloxacin; drink plenty of fluids; avoid sun exposure; take safety precautions w/ CNS
effects; report tendon pain, severe GI upset.

olanzapine (Zyprexa)
CLASS Antipsychotic, dopaminergic blocker
PREG/CONT C/NA

BBW Increased risk of death when used in elderly pts w/ dementia-related psychosis;
drug not approved for this use. Risk of severe sedation, including coma/delirium, after
each injection of Zyprexa Relprevv. Monitor pt for at least 3 hr after each injection, w/
ready access to emergency services. Because of risk, drug available only through Zyprexa
Relprevv Patient Care Program.
IND & DOSE Tx of schizophrenia. Adult: 5–10 mg/day PO. Increase to 10 mg/day PO
within several days; max, 20 mg/day. Or long-acting injection (Zyprexa Relprevv): 150,
210, or 300 mg IM q 2 wk, or 300 or 405 mg IM q 4 wk. Child 13–17 yr: 2.5–5 mg/day
PO; target, 10 mg/day. Tx of bipolar mania. Adult: 10–15 mg/day PO. Max,
20 mg/day; maint, 5–20 mg/day PO. Child 13–17 yr: 2.5–5 mg/day PO; target,
10 mg/day. Tx of agitation associated w/ schizophrenia, mania. Adult: 10 mg IM;
range, 5–10 mg. May repeat in 2 hr if needed; max, 30 mg/24 hr. Tx-resistant
depression. Adult: 5 mg/day PO w/ fluoxetine 20 mg/day PO; range, 5–12.5 mg/day
olanzapine w/ 20–50 mg/day PO fluoxetine.
ADJUST DOSE Elderly/debilitated pts
ADV EFF Constipation, dizziness, fever, headache, hyperglycemia, NMS, orthostatic
hypotension, somnolence, weight gain
INTERACTIONS Alcohol, anticholinergics, antihypertensives, benzodiazepines,
carbamazepine, CNS drugs, dopamine agonists, fluvoxamine, levodopa, omeprazole,
rifampin, smoking
NC/PT Dispense 1 wk at a time. Use care to distinguish short-term from long-term IM
form. Monitor serum glucose, lipids. Not for use in pregnancy. Pt should peel back (not
push through) foil on blister pack of disintegrating tablet, remove w/ dry hands; avoid
alcohol; report all drugs being used (many interactions possible); take safety
precautions w/ CNS effects, orthostatic hypotension; report fever, flulike symptoms.
Name confusion between Zyprexa (olanzapine) and Zyrtec (cetirizine); use caution.

olmesartan medoxomil (Benicar)

CLASS Antihypertensive, ARB
PREG/CONT D/NA

BBW Rule out pregnancy before tx; suggest barrier contraceptives. Fetal injury, death
has occurred.
IND & DOSE Tx of hypertension. Adult, child 6–16 yr, 35 kg or more: 20 mg/day PO; may
titrate to 40 mg/day after 2 wk. Child 6–16 yr, 20–under 35 kg: 10 mg/day PO; max,
20 mg/day PO.
ADV EFF Abd/back pain, angioedema, bronchitis, cough, dizziness, drowsiness, flulike
symptoms, headache, n/v/d, URI
NC/PT Alert surgeon if surgery scheduled; fluid volume expansion may be needed. Not for
use in pregnancy (barrier contraceptives advised), breast-feeding. Pt should use caution
in situations that may lead to BP drop (excessive hypotension possible); take safety
precautions w/ CNS effects; report swelling.

olsalazine sodium (Dipentum)

CLASS Anti-inflammatory
PREG/CONT C/NA

IND & DOSE Maint of remission of ulcerative colitis in pts resistant to sulfasalazine.
Adult: 1 g/day PO in divided doses w/ meals.
ADJUST DOSE Renal impairment
ADV EFF Abd pain, diarrhea, headache, itching, rash
INTERACTIONS Heparin, 6-mercaptopurine, thioguanine, varicella vaccine, warfarin
NC/PT Not for use in breast-feeding. Pt should always take w/ food, report diarrhea.

omacetaxine mepesuccinate (Synribo)

CLASS Antineoplastic, protein synthesis inhibitor
 PREG/CONT D/NA

IND & DOSE Tx of adult w/ accelerated CML w/ resistance or intolerance to two or

more kinase inhibitors. Adult: 1.25 mg/m2 subcut bid for 14 consecutive days of 28-
day cycle, then 1.25 mg/m2 subcut bid for 7 consecutive days of 28-day cycle.
ADV EFF Bleeding, fatigue, fever, hair loss, hyperglycemia, injection-site reactions,
n/v/d, severe myelosuppression
NC/PT Monitor bone marrow function frequently; dosage adjustment may be needed.
Monitor blood glucose. Not for use in pregnancy, breast-feeding.; Pt should avoid
exposure to infections; be aware fatigue, bleeding, hair loss possible; report unusual
bleeding, fever, s&sx of infection, rash.

omalizumab (Xolair)
CLASS Antiasthmatic, monoclonal antibody
PREG/CONT B/NA

BBW Anaphylaxis w/ bronchospasm, hypotension, syncope, urticaria, edema possible.

Monitor closely after each dose; have emergency equipment on hand.
IND & DOSE To decrease asthma exacerbation in pts w/ moderate to severe asthma,
positive skin test to perennial airborne allergens. Adult, child over 12 yr: 150–
375 mg subcut q 2–4 wk.
ADV EFF Anaphylaxis, cancer, injection-site reactions, pain
NC/PT Base dose on weight, pretreatment immunoglobulin E level. Monitor after each
injection for anaphylaxis. Not for use in breast-feeding. Pt should have appropriate
cancer screening, report difficulty breathing, tongue swelling, rash, chest tightness.

omega-3-acid ethyl esters (Lovaza)

CLASS Lipid-lowering drug, omega-3 fatty acid
PREG/CONT C/NA

IND & DOSEAdjunct to diet to reduce very high (over 500 mg/dL) triglycerides. Adult:
4 g/day PO as single dose (4 capsules) or divided into two doses (2 capsules PO bid).
ADV EFF Back pain, eructation, dyspepsia, flulike symptoms, infection, taste changes
INTERACTIONS Anticoagulants
NC/PT Monitor serum triglycerides. Ensure use of diet, exercise program. Not for use in
pregnancy, breast-feeding. Name confusion between Omacor (former brand name of
omega-3-acid ethyl esters) and Amicar (aminocaproic acid). Although Omacor has been
changed to Lovaza, confusion possible; use caution.

omeprazole (Prilosec, Zegerid)

CLASS Proton pump inhibitor
PREG/CONT C/NA
IND & DOSE Tx of active duodenal ulcer. Adult: 20 mg/day PO for 2–8 wk. Tx of active
gastric ulcer. Adult: 40 mg/day PO for 4–8 wk. Tx of severe erosive esophagitis,
poorly responsive GERD. Adult: 20 mg/day PO for 4–8 wk. Tx of pathologic
hypersecretory conditions. Adult: 60 mg/day PO. Up to 120 mg tid has been used. Tx
of frequent heartburn. 20 mg/day (Prilosec OTC tablet) PO in a.m. before eating for
14 days. May repeat 14-day course q 4 mo. Upper GI bleeding in critically ill pts.
Adult: 40 mg PO then 40 mg PO in 6–8 hr on day 1, then 40 mg/day for up to 14 days
(Zegerid). GERD, other acid-related disorders. Adult, child 2 yr and over: 20 kg or
more, 20 mg daily PO; 11–under 20 kg, 10 mg daily PO; 5–10 kg, 5 mg daily PO.
ADV EFF Abd pain, bone fractures, Clostridium difficile diarrhea, dizziness, headache,
n/v/d, pneumonia, rash, URI
INTERACTIONS Benzodiazepines, clopidogrel, phenytoin, sucralfate, warfarin
NC/PT If sx persist after 8 wk, reevaluate. Pt should take w/ meals; swallow capsule
whole and not cut, crush, or chew it; if cannot swallow, open capsules, sprinkle contents
on applesauce, swallow immediately; take safety precautions w/ CNS effects; report
severe diarrhea, fever.

ondansetron hydrochloride (Zofran, Zuplenz)

CLASS Antiemetic
PREG/CONT B/NA

IND & DOSE Px of chemotherapy-induced n/v. Adult: Three 0.15-mg/kg doses IV: First
dose over 15 min starting 30 min before chemotherapy; subsequent doses at 4 and 8 hr.
Or, single 32-mg dose infused over 15 min starting 30 min before chemotherapy. Or,
8 mg PO 30 min before chemotherapy, then 8 mg PO 8 hr later; give 8 mg PO q 12 hr
for 1–2 days after chemotherapy. For highly emetogenic chemotherapy, 24 mg PO
30 min before chemotherapy. Child 6 mo–18 yr: Three 0.15-mg/kg doses IV over 15 min
starting 30 min before chemotherapy, then 4 and 8 hr later. Child 4–11 yr: 4 mg PO
30 min before chemotherapy, 4 mg PO at 4 and 8 hr, then 4 mg PO tid for 1–2 days
after chemotherapy. Px of n/v associated w/ radiotherapy. Adult: 8 mg PO tid. For
total-body radiotherapy, give 1–2 hr before radiation each day. For single high-dose
radiotherapy to abdomen, give 1–2 hr before radiotherapy, then q 8 hr for 1–2 days
after therapy. For daily fractionated radiotherapy to abdomen, give 1–2 hr before tx,
then q 8 hr for each day tx given. Px of postop n/v. Adult: 4 mg undiluted IV,
preferably over 2–5 min, or as single IM dose immediately before anesthesia induction.
Or, 16 mg PO 1 hr before anesthesia. Child 1 mo–12 yr: Single dose of 4 mg IV if over 40
kg, 0.1 mg/kg IV if under 40 kg, preferably 2–5 min before or after anesthesia
induction. Infuse over at least 30 sec.
ADJUST DOSE Hepatic impairment
ADV EFF Abd pain, diarrhea, dizziness, drowsiness, headache, myalgia, pain at injection
site, prolong QT interval, weakness
INTERACTIONS QT-prolonging drugs
NC/PT Obtain baseline ECG for QT interval. Ensure timing to correspond w/ surgery,
chemotherapy. For Zofran orally disintegrating tablet, pt should peel foil back over (do
not push through) one blister, immediately place on tongue, swallow w/ saliva. For
Zuplenz, pt should use dry hands, fold pouch along dotted line, carefully tear pouch
along edge, remove film, place on tongue, swallow after it dissolves, then wash hands.
Pt should take safety precautions w/ CNS effects; report pain at injection site,
palpitations.

DANGEROUS DRUG
opium preparations (Opium Tincture, Deodorized; Paregoric)
CLASS Antidiarrheal, opioid agonist
PREG/CONT C/C-III (Paregoric); C/C-II (Opium Tincture, Deodorized)

IND & DOSE Tx of diarrhea. Adult: 5–10 mL Paregoric PO daily–qid (5 mL equivalent to

2 mg morphine), or 0.6 mL Opium Tincture qid. Max, 6 mL/day. Child: 0.25–0.5 mL/kg
Paregoric PO daily–qid.
ADJUST DOSE Elderly pts, impaired adults
ADV EFF Bronchospasm, cardiac arrest, constipation, dizziness, drowsiness, flushing,
laryngospasm, light-headedness, n/v, respiratory arrest, sedation, shock, sweating,
ureteral spasm, vision changes
INTERACTIONS Barbiturate general anesthetics
NC/PT Opium Tincture, Deodorized, contains 25 times more morphine than Paregoric; do
not confuse dosage (severe toxicity possible). Do not use in preterm infants. Pt should
take 4–6 hr before next feeding if breast-feeding; not take left-over medication; take
safety precautions w/ CNS effects; use laxative if constipated; report difficulty
breathing. Name confusion between Paregoric (camphorated tincture of opium) and
Opium Tincture, Deodorized; use caution.

oprelvekin (Neumega)
CLASS Interleukin
PREG/CONT C/NA

BBW Severe allergic reactions, including anaphylaxis, possible; monitor w/ each dose.
IND & DOSE Px of severe thrombocytopenia; to reduce need for platelet transfusions
after myelosuppressive chemotherapy in pts w/ nonmyeloid malignancies. Adult:
50 mcg/kg/day subcut starting day 1 after chemotherapy for 14–21 days.
ADJUST DOSE Renal impairment
ADV EFF Anemia, anaphylaxis, capillary leak syndrome, cardiac arrhythmias, dyspnea,
edema, fluid retention, papilledema
NC/PT Obtain baseline, periodical CBC. Monitor for anaphylaxis; stop immediately if it
occurs. Not for use in pregnancy, breast-feeding. Teach proper administration, disposal
of needles, syringes. Pt should mark calendar of injection days, report difficulty
breathing, weight gain, fluid retention, vision changes.

orlistat (Alli, Xenical)

CLASS Lipase inhibitor, weight loss drug
PREG/CONT B/NA

BBW Severe allergic reactions, including anaphylaxis, possible; monitor w/ each dose.
IND & DOSE Tx of obesity as part of weight loss program. Adult: 120 mg PO tid w/ each
fat-containing meal. OTC, 60 mg PO w/ each fat-containing meal; max, 3 capsules/day.
Child 12 yr and over: 120 mg PO tid w/ fat-containing meals. OTC not for use in
children.
ADV EFF Dry mouth, flatulence, incontinence, loose stools, severe hepatic injury,
vitamin deficiency
INTERACTIONS Fat-soluble vitamins, oral anticoagulants, pravastatin
NC/PT Increased risk of severe hepatic injury; monitor LFTs before, periodically during
tx. Ensure diet, exercise program. Not for use in pregnancy (contraceptives advised). Pt
should use sugarless lozenges for dry mouth, use fat-soluble vitamins (take separately
from orlistat doses), report right upper quadrant pain, urine/stool color changes.

orphenadrine citrate (Banflex, Flexon, Norflex)

CLASS Skeletal muscle relaxant
PREG/CONT C/NA

IND & DOSE Relief of discomfort associated w/ acute, painful musculoskeletal

conditions. Adult: 60 mg IV, IM. May repeat q 12 hr. Inject IV over 5 min. Or, 100 mg
PO q a.m. and p.m.
ADJUST DOSE Elderly pts
ADV EFF Confusion, constipation, decreased sweating, dizziness, dry mouth, flushing,
gastric irritation, headache, n/v, tachycardia, urinary hesitancy, urine retention
INTERACTIONS Alcohol, anticholinergics, haloperidol, phenothiazines
NC/PT Ensure pt supine during IV injection and for at least 15 min after; assist from
supine position after tx. Pt should swallow SR tablet whole and not cut, crush, or chew
it; empty bladder before each dose; use caution in hot weather (sweating reduced);
avoid alcohol; take safety precautions w/ CNS effects; use sugarless lozenges for dry
mouth; report difficulty swallowing, severe GI upset.

oseltamivir phosphate (Tamiflu)

CLASS Antiviral, neuraminidase inhibitor
PREG/CONT C/NA

IND & DOSETx of uncomplicated illness due to influenza virus (A or B). Adult, child 13
yr and older: 75 mg PO bid for 5 days, starting within 2 days of sx onset. Child 1–12 yr:
30–75 mg suspension PO bid for 5 days based on weight. Child 2 wk–under 1 yr: 3 mg/kg
PO bid for 5 days. Px of influenza A and B infection. Adult, child 13 yr and older:
75 mg/day PO for at least 10 days; begin within 2 days of exposure. Child 1–12 yr: Over
40 kg, 75 mg/day PO; 23–40 kg, 60 mg/day PO; 15–23 kg, 45 mg/day PO; 15 kg or
less, 30 mg/day PO. Continue for 10 days. Child 6–11 mo: 25 mg/day PO for 10 days.
Child 3–5 mo: 20 mg/day PO for 10 days.
ADJUST DOSE Renal impairment
ADV EFF Anorexia, dizziness, headache, n/v, rhinitis
NC/PT Give within 2 days of exposure or sx onset. Pt should complete full course;
refrigerate sol, shake well before each use; take safety precautions w/ dizziness; report
severe GI problems.

ospemifene (Osphena)
CLASS Estrogen modulator
PREG/CONT X/NA

BBW Increased risk of endometrial cancer in women w/ uterus and unopposed

estrogens; addition of progestin strongly advised. Increased risk of stroke, DVT; monitor
accordingly.
IND & DOSE Tx of moderate to severe dyspareunia (painful intercourse) related to
vulvar/vaginal atrophy due to menopause. Adult: 60 mg once/day with food.
ADV EFF DVT, hot flashes, hyperhidrosis, muscle spasms, PE, vaginal discharge
INTERACTIONS Estrogen, fluconazole, other estrogen modulators, rifampin
NC/PT Rule out pregnancy (contraceptives advised). Not for use in breast-feeding.
Combine w/ progestin in women w/ intact uterus; ensure annual pelvic/breast exam,
mammogram. Monitor for DVT, PE, other thrombotic events. Reevaluate need for drug q
3–6 mo. Pt should take once/day, schedule annual complete exam and mammogram,
report vision/speech changes, difficulty breathing, vaginal bleeding, chest pain, severe
leg pain.

oxacillin sodium (generic)

CLASS Penicillinase-resistant penicillin
PREG/CONT B/NA

BBW Increased risk of infection by multiple drug-resistant strains; weigh benefit/risk

before use.
IND & DOSE Infections due to penicillinase-producing staphylococci; to initiate tx
when staphylococcal infection suspected. Adult, child 40 kg or more: 250–500 mg IV q
4–6 hr; up to 1 g q 4–6 hr in severe infections. Max, 6 g/day. Child under 40 kg: 50–100
mg/kg/day IV in equally divided doses q 4–6 hr. Neonates 2 kg or more: 25–50 mg/kg IV
q 8 hr. Neonates under 2 kg: 25–50 mg/kg IV q 12 hr.
ADV EFF Anaphylaxis, bone marrow suppression, fever, gastritis, nephritis, n/v/d,
pain, phlebitis, rash, seizures, sore mouth, superinfections, wheezing
INTERACTIONS Aminoglycosides, tetracyclines
NC/PT Culture before tx. Do not mix in same IV sol as other antibiotics. Be prepared for
serious hypersensitivity reactions. Treat superinfections. Pt should avoid exposure to
infection, use mouth care for sore mouth, report rash, difficulty breathing, signs of
infection.

DANGEROUS DRUG
oxaliplatin (Eloxatin)
CLASS Antineoplastic
PREG/CONT D/NA

BBW Risk of serious to fatal anaphylactic reactions.

IND & DOSE Tx of metastatic colon/rectum cancer as first-line tx or after progression
after other tx. Adult: 85 mg/m2 IV infusion in 250–500 mL D5W w/ leucovorin 200
mg/m2 in D5W both over 2 hr followed by 5-FU 400 mg/m2 IV bolus over 2–4 min,
followed by 5-FU 600 mg/m2 IV infusion in 500 mL D5W as 22-hr continuous infusion on
day 1. Then leucovorin 200 mg/m2 IV infusion over 2 hr followed by 5-FU 400 mg/m2
bolus over 2–4 min, followed by 5-FU 600 mg/m2 IV infusion in 500 mL D5W as 22-hr
continuous infusion on day 2. Repeat cycle q 2 wk.
ADV EFF Abd pain, anaphylaxis, anorexia, constipation, cough, dyspnea, fatigue,
hyperglycemia, hypokalemia, injection-site reactions, neuropathy, n/v/d, paresthesia,
pulmonary fibrosis, RPLS
INTERACTIONS Nephrotoxic drugs
NC/PT Premedicate w/ antiemetics, dexamethasone. Monitor for potentially dangerous
anaphylactic reactions. Monitor respiratory/neurologic function. Not for use in
pregnancy, breast-feeding. Pt should take safety precautions w/ CNS effects, report
severe headache, vision changes, difficulty breathing, numbness/tingling.

oxandrolone (Oxandrin)
CLASS Anabolic steroid
PREG/CONT X/C-III

BBW Monitor LFTs, serum electrolytes periodically. Consult physician for corrective
measures; risk of peliosis hepatitis, liver cell tumors. Measure cholesterol periodically in
pts at high risk for CAD; lipids may increase.
IND & DOSE Relief of bone pain w/ osteoporosis; adjunct tx to promote weight gain
after weight loss due to extensive trauma; to offset protein catabolism associated
w/ prolonged corticosteroid use; HIV wasting syndrome; HIV-associated muscle
weakness. Adult: 2.5 mg PO bid–qid; max, 20 mg. May need 2–4 wk to evaluate
response. Child: Total daily dose, 0.1 mg/kg or less, or 0.045 mg/lb or less PO; may
repeat intermittently.
ADV EFF Abd fullness, acne, anorexia, blood lipid changes, burning of tongue, excitation,
gynecomastia, hepatitis, hirsutism in females, intra-abdominal hemorrhage, liver
cell tumors, liver failure, virilization of prepubertal males
NC/PT May need 2–4 wk to evaluate response. Monitor effect on child w/ long-bone X-
rays q 3–6 mo; stop drug well before bone age reaches norm for pt’s chronologic age.
Monitor LFTs, serum electrolytes, blood lipids. Not for use in pregnancy (barrier
contraceptives advised). Pt should take w/ food, report urine/stool color changes, abd
pain, severe n/v.

oxaprozin (Daypro), oxaprozin potassium (Daypro Alta)

CLASS NSAID
PREG/CONT C/NA

BBW Increased risk of CV events, GI bleeding; monitor accordingly. Contraindicated for

periop pain associated w/ CABG surgery.
IND & DOSE Tx of osteoarthritis. Adult: 1,200 mg/day PO. Use initial 600 mg w/ low
body weight or milder disease. Tx of rheumatoid arthritis. Adult: 1,200 mg/day PO. Tx
of juvenile rheumatoid arthritis. Child 6–16 yr: 600–1,200 mg/day PO based on body
weight.
ADJUST DOSE Renal impairment
ADV EFF Anaphylactoid reactions to anaphylactic shock, constipation, dizziness,
dyspepsia, n/v/d, platelet inhibition, rash
NC/PT Pt should take w/ food, take safety precautions w/ dizziness, report unusual
bleeding, black tarry stools.

oxazepam (generic)
CLASS Anxiolytic, benzodiazepine
PREG/CONT D/C-IV

IND & DOSE Mgt of anxiety disorders, alcohol withdrawal. Adult, child over 12 yr: 10–
15 mg PO or up to 30 mg PO tid–qid, depending on severity of anxiety sx. Higher range
recommended in alcoholics.
ADJUST DOSE Elderly, debilitated pts
ADV EFF Apathy, bradycardia, constipation, CV collapse, depression, diarrhea,
disorientation, dizziness, drowsiness, dry mouth, fatigue, fever, hiccups, lethargy, light-
headedness
INTERACTIONS Alcohol, CNS depressants, theophylline
NC/PT Taper gradually after long-term tx, especially in pts w/ epilepsy. Pt should take
safety precautions w/ CNS effects, report vision changes, fainting, rash.

oxcarbazepine (Oxtellar XR, Trileptal)

 CLASSAntiepileptic
PREG/CONT C/NA

BBW Monitor serum sodium before and periodically during tx; serious hyponatremia can
occur. Teach pt to report sx (nausea, headache, malaise, lethargy, confusion).
IND & DOSE Tx of partial seizures. Adult: 300 mg PO bid; may increase to total 1,200 mg
PO bid if clinically needed as adjunct tx. Converting to monotherapy: 300 mg PO bid
started while reducing dose of other antiepileptics; reduce other drugs over 3–6 wk while
increasing oxcarbazepine over 2–4 wk to max 2,400 mg/day. Starting as monotherapy:
300 mg PO bid; increase by 300 mg/day q third day until desired dose of 1,200 mg/day
reached. Or 600 mg/day PO ER form; increase at weekly intervals of 600 mg/day to
target 2,400 mg/day. Adjunct tx of partial seizures. Child 4–16 yr: 8–10 mg/kg/day
PO in two equally divided doses; max, 600 mg/day. Child 2–4 yr over 20 kg: 8–10
mg/kg/day PO; max, 600 mg/day. Child 2–4 yr under 20 kg: 16–20 mg/kg/day PO; max,
600 mg/day. Monotherapy for partial seizures in epileptic child. Child 4–16 yr: 8–10
mg/kg/day PO in two divided doses. If pt taking another antiepileptic, slowly withdraw
that drug over 3–6 wk. Then, increase oxcarbazepine in 10-mg/kg/day increments at
wkly intervals to desired level. If pt not taking another antiepileptic, increase dose by 5
mg/kg/day q third day.
ADJUST DOSE Elderly pts, renal impairment
ADV EFF Bradycardia, bronchospasm, confusion, disturbed coordination, dizziness,
drowsiness, hypertension, hyponatremia, hypotension, impaired fertility, n/v,
pulmonary edema, suicidality, unsteadiness
INTERACTIONS Alcohol, carbamazepine, felodipine, hormonal contraceptives,
phenobarbital, phenytoin, valproic acid, verapamil
NC/PT Monitor for hyponatremia. Taper slowly if stopping or switching to other
antiepileptic. Not for use in pregnancy (barrier contraceptives advised). Pt should
swallow ER tablets whole, not cut, crush, or chew them; take safety precautions w/ CNS
effects; avoid alcohol; wear medical ID; report unusual bleeding, difficulty breathing,
thoughts of suicide, headache, confusion, lethargy.

oxybutynin chloride (Ditropan, Gelnique, Oxytrol)

CLASS Anticholinergic, urinary antispasmodic
PREG/CONT B/NA

IND & DOSERelief of bladder instability sx; tx of overactive bladder (ER form). Adult:
5 mg PO bid or tid; max, 5 mg qid. ER tablets, 5 mg PO daily; max, 30 mg/day.
Transdermal patch, 1 patch applied to dry, intact skin on abdomen, hip, or buttock q 3–
4 days (twice wkly). (OTC form available for women 18 yr and older.) Topical gel, 1 mL
applied to thigh, abdomen, or upper arm q 24 hr. Child over 6 yr: 5 mg ER tablets PO
daily; max, 20 mg/day. Child over 5 yr: 5 mg PO bid; max, 5 mg tid.
ADJUST DOSE Elderly pts
ADV EFF Blurred vision, decreased sweating, dizziness, drowsiness, dry mouth,
tachycardia, urinary hesitancy
INTERACTIONS Amantadine, haloperidol, nitrofurantoin, phenothiazines
NC/PT Arrange for cystometry, other diagnostic tests before, during tx. Monitor vision
periodically. Periodic bladder exams needed. Pt should swallow ER tablet whole and not
cut, crush, or chew it; apply gel to thigh, abdomen, or upper arm (rotate sites); apply
patch to dry, intact skin on abdomen, hip, or buttock (remove old patch before applying
new one); take safety precautions w/ CNS effects; report vision changes vision,
vomiting.

DANGEROUS DRUG
oxycodone hydrochloride (M-oxy, Oxecta, OxyContin, OxyFAST, OxyIR,
Roxicodone)
CLASS Opioid agonist analgesic
PREG/CONT B/C-II

BBW OxyFAST, Roxicodone Intensol highly concentrated preparations; use extreme care.
Drug has abuse potential; monitor accordingly. Concurrent use of CYP3A4 inhibitors
may result in increased drug effects, potentially fatal respiratory depression.
IND & DOSE Relief of moderate to moderately severe pain. Adult: Tablets, 5–15 mg PO
q 4–6 hr; opioid-naïve, 10–30 mg PO q 4 hr. Capsules, 5 mg PO q 6 hr. Tablets in
aversion technology, 5–15 mg PO q 4 hr as needed. Oral sol, 10–30 mg PO q 4 hr as
needed. Tx of breakthrough pain. Adult: Immediate-release (OxyIR), 5 mg PO q 4 hr.
Mgt of moderate to severe pain when continuous, around-the-clock analgesic
needed for extended period. Adult: CR tablets, 10 mg PO q 12 hr for pts taking
nonopioid analgesics and requiring around-the-clock tx for extended period. Adjust q 1–
2 days as needed by increasing by 25% to 50%.
ADJUST DOSE Elderly pts, impaired adults
ADV EFF Bronchospasm, cardiac arrest, constipation, dizziness, drowsiness, flushing,
laryngospasm, light-headedness, n/v, respiratory arrest, sedation, shock, sweating,
ureteral spasm, vision changes
INTERACTIONS Barbiturate general anesthetics, opioids, protease inhibitors; avoid these
combinations
NC/PT CR form not for child. Use pediatric formulas to determine child dose for
immediate-release form. Have opioid antagonist, facilities for assisted, controlled
respiration on hand. Pt should swallow CR form whole and not cut, crush, or chew it;
take 4–6 hr before next feeding if breast-feeding; take safety precautions w/ CNS
effects; use laxative for constipation; report difficulty breathing, fainting.

oxymetazoline (Afrin, Dristan, Neo-Synephrine 12 Hour Extra Moisturizing,

Vicks Sinex 12-Hour)
CLASS Nasal decongestant
 PREG/CONT C/NA

BBW Monitor BP carefully; pts w/ hypertension may experience increased hypertension

related to vasoconstriction. If nasal decongestant needed, pseudoephedrine is drug of
choice.
IND & DOSE Symptomatic relief of nasal, nasopharyngeal mucosal congestion. Adult,
child over 6 yr: 2–3 sprays of 0.05% sol in each nostril bid a.m. and p.m. or q 10–12 hr
for up to 3 days.
ADV EFF Anxiety, arrhythmias, CV collapse, dizziness, drowsiness, dysuria, fear,
headache, hypertension, light-headedness, nausea, painful urination, rebound
congestion, restlessness, tenseness
INTERACTIONS MAOIs, methyldopa, TCAs, urine acidifiers/alkalinizers
NC/PT Systemic adverse effects less common because drug not generally absorbed
systemically. Review proper administration. Rebound congestion possible. Pt should
avoid prolonged use (over 3 days), smoky rooms; drink plenty of fluids; use humidifier;
take safety precautions w/ CNS effects; report excessive nervousness.

oxymetholone (Anadrol-50)
CLASS Anabolic steroid
PREG/CONT X/C-III

BBW Monitor LFTs, serum electrolytes during tx. Consult physician for corrective
measures; risk of peliosis hepatis, liver cell tumors. Measure cholesterol in pts at high
risk for CAD; lipids may increase.
IND & DOSE Tx of anemias, including congenital aplastic, hypoplastic. Adult, child: 1–
5 mg/kg/day PO. Give for minimum trial of 3–6 mo.
ADV EFF Abd fullness, acne, anorexia, blood lipid changes, burning of tongue, confusion,
excitation, gynecomastia, intra-abdominal hemorrhage, hepatitis, hirsutism in
females, hyperglycemia, insomnia, liver cell tumors, liver failure, virilization of
prepubertal males
INTERACTIONS Oral anticoagulants, oral antidiabetics
NC/PT Use w/ extreme caution; risk of serious disruption of growth/development; weigh
benefits, risks. Monitor LFTs, lipids, bone age in children. Not for use in pregnancy
(barrier contraceptives advised). Pt should take w/ food; monitor glucose closely if
diabetic; take safety precautions w/ CNS effects; report severe nausea, urine/stool color
changes.

DANGEROUS DRUG
oxymorphone hydrochloride (Opana)
CLASS Opioid agonist analgesic
PREG/CONT C/C-II
BBW Ensure pt swallows ER form whole; cutting, crushing, chewing could cause rapid
release and fatal overdose. ER form has abuse potential; monitor accordingly. ER form
indicated only for around-the-clock use over extended period. Do not give PRN. Pt must
not consume alcohol in any form while taking oxycodone; risk of serious serum drug
level increase, potentially fatal overdose.
IND & DOSE Relief of moderate to moderately severe acute pain. Adult: 10–20 mg PO q
4–6 hr. Relief of moderate to moderately severe pain in pts needing around-the-
clock tx. Adult: 5 mg ER tablet PO q 12 hr; may increase in 5- to 10-mg increments q 3–
7 days. Preop medication; anesthesia support; obstetric analgesia; relief of
anxiety in pts w/ pulmonary edema associated w/ left ventricular dysfx. Adult:
0.5 mg IV or 1–1.5 mg IM, subcut q 4–6 hr as needed. For analgesia during labor, 0.5–
1 mg IM.
ADJUST DOSE Elderly pts, impaired adults, renal impairment
ADV EFF Cardiac arrest, bronchospasm, constipation, dizziness, dry mouth, euphoria,
flushing, hypertension, hypotension, laryngospasm, light-headedness, n/v, respiratory
arrest, sedation, shock, sweating, urine retention
INTERACTIONS Alcohol, barbiturate anesthetics, CNS depressants
NC/PT Have opioid antagonist, facilities for assisted, controlled respiration on hand
during parenteral administration. Pt should swallow ER tablet whole and not cut, crush,
or chew it; take 4–6 hr before next feeding if breast-feeding; avoid alcohol; use laxative
for constipation; take safety precautions w/ CNS effects; report difficulty breathing.

DANGEROUS DRUG
oxytocin (Pitocin)
CLASS Hormone, oxytocic
PREG/CONT X/NA

BBW Reserve for medical use, not elective induction.

IND & DOSE Induction, stimulation of labor. Adult: 0.5–2 milliunits/min (0.0005–0.002
units/min) by IV infusion through infusion pump. Increase in increments of no more
than 1–2 milliunits/min at 30- to 60-min intervals until contraction pattern similar to
normal labor established. Rates exceeding 9–10 milliunits/min rarely needed. Control
of postpartum uterine bleeding. Adult: Add 10–40 units to 1,000 mL nonhydrating
diluent, infuse IV at rate to control uterine atony. Or, 10 units IM after delivery of
placenta. Tx of incomplete, inevitable abortion. Adult: 10 units oxytocin w/ 500 mL
physiologic saline sol or 5% dextrose in physiologic saline IV infused at 10–20 milliunits
(20–40 drops)/min. Max, 30 units in 12 hr.
ADV EFF Afibrinogenemia, anaphylactic reaction, cardiac arrhythmias, fetal
bradycardia, maternal death, neonatal jaundice, n/v, severe water intoxication
NC/PT Ensure fetal position/size, absence of complications. Continuously observe pt
receiving IV oxytocin for induction, stimulation of labor; fetal monitoring preferred.
Regulate rate to establish uterine contractions. Stop at first sign of hypersensitivity
reactions.
 DANGEROUS DRUG
paclitaxel (Abraxane)
CLASS Antimitotic, antineoplastic
PREG/CONT D/NA

BBW Do not give unless blood counts within acceptable range. Premedicate w/ one of
following to prevent severe hypersensitivity reactions: Oral dexamethasone 20 mg 12 hr
and 6 hr before paclitaxel, 10 mg if AIDS-related Kaposi sarcoma; diphenhydramine
50 mg IV 30–60 min before paclitaxel; cimetidine 300 mg IV or ranitidine 50 mg IV 30–
60 min before paclitaxel. Do not substitute Abraxane for other paclitaxel formulations.
IND & DOSE Tx of ovarian cancer after failure of other tx. Adult: Previously untreated,
135 mg/m2 IV over 24 hr or 175 mg/m2 IV over 3 hr q 3 wk, then 75 mg/m2 IV cisplatin
Previously treated, 135 mg/m2 or 175 mg/m2 IV over 3 hr q 3 wk. Tx of breast cancer
after failure of combination tx. Adult: 175 mg/m2 IV over 3 hr q 3 wk for four courses
after failure of chemotherapy; 175 mg/m2 IV over 3 hr q 3 wk after initial
chemotherapy failure or relapse within 6 mo; or 260 mg/m2 IV over 30 min q 3 wk. Tx
of AIDS-related Kaposi sarcoma. Adult: 135 mg/m2 IV over 3 hr q 3 wk or 100 mg/m2
IV over 3 hr q 2 wk. Tx of non-small-cell-lung cancer. Adult: 135 mg/m2 IV over
24 hr, then 75 mg/m2 cisplatin IV q 3 wk. Adjunct tx sequential to doxorubicin-
containing regimen for node-positive breast cancer. Adult: 175 mg/m2 IV over 3 hr
q 3 wk for four courses, with doxorubicin regimen.
ADV EFF Alopecia, arthralgia, bone marrow depression, hypersensitivity reactions,
infection, myalgia, n/v, peripheral neuropathies
INTERACTIONS Cisplatin, cyclosporine, dexamethasone, diazepam, etoposide,
ketoconazole, quinidine, teniposide, testosterone, verapamil, vincristine
NC/PT Monitor CBC carefully; dose based on response. Premedicate to decrease risk of
hypersensitivity reactions. Not for use in pregnancy (barrier contraceptives advised). Pt
should avoid exposure to infections; mark calendar of tx days; take safety precautions
w/ CNS effects; cover head at temp extremes (hair loss possible); report signs of
infection, difficulty breathing.

palifermin (Kepivance)
CLASS Keratinocyte growth factor
PREG/CONT C/NA

IND & DOSE To decrease incidence, duration of severe oral mucositis in pts w/
hematologic malignancies receiving myelotoxic chemotherapy requiring
hematopoietic stem-cell support. Adult: 60 mcg/kg/day by IV bolus for 3 consecutive
days before and 3 consecutive days after chemotherapy regimen.
ADV EFF Edema, erythema, pruritus, rash, taste alterations, tongue swelling
INTERACTIONS Heparin, myelotoxic chemotherapy
NC/PT Risk of tumor growth stimulation; monitor accordingly. Not for use in breast-
feeding. Provide nutrition support w/ taste changes, skin care for rash. Pt should report
pain at infusion site, severe rash.

paliperidone (Invega)
CLASS Atypical antipsychotic, benzisoxazole
PREG/CONT C/NA

BBW Avoid use in elderly pts w/ dementia-related psychosis; increased risk of CV death.
Drug not approved for this use.
IND & DOSE Tx of schizophrenia, schizoaffective disorder. Adult: 6 mg/ day PO in a.m.;
max, 12 mg/day PO. Tx of schizophrenia. Adult: 234 mg IM, then 156 mg IM in 1 wk,
both in deltoid; 117 mg IM 1 wk later in gluteal or deltoid. Maint, 39–234 mg/mo IM.
Child 12–17 yr: 51 kg or more, 3 mg/day PO; range, 3–12 mg/day. Under 56 kg,
3 mg/day PO; range, 3–6 mg/day.
ADJUST DOSE Renal impairment
ADV EFF Akathisia, dizziness, dry mouth, dystonia, extrapyramidal disorders,
hyperglycemia, impaired thinking, increased mortality in geriatric pts w/ dementia-
related psychosis, NMS, orthostatic hypotension, prolonged QT interval, suicidality,
tachycardia, weight gain
INTERACTIONS Alcohol, antihypertensives, CNS depressants, dopamine agonist, levodopa,
QT-prolonging drugs
NC/PT Monitor for hyperglycemia, weight gain. Tablet matrix may appear in stool. Not
for use in pregnancy, breast-feeding. Pt should swallow tablet whole and not cut, crush,
or chew it; avoid alcohol; take safety precautions w/ CNS effects; report fever, thoughts
of suicide.

palivizumab (Synagis)
CLASS Antiviral, monoclonal antibody
PREG/CONT C/NA

IND & DOSE Px of serious lower respiratory tract disease caused by RSV in children
at high risk for RSV disease. Child: 15 mg/kg IM as single injection monthly during
RSV season; give first dose before start of RSV season.
ADV EFF Chills, fever, malaise, pharyngitis, severe anaphylactoid reaction
INTERACTIONS Immunosuppressants
NC/PT Give preferably in anterolateral aspect of thigh; do not use gluteal muscle. For
cardiopulmonary bypass pts, give as soon as possible following procedure, even if under
1 mo since previous dose. Monitor for anaphylaxis, infection. Caregivers should protect
from infection, report fever, difficulty breathing.

palonosetron hydrochloride (Aloxi)

CLASS Antiemetic, selective serotonin receptor antagonist
 PREG/CONT B/NA

IND & DOSE Px of acute/delayed n/v associated w/ chemotherapy. Adult: 0.25 mg IV

as single dose over 30 sec 30 min before start of chemotherapy, or 0.5 mg PO 1 hr
before start of chemotherapy. Px of postop n/v. Adult: 0.075 mg IV as single dose over
10 sec immediately before anesthesia induction.
ADV EFF Arrhythmias, constipation, drowsiness, flulike sx, headache, somnolence
NC/PT Coordinate dose timing. Pt should take safety precautions, analgesic for headache;
report severe constipation, fever.

pamidronate disodium (Aredia)

CLASS Bisphosphonate, calcium regulator
PREG/CONT D/NA

IND & DOSETx of hypercalcemia. Adult: 60–90 mg IV over 2–24 hr as single dose; max,
90 mg/dose. Tx of Paget disease. Adult: 30 mg/day IV as 4-hr infusion on 3 consecutive
days for total dose of 90 mg; max, 90 mg/dose. Tx of osteolytic bone lesions. Adult:
90 mg IV as 2-hr infusion q 3–4 wk. For bone lesions caused by multiple myeloma,
monthly 4-hr infusion; max, 90 mg/dose.
ADJUST DOSE Renal impairment
ADV EFF Bone pain, diarrhea, headache, hypocalcemia, nausea, osteonecrosis of jaw
NC/PT Have calcium on hand for hypocalcemic tetany. Monitor serum calcium regularly.
Dental exam needed before tx for cancer pts at risk for osteonecrosis of jaw. Maintain
hydration, nutrition. Pt should not take foods high in calcium, calcium supplements
within 2 hr of dose; report muscle twitching, severe diarrhea.

pancrelipase (Creon, Pancreaze, Pertyze, Ultresa, Viokace)

CLASS Digestive enzyme
PREG/CONT C/NA

IND & DOSE Replacement tx in pts w/ deficient exocrine pancreatic secretions. Adult:
4,000–20,000 units (usually 1–3 capsules/tablets) PO w/ each meal, snacks; may
increase to 8 capsules/tablets in severe cases. Viokace: 500 units/kg/meal PO to max
2,500 units/kg/meal. Pts w/ pancreatectomy or obstruction, 72,000 units lipase meal
PO while consuming 100 g/day fat (Creon). Child 4 yr and older: 500 units
lipase/kg/meal PO to max 2,500 units/kg/meal. Child 1–under 4 yr: 1,000 units/kg/meal
PO to max 2,500 units/kg/meal or 10,000 units/kg/day. Child up to 1 yr: 3,000 units
lipase PO/120 mL formula or breast-feeding session; 2,000–4,000 units/feeding PO
(Ultresa).
ADV EFF Abd cramps, diarrhea, hyperuricemia, nausea
NC/PT Do not mix capsules directly into infant formula, breast milk; follow dose w/
formula, breast milk. Creon and Viokace are not interchangeable. Pt should not crush or
chew enteric-coated capsules; may open Ultresa capsules and sprinkle contents on food.
Pt should report difficulty breathing, joint pain.

DANGEROUS DRUG
panitumumab (Vectibix)
CLASS Monoclonal antibody, antineoplastic
PREG/CONT C/NA

BBW Monitor for possibly severe infusion reactions, dermatologic toxicity, pulmonary
fibrosis.
IND & DOSE Tx of epidermal growth factor receptor–expressing metastatic colorectal
carcinoma w/ disease progressing w/ or after chemotherapy regimens. Adult: 6
mg/kg IV over 60 min q 14 days; give doses larger than 1,000 mg over 90 min.
ADV EFF Abd pain, constipation, dermatologic toxicity, diarrhea, electrolyte
depletion, fatigue, hypomagnesemia, infusion reactions, pulmonary fibrosis
NC/PT Monitor electrolytes, respiratory function. Monitor constantly during infusion;
stop if infusion reaction. Men, women should use barrier contraceptives during and for
6 mo after tx; not for use in breast-feeding. Pt should report difficulty breathing, pain at
injection site, fever, rash.

pantoprazole (Protonix)
CLASS Proton pump inhibitor
PREG/CONT B/NA

IND & DOSE Tx of GERD; maint tx of erosive esophagitis; tx of pathological

hypersecretory disorders. Adult: 40 mg/day PO for 8 wk or less for maint healing of
erosive esophagitis. May repeat 8-wk course if no healing. Give continually for
hypersecretory disorders: 40 mg/day IV bid up to 240 mg/day (2-yr duration) or
40 mg/day IV for 7–10 days. For severe hypersecretory syndromes, 80 mg q 12 hr (up to
240 mg/day) PO, IV (6-day duration).
ADJUST DOSE Hepatic impairment
ADV EFF Abd pain, bone loss, Clostridium difficile diarrhea, dizziness, headache, insomnia,
n/v/d, pneumonia, URI
NC/PT Further evaluation needed after 4 wk of tx for GERD. Switch from IV to oral as
soon as possible. Pt should swallow tablet whole and not cut, crush, or chew it; take
safety measures for dizziness; report severe diarrhea/headache, fever.

paricalcitol (Zemplar)
CLASS Vitamin
PREG/CONT C/NA

IND & DOSE Px, tx of secondary hyperparathyroidism associated w/ chronic renal

failure. Adult: 0.04–0.1 mcg/kg injected during dialysis, no more often than q other
day. Pts not on dialysis: 1–2 mcg/day PO, or 2–4 mcg PO three times/wk based on
parathyroid level.
ADV EFF Arthralgia, chills, dry mouth, fever, flulike sx, GI hemorrhage, n/v
INTERACTIONS Aluminum-containing antacids, ketoconazole
NC/PT Arrange for calcium supplements; restrict phosphorus intake. Not for use in breast-
feeding. Pt should avoid vitamin D; report changes in thinking, appetite/weight loss,
increased thirst.

paroxetine hydrochloride (Paxil), paroxetine mesylate (Brisdelle, Pexeva)

CLASS Antidepressant, SSRI
PREG/CONT D/NA

BBW Risk of increased suicidality in children, adolescents, young adults; monitor

accordingly.
IND & DOSE Tx of depression. Adult: 20 mg/day PO; range, 20–50 mg/day. Or, 25–
62.5 mg/day CR form. Tx of OCD. Adult: 20 mg/day PO. May increase in 10-mg/day
increments; max, 60 mg/day. Tx of panic disorder. Adult: 10 mg/day PO; range, 10–
60 mg/day. Or 12.5–75 mg/day CR tablet; max, 75 mg/day. Tx of social anxiety
disorder. Adult: 20 mg/day PO in a.m. Or, 12.5 mg/day PO CR form; max, 60 mg/day
or 37.5 mg/day CR form. Tx of generalized anxiety disorder. Adult: 20 mg/day PO;
range, 20–50 mg/day. Tx of PMDD. Adult: 12.5 mg/day PO in a.m.; range, 12.5–
25 mg/day. May give daily or just during luteal phase of cycle. Tx of PTSD. Adult:
20 mg/day PO as single dose; range, 20–50 mg/day. Tx of vasomotor sx of
menopause (hot flashes). Adult: 7.5 mg/day PO at bedtime (Brisdelle).
ADJUST DOSE Elderly pts; hepatic, renal impairment
ADV EFF Anxiety, asthenia, constipation, diarrhea, dizziness, dry mouth, ejaculatory
disorders, headache, insomnia, nervousness, somnolence, suicidality
INTERACTIONS Digoxin, fosamprenavir, MAOIs, phenobarbital, phenytoin, procyclidine,
ritonavir, serotonergics, St. John’s wort, tryptophan, warfarin
NC/PT Do not give within 14 days of MAOIs. Not for use in pregnancy, breast-feeding. Pt
should take in evening; swallow CR tablet whole and not cut, crush, or chew it; shake
suspension before use; take safety precautions w/ CNS effects; avoid St. John’s wort;
report blurred vision, thoughts of suicide.

pazopanib (Votrient)
CLASS Antineoplastic, kinase inhibitor
PREG/CONT D/NA

BBW Risk of severe to fatal hepatotoxicity. Monitor LFTs regularly; adjust dose
accordingly.
IND & DOSE Tx of advanced renal cell carcinoma; tx of soft-tissue sarcoma
progressed after prior tx. Adult: 800 mg/day PO without food.
ADJUST DOSE Hepatic impairment
ADV EFF Anorexia, arterial thrombotic events, GI perforation, hair color changes,
hemorrhagic events, hepatotoxicity, hypertension, impaired wound healing,
hypothyroidism, n/v, prolonged QT interval, proteinuria
INTERACTIONS CYP3A4 inducers/inhibitors, simvastatin
NC/PT Not for use in pregnancy. Hair may lose pigmentation. Provide nutrition support
for n/v. Pt should take on empty stomach at least 1 hr before, 2 hr after meal; report all
drugs, OTC, herbs used (many drug interactions possible), report urine/stool color
changes, yellowing of skin, eyes.

pegaptanib (Macugen)
CLASS Monoclonal antibody
PREG/CONT B/NA

IND & DOSE Tx of neovascular (wet) age-related macular degeneration. Adult: 0.3 mg
q 6 wk by intravitreous injection into affected eye.
ADV EFF Anaphylaxis; endophthalmitis; eye discharge, pain, infection; increased IOP;
retinal detachment; traumatic cataract; vision changes; vitreous floaters
NC/PT Monitor IOP. Pt should mark calendar of tx days, report eye redness, sensitivity to
light, sudden vision change.

DANGEROUS DRUG
pegaspargase (Oncaspar)
CLASS Antineoplastic
PREG/CONT C/NA

IND & DOSETx of ALL. Adult: 2,500 international units/m2 IM, IV q 14 days.
ADV EFF Anaphylaxis, bone marrow depression, coagulopathy, glucose intolerance,
hepatic impairment, pancreatitis, renal toxicity
NC/PT IM route preferred; reserve IV for extreme situations. Monitor LFTs, renal
function. Not for use in breast-feeding. Pt should report excessive thirst, severe
headache, acute shortness of breath, difficulty breathing.

pegfilgrastim (Neulasta)
CLASS Colony stimulating factor
PREG/CONT C/NA

IND & DOSE To decrease incidence of infection in pts w/ nonmyeloid malignancies

receiving myelosuppressive anticancer drugs. Adult, child over 45 kg: 6 mg subcut as
single dose once per chemotherapy cycle. Do not give within 14 days before and 24 hr
after cytotoxic chemotherapy.
ADV EFF Acute respiratory distress syndrome, alopecia, anorexia, arthralgia, bone
marrow suppression, bone pain, dizziness, dyspepsia, edema, fatigue, fever,
generalized weakness, mucositis, n/v/d, splenic rupture, stomatitis
INTERACTIONS Lithium
NC/PT Monitor CBC. Protect from light. Do not shake syringe. Sol should be free of
particulate matter, not discolored. Pt should cover head at temp extremes (hair loss
possible), avoid exposure to infection, report signs of infection, difficulty breathing,
pain at injection site. Name confusion between Neulasta (pegfilgrastim) and Neumega
(oprelvekin); use caution.

peginterferon alfa-2a (Pegasys)

CLASS Interferon
PREG/CONT X/NA

BBW May cause, aggravate life-threatening to fatal neuropsychiatric, autoimmune,

ischemic, infectious disorders. Monitor closely; stop w/ persistent s&sx. Risk of serious
fetal defects when used w/ ribavirin; men, women should avoid pregnancy.
IND & DOSE Tx of hepatitis C in pts w/ compensated liver disease and not treated w/
interferon alfa. Adult: 180 mcg subcut wkly for 48 wk w/ ribavirin.
ADJUST DOSE Hepatic, renal impairment
ADV EFF Asthenia, bone marrow suppression, colitis, fatigue, fever, headache,
hemolytic anemia, hepatic impairment, infections, myalgia, neuropsychiatric
events, pancreatitis, pulmonary events, suicidality
INTERACTIONS Azathioprine, didanosine, methadone, nucleoside analogues, theophylline,
zidovudine
NC/PT Monitor closely; adverse effects may require stopping. Safety in pts w/ hepatitis B,
concomitant hepatitis C/HIV not established. Not for use in pregnancy; men, women
should use two forms of contraception during, for 6 mo after tx. Store in refrigerator.
Teach proper administration, disposal of needles, syringes. Pt should avoid exposure to
infection, report severe abd pain, bloody diarrhea, signs of infection, thoughts of
suicide, difficulty breathing.

peginterferon alfa-2b (Peg-Intron, Sylatron)

CLASS Interferon
PREG/CONT C/NA

BBW May cause, aggravate life-threatening to fatal neuropsychiatric, autoimmune,

ischemic, infectious disorders. Monitor closely; stop w/ persistent s&sx. Risk of serious
fetal defects when used w/ ribavirin; men, women should avoid pregnancy.
IND & DOSE Tx of chronic hepatitis C in pts w/ compensated livers; tx of genotype-1
chronic hepatitis C in combination w/ other drugs. Adult: 1.5 mcg/kg/wk subcut;
may give w/ ribavirin 800–1,400 mg/day PO. Child 3 yr and older: 60 mcg/kg/wk
subcut; may give w/ ribavirin 15 mg/kg/day PO.
ADJUST DOSE Hepatic, renal impairment
ADV EFF Asthenia, bone marrow suppression, colitis, fatigue, fever, headache,
hemolytic anemia, hepatic impairment, infections, ischemic cerebral events,
myalgia, neuropsychiatric events, pancreatitis, pulmonary events, suicidality
INTERACTIONS Azathioprine, didanosine, methadone, nucleoside analogues, theophylline,
zidovudine
NC/PT Monitor closely; adverse effects may require stopping. Safety in pts w/ hepatitis B,
concomitant hepatitis C/HIV not established. Not for use in pregnancy; men, women
should use two forms of contraception during, for 6 mo after tx. Store in refrigerator.
Teach proper administration, disposal of needles, syringes. Pt should avoid exposure to
infection, report severe abd pain, bloody diarrhea, signs of infection, thoughts of
suicide, difficulty breathing.

pegloticase (Krystexxa)
CLASS PEGylated uric-acid specific enzyme
PREG/CONT C/NA

BBW Severe anaphylaxis, infusion reactions have occurred; premedicate, closely

monitor. Monitor serum uric acid level.
IND & DOSE Tx of chronic gout in pts refractory to conventional tx. Adult: 8 mg by IV
infusion over no less than 120 min q 2 wk.
ADJUST DOSE Renal impairment
ADV EFF Anaphylaxis, chest pain, constipation, ecchymosis, gout flares, HF, infusion
reactions, nasopharyngitis, vomiting
NC/PT Monitor serum uric acid level. Premedicate w/ antihistamines, corticosteroids.
Contraindicated w/ G6PD deficiencies. Alert pt gout flares may occur up to 3 mo after
starting tx. Not for use in breast-feeding. Pt should report difficulty breathing, edema.

pegvisomant (Somavert)
CLASS Human growth hormone analogue
PREG/CONT C/NA

IND & DOSE Tx of acromegaly in pts w/ inadequate response to surgery, radiation.

Adult: 40 mg subcut as loading dose, then 10 mg/day subcut.
ADV EFF Diarrhea, dizziness, edema, hepatic impairment, infection, injection-site
reactions, nausea, pain, peripheral edema, sinusitis
INTERACTIONS Opioids
NC/PT Local reactions to injection common; rotate sites regularly. Monitor for infection.
Monitor liver function. Teach proper administration, disposal of needles, syringes. Not
for use in breast-feeding.
 DANGEROUS DRUG
pemetrexed (Alimta)
CLASS Antifolate antineoplastic
PREG/CONT D/NA

IND & DOSE Tx of unresectable malignant mesothelioma; tx of locally advanced,

metastatic non-small-cell lung cancer. Adult: 500 mg/m2 IV infused over 10 min on
day 1, then 75 mg/m2 cisplatin (tx of mesothelioma only) IV over 2 hr; repeat cycle q 21
days.
ADJUST DOSE Renal, hepatic impairment
ADV EFF Anorexia, bone marrow suppression, constipation, fatigue, n/v/d, renal
impairment, stomatitis
INTERACTIONS Nephrotoxic drugs, NSAIDs
NC/PT Pretreat w/ corticosteroid, folic acid, vitamin B12. Monitor CBC; dosage
adjustment based on response. Not for use in pregnancy (barrier contraceptives
advised), breast-feeding. Pt should avoid NSAIDs, exposure to infection; report unusual
bleeding, severe GI sx.

penbutolol sulfate (Levatol)

CLASS Antihypertensive, beta blocker
PREG/CONT C/NA

IND & DOSE Tx of mild to moderate hypertension. Adult: 20 mg/day PO.

ADV EFF Bradycardia, bronchospasm, cardiac arrhythmias, constipation, decreased
exercise tolerance/libido, dizziness, dyspnea, ED, fatigue, gastric pain, HF,
laryngospasm, n/v/d, pulmonary edema, rash, stroke
INTERACTIONS Beta blockers, calcium channel blockers, epinephrine, ergots, insulin,
NSAIDs, prazosin, sympathomimetics, verapamil
NC/PT Taper gradually after long-term tx. Pt should take safety precautions w/ CNS
effects, report difficulty breathing, numbness/tingling, swelling.

penicillamine (Cuprimine, Depen)

CLASS Antirheumatic, chelate
PREG/CONT D/NA

BBW Because of severe toxicity, including bone marrow suppression, renal damage,
reserve use for serious cases; monitor closely.
IND & DOSE Tx of severe, active rheumatoid arthritis, Wilson disease, cystinuria
when other measures fail. Adult: 125–250 mg/day PO; max, 1 g/day
ADV EFF Agitation, anxiety, bone marrow suppression, fever, myasthenia gravis,
paresthesia, rash, renal toxicity, tinnitus
INTERACTIONSGold salts, nephrotoxic drugs
NC/PT Monitor CBC, renal function twice/wk. Assess neurologic functioning; stop if
increasing weakness. Not for use in pregnancy (barrier contraceptives advised), breast-
feeding. Pt should avoid exposure to infection, report signs of infection, muscle
weakness, edema.

penicillin G benzathine (Bicillin L-A, Permapen)

CLASS Penicillin antibiotic
PREG/CONT B/NA

BBW Not for IV use. Do not inject or mix w/ other IV sols. Inadvertent IV administration
has caused cardiorespiratory arrest, death.
IND & DOSE Tx of streptococcal infections. Adult: 1.2 million units IM. Older child:
900,000 units IM. Child under 27 kg: 300,000–600,000 units IM. Tx of early syphilis.
Adult: 2.4 million units IM. Tx of syphilis lasting longer than 1 yr. Adult: 7.2 million
units as 2.4 million units IM wkly for 3 wk. Tx of yaws, bejel, pinta, erysipeloid.
Adult: 1.2 million units IM as single dose. Tx of congenital syphilis. Child 2–12 yr:
Adjust dose based on adult schedule. Child under 2 yr: 50,000 units/kg body weight IM.
Px of rheumatic fever, chorea. Adult: 1.2 million units IM q mo; or 600,000 units q
2 wk.
ADV EFF Anaphylaxis, bone marrow suppression, gastritis, glossitis, n/v/d, pain,
phlebitis, rash, superinfections
INTERACTIONS Amikacin, gentamicin, neomycin, tetracyclines, tobramycin
NC/PT Culture before tx. Use IM only: Upper outer quadrant of buttock (adults),
midlateral aspect of thigh (infants, small children). Pt should report difficulty breathing,
rash, pain at injection site.

penicillin G potassium, penicillin G sodium (Pfizerpen)

CLASS Penicillin antibiotic
PREG/CONT B/NA

IND & DOSE Tx of meningococcal meningitis. Adult: 1–2 million units q 2 hr IM, or 20–
30 million units/day by continuous IV infusion. Child: 200,000–300,000 units/kg/day IV
q 6 hr. Infants under 7 days: 50,000 units/kg/day IV in divided doses q 12 hr. Tx of
actinomycosis. Adult: 1–6 million units/day IM in divided doses q 4–6 hr for 6 wk, or
IV for cervicofacial cases. Or, 10–20 million units/day IV for thoracic, abd diseases. Tx
of clostridial infections. Adult: 20 million units/day in divided doses q 4–6 hr IM or IV
w/ antitoxin. Tx of fusospirochetal infections (Vincent disease). Adult: 5–10 million
units/day IM or IV in divided doses q 4–6 hr. Tx of rat-bite fever. Adult: 12–20 million
units/day IM or IV in divided doses q 4–6 hr for 3–4 wk. Tx of Listeria infections.
Adult: 15–20 million units/day IM or IV in divided doses q 4–6 hr for 2 or 4 wk
(meningitis, endocarditis, respectively). Tx of Pasteurella infections. Adult: 4–6
million units/day IM or IV in divided doses q 4–6 hr for 2 wk. Tx of erysipeloid
endocarditis. Adult: 12–20 million units/day IM or IV in divided doses q 4–6 hr for 4–
6 wk. Tx of diphtheria (adjunct tx w/ antitoxin to prevent carrier state). Adult: 2–3
million units/day IM or IV in divided doses q 4–6 hr for 10–12 days. Tx of anthrax.
Adult: Minimum 5 million units/day IM or IV in divided doses. Tx of streptococcal
infections. Adult: 5–24 million units/day IM or IV in divided doses q 4–6 hr. Child:
150,000 units/kg/day IM or IV q 4–6 hr. Child under 7 days: 75,000 units/kg/day IV in
divided doses q 8 hr. Tx of syphilis. Adult: 18–24 million units/day IV q 4–6 hr for 10–
14 days, then benzathine penicillin G 2.4 million units IM wkly for 3 wk. Tx of
gonorrhea. 10 million units/day IV q 4–6 hr until improvement. Tx of group B
streptococci. Child: 100,000 units/kg/ day IV.
ADV EFF Anaphylaxis, bone marrow suppression, gastritis, glossitis, n/v/d, pain,
phlebitis, rash, superinfections
INTERACTIONS Amikacin, gentamicin, neomycin, tetracyclines, tobramycin
NC/PT Culture before tx. Smallest volume possible for IM use. Have emergency
equipment on hand w/ IV infusion. Monitor serum electrolytes w/ penicillin potassium.
Pt should report difficulty breathing, rash, unusual bleeding, signs of infection.

penicillin G procaine (Wycillin)

CLASS Penicillin antibiotic
PREG/CONT B/NA

IND & DOSE Tx of moderately severe infections caused by sensitive strains of

streptococci, pneumococci, staphylococci. Adult: 600,000–1 million units/day IM for
minimum 10 days. Tx of bacterial endocarditis (group A streptococci). Adult:
600,000–1 million units/day IM. Tx of fusospirochetal infections, rat-bite fever,
erysipeloid, anthrax. Adult: 600,000–1 million units/day IM. Tx of diphtheria. Adult:
300,000–600,000 units/day IM w/ antitoxin. Tx of diphtheria carrier state. Adult:
300,000 units/day IM for 10 days. Tx of syphilis. Adult, child over 12 yr: 600,000
units/day IM for 8 days, 10–15 days for late-stage syphilis. Tx of neurosyphilis. Adult:
2.4 million units/day IM w/ 500 mg probenecid PO qid for 10–14 days, then 2.4 million
units benzathine penicillin G IM after completion of tx regimen. Tx of congenital
syphilis. Child under 32 kg: 50,000 units/kg/day IM for 10 days. Tx of group A
streptococcal, staphylococcal pneumonia. Child under 27 kg: 300,000 units/day IM.
ADV EFF Anaphylaxis, bone marrow suppression, gastritis, glossitis, n/v/d, pain,
phlebitis, rash, superinfections
INTERACTIONS Amikacin, gentamicin, neomycin, tetracyclines, tobramycin
NC/PT Culture before tx. IM route only in upper outer quadrant of buttock; midlateral
aspect of thigh may be preferred for infants, small children. Pt should report difficulty
breathing, rash, unusual bleeding, signs of infection.

penicillin V (generic)
 CLASSPenicillin antibiotic
PREG/CONT B/NA

IND & DOSE Tx of fusospirochetal infections, staphylococcal infections of skin, soft

tissues. Adult, child over 12 yr: 250–500 mg PO q 6–8 hr. Tx of streptococcal
infections. Adult, child over 12 yr: 125–250 mg PO q 6–8 hr for 10 days. Tx of
pneumococcal infections. Adult, child over 12 yr: 250–500 mg PO q 6 hr until afebrile
for 48 hr. Px of rheumatic fever/chorea recurrence. Adult, child over 12 yr: 25–250 mg
PO bid. Tx of Lyme disease. Adult, child over 12 yr: 500 mg PO qid for 10–20 days. Tx of
mild, uncomplicated cutaneous anthrax. Adult, child over 12 yr: 200–500 mg PO qid.
Child 2–12 yr: 25–50 mg/kg/day PO in two or four divided doses. Px of anthrax px.
Adult, child over 9 yr: 7.5 mg/kg PO qid. Child under 9 yr: 50 mg/kg/day PO in four
divided doses. Px of Streptococcus pneumoniae septicemia in sickle cell anemia.
Child 6–9 yr: 250 mg PO bid. Child 3 mo–5 yr: 125 mg PO bid.
ADV EFF Anaphylaxis, bone marrow suppression, gastritis, glossitis, n/v/d, pain,
phlebitis, rash, superinfections
INTERACTIONS Tetracyclines
NC/PT Culture before tx. Stable for max 14 days. Pt should take w/ water, not w/ milk,
fruit juices, soft drinks; refrigerate suspension; report difficulty breathing, rash, unusual
bleeding, signs of infection.

pentamidine isethionate (NebuPent, Pentam 300)

CLASS Antiprotozoal
PREG/CONT C/NA

IND & DOSE Tx of Pneumocystis jiroveci pneumonia. Adult, child: 4 mg/kg/day for 14–21
days by deep IM injection or IV infusion over 60–120 min. Px of P. jiroveci pneumonia.
Adult, child: 300 mg once q 4 wk through Respirgard II nebulizer.
ADV EFF Acute renal failure, anorexia, cough, dizziness, fatigue, fever, hypotension,
laryngospasm, metallic taste (inhalation), severe hypotension, pain at injection site,
rash, Stevens-Johnson syndrome
NC/PT Culture before tx. Drug a biohazard; use safe handling procedures. Monitor CBC,
LFTs, renal function. Have pt in supine position for parenteral administration. Pt should
take safety precautions w/ hypotension, CNS effects; learn proper use, care of Respirgard
II; report difficulty breathing, rash.

DANGEROUS DRUG
pentazocine (Talwin)
CLASS Opioid agonist-antagonist
PREG/CONT C/C-IV

BBW Pentazocine/naloxone for oral use only; can be lethal if injected.

IND & DOSE Relief of moderate to severe pain; preanesthetic (parenteral). Adult, child
over 12 yr: 50 mg PO q 3–4 hr; max, 600 mg/24 hr. Or, 30 mg IM, subcut or IV. May
repeat q 3–4 hr; max, 360 mg/24 hr. Women in labor: 30 mg IM as single dose. Or,
20 mg IV two to three times at 2- to 3-hr intervals.
ADJUST DOSE Elderly pts, impaired adults
ADV EFF Bronchospasm, cardiac arrest, constipation, dizziness, euphoria, hypotension,
light-headedness, laryngospasm, n/v, pain at injection site, sedation, shock, sweating,
urine retention
INTERACTIONS Alcohol, barbiturate anesthetics, CNS depressants, methadone, opioids
NC/PT Doses over 30 mg IV or 60 mg IM, subcut not recommended. Oral form especially
abused in combination w/ tripelennamine (“Ts and Blues”); serious, fatal consequences.
Have opioid antagonist, equipment for assisted, controlled respiration on hand during
parenteral administration. Withdraw gradually after 4–5 days. Pt should avoid alcohol,
OTC products; use laxative for constipation, take safety precautions w/ CNS effects;
report difficulty breathing.

DANGEROUS DRUG
pentobarbital (Nembutal)
CLASS Antiepileptic, barbiturate, sedative-hypnotic
PREG/CONT D/C-II

BBW Do not administer intra-arterially; may produce arteriospasm, thrombosis,

gangrene.
IND & DOSE Sedative-hypnotic, preanesthetic, emergency antiseizure. Adult: Give by
slow IV injection (max, 50 mg/min); 100 mg in 70-kg adult. Wait at least 1 min for full
effect. Base dose on response. May give additional small increments to max 200–500
mg. Minimize dose in seizure states to avoid compounding possible depression after
seizures. Or, 150–200 mg IM. Child: Reduce initial adult dose based on age, weight,
condition. Or, 25–80 mg or 2–6 mg/kg IM; max, 100 mg.
ADJUST DOSE Elderly pts, debilitated adults
ADV EFF Agitation, apnea, ataxia, bradycardia, bronchospasm, CNS depression,
circulatory collapse, confusion, dizziness, hallucinations, hyperkinesia, hypotension,
hypoventilation, insomnia, laryngospasm, pain/necrosis at injection site, somnolence,
Stevens-Johnson syndrome, syncope, withdrawal syndrome
INTERACTIONS Alcohol, beta-adrenergic blockers, CNS depressants, corticosteroids,
doxycycline, estrogens, hormonal contraceptives, metronidazole, oral anticoagulants,
phenylbutazones, quinidine, theophylline
NC/PT Use caution in children; may produce irritability, aggression, inappropriate
tearfulness. Give slowly IV or by deep IM injection. Monitor continuously during IV use;
monitor injection site for irritation. Taper gradually w/ long-term use. Pt should take
safety precautions for CNS effects; report difficulty breathing, rash.
 pentosan polysulfate sodium (Elmiron)
CLASS Bladder protectant
PREG/CONT B/NA

IND & DOSERelief of bladder pain associated w/ interstitial cystitis. Adult: 100 mg PO
tid on empty stomach.
ADV EFF Abd pain, alopecia, bleeding, diarrhea, dizziness, dyspepsia, liver function
changes, nausea
INTERACTIONS Anticoagulants, aspirin, NSAIDs
NC/PT Use caution w/ hepatic insufficiency. Drug a heparin; use caution if surgery
needed. Pt should cover head at temp extremes (hair loss possible), report unusual
bleeding, urine/stool color changes.

DANGEROUS DRUG
pentostatin (Nipent)
CLASS Antineoplastic antibiotic
PREG/CONT D/NA

BBW Associated w/ fatal pulmonary toxicity, bone marrow depression.

IND & DOSE Tx of alpha interferon–refractory hairy cell leukemia, chronic
lymphocytic leukemia, cutaneous/peripheral T-cell lymphoma. Adult: 4 mg/m2 IV q
other wk.
ADJUST DOSE Renal impairment
ADV EFF Abd pain, anorexia, bone marrow suppression, chills, cough, dizziness,
dyspepsia, n/v, pulmonary toxicity, rash
INTERACTIONS Allopurinol, cyclophosphamide, fludarabine, vidarabine
NC/PT Toxic drug; use special precautions in handling. Monitor CBC regularly; monitor
pulmonary function. Not for use in pregnancy, breast-feeding. Pt should mark calendar
of tx days, avoid exposure to infection, report difficulty breathing, signs of infection.

pentoxifylline (Trental)
CLASS Hemorrheologic, xanthine
PREG/CONT C/NA

IND & DOSE Tx of intermittent claudication. Adult: 400 mg PO tid w/ meals for at least
8 wk.
ADJUST DOSE Renal impairment
ADV EFF Angina, anxiety, dizziness, dyspepsia, headache, nausea, rash
INTERACTIONS Anticoagulants, theophylline
NC/PT Pt should take w/ meals; swallow tablet whole and not cut, crush, or chew it; take
safety precautions w/ CNS effects; report chest pain.
 perampanel (Fycompa)
CLASS Antiepileptic, glutamate receptor antagonist
PREG/CONT C/NA

BBW Risk of serious to life-threatening psychiatric, behavioral reactions; monitor pt

closely especially when starting drug or changing dose.
IND & DOSE Adjunct tx of partial-onset seizures. Adult, child 12 yr and older: 2 mg/day
PO at bedtime, 4 mg/day PO at bedtime if also on enzyme-inducing antiepileptics; max,
12 mg/day PO.
ADJUST DOSE Mild to moderate hepatic impairment: severe hepatic, renal impairment;
dialysis (not recommended)
ADV EFF Ataxia, balance disorders, falls, fatigue, gait disturbances, irritability, nausea,
serious psychiatric/behavioral reactions, somnolence, suicidality, weight gain
INTERACTIONS Alcohol, carbamazepine, CNS depressants, hormonal contraceptives,
oxcarbazepine, phenytoin, rifampin, St. John’s wort
NC/PT Monitor closely when starting tx or changing dose; taper gradually after long-term
use. Not for use in pregnancy, breast-feeding. Protect from falls; advise pt to avoid
driving, operating dangerous machinery. Pt should take once a day at bedtime; not stop
drug suddenly; avoid alcohol, St John’s wort; use caution to avoid falls, injury; be aware
behavior changes, suicidal thoughts possible; report severe dizziness, trouble walking,
suicidal thoughts, behavior changes.

perindopril erbumine (Aceon)

CLASS ACE inhibitor, antihypertensive
PREG/CONT D/NA

BBW Serious fetal injury possible; advise barrier contraceptives.

IND & DOSE Tx of hypertension. Adult: 4 mg/day PO; max, 16 mg/day. Tx of pts w/
stable CAD to reduce risk of CV mortality, nonfatal MI. Adult: 4 mg/day PO for
2 wk; maint, 8 mg/day PO.
ADJUST DOSE Elderly pts, renal impairment
ADV EFF Airway obstruction, angioedema, bone marrow suppression, diarrhea,
dizziness, fatigue, gastric irritation, headache, insomnia, nausea, orthostatic
hypotension, somnolence
INTERACTIONS Indomethacin, lithium, potassium-sparing diuretics, potassium supplements
NC/PT Have epinephrine on hand for angioedema of face, neck. Alert surgeons; volume
replacement may be needed if surgery required. Use caution in conditions w/ possible
BP drop (diarrhea, sweating, vomiting, dehydration). Not for use in pregnancy (barrier
contraceptives advised). Pt should avoid potassium supplements, OTC drugs that might
increase BP; take safety precautions w/ CNS effects; report difficulty breathing, signs of
infection, swelling of face, neck.
 pertuzumab (Perjeta)
CLASS Antiepileptic, HER2/NEU receptor antagonist
PREG/CONT D/NA

BBW Risk of embryo-fetal and/or birth defects; not for use in pregnancy.
IND & DOSE Adjunct tx of pts w/ HER2-positive metastatic breast cancer who have
not received prior HER2 therapy or tx for metastatic disease, w/ trastuzumab and
docetaxel. Adult: 840 mg IV over 60 min, then 420 mg IV over 30–60 min q 3 wk, w/
trastuzumab and docetaxel.
ADV EFF Alopecia, fatigue, infusion reaction, left ventricular (LV) dysfunction,
neutropenia, n/v, peripheral neuropathy, rash
NC/PT Perform HER2 testing before use; ensure concurrent use of trastuzumab, docetaxel.
Infuse first dose over 60 min, subsequent doses over 30–60 min; do not give as bolus.
Not for use in pregnancy (contraceptives advised during and for 6 mo after tx), breast-
feeding. Monitor for infusion reactions, LV dysfunction. Pt should mark calendar for
injection days; be aware hair loss possible; report difficulty breathing,
numbness/tingling, fever, s&sx of infection.

phenazopyridine hydrochloride (Azo-Standard, Baridium, Pyridium, Urinary

Pain Relief)
CLASS Urinary analgesic
PREG/CONT B/NA

IND & DOSE Symptomatic relief of s&sx of lower urinary tract irritation. Adult, child
over 12 yr: 100–200 mg PO tid after meals for max 2 days. Child 6–12 yr: 12 mg/kg/day
divided into three doses PO for max 2 days.
ADJUST DOSE Elderly pts, renal impairment
ADV EFF GI disturbances, headache, rash, yellowish orange urine
NC/PT May permanently stain contact lenses. Stop if skin, sclera become yellow; may
indicate drug accumulation. Urine may be yellowish orange; will stain fabric. Pt should
take after meals and not take longer than 2 days, report unusual bleeding, fever.

phenelzine sulfate (Nardil)

CLASS Antidepressant, MAOI
PREG/CONT C/NA

BBW Increased risk of suicidality in children, adolescents, young adults; monitor

accordingly.
IND & DOSE Tx of depression in pts unresponsive to other tx. Adult: 15 mg PO tid.
Rapidly increase to at least 60 mg/day. After max benefit achieved, reduce dose slowly
over several wk. Maint, 15 mg/day or q other day PO.
ADJUST DOSE Elderly pts
ADV EFF Abd pain, anorexia, blurred vision, confusion, constipation, dizziness,
drowsiness, dry mouth, headache, hyperreflexia, hypertensive crisis, hypomania,
hypotension, insomnia, jitteriness, liver toxicity, n/v/d, orthostatic hypotension,
suicidal thoughts, twitching, vertigo
INTERACTIONS Alcohol, amphetamines, antidiabetics, beta blockers, dextromethorphan,
meperidine, SSRIs, sympathomimetics, TCAs, thiazides, tyramine-containing foods
NC/PT Have phentolamine/other alpha-adrenergic blocker on hand for hypertensive
crisis. Monitor LFTs, BP regularly. Pt should avoid diet high in tyramine-containing
foods during, for 2 wk after tx; avoid alcohol, OTC appetite suppressants; take safety
precautions w/ CNS effects; change position slowly if orthostatic hypotension; report
rash, urine/stool color changes, thoughts of suicide.

DANGEROUS DRUG
phenobarbital (Bellatal, Solfoton), phenobarbital sodium (Luminal Sodium)
CLASS Antiepileptic, barbiturate, sedative-hypnotic
PREG/CONT D/C-IV

BBW Increased risk of suicidality in children, adolescents, young adults; monitor

accordingly.
IND & DOSE Sedation. Adult: 30–120 mg/day PO in two to three divided doses; max, 400
mg/24 hr. Or, 30–120 mg/day IM or IV in two to three divided doses. Child: 6
mg/kg/day PO in divided doses. Preop sedation. Adult: 100–200 mg IM 60–90 min
before surgery. Child: 1–3 mg/kg IM or IV 60–90 min before surgery. Hypnotic. Adult:
100–320 mg PO at bedtime, or 100–320 mg IM or IV. Antiepileptic. Adult: 60–
300 mg/day PO. Child: 3–6 mg/kg/day PO. Or, 4–6 mg/kg/day IM or IV for 7–10 days
to blood level of 10–15 mcg/mL. Or, 10–15 mg/kg/day IV or IM. Tx of acute seizures.
Adult: 200–320 mg IM or IV repeated in 6 hr if needed. Tx of status epilepticus. Child:
15–20 mg/kg IV over 10–15 min.
ADJUST DOSE Elderly pts, debilitated adults; hepatic, renal impairment
ADV EFF Agitation, apnea, ataxia, bradycardia, bronchospasm, CNS depression,
circulatory collapse, confusion, dizziness, hallucinations, hypotension,
hypoventilation, hyperkinesia, insomnia, laryngospasm, pain/necrosis at injection site,
somnolence, Stevens-Johnson syndrome, syncope, withdrawal syndrome
INTERACTIONS Alcohol, beta-adrenergic blockers, CNS depressants, corticosteroids,
doxycycline, felodipine, fenoprofen, estrogens, hormonal contraceptives, metronidazole,
oral anticoagulants, phenylbutazones, quinidine, theophylline, valproic acid
NC/PT Use caution in children; may produce irritability, aggression, inappropriate
tearfulness. Do not give intra-arterially; arteriospasm, thrombosis, gangrene possible.
Give slowly IV or by deep IM injection. Monitor continuously during IV use; monitor
injection site for irritation. Taper gradually w/ long-term use. Not for use in pregnancy
(contraceptives advised). Pt should take safety precautions w/ CNS effects; not take
longer than 2 wk for insomnia; wear medical ID for seizure disorder; report difficulty
breathing, rash, thoughts of suicide.

DANGEROUS DRUG
phentolamine mesylate (OraVerse)
CLASS Alpha blocker, diagnostic agent
PREG/CONT C/NA

IND & DOSE Px, control of hypertensive episodes in pheochromocytoma. Adult: For
preop reduction of elevated BP, 5 mg IV or IM 1–2 hr before surgery; repeat if
necessary. Give 5 mg IV during surgery as indicated to control paroxysms of
hypertension, other epinephrine toxicity effects. Child: 1 mg IV or IM 1–2 hr before
surgery; repeat if necessary. Give 1 mg IV during surgery as indicated for epinephrine
toxicity. Px of tissue necrosis, sloughing after IV dopamine extravasation. Adult:
Infiltrate 10–15 mL normal saline injection containing 5–10 mg phentolamine. Child:
Infiltrate 0.1–0.2 mg/kg to max 10 mg. Px of tissue necrosis, sloughing after IV
norepinephrine extravasation. Adult: 10 mg phentolamine added to each liter IV
fluids containing norepinephrine. Dx of pheochromocytoma. Adult: Use only to
confirm evidence after risks carefully considered. Usual dose, 5 mg IM or IV. Reversal
of soft-tissue anesthesia. Adult: 0.2–0.8 mg based on amount of local anesthetic given,
injected into anesthetized area. Child 6 yr and older, over 30 kg: Adult dose w/ max
0.4 mg. Child 6 yr and older, 15–30 kg: Max, 0.2 mg.
ADV EFF Acute, prolonged hypotension; arrhythmias; dizziness; MI; nausea; weakness
INTERACTIONS Ephedrine, epinephrine
NC/PT Give OraVerse after dental procedure, using same location as local anesthetic.
Monitor P, BP closely. Pt should take safety precautions w/ CNS effects, hypotension;
report palpitations, chest pain.

DANGEROUS DRUG
phenylephrine hydrochloride (Neo-Synephrine, PediaCare Children’s
Decongestant, Sudafed PE, Vicks Sinex Ultra Fine Mist)
CLASS Alpha agonist, nasal decongestant, ophthalmic mydriatic, sympathomimetic
PREG/CONT C/NA

BBW Protect parenteral sol from light. Do not give unless sol is clear; discard unused sol.
IND & DOSE Tx of mild to moderate hypotension. Adult: 1–10 mg subcut, IM; max initial
dose, 5 mg. Or, 0.1 or 0.5 mg IV; max initial dose, 0.5 mg. Do not repeat more often
than q 10–15 min; 0.5 mg IV should raise BP for 15 min. Tx of severe hypotension,
shock. Adult: For continuous infusion, add 10 mg to 500 mL dextrose or normal saline
injection. Start at 100–180 mcg/min (based on drop factor of 20 drops/mL [100–180
drops/min]). When BP stabilized, maint, 40–60 mcg/min. Spinal anesthesia. Adult: 2–
3 mg subcut or IM 3–4 min before spinal anesthetic injection. Hypotensive
emergencies during anesthesia. Adult: 0.2 mg IV; max, 0.5 mg/dose. Child: 0.5–1
mg/11.3 kg subcut, IM. Prolongation of spinal anesthesia. Adult: Adding 2–5 mg to
anesthetic sol increases motor block duration by as much as 50%. Vasoconstrictor for
regional anesthesia. Adult: 1:20,000 concentration (add 1 mg phenylephrine to q 20
mL local anesthetic sol). Tx of paroxysmal supraventricular tachycardia. Adult:
Rapid IV injection (within 20–30 sec) recommended. Max initial dose, 0.5 mg.
Subsequent doses should not exceed preceding dose by more than 0.1–0.2 mg; should
never exceed 1 mg. Use only after other tx failed. Tx of nasal congestion. Adult: 2–
3 sprays, drops of 0.25% or 0.5% sol in each nostril q 3–4 hr. In severe cases, may need
0.5% or 1% sol. Or, 10 mg PO bid–qid. Or, 1–2 tablets PO q 4 hr. Or, 1 strip q 4 hr;
max, 6 strips/24 hr. Place 1 strip on tongue; let dissolve. Or, 10 mL liquid q 6 hr. Child 6
yr and older: 2–3 sprays 0.25% sol in each nostril no more than q 4 hr. Or, 1 tablet PO q
4 hr. Child 2–5 yr: 2–3 drops 0.125% sol in each nostril q 4 hr PRN. Or, 1 dropperful (5
mL [2.5 mg]) 0.25% oral drops q 4 hr; max, 6 mL (15 mg)/day. Vasoconstriction,
pupil dilation. Adult: 1 drop 2.5% or 10% sol on upper limbus. May repeat in 1 hr. Tx
of uveitis to prevent posterior synechiae. Adult: 1 drop 2.5% or 10% sol on surface of
cornea w/ atropine. Max, three times. Tx of wide-angle glaucoma. Adult: 1 drop 2.5%
or 10% sol on upper surface of cornea repeated as necessary, w/ miotics. Intraocular
surgery. Adult: 2.5% or 10% sol in eye 30–60 min before procedure. Refraction. Adult:
1 drop of cycloplegic then, in 5 min, 1 drop phenylephrine 2.5% sol and, in 10 min,
another drop of cycloplegic. Ophthalmoscopic exam. Adult: 1 drop 2.5% sol in each
eye. Mydriasis produced in 15–30 min, lasting 4–6 hr. Tx of minor eye irritation.
Adult: 1–2 drops 0.12% sol in eye bid–qid as needed.
ADJUST DOSE Elderly pts
ADV EFF Anorexia, anxiety, blurred vision, cardiac arrhythmias, decreased urine output,
dizziness, drowsiness, dysuria, fear, headache, light-headedness, local stinging
w/ ophthalmic sol, nausea, pallor, rebound congestion w/ nasal sol, urine retention
INTERACTIONS Halogenated anesthetics, MAOIs, methyldopa, oxytocics,
sympathomimetics, TCAs
NC/PT Have alpha-adrenergic blocker on hand. If extravasation, infiltrate area w/
phentolamine (5–10 mg in 10–15 mL saline) using fine hypodermic needle; usually
effective if area infiltrated within 12 hr of extravasation. Five mg IM should raise BP for
1–2 hr; 0.5 mg IV, for 15 min. Do not give within 14 days of MAOIs. Monitor closely
during administration. Teach proper administration of nasal sol, eyedrops. Pt should not
use longer than prescribed; take safety precautions w/ CNS effects; report chest pain,
palpitations, vision changes.

phenytoin (Dilantin, Phenytek)

CLASS Antiarrhythmic, antiepileptic, hydantoin
PREG/CONT D/NA

BBW Give IV slowly to prevent severe hypotension, venous irritation; small margin of
safety between full therapeutic, toxic doses. Continually monitor cardiac rhythm; check
BP frequently, regularly during infusion. Suggest use of fosphenytoin sodium if IV route
needed.
IND & DOSE Tx of status epilepticus. Adult: 10–15 mg/kg by slow IV. Maint, 100 mg PO
IV q 6–8 hr; max infusion rate, 50 mg/min. Child: Dose based on children’s formulas;
may also calculate infants’, children’s doses based on 10–15 mg/kg IV in divided doses
of 5–10 mg/kg. For neonates, 15–20 mg/kg IV in divided doses of 5–10 mg/kg
recommended. Px of seizures during neurosurgery. Adult: 100–200 mg IM q 4 hr
during surgery, postop; not preferred route. Tx of tonic-clonic, psychomotor seizures.
Adult: Loading dose in hospitalized pts: 1 g phenytoin capsules (phenytoin sodium,
prompt) divided into three doses (400 mg, 300 mg, 300 mg) and given PO q 2 hr. When
control established, may consider once-a-day dosing w/ 300 mg PO. W/ no previous tx:
Initially, 100 mg PO tid; maint, 300–400 mg/day. Child not previously treated: 5
mg/kg/day PO in two to three equally divided doses. Max, 300 mg/day; maint, 4–
8 mg/kg. Child older than 6 yr may need minimum adult dose (300 mg/day). IM tx in
pt previously stabilized on oral dose. Adult: Increase dose by 50% over oral dose.
When returning to oral dose, decrease dose by 50% of original oral dose for 1 wk to
prevent excessive plasma level.
ADJUST DOSE Elderly pts, hepatic impairment
ADV EFF Aplastic anemia, ataxia, dizziness, drowsiness, dysarthria, frank malignant
lymphoma, bullous/exfoliative/purpuric dermatitis, CV collapse, gum hyperplasia,
hematopoietic complications, insomnia, irritation, liver damage, lupus
erythematosus, mental confusion, nausea, nystagmus, Stevens-Johnson syndrome
INTERACTIONS Acetaminophen, alcohol, allopurinol, amiodarone, antineoplastics,
atracurium, benzodiazepines, carbamazepine, cardiac glycosides, chloramphenicol,
cimetidine, corticosteroids, cyclosporine, diazoxide, disopyramide, disulfiram,
doxycycline, estrogens, fluconazole, folic acid, furosemide, haloperidol, hormonal
contraceptives, isoniazid, levodopa, loxapine, methadone, metronidazole, metyrapone,
mexiletine, miconazole, nitrofurantoin, omeprazole, pancuronium, phenacemide,
phenothiazide, phenylbutazone, primidone, pyridoxine, quinidine, rifampin, sucralfate,
sulfonamides, sulfonylureas, theophylline, trimethoprim, valproic acid, vecuronium
NC/PT Monitor for therapeutic serum level (10–20 mcg/mL). Enteral tube feedings may
delay absorption. Provide 2-hr window between Dilantin doses, tube feedings. Reduce
dose, stop phenytoin, or substitute other antiepileptic gradually; stopping abruptly may
precipitate status epilepticus. Stop if rash, depressed blood count, enlarged lymph
nodes, hypersensitivity reaction, signs of liver damage, Peyronie disease (induration of
corpora cavernosa of penis); start another antiepileptic promptly. Have lymph node
enlargement during tx evaluated carefully. Lymphadenopathy that simulates Hodgkin
lymphoma has occurred; lymph node hyperplasia may progress to lymphoma. Not for
use in pregnancy (contraceptives advised). Pt should have regular dental care; take
safety precautions for CNS effects; wear medical ID; report rash, unusual bleeding,
urine/stool color changes, thoughts of suicide.
 pilocarpine hydrochloride (Salagen)
CLASS Parasympathomimetic
PREG/CONT C/NA

IND & DOSETx of sx of xerostomia from salivary gland dysfx caused by radiation for
head/neck cancer. Adult: 5–10 mg PO tid. Tx of dry mouth in Sjögren syndrome.
Adult: 5 mg PO qid.
ADJUST DOSE Severe hepatic impairment
ADV EFF Bronchospasm, headache, hypertension, hypotension, n/v/d, renal colic,
sweating, tearing, visual changes
INTERACTIONS Anticholinergics, beta blockers
NC/PT Maintain hydration. Not for use in breast-feeding. Pt should take safety
precautions w/ vision changes, report dehydration, difficulty breathing.

pimozide (Orap)
CLASS Antipsychotic, diphenylbutylpiperidine
PREG/CONT C/NA

IND & DOSE To suppress severely compromising motor, phonic tics in Tourette
syndrome. Adult: 1–2 mg/day PO; max, 10 mg/day.
ADJUST DOSE Severe hepatic impairment
ADV EFF Akathisia, asthenia, dry mouth, extrapyramidal effects, fever, headache,
increased salivation, motor restlessness, NMS, prolonged QT interval, sedation,
somnolence, tardive dyskinesia
INTERACTIONS Amphetamines, antifungals, citalopram, escitalopram, grapefruit juice,
methylphenidate, nefazodone, pemoline, protease inhibitors, QT-prolonging drugs,
sertraline, strong CYP2D6 inhibitors
NC/PT Ensure correct dx. Obtain baseline, periodic ECG. Not for use in breast-feeding.
Check pt’s drugs closely; numerous drug interactions w/ contraindications. Pt should
take safety precautions w/ CNS effects, avoid grapefruit juice.

pindolol (Visken)
CLASS Antihypertensive, beta blocker
PREG/CONT B/NA

IND & DOSE Tx of hypertension. Adult: 5 mg PO bid; max, 60 mg/day. Usual maint, 5 mg
PO tid.
ADV EFF Arrhythmias, bronchospasm, constipation, decreased exercise tolerance/libido,
fatigue, flatulence, gastric pain, serum glucose changes, HF, laryngospasm, n/v/d
INTERACTIONS Clonidine, epinephrine, ergots, ibuprofen, indomethacin, insulin, lidocaine,
naproxen, piroxicam, prazosin, sulindac, theophyllines, thioridazine, verapamil
NC/PTWhen stopping, taper gradually over 2 wk w/ monitoring. Pt should take safety
precautions w/ CNS effects, report difficulty breathing, swelling. Name confusion
between pindolol and Plendil (felodipine); use caution.

pioglitazone (Actos)
CLASS Antidiabetic, thiazolidinedione
PREG/CONT C/NA

BBW Thiazolidinediones cause or worsen HF in some pts; pioglitazone not recommended

for pts w/ symptomatic HF (contraindicated in NYHA Class III, IV HF). After starting or
increasing, watch carefully for HF s&sx. If they occur, manage HF according to current
standards of care. Pioglitazone may be reduced or stopped. Increased risk of bladder
cancer when used for longer than 1 yr; monitor accordingly.
IND & DOSE Adjunct to diet, exercise to improve glucose control in type 2 diabetes as
monotherapy or w/ insulin, sulfonylurea, metformin. Adult: 15–30 mg/day PO;
max, 45 mg daily PO.
ADJUST DOSE Hepatic impairment
ADV EFF Aggravated diabetes, fatigue, headache, hepatic injury, hyperglycemia,
hypoglycemia, infections, myalgia, pain
INTERACTIONS Celery, coriander, dandelion root, fenugreek, garlic, ginseng, hormonal
contraceptives, juniper berries
NC/PT Interferes w/ hormonal contraceptives; suggest alternative birth control method or
consider higher contraceptive dose. Increased risk of bladder cancer when used for
longer than 1 yr; monitor accordingly. Monitor blood glucose regularly; ensure complete
diabetic teaching, support. Pt should take without regard to meals, report infections,
difficulty breathing. Name confusion between Actos (pioglitazone) and Actonel
(risedronate); use caution.

piroxicam (Feldene)
CLASS NSAID
PREG/CONT C/NA

BBW Increased risk of CV events, GI bleeding; monitor accordingly. Contraindicated for

periop pain after CABG surgery.
IND & DOSE Relief of s&sx of acute/chronic rheumatoid arthritis, osteoarthritis.
Adult: 20 mg/day PO.
ADV EFF Anaphylactoid reactions to anaphylactic shock, bone marrow suppression,
bronchospasm, constipation, dizziness, dyspepsia, edema, fatigue, GI pain, headache,
insomnia, nausea, rash, somnolence
INTERACTIONS Beta blockers, cholestyramine, lithium, oral anticoagulants
NC/PT Take w/ food or milk; use safety precautions w/ CNS effects; report swelling,
difficulty breathing, rash.
 pitavastatin (Livalo)
CLASS Antihyperlipidemic, statin
PREG/CONT X/NA

IND & DOSETo reduce elevated total cholesterol, LDLs, apolipoprotein B,

triglycerides, increase HDL in primary hyperlipidemia, mixed dyslipidemia. Adult:
2 mg/day PO; max, 4 mg/day.
ADJUST DOSE Renal impairment (pts on dialysis)
ADV EFF Back pain, constipation, diarrhea, flulike sx, headache, liver toxicity, myalgias,
rhabdomyolysis
INTERACTIONS Alcohol, cyclosporine, erythromycin, fibrates, lopinavir/ ritonavir, niacin,
rifampin
NC/PT Monitor LFTs regularly. Ensure diet, exercise program. Not for use in pregnancy
(barrier contraceptives advised), breast-feeding. Pt should get regular blood tests, avoid
alcohol, report severe muscle pain w/ fever, weakness, urine/stool color changes.

plasma protein fraction (Plasmanate, Plasma-Plex, Protenate)

CLASS Blood product, plasma protein
PREG/CONT C/NA

IND & DOSE Tx of hypovolemic shock. Adult: Initially, 250–500 mL IV. Max, 10 mL/min;
do not exceed 5–8 mL/min as plasma volume nears normal. Tx of hypoproteinemia.
Adult: 1,000–1,500 mL IV daily; max, 5–8 mL/min. Adjust rate based on pt response.
ADV EFF Chills, fever, HF, hypotension, n/v, pulmonary edema after rapid infusion,
rash
INTERACTIONS Alcohol, cyclosporine, erythromycin, fibrates, lopinavir/ ritonavir, niacin,
rifampin
NC/PT Infusion only provides symptomatic relief of hypoproteinemia; consider need for
whole blood based on pt’s clinical condition. Give IV without regard to blood type.
Monitor closely during infusion. Pt should report headache, difficulty breathing.

plerixafor (Mozobil)
CLASS Hematopoietic stem-cell mobilizer
PREG/CONT D/NA

IND & DOSETo mobilize hematopoietic stem cells to peripheral blood for collection,
subsequent autologous transplantation in pts w/ non-Hodgkin
lymphoma/multiple myeloma, w/ granulocyte-colony stimulating factor (G-CSF).
Adult: 0.24 mg/kg subcut for up to 4 consecutive days; start after pt has received G-CSF
once daily for 4 days. Give approximately 11 hours before apheresis.
ADJUST DOSE Renal impairment
ADV EFF Dizziness, headache, injection-site reactions, n/v/d, orthostatic hypotension,
rash, splenic rupture
NC/PT Do not use in leukemia; may mobilize leukemic cells. Not for use in pregnancy
(barrier contraceptives advised), breast-feeding. Pt should report rash, injection-site
reactions, difficulty breathing, edema.

polidocanol (Asclera)
CLASS Sclerosing agent
PREG/CONT C/NA

IND & DOSE Tx of uncomplicated spider, reticular veins in lower extremities. Adult:
0.1–0.3 mL as IV injection at varicose vein site; max volume/session, 10 mL.
ADV EFF Anaphylaxis, injection-site reactions
NC/PT Do not inject intra-arterially. Have emergency equipment on hand. Advise
compression stockings, support hose on treated legs continuously for 2 to 3 days, then
for 2 to 3 wk during the day; walk for 15–20 min immediately after procedure and daily
for next few days.

poly-l-lactic acid (Sculptra)

CLASS Polymer
PREG/CONT Unkn/NA

IND & DOSE To restore, correct sx of lipoatrophy in pts w/ HIV syndrome. Adult: 0.1–
0.2 mL injected intradermally at each injection site. May need up to 20
injections/cheek; retreat periodically.
ADV EFF Injection-site reactions
NC/PT Do not use if signs of skin infection. Apply ice packs to area immediately after
injection and for first 24 hr. Massage injection sites daily. Monitor pt on anticoagulants
for increased bleeding.

DANGEROUS DRUG
polymyxin B sulfate (generic)
CLASS Antibiotic
PREG/CONT C/NA

BBW Monitor renal function carefully; nephrotoxicity possible. Avoid concurrent use of
other nephrotoxics. Neurotoxicity can cause respiratory paralysis; monitor accordingly.
IV, intrathecal administration for hospitalized pts only.
IND & DOSE Tx of acute infections caused by susceptible bacteria strains when less
toxic drugs contraindicated. Adult, child over 2 yr: 15,000–25,000 units/kg/day IV q
12 hr; max, 25,000 units/kg/day. Infants: 40,000 units/kg/day IV, IM. Tx of meningeal
infections caused by Pseudomonas aeruginosa. Adult, child over 2 yr: 50,000 units/day
intrathecally for 3–4 days; then 50,000 units q other day for at least 2 wk after CSF
cultures negative, glucose content normal. Infants: 20,000 units/day intrathecally for 3–
4 days or 25,000 units q other day. Continue w/ 25,000 units once q other day for at
least 2 wk after CSF cultures negative, glucose content normal.
ADJUST DOSE Renal impairment
ADV EFF Apnea, nephrotoxicity, neurotoxicity, pain at injection site, rash,
superinfections, thrombophlebitis
INTERACTIONS Aminoglycosides, nephrotoxic drugs, NMJ blockers
NC/PT Culture before tx. Monitor renal function regularly. IM route may cause severe
pain. Treat superinfections. Pt should take safety precautions w/ CNS effects, report
swelling, difficulty breathing, vision changes.

pomalidomide (Pomalyst)
CLASS Antineoplastic, thalidomide analogue
PREG/CONT X/NA

BBW Known human teratogen. Can cause severe, life-threatening birth defects; not for
use in pregnancy. Risk of DVT, PE in pts treated for multiple myeloma.
IND & DOSE Tx of multiple myeloma in pts who have had disease progression after
at least two other therapies. Adult: 4 mg/day PO on days 1–21 of repeated 28-day
cycle until progression occurs.
ADJUST DOSE Severe hepatic, renal impairment
ADV EFF Anemia, asthenia, back pain, confusion, constipation, diarrhea, dizziness, DVT,
dyspnea, fatigue, nausea, neuropathy, neutropenia, PE, URI
NC/PT Available only through restricted access program. Rule out pregnancy before
starting drug. Ensure monthly negative pregnancy test; recommend highly effective
contraceptive measures for men, women. Not for use in breast-feeding. Monitor for
DVT, PE. Obtain baseline, periodic CBC. Pt should take drug once/day at about same
time each day; swallow capsule whole w/ water and not cut, crush, or chew it; obtain
monthly pregnancy test; avoid donating blood during and for 1 mo after tx; take safety
precautions w/ CNS effects; report extreme fatigue, difficulty breathing, calf pain.

DANGEROUS DRUG
ponatinib (Iclusig)
CLASS Antineoplastic, kinase inhibitor
PREG/CONT D/NA

BBW Risk of vascular occlusion, HF, hepatotoxicity, any of which can lead to death.
IND & DOSE Tx of T3151-positive CML or T3151-positive ALL. Adult: 45 mg/day with
food; adjust based on toxicity.
ADJUST DOSE Severe hepatic impairment
ADV EFF Abd pain, arrhythmias, arthralgia, compromised wound healing, constipation,
fever, fluid retention, HF, hepatotoxicity, hypertension, myelosuppression,
neuropathies, n/v, pancreatitis, vascular occlusions, vision changes
INTERACTIONS CYP3A inhibitors
NC/PT Ensure proper dx. Monitor LFTs, lipase, cardiac function, CBC, BP, vision. Ensure
adequate hydration; correct uric acid levels. Pt should avoid pregnancy (serious fetal
harm possible), breast-feeding; report fever, extreme fatigue, color changes in
urine/stool, headache, vision changes.

poractant alfa (Curosurf)

CLASS Lung surfactant
PREG/CONT Unkn/NA

IND & DOSE Rescue tx of infants w/ RDS. Infants: Entire contents of vial (2.5 mL/kg birth
weight) intratracheally, ½ of dose into each bronchi. Give first dose as soon as possible
after RDS dx and when pt on ventilator. May need up to two subsequent doses of 1.25
mL/kg birth weight at 12-hr intervals. Max total dose, 5 mL/kg (sum of initial, two
repeat doses).
ADV EFF Bradycardia, flushing, hyperbilirubinemia, hypotension, infections,
intraventricular hemorrhage, patent ductus arteriosus, pneumothorax, sepsis
NC/PT Ensure ET tube in correct position, w/ bilateral chest movement, lung sounds.
Store in refrigerator; protect from light. Enter vial only once. Instill slowly; inject ¼ of
dose over 2–3 sec. Do not suction infant for 1 hr after completion of full dose; do not
flush catheter. Maintain appropriate interventions for critically ill infant.

DANGEROUS DRUG
porfimer sodium (Photofrin)
CLASS Antineoplastic
PREG/CONT C/NA

IND & DOSE Photodynamic tx for palliation of pts w/ completely/partially

obstructing esophageal/transitional cancer who cannot be treated w/ laser
alone; transitional cell carcinoma in situ of urinary bladder; endobronchial non-
small-cell lung cancer; high-grade dysplasia of Barrett esophagus. Adult: 2 mg/kg
as slow IV injection over 3–5 min; laser tx must follow in 40–50 hr and again in 96–
120 hr.
ADV EFF Abd pain, anemia, bleeding, chest pain, constipation, dyspnea, GI perforation,
n/v, photosensitivity, pleural effusion, respiratory toxicity
NC/PT Monitor for pleural effusion, respiratory complications. Avoid contact w/ drug.
Protect pt from light exposure for 30 days after tx; photosensitivity may last up to 90
days. Pt should report difficulty breathing/swallowing, unusual bleeding.

DANGEROUS DRUG
 posaconazole (Noxafil)
CLASS Antifungal
PREG/CONT C/NA

IND & DOSE Px of invasive Aspergillus, Candida infections in immunosuppressed pts.

Adult, child 13 yr and older: 200 mg (5 mL) PO tid. Tx of oropharyngeal candidiasis.
Adult, child 13 yr and older: 100 mg (2.5 mL) PO bid on day 1; then 100 mg/day PO for
13 days. For refractory infection, 400 mg (10 mL) PO bid; duration based on pt
response.
ADJUST DOSE Hepatic impairment
ADV EFF Abd pain, anemia, constipation, cough, dizziness, dyspnea, epistaxis, fatigue,
fever, headache, hepatotoxicity, insomnia, n/v/d, prolonged QT interval, rash
INTERACTIONS Calcium channel blockers, cimetidine, cyclosporine, ergots, midazolam,
phenytoin, quinidine, rifabutin, sirolimus, statins, tacrolimus, vincristine, vinblastine
NC/PT Culture before tx. Obtain baseline ECG; monitor LFTs. Shake bottle well before
use. Give w/ full meal or nutritional supplement. Maintain hydration, nutrition. Not for
use in pregnancy, breast-feeding. Pt should report fever, urine/stool color changes.

DANGEROUS DRUG
potassium acetate, potassium chloride, potassium gluconate (Kaon-Cl, Kaylixir,
K-Dur, K-G Elixir, Klorvess, Klotrix, Tri-K)
CLASS Electrolyte
PREG/CONT C/NA

IND & DOSE Px of potassium deficiency. Adult: 16–24 mEq/day PO. Tx of potassium
deficiency. 40–100 mEq/day PO or IV. Child: 2–3 mEq/kg/day or 40 mEq/m2/day PO
or IV; 2–6 mEq/kg/hr PO or IV for newborns.
ADJUST DOSE Elderly pts, renal impairment
ADV EFF Abd pain, hyperkalemia, n/v/d, tissue sloughing, venospasm
INTERACTIONS Potassium-sparing diuretics, salt substitutes using potassium
NC/PT Obtain baseline, periodic serial serum potassium level. Dilute in dextrose sol to
40–80 mEq/L; do not give undiluted. Monitor for cardiac arrhythmias during IV
infusion. Monitor injection site carefully. Wax tablet matrix may appear in stool. Pt
should swallow tablet whole and not cut, crush, or chew it; take w/ food or after meals;
avoid salt substitutes, report tingling in hands/feet, black tarry stools, pain at IV
injection site.

pralatrexate (Folotyn)
CLASS Folate analogue metabolic inhibitor, antineoplastic
PREG/CONT X/NA

IND & DOSE Tx of relapsed, refractory peripheral T-cell lymphoma. Adult: 30

mg/m2/wk as IV push over 3–5 min for 6 wk in 7-wk cycle.
ADJUST DOSE Elderly pts, renal impairment
ADV EFF Bone marrow suppression, dehydration, dyspnea, fatigue, mucositis, n/v/d,
night sweats, pain, rash, serious to fatal dermatologic reactions, tumor lysis
syndrome
NC/PT Monitor CBC, skin. Pt should also receive vitamin B12 (1 mg IM q 8–10 wk) and
folic acid (1–1.25 mg/day PO). Maintain hydration. Not for use in pregnancy
(contraceptives advised), breast-feeding. Provide skin care. Pt should avoid exposure to
infection, report signs of infection, unusual bleeding, rash.

pralidoxime chloride (Protopam Chloride)

CLASS Antidote
PREG/CONT C/NA

IND & DOSE Antidote in poisoning due to organophosphate pesticides, chemicals w/

anticholinesterase activity. Adult: Atropine 2–4 mg IV. If cyanotic, 2–4 mg atropine
IM while improving ventilation; repeat q 5–10 min until signs of atropine toxicity
appear. Maintain atropinization for at least 48 hr. Give pralidoxime concomitantly:
Initially, 1–2 g pralidoxime IV, preferably as 15–30 min infusion in 100 mL saline. After
1 hr, give second dose of 1–2 g IV if muscle weakness not relieved. Give additional doses
cautiously q 10–12 hr. If IV route not feasible or pulmonary edema present, give IM or
subcut. Child 16 yr and under: Loading dose, 20–50 mg/kg (max, 2,000 mg/dose) IV over
15–30 min, then continuous IV infusion of 10–20 mg/kg/hr. Or, 20–50 mg/kg (max,
2,000 mg/dose) IV over 15–30 min. Give second dose of 20–50 mg/kg in 1 hr if muscle
weakness not relieved. May repeat dosing q 10–12 hr as needed. Or, for pt 40 kg and
over, 1,800 mg IM/course of tx; under 40 kg, 15 mg/kg IM q 15 min if needed, to total
of three doses (45 mg/kg). Adjunct to atropine in poisoning by nerve agents
w/ anticholinesterase activity. Adult: Give atropine, pralidoxime as soon as possible
after exposure. Use autoinjectors, giving atropine first. Repeat both atropine,
pralidoxime after 15 min. If sx after additional 15 min, repeat injections. If sx persist
after third set of injections, seek medical help. Tx of anticholinesterase overdose of
myasthenia gravis drugs. Adult: 1–2 g IV, then increments of 250 mg q 5 min.
ADV EFF Blurred vision, diplopia, dizziness, drowsiness, headache, pain at injection site,
transient LFT increases
NC/PT For acute organophosphate poisoning, remove secretions, maintain patent airway,
provide artificial ventilation as needed; then begin tx. After skin exposure to
organophosphate poisoning, remove clothing, thoroughly wash hair/skin w/ sodium
bicarbonate or alcohol as soon as possible. Give by slow IV infusion. Have IV sodium
thiopental or diazepam on hand if seizures occur. Pt should report pain at injection site,
vision changes.

pramipexole dihydrochloride (Mirapex)

 CLASSAntiparkinsonian, dopamine receptor agonist
PREG/CONT C/NA

BBW Use extreme caution in pts w/ hx of hypotension, hallucinations, confusion,

dyskinesias.
IND & DOSE Tx of sx of Parkinson disease. Adult: 0.125 mg PO tid for 1 wk; wk 2,
0.25 mg PO tid; wk 3, 0.5 mg PO tid; wk 4, 0.75 mg PO tid; wk 5, 1 mg PO tid; wk 6,
1.25 mg PO tid; wk 7, 1.5 mg PO tid. Once levels established, may use ER tablets for
once-a-day dosing. Tx of restless legs syndrome (Mirapex). Adult: 0.125 mg/day PO
2–3 hr before bedtime. May increase q 4–7 days, if needed, to 0.25 mg/day; max,
0.5 mg/day.
ADJUST DOSE Renal impairment
ADV EFF Asthenia, constipation, dizziness, extrapyramidal sx, headache, insomnia,
orthostatic hypotension, somnolence
INTERACTIONS Cimetidine, diltiazem, dopamine antagonists, levodopa, quinidine, quinine,
ranitidine, triamterene, verapamil
NC/PT Give w/ extreme caution to pts w/ hx of hypotension, hallucinations, confusion,
dyskinesia. Taper gradually over at least 1 wk when stopping. Not for use in pregnancy
(barrier contraceptives advised). Pt should swallow ER tablet whole and not cut, crush,
or chew it; take safety precautions w/ CNS effects; report hallucinations, swelling.

DANGEROUS DRUG
pramlintide acetate (Symlin)
CLASS Amylinomimetic, antidiabetic
PREG/CONT C/NA

BBW Severe hypoglycemia associated w/ combined use of insulin, pramlintide; usually

seen within 3 hr of pramlintide injection. Monitor accordingly.
IND & DOSE Adjunct tx in pts w/ type 1, 2 diabetes who use mealtime insulin and
have failed to achieve desired glucose control. Adult w/ type 1 diabetes: 15 mcg
subcut before major meals; titrate at 15-mcg increments to maint of 30 or 60 mcg as
tolerated. Adult w/ type 2 diabetes: 60–120 mcg subcut immediately before major meals.
ADV EFF Cough, dizziness, hypoglycemia, injection-site reactions, n/v
INTERACTIONS Anticholinergics, oral drugs
NC/PT Doses of oral drugs, insulins will need reduction, usually by 50% based on pt
response. Drug affects gastric emptying; if rapid effect needed, give oral medication 1 hr
before or 2 hr after pramlintide. Inject subcut more than 2 inches away from insulin
injection site. Rotate sites. Do not mix in syringe w/ insulin. Use caution in pregnancy,
breast-feeding. Store unopened vial in refrigerator; may store opened vial at room
temp. Teach proper administration, disposal of needles, syringes. Pt should not take if
not going to eat; avoid alcohol; continue diet, exercise, other diabetes tx; monitor blood
glucose level; report hypoglycemic reactions, injection-site pain/swelling.
 DANGEROUS DRUG
prasugrel (Effient)
CLASS Platelet inhibitor
PREG/CONT B/NA

BBW Risk of serious to fatal bleeding; do not use w/ active bleeding or hx of TIA, stroke.
Risk increased w/ age older than 75 yr, weight under 60 kg, bleeding tendency,
warfarin/NSAID use. Do not use in likely candidates for CABG surgery; if pts taking
drug need CABG, stop prasugrel at least 7 days before surgery. Suspect bleeding in pt
who becomes hypotensive and has undergone invasive procedure. If possible, control
bleeding without stopping prasugrel; stopping prematurely increases risk of thrombotic
episodes.
IND & DOSE To reduce risk of thrombotic CV events (including stent thrombosis) in
pts w/ acute coronary syndrome who are to be managed w/ percutaneous
coronary intervention. Adult: 60 mg PO as single dose, then 10 mg/day PO without
regard to food. Use 5 mg/day in pt weighing under 60 kg. Pt should also receive aspirin
(75–325 mg/day).
ADV EFF Bleeding, fatigue, fever, headache, hyperlipidemia, hypertension, pain, rash,
risk of thrombotic episodes if stopped prematurely, thrombotic thrombocytopenic
purpura
INTERACTIONS NSAIDs
NC/PT Ensure pt also receives aspirin. Limit invasive procedures; monitor for bleeding.
Stop drug 7 days before planned surgery. Protect from injury. Not for use in pregnancy
(barrier contraceptives advised), breast-feeding. Do not stop prematurely; risk of
rebound thrombotic events. Pt should wear medical ID; inform all health care providers
about pramlintide use, increased risk of bleeding; report excessive bleeding, fever,
purple skin patches; pink, brown urine, black or bloody stools.

pravastatin sodium (Pravachol)

CLASS Antihyperlipidemic, statin
PREG/CONT X/NA

IND & DOSEAdjunct to diet in tx of elevated total cholesterol, LDL cholesterol; px of

MI in pts at risk for first MI; to slow progression of CAD in pts w/ clinically
evident CAD; to reduce risk of stroke, MI. Adult: 40 mg/day PO at bedtime. Max,
80 mg/day. Adult on immunosuppressants: 10 mg/day PO; max, 20 mg/day. Tx of
heterozygous familial hypercholesterolemia as adjunct to diet, exercise: Child
14–18 yr: 40 mg/day PO. Child 8–13 yr: 20 mg/day PO.
ADJUST DOSE Elderly pts; hepatic, renal impairment
ADV EFF Abd pain, blurred vision, cataracts, constipation, cramps, dizziness, flatulence,
LFT elevations, n/v, rhabdomyolysis
INTERACTIONS Bile acid sequestrants, cyclosporine, digoxin, erythromycin, gemfibrozil,
itraconazole, niacin, warfarin
NC/PT Ensure diet, exercise program for CAD. Not for use in pregnancy (barrier
contraceptives advised), breast-feeding. Pt should take at bedtime, have periodic eye
exams, report severe GI upset, urine/stool color changes, muscle pain.

praziquantel (Biltricide)
CLASS Anthelmintic
PREG/CONT B/NA

IND & DOSE Tx of Schistosoma infections, liver flukes. Adult, child over 4 yr: Three doses
of 20–25 mg/kg PO as one-day tx, w/ 4–6 hr between doses.
ADV EFF Abd pain, dizziness, fever, malaise, nausea, urticaria
INTERACTIONS Chloroquine, CP450 inducers, grapefruit juice
NC/PT Give w/ food; GI upset common. Pt should swallow tablet whole and not cut,
crush, or chew it; avoid grapefruit juice.

prazosin hydrochloride (Minipress)

CLASS Alpha blocker, antihypertensive
PREG/CONT C/NA

IND & DOSE Tx of hypertension. Adult: 1 mg PO bid–tid. Increase to total 20 mg/day in

divided doses; range, 6–15 mg/day. If using w/ other antihypertensives, reduce dose to
1–2 mg PO tid, titrate to control BP.
ADV EFF Abd pain, dizziness, drowsiness, dry mouth, headache, hypotension, lack of
energy, nausea, paresthesia, weakness
INTERACTIONS Beta blockers, sildenafil, tadalafil, vardenafil, verapamil
NC/PT First dose may cause syncope w/ sudden loss of consciousness; limit first dose to
1 mg PO, give at bedtime. Pt should take safety precautions w/ CNS effects, use
sugarless lozenges for dry mouth, report fainting.

prednisoLONE, prednisoLONE acetate, prednisoLONE sodium phosphate

(Hydrocortone, Orapred, Pred Forte, Pred Mild, Prelone)
CLASS Corticosteroid, anti-inflammatory
PREG/CONT C/NA

IND & DOSE Mgt of inflammatory disorders; tx of hypercalcemia of cancer. Adult: 5–

60 mg/day PO based on condition, response. Child: 0.14–2 mg/kg/day PO in three to
four divided doses. Mgt of acute MS exacerbations. Adult: 200 mg/day PO for 1 wk,
then 80 mg q other day for 1 mo (sodium phosphate). Mgt of nephrotic syndrome.
Child: 60 mg/m2/day PO in three divided doses for 4 wk (sodium phosphate). Then
single doses for 4 wk. Or, 40 mg/m2/day PO. Mgt of inflammation of eyelid,
conjunctiva, cornea, globe. Adult, child: 2 drops qid. For Pred Mild/Forte, sodium
phosphate, 1–2 drops q hr during day, q 2 hr at night. W/ favorable results, 1 drop q
4 hr, then 1 drop three to four times/day to control sx.
ADV EFF Aggravation of infections, amenorrhea, anaphylactic reactions, edema, fluid
retention, headache, hyperglycemia, hypotension, immunosuppression, impaired
healing, increased appetite, shock, vertigo
INTERACTIONS Ambenonium, barbiturates, cyclosporine, edrophonium, estrogens,
hormonal contraceptives, ketoconazole, neostigmine, phenytoin, pyridostigmine,
rifampin, salicylates
NC/PT Individualize dose, depending on severity, response. Give daily dose before 9 a.m.
to minimize adrenal suppression. For maint, reduce initial dose in small increments at
intervals until lowest satisfactory dose reached. If long-term tx needed, consider
alternate-day tx w/ short-acting corticosteroid. After long-term tx, withdraw slowly to
prevent adrenal insufficiency. Monitor serum glucose level. Pt should avoid exposure to
infection, bright light (eyes may be sensitive); learn proper eyedrop technique; report
signs of infection, black tarry stools.

predniSONE (Prednisone Intensol Concentrate, Rayos)

CLASS Corticosteroid
PREG/CONT C/NA

IND & DOSE Mgt of inflammatory disorders; tx of hypercalcemia of cancer;

replacement tx w/ adrenal insufficiency. Adult: 5–60 mg/day PO titrated based on
response. Child: 0.05–2 mg/kg/day PO or 4–5 mg/m2/day PO in equal divided doses q
12 hr. Mgt of acute MS exacerbations. Adult: 200 mg/day PO for 1 wk, then 80 mg PO
q other day for 1 mo.
ADV EFF Aggravation of infections, amenorrhea, anaphylactic reactions, edema, fluid
retention, headache, hyperglycemia, hypotension, immunosuppression, impaired
healing, increased appetite, shock, vertigo
INTERACTIONS Barbiturates, cyclosporine, edrophonium, estrogens, hormonal
contraceptives, ketoconazole, neostigmine, phenytoin, pyridostigmine, rifampin,
salicylates, troleandomycin
NC/PT Individualize dose, depending on severity, response. Give daily dose before 9 a.m.
to minimize adrenal suppression. For maint, reduce initial dose in small increments at
intervals until lowest satisfactory dose reached. If long-term tx needed, consider
alternate-day tx w/ short-acting corticosteroid. After long-term tx, withdraw slowly to
prevent adrenal insufficiency. Monitor serum glucose level. Pt should avoid exposure to
infections, report signs of infection, worsening of condition.

pregabalin (Lyrica)
CLASS Analgesic, antiepileptic, calcium channel modulator
PREG/CONT C/C-V
BBW Increased risk of suicidal ideation; monitor accordingly.
IND & DOSE Mgt of neuropathic pain. Adult: 100 mg PO tid. Max, 300 mg/day. Mgt of
postherpetic neuralgia. Adult: 75–150 mg PO bid or 50–100 mg PO tid; max,
600 mg/day. Adjunct tx for partial-onset seizures. 150–600 mg/day PO divided into
two to three doses. Mgt of fibromyalgia. Adult: 75–150 mg PO bid. Max, 450 mg/day.
Mgt of neuropathic pain associated w/ spinal cord injuries. Adult: 75 mg PO bid.
Increase to 150 mg PO bid within 1 wk; may increase to 300 mg PO bid if insufficient
relief.
ADJUST DOSE Renal impairment
ADV EFF Angioedema, confusion, constipation, dizziness, dry mouth, infection,
neuropathy, peripheral edema, somnolence, thrombocytopenia, weight gain
INTERACTIONS Alcohol, CNS depressants, pioglitazone, rosiglitazone
NC/PT Taper when stopping. Not for use in pregnancy (barrier contraceptives advised),
breast-feeding. Men should not father child during tx. Pt should take safety measures w/
CNS effects, avoid alcohol, report vision changes, weight gain, increased bleeding,
thoughts of suicide.

primidone (Mysoline)
CLASS Antiepileptic
PREG/CONT D/NA

BBW Increased risk of suicidal ideation; monitor accordingly.

IND & DOSE Control of tonic-clonic, psychomotor, focal epileptic seizures. Adult w/ no
previous tx: Days 1–3, 100–125 mg PO at bedtime; days 4–6, 100–125 mg PO bid; days
7–9, 100–125 mg PO tid; day 10, maint, 250 mg tid. Max, 500 mg qid (2 g/day). Adult
on other epileptics: 100–125 mg PO at bedtime. When primidone alone desired, do not
complete transition in under 2 wk. Child under 8 yr: Days 1–3, 50 mg PO at bedtime;
days 4–6, 50 mg PO bid; days 7–9, 100 mg PO bid; day 10, maint, 125–250 mg tid or
10–25 mg/kg/day in divided doses.
ADV EFF Anorexia, ataxia, fatigue, hyperirritability, megaloblastic anemia, nausea, rash
INTERACTIONS Acetazolamide, alcohol, carbamazepine, isoniazid, nicotinamide,
phenytoins, succinimides
NC/PT Taper when stopping; evaluate for therapeutic serum level (5–12 mcg/mL).
Monitor CBC, folic acid for megaloblastic anemia. Not for use in pregnancy (barrier
contraceptives advised). Pt should take safety measures w/ CNS effects, wear medical
ID, avoid alcohol, report rash, fever, thoughts of suicide.

probenecid (Probalan)
CLASS Antigout, uricosuric
PREG/CONT B/NA

IND & DOSE Tx of hyperuricemia associated w/ gout, gouty arthritis. Adult: 0.25 g PO
bid for 1 wk, then 0.5 g PO bid. Max, 2–3 g/day. Adjuvant to tx w/ penicillins,
cephalosporins. Adult: 2 g/day PO in divided doses. Child 2–14 yr: Initially, 25 mg/kg
PO, then 40 mg/kg/day in four divided doses. Tx of gonorrhea. Adult: Single 1-g dose
PO 30 min before penicillin. Child under 45 kg: 23 mg/kg PO in one single dose 30 min
before penicillin.
ADJUST DOSE Elderly pts, renal impairment
ADV EFF Anaphylaxis, anemia, anorexia, dizziness, n/v, rash, urinary frequency
INTERACTIONS Acyclovir, allopurinol, benzodiazepines, clofibrate, dapsone, dyphylline,
methotrexate, NSAIDs, rifampin, sulfonamides, thiopental, zidovudine
NC/PT Check urine alkalinity; urates crystallize in acidic urine. Sodium bicarbonate,
potassium citrate may be ordered to alkalinize urine. Pt should take w/ meals, antacids;
drink 2.5–3 L fluid/day; take safety precautions w/ dizziness; report dark urine, painful
urination.

DANGEROUS DRUG
procarbazine hydrochloride (Matulane)
CLASS Antineoplastic
PREG/CONT D/NA

IND & DOSEPart of MOPP regimen for tx of stage III, IV Hodgkin lymphoma. Adult: 2–
4 mg/kg/day PO for first wk, then 4–6 mg/kg/day PO. Maint, 1–2 mg/kg/day PO.
ADJUST DOSE Elderly pts, renal impairment
ADV EFF Bone marrow suppression, confusion, diarrhea, fever, hallucinations,
hepatotoxicity, hypertensive crisis, pneumonitis
INTERACTIONS Alcohol, anticholinergics, antihistamines, MAOIs, oral anticoagulants, TCAs
NC/PT Monitor CBC, LFTs; do not give within 14 days of MAOIs. Not for use in
pregnancy (barrier contraceptives advised), breast-feeding. Pt should follow
prescription carefully; avoid exposure to infection, injury; report severe headache,
unusual bleeding, signs of infection.

prochlorperazine (Compro), prochlorperazine edisylate, prochlorperazine

maleate (Procomp)
CLASS Antiemetic, antipsychotic, dopaminergic blocker, phenothiazine
PREG/CONT C/NA

BBW Increased risk of death if used to treat dementia-related psychosis in elderly pts;
not approved for this use.
IND & DOSE Mgt of manifestations of psychotic disorders. Adult: 5–10 mg PO tid or qid.
Range, 50–75 mg/day for mild/moderate disturbances, 100–150 mg/day PO for more
severe disturbances. For immediate control of severely disturbed adults, 10–20 mg IM
repeated q 2–4 hr (q hour for resistant cases). Child 2–12 yr: 2.5 mg PO or rectally bid–
tid; max, 25 mg/day (6–12 yr), 20 mg/day (2–5 yr). Child under 12 yr: 0.132 mg/kg by
deep IM injection. Switch to oral as soon as possible (usually after one dose). Tx of
emesis. Adult: 5–10 mg PO tid–qid; or 15 mg SR on arising; or 25 mg rectally bid; or 5–
10 mg IM initially, then q 3–4 hr (max, 40 mg/day). Child over 2 yr: 18.2–38.6 kg,
2.5 mg PO or rectally tid or 5 mg bid; max, 15 mg/day. 13.6–17.7 kg, 2.5 mg PO or
rectally bid–tid; max, 10 mg/day. 9.1–13.2 kg, 2.5 mg PO or rectally daily–bid; max,
7.5 mg/day. Child 2 yr and older, at least 9.1 kg: 0.132 mg/kg IM (usually one dose). Mgt
of n/v related to surgery. Adult: 5–10 mg IM 1–2 hr before anesthesia or periop and
postop (may repeat once in 30 min); or 5–10 mg IV 15 min before anesthesia or periop
and postop (may repeat once); or 20 mg/L isotonic sol added to IV infusion 15–30 min
before anesthesia. Tx of nonpsychotic anxiety. Adult: 5 mg PO tid or qid; max,
20 mg/day for no more than 12 wk.
ADV EFF Akathisia, aplastic anemia, blurred vision, bone marrow suppression,
bronchospasm, dizziness, drowsiness, dystonia, HF, laryngospasm, NMS,
photosensitivity, pink to red-brown urine, pseudoparkinsonism, rash, refractory
arrhythmias, tardive dyskinesia
INTERACTIONS Alcohol, anticholinergics, barbiturate anesthetics
NC/PT Monitor CBC, renal function; elderly pts may be more susceptible to adverse
reactions. Maintain hydration. Avoid skin contact w/ oral sol. Give IM injection deep
into upper outer quadrant of buttock. Urine may be pink to red-brown. Pt should avoid
sun exposure, take safety precautions w/ CNS effects, report unusual bleeding, swelling,
fever.

progesterone (Crinone, Endometrin, Prometrium)

CLASS Hormone, progestin
PREG/CONT B (oral), X (injection)/NA

BBW Do not use for px of CV disease. Not effective for this use; may actually increase
risk of CV disease. Increased risk of dementia; weigh risks. Increased risk of invasive
breast cancer; monitor pt closely.
IND & DOSE Tx of primary amenorrhea. Adult: 5–10 mg/day IM for 6–8 consecutive days.
Or, 400 mg PO in p.m. for 10 days. Tx of secondary amenorrhea. Adult: 4%–8% gel,
45–90 mg q other day; max, six doses. Mgt of uterine bleeding. Adult: 5–10 mg/day IM
for six doses. If estrogen given, begin progesterone after 2 wk of estrogen tx. Tx of
endometrial hyperplasia. Adult: 200 mg/day PO in p.m. for 12 days/28-day cycle w/
daily conjugated estrogen. Tx of infertility. Adult: 90 mg vaginally daily in women
needing progesterone supplementation; 90 mg vaginally bid for replacement. Continue
for 10–12 wk into pregnancy if it occurs. Support for embryo implantation. Adult:
100 mg vaginally two to three times daily starting at oocyte retrieval, continuing for up
to 10 wk.
ADV EFF Abd cramps, amenorrhea; breakthrough bleeding, spotting; breast tenderness;
cervical erosion; change in menstrual flow, weight; constipation; dizziness; headache;
PE; photosensitivity; rash; somnolence; thromboembolic/thrombotic disease
INTERACTIONS Grapefruit juice
NC/PT Obtain baseline, periodic (at least annual) hx, physical exam. Insert intrauterine
system during or immediately after menstrual period. Give IM by deep injection. Stop at
first sign of thromboembolic problems. Not for use in pregnancy (contact prescriber if
pregnancy occurs). Pt should perform monthly breast self-exams; avoid grapefruit juice,
sun exposure; stop if sudden vision loss, difficulty breathing, leg pain/swelling.

DANGEROUS DRUG
promethazine hydrochloride (Phenadoz, Phenergan, Promethegan)
CLASS Antiemetic, antihistamine, anti–motion sickness drug, dopaminergic blocker,
phenothiazine, sedative-hypnotic
PREG/CONT C/NA

BBW Do not give to child under 2 yr; risk of fatal respiratory depression. Use lowest
effective dose, caution in child 2 yr and older. Give IM injection deep into muscle. Do
not give subcut; tissue necrosis possible. Do not give intra-arterially; arteriospasm, limb
gangrene possible. If IV route used, limit drug conc, rate of administration; ensure open
IV line.
IND & DOSE Relief of allergy s&sx. Adult: 25 mg PO, rectally, preferably at bedtime. If
needed, 12.5 mg PO before meals and at bedtime. Or, 25 mg IM or IV for serious
reactions. May repeat within 2 hr if needed. Child over 2 yr: 25 mg PO at bedtime or
6.25–12.5 mg tid. Tx, px of motion sickness. Adult: 25 mg PO bid 30–60 min before
travel; repeat in 8–12 hr if needed. Then, 25 mg on rising and before evening meal.
Child over 2 yr: 12.5–25 mg PO, rectally bid. Tx, px of n/v. Adult: 25 mg PO; repeat
doses of 12.5–25 mg as needed q 4–6 hr. Give rectally or parenterally if PO not
tolerated. Or, 12.5–25 mg IM or IV; max, q 4–6 hr. Child over 2 yr: 0.5 mg/lb body
weight IM q 4–6 hr as needed. Sedation, postop sedation, adjunctive use w/
analgesics. Adult: 25–50 mg PO, IM or IV. Child over 2 yr: 12.5–25 mg PO rectally at
bedtime. For postop sedation, 12.5–25 mg PO, IV or IM, rectally. Preop use. Adult:
50 mg PO night before surgery. Child over 2 yr: 0.5 mg/lb body weight PO. Obstetric
sedation. Adult: 50 mg IM or IV in early stages. When labor established, 25–75 mg
w/ reduced opioid dose. May repeat once or twice at 4-hr intervals. Max within 24 hr,
100 mg.
ADV EFF Agranulocytosis, confusion, dizziness, drowsiness, dysuria, epigastric distress,
excitation, hypotension, pancytopenia, photosensitivity, poor coordination, thickened
bronchial secretions, urinary frequency
INTERACTIONS Alcohol, anticholinergics, methohexital, phenobarbital anesthetic,
thiopental
NC/PT Do not give subcut, deep IM. Maintain hydration. Pt should take safety
precautions w/ CNS effects, avoid sun exposure, report unusual bleeding, rash, dark
urine.
 DANGEROUS DRUG
propafenone hydrochloride (Rythmol)
CLASS Antiarrhythmic
PREG/CONT C/NA

BBW Arrange for periodic ECG to monitor effects on cardiac conduction; risk of serious
proarrhythmias. Monitor pt response carefully, especially at start of tx; increase dosage
at minimum of 3- to 4-day intervals.
IND & DOSE Tx of documented life-threatening ventricular arrhythmias; tx of
paroxysmal supraventricular tachycardia w/ disabling s&sx in pts w/out
structural heart disease. Adult: 150 mg PO q 8 hr (450 mg/day). May increase at
minimum of 3- to 4-day intervals to 225 mg PO q 8 hr (675 mg/day) to max 300 mg PO
q 8 hr (900 mg/day). To prolong time to recurrence of symptomatic atrial
fibrillation in pts w/ structural heart disease. Adult: 225 mg ER tablet PO q 12 hr;
titrate at 5-day intervals to max 425 mg q 12 hr.
ADJUST DOSE Elderly pts; hepatic, renal impairment
ADV EFF Agranulocytosis, arrhythmias, blurred vision, constipation, dizziness, headache,
cardiac arrest, coma, fatigue, headache, HF, n/v, unusual taste
INTERACTIONS Beta blockers, cimetidine, cyclosporine, digoxin, quinidine, ritonavir, SSRIs,
theophylline, warfarin
NC/PT Monitor ECG periodically. Not for use in pregnancy. Pt should swallow ER tablet
whole and not cut, crush, or chew it; take around the clock; use safety precautions w/
CNS effects; report difficulty breathing, fainting, palpitations.

propantheline bromide (generic)

CLASS Anticholinergic, antispasmodic, parasympatholytic
PREG/CONT C/NA

IND & DOSE Adjunct tx in peptic ulcer. Adult: 7.5–15 mg PO 30 min before meals and at
bedtime. Child: 1.5 mg/kg/day PO in divided doses tid to qid.
ADJUST DOSE Elderly pts; hepatic, renal impairment
ADV EFF Blurred vision, decreased sweating, drowsiness, dry mouth, headache, n/v, urine
retention
INTERACTIONS Antacids, anticholinergics, digoxin, phenothiazines
NC/PT Risk of heat prostration; maintain hydration. Pt should swallow ER tablet whole
and not cut, crush, or chew it; take 30 min before meals and at bedtime; empty bladder
before each dose; use sugarless lozenges for dry mouth; take safety precautions for CNS
effects; report rash, eye pain.

DANGEROUS DRUG
propofol disodium (Diprivan)
 CLASSSedative/hypnotic
PREG/CONT B/NA

IND & DOSE Induction of general anesthesia. Adult: 2–2.5 mg/kg IV at 40 mg/10 sec.
Children 3–16 yr: 2.5–3.5 mg/kg IV over 20–30 sec. Induction of general anesthesia in
neurosurgery. Adult: 1–2 mg/kg IV at 20 mg/10 sec. Induction of general anesthesia
in cardiac surgery. Adult: 0.5–1.5 mg/kg IV at 20 mg/10 sec. Maintenance of general
anesthesia. Adult: 100–200 mcg/kg/min IV or 25–50 mg intermittent IV bolus, based on
pt response. Children 3–16 yr: 125–150 mcg/kg/min IV, based on pt response.
Monitored anesthesia care. Adult: 25–75 mcg/kg/min IV, based on pt response. ICU
sedation of intubated pts. Adult: 5–50 mcg/kg/min IV as continuous infusion.
ADJUST DOSE Elderly, debilitated pts
ADV EFF Anxiety, apnea, chills, confusion, dry mouth, hypoxemia, injection-site
reactions, loss of responsiveness, MI, respiratory depression
INTERACTIONS Benzodiazepines, opioid analgesics
NC/PT Monitor continuously. Perform frequent BP checks, oximetry; give oxygen; have
emergency equipment on standby; ensure pt safety w/ CNS effects; taper after
prolonged ICU use. Pt should be aware of sedation effects (do not drive; avoid
important decisions, tasks requiring alertness); report difficulty breathing, chest pain,
pain at injection site.

DANGEROUS DRUG
propranolol hydrochloride (Inderal, InnoPran XL)
CLASS Antianginal, antiarrhythmic, antihypertensive, beta blocker
PREG/CONT C/NA

BBW Do not stop abruptly after long-term tx (hypersensitivity to catecholamines

possible, causing angina exacerbation, MI, ventricular arrhythmias). Taper gradually
over 2 wk w/ monitoring.
IND & DOSE Tx of hypertension. Adult: 40 mg PO regular propranolol bid, or 80 mg (SR,
ER) PO daily initially; range, 120–240 mg/day bid or tid or 120–160 mg (SR, ER) daily
(max, 640 mg/day). Tx of angina. Adult: 80–320 mg/day PO divided bid, tid, or qid, or
80 mg (SR, ER) daily initially; usual dose, 160 mg/day (max, 320 mg/day). Mgt of
IHSS. Adult: 20–40 mg PO tid or qid, or 80–160 mg PO (SR, ER) daily. Post-MI. Adult:
120 mg/day PO divided tid. After 1 mo, may titrate to 180–240 mg/day PO tid or qid
(max, 240 mg/day). Mgt of pheochromocytoma s&sx. Adult: Preop, 60 mg/day PO for
3 days in divided doses; inoperable tumor, 30 mg/day in divided doses. Px of migraine.
Adult: 80 mg/day PO (SR, ER) once or in divided doses; range, 160–240 mg/day. Mgt of
essential tremor. Adult: 40 mg PO bid; maint, 120 mg/day (max, 320 mg/day). Tx of
arrhythmias. Adult: 10–30 mg PO tid or qid, or 1–3 mg IV w/ careful monitoring; max,
1 mg/min. May give second dose in 2 min, then do not repeat for 4 hr.
ADV EFF Arrhythmias, bronchospasm, constipation, decreased exercise tolerance/libido,
fatigue, flatulence, gastric pain, serum glucose changes, HF, laryngospasm, n/v/d,
stroke
INTERACTIONS Barbiturates, clonidine, epinephrine, ergots, ibuprofen, indomethacin,
insulin, lidocaine, methimazole, naproxen, phenothiazines, piroxicam, prazosin,
propylthiouracil, sulindac, theophyllines, thioridazine, verapamil
NC/PT Provide continuous cardiac, regular BP monitoring w/ IV form. Change to oral
form as soon as possible. Taper when stopping. Pt should take w/ food, take safety
precautions w/ CNS effects, report difficulty breathing, swelling, numbness/tingling.

propylthiouracil (PTU) (generic)

CLASS Antithyroid drug
PREG/CONT D/NA

BBW Associated w/ severe, possibly fatal, liver injury. Monitor carefully for liver
adverse effects, especially during first 6 mo of tx. Do not use in child unless allergic to or
intolerant of other tx; risk of liver toxicity higher in children. Drug of choice when
antithyroid tx needed during or just before first trimester (fetal abnormalities are
associated w/ methimazole).
IND & DOSE Tx of hyperthyroidism. Adult: 300 mg/day PO in divided doses q 8 hr, up to
400–900 mg/day in severe cases. Range, 100–150 mg/day in divided doses q 8 hr. Child
6 and older intolerant to other tx: 50 mg/ day PO in divided doses q 8 hr.
ADV EFF Agranulocytosis, drowsiness, epigastric distress, fever, neuritis, n/v,
paresthesia, rash, severe liver injury, vertigo
INTERACTIONS Cardiac glycosides, metoprolol, oral anticoagulants, propranolol,
theophylline
NC/PT Monitor TSH, T3/T4. Prolonged tx will be needed. Alert surgeon that drug may
increase risk of bleeding. Pt should take around the clock, use safety precautions w/ CNS
effects, report signs of infection, urine/stool color changes. Name confusion between
propylthiouracil and Purinethol (mercaptopurine); use extreme caution.

protamine sulfate (generic)

CLASS Heparin antagonist
PREG/CONT C/NA

BBW Keep emergency equipment on hand in case of anaphylactic reaction.

IND & DOSE Tx of heparin overdose. Adult, child: 1 mg IV neutralizes not less than 100
heparin units.
ADV EFF Anaphylaxis, hypotension, n/v, rash
NC/PT Monitor coagulation studies to adjust dose; screen for heparin rebound and
response. Pt should report difficulty breathing, dizziness.

DANGEROUS DRUG
 protein C concentrate (Ceprotin)
CLASS Anticoagulant, blood product
PREG/CONT C/NA

IND & DOSE Replacement tx for pts w/ severe congenital protein C deficiency. Adult,
child: 100–120 international units/kg by IV injection. Then 60–80 international units/kg
IV q 6 hr for three more doses. Maint, 45–60 international units/kg IV q 6–12 hr.
ADV EFF Anaphylactoid reaction, bleeding, hemothorax, hypotension, light-
headedness, pruritus, rash
NC/PT Risk of disease transmission w/ blood products. Protect from light. Monitor for
bleeding. Pt should report difficulty breathing, hives, rash, unusual bleeding.

prothrombin complex concentrate (Kcentra, Octaplex)

CLASS Vitamin K anticoagulant reversal agent
PREG/CONT C/NA

BBW Risk of thromboembolic complications. Monitor closely; consider need to resume

anticoagulant therapy when risks outweigh benefits.
IND & DOSE Urgent reversal of acquired coagulation factor deficiency from warfarin
overactivity w/ major bleeding. Adult: INR of 2 to less than 4, 25 units/kg IV; max,
2,500 units. INR of 4–6, 35 units/kg IV; max, 3,500 units. INR greater than 6,
50 units/kg IV; max, 5,000 units.
ADV EFF Arthralgia, blood-related infections, DVT, headache, hypotension, n/v, serious
hypersensitivity reactions, stroke
NC/PT Monitor INR during and after tx. Monitor for hypersensitivity reactions, sx of
thrombotic events. Pt should know risks of receiving blood products. Risks in pregnancy,
breast-feeding unknown. Pt should report difficulty breathing, chest pain, acute leg
pain, numbness or tingling, vision or speech changes, abnormal swelling.

protriptyline hydrochloride (Vivactil)

CLASS TCA
PREG/CONT C/NA

BBW Limit drug access in depressed, potentially suicidal pts. Increased risk of suicidality
in children, adolescents, young adults; monitor accordingly.
IND & DOSE Relief of sx of depression. Adult: 15–40 mg/day PO in three to four divided
doses; max, 60 mg/day.
ADJUST DOSE Elderly pts
ADV EFF Anticholinergic effects, bone marrow suppression, constipation, dry mouth,
extrapyramidal effects, MI, orthostatic hypotension, photosensitivity, rash, stroke
INTERACTIONS Alcohol, cimetidine, clonidine, fluoxetine, MAOIs, ranitidine,
sympathomimetics, tramadol
NC/PT Do not stop suddenly. Monitor CBC periodically. Not for use in pregnancy
(contraceptives advised). Pt should avoid sun exposure, take safety precautions w/ CNS
effects, use sugarless lozenges for dry mouth, report thoughts of suicide, excessive
sedation.

pseudoephedrine hydrochloride, pseudoephedrine sulfate (Efidac/24,

Genaphed, Sudafed, Unifed)
CLASS Nasal decongestant, sympathomimetic
PREG/CONT C/NA

BBW Administer cautiously to pts with CV disease, diabetes, hyperthyroidism, glaucoma,

hypertension, over 65 yr; increased sensitivity to sympathetic amines possible in these
pts.
IND & DOSE Relief of nasal congestion. Adult, child over 12 yr: 60 mg PO q 4–6 hr (ER,
120 mg PO q 12 hr; CR, 240 mg/day PO); max, 240 mg/24 hr. Child 6–12 yr: 30 mg PO
q 4–6 hr; max, 120 mg/24 hr. Child 2–5 yr: 15 mg PO (syrup) q 4–6 hr; max, 60
mg/24 hr.
ADJUST DOSE Elderly pts
ADV EFF Arrhythmias, anxiety, dizziness, drowsiness, fear, headache, hypertension, n/v,
pallor, restlessness, seizures, tenseness, tremors
INTERACTIONS MAOIs, methyldopa, urine acidifiers/alkalinizers
NC/PT Avoid prolonged use. Underlying medical problems may be causing congestion. Pt
should swallow ER tablet whole and not cut, crush, or chew it; take safety precautions
w/ CNS effects; report sweating, sleeplessness.

pyrantel pamoate (Pin-Rid, Pin-X, Reese’s Pinworm)

CLASS Anthelmintic
PREG/CONT C/NA

IND & DOSE Tx of enterobiasis, ascariasis. Adult, child over 2 yr: 11 mg/kg (5 mg/lb) PO
as single oral dose. Max total dose, 1 g.
ADJUST DOSE Hepatic impairment
ADV EFF Abd cramps, anorexia, dizziness, drowsiness, headache, n/v/d
INTERACTIONS Piperazine, theophylline
NC/PT Culture before tx. Pt should shake suspension well; take w/ fruit juice, milk; use
strict hand washing, hygiene measures; launder undergarments, bed linens, nightclothes
daily; disinfect toilet facilities daily, bathroom floors periodically; take safety
precautions w/ CNS effects; report severe headache.

pyrazinamide (generic)
CLASS Antituberculotic
 PREG/CONT C/NA

IND & DOSE Tx of active, drug-resistant TB. Adult, child: 15–30 mg/kg/day PO; max, 2
g/day. Always use w/ up to four other antituberculotics; give for first 2 mo of 6-mo tx
program.
ADV EFF Bone marrow suppression, gouty arthritis, hepatotoxicity, n/v,
photosensitivity, rash
INTERACTIONS Piperazine, theophylline
NC/PT Give only w/ other antituberculotics. Monitor LFTs during tx. Pt should have
regular medical follow-up, report unusual bleeding, urine/stool color changes, severe
joint pain.

pyridostigmine bromide (Mestinon, Regonol)

CLASS Antimyasthenic, cholinesterase inhibitor
PREG/CONT C/NA

IND & DOSE Control of myasthenia gravis sx. Adult: 600 mg PO over 24 hr; range, 60–
1,500 mg. Or, 180–540 mg (ER) PO daily, bid. As supplement to oral dose preop,
postop, during labor/myasthenic crisis, etc: Give 1/30 oral dose IM or very slow IV. May
give 1 hr before second stage of labor completed. Child: 7 mg/kg/day PO divided into
five or six doses (over 30 days); 5 mg/kg/day PO divided into five or six doses (29 days
or younger). Neonates w/ myasthenic mothers who have difficulty swallowing,
sucking, breathing. 0.05–0.15 mg/kg IM. Change to syrup as soon as possible.
Military w/ threat of sarin nerve gas exposure. Adult: 30 mg PO q 8 hr starting
several hr before exposure; stop if exposure occurs. Antidote for NMJ blocker.
Atropine sulfate 0.6–1.2 mg IV immediately before slow IV injection of pyridostigmine
0.1–0.25 mg/kg; 10–20 mg pyridostigmine usually suffices. Full recovery usually within
15 min; may take 30 min.
ADV EFF Abd cramps, anaphylaxis, bradycardia, bronchospasm, cardiac arrhythmias,
dysphagia, increased respiratory secretions/lacrimation/salivation, laryngospasm,
urinary frequency/incontinence
INTERACTIONS Corticosteroids, succinylcholine
NC/PT Have atropine on hand as antidote. Give IV slowly. Pt should swallow ER tablet
whole and not cut, crush, or chew it; report difficulty breathing, excessive sweating.

quazepam (Doral)
CLASS Benzodiazepine, sedative-hypnotic
PREG/CONT X/C-IV

IND & DOSETx of insomnia. Adult: 7.5–15 mg PO at bedtime.

ADJUST DOSE Elderly, debilitated pts
ADV EFF Anaphylaxis, angioedema, apathy, bradycardia, CV collapse, constipation,
depression, diarrhea, disorientation, dizziness, drowsiness, dry mouth, fatigue, fever,
hiccups, lethargy, light-headedness
INTERACTIONS Alcohol, aminophylline, anticonvulsants, antihistamines, cimetidine,
disulfiram, hormonal contraceptives, psychotropics, smoking, theophylline
NC/PT Monitor LFTs, CBC, renal function w/ long-term tx. Taper gradually after long-
term use. Not for use in pregnancy (barrier contraceptives advised). Pt should take
safety precautions w/ CNS effects, report rash, swelling, vision changes, difficulty
breathing.

quetiapine fumarate (Seroquel)

CLASS Antipsychotic
PREG/CONT C/NA

BBW Do not use in elderly pts w/ dementia-related psychosis; increased risk of CV

mortality, including stroke, MI. Increased risk of suicidality in children, adolescents,
young adults; monitor accordingly. Not approved for use in children.
IND & DOSE Tx of schizophrenia. Adult: 25 mg PO bid. Increase in increments of 25–
50 mg bid–tid on days 2, 3. Range by day 4, 300–400 mg/day in two to three divided
doses; max, 800 mg/day. Once stabilized, switch to ER, 300 mg/day PO in p.m.; range,
400–800 mg/day. Child 13–17 yr: Divided dose bid. Total dose: day 1, 50 mg PO; day 2,
100 mg; day 3, 200 mg; day 4, 300 mg; day 5, 400 mg. Range, 400–800 mg/day. Tx of
manic episodes of bipolar 1 disorder. Adult: 100 mg/day PO divided bid on day 1;
increase to 400 mg/day PO in bid divided doses by day 4, using 100-mg/day
increments. Range, 400–800 mg/day in divided doses. ER: 300 mg/day PO on day 1;
600 mg on day 2; may adjust to 800 mg on day 3 if needed. Child 10–17 yr: 50 mg PO
on day 1, 100 mg on day 2, 200 mg on day 3, 300 mg on day 4, 400 mg on day 5. Max,
600 mg/day. Tx of depressive episodes of bipolar 1 disorder. Adult: 50 mg (ER) PO
on day 1, then 100 mg at bedtime on day 2; increase to desired dose of 300 mg/day by
day 4. Tx of major depressive disorder. Adult: 50 mg (ER) PO at bedtime; on day 3,
increase to 150 mg in evening. Range, 150–300 mg/day.
ADJUST DOSE Elderly, debilitated pts; hepatic impairment
ADV EFF Dizziness, drowsiness, dry mouth, headache, hyperglycemia, NMS, orthostatic
hypotension, prolonged QT interval, sweating
INTERACTIONS Alcohol, anticholinergics, antihypertensives, carbamazepine, CNS
depressants, dopamine antagonists, glucocorticoids, levodopa, lorazepam,
phenobarbital, phenytoin, QT-prolonging drugs, rifampin, thioridazine
NC/PT Monitor for hyperglycemia. Ensure hydration in elderly pts. Not for use in
pregnancy (barrier contraceptives advised). Pt should swallow ER tablet whole and not
cut, crush, or chew it; avoid alcohol; take safety precautions w/ CNS effects; report
fever, unusual bleeding, rash, suicidal thoughts.

quinapril hydrochloride (Accupril)

 CLASSACE inhibitor, antihypertensive
PREG/CONT D/NA

BBW Should not be used during pregnancy; advise barrier contraceptives.

IND & DOSE Tx of hypertension. Adult: 10 or 20 mg/day PO; maint, 20–80 mg/day PO.
Adjunct tx of HF. Adult: 5 mg PO bid; range, 10–20 mg PO bid.
ADJUST DOSE Elderly pts, renal impairment
ADV EFF Angioedema, cough, dizziness, headache, orthostatic hypotension, LFT changes,
rash
INTERACTIONS Lithium, potassium-sparing diuretics, tetracycline
NC/PT Alert surgeon to drug use; volume replacement may be needed after surgery.
Maintain hydration. Pt should use care in situations that may lead to BP drop; take
safety precautions w/ dizziness, hypotension; report fever, difficulty breathing, swelling
of lips/tongue.

DANGEROUS DRUG
quinidine gluconate, quinidine sulfate (generic)
CLASS Antiarrhythmic
PREG/CONT C/NA

IND & DOSE Tx of atrial arrhythmias; paroxysmal, chronic ventricular tachycardia.

Adult: 400–600 mg (sulfate) PO q 2–3 hr until paroxysm terminated. Child: 30
mg/kg/24 hr PO in five equally divided doses. Conversion of atrial fibrillation (AF).
Adult: 648 mg (gluconate) PO q 8 hr; may increase after three to four doses if needed.
Or, 324 mg (gluconate) PO q 8 hr for 2 days, then 648 mg PO q 8 hr for 2 days. Or, 5–
10 mg/kg (gluconate) IV. For ER, 300 mg (sulfate) PO q 8–12 hr; may increase
cautiously if serum level in therapeutic range. For immediate-release, 400 mg (sulfate)
PO q 6 hr; may increase after four to five doses if no conversion. To reduce relapse
into AF. Adult: 324 mg (gluconate) PO q 8–12 hr. For ER, 300 mg (sulfate) PO q 8–
12 hr. For immediate-release, 200 mg (sulfate) PO q 6 hr. Tx of Plasmodium falciparum
malaria. Adult: 24 mg/kg gluconate IV in 250 mL normal saline infused over 4 hr; then
12 mg/kg IV infused over 4 hr q 8 hr for 7 days. Or, 10 mg/kg gluconate in 5 mL/kg IV
as loading dose; then maint IV infusion of 20 mcg/kg/min. May switch to same oral
dose of sulfate q 8 hr for 72 hr or until parasitemia decreased to 1% or less.
ADJUST DOSE Hepatic, renal impairment
ADV EFF Bone marrow suppression, cardiac arrhythmias, cinchonism, diarrhea,
headache, hepatic impairment, light-headedness, nausea, rash, vision changes
INTERACTIONS Amiodarone, cimetidine, digoxin, grapefruit juice, hydantoins, NMJ
blockers, oral anticoagulants, phenobarbital, rifampin, sodium bicarbonate,
succinylcholine, sucralfate, TCAs, verapamil
NC/PT Give test dose of 200 mg PO or 200 mg IV for idiosyncratic reaction. Ensure pts w/
atrial flutter, fibrillation digitalized before starting quinidine. Monitor for safe, effective
serum level (2–6 mcg/mL). Pt should swallow ER tablet whole and not cut, crush, or
chew it; wear medical ID; take safety precautions w/ CNS effects; report vision
disturbances, unusual bleeding, signs of infection.

quinine sulfate (Qualaquin)

CLASS Antimalarial, cinchonan
PREG/CONT C/NA

BBW Not for tx, px of nocturnal leg cramps; serious to life-threatening hematologic
reactions possible. No evidence for therapeutic effectiveness for nocturnal leg cramps.
IND & DOSE Tx of uncomplicated Plasmodium falciparum malaria. Adult: 648 mg (two
capsules) PO q 8 hr for 7 days.
ADJUST DOSE Renal impairment
ADV EFF Abd pain, anaphylaxis, blindness, blurred vision, cardiac arrhythmias, deafness,
dizziness, headache, hearing impairment, hypoglycemia, n/v/d, prolonged QT
interval, sweating, tinnitus, thrombocytopenia including idiopathic
thrombocytopenic purpura, vertigo
INTERACTIONS CYP3A4 inducers/inhibitors, digoxin, NMJ blockers, QT-prolonging drugs,
rifampin
NC/PT Monitor LFTs, renal function, blood glucose, CBC. Use caution in pregnancy,
breast-feeding. Pt should report unusual bleeding, difficulty breathing, palpitations,
fainting.

rabeprazole sodium (AcipHex)

CLASS Proton pump inhibitor
PREG/CONT B/NA

IND & DOSETx of GERD. Adult, child 12 yr and older: 20 mg/day PO for 4–8 wk; maint, 20
mg/day PO. Child 1–11 yr: 15 kg or more, 10 mg/day PO; under 15 kg, 5 mg/day PO for
up to 12 wk. Healing of duodenal ulcer. Adult: 20 mg PO daily for up to 4 wk. Tx of
pathological hypersecretory conditions. Adult: 60 mg PO daily–bid. Helicobacter
pylori eradication. Adult: 20 mg PO bid w/ amoxicillin 1,000 mg PO bid and
clarithromycin 500 mg PO bid w/ meals for 7 days.
ADJUST DOSE Hepatic impairment
ADV EFF Asthenia, bone loss, Clostridium difficile diarrhea, diarrhea, dizziness, dry mouth,
headache, hypomagnesemia, n/v, pneumonia, URI sx
INTERACTIONS Azole antifungals, digoxin, warfarin
NC/PT Pt should swallow tablet whole and not cut, crush, or chew it; maintain other tx
for condition; take safety precautions w/ CNS effects; maintain nutrition; report
worsening of condition, severe diarrhea.

radium Ra 223 dichloride (Xofigo)

 CLASSAntineoplastic, radioactive particle–emitting agent
PREG/CONT X/NA

IND & DOSE Tx of castration-resistant prostate cancer w/ symptomatic bone

metastases and no known visceral metastatic disease. Adult: 50 kBq (1.35
microcurie)/kg by slow IV injection (over 1 min) at 4-wk intervals for six injections.
ADV EFF Bone marrow suppression, n/v/d, peripheral edema
NC/PT Ensure proper dx, proper handling of drug. Monitor CBC; provide supportive
measures. Use universal precautions with body fluids. Pt should use gloves when
handling body fluids; flush toilet several times; avoid pregnancy (men should use barrier
contraceptives during and for 6 mo after use); report extreme fatigue, bleeding, severe
vomiting, diarrhea.

raloxifene hydrochloride (Evista)

CLASS Selective estrogen receptor modulator
PREG/CONT X/NA

BBW Increased risk of DVT, PE; monitor accordingly. Increased risk of stroke, CV events
in women w/ documented CAD; weigh benefits/risks before use in these women.
IND & DOSE Px, tx of osteoporosis in postmenopausal women; to reduce risk of
invasive breast cancer in postmenopausal women w/ osteoporosis and high risk
of invasive breast cancer. Adult: 60 mg/day PO.
ADV EFF Depression, dizziness, edema, flulike sx, hot flashes, light-headedness, rash,
vaginal bleeding, venous thromboembolism
INTERACTIONS Cholestyramine, oral anticoagulants
NC/PT Obtain periodic CBC. Provide comfort measures for effects. Not for use in
pregnancy (contraceptives advised). Pt should take safety precautions w/ CNS effects,
report difficulty breathing, numbness/tingling, pain/swelling in legs.
 raltegravir (Isentress)
CLASS Antiretroviral, integrase inhibitor
PREG/CONT C/NA

IND & DOSE Tx of HIV-1 infection. Adult, child 12 yr and older: 400 mg PO bid w/ other
antivirals, without regard to food. If given w/ rifampin, 800 mg PO bid without regard
to food. Child 6–under 12 yr: 25 kg or more, 400 mg PO bid or up to 300 mg PO bid
chewable tablet; under 25 kg, chewable tablets weight-based to max 300 mg PO bid.
Child 2–under 6 yr: 40 kg or more, 300 mg PO bid; 28–under 40 kg, 200 mg PO bid; 20–
under 28 kg, 150 mg PO bid; 14–under 20 kg, 100 mg PO bid; 10–under 14 kg, 75 mg
PO bid; under 10 kg, not recommended. Child 4 wk–under 2 yr: 14–under 20 kg, 5 mL
(100 mg) PO bid; 11–under 14 kg, 4 mL (80 mg) PO bid; 8–under 11 kg, 3 mL (60 mg)
PO bid; 6–under 8 kg, 2 mL (40 mg) PO bid; 4–under 6 kg, 1.5 mL (30 mg) PO bid; 3–
less than 4 kg, 1 mL (20 mg) PO bid.
ADV EFF Diarrhea, dizziness, headache, fever, n/v, rhabdomyolysis
INTERACTIONS Rifampin, St. John’s wort
NC/PT Ensure pt taking other antivirals. Not for use in pregnancy, breast-feeding.
Calculate weight-based use of chewable tablets for child. Pt should not let prescription
run out or stop temporarily (virus could become resistant to antivirals); take precautions
to avoid spread (drug not a cure); avoid St. John’s wort; report signs of infection,
unexplained muscle pain/weakness.

ramelteon (Rozerem)
CLASS Melatonin receptor agonist, sedative-hypnotic
PREG/CONT C/NA

IND & DOSE Tx of insomnia. Adult: 8 mg PO within 30 min of bedtime.

ADJUST DOSE Hepatic impairment
ADV EFF Amenorrhea, anaphylaxis, angioedema, decreased testosterone, depression,
diarrhea, galactorrhea, headache, insomnia, suicidality
INTERACTIONS Clarithromycin, fluconazole, fluvoxamine, itraconazole, ketoconazole,
nefazodone, nelfinavir, ritonavir
NC/PT Not for use in pregnancy, breast-feeding. Pt should take 30 min before bed, avoid
activities after taking, plan on 8 or more hr sleep, report difficulty breathing, swelling,
thoughts of suicide.

ramipril (Altace)
CLASS ACE inhibitor, antihypertensive
PREG/CONT D/NA

BBW Not for use in pregnancy; risk of fetal harm. Advise contraceptives.
IND & DOSETx of hypertension. Adult: 2.5 mg PO daily; range, 2.5–20 mg/day. Tx of HF
first few days post MI. Adult: 2.5 mg PO bid; if hypotensive, may use 1.25 mg PO bid;
target dose, 5 mg PO bid. To decrease risk of MI, stroke, death from CV disease.
Adult 55 yr and older: 2.5 mg/day PO for 1 wk, then 5 mg/day PO for 3 wk; maint, 10
mg PO daily.
ADJUST DOSE Elderly pts, renal impairment
ADV EFF Agranulocytosis, angioedema, aphthous ulcers, bone marrow suppression,
cough, dizziness, dysgeusia, gastric irritation, HF, light-headedness, proteinuria, rash,
Stevens-Johnson syndrome, tachycardia
INTERACTIONS Capsaicin, lithium
NC/PT Stop diuretics 2-3 days before tx. Not for use in pregnancy (barrier contraceptives
advised). Alert surgeon of ramipril use; volume replacement may be needed postop.
Stable for 24 hr at room temp, 48 hr if refrigerated. Pt should open capsules, sprinkle
contents over small amount of applesauce or mix in applesauce/water; take safety
precautions w/ CNS effects; use caution in situations that could lead to fluid loss,
decreased BP; maintain hydration; report unusual bleeding, swelling, rash.

ranibizumab (Lucentis)
CLASS Monoclonal antibody, ophthalmic agent
PREG/CONT C/NA

IND & DOSE Tx of neovascular (wet) age-related macular degeneration; macular

edema after retinal vein occlusion. 0.5 mg (0.05 mL) by intravitreal injection q 1–3
mo.
ADV EFF Conjunctival hemorrhage, eye pain, hypersensitivity reactions, increased IOP,
intraocular inflammation, ocular infection, vision changes, vitreous floaters
NC/PT Monitor carefully for detached retina, increased IOP. Pt should be anesthetized
before injection, receive antibiotic. Pt should report increased light sensitivity, vision
changes, painful eye.

ranitidine hydrochloride (Zantac)

CLASS Gastric acid secretion inhibitor, histamine-2 antagonist
PREG/CONT B/NA

IND & DOSETx of active duodenal ulcer. Adult: 150 mg PO bid for 4–8 wk, or 300 mg PO
once daily at bedtime, or 50 mg IM or IV q 6–8 hr or by intermittent IV infusion, diluted
to 100 mL and infused over 15–20 min. Max, 400 mg/day; maint, 150 mg PO at
bedtime. Child 1 mo–16 yr: 2–4 mg/kg PO bid for tx; once daily for maint. Max, 3,000
mg/day (tx), 1,500 mg/day (maint). Or, 2–4 mg/kg/day IV or IM q 6–8 hr; max, 50 mg
q 6–8 hr. Tx of active gastric ulcer. Adult: 150 mg PO bid, or 50 mg IM or IV q 6-8 hr.
Tx of pathologic hypersecretory syndrome, GERD maint, esophagitis, benign
gastric ulcer. Adult: 150 mg PO bid; max, 6 g/day. Tx of heartburn, acid indigestion.
Adult: 75 mg PO as needed.
ADJUST DOSE Elderly pts, renal impairment
ADV EFF Abd pain, bradycardia, bone marrow suppression, constipation, headache,
n/v/d, pain at injection site, rash
INTERACTIONS Warfarin
NC/PT Give IM undiluted into large muscle; give oral drug w/ meals and at bedtime. May
continue antacids for pain relief. Pt should report unusual bleeding, signs of infection.
Name confusion w/ Zantac (ranitidine), Zyrtec (cetirizine), Xanax (alprazolam); use
caution.

ranolazine (Ranexa)
CLASS Antianginal, piperazineacetamide
PREG/CONT C/NA

IND & DOSE Tx of chronic angina. Adult: 500 mg PO bid; max, 1,000 mg bid.
ADJUST DOSE Hepatic impairment (not recommended)
ADV EFF Constipation, dizziness, headache, nausea, prolonged QT interval
INTERACTIONS Antipsychotics, digoxin, diltiazem, grapefruit juice, HIV protease inhibitors,
ketoconazole, macrolide antibiotics, QT-prolonging drugs, rifampin, TCAs, verapamil
NC/PT Obtain baseline ECG, LFTs, renal function. Continue other antianginals. Not for
use in pregnancy (contraception advised), breast-feeding. Pt should swallow tablet
whole and not cut, crush, or chew it; take safety measures w/ dizziness; avoid grapefruit
juice; use laxative for severe constipation; report fainting, palpitations.

rasagiline (Azilect)
CLASS Antiparkinsonian, MAO type B inhibitor
PREG/CONT C/NA

IND & DOSE Tx of s&sx of idiopathic Parkinson disease. Adult: 1 mg/day PO as

monotherapy; 0.5–1 mg/day PO w/ levodopa.
ADJUST DOSE CYP1A2 inhibitors, hepatic impairment
ADV EFF Arthralgia, dizziness, dyspepsia, dry mouth, headache, hypotension, melanoma,
vertigo
INTERACTIONS Cyclobenzaprine, CYP1A2 inhibitors (ciprofloxacin), dextromethorphan,
MAOIs, meperidine, methadone, mirtazapine, SSRIs, St. John’s wort, sympathomimetic
amines, TCAs, tramadol, tyramine-rich food
NC/PT Obtain baseline LFTs, skin evaluation. Continue other Parkinson drugs. Use
caution w/ pregnancy, breast-feeding. Pt should avoid sun exposure, tyramine-rich
foods, St. John’s wort; take safety measures w/ dizziness; tell all health care providers
about prescribed/OTC drugs, herbs being used (drug reacts w/ many other drugs);
report skin changes, worsening of condition.
 rasburicase (Elitek)
CLASS Enzyme
PREG/CONT C/NA

BBW Risk of anaphylaxis, hemolysis (in pts w/ G6PD deficiency; screen before tx),
methemoglobinemia, uric acid measurement alterations.
IND & DOSE Mgt of plasma uric acid level in pts w/ leukemia, lymphoma, solid tumor
malignancies receiving anticancer tx expected to result in tumor lysis. Adult: 0.15
or 0.2 mg/kg IV as single daily infusion over 30 min for 5 days. Chemotherapy should
start 4–24 hr after first dose.
ADV EFF Abd pain, anaphylaxis, anxiety, constipation, headache, hemolysis, n/v/d
NC/PT Screen for G6PD deficiency. Monitor closely during infusion; stop immediately if
hypersensitivity reactions. Monitor CBC. Blood drawn to monitor uric acid level must be
collected in prechilled, heparinized vials and kept in ice-water bath; analysis must be
done within 4 hr. Give analgesics for headache. Pt should report difficulty breathing,
chest pain, rash.

raxibacumab (generic)
CLASS Monoclonal antibody
PREG/CONT B/NA

IND & DOSE Tx, px of inhalational anthrax, w/ antibacterial drugs. Adult, child over 50
kg: 40 mg/kg IV over 2 hr, 15 min. Child over 15 kg–50 kg: 60 mg/kg IV over 2 hr, 15
min. Child 15 kg and less: 80 mg/kg IV over 2 hr, 15 min.
ADV EFF Extremity pain, infusion reaction, pruritus, rash, somnolence
NC/PT TEACH Premedicate w/ diphenhydramine. Monitor for infusion reaction; slow,
interrupt infusion as needed. Pt should report itching, difficulty breathing, rash.

regorafenib (Stivarga)
CLASS Antineoplastic, kinase inhibitor
PREG/CONT D/NA

BBW Severe to fatal hepatotoxicity reported; monitor LFTs before, during tx.
IND & DOSE Tx of metastatic colorectal cancer in pts previously treated w/ other
agents; tx of advanced, unresectable GI stomal tumors. Adult: 160 mg/day PO for
first 21 days of 28-day cycle. Give w/ low-fat breakfast.
ADV EFF Anorexia, cardiac ischemia/ infarction, dermatologic toxicity, diarrhea,
dysphonia, GI perforation/fistula, hepatotoxicity, hypertension, mucositis, RPLS,
weight loss, wound-healing complications
INTERACTIONS Grapefruit juice, St. John’s wort, strong CYP3A4 inducers/inhibitors; avoid
these combinations
NC/PT Monitor LFTs; arrange to decrease dose or stop drug if hepatotoxicity occurs.
Monitor for skin reactions, bleeding, problems w/ wound healing. Not for use in
pregnancy, breast-feeding. Stop drug at least 24 hr before scheduled surgery. Pt should
take daily in a.m. w/ low-fat breakfast, report chest pain, severe GI pain, bleeding,
urine/stool color changes.

DANGEROUS DRUG
repaglinide (Prandin)
CLASS Antidiabetic, meglitinide
PREG/CONT C/NA

IND & DOSE Adjunct to diet, exercise to lower blood glucose in pts w/ type 2
diabetes, as monotherapy or w/ other antidiabetics. Adult: 0.5–4 mg PO tid or qid
15–30 min (usually within 15 min) before meals; max, 16 mg/day.
ADJUST DOSE Hepatic, renal impairment
ADV EFF Diarrhea, headache, hypoglycemia, nausea, URI
INTERACTIONS Celery, coriander, dandelion root, fenugreek, garlic, gemfibrozil, ginseng,
itraconazole, juniper berries
NC/PT Review complete diabetic teaching program. Pt should always take before meals
(if meal is skipped or added, dose should be skipped or added appropriately), monitor
serum glucose, continue exercise/diet program, report fever, unusual bleeding/bruising,
frequent hypoglycemia.

ribavirin (Copegus, Rebetol, Ribasphere, Virazole)

CLASS Antiviral
PREG/CONT X/NA

BBW Inhaled form not for use in adults; testicular lesions, birth defects possible.
Monotherapy not effective for tx of chronic hepatitis C; do not use alone for this
indication. High risk of hemolytic anemia, which could lead to MI; do not use in
significant, unstable CV disease. Monitor respiratory status frequently; pulmonary
deterioration, death have occurred during, shortly after tx w/ inhaled form. Risk of
significant fetal defects; caution women to avoid pregnancy during tx (barrier
contraceptives advised). Male partners of pregnant women should not take drug.
IND & DOSE Tx of hospitalized infants, children w/ severe RSV infection of lower
respiratory tract. Child: Dilute aerosol powder to 20 mg/mL, deliver for 12–18 hr/day
for at least 3 but not more than 7 days. Tx of chronic hepatitis C. Adult over 75 kg:
Three 200-mg capsules PO in a.m., three 200-mg capsules PO in p.m. w/ Intron A 3
million international units subcut three times/wk, or w/ Pegasys 180 mcg/wk subcut for
24–48 wk. Adult 75 kg or less: Two 200-mg capsules PO in a.m., three 200-mg capsules
PO in p.m. w/ Intron A 3 million international units subcut three times/wk, or w/
Pegasys 180 mcg/wk subcut for 24–48 wk. Child: 15 mg/kg/ day PO in divided doses
a.m. and p.m. Child 25–62 kg may use oral sol. Give w/ Intron A 3 million international
units/m2 subcut three times/wk.
ADJUST DOSE Anemia
ADV EFF Anemia, apnea, cardiac arrest, depression, deteriorating respiratory function,
hemolytic anemia, nervousness, rash, suicidality
INTERACTIONS Antacids, nucleoside reverse transcriptase inhibitors
NC/PT Monitor CBC regularly. Review use, care of inhaler. Ensure pt on oral tx also
taking other antivirals. Not for use in pregnancy (barrier contraceptives advised). Pt
should report thoughts of suicide, chest pain, difficulty breathing.

rifabutin (Mycobutin)
CLASS Antibiotic
PREG/CONT B/NA

IND & DOSE Px, tx of disseminated Mycobacterium avium complex in pts w/ advanced
HIV infection. Adult: 300 mg/day PO. Child: 5 mg/kg/day PO.
ADV EFF Abd pain, anorexia, Clostridium difficile diarrhea, headache, nausea, rash, red to
orange urine
INTERACTIONS Clarithromycin, delavirdine, indinavir, nelfinavir, oral contraceptives,
ritonavir, saquinavir
NC/PT Negative TB test needed before starting tx. Not for use in pregnancy (barrier
contraceptives advised), breast-feeding. Urine, body fluids may turn red to orange,
staining fabric, contact lenses. Pt should report diarrhea, difficulty breathing.

rifampin (Rifadin)
CLASS Antibiotic, antituberculotic
PREG/CONT C/NA

IND & DOSE Tx of pulmonary TB. Adult: 10 mg/kg/day PO or IV; max, 600 mg/day in
single dose (w/ other antituberculotics). Child: 10–20 mg/kg/ day PO or IV; max, 600
mg/day. Tx of Neisseria meningitidis carriers to eliminate meningococci from
nasopharynx. Adult: 600 mg/day PO or IV for 4 consecutive days or 600 mg q 12 hr for
2 days. Child over 1 mo: 10 mg/kg PO or IV q 12 hr for 2 days; max, 600 mg/dose. Child
under 1 mo: 5 mg/kg PO or IV q 12 hr for 2 days.
ADJUST DOSE Renal impairment
ADV EFF Acute renal failure, bone marrow suppression, discolored body fluids,
dizziness, drowsiness, epigastric distress, fatigue, flulike sx, headache, heartburn, rash
INTERACTIONS Antiarrhythmics, benzodiazepine, buspirone, corticosteroids, cyclosporine,
digoxin, doxycycline, fluoroquinolones, hormonal contraceptives, isoniazid,
itraconazole, ketoconazole, methadone, metoprolol, nifedipine, oral anticoagulants, oral
sulfonylureas, phenytoin, propranolol, quinidine, theophyllines, verapamil, zolpidem
NC/PT Monitor renal function, CBC, LFTs periodically. Body fluids will turn reddish
orange. Pt should take once/day on empty stomach 1 hr before or 2 hr after meals, take
safety precautions w/ CNS effects, not wear soft contact lenses (may become
permanently stained), report signs of infection, swelling, unusual bleeding/bruising.

rifapentine (Priftin)
CLASS Antibiotic, antituberculotic
PREG/CONT C/NA

IND & DOSE Tx of pulmonary TB. Adult, child 12 and over: 600 mg PO twice wkly w/
interval of at least 72 hr between doses. Continue for 2 mo, then 600 mg/wk PO for 4
mo w/ other antituberculotics.
ADJUST DOSE Elderly pts
ADV EFF Diarrhea, dizziness, headache, hematuria, hyperuricemia, proteinuria, pyuria,
reddish body fluids
INTERACTIONS Antiarrhythmics, benzodiazepine, buspirone, corticosteroids, cyclosporine,
digoxin, doxycycline, fluoroquinolones, hormonal contraceptives, isoniazid,
itraconazole, ketoconazole, methadone, metoprolol, nifedipine, oral anticoagulants, oral
sulfonylureas, phenytoin, propranolol, protease inhibitors, quinidine, theophyllines,
verapamil, zolpidem
NC/PT Always give w/ other antituberculotics. Body fluids will turn reddish orange. Not
for use in pregnancy (barrier contraceptives advised). Pt should mark calendar for tx
days, take once/day on empty stomach 1 hr before or 2 hr after meals, not wear contact
lenses (may become permanently stained), take safety precautions w/ CNS effects,
report signs of infection, swelling, unusual bleeding/bruising.

rifaximin (Xifaxan)
CLASS Antibiotic, antidiarrheal
PREG/CONT C/NA

IND & DOSE Tx of traveler’s diarrhea. Adult, child 12 yr and older: 200 mg PO tid for 3
days. To reduce recurrence of hepatic encephalopathy in pts w/ advanced liver
disease. Adult: 550 mg PO bid.
ADV EFF Diarrhea, dizziness, fever, flatulence, headache, pseudomembranous colitis,
rash
NC/PT Do not use w/ diarrhea complicated by fever, blood in stool. Not for use in
pregnancy, breast-feeding. Pt should swallow tablet whole and not cut, crush, or chew
it; stop if diarrhea does not resolve or worsens in 48 hr; take safety precautions w/
dizziness; report bloody diarrhea, fever.

rilonacept (Arcalyst)
CLASS Anti-inflammatory, interleukin blocker
PREG/CONT C/NA
IND & DOSE Tx of cryopyrin-associated periodic syndromes, including familial cold
autoinflammatory syndrome, Muckle-Wells syndrome. Adult: Loading dose, 320 mg
as two 160-mg (2-mL) subcut injections at different sites; then once-wkly subcut
injections of 160 mg (2 mL). Child 12–17 yr: Loading dose, 4.4 mg/kg subcut; max, 320
mg. May give in divided doses if needed. Then once-wkly injections of 2.2 mg/kg; max,
160 mg.
ADV EFF Injection-site reactions, lipid changes, serious infections, URI
INTERACTIONS Live vaccines, TNF blockers
NC/PT Stop if infection occurs. Use caution in pregnancy, breast-feeding. Teach proper
administration, disposal of needles, syringes. Pt should rotate injection sites, report
injection-site reactions, signs of infection.

rilpivirine (Edurant)
CLASS Antiviral, nonnucleoside reverse transcriptase inhibitor (NNRTI)
PREG/CONT B/NA

IND & DOSE Tx of HIV-1 infection in tx-naïve pts. Adult: 25 mg/day PO.
ADV EFF Body fat redistribution, depression, headache, immune reconstitution syndrome,
insomnia, prolonged QT interval, rash, suicidality
INTERACTIONS Antacids, CYP3A4 inducers/inhibitors, drugs that decrease stomach acid,
other NNRTIs, QT-prolonging drugs, St. John’s wort
NC/PT Monitor viral load, response carefully. Ensure pt taking other antivirals. Not for
use in pregnancy, breast-feeding. Body fat may redistribute to back, breasts, middle of
body. Check pt drug list carefully; drug interacts w/ many drugs. Pt should report all
drugs, herbs, OTC products used to health care provider; take once/day w/ meal; take
precautions to prevent spread (drug not a cure); continue to take other antivirals; report
signs of infection, thoughts of suicide.

riluzole (Rilutek)
CLASS Amyotrophic lateral sclerosis (ALS) drug
PREG/CONT C/NA

IND & DOSETx of ALS. Adult: 50 mg PO q 12 hr.

ADV EFF Abd pain, asthenia, anorexia, circumoral paresthesia, diarrhea, dizziness,
interstitial pneumonitis, liver injury, neutropenia, somnolence, vertigo
INTERACTIONS Allopurinol, methyldopa, sulfasalazine, warfarin
NC/PT Monitor CBC, lung function, LFTs carefully. Protect from light. Use caution in
pregnancy, breast-feeding. Slows disease progress; not a cure. Pt should take on empty
stomach, use safety precautions w/ dizziness, report signs of infection, difficulty
breathing.
 rimantadine hydrochloride (Flumadine)
CLASS Antiviral
PREG/CONT C/NA

IND & DOSE Px of illness caused by influenza A virus. Adult, child over 10 yr: 100
mg/day PO bid. Child 1–9 yr: 5 mg/kg/day PO; max, 150 mg/dose. Tx of illness caused
by influenza A virus. Adult, child over 10 yr: 100 mg/day PO bid as soon after exposure
as possible, continuing for 7 days.
ADJUST DOSE Nursing home pts; hepatic, renal impairment
ADV EFF Ataxia, dizziness, dyspnea, HF, insomnia, light-headedness, mood changes,
nausea
INTERACTIONS Acetaminophen, aspirin, cimetidine, intranasal influenza virus vaccine
NC/PT Pt should take full course of drug, take safety precautions for CNS effects, report
swelling, severe mood changes.

riociguat (Adempas)
CLASS Cyclase stimulator, pulmonary hypertension drug
PREG/CONT X/NA

BBW Known teratogen. Serious to fatal birth defects; monthly negative pregnancy test
required. Available by limited access program for women.
IND & DOSE Tx of thromboembolic pulmonary hypertension, idiopathic pulmonary
hypertension. Adult: 1.5–2.5 mg PO tid.
ADJUST DOSE Severe renal, hepatic impairment (not recommended); smokers
ADJUST DOSE Anemia, bleeding, constipation, dizziness, dyspepsia, headache,
hypotension, n/v/d, pulmonary edema
INTERACTIONS Antacids; CYP inhibitors; nitrates; P-glycoprotein, phosphodiesterase
inhibitors
NC/PT Smokers may need higher doses. Monitor BP, respiratory status. Ensure negative
pregnancy test, safety precautions w/ CNS effects. Pt should avoid pregnancy (during
and for 1 mo after use), breast-feeding; monitor activity tolerance, respiratory sx; take
safety precautions; report worsening of sx, bleeding, severe n/v.

risedronate sodium (Actonel, Atelvia)

CLASS Bisphosphonate
PREG/CONT C/NA

IND & DOSE Tx, px of postmenopausal osteoporosis. Adult: 5 mg/day PO taken in

upright position w/ 6–8 oz water at least 30 min before or after other beverage, food;
may switch to 35-mg tablet PO once/wk, or 75 mg PO on 2 consecutive days each mo
(total, 2 tablets/mo), or one 150-mg tablet PO per mo. Tx, px of glucocorticoid
osteoporosis. Adult: 5 mg/day PO. Tx of Paget disease. Adult: 30 mg/day PO for 2 mo
taken in upright position w/ 6–8 oz water at least 30 min before or after other
beverage, food; may retreat after at least 2-mo posttreatment period if indicated. To
increase bone mass in men w/ osteoporosis. Adult: 35 mg PO once/wk.
ADJUST DOSE Renal impairment
ADV EFF Anorexia, arthralgia, diarrhea, dizziness, dyspepsia, esophageal rupture,
headache, increased bone pain, osteonecrosis of jaw
INTERACTIONS Aluminum, aspirin, calcium, magnesium
NC/PT Monitor serum calcium level. May increase risk of osteonecrosis of jaw; pts having
invasive dental procedures should discuss risk. Give w/ full glass of plain (not mineral)
water at least 30 min before or after other beverage, food, medication. Have pt remain
in upright position for at least 30 min to decrease GI effects. Pt should swallow DR
tablet whole and not cut, crush, or chew it; mark calendar if taking wkly; take
supplemental calcium, vitamin D; report muscle twitching, difficulty swallowing,
edema.

risperidone (Risperdal)
CLASS Antipsychotic, benzisoxazole
PREG/CONT C/NA

BBW Not for use in elderly pts w/ dementia; increased risk of CV mortality. Not
approved for this use.
IND & DOSE Tx of schizophrenia. Adult: 1 mg PO bid or 2 mg PO once daily; target, 3 mg
PO bid by third day. Range, 4–8 mg/day or 25 mg IM q 2 wk. Max, 50 mg IM q 2 wk.
Delaying relapse time in long-term tx: 2–8 mg/day PO. Child 13–17 yr: 0.5 mg/day PO;
target, 3 mg/day. Tx of bipolar I disorder. Adult: 25–50 mg IM q 2 wk. Tx of bipolar
mania. Adult: 2–3 mg/day PO; range, 1–6 mg/day. Child 10–17 yr: 0.5 mg/day PO;
target, 2.5 mg/day. Irritability associated w/ autistic disorder. Child 5–17 yr: 0.5
mg/day (20 kg or more), 0.25 mg/day PO (under 20 kg). After at least 4 days, may
increase to 1 mg/day (20 kg or more), 0.5 mg/day (under 20 kg). Maintain dose for at
least 14 days; then may increase in increments of 0.5 mg/day (20 kg or more), 0.25
mg/day (under 20 kg) at 2-wk intervals.
ADJUST DOSE Elderly pts; hepatic, renal impairment
ADV EFF Agitation, arrhythmias, anxiety, aggression, constipation, dizziness, drowsiness,
headache, hyperglycemia, insomnia, n/v, NMS, photosensitivity
INTERACTIONS Alcohol, carbamazepine, clonidine, levodopa
NC/PT If restarting tx, follow initial dose guidelines, using extreme care due to increased
risk of severe adverse effects w/ reexposure. Stop other antipsychotics before starting
risperidone. Not for use in pregnancy. Pt should open blister units of orally
disintegrating tablets individually (not push tablet through foil); use dry hands to
remove tablet, immediately place on tongue but do not chew; mix oral sol in 3–4 oz
water, coffee, orange juice, low-fat milk (not cola, tea); take safety precautions w/ CNS
effects; avoid sun exposure; report signs of infection, palpitations, increased
thirst/urination. Name confusion between Risperdal (risperidone) and Requip
(ropinirole); use caution.

ritonavir (Norvir)
CLASS Antiviral
PREG/CONT B/NA

BBW Potentially large increase in serum conc, risk of serious arrhythmias, seizures, fatal
reactions w/ alfuzosin, amiodarone, astemizole, bepridil, bupropion, clozapine,
ergotamine, flecainide, meperidine, pimozide, piroxicam, propafenone, quinidine,
rifabutin, terfenadine, voriconazole. Potentially large increase in serum conc of these
sedatives/hypnotics: Alprazolam, clonazepam, diazepam, estazolam, flurazepam,
midazolam, triazolam, zolpidem; extreme sedation, respiratory depression possible. Do
not give ritonavir w/ any drugs listed above.
IND & DOSE Tx of HIV infection. Adult: 600 mg PO bid w/ food. Child: 250 mg/m2 PO bid.
Increase by 50 mg/m2 bid at 2- to 3-day intervals to max 400 mg/m2 PO bid. Max, 600
mg bid.
ADV EFF Abd pain, anorexia, anxiety, asthenia, dizziness, dysuria, n/v/d,
peripheral/circumoral paresthesia
INTERACTIONS Grapefruit juice, QT-prolonging drugs, St. John’s wort. See also Black Box
Warning above.
NC/PT Carefully screen drug hx for potentially serious drug-drug interactions. Pt should
store capsules, oral sol in refrigerator; take w/ food; avoid grapefruit juice, St. John’s
wort; use precautions to avoid spread (drug not a cure); report severe diarrhea, changes
in drugs being taken, signs of infection. Name confusion between Retrovir (zidovudine)
and ritonavir; use caution.

DANGEROUS DRUG
rituximab (Rituxan)
CLASS Antineoplastic, monoclonal antibody
PREG/CONT C/NA

BBW Fatal infusion reactions, severe cutaneous reactions, tumor lysis syndrome possible.
Risk of reactivation of hepatitis B at drug initiation; screen for hepatitis B before use.
IND & DOSE Tx of lymphoma. Adult: 375 mg/m2 IV once wkly for four or eight doses. To
reduce s&sx of rheumatoid arthritis. Adult: Two 1,000-mg IV infusions separated by 2
wk, w/ methotrexate. Tx of chronic lymphocytic leukemia. Adult: 375 mg/m2 IV day
before fludarabine/cyclophosphamide; then 500 mg/m2 on day 1 of cycles 2–6 (q 28
days). Tx of Wegener granulomatosis, microscopic polyangiitis. Adult: 375 mg/m2
IV once wkly for 4 wk, w/ glucocorticoids.
ADV EFF Bowel obstruction, bronchitis, cardiac arrhythmias, infusion reactions,
infections, hepatitis B reactivation, progressive multifocal leukoencephalopathy,
tumor lysis syndrome, URI
INTERACTIONS Live vaccines
NC/PT Premedicate w/ acetaminophen, diphenhydramine to decrease fever, chills
associated w/ infusion. Protect from infection exposure. Monitor for hepatitis B
reactivation; stop if viral hepatitis occurs. Use caution in pregnancy, breast-feeding. Pt
should mark calendar of tx days, report severe abd pain, headache, signs of infection,
urine/stool color changes.

rivaroxaban (Xarelto)
CLASS Anticoagulant, factor Xa inhibitor
PREG/CONT C/NA

BBW Risk of epidural, spinal hematomas w/ related neurologic impairment, possible

paralysis if used in pts receiving neuraxial anesthesia or undergoing spinal puncture.
Carefully consider benefits/risks of neuraxial intervention in pts who are or will be
anticoagulated. If rivaroxaban used, monitor frequently for neurologic impairment; be
prepared for rapid tx if necessary. Stopping drug increases risk of thromboembolic
events; if stopped for any reason other than pathological bleeding, start another
anticoagulant.
IND & DOSE Px of DVT, which may lead to PE in pts undergoing knee, hip
replacement; Adult: 10 mg/day PO. Start within 6–10 hr of surgery; continue for 12
days after knee replacement, 35 days after hip replacement, continuously for AF. To
reduce risk of stroke in pts w/ nonvalvular atrial fibrillation; to reduce risk of
recurrent DVT, PE. Adult: 20 mg/day PO w/ evening meal.
ADJUST DOSE Renal, hepatic impairment
ADV EFF Bleeding, dysuria, elevated liver enzymes, hemorrhage, rash
INTERACTIONS Aspirin, carbamazepine, clarithromycin, clopidogrel, erythromycin,
ketoconazole, NSAIDs, phenytoin, platelet inhibitors, rifampin, ritonavir, St. John’s
wort, warfarin
NC/PT Monitor for bleeding. Do not stop abruptly (increased risk of stroke); taper when
stopping, consider use of another anticoagulant. Not for use in pregnancy
(contraceptives advised), breast-feeding. Pt should report all prescribed/OTC drugs,
herbs being taken; take precautions to prevent injury; report stool color changes,
unusual bleeding, dizziness.

rivastigmine tartrate (Exelon)

CLASS Alzheimer disease drug, cholinesterase inhibitor
PREG/CONT B/NA

Tx of Alzheimer disease. Adult: 1.5 mg PO bid w/ food. Range, 6–12

IND & DOSE
mg/day; max, 12 mg/day. Transdermal patch: One 4.6-mg/24 hr patch once/day; after
4 or more wk, may increase to one 9.5-mg/24 hr patch. Tx of Parkinson dementia.
Adult: 3–12 mg/day PO bid in divided doses. Transdermal patch: one 4.6-mg/ 24 hr
patch once/day; after 4 or more wk, may increase to one 9.5-mg/ 24 hr patch.
ADV EFF Abd pain, anorexia, ataxia, bradycardia, confusion, fatigue, insomnia, n/v/d
INTERACTIONS Anticholinergics, NSAIDs, other cholinesterase inhibitors, theophylline
NC/PT Establish baseline function before tx. Pt should take w/ food; mix sol w/ water,
fruit juice, soda to improve compliance; apply patch to clean, dry skin (remove old
patch before applying new one), rotate sites; take safety precautions w/ CNS effects;
report diarrhea, changes in neurologic function.

rizatriptan (Maxalt)
CLASS Antimigraine, serotonin selective agonist
PREG/CONT C/NA

IND & DOSE Tx of acute migraine attacks. Adult: 5 or 10 mg PO at onset of headache;

may repeat in 2 hr if needed. Max, 30 mg/day.
ADJUST DOSE Hepatic, renal impairment
ADV EFF Chest pain, dizziness, jaw pain, paresthesia, somnolence, throat pressure,
vertigo, weakness
INTERACTIONS Ergots, MAOIs, propranolol
NC/PT Do not give within 14 days of MAOIs. For acute attack only, not px. Monitor BP in
pts w/ known CAD. Not for use in pregnancy. Pt should place orally disintegrating
tablet on tongue, then swallow; take safety measures w/ CNS effects; continue normal
migraine relief measures; report chest pain, numbness/tingling.

roflumilast (Daliresp)
CLASS Phosphodiesterase-4 inhibitor
PREG/CONT C/NA

IND & DOSETo reduce exacerbation risk in severe COPD. Adult: 500 mcg/day PO.
ADJUST DOSE Hepatic impairment
ADV EFF Depression, diarrhea, dizziness, headache, insomnia, suicidality, weight loss
INTERACTIONS Carbamazepine, cimetidine, erythromycin, ethinyl estradiol, fluvoxamine,
ketoconazole, phenobarbital, phenytoin, rifampin
NC/PT Not for acute bronchospasm. Monitor weight; if significant weight loss, stop drug.
Not for use in pregnancy (contraceptives advised), breast-feeding. Pt should continue
other COPD tx, report all drugs being taken, weight loss, thoughts of suicide.

romidepsin (Istodax)
CLASS Antineoplastic, histone deacetylase inhibitor
PREG/CONT D/NA
IND & DOSETx of pts w/ cutaneous, peripheral T-cell lymphoma who have received
at least one prior systemic tx. Adult: 14 mg/m2 IV over 4 hr on days 1, 8, 15 of 28-day
cycle. Repeat q 28 days.
ADJUST DOSE Hepatic, severe renal impairment
ADV EFF Anemia, anorexia, bone marrow suppression, fatigue, infections, n/v/d, QT
prolongation, tumor lysis syndrome
INTERACTIONS CYP3A4 inducers/inhibitors. QT-prolonging drugs, warfarin
NC/PT Monitor CBC, LFTs, renal function. Obtain baseline, periodic ECG. Not for use in
pregnancy (contraceptives advised), breast-feeding. Pt should mark calendar of tx days,
avoid exposure to infection, report signs of infection, unusual bleeding/bruising.

romiplostim (Nplate)
CLASS Thrombopoietin receptor agonist
PREG/CONT C/NA

IND & DOSE Tx of thrombocytopenia in pts w/ chronic immune thrombocytopenic

purpura. Adult: 1 mcg/kg/wk subcut; adjust in increments of 1 mcg/kg to achieve
platelet count of 50 × 109. Max, 10 mcg/kg/wk.
ADJUST DOSE Hepatic, severe renal impairment
ADV EFF Abd pain, arthralgia, dizziness, dyspepsia, headache, insomnia, myalgia, pain,
paresthesia, progression to acute myelogenous leukemia, severe
thrombocytopenia, thrombotic events
NC/PT Pt must be enrolled in Nplate NEXUS program; drug must be given by health care
provider enrolled in program who will do blood test for platelet count before injection.
Not for use in pregnancy, breast-feeding. Not for home administration. Pt should take
safety precautions w/ dizziness, report difficulty breathing, numbness/tingling, leg
pain.

ropinirole hydrochloride (Requip)

CLASS Antiparkinsonian, dopamine receptor agonist
PREG/CONT C/NA

IND & DOSETx of idiopathic Parkinson disease. Adult: 0.25 mg PO tid (1st wk); 0.5 mg
PO tid (2nd wk); 0.75 mg PO tid (3rd wk); 1 mg PO tid (4th wk). May increase by 1.5
mg/day at 1-wk intervals to 9 mg/day, then by up to 3 mg/day at 1-wk intervals to max
24 mg/day. ER tablets: 2 mg/day PO. After 1–2 wk, may increase by 2 mg/day. Titrate
w/ wkly increases of 2 mg/day to max 24 mg/day. If used w/ levodopa, decrease
levodopa gradually; average reduction, 31% w/ immediate-release ropinirole, 34% w/
ER form. Tx of restless legs syndrome. Adult: 0.25 mg/day PO 1–3 hr before bed. After
2 days, increase to 0.5 mg/day PO; after 1 wk, to 1 mg/day PO. Wk 3, increase to 1.5
mg/day; wk 4, 2 mg/day; wk 5, 2.5 mg/day; wk 6, 3 mg/day; wk 7, 4 mg/day PO.
ADJUST DOSE Elderly pts
ADV EFF Constipation, dizziness, hyperkinesia, hypokinesia, insomnia, nausea, orthostatic
hypotension, somnolence, vision changes
INTERACTIONS Alcohol, ciprofloxacin, estrogens, levodopa, warfarin
NC/PT Withdraw gradually over 1 wk if stopping. Monitor orthostatic BP. Pt should
swallow ER tablet whole and not cut, crush, or chew it; take w/ food; use safety
precautions w/ CNS effects; change position slowly; report black tarry stools,
hallucinations, falling asleep during daily activities. Name confusion between Requip
(ropinirole) and Risperdal (risperidone); use caution.

rosiglitazone (Avandia)
CLASS Antidiabetic, thiazolidinedione
PREG/CONT C/NA

BBW Increased risk of HF, MI. Do not use in pts w/ known heart disease, symptomatic
HF; monitor accordingly.
IND & DOSE As adjunct to diet, exercise to improve glycemic control in adults
already on rosiglitazone and tolerating it well or who cannot achieve glycemic
control w/ other antidiabetics. Adult: 4 mg PO daily; max, 8 mg/day.
ADJUST DOSE Hepatic impairment
ADV EFF Anemia, fluid retention, headache, HF, hypoglycemia, macular edema, MI, UTI,
weight gain
INTERACTIONS CYP2C8 inducers/inhibitors, insulin
NC/PT Pt must enroll in limited-access program; not available in pharmacies. Not for use
in pregnancy, breast-feeding. Monitor weight; check for signs of HF. Ensure full diabetic
teaching. Pt should continue diet, exercise program for diabetes; report weight gain of 3
or more lb/day, chest pain, swelling.

rosuvastatin calcium (Crestor)

CLASS Antihyperlipidemic, statin
PREG/CONT X/NA

IND & DOSE Tx of hypercholesterolemia, mixed dyslipidemia, primary

dysbetalipoproteinemia, hypertriglyceridemia; primary px of CAD;
atherosclerosis. Adult: 5–40 mg/day PO; 10 mg/day PO if combined w/ other lipid-
lowering drugs; 5 mg/day PO if combined w/ cyclosporine. Tx of heterozygous
familial hypercholesterolemia. Child 10–17 yr (girls must be at least 1 yr
postmenarchal): 5–20 mg/day PO.
ADJUST DOSE Renal impairment
ADV EFF Diarrhea, dizziness, flulike sx, headache, liver failure, myopathy, nausea,
pharyngitis, rhabdomyolysis, rhinitis
INTERACTIONS Antacids, cyclosporine, gemfibrozil, lopinavir/ritonavir, warfarin
NC/PT Risk of increased adverse effects in Asian pts; initiate tx w/ 5 mg/day PO and
adjust based on lipid levels, adverse effects. Obtain baseline lipid profile. Not for use in
pregnancy (barrier contraceptives advised), breast-feeding. Pt should take at bedtime;
have regular blood tests; continue diet, exercise program; take antacids at least 2 hr
after rosuvastatin; report muscle pain w/ fever, unusual bleeding/bruising.

rotigotine (Neupro)
CLASS Antiparkinsonian, dopamine agonist
PREG/CONT C/NA

IND & DOSE Tx of s&sx of Parkinson’s disease. Adult: 2 mg/24 hr transdermal patch;
range, 2–8 mg/24 hr patch. Tx of moderate to severe restless legs syndrome. Adult: 1
mg/24 hr transdermal patch; max, 3 mg/24 hr transdermal patch.
ADV EFF Anorexia, application-site reactions, dizziness, dyskinesia, edema, hallucinations,
headache, hyperpyrexia, hypotension, insomnia, melanoma, n/v, orthostatic
hypotension, severe allergic reaction
INTERACTIONS Antipsychotics, dopamine antagonists, metoclopramide
NC/PT Apply to clean, dry skin; press firmly for 30 sec. Rotate application sites; remove
old patch before applying new one. Taper after long-term use. Remove patch before
MRI. Not for use in pregnancy. Pt should not open patch until ready to apply; remove
old patch before applying new one; rotate application sites; not stop use suddenly; take
safety precautions w/ CNS effects; report application-site reactions, skin reactions,
difficulty breathing, fever, changes in behavior, dizziness.

rufinamide (Banzel)
CLASS Antiepileptic, sodium channel blocker
PREG/CONT C/NA

IND & DOSE Adjunct tx of seizures associated w/ Lennox-Gastaut syndrome. Adult:

400–800 mg/day PO in two equally divided doses; target, 3,200 mg/day PO in two
equally divided doses. Child 4 yr and older: 10 mg/kg/day PO in two equally divided
doses; target, 45 mg/kg/day or 3,200 mg/day.
ADJUST DOSE Hepatic, renal impairment
ADV EFF Ataxia, coordination disturbances, dizziness, fatigue, headache, nausea, seizures,
severe hypersensitivity reactions, somnolence, suicidality
INTERACTIONS CYP450 inducers, hormonal contraceptives, valproate
NC/PT Withdraw gradually; do not stop abruptly. Stable for 90 days. Not for use in
pregnancy (hormonal contraceptives may be ineffective; second contraceptive form
advised), breast-feeding. Pt should take w/ food; swallow tablet whole and not cut,
crush, or chew it; store suspension upright, measure using medical measuring device;
take safety precautions w/ CNS effects; report difficulty breathing, rash, thoughts of
suicide, mood changes.
 ruxolitinib (Jakafi)
CLASS Kinase inhibitor
PREG/CONT C/NA

IND & DOSE Tx of intermediate, high-risk myelofibrosis. Adult: 20 mg PO bid; max, 25

mg bid.
ADJUST DOSE Hepatic, renal impairment
ADV EFF Anemia, bruising, dizziness, headache, serious infections, thrombocytopenia
INTERACTIONS CYP450 inducers/inhibitors
NC/PT Stop after 6 mo if no spleen reduction or sx improvement. Not for use in breast-
feeding. Monitor for infection. Pt should take safety precautions w/ dizziness, report
signs of infection, unusual bleeding.

sacrosidase (Sucraid)
CLASS Enzyme
PREG/CONT C/NA

IND & DOSE Oral replacement of genetically determined sucrase deficiency. Adult,
child over 15 kg: 2 mL PO or 44 drops/meal or snack PO. Adult, child 15 kg or less: 1 mL
or 22 drops/meal or snack PO.
ADV EFF Abd pain, constipation, dehydration, headache
NC/PT Do not use in known allergy to yeast. Must dilute w/ 60–120 mL water, milk,
infant formula before giving. Do not dilute, consume w/ fruit juice. Refrigerate bottle;
discard 4 wk after opening. Give cold or at room temp. Pt should report difficulty
breathing, swelling of tongue/face.

saliva substitute (Entertainer’s Secret, Moi-Stir, MouthKote, Salivart)

CLASS Saliva substitute
PREG/CONT Unkn/NA

IND & DOSE Mgt of dry mouth, throat in xerostomia, hyposalivation. Adult: Spray for
½ second or apply to oral mucosa.
ADV EFF Excessive electrolyte absorption
NC/PT Monitor pt while eating; swallowing may be impaired and additional tx needed.
Pt should swish around in mouth after application, report difficulty swallowing,
headache, leg cramps.

salmeterol xinafoate (Serevent Diskus)

CLASS Antiasthmatic, beta selective agonist
PREG/CONT C/NA
BBW Ensure drug not used for acute asthma or w/ worsening/deteriorating asthma; risk
of death. Increased risk of asthma-related hospitalization when used in children,
adolescents. When long-acting sympathomimetic, inhaled corticosteroid needed, fixed-
dose combination strongly recommended. Do not use for asthma unless combined w/
long-term asthma-control medication; risk of death. Use only as additional tx in pts not
controlled by other medications.
IND & DOSE Maint tx for asthma, bronchospasm. Adult, child 4 yr and over: 1 inhalation
(50 mcg) bid at 12-hr intervals. Px of exercise-induced asthma. Adult, child 4 yr and
older: 1 inhalation 30 min or more before exertion. Long-term maint of bronchospasm
w/ COPD. Adult: 1 inhalation (50 mcg) bid at 12-hr intervals.
ADV EFF Asthma-related deaths (risk higher in black pts), bronchospasm, headache,
pain, palpitations, tachycardia, tremors
INTERACTIONS Beta blockers, diuretics, MAOIs, protease inhibitors, TCAs
NC/PT Arrange for periodic evaluation of respiratory condition. Not for tx of acute
asthma attack. Review proper use of Diskus. Pt should never take drug alone for tx of
asthma; take safety precautions w/ tremors; report irregular heartbeat, difficulty
breathing, worsening of asthma.

salsalate (Amigesic, Argesic-SA, Disalcid, Marthritic, Salflex, Salsitab)

CLASS Analgesic, NSAID, salicylate
PREG/CONT C/NA

BBW Increased risk of GI bleeding, CV events; monitor accordingly.

IND & DOSE Relief of pain, sx of inflammatory conditions. Adult: 3,000 mg/day PO in
divided doses.
ADV EFF Acute salicylate toxicity, anaphylactoid reactions to anaphylactic shock,
bone marrow suppression, bronchospasm, constipation, CV collapse, dizziness,
dyspepsia, GI pain, insomnia, renal/respiratory failure
INTERACTIONS Alcohol, antacids, carbonic anhydrase inhibitors, corticosteroids, insulin,
probenecid, spironolactone, sulfonylureas, urine alkalinizers, valproic acid
NC/PT Pt should take w/ full glass of water; w/ food if GI upset. Continue other measures
for relief of pain, inflammation; report ringing in ears, rapid, difficult breathing.

sapropterin dihydrochloride (Kuvan)

CLASS Coenzyme factor, phenylalanine reducer
PREG/CONT C/NA

IND & DOSE W/ diet to reduce blood phenylalanine level in hyperphenylalinemia

caused by tetrahydrobiopterin-responsive phenylketonuria. Pt 4 yr and older: 10
mg/kg/day PO. May adjust to 5–20 mg/kg/day based on blood phenylalanine level.
ADV EFF Abd pain, headache, n/v/d, pharyngolaryngeal pain
NC/PT Do not use w/ levodopa, ED drugs, drugs that inhibit folate metabolism. Must use
w/ phenylalanine dietary restrictions. Protect from moisture; do not use if outdated.
Dissolve tablets in water, apple juice; have pt drink within 15 min. Monitor
phenylalanine level; adjust dose as needed. Pt should report severe headache, anorexia,
fever.

saquinavir mesylate (Invirase)

CLASS Antiviral, protease inhibitor
PREG/CONT B/NA

BBW Capsules, tablets not interchangeable; use tablets only when combined w/
ritonavir. If saquinavir only protease inhibitor in regimen, use capsules.
IND & DOSE Tx of HIV infection. Adult, child over 16 yr: 1,000 mg PO bid w/ ritonavir 100
mg bid given together within 2 hr after meal. Or, w/ lopinavir 400 mg/ritonavir 100 mg
PO bid (tablets). Or, 1,000 mg PO bid w/ lopinavir 400 mg/ritonavir 100 mg PO bid
(capsules).
ADJUST DOSE Hepatic impairment
ADV EFF Asthenia, diarrhea, dizziness, dyspepsia, fat redistribution, GI pain, headache,
nausea, prolonged QT interval
INTERACTIONS Antiarrhythmics, carbamazepine, clarithromycin, delavirdine,
dexamethasone, ergots, grapefruit juice, indinavir, ketoconazole, midazolam, nelfinavir,
nevirapine, phenobarbital, phenytoin, QT-prolonging drugs, rifabutin, rifampin,
ritonavir, sildenafil, statins, triazolam, St. John’s wort
NC/PT Store at room temp; use by expiration date. Give within 2 hr after full meal,
always w/ other antivirals. Monitor for opportunistic infections. Pt should take
precautions to prevent spread (drug not a cure), avoid grapefruit juice, St. John’s wort;
take safety precautions w/ dizziness, report severe headache, urine/stool color changes.
Name confusion between saquinavir and Sinequan; use caution.

sargramostim (Leukine)
CLASS Colony-stimulating factor
PREG/CONT C/NA

IND & DOSE Myeloid reconstitution after autologous, allogenic bone marrow
transplantation. Adult: 250 mcg/m2/day for 21 days as 2-hr IV infusion starting 2–4 hr
after autologous bone marrow infusion and not less than 24 hr after last dose of
chemotherapy, radiation. Do not give until post-marrow infusion ANC less than 500
cells/mm3. Continue until ANC greater than 1,500 cells/mm3 for 3 consecutive days.
Bone marrow transplantation failure, engraftment delay. Adult: 250 mcg/m2/day
for 14 days as 2-hr IV infusion; may repeat after 7 days off tx if no engraftment. If still
no engraftment, may give third dose of 500 mcg/m2/day for 14 days after another 7
days off tx. Neutrophil recovery after chemotherapy in AML. Adult: 250 mcg/m2/day
IV over 4 hr starting about day 11 or 4 days after chemotherapy induction.
Mobilization of peripheral blood progenitor cells (PBPCs). Adult: 250 mcg/m2/day
IV over 24 hr or subcut once daily; continue throughout harvesting. Post-PBPC
transplant. Adult: 250 mcg/m2/day IV over 24 hr or subcut once daily starting
immediately after PBPC infusion; continue until ANC greater than 1,500 cells/mm3 for 3
consecutive days.
ADV EFF Alopecia, bone pain, diarrhea, fever, hemorrhage, n/v/d
INTERACTIONS Corticosteroids, lithium
NC/PT Give no less than 24 hr after cytotoxic chemotherapy and within 2–4 hr of bone
marrow infusion. Store in refrigerator; do not freeze/shake. Not for use in pregnancy
(barrier contraceptives advised). Use powder within 6 hr of mixing. If using powder, use
each vial for one dose; do not reenter vial. Discard unused drug. Infuse over 2 hr. Do not
use in-line membrane filter or mix w/ other drugs or in other diluent. Monitor CBC. Pt
should cover head at temp extremes (hair loss possible), avoid exposure to infection,
report fever, signs of infection, difficulty breathing.

DANGEROUS DRUG
saxagliptin (Onglyza)
CLASS Antidiabetic, DPP-4 inhibitor
PREG/CONT B/NA

IND & DOSE As adjunct to diet, exercise to improve glycemic control in type 2
diabetics. Adult: 2.5–5 mg/day PO without regard to meals.
ADJUST DOSE Renal impairment
ADV EFF Headache, hypoglycemia, URI, UTI
INTERACTIONS Atazanavir, celery, clarithromycin, coriander, dandelion root, fenugreek,
garlic, ginseng, indinavir, itraconazole, juniper berries, ketoconazole, nefazodone,
nelfinavir, ritonavir, saquinavir, telithromycin
NC/PT Monitor blood glucose, HbA1c, renal function before, periodically during tx. Ensure
thorough diabetic teaching program. Pt may be switched to insulin during times of
stress. Pt should continue diet, exercise program, other prescribed diabetes drugs; report
all other prescribed/OTC drugs, herbs being taken (dose adjustment may be needed);
report uncontrolled glucose levels, severe headache, signs of infection.

scopolamine hydrobromide (Transderm-Scop)

CLASS Anticholinergic, antiemetic, anti–motion sickness drug, antiparkinsonian,
belladonna alkaloid, parasympatholytic
PREG/CONT C/NA

IND & DOSE Tx of motion sickness. Adult: Apply 1 transdermal system to postauricular
skin at least 4 hr before antiemetic effect needed or in evening before scheduled
surgery; delivers scopolamine 1 mg over 3 days. May replace system q 3 days. Obstetric
amnesia, preoperative sedation. Adult: 0.32–0.65 mg subcut or IM. May give IV after
dilution in sterile water for injection. May repeat up to qid. Child: General guidelines,
0.006 mg/kg subcut, IM or IV; max, 0.3 mg. 3 yr–6 yr: 0.2–0.3 mg IM or IV. 6 mo–3 yr:
0.1–0.15 mg IM or IV. Sedation, tranquilization. Adult: 0.6 mg subcut or IM tid–qid.
Antiemetic. Adult: 0.6–1 mg subcut. Child: 0.006 mg/kg subcut. Refraction. Adult:
Instill 1–2 drops into eye(s) 1 hr before refracting. Uveitis. Adult: Instill 1–2 drops into
eye(s) up to qid.
ADJUST DOSE Elderly pts
ADV EFF Anaphylaxis, blurred vision, constipation, decreased sweating, dizziness,
drowsiness, dry mouth, nasal congestion, photophobia, pupil dilation, urinary hesitancy,
urine retention
INTERACTIONS Alcohol, antidepressants, antihistamines, haloperidol, phenothiazines
NC/PT Ensure adequate hydration. Provide temp control to prevent hyperpyrexia. W/
transdermal system, have pt wash hands thoroughly after handling patch, dispose of
patch properly to avoid contact w/ children/pets, remove old patch before applying
new one, do not cut patch. Pt should empty bladder before each dose; avoid alcohol, hot
environments; use laxative for constipation; take safety precautions w/ CNS effects;
report severe dry mouth, difficulty breathing.

DANGEROUS DRUG
secobarbital sodium (Seconal Sodium)
CLASS Antiepileptic, barbiturate, sedative-hypnotic
PREG/CONT D/C-II

IND & DOSE Intermittent use as sedative-hypnotic. Adult: 100 mg PO at bedtime for up
to 2 wk. Preop sedation. Adult: 200–300 mg PO 1–2 hr before surgery. Child: 2–6
mg/kg PO 1–2 hr before surgery; max, 100 mg/dose.
ADJUST DOSE Elderly, debilitated pts; hepatic, renal impairment
ADV EFF Anaphylaxis, angioedema, agitation, anxiety, apnea, ataxia, bradycardia,
confusion, constipation, dizziness, epigastric pain, hallucinations, hyperkinesia,
hypotension, hypoventilation, insomnia, laryngospasm, n/v/d, psychiatric
disturbances, respiratory depression, sleep disorders, somnolence, Stevens-Johnson
syndrome, syncope
INTERACTIONS Alcohol, anticoagulants, antihistamines, corticosteroids, doxycycline,
estrogens, hormonal contraceptives, hypnotics, metoprolol, metronidazole,
oxyphenbutazone, phenylbutazone, propranolol, quinidine, sedatives, theophylline,
verapamil
NC/PT Monitor blood levels, watch for anaphylaxis, angioedema w/ above interacting
drugs. Not for use in pregnancy (barrier contraceptives advised), breast-feeding.
Barbiturates may produce irritability, excitability, inappropriate tearfulness, aggression
in children; stay w/ children who receive preop sedation. Taper gradually after repeated
use. Pt should avoid alcohol, take safety precautions, report difficulty breathing,
swelling.
 secretin (ChiRhoStim)
CLASS Diagnostic agent
PREG/CONT C/NA

IND & DOSE To stimulate pancreatic secretions to aid in dx of pancreatic exocrine

dysfx, gastric secretions to aid in dx of gastrinoma. Adult: 0.2–0.4 mcg/kg IV over 1
min.
ADV EFF Abd pain, allergic reactions, flushing, n/v
INTERACTIONS Anticholinergics
NC/PT Monitor carefully during infusion for allergic reaction; have emergency equipment
on hand. Do not use w/ acute pancreatitis. Pt should report severe abd pain, difficulty
breathing.

selegiline hydrochloride (Eldepryl, Emsam, Zelapar)

CLASS Antidepressant, antiparkinsonian, MAO type B inhibitor
PREG/CONT C/NA

BBW Increased risk of suicidality in children, adolescents, young adults; monitor

accordingly.
IND & DOSE Mgt of pts w/ Parkinson disease whose response to levodopa/carbidopa
has decreased. Adult: 10 mg/day PO in divided doses of 5 mg each at breakfast, lunch.
After 2–3 days, attempt to reduce levodopa/ carbidopa dose; reductions of 10%–30%
typical. For orally disintegrating tablet, 1.25 mg/day PO in a.m. before breakfast. May
increase after 6 wk to 2.5 mg/day; max, 10 mg/day. Tx of major depressive disorder.
Adult, child over 12 yr: One patch (Emsam) daily to dry, intact skin on upper torso, upper
thigh, or outer surface of upper arm. Start w/ 6-mg/24 hr system; increase to max 12
mg/24 hr if needed, tolerated.
ADJUST DOSE Elderly pts
ADV EFF Abd pain, asthma, confusion, dizziness, dyskinesia, hallucinations, headache,
light-headedness, local reactions to dermal patch, n/v, vivid dreams
INTERACTIONS Carbamazepine, fluoxetine, meperidine, methadone, opioid analgesics,
oxcarbazepine, TCAs, tramadol, tyramine-rich foods
NC/PT Pt should place oral tablet on top of tongue, avoid food, beverage for 5 min; apply
dermal patch to dry, intact skin on upper torso, upper thigh, or outer upper arm,
replace q 24 hr (remove old patch before applying new one); continue other Parkinson
disease drugs; take safety precautions w/ CNS effects; report all drugs being used (dose
adjustments may be needed); report confusion, fainting, thoughts of suicide.

sertraline hydrochloride (Zoloft)

CLASS Antidepressant, SSRI
PREG/CONT C (1st trimester); D (2nd, 3rd trimesters)/NA
BBW Increased risk of suicidality in children, adolescents, young adults; monitor
accordingly.
IND & DOSE Tx of major depressive disorder, OCD. Adult: 50 mg PO once daily, a.m. or
p.m.; may increase to max 200 mg/day. Child 13–17 yr: For OCD, 50 mg/day PO; max,
200 mg/day. Child 6–12 yr: For OCD, 25 mg/day PO; max, 200 mg/day. Tx of panic
disorder, PTSD. Adult: 25–50 mg/day PO, up to max 200 mg/day. Tx of PMDD. Adult:
50 mg/day PO daily or just during luteal phase of menstrual cycle. Range, 50–150
mg/day. Tx of social anxiety disorder. Adult: 25 mg/day PO; range, 50–200 mg/day.
ADJUST DOSE Hepatic, renal impairment
ADV EFF Anxiety, diarrhea, dizziness, drowsiness, dry mouth, fatigue, headache, insomnia,
nausea, nervousness, painful menstruation, rhinitis, suicidality, vision changes
INTERACTIONS Cimetidine, MAOIs, pimozide, St. John’s wort
NC/PT Do not give within 14 days of MAOIs. Dilute oral concentrate in 4 oz water,
ginger ale, lemon-lime soda, lemonade, orange juice only; give immediately after
diluting. Not for use in pregnancy (barrier contraceptives advised). May take up to 4–6
wk to see depression improvement. Pt should take safety precautions w/ CNS effects,
avoid St. John’s wort, report difficulty breathing, thoughts of suicide.

sevelamer hydrochloride (Renagel)

CLASS Calcium-phosphate binder
PREG/CONT C/NA

IND & DOSE To reduce serum phosphorus level in hemodialysis pts w/ end-stage
renal disease. Adult: 1–4 tablets PO w/ each meal based on serum phosphorus level;
may increase by one tablet/meal to achieve desired serum phosphorus level.
ADV EFF Cough, diarrhea, dyspepsia, headache, hypotension, thrombosis, vomiting
NC/PT Do not use w/ hypophosphatemia or bowel obstruction. Pt should take other oral
drugs at least 1 hr before or 3 hr after sevelamer; have blood tests regularly to monitor
phosphorus level, report chest pain, difficulty breathing.

sildenafil citrate (Revatio, Viagra)

CLASS ED drug, phosphodiesterase inhibitor
PREG/CONT B/NA

IND & DOSETx of ED. Adult: 50 mg PO 1 hr before anticipated sexual activity; range, 25–
100 mg PO. May take 30 min–4 hr before sexual activity. Limit use to once/day (Viagra).
Tx of pulmonary arterial hypertension. Adult: 20 mg PO tid at least 4–6 hr apart
without regard to food (Revatio), or 10 mg by IV bolus tid (Revatio).
ADJUST DOSE Elderly pts; hepatic, renal impairment
ADV EFF Dyspepsia, flushing, headache, hearing/vision loss, hypotension, priapism
INTERACTIONS Alcohol, alpha adrenergic blockers, amlodipine, cimetidine, erythromycin,
grapefruit juice, nitrates, protease inhibitors
NC/PT Ensure proper dx before tx. Revatio contraindicated in children 1–17 yr; deaths
have been reported. Reserve IV use for pts unable to take orally. Viagra ineffective in
absence of sexual stimulation. Pt should take appropriate measures to prevent STDs,
report difficult urination, hearing/ vision loss, erection lasting longer than 4 hr.

silodosin (Rapaflo)
CLASS Alpha blocker, BPH drug
PREG/CONT B/NA

IND & DOSE Tx of s&sx of BPH. Adult: 8 mg/day PO w/ meal.

ADJUST DOSE Hepatic, renal impairment
ADV EFF Abnormal/retrograde ejaculation, dizziness, headache, liver impairment,
orthostatic hypotension, rash
INTERACTIONS Clarithromycin, cyclosporine, itraconazole, ketoconazole, other alpha
blockers, ritonavir
NC/PT Rule out prostate cancer before tx. Pt undergoing cataract surgery at risk for
intraop floppy iris syndrome; alert surgeon about drug use. Pt should take safety
precautions for dizziness, orthostatic hypotension; report urine/stool color changes,
worsening of sx.

simeprevir (Olysio)
CLASS Hepatitis C drug, protease inhibitor
PREG/CONT C/NA

IND & DOSE Tx of chronic hepatitis C, w/ other antiretrovirals. Adult: 150 mg/day PO
w/ food; combined w/ peginterferon alfa and ribavirin for 12 wk, then peginterferon
alfa and ribavirin for 24–36 wk.
ADV EFF Nausea, photosensitivity, rash
INTERACTIONS CYP3A inducers/inhibitor
NC/PT Ensure concurrent use of peginterferon alfa and ribavirin; not for monotherapy.
Negative pregnancy test required monthly. Pt should swallow capsule whole, not cut,
crush, or chew it; avoid pregnancy or fathering a child (two forms of contraception
advised), breast-feeding, sun exposure; use precautions to avoid spread of disease;
report rash, itching, severe nausea.

simethicone (Flatulex, Gas-X, Phazyme)

CLASS Antiflatulent
PREG/CONT C/NA

Relief of sx of excess gas in digestive tract. Adult: 40–360 mg PO as needed

IND & DOSE
after meals, at bedtime; max, 500 mg/day. Child 2–12 yr, over 11 kg: 40 mg PO as
needed after meals, at bedtime. Child under 2 yr: 20 mg PO as needed after meals, at
bedtime; max, 240 mg/day.
ADV EFF Constipation, diarrhea, flatulence
NC/PT Pt should shake drops thoroughly before each use; add drops to 30 mL cool water,
infant formula, other liquid to ease administration to infants; let strips dissolve on
tongue; chew chewable tablets thoroughly before swallowing; report extreme abd pain,
vomiting.

simvastatin (Zocor)
CLASS Antihyperlipidemic, statin
PREG/CONT X/NA

IND & DOSE Tx of hyperlipidemia; px of coronary events. Adult: 10–20 mg PO, up to 40

mg, daily in evening. Range, 5–40 mg/day; max, 40 mg/day. Tx of familial
hypercholesterolemia. Adult: 40 mg/day PO in evening. Child 10–17 yr: 10 mg/day PO
in evening; range, 10–40 mg/day. Combination tx of CAD. Adult: Do not use w/ other
statins. If used w/ fibrates, niacin, max of 10 mg/day. Give regular dose if used w/ bile
acid sequestrants; give sequestrants at least 4 hr before simvastatin. If used w/
cyclosporine, start w/ 5 mg/day; max, 10 mg/day. If used w/ amiodarone, verapamil,
max of 10 mg/day. If used w/ diltiazem, max of 40 mg/day.
ADJUST DOSE Renal impairment
ADV EFF Abd pain, acute renal failure, cramps, flatulence, headache, liver failure,
n/v/d, rhabdomyolysis
INTERACTIONS Amiodarone, clarithromycin, cyclosporine, digoxin, diltiazem,
erythromycin, fibrates, grapefruit juice, hepatotoxic drugs, HIV protease inhibitors,
itraconazole, ketoconazole, nefazodone, niacin, verapamil, warfarin
NC/PT Ensure pt has tried cholesterol-lowering diet for 3–6 mo before starting tx. Avoid
80-mg dose because of increased risk of muscle injury, rhabdomyolysis; if pt already
stable on 80 mg, monitor closely. Not for use in pregnancy (barrier contraceptives
advised). Pt should continue diet, take in p.m., have blood tests regularly, avoid
grapefruit juice, report urine/stool color changes, muscle pain/soreness.

sipuleucel-T (Provenge)
CLASS Cellular immunotherapy
PREG/CONT C/NA

IND & DOSE Tx of asymptomatic, minimally symptomatic metastatic castrate-

resistant prostate cancer. Adult: 50 million autologous CD54+ cells activated w/ PAP-
GM-CSF suspended in 250 mL lactated Ringer’s injection IV.
ADV EFF Acute infusion reactions, back pain, chills, fatigue, fever, headache, joint ache,
nausea
INTERACTIONS Immunosuppressants
NC/PT Autologous use only. Leukapheresis will be done 3 days before infusion. Ensure pt
identity. Premedicate w/ oral acetaminophen and antihistamine. Risk of acute infusion
reactions; closely monitor pt during infusion. Universal precautions required. Pt should
report difficulty breathing, signs of infection.

sirolimus (Rapamune)
CLASS Immunosuppressant
PREG/CONT C/NA

BBW Risk of increased susceptibility to infection; graft loss, hepatic artery thrombosis
w/ liver transplant; bronchial anastomotic dehiscence in lung transplants.
IND & DOSE Px for organ rejection in renal transplant. Adult, child 13 yr and older: 40
kg or more: Loading dose of 6 mg PO as soon after transplant as possible, then 2
mg/day PO. Under 40 kg: Loading dose of 3 mg/m2, then 1 mg/m2/day PO.
ADJUST DOSE Hepatic impairment
ADV EFF Abd pain, anaphylaxis, anemia, angioedema, arthralgia, delayed wound
healing, edema, fever, headache, hypertension, interstitial lung disease, lipid profile
changes, pain, skin cancer, thrombocytopenia
INTERACTIONS CYP3A4 inducers/inhibitors, grapefruit juice, live vaccines
NC/PT Always use w/ adrenal corticosteroids, cyclosporine. Monitor pulmonary function,
LFTs, renal function. Not for use in pregnancy (contraceptives advised), breast-feeding.
Pt should avoid grapefruit juice, sun exposure; report difficulty breathing, swelling.

DANGEROUS DRUG
sitagliptin phosphate (Januvia)
CLASS Antidiabetic, DPP-4 inhibitor
PREG/CONT B/NA

IND & DOSE As adjunct to diet, exercise to improve glycemic control in type 2
diabetics. Adult: 100 mg/day PO.
ADJUST DOSE Renal impairment
ADV EFF Headache, hypoglycemia, URI, UTI
INTERACTIONS Atazanavir, celery, clarithromycin, coriander, dandelion root, fenugreek,
garlic, ginseng, indinavir, itraconazole, juniper berries, ketoconazole, nefazodone,
nelfinavir, ritonavir, saquinavir, telithromycin
NC/PT Monitor blood glucose, HbA1c, renal function before, periodically during tx. Ensure
thorough diabetic teaching program. Pt may be switched to insulin during times of
stress. Pt should continue diet, exercise program, other prescribed diabetes drugs; report
all other prescribed/OTC drugs, herbs being taken.

sodium bicarbonate (Bell/ans, Neut)

CLASS Antacid, electrolyte; systemic, urine alkalinizer
 PREG/CONT C/NA

IND & DOSE Urine alkalinization. Adult: 3,900 mg PO, then 1,300–2,600 mg PO q 4 hr.
Child: 84–840 mg/kg/day PO. Antacid. Adult: 300 mg–2 g PO daily–qid usually 1–3 hr
after meals, at bedtime. Adjunct to advanced CV life support during CPR. Adult:
Inject IV either 300–500 mL of 5% sol or 200–300 mEq of 7.5% or 8.4% sol as rapidly as
possible. Base further doses on subsequent blood gas values. Or, 1 mEq/kg dose, then
repeat 0.5 mEq/kg q 10 min. Child 2 yr and older: 1 to 2 mEq/kg (1 mL/kg 8.4% sol) by
slow IV. Child under 2 yr: 4.2% sol; max, 8 mEq/kg/day IV. Severe metabolic acidosis.
Adult, child: Dose depends on blood carbon dioxide content, pH, pt’s clinical condition.
Usually, 90–180 mEq/L IV during first hr, then adjust PRN. Less urgent metabolic
acidosis. Adult, adolescent: 5 mEq/kg as 4–8 hr IV infusion.
ADJUST DOSE Elderly pts, renal impairment
ADV EFF Local irritation, tissue necrosis at injection site, systemic alkalosis
INTERACTIONS Amphetamines, anorexiants, doxycycline, ephedrine, flecainide, lithium,
methotrexate, quinidine, pseudoephedrine, salicylates, sulfonylureas,
sympathomimetics, tetracyclines
NC/PT Monitor ABGs. Calculate base deficit when giving parenteral sodium bicarbonate.
Adjust dose based on response. Give slowly. Do not attempt complete correction within
first 24 hr; increased risk of systemic alkalosis. Monitor cardiac rhythm, potassium level.
Pt should chew tablets thoroughly before swallowing, follow w/ full glass of water;
avoid oral drug within 1–2 hr of other oral drugs; report pain at injection site, headache,
tremors.

sodium ferric gluconate complex (Ferrlecit)

CLASS Iron product
PREG/CONT B/NA

IND & DOSE Tx of iron deficiency in pts undergoing long-term hemodialysis who are
on erythropoietin. Adult: Test dose: 2 mL diluted in 50 mL normal saline injection IV
over 60 min. Adult: 10 mL diluted in 100 mL normal saline injection IV over 60 min.
Child 6 yr and over: 0.12 mL/kg diluted in 25 mL normal saline by IV infusion over 1 hr
for each dialysis session.
ADV EFF Cramps, dizziness, dyspnea, flushing, hypotension, hypersensitivity reactions,
injection-site reactions, iron overload, n/v/d, pain
NC/PT Monitor iron level, BP. Most pts will initially need eight doses given at sequential
dialysis sessions, then periodic use based on hematocrit. Do not mix w/ other drugs in
sol. Have emergency equipment on hand for hypersensitivity reactions. Use caution in
pregnancy, breast-feeding. Pt should take safety precautions w/ CNS effects, report
difficulty breathing, pain at injection site.

sodium fluoride (Fluoritab, Flura, Karigel, Pharmaflur, Stop)

 CLASSMineral
PREG/CONT C/NA

IND & DOSE Px of dental caries. Adult: 10 mL rinse once daily or wkly; swish around
teeth, spit out. Or, apply thin ribbon to toothbrush or mouth tray for 1 min; brush, rinse,
spit out. Child: Fluoride in drinking water over 0.6 ppm: No tx. Fluoride in drinking
water 0.3–0.6 ppm: 6–16 yr, 0.5 mg/day PO; 3–6 yr, 0.25 mg/day PO. Fluoride in
drinking water under 0.3 ppm: 6–16 yr, 1 mg/day PO; 3–6 yr, 0.5 mg/day PO; 6 mo–3
yr, 0.25 mg/day PO. Child 6–12 yr: 10 mL/ day rinse; have pt swish around teeth for 1
min, spit out. Or, 4–6 drops gel on applicator. Have pt put applicator over teeth, bite
down for 6 min, spit out excess gel.
ADV EFF Eczema, gastric distress, headache, rash, teeth staining, weakness
INTERACTIONS Dairy products
NC/PT Do not give within 1 hr of milk, dairy products. Pt may chew tablets, swallow
whole, or add to drinking water, juice. Pt should brush, floss teeth before using rinse,
then spit out fluid (should not swallow fluid, cream, gel, rinse); have regular dental
exams; report increased salivation, diarrhea, seizures, teeth mottling.

sodium oxybate (Xyrem)

CLASS Anticataplectic, CNS depressant
PREG/CONT B/C-III

BBW Counsel pt that drug, also called GHB, is known for abuse. Pt will be asked to view
educational program, agree to safety measures to ensure only pt has drug access, and
agree to return for follow-up at least q 3 mo.
IND & DOSE Tx of excessive daytime sleepiness, cataplexy in pts w/ narcolepsy. Adult:
4.5 g/day PO divided into two equal doses of 2.25 g. Give at bedtime and again 2½–4
hr later. May increase no more often than q 1–2 wk to max 9 g/day in increments of 1.5
g/day (0.75 g/dose). Range, 6–9 g daily.
ADJUST DOSE Hepatic impairment
ADV EFF Dizziness, dyspepsia, flulike sx, headache, n/v/d, pharyngitis, respiratory
depression, somnolence, URI
INTERACTIONS Alcohol, CNS depressants
NC/PT Not for use in pregnancy. Dilute each dose w/ 60 mL water in child-resistant
dosing cup. Give first dose of day when pt still in bed; should stay in bed after taking.
Give second dose 2½–4 hr later, w/ pt sitting up in bed. After second dose, pt should lie
in bed. Pt should take safety precautions w/ CNS effects; avoid eating for at least 2 hr
before bed; keep drug secure; avoid alcohol; report difficulty breathing, confusion.

sodium phenylacetate/sodium benzoate (Ammonul)

CLASS Ammonia reducer, urea substitute
PREG/CONT C/NA
IND & DOSE Adjunct tx in hyperammonemia, encephalopathy in pts w/ enzyme
deficiencies associated w/ urea cycle. Adult, child: Over 20 kg, 55 mL/m2. 0–20 kg,
2.5 mL/kg; Give IV through central line w/ arginine.
ADJUST DOSE Hepatic, renal impairment
ADV EFF Hyperglycemia, hyperventilation, hypokalemia, mental impairment, injection-
site reaction/necrosis, metabolic acidosis, neurotoxicity, seizures
NC/PT Monitor plasma ammonia level. Not for use in pregnancy; use caution in breast-
feeding. Ammonia level will be monitored; when normalized, dietary protein intake can
be increased. Pt should report pain at injection site, numbness/tingling, rapid
respirations.

sodium polystyrene sulfonate (Kalexate, Kayexalate, Kionex)

CLASS Potassium-removing resin
PREG/CONT C/NA

IND & DOSE Tx of hyperkalemia. Adult: 15–60 g/day PO best given as 15 g daily–qid.
May give powder as suspension w/ water, syrup (20–100 mL). May introduce into
stomach via NG tube. Or, 30–50 g by enema q 6 hr, retained for 30–60 min or as long as
possible. Child: Give lower doses, using exchange ratio of 1 mEq potassium/g resin as
basis for calculation.
ADV EFF Anorexia, constipation, gastric irritation, hypokalemia, n/v
INTERACTIONS Antacids
NC/PT Give resin through plastic stomach tube, or mixed w/ diet appropriate for renal
failure. Give powder form in oral suspension w/ syrup base to increase palatability.
Give enema after cleansing enema; help pt retain for at least 30 min. Monitor serum
electrolytes; correct imbalances. If severe constipation, stop drug until function returns;
do not use sorbitol, magnesium-containing laxatives. Pt should report confusion,
constipation, irregular heartbeat.

sofosbuvir (Sovaldi)
CLASS Hepatitis C drug, nucleoside analog inhibitor
PREG/CONT C/NA

IND & DOSE Tx of hepatitis C, w/ peginterferon alfa and ribavirin (genotype 1 or 4)

or w/ ribavirin (genotypes 2 and 3). Adult: 400 mg/day PO w/ peginterferon and
ribavirin for 12 wk (genotype 1 or 4); w/ ribavirin for 12 wk (genotype 2) or 24 wk
(genotype 3).
ADJUST DOSE Hepatitis C virus/HIV coinfection, pts w/ hepatocellular carcinoma awaiting
liver transplant
ADV EFF Anemia, fatigue, headache, insomnia, nausea
INTERACTIONS Rifampin, St. John’s wort
NC/PT Ensure proper dx. Monthly negative pregnancy test required (use of barrier
contraceptives advised for men and women during and for 6 mo after use). Drug is not a
cure. Pt should eat small meals for nausea; take analgesic for headache; avoid St. John’s
wort; consult health care provider before stopping drug; take precautions to avoid
spread of disease; report severe headache, color changes in urine/stool.

solifenacin succinate (VESIcare)

CLASS Muscarinic receptor antagonist, urinary antispasmodic
PREG/CONT C/NA

IND & DOSE Tx of overactive bladder. Adult: 5–10 mg/day PO swallowed whole w/
water.
ADJUST DOSE Moderate to severe hepatic impairment, severe renal impairment
ADV EFF Constipation, dizziness, dry eyes, dry mouth, prolonged QT interval, urine
retention
INTERACTIONS CYP3A4 inhibitors, ketoconazole, potassium chloride, QT-prolonging drugs
NC/PT Arrange tx for underlying cause. Not for use in breast-feeding. Pt should empty
bladder before each dose if urine retention an issue; swallow tablet whole and not cut,
crush, or chew it; use sugarless lozenges for dry mouth, laxatives for constipation; take
safety precautions w/ dizziness; report inability to void, fever, blurred vision.

somatropin (Genotropin, Humatrope, Norditropin, Nutropin, Omnitrope,

Saizen, Serostim, Tev-Tropin, Zorbtive)
CLASS Hormone
PREG/CONT C; B (Genotropin, Omnitrope, Saizen, Serostim, Zorbtive)/NA

IND & DOSE (Adult) Tx of GH deficiency, replacement of endogenous GH in adults w/

GHD w/ multiple hormone deficiencies (Genotropin, Humatrope, HumatroPen,
Norditropin, Nutropin, Nutropin AQ, Omnitrope, Saizen). Genotropin, Omnitrope, 0.04–0.08
mg/kg/wk subcut divided into seven daily injections. Humatrope, HumatroPen, 0.006–
0.0125 mg/kg/day subcut. Nutropin, Nutropin AQ, Usual, 0.006 mg/kg/day subcut with
max, 0.0125 mg/kg/day (over 35 yr), 0.025 mg/kg/day (under 35 yr). Norditropin,
0.004–0.016 mg/kg/day subcut. Saizen, Up to 0.005 mg/kg/day subcut; may increase up
to 0.01 mg/kg/ day after 4 wk. Tx of AIDS-wasting or cachexia. Serostim, Over 55 kg:
6 mg/day subcut; 45–55 kg: 5 mg/day subcut; 35–45 kg: 4 mg/day subcut; under 35 kg:
0.1 mg/kg/day subcut. Tx of short bowel syndrome in pts receiving specialized
nutritional support (Zorbtive). 0.1 mg/kg/day subcut for 4 wk; max, 8 mg/day.
IND & DOSE (Child) Tx of growth failure related to renal dysfx. 0.35 mg/kg/wk subcut
divided into daily doses (Nutropin, Nutropin AQ). Tx of girls w/ Turner syndrome.
0.33 mg/kg/wk divided into six to seven subcut injections (Genotropin). Or, up to 0.375
mg/kg/wk subcut divided into equal doses six to seven times/wk (Humatrope,
HumatroPen). Or, up to 0.067 mg/kg/day subcut (Norditropin). Or, up to
0.375 mg/kg/wk subcut divided into equal doses (Nutropin, Nutropin AQ). Long-term tx
of growth failure due to Prader-Willi syndrome. 0.24 mg/kg/wk subcut divided into
daily doses (Genotropin). Small for gestational age. 0.48 mg/kg/wk (Genotropin). Tx
of short stature, growth failure in short stature homeobox (SHOX)-containing
gene deficiency. 0.35 mg/kg/wk subcut (Humatrope, HumatroPen). Tx of short stature
in Noonan syndrome. Up to 0.066 mg/kg/day subcut (Norditropin). Long-term tx of
idiopathic short stature when epiphyses not closed and diagnostic evaluation
excludes other causes treatable by other means. 0.47 mg/kg/wk subcut divided into
six to seven doses (Genotropin). Or, 0.18–0.3 mg/kg/wk subcut or IM given in divided
doses 3 time/wk (Humatrope, HumatroPen). Or, 0.3 mg/kg/wk subcut in divided daily
doses (Nutropin, Nutropin AQ). Long-term tx of growth failure due to lack of
adequate endogenous GH secretion. 0.18–0.3 mg/kg/wk subcut divided into daily
doses given six to seven times/wk (Accretropin). Or, 0.18–0.3 mg/kg/wk subcut divided
into doses six to seven 7 times/wk (Humatrope, HumatroPen). Or, 0.3 mg/kg/wk subcut
in divided daily doses (Nutropin, Nutropin AQ). Or, 0.16–0.24 mg/kg/ wk subcut divided
into daily doses (Genotropin). Or, 0.16–0.24 mg/kg/wk subcut divided into daily doses
(Omnitrope). Or, 0.06 mg/kg subcut, IM three times/wk (Saizen). Or, 0.024–0.034 mg/kg
subcut, six to seven times/wk (Norditropin). Or, up to 0.1 mg/kg subcut three times/wk
(Tev-Tropin). Tx of short stature w/ no catch-up growth by 2–4 yr. 0.35 mg/kg/wk
subcut injection divided into equal daily doses (Humatrope, HumatroPen), 0.024–0.034
mg/kg subcut six to seven times/wk (Norditropin).
ADV EFF Development of GH antibodies, headache, hypothyroidism, insulin resistance,
leukemia, pain, pain at injection site
INTERACTIONS CYP450 inducers/inhibitors
NC/PT Arrange tests for glucose tolerance, thyroid function, growth hormone antibodies;
tx as indicated. Rotate injection sites. Teach proper administration, disposal of needles,
syringes. Pt should have frequent blood tests, report increased thirst/voiding, fatigue,
cold intolerance.

DANGEROUS DRUG
sorafenib tosylate (Nexavar)
CLASS Antineoplastic, kinase inhibitor
PREG/CONT D/NA

IND & DOSE Tx of advanced renal cell, hepatocellular carcinoma. Adult: 400 mg PO
bid on empty stomach.
ADV EFF Alopecia, fatigue, GI perforation, hand-foot syndrome, hemorrhage,
hypertension, MI, n/v/d, QT prolongation, skin reactions, weight loss, wound-healing
complications
INTERACTIONS CYP3A4 inducers, grapefruit juice
NC/PT Obtain baseline, periodic ECG; monitor BP regularly. Not for use in pregnancy
(contraceptives advised). Pt should take on empty stomach, avoid grapefruit juice, cover
head at temp extremes (hair loss possible), report headache, rash, nonhealing wounds.

sotalol hydrochloride (Betapace, Betapace AF, Sorine)

CLASS Antiarrhythmic, beta blocker
PREG/CONT B/NA

BBW Do not give for ventricular arrhythmias unless pt unresponsive to other

antiarrhythmics and has life-threatening ventricular arrhythmia. Monitor response
carefully; proarrhythmic effect can be pronounced. Do not initiate tx if baseline QT
interval over 450 msec. If QT interval increases to 500 msec or more during tx, reduce
dose, extend infusion time, or stop drug.
IND & DOSE Tx of life-threatening ventricular arrhythmias (Betapace); maint of sinus
rhythm after atrial fibrillation (AF) conversion (Betapace AF). Adult: 80 mg PO bid.
Adjust gradually, q 3 days, until appropriate response; may need 240–320 mg/day PO
(Betapace); up to 120 mg bid PO (Betapace AF). Or, 75 mg IV over 5 hr bid; may increase
in increments of 75 mg/day q 3 days. Range, 225–300 mg once or twice a day for
ventricular arrhythmias; 112.5 mg once or twice a day IV for AF if oral not possible.
Converting between oral, IV doses: 80 mg oral–75 mg IV; 120 mg oral–112.5 mg IV; 160
mg oral–150 mg IV. Child over 2 yr w/ normal renal function: 30 mg/m2 tid PO. Max, 60
mg/m2 tid.
ADJUST DOSE Elderly pts, renal impairment
ADV EFF Bronchospasm, cardiac arrhythmias, constipation, decreased exercise
tolerance/libido, ED, flatulence, gastric pain, HF, laryngospasm, n/v/d, pulmonary
edema, stroke
INTERACTIONS Antacids, aspirin, bismuth subsalicylate, clonidine, hormonal
contraceptives, insulin, magnesium salicylate, NSAIDs, prazosin, QT-prolonging drugs,
sulfinpyrazone
NC/PT Monitor QT interval. Switch from IV to oral as soon as possible. Do not stop
abruptly; withdraw gradually. Pt should take on empty stomach, take safety precautions
w/ dizziness, report difficulty breathing, confusion, edema, chest pain.

spironolactone (Aldactone)
CLASS Aldosterone antagonist, potassium-sparing diuretic
PREG/CONT C; D (gestational hypertension)/NA

BBW Drug a tumorigen, w/ chronic toxicity in rats; avoid unnecessary use.

IND & DOSE Dx of hyperaldosteronism. Adult: Long test, 400 mg/day PO for 3–4 wk;
correction of hypokalemia, hypertension presumptive evidence of primary
hyperaldosteronism. Short test, 400 mg/day PO for 4 days. If serum potassium increases
but decreases when drug stopped, presumptive dx can be made. Tx of edema. Adult: 100
mg/day PO; range, 25–200 mg/day. Tx of hypertension. Adult: 50–100 mg/day PO for
at least 2 wk. Tx of hypokalemia. Adult: 25–100 mg/day PO. Tx of
hyperaldosteronism. Adult: 100–400 mg/day PO in preparation for surgery. Tx of
severe HF. Adult: 25–50 mg/day PO if potassium 5 mEq/L or less, creatinine 2.5 mg/dL
or less.
ADV EFF Cramping, diarrhea, dizziness, drowsiness, gynecomastia, headache, hirsutism,
hyperkalemia, voice deepening
INTERACTIONS ACE inhibitors, anticoagulants, antihypertensives, ganglionic blockers,
licorice, potassium-rich diet, salicylates
NC/PT Monitor electrolytes periodically. Pt should avoid potassium-rich foods, excessive
licorice intake; take safety precautions w/ dizziness; weigh self daily, report change of 3
lb or more/day; report swelling, muscle cramps/weakness.

stavudine (d4T) (Zerit)

CLASS Antiviral, nucleoside reverse transcriptase inhibitor
PREG/CONT C/NA

BBW Monitor closely for pancreatitis during tx; fatal, nonfatal pancreatitis has occurred.
Monitor LFTs; lactic acidosis, severe hepatomegaly possible.
IND & DOSE Tx of HIV-1 infection. Adult, child over 13 days: 60 kg or more, 40 mg PO q
12 hr; 30–less than 60 kg, 30 mg PO q 12 hr; under 30 kg, 1 mg/kg/dose PO q 12 hr.
Child birth–13 days: 0.5 mg/kg/dose PO q 12 hr.
ADJUST DOSE Renal impairment
ADV EFF Agranulocytopenia, asthenia, dizziness, fever, GI pain, headache, hepatomegaly
w/ steatosis, lactic acidosis, n/v/d, pancreatitis, paresthesia
INTERACTIONS Didanosine, doxorubicin, ribavirin, zidovudine
NC/PT Monitor LFTs, pancreatic function, neurologic status before, q 2 wk during tx.
Always give w/ other antivirals. Not for use in pregnancy (barrier contraceptives
advised). Pt should take precautions to prevent spread (drug not a cure), avoid
infections, take safety precautions w/ CNS effects, report numbness/tingling, severe
headache, difficulty breathing.

streptomycin sulfate (generic)

CLASS Antibiotic
PREG/CONT D/NA

BBW Risk of severe neurotoxic, nephrotoxic reactions; monitor closely. Do not use w/
other neurotoxic, nephrotoxic drugs.
IND & DOSE Tx of subacute bacterial endocarditis, resistant TB. Adult: 15 mg/kg/day
IM, or 25–30 mg/kg IM two or three times/wk. Child: 20–40 mg/ kg/day IM or 25–30
mg/kg/IM two or three times/wk. Tx of tularemia. Adult: 1–2 g/day IM for 7–14 days.
Tx of plaque. Adult: 2 g/day IM in two divided doses for at least 10 days.
ADJUST DOSE Renal impairment
ADV EFF Dizziness, hearing loss, injection-site reactions, renal toxicity, respiratory
paralysis, ringing in ears
INTERACTIONS Diuretics
NC/PT Monitor renal function regularly. Monitor injection sites. Teach appropriate
administration, disposal of needles, syringes. Ensure pt with TB is also receiving other
drugs. Not for use in pregnancy (barrier contraceptives advised), breast-feeding. Pt
should take safety precautions w/ CNS effects, report difficulty breathing, dizziness,
edema, hearing changes.

streptozocin (Zanosar)
CLASS Alkylating drug, antineoplastic
PREG/CONT D/NA

BBW Monitor for renal, liver toxicity. Special drug handling required.
IND & DOSE Tx of metastatic islet cell carcinoma of pancreas. Adult: 500 mg/m2 IV for
5 consecutive days q 6 wk; or 1,000 mg/m2 IV once/wk for 2 wk, then increase to 1,500
mg/m2 IV each wk.
ADJUST DOSE Renal impairment
ADV EFF Bone marrow suppression, dizziness, drowsiness, glucose intolerance, n/v/d,
severe to fatal renal toxicity
INTERACTIONS Doxorubicin
NC/PT Monitor LFTs, renal function closely. Handle drug as biohazard. Monitor CBC to
determine dose. Give antiemetics for n/v. Not for use in pregnancy, breast-feeding. Pt
should avoid exposure to infection, maintain nutrition, report unusual
bleeding/bruising, increased thirst, swelling.

succimer (Chemet)
CLASS Antidote, chelate
PREG/CONT C/NA

IND & DOSE Tx of lead poisoning in child w/ blood level over 45 mcg/dL. Child: 10
mg/kg or 350 mg/m2 PO q 8 hr for 5 days; reduce to 10 mg/kg or 350 mg/m2 PO q 12
hr for 2 wk (tx runs for 19 days).
ADV EFF Back pain, dizziness, drowsiness, flank pain, headache, n/v, rash, urination
difficulties
INTERACTIONS EDTA
NC/PT Monitor serum lead level, transaminase levels before, q 2 wk during tx. Continue
tx for full 19 days. Have pt swallow capsule whole; if unable to swallow capsule, open
and sprinkle contents on soft food or give by spoon followed by fruit drink. Pt should
maintain hydration, report difficulty breathing, tremors.

sucralfate (Carafate)
CLASS Antiulcer drug
 PREG/CONT B/NA

IND & DOSE Tx, maint of duodenal, esophageal ulcers. Adult: 1 g PO qid on empty
stomach for 4–8 wk; maint, 1 g PO bid.
ADV EFF Constipation, dizziness, dry mouth, gastric discomfort, rash, vertigo
INTERACTIONS Antacids, ciprofloxacin, digoxin, ketoconazole, levothyroxine, norfloxacin,
penicillamine, phenytoin, quinidine, tetracycline, theophylline, warfarin
NC/PT Pt should take on empty stomach, 1 hr before or 2 hr after meals, and at bedtime;
avoid antacids within 30 min of sucralfate; take safety precautions w/ CNS effects; use
laxative for constipation; report severe gastric pain.

DANGEROUS DRUG
sufentanil citrate (Sufenta)
CLASS Opioid agonist analgesic
PREG/CONT C/C-II

IND & DOSEAdjunct to general anesthesia. Adult: Initially, 1–2 mcg/kg IV. Maint, 10–25
mcg; max, 1 mcg/kg/hr of expected surgical time. Anesthesia. Adult: Initially, 8–30
mcg/kg IV; supplement w/ doses of 0.5–10 mcg/kg IV. Max, 30 mcg/kg for procedure.
Give w/ oxygen, skeletal muscle relaxant. Child 2–12 yr: Initially, 10–25 mcg/kg IV;
supplement w/ doses of 25–50 mcg IV. Give w/ oxygen, skeletal muscle relaxant.
Epidural analgesia. Adult: 10–15 mcg via epidural administration w/ 10 mL
bupivacaine 0.125%. May repeat twice at 1-hr or longer intervals (total, three doses).
ADV EFF Arrhythmias, bradycardia, bronchospasm, cardiac arrest, clamminess,
confusion, constipation, dizziness, dry mouth, headache, floating feeling,
laryngospasm, lethargy, light-headedness, n/v, sedation, shock, tachycardia, urinary
hesitancy, urine retention, vertigo
INTERACTIONS Barbiturates beta blockers, calcium channel blockers, general anesthetics,
grapefruit juice, hypnotics, opiate agonists, sedatives
NC/PT Protect vials from light. Provide opioid antagonist. Have equipment for assisted,
controlled respiration on hand during parenteral administration. Give to breast-feeding
women 4–6 hr before next feeding. Pt should avoid grapefruit juice, take safety
precautions w/ CNS effects, report difficulty breathing, palpitations. Name confusion
between sufentanil and fentanyl; use extreme caution.

sulfADIAZINE (generic)
CLASS Sulfonamide antibiotic
PREG/CONT C; D (labor & delivery)/NA

IND & DOSETx of acute infections caused by susceptible bacteria strains. Adult: 2–4 g
PO, then 2–4 g/day PO in three to six divided doses. Child over 2 mo: 75 mg/kg PO, then
150 mg/kg/day PO in four to six divided doses; max 6 g/day Tx of toxoplasmosis.
Adult: 1–1.5 g PO qid w/ pyrimethamine for 3–4 wk. Child over 2 mo: 100–200
mg/kg/day PO w/ pyrimethamine for 3–4 wk. Suppressive, maint tx in HIV pts.
Adult: 0.5–1 g PO q 6 hr w/ oral pyrimethamine, leucovorin. Infant, child: 85–120
mg/kg/day PO in two to four divided doses w/ oral pyrimethamine, leucovorin.
Adolescent: 0.5–1 g PO q 6 hr w/ oral pyrimethamine, leucovorin. Px of recurrent
attacks of rheumatic fever. Adult: Over 30 kg, 1 g/day PO. Under 30 kg, 0.5 g/day
PO.
ADV EFF Abd pain, crystalluria, headache, hematuria, hepatocellular necrosis, n/v,
photosensitivity, rash, Stevens-Johnson syndrome
INTERACTIONS Acetohexamide, chlorpropamide, cyclosporine, glyburide, glipizide, oral
anticoagulants, phenytoin, tolbutamide, tolazamide
NC/PT Culture before tx. Pt should take on empty stomach 1 hr before or 2 hr after meals
w/ full glass of water; drink 8 glasses of water/day; avoid sun exposure; take safety
precautions w/ CNS effects; report bloody urine, ringing in ears, difficulty breathing.
Name confusion between sulfadiazine and Silvadene (silver sulfadiazine); use caution.

sulfasalazine (Azulfidine)
CLASS Anti-inflammatory, antirheumatic, sulfonamide
PREG/CONT B/NA

IND & DOSE Tx of ulcerative colitis. Adult: 3–4 g/day PO in evenly divided doses. Maint,
2 g/day PO in evenly spaced doses (500 mg qid); max, 4 g/day. Child 6 yr and over: 40–
60 mg/kg/24 hr PO in three to six divided doses. Maint, 30 mg/kg/ 24 hr PO in four
equally divided doses; max, 2 g/day. Tx of rheumatoid arthritis (RA). Adult: 0.5–1
g/day PO (DR); may increase to 2 g daily in two evenly divided doses. Tx of juvenile
RA (polyarticular course). Child 6 yr and over: 30–50 mg/kg/day PO in two evenly
divided doses; max, 2 g/day.
ADV EFF Abd pain, agranulocytosis, aplastic anemia, crystalluria, headache,
hematuria, hepatocellular necrosis, n/v, paresthesia, photosensitivity, Stevens-
Johnson syndrome, thrombocytopenia
INTERACTIONS Digoxin, folate
NC/PT Pt should take w/ meals; swallow DR tablet whole and not cut, crush, or chew it;
drink 8 glasses of water/day; avoid sun exposure; take safety precautions w/ CNS
effects; report difficulty breathing, bloody urine, rash.

sulindac (Clinoril)
CLASS NSAID
PREG/CONT B (1st, 2nd trimesters); D (3rd trimester)/NA

BBW Increased risk of CV events, GI bleeding; monitor accordingly. Contraindicated for

periop pain in CABG surgery.
IND & DOSE Tx of pain of rheumatoid arthritis, osteoarthritis, ankylosing
spondylitis. Adult: 150 mg PO bid. Tx of acute painful shoulder, acute gouty
arthritis. Adult: 200 mg PO bid for 7–14 days (acute painful shoulder), 7 days (acute
gouty arthritis).
ADJUST DOSE Hepatic, renal impairment
ADV EFF Anaphylactoid reactions to fatal anaphylactic shock, bone marrow
suppression, constipation, dizziness, drowsiness, dyspepsia, edema, fatigue, GI pain,
headache, insomnia, HF, n/v, vision disturbances
INTERACTIONS Beta blockers, diuretics, lithium
NC/PT Pt should take w/ food, milk if GI upset, take safety precautions w/ CNS effects,
report swelling, difficulty breathing, black tarry stools.

sumatriptan succinate (Alsuma, Imitrex, Zecuity)

CLASS Antimigraine drug, triptan
PREG/CONT C/NA

IND & DOSE Tx of acute migraine attacks. Adult: 25, 50, or 100 mg PO; may repeat in 2
hr or more. Max, 200 mg/day. Or, 6 mg subcut; may repeat in 1 hr. Max, 12 mg/24 hr.
Or, 5, 10, or 20 mg into one nostril, or 10 mg divided into two doses (5 mg each), one in
each nostril, repeated q 2 hr; max, 40 mg/24 hr. Battery-powered transdermal patch
delivers 6.5 mg over 4 hr.
ADJUST DOSE Hepatic impairment
ADV EFF Altered BP, burning/tingling sensation, chest pain/pressure, dizziness, feeling of
tightness, injection-site reactions, shock
INTERACTIONS Ergots, MAOIs, St. John’s wort
NC/PT For tx, not px, of acute migraines. May repeat dose in 2 hr if needed. Teach
proper administration of each form; disposal of needles, syringes for subcut use. Not for
use in pregnancy (barrier contraceptives advised). Pt should continue migraine comfort
measures, take safety precautions w/ CNS effects, avoid St. John’s wort, report chest
pain, swelling, numbness/tingling.

DANGEROUS DRUG
sunitinib (Sutent)
CLASS Antineoplastic, kinase inhibitor
PREG/CONT D/NA

BBW Risk of serious to fatal hepatotoxicity; monitor LFTs closely.

IND & DOSE Tx of GI stromal tumor, advanced renal cell carcinoma. Adult: 50 mg/day
PO for 4 wk, then 2 wk of rest. Repeat cycle. Tx of progressive neuroendocrine
cancerous pancreatic tumors. 37.5 mg/day PO continuously.
ADJUST DOSE Hepatic impairment
ADV EFF Abd pain, arthralgia, asthenia, anorexia, cardiac toxicity, constipation, cough,
dyspnea, edema, fatigue, fever, hemorrhage, hepatotoxicity, hypertension,
mucositis, n/v/d, prolonged QT interval, skin color changes, thyroid dysfx
INTERACTIONS CYP3A4 inducers/inhibitors, grapefruit juice
NC/PT Obtain baseline, periodic ECG, BP. Monitor LFTs. Not for use in pregnancy
(barrier contraceptives advised), breast-feeding. Pt should mark calendar for tx days,
take safety precaution w/ CNS effects, report unusual bleeding, palpitations, urine/stool
color changes.

tacrolimus (Prograf, Protopic)

CLASS Immunosuppressant
PREG/CONT C/NA

BBW High risk of infection, lymphoma. Protect from infection; monitor closely. ER form
not recommended for liver transplants; risk of death in female liver transplant pts.
IND & DOSE Px of rejection after kidney transplant. Adult: 0.2 mg/kg/day PO divided q
12 hr, or 0.03–0.05 mg/kg/day as continuous IV infusion. Or, 0.1 mg/kg/day PO ER
capsule preop, 0.2 mg/kg/day PO ER capsule postop; if using basiliximab, 0.15
mg/kg/day PO ER capsule. Px of rejection after liver transplant. Adult: 0.10–0.15
mg/kg/day PO divided q 12 hr; give initial dose no sooner than 6 hr after transplant.
Or, 0.03–0.05 mg/kg/day as continuous IV infusion. Child: 0.15–0.20 mg/kg/day PO, or
0.03–0.05 mg/kg/day IV infusion. Px of rejection after heart transplant. Adult: 0.075
mg/kg/day PO or IV in two divided doses q 12 hr; give first dose no sooner than 6 hr
after transplant. Tx of atopic dermatitis. Adult: Apply thin layer 0.03% or 0.1%
ointment to affected area bid; rub in gently, completely. Child 2–15 yr: Apply thin layer
0.03% ointment bid.
ADJUST DOSE Hepatic, renal impairment
ADV EFF Abd pain, anaphylaxis, constipation, diarrhea, fever, headache,
hepatotoxicity, infections, renal impairment
INTERACTIONS Calcium channel blockers, carbamazepine, cimetidine, clarithromycin,
cyclosporine, erythromycin, grapefruit juice, live vaccines, metoclopramide, nicardipine,
phenobarbital, phenytoin, rifamycins, statins, St. John’s wort
NC/PT Monitor LFTs, serum tacrolimus. Use IV route only if PO not possible; switch to PO
as soon as possible. Not for use in pregnancy. Pt should avoid exposure to sunlight
(topical form), infection; avoid grapefruit juice, St. John’s wort, live vaccines; report
unusual bleeding, signs of infection.

tadalafil (Adcirca, Cialis)

CLASS Impotence drug, phosphodiesterase-5 inhibitor
PREG/CONT B/NA

IND & DOSE Tx of ED, BPH w/ ED (Cialis). Adult: 10 mg PO before anticipated sexual
activity; range, 5–20 mg PO. Limit use to once/day. Or, 2.5–5 mg/day PO w/out regard
to timing of sexual activity. Tx of pulmonary arterial hypertension (Adcirca).
40 mg/day PO.
ADJUST DOSE Hepatic, renal impairment; tx with CYP3A4 inhibitors
ADV EFF Diarrhea, dizziness, dyspepsia, dry mouth, flulike symptoms, flushing, headache,
MI, priapism, Stevens-Johnson syndrome
INTERACTIONS Alcohol, alpha blockers, erythromycin, grapefruit juice, indinavir,
itraconazole, ketoconazole, nitrates, rifampin, ritonavir
NC/PT Ensure proper dx. For ED, does not protect against STDs, will not work in absence
of sexual stimulation. Pt should not use w/ nitrates, antihypertensives, grapefruit juice,
alcohol; report vision changes, loss of vision, erection lasting more than 4 hr, sudden
hearing loss.

talc, USP (Sterile Talc Powder)

CLASS Sclerosing drug
PREG/CONT B/NA

IND & DOSE To decrease recurrence of malignant pleural effusion. Adult: 5 g in 50–100
mL sodium chloride injection injected into chest tube after pleural fluid drained; clamp
chest tube, have pt change positions for 2 hr; unclamp chest tube, continue external
suction.
ADV EFF Acute pneumonitis, dyspnea, hypotension, localized bleeding, MI, RDS,
tachycardia
NC/PT Ensure proper chest tube placement, pt positioning, draining. Pt should report
difficulty breathing, chest pain.

taliglucerase alfa (Elelyso)

CLASS Enzyme
PREG/CONT B/NA
IND & DOSE Long-term enzyme replacement tx for adult w/ type 1 Gaucher disease.
Adult: 60 units/kg IV q other wk as 60–120 min infusion.
ADV EFF Anaphylaxis, arthralgia, back pain, headache, influenza, infusion reaction,
pain, pharyngitis, throat infection, URI
NC/PT Give IV only. Monitor for infusion reactions; decrease infusion rate, consider use
of antipyretics, antihistamines. Pt should mark calendar for infusion dates; report
difficulty breathing, fever, chest/back pain, rash.

DANGEROUS DRUG
tamoxifen citrate (Soltamox)
CLASS Antiestrogen, antineoplastic
PREG/CONT D/NA

BBW Alert women w/ ductal carcinoma in situ (DCIS) and those at high risk for breast
cancer of risks of serious to potentially fatal drug effects, including stroke, embolic
events, uterine malignancies; discuss benefits/risks.
IND & DOSE Tx of metastatic breast cancer. Adult: 20–40 mg/day PO for 5 yr. Give doses
of more than 20 mg/day in divided doses, a.m. and p.m. To reduce breast cancer
incidence in high-risk women; tx of DCIS. Adult: 20 mg/day PO for 5 yr.
ADV EFF Corneal changes, depression, dizziness, DVT, edema, hot flashes, n/v, PE, rash,
stroke, vaginal bleeding
INTERACTIONS Bromocriptine, cytotoxic agents, grapefruit juice, oral anticoagulants
NC/PT Monitor CBC periodically. Not for use in pregnancy (barrier contraceptives
advised). Pt should have regular gynecologic exams, take safety precautions w/ CNS
effects, report leg pain/swelling, chest pain, difficulty breathing.

tamsulosin hydrochloride (Flomax)

CLASS Alpha-adrenergic blocker, BPH drug
PREG/CONT B/NA

IND & DOSE Tx of s&sx of BPH. Adult: 0.4–0.8 mg PO daily 30 min after same meal each
day.
ADV EFF Abnormal ejaculation, dizziness, headache, insomnia, orthostatic hypotension,
somnolence
INTERACTIONS Alpha-adrenergic antagonists, cimetidine, saw palmetto, sildenafil,
tadalafil, vardenafil
NC/PT Ensure accurate dx. Alert surgeon; increased risk of intraop floppy iris syndrome
w/ cataract surgery. Pt should swallow capsule whole and not cut, crush, or chew it;
change position slowly to avoid dizziness; not take w/ ED drugs; take safety precautions
w/ CNS effects; avoid saw palmetto; report fainting, worsening of sx. Name confusion
between Flomax (tamsulosin) and Fosamax (alendronate); use caution.
 tapentadol (Nucynta, Nucynta ER)
CLASS Norepinephrine reuptake inhibitor, opioid receptor analgesic
PREG/CONT C/C-II

BBW Risk of abuse potention; limit use w/ hx of addiction. Risk of fatal respiratory
depression, highest at start and w/ dose changes; monitor accordingly. Accidental
ingestion of ER form can cause fatal overdose in child; secure drug. Risk of fatally high
tapentadol level w/ alcohol; pt should avoid alcohol, all medications containing alcohol.
IND & DOSE Relief of moderate to severe pain. Adult: 50–100 mg PO q 4–6 hr. mgt of
moderate to severe chronic pain when round-the-clock opioid use needed (ER
form);. Adult: 100–250 mg PO bid. Reduce initial dose to 50 mg in analgesic-naïve pt;
max, 500 mg/day. Relief of pain of diabetic peripheral neuropathy (Nucynta ER).
Adult: 50 mg PO bid.
ADJUST DOSE Elderly, debilitated pts; hepatic impairment
ADV EFF Dizziness, drowsiness, headache, n/v, respiratory depression
INTERACTIONS Alcohol, general anesthetics, hypnotics, MAOIs, opioids, phenothiazines,
sedatives, St. John’s wort, SSRIs, TCAs, triptans
NC/PT Assess pain before, periodically during tx. Safety precautions needed w/ CNS
effects. Do not give within 14 days of MAOIs. Pt should avoid alcohol, St. John’s wort; if
breast-feeding, take at least 3–4 hr before next feeding; take safety precautions w/ CNS
effects; report difficulty breathing, rash.

tasimelteon (Hetlioz)
CLASS Melatonin receptor agonist
PREG/CONT C/NA

IND & DOSE Tx of non-24 hr-sleep-wake disorder in totally blind pts. Adult: 20 mg
before bedtime at same time each night.
ADJUST DOSE Severe hepatic impairment, smokers
ADV EFF Elevated alanine aminotransferase, headache, nightmares, somnolence, URI, UTI
INTERACTIONS Fluvoxamine, ketoconazole, rifampin
NC/PT Monitor LFTs. Pt should swallow capsule whole, not cut, crush, or chew it; avoid
pregnancy, breast-feeding; limit activities after taking drug; take safety measures
w/ somnolence; report changes in behavior, severe somnolence.

teduglutide (Gattex)
CLASS Glucagon-like peptide-2
PREG/CONT B/NA

Tx of adults w/ short bowel syndrome who are dependent on parenteral

IND & DOSE
support Adult: 0.05 mg/kg subcut.
ADJUST DOSE Renal impairment
ADV EFF Abd pain/distention, biliary and pancreatic disease, fluid overload,
headache, intestinal obstruction, neoplastic growth, n/v
INTERACTIONS Oral drugs
NC/PT Subcut use only. Single-use vial; discard within 3 hr of reconstitution. Ensure
complete colonoscopy, polyp removal before tx and at least q 5 yr. Rotate injection
sites. Monitor for fluid overload; support as needed. Oral drugs may not be absorbed;
monitor pt, consider need for oral drug dosage adjustment. Monitor pancreatic function.
Pt should learn preparation of subcut injection, disposal of syringes, needles; rotate
injection sites; schedule periodic blood tests; report severe abd pain, chest pain, swelling
in extremities, severe epigastric pain, difficulty swallowing.

telaprevir (Incivek)
CLASS Antiviral, protease inhibitor
PREG/CONT B/NA

BBW Risk of serious to fatal skin reactions; monitor accordingly.

IND & DOSE Tx of chronic hepatitis C genotype 1 infection. Adult: 750 mg PO tid at 7-
to 9-hr intervals w/ food; must give w/ ribavirin, peginterferon alfa.
ADJUST DOSE Hepatic impairment
ADV EFF Anemia, anal pruritus, anorectal discomfort, fatigue, hemorrhoids, rash, serious
skin reactions
INTERACTIONS Alprazolam, atazanavir, atorvastatin, cyclosporine, darunavir, digoxin,
efavirenz, estrogens, fosamprenavir, ketoconazole, lopinavir, methadone, midazolam,
tacrolimus, zolpidem
NC/PT Ensure negative pregnancy test before tx; men, women should use two forms of
contraceptives during, for 6 mo after tx. Must give w/ ribavirin, peginterferon alfa.
Monitor CBC. Pt should allow 7–9 hr between doses, report rash, increasing fatigue.

telavancin (Vibativ)
CLASS Antibiotic, lipoglycopeptide
PREG/CONT C/NA

BBW Fetal risk; women of childbearing age should have serum pregnancy test before
start of tx. Avoid use in pregnancy; advise contraceptive use.
IND & DOSE Tx of complicated skin, skin-structure infections caused by susceptible
strains of gram-positive organisms. Tx of hospital-acquired and ventilator-
assisted pneumonia caused by Staphylococcus aureus when other tx not suitable.
Adult: 10 mg/kg IV infused over 60 min once q 24 hr for 7–14 days.
ADJUST DOSE Renal impairment
ADV EFF Bleeding, Clostridium difficile diarrhea, dizziness, foamy urine, nephrotoxicity,
n/v, QT prolongation, red man syndrome (w/ rapid infusion), taste disturbance
INTERACTIONS Nephrotoxic drugs, QT-prolonging drugs
NC/PT Culture before tx. Infuse over at least 60 min. Monitor clotting time, renal
function periodically. Not for use in pregnancy (contraceptives advised), breast-feeding.
Negative pregnancy test needed before tx. Urine may become foamy. Pt should take
safety precautions w/ CNS effects, report fever, unusual bleeding, irregular heartbeat.

telbivudine (Tyzeka)
CLASS Antiviral, nucleoside
PREG/CONT B/NA

BBW Monitor for myopathy, severe hepatic failure w/ steatosis, hepatitis B exacerbation
w/ drug discontinuation.
IND & DOSE Tx of chronic hepatitis B. Adult, child over 16 yr: 600 mg/day PO w/ or
without food.
ADJUST DOSE Renal impairment
ADV EFF Abd pain, arthralgia, back pain, cough, diarrhea, dyspepsia, headache, hepatitis
B exacerbation, hepatomegaly w/ steatosis, insomnia, myopathy, nephrotoxicity,
peripheral neuropathy
INTERACTIONS Nephrotoxic drugs, peginterferon alfa-2a
NC/PT Monitor LFTs, renal function. Not for use in pregnancy (contraceptives advised),
breast-feeding. Pt should take safety precautions w/ CNS effects, report unusual
bleeding, urine/stool color changes, numbness/tingling.

telithromycin (Ketek)
CLASS Ketolide antibiotic
PREG/CONT C/NA

BBW Contraindicated w/ myasthenia gravis; life-threatening respiratory failure possible.

IND & DOSE Tx of mild to moderately severe community-acquired pneumonia caused
by susceptible strains. Adult: 800 mg/day PO for 7–10 days.
ADJUST DOSE Renal impairment
ADV EFF Anaphylaxis, diarrhea, dizziness, headache, hepatic impairment, n/v,
pseudomembranous colitis, superinfections, visual disturbances
INTERACTIONS Serious reactions w/ atorvastatin, lovastatin, midazolam, pimozide,
simvastatin; avoid these combinations. Also, carbamazepine, digoxin, metoprolol,
phenobarbital, phenytoin, rifampin, theophylline.
NC/PT Culture before tx. Monitor LFTs. Treat superinfections. Pt should swallow tablet
whole and not cut, crush, or chew it; take safety precautions w/ dizziness; avoid quickly
looking between distant and nearby objects (if visual difficulties); report bloody
diarrhea, difficulty breathing, unusual bleeding.
 telmisartan (Micardis)
CLASS Antihypertensive, ARB
PREG/CONT D/NA

BBW Rule out pregnancy before tx. Suggest barrier contraceptives during tx; fetal injury,
deaths have occurred.
IND & DOSE Tx of hypertension. Adult: 40 mg/day PO. Range, 20–80 mg/day; max,
80 mg/day. To reduce CV risk in high-risk pts unable to take ACE inhibitors. Adult:
80 mg/day PO.
ADV EFF Dermatitis, dizziness, flatulence, gastritis, headache, hypotension, light-
headedness, palpitations, rash
INTERACTIONS Digoxin, potassium-sparing diuretics
NC/PT Monitor BP carefully. Alert surgeon; volume replacement may be needed postop.
Not for use in pregnancy (contraceptives advised), breast-feeding. Pt should take safety
precautions w/ CNS effects, report fever, severe dizziness.

temazepam (Restoril)
CLASS Benzodiazepine, sedative-hypnotic
PREG/CONT X/C-IV

BBW Taper dosage gradually after long-term use; risk of refractory seizures.
IND & DOSE Short-term tx of insomnia. Adult: 15–30 mg PO before bedtime for 7-
10 days; 7.5 mg may be sufficient for some pts.
ADJUST DOSE Elderly, debilitated pts
ADV EFF Anaphylaxis, angioedema, bradycardia, confusion, constipation, CV collapse,
diarrhea, drowsiness, drug dependence, fatigue, hiccups, nervousness, tachycardia,
urticaria
INTERACTIONS Alcohol, aminophylline, CNS depressants, dyphylline, theophylline
NC/PT Not for use in pregnancy (contraceptives advised). Pt should take for no longer
than 7–10 days, avoid alcohol, take safety precautions w/ CNS effects, report difficulty
breathing, face/eye swelling, continued sleep disorders.

DANGEROUS DRUG
temozolomide (Temodar)
CLASS Antineoplastic
PREG/CONT D/NA

IND & DOSE Tx of refractory astrocytoma. Adult: 150 mg/m2/day PO or IV for 5

consecutive days for 28-day tx cycle. Tx of glioblastoma multiforme. Adult:
75 mg/m2/day PO or IV for 42 days w/ focal radiation therapy; then six cycles: Cycle 1,
150 mg/m2/day PO, IV for 5 days then 23 days rest; cycles 2–6, 200 mg/m2/day PO or
IV for 5 days then 23 days rest.
ADJUST DOSE Elderly pts; hepatic, renal impairment
ADV EFF Amnesia, bone marrow suppression, cancer, constipation, dizziness, headache,
insomnia, n/v/d, PCP, rash, seizures
INTERACTIONS Valproic acid
NC/PT Monitor CBC before each dose; adjustment may be needed. Not for use in
pregnancy (contraceptives advised), breast-feeding. Pt should take safety precautions
w/ CNS effects, avoid exposure to infection, report unusual bleeding, difficulty
breathing.

DANGEROUS DRUG
temsirolimus (Torisel)
CLASS Antineoplastic, kinase inhibitor
PREG/CONT D/NA

IND & DOSE Tx of advanced renal cell carcinoma. Adult: 25 mg/wk IV infused over 30–
60 min; give 30 min after giving prophylactic diphenhydramine 25–50 mg IV.
ADJUST DOSE Elderly pts, hepatic impairment
ADV EFF Abd pain, alopecia, body aches, bowel perforation, confusion, constipation,
drowsiness, hepatic impairment, hyperglycemia, hypersensitivity/infusion
reactions, interstitial pneumonitis, nephrotoxicity, n/v/d, painful urination, rash,
wound-healing problems
INTERACTIONS CYP3A4 inducers/inhibitors, grapefruit juice, live vaccines, St. John’s wort
NC/PT Monitor LFTs, renal/respiratory function. Premedicate to decrease infusion
reaction risk. Not for use in pregnancy (barrier contraceptives advised), breast-feeding.
Pt should mark calendar of tx days; cover head at temp extremes (hair loss possible);
take safety precautions w/ CNS effects; avoid St. John’s wort, grapefruit juice; report
difficulty breathing, severe abd pain, urine/stool color changes.

DANGEROUS DRUG
tenecteplase (TNKase)
CLASS Thrombolytic enzyme
PREG/CONT C/NA

BBW Arrange to stop concurrent heparin, tenecteplase if serious bleeding occurs.

IND & DOSE To reduce mortality associated w/ acute MI. Adult: Initiate tx as soon as
possible after onset of acute MI. Give as IV bolus over 5 sec. Dose based on weight (max,
50 mg/dose): 90 kg or more, 50 mg; 80–89 kg, 45 mg; 70–79 kg, 40 mg; 60–69 kg,
35 mg; under 60 kg, 30 mg.
ADJUST DOSE Elderly pts
ADV EFF Bleeding, cardiac arrhythmias, MI, rash, urticaria
INTERACTIONS Aminocaproic acid, anticoagulants, aspirin, clopidogrel, dipyridamole,
heparin, ticlopidine
NC/PT Can only give IV under close supervision. Do not add other drugs to infusion sol.
Stop current heparin tx. Apply pressure to all dressings. Avoid invasive procedures.
Monitor coagulation studies; watch for signs of bleeding. Pt should report blood in
urine, bleeding, chest pain, difficulty breathing.

tenofovir disoproxil fumarate (Viread)

CLASS Antiviral, nucleoside reverse transcriptase inhibitor
PREG/CONT B/NA

BBW Risk of lactic acidosis, severe hepatotoxicity; monitor hepatic function closely.
Severe hepatitis B exacerbation has occurred when anti–hepatitis B tx stopped; monitor
for several mo if drug discontinued.
IND & DOSE Tx of HIV-1 infection. Adult, child 12 yr and older, 35 kg or more: 300 mg/day
PO. Child 2–11 yr: 8 mg/kg/day PO. Tx of chronic hepatitis B. Adult, child 12 yr and
older, 35 kg or more: 300 mg/day PO.
ADJUST DOSE Renal impairment
ADV EFF Asthenia, body fat redistribution, headache, lactic acidosis, n/v/d, severe
hepatomegaly w/ steatosis
INTERACTIONS Atazanavir, didanosine, lopinavir, ritonavir
NC/PT Always give w/ other antivirals. Monitor LFTs, renal function regularly; stop at
first sign of lactic acidosis. Not for use in pregnancy, breast-feeding. Body fat may
redistribute to back, middle, chest. Pt should take precautions to avoid disease spread
(drug not a cure), avoid exposure to infections, report urine/stool color changes, rapid
respirations.

terazosin hydrochloride (Hytrin)

CLASS Alpha blocker, antihypertensive, BPH drug
PREG/CONT C/NA

BBW Give first dose just before bed to lessen likelihood of first-dose syncope due to
orthostatic hypotension.
IND & DOSE Tx of hypertension. Adult: 1 mg PO at bedtime. Slowly increase to achieve
desired BP response. Usual range, 1–5 mg PO daily. Tx of BPH. Adult: 1 mg PO at
bedtime. Increase to 2, 5, or 10 mg PO daily. May need 10 mg/day for 4–6 wk to assess
benefit.
ADV EFF Allergic anaphylaxis, blurred vision, dizziness, drowsiness, dyspnea, headache,
nasal congestion, n/v, orthostatic hypotension, palpitations, priapism, sinusitis
INTERACTIONS ED drugs
NC/PT If not taken for several days, restart w/ initial dose. Always start first dose at
bedtime to lessen likelihood of syncope; have pt lie down if syncope occurs. Pt should
take safety precautions w/ CNS effects, use caution w/ ED drugs, report fainting,
dizziness.

terbinafine hydrochloride (Lamisil)

CLASS Allylamine, antifungal
PREG/CONT B/NA

BBW Monitor regularly for s&sx of hepatic impairment; liver failure possible.
IND & DOSE Tx of onychomycosis of fingernail, toenail. Adult: 250 mg/day PO for 6 wk
(fingernail), 12 wk (toenail). Tx of tinea capitis. Adult: 250 mg/day PO for 6 wk. Child
4 yr and over: Over 35 kg, 250 mg/day PO for 6 wk; 25–35 kg, 187.5 mg/day PO for 6
wk; under 25 kg, 125 mg/day PO for 6 wk. Tx of athlete’s foot. Adult, child: Apply
topically between toes bid for 1 wk. Tx of ring worm, jock itch. Adult, child: Apply
topically once daily for 1 wk.
ADV EFF Abd pain, dyspepsia, headache, hepatic failure, nausea, pruritus, rash
INTERACTIONS Cimetidine, cyclosporine, dextromethorphan, rifampin
NC/PT Culture before tx. Monitor LFTs regularly. Not for use in pregnancy, breast-
feeding. Pt should sprinkle oral granules on spoonful of nonacidic food such as mashed
potatoes, swallow entire spoonful without chewing; take analgesics for headache; report
urine/stool color changes, unusual bleeding, rash. Name confusion w/ Lamisil
(terbinafine), Lamictal (lamotrigine), Lamisil AF (tolnaftate), Lamisil AT (terbinafine); use
caution.

terbutaline sulfate (generic)

CLASS Antiasthmatic, beta selective agonist, bronchodilator, sympathomimetic
PREG/CONT B/NA

BBW Do not use injectable form in pregnant women for px, prolonged tx (beyond 48–
72 hr) of preterm labor in hospital or outpt setting; risk of serious maternal heart
problems, death.
IND & DOSE Px, tx of bronchial asthma, reversible bronchospasm. Adult, child over 15
yr: 2.5–5 mg PO tid at 6-hr intervals during waking hours; max, 15 mg/day. Or, 0.25 mg
subcut into lateral deltoid area. If no significant improvement in 15–30 min, give
another 0.25-mg dose. Max, 0.5 mg/4 hr. Child 12–15 yr: 2.5 mg PO tid; max,
7.5 mg/24 hr.
ADJUST DOSE Elderly pts
ADV EFF Anxiety, apprehension, bronchospasm, cardiac arrhythmias, cough, fear,
nausea, palpitations, pulmonary edema, respiratory difficulties, restlessness,
sweating
INTERACTIONS Diuretics, halogenated hydrocarbons, MAOIs, sympathomimetics, TCAs,
theophylline
NC/PT Due to similar packaging, terbutaline injection confused w/ Methergine injection
(methylergonovine maleate); use extreme caution. Have beta blocker on hand for
arrhythmias, respiratory distress. Pt should take safety precautions w/ CNS effects,
report chest pain, difficulty breathing, irregular heartbeat, failure to respond to usual
dose.

teriflunomide (Aubagio)
CLASS MS drug, pyrimidine synthesis inhibitor
PREG/CONT X/NA

BBW Risk of severe hepatotoxicity; monitor LFTs before tx and at least monthly for 6
mo. Risk of major birth defects. Contraindicated in pregnancy; contraceptives required.
IND & DOSE Tx of relapsing MS. Adult: 7 or 14 mg/day PO.
ADJUST DOSE Severe hepatic impairment
ADV EFF Alopecia, BP changes, hyperkalemia, influenza, neutropenia, n/v, paresthesia,
peripheral neuropathy, renal failure, severe skin reactions
INTERACTIONS Alosetron, duloxetine, hormonal contraceptives, paclitaxel, pioglitazone,
repaglinide, rosiglitazone, theophylline, tizanidine, warfarin
NC/PT Do not begin tx if acute infection; monitor for s&sx of infection, changes in
potassium levels, BP changes, peripheral neuropathy, skin reactions. Monitor LFTs
before, during tx. Not for use in pregnancy (contraceptives required), breast-feeding;
advise pt of risk of fetal harm. Pt should take once daily; avoid exposure to infection;
report urine/stool color changes, extreme fatigue, fever, infection, skin reactions,
muscle cramping, numbness/tingling.

teriparatide (Forteo)
CLASS Calcium regulator, parathyroid hormone
PREG/CONT C/NA

BBW Increased risk of osteosarcoma in rats; do not use in pts w/ increased risk of
osteosarcoma (Paget disease, unexplained alkaline phosphatase elevations, open
epiphyses, prior external beam, implant radiation involving skeleton). Not
recommended for bone disease other than osteoporosis.
IND & DOSE Tx of postmenopausal women w/ osteoporosis, glucocorticoid-related
osteoporosis, hypogonadal osteoporosis in men. Adult: 20 mcg/day subcut in thigh
or abd wall for no more than 2 yr.
ADV EFF Arthralgia, hypercalcemia, nausea, orthostatic hypotension, pain, urolithiasis
INTERACTIONS Digoxin
NC/PT Do not use in pts at risk for osteosarcoma; use for no more than 2 yr. Monitor
serum calcium. Not for use in pregnancy, breast-feeding. Teach proper administration,
disposal of needles, delivery device. Pt should rotate injection sites, have blood tests to
monitor calcium level, change positions slowly after injection, report constipation,
muscle weakness.

tesamorelin (Egrifta)
CLASS GHRF analogue
PREG/CONT X/NA

IND & DOSETo reduce excess abd fat in HIV-infected pts w/ lipodystrophy related to
antiviral use. Adult 2 mg/day subcut.
ADV EFF Acute illness, arthralgia, cancer, edema, fluid retention, glucose intolerance,
hypersensitivity reactions, injection-site reactions
INTERACTIONS Anticonvulsants, corticosteroids, cyclosporine, estrogen, progesterone,
testosterone
NC/PT Monitor blood glucose. Arrange for cancer screening. Teach proper
administration, disposal of needles, syringes. Not for use in pregnancy, breast-feeding.
Pt should rotate injection sites, report signs of infection, injection-site reaction,
increased thirst.

testosterone (Androderm, AndroGel, Axiron, Delatestryl, Fortesta, Striant,

Testim, Testopel)
CLASS Androgen, hormone
PREG/CONT X/C-III

BBW Risk of toxic effects (enlarged genitalia, greater-than-normal bone age) in children
exposed to pt using transdermal form (AndroGel, Testim). Pt should wash hands after
applying, cover treated area w/ clothing to reduce exposure.
IND & DOSE Replacement tx in hypogonadism. Adult: 50–400 mg (cypionate, enanthate)
IM q 2–4 wk, or 150–450 mg (enanthate pellets) implanted subcut q 3–6 mo. Or,
initially 5-mg/day system (patch) applied to nonscrotal skin; then 2.5-mg/day system
(Androderm). Or, 5 mg/day AndroGel, Testim (preferably in a.m.) applied to clean, dry,
intact skin of shoulders, upper arms, or abdomen. Or, 4 actuations (40 mg) Fortesta
applied to inner thighs in a.m. Or, 1 pump actuation (30 mg) Axiron to each axilla
once/day. Or, 2 actuations (40.5 mg) AndroGel 1.62% once daily in a.m. to shoulders or
upper arms. Or, 1 buccal system (30 mg) (Striant) to gum region bid (a.m. and p.m.).
Rotate sites; usual position is above incisor on either side of mouth. Tx of males w/
delayed puberty. Adult: 50–200 mg enanthate IM q 2–4 wk for 4–6 mo, or 150 mg
pellets subcut q 3–6 mo. Tx of carcinoma of breast, metastatic mammary cancer.
Adult: 200–400 mg IM enanthate q 2–4 wk.
ADV EFF Androgenic effects, chills, dizziness, fatigue, fluid retention, headache,
hepatocellular carcinoma, hypoestrogenic effects, leukopenia, polycythemia, rash
INTERACTIONS Grapefruit juice, metronidazole
NC/PT Monitor blood glucose, serum calcium, LFTs, serum electrolytes, lipids. Review
proper administration of each delivery form; sprays not interchangeable. Women using
drug should avoid pregnancy. Pt should mark calendar of tx days; remove old
transdermal patch before applying new one; cover topical gel application sites if in
contact w/ children; avoid grapefruit juice; report swelling, urine/stool color changes,
unusual bleeding/bruising.

tetrabenazine (Xenazine)
CLASS Anti-chorea drug, monoamine depletor
PREG/CONT C/NA

BBW Increased risk of depression, suicidality; monitor accordingly.

IND & DOSE Tx of chorea associated w/ Huntington disease. Adult: 12.5 mg/day PO in
a.m. After 1 wk, increase to 12.5 mg PO bid; max, 100 mg/day in divided doses.
ADV EFF Akathisia, anxiety, confusion, depression, fatigue, insomnia, nausea, Parkinson-
like sx, QT prolongation, sedation, URI
INTERACTIONS Alcohol, antiarrhythmics, antipsychotics, dopamine agonists, fluoxetine,
MAOIs, paroxetine, quinidine
NC/PT Obtain baseline of chorea sx. Do not give within 14 days of MAOIs. Not for use in
pregnancy (contraceptives advised), breast-feeding. Pt should take safety measures w/
CNS effects, avoid alcohol; report tremors, behavior changes, thoughts of suicide.

tetracycline hydrochloride (generic)

CLASS Antibiotic
PREG/CONT D/NA

IND & DOSE Tx of infections caused by susceptible bacteria. Adult: 1–2 g/day PO in two
to four equal doses; max, 500 mg PO qid. Child over 8 yr: 25–50 mg/kg/day PO in four
equal doses. Tx of brucellosis. Adult: 500 mg PO qid for 3 wk w/ 1 g streptomycin IM
bid first wk and daily second wk. Tx of syphilis. Adult: 30–40 g PO in divided doses
over 10–15 days (Sumycin); 500 mg PO qid for 15–30 days (all others). Tx of
uncomplicated gonorrhea. Adult: 500 mg PO q 6 hr for 7 days. Tx of gonococcal
urethritis. Adult: 500 mg PO q 4–6 hr for 4–6 days. Tx of uncomplicated urethral,
endocervical, rectal infections w/ Chlamydia trachomatis. Adult: 500 mg PO qid for
at least 7 days. Tx of severe acne. Adult: 1 g/day PO in divided doses; then 125–
500 mg/day.
ADV EFF Anaphylaxis; bone marrow suppression; discoloring, inadequate calcification
of primary teeth of fetus if used by pregnant women, of permanent teeth if used during
dental development; hepatic impairment; phototoxic reactions; superinfections
INTERACTIONS Aluminum, bismuth, calcium salts; charcoal; dairy products; food; hormonal
contraceptives; iron, magnesium salts; penicillins; urinary alkalinizers; zinc salts
NC/PT Culture before tx. Arrange tx of superinfections. Not for use in pregnancy
(hormonal contraceptives may be ineffective; barrier contraceptives advised). Pt should
take on empty stomach 1 hr before or 2 hr after meals; do not use outdated drugs; report
rash, urine/stool color changes.

tetrahydrozoline hydrochloride (Murine Plus, Opticlear, Optigene 3, Tyzine,

Visine)
CLASS Alpha agonist; decongestant; ophthalmic vasoconstrictor, mydriatic
PREG/CONT C/NA

IND & DOSE Relief of nasal, nasopharyngeal mucosal congestion. Adult, child 6 yr and
older: 2–4 drops 0.1% sol in each nostril three to four times/day; or 3–4 sprays in each
nostril q 4 hr as needed. Not more often than q 3 hr. Child 2–6 yr: 2–3 drops 0.05% sol in
each nostril q 4–6 hr as needed Not more often than q 3 hr. Temporary relief of eye
redness, burning, irritation. Adult: 1–2 drops into eye(s) up to qid.
ADV EFF Anxiety, CV collapse w/ hypotension, dizziness, drowsiness, headache, light-
headedness, pallor, rebound congestion, restlessness, tenseness
INTERACTIONS Methyldopa, MAOIs, reserpine, TCAs, urine acidifiers/alkalinizers
NC/PT Monitor BP in pt w/ CAD. Review proper administration. Rebound congestion
may occur when drug stopped. Pt should remove contact lenses before using drops,
drink plenty of fluids, use humidifier for at least 72 hr, take safety precautions w/ CNS
effects, report blurred vision, fainting.

thalidomide (Thalomid)
CLASS Immunomodulator
PREG/CONT X/NA

BBW Associated w/ severe birth defects. Women must have pregnancy test, signed
consent to use birth control to avoid pregnancy during tx (STEPS program). Significant
risk of venous thromboembolic events when used in multiple myeloma; monitor
accordingly.
IND & DOSE Tx of erythema nodosum leprosum. Adult 100–300 mg/day PO at bedtime
for at least 2 wk. Taper in decrements of 50 mg q 2–4 wk. Tx of newly diagnosed
multiple myeloma. Adult: 200 mg/day PO w/ dexamethasone.
ADV EFF Agitation, anorexia, anxiety, bradycardia, dizziness, dry skin, dyspnea,
headache, nausea, neutropenia, orthostatic hypotension, peripheral neuropathy, rash,
somnolence, Stevens-Johnson syndrome, tumor lysis syndrome
INTERACTIONS Alcohol, CNS depressants, hormonal contraceptives
NC/PT Rule out pregnancy; ensure pt has read, agreed to contraceptive use. Monitor BP,
WBC count. Not for use in breast-feeding. Pt should take safety precautions w/ CNS
effects, avoid exposure to infection, report dizziness, rash, signs of infection.

theophylline (Elixophyllin, Theo-24, Theochron)

CLASS Bronchodilator, xanthine
PREG/CONT C/NA
IND & DOSE Sx relief or px of bronchial asthma, reversible bronchospasm. Note: For
dosages for specific populations, see manufacturer’s details. Adult, child over 45 kg: 300–
600 mg/day PO, or 0.4 mg/kg/hr IV. Child under 45 kg: Total dose in mg = [(0.2 × age
in wk) + 5] × body wt in kg PO/day in four equal doses. Or, 0.7 - 0.8 mg/kg/hr IV (1 -
1.5 mg/kg/12 hr IV for neonate).
ADV EFF Anorexia, death, dizziness, headache, insomnia, irritability, life-threatening
ventricular arrhythmias, n/v, restlessness, seizures
INTERACTIONS Barbiturates, benzodiazepines, beta blockers, charcoal, cigarette smoking,
cimetidine, ciprofloxacin, erythromycin, halothane, hormonal contraceptives, NMJ
blockers, norfloxacin, ofloxacin, phenytoins, rifampin, ranitidine, St. John’s wort,
ticlopidine, thioamides, thyroid hormones
NC/PT Maintain serum level in therapeutic range (5–15 mcg/mL); adverse effects related
to serum level. Do not add in sol w/ other drugs. Not for use in pregnancy (barrier
contraceptives advised). Pt should take ER form on empty stomach 1 hr before or 2 hr
after meals, do not cut, crush or chew it; limit caffeine intake; avoid St. John’s wort;
report smoking changes (dose adjustment needed); take safety precautions w/ CNS
effects; report irregular heartbeat, severe GI pain.

DANGEROUS DRUG
thioguanine (Tabloid)
CLASS Antimetabolite, antineoplastic
PREG/CONT D/NA

IND & DOSE Remission induction, consolidation, maint tx of acute nonlymphocytic

leukemias. Adult, child 3 yr and over: 2 mg/kg/day PO for 4 wk. If no clinical
improvement, no toxic effects, increase to 3 mg/kg/day PO.
ADV EFF Anorexia, bone marrow suppression, hepatotoxicity, hyperuricemia, n/v,
stomatitis, weakness
NC/PT Monitor CBC (dose adjustment may be needed), LFTs. Not for use in pregnancy
(contraceptives advised). Pt should drink 8–10 glasses of fluid/day; avoid exposure to
infection; have regular blood tests; perform mouth care for mouth sores; report signs of
infection, urine/stool color changes, swelling.

DANGEROUS DRUG
thiotepa (Thioplex)
CLASS Alkylating agent, antineoplastic
PREG/CONT D/NA

IND & DOSETx of adenocarcinoma of breast, ovary. Adult: 0.3–0.4 mg/kg IV at 1- to 4-

wk intervals. Or, diluted in sterile water to conc of 10 mg/mL, then 0.6–0.8 mg/kg
injected directly into tumor after local anesthetic injected through same needle. Maint,
0.6–0.8 mg/kg IV q 1–4 wk. Or, 0.6–0.8 mg/kg intracavity q 1–4 wk through same tube
used to remove fluid from bladder. Superficial papillary carcinoma of urinary
bladder. Adult: Dehydrate pt for 8–12 hr before tx. Instill 30–60 mg in 60 mL normal
saline injection into bladder by catheter. Have pt retain for 2 hr. If pt unable to retain
60 mL, give in 30 mL. Repeat once/wk for 4 wk.
ADV EFF Amenorrhea, bone marrow suppression, dizziness, fever, headache, n/v, skin
reactions
NC/PT Monitor CBC; dose adjustment may be needed. IV sol should be clear w/out
solutes. Not for use in pregnancy. Pt should mark calendar of tx days, avoid exposure to
infections, take safety precautions w/ dizziness, report unusual bleeding, signs of
infection, rash.

thiothixene (Navane)
CLASS Antipsychotic, dopaminergic blocker, thioxanthene
PREG/CONT C/NA

BBW Increased risk of death if antipsychotics used to treat elderly pts w/ dementia-
related psychosis; not approved for this use.
IND & DOSE Mgt of schizophrenia. Adult, child over 12 yr: 2 mg PO tid (mild conditions),
5 mg bid (more severe conditions). Range, 20–30 mg/day; max, 60 mg/day.
ADJUST DOSE Elderly, debilitated pts
ADV EFF Aplastic anemia, autonomic disturbances, blurred vision, bronchospasm,
drowsiness, dry mouth, extrapyramidal effects, gynecomastia, HF, laryngospasm,
nonthrombocytopenic purpura, pancytopenia, photophobia, pink to red-brown
urine, refractory arrhythmias
INTERACTIONS Alcohol, antihypertensives, carbamazepine
NC/PT Monitor renal function, CBC. Urine will turn pink to red-brown. Pt should avoid
sun exposure, take safety precautions w/ CNS effects, maintain fluid intake, report signs
of infection, unusual bleeding, difficulty breathing. Name confusion between Navane
(thiothixene) and Norvasc (amlodipine); use caution.

thyroid, desiccated (Armour Thyroid, Nature Thyroid, Thyroid USP, Westhroid)

CLASS Thyroid hormone
PREG/CONT A/NA

BBW Do not use to treat obesity. Large doses in euthyroid pts may produce serious to
life-threatening s&sx of toxicity.
IND & DOSE Tx of hypothyroidism. Adult: 30 mg/day PO, increased by 15 mg/day q 2–3
wk. Usual maint, 60–120 mg PO daily. Child: Over 12 yr, 90 mg/day PO; 6–12 yr, 60–
90 mg/day PO; 1–5 yr, 45–60 mg/day PO; 6–12 mo, 30–45 mg/day PO; 0–6 mo, 7.5–
30 mg/day PO.
ADJUST DOSE Elderly pts, long-standing heart disease
ADV EFF Cardiac arrest, hyperthyroidism, n/v/d, skin reactions
INTERACTIONS Antacids, cholestyramine, digoxin, theophylline, warfarin
NC/PT Monitor thyroid function to establish dose, then at least yearly. Pt should wear
medical ID, report headache, palpitations, heat/cold intolerance.

tiagabine hydrochloride (Gabitril Filmtabs)

CLASS Antiepileptic
PREG/CONT C/NA

BBW Increased risk of suicidal ideation; monitor accordingly.

IND & DOSE Adjunctive tx in partial seizures. Adult: 4 mg/day PO for 1 wk; may
increase by 4–8 mg/wk until desired response. Usual maint, 32–56 mg daily; max,
56 mg/day in two to four divided doses. Child 12–18 yr: 4 mg/day PO for 1 wk; may
increase to 8 mg/day in two divided doses for 1 wk, then by 4–8 mg/wk. Max,
32 mg/day in two to four divided doses.
ADV EFF Asthenia, dizziness, GI upset, incontinence, eye changes, potentially serious
rash, somnolence
INTERACTIONS Alcohol, carbamazepine, CNS depressants, phenobarbital, phenytoin,
primidone, valproate
NC/PT Taper when stopping. Not for use in pregnancy (contraceptives advised). Pt
should not stop suddenly; take w/ food; avoid alcohol, sleeping pills; wear medical ID;
take safety precautions w/ dizziness, vision changes; report rash, thoughts of suicide,
vision changes.

ticagrelor (Brilinta)
CLASS Antiplatelet
PREG/CONT C/NA

BBW Significant to fatal bleeding possible; do not use w/ active bleeding, CABG planned
within 5 days, surgery. Maint aspirin doses above 100 mg reduce effectiveness; maintain
aspirin dose at 75–100 mg/day.
IND & DOSE To reduce rate of thrombotic CV events in pts w/ acute coronary
syndrome. Adult: Loading dose, 180 mg PO; then 90 mg PO bid w/ 325 mg PO aspirin
as loading dose, then maint aspirin dose of 75–100 mg/day PO.
ADV EFF Bleeding, dyspnea
INTERACTIONS Potent CYP3A4 inducers (carbamazepine, dexamethasone, phenobarbital,
phenytoin, rifampin), potent CYP3A4 inhibitors (atazanavir, clarithromycin, indinavir,
itraconazole, ketoconazole, nefazodone, nelfinavir, ritonavir, saquinavir, telithromycin,
voriconazole); avoid these combinations. Digoxin, drugs affecting coagulation,
lovastatin, simvastatin
NC/PT Continually monitor for s&sx of bleeding. Ensure concurrent use of 75–100 mg
aspirin; do not stop drug except for pathological bleeding. Increased risk of CV events; if
drug must be stopped, start another anticoagulant. Assess pt w/ dyspnea for potential
underlying cause. Not for use in pregnancy (barrier contraceptive advised), breast-
feeding. Pt should take drug exactly as prescribed w/ prescribed dose of aspirin; not
increase doses; not stop drug suddenly; report other drugs or herbs being used (many
reactions possible; bleeding time may be prolonged), excessive bleeding, difficulty
breathing, chest pain, numbness/tingling.

ticlopidine hydrochloride (Ticlid)

CLASS Antiplatelet
PREG/CONT B/NA

BBW Monitor WBC count before, frequently while starting tx; if neutropenia present,
stop drug immediately.
IND & DOSE To reduce thrombotic stroke risk in pts who have experienced stroke
precursors; px of acute stent thrombosis in coronary arteries. Adult: 250 mg PO bid
w/ food.
ADV EFF Abd pain, bleeding, dizziness, neutropenia, n/v/d, pain, rash
INTERACTIONS Antacids, aspirin, cimetidine, digoxin, NSAIDs, theophylline
NC/PT Mark chart to alert all health care providers of use. Monitor WBC; watch for signs
of bleeding. Pt should take w/ meals, report unusual bleeding/bruising, signs of
infection.

tigecycline (Tygacil)
CLASS Glycylcycline antibiotic
PREG/CONT D/NA

IND & DOSE Tx of complicated skin, skin-structure infections; community-acquired

pneumonia; intra-abdominal infections caused by susceptible bacteria strains.
Adult: 100 mg IV, then 50 mg IV q 12 hr for 5–14 days; infuse over 30–60 min.
ADJUST DOSE Severe hepatic impairment
ADV EFF Cough, dizziness, dyspnea, headache, n/v/d, photosensitivity,
pseudomembranous colitis, superinfections
INTERACTIONS Oral contraceptives, warfarin
NC/PT Culture before tx. Not for use in pregnancy, breast-feeding. Pt should avoid sun
exposure, report bloody diarrhea, rash, pain at injection site.

tiludronate disodium (Skelid)

CLASS Bisphosphonate
PREG/CONT D/NA

IND & DOSE Tx of Paget disease. Adult: 400 mg/day PO for 3 mo w/ 6–8 oz plain water
at least 2 hr before food or other beverage.
ADJUST DOSE Severe hepatic impairment
ADV EFF Dyspepsia, flulike sx, headache, hypocalcemia, n/v/d
INTERACTIONS Antacids, aspirin, calcium, indomethacin
NC/PT Monitor serum calcium. Not for use in pregnancy. Allow 3-mo rest period if
retreatment needed. Pt should take w/ full glass of water, stay upright for 30 min after
taking; not take within 2 hr of food, other oral drug; maintain calcium, vitamin D
intake; report difficulty swallowing, muscle tremors.

timolol maleate (Betimol, Blocadren, Istalol, Timoptic)

CLASS Antiglaucoma, antihypertensive, beta blocker
PREG/CONT C/NA

BBW Do not stop abruptly after long-term tx (hypersensitivity to catecholamines

possible, causing angina exacerbation, MI, ventricular arrhythmias). Taper gradually
over 2 wk w/monitoring.
IND & DOSE Tx of hypertension. Adult: 10 mg bid PO; max, 60 mg/day in two divided
doses. Usual range, 20–40 mg/day in two divided doses. Px of reinfarction in MI.
10 mg PO bid within 1–4 wk of infarction. Px of migraine. Adult: 10 mg PO bid; during
maint, may give 20 mg/day as single dose. To reduce IOP in chronic open-angle
glaucoma. 1 drop 0.25% sol bid into affected eye(s); adjust based on response to 1 drop
0.5% sol bid or 1 drop 0.25% sol daily. Or, 1 drop in affected eye(s) each morning
(Istalol).
ADV EFF Arrhythmias, bronchospasm, constipation, decreased exercise tolerance,
dizziness, ED, flatulence, gastric pain, HF, hyperglycemia, laryngospasm, n/v/d, ocular
irritation w/ eyedrops, PE, stroke
INTERACTIONS Antacids, aspirin, calcium, indomethacin
NC/PT Alert surgeon if surgery required. Do not stop abruptly; must be tapered. Teach
proper eyedrop administration. Pt should take safety precautions w/ dizziness, report
difficulty breathing, swelling, numbness/tingling.

tinidazole (Tindamax)
CLASS Antiprotozoal
PREG/CONT C/NA

BBW Avoid use unless clearly needed; carcinogenic in lab animals.

IND & DOSE Tx of trichomoniasis, giardiasis. Adult: Single dose of 2 g PO w/ food. Child
over 3 yr: For giardiasis, single dose of 50 mg/kg PO (up to 2 g) w/ food. Tx of
amebiasis. Adult: 2 g/day PO for 3 days w/ food. Child over 3 yr: 50 mg/kg/day PO (up
to 2 g/day) for 3 days w/ food. For giardiasis, Tx of amebic liver abscess. Adult: 2
g/day PO for 3–5 days w/ food. Child over 3 yr: 50 mg/kg/day PO (up to 2 g/day) for 3–
5 days w/ food.
ADV EFF Anorexia, dizziness, drowsiness, metallic taste, neutropenia, seizures, severe
hypersensitivity reactions, superinfections, weakness
INTERACTIONS Alcohol, cholestyramine, cimetidine, cyclosporine, disulfiram, 5-FU,
ketoconazole, lithium, oral anticoagulants, oxytetracycline, phenytoin, tacrolimus
NC/PT Give w/ food. Ensure proper hygiene, tx of superinfections. Urine may become
very dark. Pt should take safety precautions w/ dizziness; avoid alcohol during, for
3 days after tx; report vaginal itching, white patches in mouth, difficulty breathing.

tiopronin (Thiola)
CLASS Thiol compound
PREG/CONT C/NA

IND & DOSE Px of cystine kidney stone formation in severe homozygous cystinuria.
Adult: 800 mg/day PO; increase to 1,000 mg/day in divided doses on empty stomach.
Child 9 yr and over: 15 mg/kg/day PO on empty stomach; adjust based on urine cystine
level.
ADV EFF Hepatotoxicity, nephrotoxicity, n/v/d, rash, skin/taste changes
NC/PT Monitor cystine at 1 mo, then q 3 mo. Not for use in breast-feeding. Pt should
drink fluids liberally (to 3 L/day), report urine/stool color changes, rash.

tiotropium bromide (Spiriva)

CLASS Anticholinergic, bronchodilator
PREG/CONT C/NA

IND & DOSE Long-term once-daily maint tx of bronchospasm. Adult: 2 inhalations/day

of contents of one capsule using HandiHaler device.
ADV EFF Abd pain, blurred vision, constipation, dry mouth, epistaxis, glaucoma, rash,
urine retention
INTERACTIONS Anticholinergics
NC/PT Evaluate for glaucoma; stop drug if increased IOP. Not for use in acute attacks.
Review proper use of HandiHaler device. Pt should empty bladder before each dose, use
sugarless lozenges for dry mouth, report eye pain, vision changes.

tipranavir (Aptivus)
CLASS Antiviral, protease inhibitor
PREG/CONT C/NA

BBW Increased risk of hepatotoxicity in pts w/ hepatitis; assess liver function before,
periodically during tx. Giving w/ ritonavir has caused nonfatal, fatal intracranial
hemorrhage; monitor carefully.
IND & DOSE Tx of HIV infection. Adult: 500 mg/day PO w/ ritonavir 200 mg, w/ food.
Child 2–18 yr: 14 mg/kg w/ ritonavir 6 mg/kg PO bid (375 mg/m2 w/ ritonavir
150 mg/m2 PO bid). Max, 500 mg bid w/ ritonavir 200 mg bid, w/ food.
ADV EFF Abd pain, cough, depression, fever, flulike sx, headache, hepatomegaly and
steatosis, n/v/d, potentially fatal liver impairment
INTERACTIONS Amprenavir, atorvastatin, calcium channel blockers, cyclosporine,
desipramine, didanosine, disulfiram, hormonal contraceptives, itraconazole,
ketoconazole, lopinavir, meperidine, methadone, metronidazole, oral antidiabetics,
saquinavir, sildenafil, sirolimus, SSRIs, St. John’s wort, tacrolimus, tadalafil, vardenafil,
voriconazole, warfarin. Contraindicated w/ amiodarone, dihydroergotamine,
ergotamine, flecainide, lovastatin, methylergonovine, midazolam, pimozide,
propafenone, quinidine, rifampin, simvastatin, triazolam.
NC/PT Ensure pt also taking ritonavir. Review drug hx before tx; multiple interactions
possible. Monitor LFTs. Not for use in pregnancy, breast-feeding. Pt should take w/
food; swallow capsule whole and not cut, crush, or chew it; store capsules in refrigerator
(do not refrigerate sol); not use after expiration date; use precautions to prevent spread
(drug not a cure); avoid exposure to infection, St. John’s wort; report general malaise,
urine/stool color changes, yellowing of skin/eyes.

tirofiban hydrochloride (Aggrastat)

CLASS Antiplatelet
PREG/CONT B/NA

IND & DOSE Tx of acute coronary syndromes, w/ heparin; px of cardiac ischemic

complications in percutaneous coronary intervention. Adult: 0.4 mcg/kg/min IV
infusion over 30 min; continue at rate of 0.1 mcg/kg/min.
ADJUST DOSE Renal impairment
ADV EFF Bleeding, bradycardia, dizziness, flushing, hypotension, syncope
INTERACTIONS Antiplatelets, aspirin, chamomile, don quai, feverfew, garlic, ginger,
ginkgo, ginseng, grape seed extract, green leaf tea, heparin, horse chestnut seed,
NSAIDs, turmeric, warfarin
NC/PT Obtain baseline, periodic CBC, PT, aPTT, active clotting time. Maintain aPTT
between 50 and 70 sec, and active clotting time between 300 and 350 sec. Avoid
noncompressible IV access sites to prevent excessive, uncontrollable bleeding. Pt should
report light-headedness, palpitations, pain at injection site. Name confusion between
Aggrastat (tirofiban) and argatroban; use caution.

tizanidine (Zanaflex)
CLASS Alpha agonist, antispasmodic
PREG/CONT C/NA

IND & DOSE Acute, intermittent mgt of increased muscle tone associated w/
spasticity. Adult: 4 mg/day PO, increased in 2- to 4-mg increments as needed over 2–4
wk. Maint, 8 mg PO q 6–8 hr; max, 36 mg/day in divided doses.
ADJUST DOSE Hepatic, renal impairment
ADV EFF Asthenia, constipation, dizziness, drowsiness, dry mouth, QT prolongation,
sedation
INTERACTIONS Alcohol, baclofen, CNS depressants, hormonal contraceptives, other alpha 2-
adrenergic agonists
NC/PT Continue all supportive measures for neurologically damaged pt. Pt should take
around the clock for best results, use sugarless lozenges for dry mouth, avoid alcohol,
take safety precautions w/ CNS effects, know that hormonal contraceptives may be
ineffective; report vision changes, difficulty swallowing, fainting.

tobramycin sulfate (TOBI, Tobrex Ophthalmic)

CLASS Alpha agonist, antispasmodic
PREG/CONT D (injection, inhalation); B (ophthalmic)/NA

BBW Injection may cause serious ototoxicity, nephrotoxicity, neurotoxicity. Monitor

closely for changes in renal, CNS function.
IND & DOSE Tx of serious infections caused by susceptible bacteria strains. Adult:
3 mg/kg/day IM or IV in three equal doses q 8 hr; max, 5 mg/kg/day. Child over 1 wk:
6–7.5 mg/kg/day IM or IV in three to four equally divided doses. Premature infants,
neonates 1 wk or younger: Up to 4 mg/kg/day IM or IV in two equal doses q 12 hr. Mgt
of cystic fibrosis pts w/ Pseudomonas aeruginosa. Adult, child 6 yr and older: 300 mg
bid by nebulizer inhaled over 10–15 min. Give in 28-day cycles: 28 days on, 28 days
rest. Tx of superficial ocular infections due to susceptible organism strains. Adult,
child 6 yr and older: 1–2 drops into conjunctival sac of affected eye(s) q 4 hr, 2 drops/hr
in severe infections. Or, ½ inch ribbon bid–tid.
ADJUST DOSE Elderly pts, renal impairment
ADV EFF Anorexia, leukemoid reaction, palpitations, ototoxicity, nephrotoxicity,
numbness/tingling, n/v/d, purpura, rash, superinfections, vestibular paralysis
INTERACTIONS Aminoglycosides, beta-lactam antibiotics, cephalosporins, NMJ blockers,
penicillin, succinylcholine
NC/PT Culture before tx. Limit tx duration to 7–14 days to decrease toxic reactions. Do
not mix in sol w/ other drugs. Review proper administration of eyedrops, nebulizer. Pt
should mark calendar of tx days; store in refrigerator, protected from light; drink 8–10
glasses of fluid/day; take safety precautions w/ CNS effects; report hearing changes,
dizziness, pain at injection site.

tocilizumab (Actemra)
CLASS Antirheumatic, interleukin-6 receptor inhibitor
PREG/CONT C/NA

BBW  Serious to life-threatening infections possible, including TB and bacterial, invasive

fungal, viral, opportunistic infections. Perform TB test before tx. Interrupt tx if serious
infection occurs; monitor for TB s&sx during tx.
IND & DOSE Tx of moderately to severely active rheumatoid arthritis. Adult: 4 mg/kg
by IV infusion over 1 hr, then increase to 8 mg/kg based on clinical response; may
repeat once q 4 wk; max, 800 mg/infusion. Tx of active systemic juvenile
arthritis/Still disease (systemic idiopathic juvenile arthritis). Child 2 yr and over: 30
kg or more, 8 mg/kg IV q 2 wk; under 30 kg, 12 mg/kg IV q 2 wk.
ADV EFF Anaphylaxis, dizziness, hypertension, increased liver enzymes, nasopharyngitis,
potentially serious infections, URI
INTERACTIONS Anti-CD20 monoclonal antibodies, cyclosporine, interleukin receptor
antagonists, live vaccines, omeprazole, statins, TNF antagonists, warfarin
NC/PT Do not mix in sol w/ other drugs. Monitor CBC, LFTs, lipids carefully. Not for use
in pregnancy, breast-feeding. Pt should continue other drugs for arthritis; avoid live
vaccines, exposure to infection; report signs of infection, difficulty breathing, easy
bruising/bleeding.

tofacitinib (Xeljanz)
CLASS Antirheumatic, kinase inhibitor
PREG/CONT C/NA

BBW Risk of serious to fatal infections, including TB; test for TB before tx; do not give
w/ active infections. Risk of lymphoma, other malignancies.
IND & DOSE Tx of adults w/ moderately to severely active rheumatoid arthritis
intolerant to other therapies. Adult: 5 mg PO bid.
ADJUST DOSE Hepatic, renal impairment
ADV EFF Diarrhea, GI perforation, headache, lymphoma, serious to fatal infections,
URI
INTERACTIONS Fluconazole, ketoconazole, rifampin, vaccines
NC/PT Screen for TB, active infection before tx; monitor for s&sx of infection. Monitor for
lymphoma, other malignancies. May combine w/ other antirheumatics. Not for use in
pregnancy. Pt should take as directed bid; avoid exposure to infections; avoid vaccines;
report severe GI pain, fever, s&sx of infection.

TOLAZamide (generic)
CLASS Antidiabetic, sulfonylurea
PREG/CONT C/NA

BBW Increased risk of CV mortality; monitor accordingly.

IND & DOSE Adjunct to diet, exercise to control blood glucose in pts w/ type 2
diabetes; w/ insulin to control blood glucose in select pts with type 1 diabetes.
Adult: 100–250 mg/day PO; max, 1 g/day.
ADJUST DOSE Elderly pts
ADV EFF Bone marrow suppression, dizziness, fatigue, heartburn, hypoglycemia, rash,
vertigo
INTERACTIONS Beta-adrenergic blockers, calcium channel blockers, chloramphenicol,
corticosteroids, coumarins, estrogens, isoniazid, MAOIs, miconazole, nicotinic acid, oral
contraceptives, phenothiazines, phenytoin, probenecid, salicylates, sulfonamides,
sympathomimetics, thyroid products
NC/PT Review complete diabetic teaching program. Pt should take in a.m. w/ breakfast
(do not take if not eating that day); continue diet, exercise program; avoid exposure to
infection; report uncontrolled blood glucose, dizziness.

TOLBUTamide (Orinase)
CLASS Antidiabetic, sulfonylurea
PREG/CONT C/NA

BBW Increased risk of CV mortality; monitor accordingly.

IND & DOSE Adjunct to diet, exercise to control blood glucose in pts w/ type 2
diabetes; w/ insulin to control blood glucose in select pts with type 1 diabetes.
Adult: 1–2 g/day PO in a.m. before breakfast. Maint, 0.25–3 g/day PO; max, 3 g/day.
Dx of pancreatic islet cell adenoma. Adult: 20 mL IV infused over 2–3 min.
ADJUST DOSE Elderly pts
ADV EFF Bone marrow suppression, dizziness, fatigue, heartburn, hypoglycemia, rash,
vertigo
INTERACTIONS Beta-adrenergic blockers, calcium channel blockers, chloramphenicol,
corticosteroids, coumarins, estrogens, isoniazid, MAOIs, miconazole, nicotinic acid, oral
contraceptives, phenothiazines, phenytoin, probenecid, salicylates, sulfonamides,
sympathomimetics, thyroid products
NC/PT Review complete diabetic teaching program. Pt may be switched to insulin during
high stress. Pt should take in a.m. w/ breakfast (do not take if not eating that day);
continue diet, exercise program; avoid exposure to infection; report uncontrolled blood
glucose, dizziness.

tolcapone (Tasmar)
CLASS Antiparkinsonian, COMT inhibitor
PREG/CONT C/NA

BBW Risk of potentially fatal acute fulminant liver failure. Monitor LFTs before, q 2 wk
during tx; discontinue if signs of liver damage. Use for pts no longer responding to other
therapies.
IND & DOSE Adjunct w/ levodopa/carbidopa in tx of s&sx of idiopathic Parkinson
disease. Adult: 100 mg PO tid; max, 600 mg.
ADJUST DOSE Hepatic, renal impairment
ADV EFF Confusion; constipation; disorientation; dry mouth; fulminant, possibly fatal
liver failure; hallucinations; hypotension; light-headedness; n/v, rash, weakness
INTERACTIONS MAOIs
NC/PT Monitor LFTs before, q 2 wk during tx. Always give w/ levodopa/carbidopa. Do
not give within 14 days of MAOIs. Taper over 2 wk when stopping. Not for use in
pregnancy, breast-feeding. Pt should take w/ meals, use sugarless lozenges for dry
mouth, take safety precautions w/ CNS effects, use laxative for constipation, report
urine/stool color changes, fever.

tolmetin sodium (generic)

CLASS NSAID
PREG/CONT C (1st, 2nd trimesters); D (3rd trimester)/NA

BBW Increased risk of CV events, GI bleeding; monitor accordingly. Not for use for
periop pain in CABG surgery.
IND & DOSE Tx of acute flares; long-term mgt of rheumatoid arthritis (RA),
osteoarthritis. Adult: 400 mg PO tid (1,200 mg/day) preferably including dose on
arising and at bedtime. Maint, 600–1,800 mg/day in three to four divided doses for RA,
600–1,600 mg/day in three to four divided doses for osteoarthritis. Tx of juvenile RA.
Child 2 yr and older: 20 mg/kg/day PO in three to four divided doses. Usual dose, 15–30
mg/kg/day; max, 30 mg/kg/day.
ADV EFF Anaphylactoid reactions to fatal anaphylactic shock, bone marrow
suppression, bronchospasm, diarrhea, dizziness, dyspepsia, dysuria, GI pain,
headache, insomnia, rash, somnolence, vision problems
NC/PT Pt should take w/ milk if GI upset a problem, have periodic eye exams, take safety
precautions w/ CNS effects, report signs of infection, difficulty breathing, unusual
bleeding.

tolterodine tartrate (Detrol)

CLASS Antimuscarinic
PREG/CONT C/NA

IND & DOSE Tx of overactive bladder. Adult: 1–2 mg PO bid. ER form, 2–4 mg/day PO.
ADJUST DOSE Hepatic, renal impairment
ADV EFF Blurred vision, constipation, dizziness, dry mouth, dyspepsia, n/v, vision
changes, weight gain
INTERACTIONS CYP2D6, CYP3A4 inhibitors
NC/PT Pt should swallow capsule whole and not cut, crush, or chew it; use sugarless
lozenges for dry mouth; take laxative for constipation, safety precautions w/ CNS
effects; report rash, difficulty breathing, palpitations.

tolvaptan (Samsca)
CLASS Selective vasopressin receptor antagonist
PREG/CONT C/NA
BBW Initiate tx in hospital setting, w/ close supervision of sodium, volume. Not for use
when rapid correction of hyponatremia needed.
IND & DOSE Tx of clinically significant hypervolemic, euvolemic hyponatremia.
Adult: 15 mg/day PO; may increase after at least 24 hr to max 60 mg/day.
ADV EFF Asthenia, constipation, dehydration, dry mouth, hyperglycemia, polyuria,
serious liver toxicity, thirst
INTERACTIONS CYP3A inducers/inhibitors
NC/PT Do not use w/ hypertonic saline sol. Monitor serum electrolytes. Not for use in
emergency situation, pregnancy, breast-feeding. Pt should report severe constipation,
increasing thirst, fainting.

topiramate (Topamax, Topiragen)

CLASS Antiepileptic, antimigraine
PREG/CONT D/NA

BBW Increased risk of suicidality; monitor accordingly. Reduce dose, stop, or substitute
other antiepileptic gradually; stopping abruptly may precipitate status epilepticus.
IND & DOSE Px of migraines: Adult, child 17 yr and older: 25 mg PO in p.m. for 1 wk; wk
2, 25 mg PO bid a.m. and p.m.; wk 3, 25 mg PO in a.m., 50 mg PO in p.m.; wk 4, 50 mg
PO a.m. and p.m. Tx of seizure disorders. Adult, child 17 yr and older: 200–400 m/day
PO in two divided doses. Child 10 yr and older: 25 mg PO bid, titrating to maint dose of
200 mg PO bid over 6 wk. wk 1, 25 mg bid; wk 2, 50 mg bid; wk 3, 75 mg bid; wk 4,
100 mg bid; wk 5, 150 mg bid; wk 6, 200 mg bid. Or ER form, 25 mg PO at bedtime,
range 1–3 mg/kg for first week; titrate at 1- to 2-wk intervals by 1- to 3-mg/kg
increments to 5–9 mg/kg/day PO. Child 2–16 yr: 5–9 mg/kg/day PO in two divided
doses. Start tx at nightly dose of 25 mg (or less, based on 1–3 mg/kg/ day) for first wk.
May titrate up by increments of 1–3 mg/kg/day (in two divided doses) at 1- to 2-wk
intervals.
ADJUST DOSE Hepatic, renal impairment
ADV EFF Ataxia, dizziness, dysmenorrhea, dyspepsia, fatigue, nausea, nystagmus,
paresthesia, renal stones, somnolence, URI
INTERACTIONS Alcohol, carbamazepine, carbonic anhydrase inhibitors, CNS depressants,
hormonal contraceptives, phenytoin, valproic acid
NC/PT Taper if stopping. Not for use in pregnancy (may make hormonal contraceptives
ineffective; barrier contraceptives advised). Pt should not cut, crush, or chew tablets
(bitter taste); may swallow sprinkle capsule whole or sprinkle contents on soft food,
swallow immediately; should avoid alcohol; take safety precautions w/ CNS effects;
report vision changes, flank pain, thoughts of suicide. Name confusion between
Topamax and Toprol-XL (metoprolol); use caution.

DANGEROUS DRUG
topotecan hydrochloride (Hycamtin)
 CLASSAntineoplastic
PREG/CONT D/NA

BBW Monitor bone marrow carefully; do not give dose until bone marrow responsive.
IND & DOSE Tx of metastatic ovarian cancer, small-cell lung cancer. Adult: 1.5
mg/m2/day IV over 30 min for 5 days, starting on day 1 of 21-day course. Minimum
four courses recommended. Tx of persistent cervical cancer. Adult: 0.75 mg/m2 by IV
infusion over 30 min on days 1, 2, 3 followed by cisplatin on day 1. Repeat q 21 days.
ADJUST DOSE Hepatic, renal impairment
ADV EFF Alopecia, bone marrow suppression, constipation, fever, infections,
interstitial pneumonitis, n/v/d, pain
INTERACTIONS Cytotoxic drugs
NC/PT Monitor CBC; dose adjustment may be needed. Not for use in pregnancy (barrier
contraceptives advised), breast-feeding. Pt should mark calendar of tx days, cover head
at temp extremes (hair loss possible), avoid exposure to infection, take analgesics for
pain, report difficulty breathing, unusual bleeding, signs of infection.

DANGEROUS DRUG
toremifene citrate (Fareston)
CLASS Antineoplastic, estrogen receptor modulator
PREG/CONT D/NA

BBW Risk of prolonged QT interval. Obtain baseline, periodic ECG; avoid concurrent use
of other QT-prolonging drugs.
IND & DOSE Tx of advanced breast cancer in postmenopausal women. Adult: 60 mg PO
daily; continue until disease progression.
ADV EFF Depression, dizziness, headache, hot flashes, n/v, prolonged QT interval, rash,
vaginal discharge
INTERACTIONS Oral anticoagulants, other drugs that decrease calcium excretion, QT-
prolonging drugs
NC/PT Obtain baseline ECG; monitor periodically during tx. Not for use in pregnancy
(barrier contraceptives advised). Pt should take safety precautions w/ dizziness, report
palpitations, vision changes.

torsemide (Demadex)
CLASS Loop diuretic, sulfonamide
PREG/CONT B/NA

IND & DOSETx of edema associated w/ HF. Adult: 10–20 mg/day PO or IV; max, 200
mg/day. Tx of edema associated w/ chronic renal failure. Adult: 20 mg/day PO or
IV; max, 200 mg/day. Tx of edema associated w/ hepatic failure. Adult: 5–10 mg/day
PO or IV; max, 40 mg/day. Tx of hypertension. Adult: 5 mg/day PO.
ADV EFF Anorexia, asterixis, dizziness, drowsiness, headache, hypokalemia, nocturia,
n/v/d, orthostatic hypotension, ototoxicity, pain, phlebitis at injection site, polyuria
INTERACTIONS Aminoglycoside antibiotics, cisplatin, digoxin, ethacrynic acid, NSAIDs
NC/PT Monitor serum electrolytes. Pt should take early in day to prevent sleep
disruption; weigh self daily, report changes of more than 3 lb/day; take safety
precautions w/ CNS effects; report swelling, hearing loss, muscle cramps/weakness.

DANGEROUS DRUG
tositumomab and iodine I-131 tositumomab (Bexxar)
CLASS Antineoplastic, monoclonal antibody
PREG/CONT X/NA

BBW Risk of severe, prolonged cytopenia. Hypersensitivity reactions, including

anaphylaxis, have occurred.
IND & DOSE Tx of CD20-positive, follicular non-Hodgkin lymphoma. Adult: 450 mg
tositumomab IV in 50 mL normal saline over 60 min, 5 mCi I-131 w/ 35 mg
tositumomab in 30 mL normal saline IV over 20 min; then repeat as therapeutic step,
adjusting I-131 based on pt response.
ADV EFF Anorexia, asthenia, cancer development, fever, headache, hypothyroidism,
n/v/d, severe cytopenia
NC/PT Radioactive; use special handling precautions. Rule out pregnancy; not for use in
pregnancy (two types of contraceptives advised), breast-feeding. Monitor CBC, renal
function. Discuss limiting exposure to family; will take about 12 days to clear body. Pt
should report signs of infection, unusual bleeding.

DANGEROUS DRUG
tramadol hydrochloride (ConZip, Rybix ODT, Ryzolt, Ultram)
CLASS Opioid analgesic
PREG/CONT C/NA

IND & DOSE Relief of moderate to moderately severe pain. Adult: 50–100 mg PO q 4–
6 hr; max, 400 mg/day. For chronic pain, 25 mg/day PO in a.m.; titrate in 25-mg
increments q 3 days to 100 mg/day. Then, increase in 50-mg increments q 3 days to
200 mg/day. After titration, 50–100 mg q 4–6 hr PO; max, 400 mg/day. Or, 100-mg PO
ER tablet once daily, titrated by 100-mg increments q 5 days; max, 300 mg/day. For
orally disintegrating tablets, max, 200 mg/day PO.
ADJUST DOSE Elderly pts; hepatic, renal impairment
ADV EFF Anaphylactoid reactions, constipation, dizziness, headache, hypotension, n/v,
sedation, seizures, suicidality, sweating, vertigo
INTERACTIONS Alcohol, carbamazepine, CNS depressants, MAOIs, SSRIs
NC/PT Control environment; use other measures to relieve pain. Limit use w/ hx of
addiction. Pt should swallow ER tablet whole and not cut, crush, or chew it; dissolve
orally disintegrating tablets in mouth, then swallow w/ water; take safety precautions
w/ CNS effects; report thoughts of suicide.

trametinib (Mekinist)
CLASS Antineoplastic, kinase inhibitor
PREG/CONT D/NA

IND & DOSETx of unresectable or metastatic melanoma with BRAF V600E or V600K
mutations. Adult: 2 mg/day PO 1 hr before or 2 hr after meal.
ADJUST DOSE Severe renal, hepatic impairment
ADV EFF Cardiomyopathy, diarrhea, interstitial lung disease, lymphedema, retinal
pigment epithelial detachment, retinal vein occlusion, serious skin toxicity
NC/PT Ensure regular ophthalmic exams. Evaluate left ventricular ejection fraction before
and every 2 mo during tx. Evaluate lung function; stop drug if sx of interstitial
pneumonitis. Watch for rash, skin toxicity; stop drug if grade 2–4 rash does not improve
with 3-wk interruption. Pt should take drug 1 hr before or 2 hr after meal; avoid
pregnancy, breast-feeding; know frequent testing and follow-up will be needed; be
aware drug could impair fertility; report difficulty breathing, extreme fatigue, swelling
of extremities, rash, vision changes.

trandolapril (Mavik)
CLASS ACE inhibitor, antihypertensive
PREG/CONT D/NA

BBW Rule out pregnancy before tx; advise use of barrier contraceptives. Fetal injury,
death has occurred when used in second, third trimester.
IND & DOSE Tx of hypertension. Adult: African-American pts: 2 mg/day PO. All other pts:
1 mg/day PO. Maint, 2–4 mg/day; max, 8 mg/day. Tx of HF post-MI. Adult: 1 mg/day
PO; may start 3–5 days after MI. Adjust to target 4 mg/day.
ADJUST DOSE Hepatic, renal impairment
ADV EFF Cough, diarrhea, dizziness, headache, hypersensitivity reactions, MI, renal
impairment, tachycardia
INTERACTIONS Diuretics, lithium, potassium supplements
NC/PT If pt on diuretic, stop diuretic 2–3 days before starting trandolapril; resume
diuretic only if BP not controlled. If diuretic cannot be stopped, start at 0.5 mg PO daily;
adjust upward as needed. Alert surgeon; volume replacement may be needed postop.
Not for use in pregnancy (barrier contraceptives advised). Pt should use care in
situations that could lead to BP drop; take safety precautions w/ CNS effects; report
difficulty breathing, swelling of lips/face, chest pain.

tranexamic acid (Lysteda)

CLASS Antifibrinolytic
 PREG/CONT B/NA

IND & DOSE Tx of cyclic heavy menstrual bleeding. Adult: 1,300 mg PO tid for max
5 days during monthly menstruation.
ADJUST DOSE Hepatic, renal impairment
ADV EFF Abd pain, anaphylactic shock, anaphylactoid reactions, arthralgia, back
pain, fatigue, headache, n/v/d, thromboembolic events, visual disturbances
INTERACTIONS Hormonal contraceptives, TPAs
NC/PT Obtain baseline, periodic evaluation of bleeding. Not for use in pregnancy
(hormonal contraceptives may increase thromboembolic event risk; barrier
contraceptives advised). Pt should report difficulty breathing, leg pain/swelling, severe
headache, vision changes.

tranylcypromine sulfate (Parnate)

CLASS Antidepressant, MAOI
PREG/CONT C/NA

BBW Limit amount available to suicidal pts. Possible increased risk of suicidality in
children, adolescents, young adults; monitor accordingly.
IND & DOSE Tx of major depressive disorder. Adult: 30 mg/day PO in divided doses. If
no improvement within 2–3 wk, increase in 10-mg/day increments q 1–3 wk. Max, 60
mg/day.
ADJUST DOSE Elderly pts
ADV EFF Abd pain, anorexia, blurred vision, confusion, constipation, dizziness,
drowsiness, dry mouth, headache, hyperreflexia, hypertensive crises, hypomania,
hypotension, insomnia, jitteriness, liver toxicity, n/v/d, orthostatic hypotension,
photosensitivity, suicidal thoughts, twitching, vertigo
INTERACTIONS Alcohol, amphetamines, antidiabetics, beta blockers, bupropion, buspirone,
general anesthetics, meperidine, SSRIs, sympathomimetics, TCAs, thiazides, tyramine-
containing foods
NC/PT Have phentolamine, another alpha-adrenergic blocker on hand for hypertensive
crisis. Do not use within 14 days of MAOIs, within 10 days of buspirone, bupropion.
Monitor LFTs, BP regularly. Pt should avoid diet high in tyramine-containing foods
during, for 2 wk after tx; avoid alcohol, OTC appetite suppressants; take safety
precautions w/ CNS effects; change position slowly w/ orthostatic hypotension; report
rash, urine/stool color changes, thoughts of suicide.

DANGEROUS DRUG
trastuzumab (Herceptin)
CLASS Antineoplastic, monoclonal antibody (anti-HER2)
PREG/CONT D/NA
BBW Monitor pt during infusion; provide comfort measures, analgesics as appropriate
for infusion reaction. Monitor cardiac status, especially if pt receiving chemotherapy; do
not give w/ anthracycline chemotherapy. Have emergency equipment on hand for
cardiotoxicity; cardiomyopathy possible. Monitor for possibly severe pulmonary toxicity,
especially within 24 hours of infusion. Stop if s&sx of respiratory involvement.
Embryotoxic; ensure pt is not pregnancy before tx (advise use of contraceptive
measures).
IND & DOSE Tx of metastatic HER2 overexpressing breast cancer. Adult: 4 mg/kg IV
once by IV infusion over 90 min. Maint, 2 mg/kg/wk IV over at least 30 min as
tolerated; max, 500 mg/dose. Adjunct tx of HER2-overexpressing breast cancer.
Adult: After completion of doxorubicin, cyclophosphamide tx, give wkly for 52 wk.
Initially, 4 mg/kg by IV infusion over 90 min; maint, 2 mg/kg/wk by IV infusion over
30 min. Or, initially, 8 mg/kg by IV infusion over 90 min; then 6 mg/kg by IV infusion
over 30–90 min q 3 wk. During first 12 wk, give w/ paclitaxel. Tx of metastatic gastric
cancer. Adult: 8 mg/kg IV over 90 min; then 6 mg/kg IV over 30 min q 3 wk until
disease progression.
ADV EFF Abd pain, anemia, diarrhea, fever, infections, injection-site reactions,
leukopenia, paresthesia, pulmonary toxicity, serious cardiac toxicity
NC/PT Do not mix w/ other drug sols or add other drugs to IV line. Monitor cardiac
status; have emergency equipment on hand. Monitor respiratory status. Pt should mark
calendar of tx days; avoid exposure to infection; avoid pregnancy (contraceptive
measures advised); report chest pain, difficulty breathing, pain at injection site.

trazodone hydrochloride (Oleptro)

CLASS Antidepressant
PREG/CONT C/NA

BBW Increased risk of suicidality; limit quantities in depressed, suicidal pts.

IND & DOSE Tx of depression. Adult: 150 mg/day PO in divided doses; max, 400 mg/day
PO in divided doses. ER tablets (Oleptro), 150 mg/day PO; max, 375 mg/day. For severe
depression, max, 600 mg/day PO.
ADJUST DOSE Elderly pts
ADV EFF Blurred vision, constipation, dizziness, NMS, orthostatic hypotension, sedation,
withdrawal syndrome
INTERACTIONS Alcohol, aspirin, CNS depressants, CYP3A4 inducers/inhibitors, digoxin,
MAOIs, NSAIDS, phenytoin, SSRIs, St. John’s wort
NC/PT Do not give within 14 days of MAOIs. Taper when stopping; do not stop abruptly.
Use caution in pregnancy, breast-feeding. Pt should take safety precautions w/ CNS
effects, report fever, severe constipation, thoughts of suicide.

treprostinil sodium (Remodulin, Tyvaso)

CLASS Endothelin receptor antagonist, vasodilator
 PREG/CONT B/NA

IND & DOSE Tx of pulmonary arterial hypertension. Adult: 1.25 ng/kg/min subcut
infusion. Increase rate in increments of no more than 1.25 ng/kg/ min wkly for first 4
wk, then by 2.5 ng/kg/min wkly. Max, 40 ng/kg/min or 3 breaths (18 mcg), using
Tyvaso Inhalation System, per tx session; 4 sessions/ day, approximately 4 hr apart
during waking hours. Increase by additional 3 breaths/session at 1- to 2-wk intervals if
needed, tolerated. Maint, 9 breaths (54 mcg)/session.
ADJUST DOSE Hepatic impairment
ADV EFF Edema, headache, infusion-site reaction, jaw pain, n/d, rash
INTERACTIONS Anticoagulants, antihypertensives, antiplatelets
NC/PT See manufacturer’s instructions if switching from epoprostenol (Flolan). Obtain
baseline pulmonary status, exercise tolerance. Not for use in pregnancy (barrier
contraceptives advised). Taper slowly when stopping. Evaluate subcut infusion site
wkly; give analgesics for headache. Teach proper care, use of continuous subcut
infusion; if using inhalation, review proper use. Pt should continue usual tx procedures,
report swelling, injection site pain/swelling, worsening condition.

DANGEROUS DRUG
tretinoin (Atralin, Avita, Renova, Retin-A, Tretin-X)
CLASS Antineoplastic, retinoid
PREG/CONT D/NA

BBW Rule out pregnancy before tx; arrange for pregnancy test within 2 wk of starting
tx. Advise use of two forms of contraception during tx, for 1 mo after tx ends. Should
only be used under supervision of experienced practitioner or in institution experienced
w/ its use. Risk of rapid leukocytosis (40% of pts); notify physician immediately if this
occurs. Stop drug, notify physician if LFTs over five times upper limit of normal,
pulmonary infiltrates appear, or pt has difficulty breathing; serious side effects possible.
Monitor for retinoic acid-APL syndrome (fever, dyspnea, acute respiratory distress,
weight gain, pulmonary infiltrates, pleural/pericardial effusion, multiorgan failure);
endotracheal intubation, mechanical ventilation may be needed.
IND & DOSE To induce remission in acute promyelocytic leukemia (APL). Adult, child 1
yr and over: 45 mg/m2/day PO in two evenly divided doses until complete remission;
stop tx 30 days after complete remission obtained or after 90 days, whichever first.
Topical tx of acne vulgaris; mitigation of wrinkles; mottled hyperpigmentation.
Adult, child 1 yr and over: Apply once/day before bedtime. Cover entire affected area
lightly, avoiding mucous membranes.
ADV EFF Cardiac arrest, dry skin, earache, fever, GI bleeding, headache, lipid changes,
MI, n/v, pseudotumor cerebri, rapid/evolving leukocytosis, rash, sweating, visual
disturbances.
INTERACTIONS Hydroxyurea, keratolytic agents, ketoconazole, tetracyclines
NC/PT Monitor LFTs, lipids, vision. Not for use in pregnancy (two forms of
contraceptives, during and for 1 mo after tx, advised). Pt cannot donate blood during tx.
Pt should not cut, crush oral capsule; have frequent blood tests; avoid products
containing vitamin D; take safety precautions w/ CNS effects; use sugarless lozenges w/
dry mouth; report severe/bloody diarrhea, difficulty breathing, thoughts of suicide.

triamcinolone acetonide (Kenalog, Nasacort), triamcinolone diacetate,

triamcinolone hexacetonide (Aristospan)
CLASS Corticosteroid
PREG/CONT C/NA

IND & DOSE Hypercalcemia of cancer; mgt of various inflammatory disorders; tx of

idiopathic thrombocytopenic purpura. Adult: Individualize dose, depending on
condition severity, pt response. Give daily dose before 9 a.m. to minimize adrenal
suppression. If long-term tx needed, consider alternate-day tx. After long-term tx,
withdraw slowly to avoid adrenal insufficiency. Range, 2.5–100 mg/day IM. Child:
Individualize dose based on response, not formulae; monitor growth. Maint, tx of
bronchial asthma. Adult, child 6–12 yr: 200 mcg inhalant released w/ each actuation
delivers about 100 mcg. Two inhalations tid–qid; max, 16 inhalations/day. Tx of
seasonal, perennial allergic rhinitis. Adult: 2 sprays (220 mcg total dose) in each
nostril daily; max, 4 sprays/day. Child 6–12 yr: 1 spray in each nostril once/day (100–
110 mcg dose); max, 2 sprays/nostril/day. Intra-articular relief of inflammatory
conditions. Adult, child: Acetonide, 2.5–15 mg intra-articular. Diacetate, 5–40 mg intra-
articular, 5–48 mg intralesional; max, 12.5 mg/injection site, 25 mg/lesion.
Hexacetonide, 2–20 mg intra-articular; up to 0.5 mg/square inch of affected area
intralesional. Relief of inflammatory, pruritic s&sx of dermatoses. Adult, child: Apply
sparingly to affected area bid–qid. Tx of oral lesions. Adult: Press small dab (1/4 inch)
to each lesion until thin film develops, two to three times/day after meals.
ADV EFF Headache, increased appetite, immunosuppression, impaired wound healing,
infections, menstrual changes, osteoporosis, sodium/fluid retention, vertigo, weight gain
INTERACTIONS Barbiturates, edrophonium, neostigmine, oral antidiabetics, phenytoin,
pyridostigmine, rifampin, salicylates
NC/PT Not for acute asthmatic attack. Give in a.m. to mimic normal levels. Taper when
stopping after long-term tx. Do not use occlusive dressings w/ topical form. Review
proper administration. Pt should avoid exposure to infection, joint overuse after intra-
articular injection; keep topical forms away from eyes; report swelling, signs of
infection, worsening of condition.

triamterene (Dyrenium)
CLASS Potassium-sparing diuretic
PREG/CONT C/NA
BBW Risk of hyperkalemia (possibly fatal), more likely w/ diabetics, elderly/severely ill
pts; monitor potassium carefully.
IND & DOSE Tx of edema associated w/ systemic conditions. Adult: 100 mg PO bid;
max, 300 mg/day. Tx of hypertension. Adult: 25 mg/day PO; usual dose, 50–
100 mg/day.
ADV EFF Abd pain, anorexia, dizziness, drowsiness, dry mouth, hyperkalemia, n/v/d,
rash, renal stones
INTERACTIONS Amantadine, lithium, potassium supplements
NC/PT Pt should take in a.m. to decrease sleep interruption, w/ food if GI upset; weigh
self regularly, report change of 3 lb/day; take safety precautions w/ CNS effects; avoid
foods high in potassium; report swelling, difficulty breathing, flank pain, muscle
cramps, tremors.

triazolam (Halcion)
CLASS Benzodiazepine, sedative-hypnotic
PREG/CONT X/C-IV

IND & DOSE Tx of insomnia. Adult: 0.125–0.25 mg PO before retiring. May increase to
max 0.5 mg. Limit use to 7–10 days.
ADJUST DOSE Elderly, debilitated pts
ADV EFF Anaphylaxis, angioedema, bradycardia, confusion, constipation, CV collapse,
diarrhea, drowsiness, drug dependence, fatigue, hiccups, nervousness, tachycardia,
urticaria
INTERACTIONS Alcohol, aminophylline, cimetidine, CNS depressants, disulfiram,
dyphylline, grapefruit juice, hormonal contraceptives, itraconazole, ketoconazole,
omeprazole, theophylline
NC/PT Taper gradually after long-term use. Monitor renal function, CBC periodically. Not
for use in pregnancy (barrier contraceptives advised). Pt should avoid grapefruit juice,
alcohol; take safety precautions w/ CNS effects; report difficulty breathing, swelling of
face/eyes, continued sleep disorders.

trientine hydrochloride (Syprine)

CLASS Chelate
PREG/CONT C/NA

IND & DOSE Tx of pts w/ Wilson disease intolerant of penicillamine. Adult: 750–
1,250 mg/day PO in divided doses; max, 2 g/day. Child: 500–750 mg/day PO; max,
1,500 mg/day.
ADV EFF Abd pain, anorexia, epigastric pain, hypersensitivity reactions, iron
deficiency, muscle spasm, myasthenia gravis, rash, rhabdomyolysis, SLE, weakness
NC/PT Pt should take on empty stomach 1 hr before, 2 hr after meals; swallow capsule
whole and not cut, crush, or chew it; monitor temp nightly for first mo of tx; space iron
supplement at least 2 hr apart from trientine; report fever, muscle weakness/pain,
difficulty breathing.

trihexyphenidyl hydrochloride (generic)

CLASS Antiparkinsonian (anticholinergic type)
PREG/CONT C/NA

BBW Stop or decrease dosage if dry mouth interferes with swallowing, speaking.
IND & DOSE Adjunct in tx of parkinsonism. Adult: 1 mg PO first day. Increase by 2-mg
increments at 3- to 5-day intervals until total of 6–10 mg/day. Postencephalitic pts may
need 12–15 mg/day. W/ levodopa: Adjust based on response; usual, 3–6 mg/day PO. Tx
of drug-induced extrapyramidal sx. Adult: 1 mg PO. May need to temporarily reduce
tranquilizer dose to expedite control of extrapyramidal sx. Usual dose, 5–15 mg/day.
ADJUST DOSE Elderly pts
ADV EFF Blurred vision, confusion, constipation, decreased sweating, delusions,
disorientation, dizziness, drowsiness, dry mouth, flushing, light-headedness, urine
retention
INTERACTIONS Haloperidol, phenothiazines
NC/PT Pt should empty bladder before each dose; use caution in hot weather (decreased
sweating can lead to heat stroke); use sugarless lozenges for dry mouth; take safety
precautions w/ CNS effects; report eye pain, rash, rapid heartbeat, difficulty
swallowing/speaking.

trimethobenzamide hydrochloride (Tigan)

CLASS Antiemetic (anticholinergic)
PREG/CONT C/NA

IND & DOSE Control of postop n/v, nausea associated w/ gastroenteritis. Adult:
300 mg PO tid–qid, or 200 mg IM tid–qid.
ADJUST DOSE Elderly pts
ADV EFF Blurred vision, dizziness, drowsiness, headache, hypotension, pain/swelling at
injection site
NC/PT Ensure adequate hydration. Pt should avoid alcohol (sedation possible), take
safety precautions w/ CNS effects, report unusual bleeding, visual disturbances, pain at
injection site.

trimethoprim (Primsol, Trimpex)

CLASS Antibiotic
PREG/CONT C/NA

IND & DOSE Uncomplicated UTIs caused by susceptible bacteria strains. Adult, child 12
yr and older: 100 mg PO q 12 hr or 200 mg PO q 24 hr for 10–14 days. Tx of otitis
media. Child under 12 yr: 10 mg/kg/day PO in divided doses q 12 hr for 10 days.
ADJUST DOSE Elderly pts, renal impairment
ADV EFF Bone marrow suppression, epigastric distress, exfoliative dermatitis, hepatic
impairment, pruritus, rash
INTERACTIONS Phenytoin
NC/PT Culture before tx. Protect drug from light. Monitor CBC. Pt should take full course,
avoid exposure to infection, report unusual bleeding, signs of infection, rash.

trimipramine maleate (Surmontil)

CLASS TCA
PREG/CONT C/NA

BBW Limit access in depressed, potentially suicidal pts. Monitor for suicidal ideation,
especially when beginning tx, changing doses. High risk of suicidality in children,
adolescents, young adults.
IND & DOSE Relief of sx of depression. Adult: Inpts, 100 mg/day PO in divided doses.
Gradually increase to 200 mg/day as needed; max, 250–300 mg/day. Outpts, 75 mg/day
PO in divided doses. May increase to 150 mg/day; max, 200 mg/day. Child 12 yr and
older: 50 mg/day PO w/ gradual increases up to 100 mg/day.
ADJUST DOSE Elderly pts
ADV EFF Anticholinergic effects, bone marrow suppression, constipation, dry mouth,
extrapyramidal effects, MI, orthostatic hypotension, photosensitivity, rash, stroke
INTERACTIONS Alcohol, cimetidine, clarithromycin, clonidine, fluoroquinolones, fluoxetine,
MAOIs, ranitidine, sympathomimetics, tramadol
NC/PT Monitor CBC periodically. Not for use in pregnancy (contraceptives advised). Pt
should not stop suddenly; avoid sun exposure, alcohol; take safety precautions w/ CNS
effects; use sugarless lozenges for dry mouth; report thoughts of suicide, excessive
sedation.

DANGEROUS DRUG
triptorelin pamoate (Trelstar)
CLASS Antineoplastic, LHRH analogue
PREG/CONT X/NA

IND & DOSE Palliative tx of advanced prostate cancer. Adult: 3.75-mg depot injection
IM once monthly into buttock, or 11.25-mg injection IM q 12 wk into buttock, or
22.5 mg IM q 24 wk into buttock.
ADV EFF Anaphylaxis, angioedema, bone pain, decreased erection, headache, HF, hot
flashes, injection-site pain, insomnia, sexual dysfx, urinary tract sx
INTERACTIONS Antipsychotics, metoclopramide
NC/PT Monitor testosterone, PSA before, periodically during tx. Not for use in pregnancy.
Pt should mark calendar for injection days; use comfort measures for hot flashes, pain;
report swelling, difficulty breathing, signs of infection at injection sites.

trospium chloride (Sanctura)

CLASS Antimuscarinic, antispasmodic
PREG/CONT C/NA

IND & DOSE Tx of s&sx of overactive bladder. Adult under 75 yr: 20 mg PO bid on empty
stomach, at least 1 hr before meals. Or, 60 mg ER tablet PO once/day. Adult over 75 yr:
Monitor pt response; adjust down to 20 mg/day.
ADJUST DOSE Renal impairment
ADV EFF Constipation, decreased sweating, dizziness, drowsiness, dry mouth, fatigue,
headache, urine retention
INTERACTIONS Digoxin, metformin, morphine, other anticholinergics, procainamide,
pancuronium, tenofovir, vancomycin
NC/PT Pt should empty bladder before each dose; take on empty stomach 1 hr before,
2 hr after food; not cut, crush, or chew ER tablet; use sugarless lozenges, mouth care for
dry mouth; maintain hydration; use caution in hot environments (decreased sweating
could lead to heat stroke); take safety precautions w/ CNS effects; report inability to
urinate, fever.

urofollitropin (Bravelle)
CLASS Fertility drug
PREG/CONT X/NA

IND & DOSE Stimulation of follicle development, ovulation. Adults who have received
gonadotropin-releasing hormone agonist, antagonist suppression: 150 units/day subcut or IM
for first 5 days. Subsequent dosing should not exceed 75–150 units/adjustment. Max,
450 units/day. Tx beyond 12 days not recommended. If pt response appropriate, give
HCG 5,000–10,000 units 1 day after last Bravelle dose.
ADV EFF Multiple births, nausea, ovarian cyst, ovarian hyperstimulation,
pulmonary/vascular complications, URI
NC/PT Ensure uterine health. Alert pt to risk of multiple births. Monitor regularly;
monitor for thrombotic events. Teach proper administration, disposal of needles,
syringes.

ursodiol (Actigall, URSO)

CLASS Gallstone-solubilizing drug
PREG/CONT B/NA

IND & DOSE Gallstone solubilization. Adult: 8–10 mg/kg/day PO in two to three divided
doses. Px of gallstones w/ rapid weight loss. Adult: 300 mg PO bid or 8–10
mg/kg/day PO in two to three divided doses. Tx of biliary cirrhosis. Adult: 13–15
mg/kg/day PO in two to four divided doses w/ food.
ADV EFF Abd pain, cramps, diarrhea, epigastric distress, fatigue, headache, rash
INTERACTIONS Antacids, bile-acid sequestrants
NC/PT Drug not a cure; gallstones may recur. Schedule periodic oral cholecystograms or
ultrasonograms to evaluate effectiveness at 6-mo intervals until resolution, then every
3 mo to monitor stone formation. Monitor LFTs periodically. Pt should avoid antacids,
report yellowing of skin/eyes, gallstone attacks.

ustekinumab (Stelara)
CLASS Monoclonal antibody
PREG/CONT B/NA

IND & DOSETx of mild to moderate plaque psoriasis. Adult: Over 100 kg, 90 mg subcut,
then 90 mg in 4 wk, then q 12 wk. 100 kg or less, 45 mg subcut, then 45 mg in 4 wk,
then q 12 wk.
ADV EFF Fatigue, headache, malignancies, serious infections, URI
INTERACTIONS Immunosuppressants, live vaccines, phototherapy
NC/PT Not for use in pregnancy, breast-feeding. Ensure appropriate cancer screening. Pt
should mark calendar of injection days, avoid live vaccines, report signs of infection,
worsening of condition.
 valacyclovir hydrochloride (Valtrex)
CLASS Antiviral
PREG/CONT B/NA

IND & DOSE Tx of herpes zoster. Adult: 1 g PO tid for 7 days; most effective if started
within 48 hr of sx onset (rash). Tx of genital herpes. Adult: 1 g PO bid for 7–10 days
for initial episode. Episodic tx of recurrent genital herpes. Adult: 500 mg PO bid for
3 days, or 1 g/day for 5 days. To suppress recurrent episodes of genital herpes.
Adult: 1 g/day PO; pts w/ hx of less than nine episodes in 1 yr may respond to 500 mg
PO daily. To suppress recurrent episodes of genital herpes in pts w/ HIV. 500 mg
PO bid for 5–10 days. To reduce risk of herpes zoster transmission. Adult:
500 mg/day PO for source partner. For HIV-positive pts, 500 mg PO bid. Tx of cold
sores. Adult, child 12 yr and over: 2 g PO bid for 1 day, 12 hr apart. Tx of chickenpox.
Child 2–18 yr: 20 mg/kg PO tid for 5 days; max, 1 g tid.
ADJUST DOSE Renal impairment
ADV EFF Abd pain, acute renal failure, dizziness, headache, n/v/d, rash
INTERACTIONS Cimetidine, probenecid
NC/PT Begin tx within 48–72 hr of onset of shingles sx or within 24 hr of onset of
chickenpox rash. Pt should take full course of tx; avoid contact w/ lesions; avoid
intercourse when lesions present; take analgesics for headache; report severe diarrhea,
worsening of condition. Name confusion between Valtrex (valacyclovir) and Valcyte
(valganciclovir); use caution.

valganciclovir hydrochloride (Valcyte)

CLASS Antiviral
PREG/CONT C/NA

BBW Arrange for CBC before tx, at least wkly thereafter. Arrange for reduced dose if
WBC, platelet counts fall. Toxicity includes granulocytopenia, anemia,
thrombocytopenia. Advise pt drug has caused cancer, fetal damage in animals and that
risk possible in humans.
IND & DOSE Tx of cytomegalovirus (CMV) infection. Adult: 900 mg PO bid for 21 days;
maint, 900 mg/day PO. Px of CMV infection in high-risk kidney, pancreas, kidney,
heart transplant. Adult: 900 mg/day PO initiated within 10 days of transplant,
continued for 100 days after transplant. Child 4 mo– 16 yr: Dose in mg = 7 × BSA ×
CrCl PO. Max, 900 mg/ day. May use oral sol, tablets.
ADJUST DOSE Renal impairment
ADV EFF Anemia, bone marrow suppression, confusion, dizziness, drowsiness, fever,
headache, insomnia, n/v/d
INTERACTIONS Cytotoxic drugs, didanosine, imipenem/cilastatin, probenecid, zidovudine
NC/PT Cannot be substituted for ganciclovir capsules on one-to-one basis. Monitor CBC.
Precautions needed for disposal of nucleoside analogues; consult pharmacy for proper
disposal of unused tablets. Not for use in pregnancy; men, women should use barrier
contraceptives during, for 90 days after tx. Avoid handling broken tablets. Pt should not
cut, crush, or chew tablets; drink 2–3 L water/day; have frequent blood tests, eye exams
to evaluate progress; take safety precautions w/ CNS effects; avoid exposure to
infection; report bruising/bleeding, signs of infection. Name confusion between Valcyte
(valganciclovir) and Valtrex (valacyclovir); use caution.

valproic acid (Stavzor), sodium valproate (Depakene, Depacon), divalproex

sodium (Depakote, Divalproex)
CLASS Antiepileptic
PREG/CONT D, X (migraine prophylaxis)/NA

BBW Increased risk of suicidal ideation, suicidality; monitor accordingly. Arrange for
frequent LFTs; stop drug immediately w/ suspected, apparent significant hepatic
impairment. Continue LFTs to determine if hepatic impairment progresses despite
discontinuation. Arrange for counseling for women of childbearing age who wish to
become pregnant; drug may be teratogenic. Not recommended for women of
childbearing age; risk of lower cognitive test scores in children when drug taken during
pregnancy compared to other anticonvulsants. Stop drug at any sign of pancreatitis;
life-threatening pancreatitis has occurred.
IND & DOSE Tx of simple, complex absence seizures. Adult: 10–15 mg/kg/day PO,
increasing at 1-wk intervals by 5–10 mg/kg/day until seizures controlled or side effects
preclude further increases; max, 60 mg/kg/day PO. If total dose exceeds 250 mg/day,
give in divided doses. Child 10 yr and older: 10–15 mg/kg/day PO. Tx of acute mania,
bipolar disorder. Adult: 25 mg/kg/day PO. Increase rapidly to achieve lowest
therapeutic dose. Max, 60 mg/kg/day PO (Depakote ER only). Tx of bipolar mania:
Adult: 750 mg/day PO in divided doses; max, 60 mg/kg/day (Divalproex DR only). Px of
migraine. Adult: 250 mg PO bid; up to 1,000 mg/day has been used (Divalproex DR,
Stavzor); 500 mg/day ER tablet.
ADV EFF Bone marrow suppression, depression, dizziness, hepatic failure, indigestion,
life-threatening pancreatitis, n/v/d, rash
INTERACTIONS Alcohol, carbamazepine, charcoal, cimetidine, chlorpromazine, CNS
depressants, diazepam, erythromycin, ethosuximide, felbamate, lamotrigine,
phenobarbital, phenytoin, primidone, rifampin, salicylates, zidovudine
NC/PT Taper when stopping. Monitor CBC, LFTs, therapeutic serum level (usually 50–100
mcg/mL). Not for use in pregnancy (barrier contraceptives advised). May open Depakote
Sprinkle tablets and sprinkle on applesauce, pudding. Pt should swallow tablet/capsule
whole and not chew it; avoid alcohol, OTC sleeping pills; have frequent blood tests;
wear medical ID; take safety precautions w/ CNS effects; avoid injury, exposure to
infection; report bleeding, stool color changes, thoughts of suicide. Confusion between
DR Depakote and Depakote ER. Dosage very different, serious adverse effects possible; use
extreme caution.

valsartan (Diovan)
CLASS Antihypertensive, ARB
PREG/CONT D/NA

BBW Rule out pregnancy before starting tx. Suggest barrier contraceptives during tx;
fetal injury, deaths have occurred.
IND & DOSE Tx of hypertension. Adult: 80 mg/day PO; range, 80–320 mg/day. Child 6–16
yr: 1.3 mg/kg/day PO (max, 40 mg). Target, 1.3–2.7 mg/kg/day PO (40–160 mg/day).
Tx of HF. Adult: 40 mg PO bid; titrate to 80 mg and 160 mg bid, to highest dose
tolerated by pt. Max, 320 mg/day. Tx of post-MI left ventricular dysfx. Adult: Start as
early as 12 hr post-MI; 20 mg PO bid. May increase after 7 days to 40 mg PO bid.
Titrate to 160 mg PO bid if tolerated.
ADJUST DOSE Hepatic, renal impairment
ADV EFF Abd pain, cough, dizziness, headache, hypotension, n/v/d, URI
NC/PT Alert surgeon; volume replacement may be needed postop. Do not stop abruptly.
Not for use in pregnancy (barrier contraceptives advised), breast-feeding. Pt should take
safety precautions w/ CNS effects, use caution in situations that can lead to BP drop;
report chills, pregnancy.

vancomycin hydrochloride (Vancocin)

CLASS Antibiotic
PREG/CONT C; B (pulvules)/NA

BBW Pt at risk for development of multiple drug-resistant organisms; ensure appropriate

use.
IND & DOSE Tx of severe to life-threatening infections caused by susceptible bacteria
strains and unresponsive to other antibiotics. Adult: 500 mg–2 g/day PO in three to
four divided doses for 7–10 days. Or, 500 mg IV q 6 hr or 1 g IV q 12 hr. Child: 40
mg/kg/day PO in three to four divided doses for 7–10 days. Or, 10 mg/kg/dose IV q
6 hr. Max, 2 g/day. Premature, full-term neonate: Use w/ caution because of incompletely
developed renal function. Initially, 15 mg/kg IV, then 10 mg/kg q 12 hr in first wk of
life, then q 8 hr up to age 1 mo. Tx of pseudomembranous colitis due to Clostridium
difficile. Adult: 500 mg–2 g/day PO in three to four divided doses for 7–10 days, or
125 mg PO tid–qid. Child: 40 mg/kg/day PO in four divided doses for 7–10 days. Max, 2
g/day.
ADJUST DOSE Elderly pts, renal failure
ADV EFF Fever, hypotension, nausea, nephrotoxicity, ototoxicity, paresthesia, “red man
syndrome,” superinfections, rash
INTERACTIONS Aminoglycosides, amphotericin B, atracurium, bacitracin, cisplatin,
pancuronium, tubocurarine, vecuronium
NC/PT Culture before tx. Monitor for red man syndrome during IV infusion. Monitor
renal function. Monitor for safe serum level (conc of 60–80 mcg/mL toxic). Pt should
take full course; perform hygiene measures to avoid possible infections of mouth,
vagina; report ringing in ears, hearing loss, swelling.

vardenafil hydrochloride (Levitra, Staxyn)

CLASS ED drug, phosphodiesterase type 5 inhibitor
PREG/CONT B/NA

IND & DOSE Tx of ED. Adult: 5–10 mg PO 1 hr before anticipated sexual activity; range, 5–
20 mg PO. Limit use to once/day.
ADJUST DOSE Elderly pts, hepatic impairment
ADV EFF Abnormal ejaculation, angina, dyspnea, flushing, GERD, headache, hearing loss,
hypotension, rhinitis, vision changes/loss
INTERACTIONS Alpha blockers, erythromycin, indinavir, itraconazole, ketoconazole,
nitrates, ritonavir
NC/PT Ensure dx. Drug not effective without sexual stimulation. Does not protect against
STDs. Pt should avoid nitrates, alpha blocker antihypertensives; stop drug, immediately
report loss of vision/hearing; report difficult urination, erection lasting longer than
4 hr, fainting.

varenicline tartrate (Chantix)

CLASS Nicotine receptor antagonist, smoking deterrent
PREG/CONT C/NA

BBW Risk of serious mental health events, including changes in behavior, depressed
mood, hostility, suicidal thoughts; monitor accordingly. Higher risk of MI, stroke, death
compared with placebo; use w/ caution.
IND & DOSE Aid to smoking cessation tx. Adult: Pt should pick date to stop smoking,
begin tx 1 wk before that date. Or, pt can begin drug, quit smoking between days 8 and
35 of tx. days 1–3, 0.5 mg/day PO; days 4–7, 0.5 mg PO bid; day 8 until end of tx, 1 mg
PO bid.
ADJUST DOSE Severe renal impairment
ADV EFF Abd pain, abnormal dreams, constipation, fatigue, flatulence, headache,
insomnia, MI, nausea, rhinorrhea, stroke, suicidality
INTERACTIONS Cimetidine, nicotine transdermal systems
NC/PT Ensure comprehensive tx program. Not for use in pregnancy, breast-feeding; Tx
should last 12 wk; pt who successfully quits smoking in that time may benefit from
another 12 wk to increase likelihood of long-term abstinence. Use caution w/ known
CAD. Pt should take after eating w/ full glass of water; follow dosing protocol closely; if
relapse occurs, discuss w/ prescribe; report failure to quit smoking, behavioral changes,
thoughts of suicide, chest pain.
 velaglucerase (VPRIV)
CLASS Lysosomal enzyme
PREG/CONT B/NA

IND & DOSE Long-term replacement tx for type 1 Gaucher disease. Adult, child: 60
units/kg as 60-min IV infusion q other wk.
ADV EFF Abd pain, back pain, dizziness, headache, hypersensitivity/infusion reactions,
joint pain, nausea, URI
NC/PT May use antihistamines, corticosteroids to alleviate infusion reactions. Pt should
mark calendar for infusion days, report difficulty breathing, pain at injection site.

vemurafenib (Zelboraf)
CLASS Antineoplastic, kinase inhibitor
PREG/CONT B/NA

IND & DOSE Tx of pts w/ unresectable, metastatic melanoma w/ BRAF mutation as

detected by approved BRAF test. Adult: 960 mg PO bid approximately 12 hr apart.
ADV EFF Alopecia, arthralgia, cutaneous squamous cell carcinoma, fatigue, liver
toxicity, nausea, new malignant melanomas, photosensitivity, pruritus, QT
prolongation, serious hypersensitivity reactions, serious ophthalmologic toxicity,
skin papilloma, Stevens-Johnson syndrome
INTERACTIONS CYP substrates, warfarin
NC/PT BRAF confirmation test required before use to ensure appropriate drug selection.
Obtain baseline ECG; periodically monitor QT interval. Monitor skin, eye reactions. Not
for use in pregnancy, breast-feeding. Pt should cover head at temp extremes (hair loss
possible), avoid sun exposure, report rash, difficulty breathing, urine/stool color
changes, vision changes.

venlafaxine hydrochloride (Effexor XR)

CLASS Antidepressant, anxiolytic
PREG/CONT C/NA

BBW Monitor pts for suicidal ideation, especially when starting tx, changing dose; high
risk in children, adolescents, young adults.
IND & DOSE Tx of depression. Adult: 75 mg/day PO in two to three divided doses (or
once/day, ER capsule). Increase at intervals of no less than 4 days up to 225 mg/day to
achieve desired effect; max, 375 mg/day in three divided doses. Tx of generalized
anxiety disorder/social anxiety. Adult: 75–225 mg/day ER form PO. Tx of panic
disorder. Adult: 37.5 mg/day PO for 7 days, then 75 mg/day for 7 days, then 75
mg/day wkly. Max, 225 mg/day (ER only).
ADJUST DOSE Hepatic, renal impairment
ADV EFF Abnormal ejaculation, asthenia, anorexia, constipation, dizziness, dry mouth,
headache, insomnia, nausea, nervousness, somnolence, sweating, suicidality
INTERACTIONS Alcohol, MAOIs, St. John’s wort, trazodone
NC/PT To transfer to, from MAOI: Allow at least 14 days to elapse from stopping MAOI
to starting venlafaxine; allow at least 7 days to elapse from stopping venlafaxine to
starting MAOI. Not for use in pregnancy. Pt should swallow ER capsule whole and not
cut, crush, or chew it; take w/ food; avoid alcohol, St. John’s wort; take safety
precautions w/ CNS effects; use sugarless lozenges w/ dry mouth; report rash, thoughts
of suicide.

DANGEROUS DRUG
verapamil hydrochloride (Calan, Verelan)
CLASS Antianginal, antihypertensive, calcium channel blocker
PREG/CONT C/NA

BBW Monitor pt carefully during drug titration; dosage may be increased more rapidly
w/ hospitalized, monitored pts.
IND & DOSE Tx of angina. Adult: 80–120 mg PO tid. Maint, 240–480 mg/day. Tx of
arrhythmias. Adult: 240–480 mg/day PO in divided doses. Or, 120–240 mg/day PO in
a.m. ER capsules; max, 480 mg/day. Or, 120–180 mg/day PO in a.m. ER or SR tablets.
Or, 5–10 mg IV over 2 min; may repeat dose of 10 mg 30 min after first dose if initial
response inadequate. In digitalized pts, 240–320 mg/ day PO. Child 1–15 yr: 0.1–0.3
mg/kg IV over 2 min; max, 5 mg. Repeat dose 30 min after initial dose if response
inadequate. Max for repeat dose, 10 mg. Child 1 yr and younger: 0.1–0.2 mg/kg IV over 2
min. Tx of hypertension. Adult: 40–80 mg PO tid.
ADJUST DOSE Elderly pts, renal impairment
ADV EFF Cardiac arrhythmias, constipation, dizziness, edema, headache, hypotension,
nausea
INTERACTIONS Antihypertensives, beta blockers, calcium, carbamazepine, digoxin,
grapefruit juice, prazosin, quinidine, rifampin, verapamil
NC/PT When pt stabilized, may switch to ER capsules (max, 480 mg/day), ER tablets
(max, 240 mg q 12 hr), SR forms (max, 480 mg in a.m.). Protect IV sol from light.
Monitor BP, cardiac rhythm closely. Pt should swallow ER, SR forms whole and not cut,
crush, or chew them; take safety precautions w/ dizziness; avoid grapefruit juice; report
swelling, difficulty breathing.

verteporfin (Visudyne)
CLASS Ophthalmic drug
PREG/CONT C/NA

IND & DOSETx of age-related macular degeneration, pathologic myopia, ocular

histoplasmosis. Adult: 6 mg/m2 diluted in D5W to total 30 mL IV into free-flowing IV
over 10 min at 3 mL/min using inline filter, syringe pump.
ADJUST DOSE Hepatic impairment
ADV EFF Dizziness, headache, injection-site reactions, malaise, photosensitivity, pruritus,
rash, visual disturbances
NC/PT Laser light tx should begin within 15 min of starting IV; may repeat in 3 mo if
needed. Not for use in breast-feeding. Protect pt from exposure to bright light for at
least 5 days after tx. Pt should report vision changes, eye pain, injection-site
pain/swelling.

vigabatrin (Sabril)
CLASS Antiepileptic, GABAase inhibitor
PREG/CONT C/NA

BBW Available only through restricted distribution program. Causes progressive,

permanent, bilateral vision loss. Monitor vision; stopping drug may not stop vision loss.
Increased risk of suicidality; monitor accordingly.
IND & DOSE Adjunct tx of refractory complex seizures Adult: 500 mg PO bid; increase
slowly to max 1.5 mg PO bid.
ADJUST DOSE Renal impairment
ADV EFF Abnormal coordination, anemia, arthralgia, confusion, edema, fatigue,
nystagmus, permanent vision loss, somnolence, suicidality, tremor, weight gain
NC/PT Available only through limited access. Taper gradually to avoid withdrawal
seizures. Monitor vision; permanent vision loss possible. Give w/ other antiepileptics.
Nor for use in pregnancy, breast-feeding. Pt should take precautions w/ CNS effects,
report changes in vision, thoughts of suicide, extreme fatigue, weight gain.

vilazodone hydrochloride (Viibryd)

CLASS SSRI
PREG/CONT C/NA

BBW High risk of suicidality in children, adolescents, young adults. Establish suicide
precautions for severely depressed pts, limit quantity of drug dispensed. Vilazodone not
approved for use in children.
IND & DOSE Tx of major depressive disorder. Adult: 10 mg/day PO for 7 days, then 20
mg/day PO for 7 days; maint, 40 mg/day PO.
ADV EFF Dizziness, dry mouth, insomnia, n/v/d, NMS, paresthesia, seizures
INTERACTIONS Alcohol, aspirin, diltiazem, ketoconazole, MAOIs, NSAIDs, serotonergic
drugs, St. John’s wort, warfarin
NC/PT Therapeutic effects may not occur for 4 wk. Taper when stopping. Not for use in
pregnancy, breast-feeding. Pt should take w/ food in a.m.; avoid alcohol, NSAIDs, St.
John’s wort; take safety precautions w/ CNS effects; report seizures, thoughts of suicide.
 DANGEROUS DRUG
vinBLAStine sulfate (generic)
CLASS Antineoplastic, mitotic inhibitor
PREG/CONT D/NA

BBW Do not give IM, subcut due to severe local reaction, tissue necrosis. Fatal if given
intrathecally; use extreme caution. Watch for irritation, infiltration; extravasation
causes tissue damage, necrosis. If it occurs, stop injection immediately; give remainder
of dose in another vein. Arrange for hyaluronidase injection into local area, after which
apply moderate heat to disperse drug, minimize pain.
IND & DOSE Palliative tx of lymphocytic/histiocytic lymphoma, generalized Hodgkin
lymphoma (stages III, IV), mycosis fungoides, advanced testicular carcinoma,
Kaposi sarcoma, Letterer-Siwe disease; tx of choriocarcinoma, breast cancer,
Hodgkin lymphoma, advanced testicular germinal-cell cancers. Adult: Initially, 3.7
mg/m2 as single IV dose, followed at wkly intervals by increasing doses at 1.8-mg/m2
increments; use these increments until max 18.5 mg/m2 reached. When WBC count
3,000/mm3, use dose one increment smaller for wkly maint. Do not give another dose
until WBC count is 4,000/mm3 even if 7 days have passed. Child: 2.5 mg/m2 as single IV
dose, followed at wkly intervals by increasing doses at 1.25-mg/m2 increments. Max,
12.5 mg/m2/dose.
ADJUST DOSE Hepatic impairment
ADV EFF Alopecia, anorexia, bone marrow suppression, cellulitis at injection site,
headache, n/v/d, paresthesia, weakness
INTERACTIONS Erythromycin, grapefruit juice, phenytoins
NC/PT Do not give IM, subcut. Monitor CBC closely. Give antiemetic for severe n/v. Not
for use in pregnancy. Pt should mark calendar of tx days; take safety precautions w/
CNS effects; cover head at temp extremes (hair loss possible); avoid exposure to
infection, injury; avoid grapefruit juice; report pain at injection site, signs of infection,
bleeding. Name confusion between vinblastine and vincristine; use caution.

DANGEROUS DRUG
vinCRIStine sulfate (Marqibo)
CLASS Antineoplastic, mitotic inhibitor
PREG/CONT D/NA

BBW Do not give IM, subcut due to severe local reaction, tissue necrosis. Fatal if given
intrathecally; use extreme caution. Watch for irritation, infiltration; extravasation
causes tissue damage, necrosis. If it occurs, stop injection immediately; give remainder
of dose in another vein. Arrange for hyaluronidase injection into local area, after which
apply moderate heat to disperse drug, minimize pain.
IND & DOSE Tx of acute leukemia, Hodgkin lymphoma, non-Hodgkin lymphoma,
rhabdomyosarcoma, neuroblastoma, Wilms tumor. Adult: 1.4 mg/m2 IV at wkly
intervals. Child over 10 kg or BSA over 1 m2: 1–2 mg/m2/wk IV. Max, 2 mg/dose. Child
under 10 kg or BSA under 1 m2: 0.05 mg/kg/wk IV. Tx of adults with Philadelphia
chromosome–negative acute ALL who have relapsed after other tx. Adult: 2.25
mg/m2 IV over 1 hr q 7 days (Marqibo).
ADJUST DOSE Elderly pts, hepatic impairment
ADV EFF Alopecia, ataxia, constipation, cranial nerve manifestations, death, neuritic
pain, paresthesia, photosensitivity, renal impairment, weight loss
INTERACTIONS Digoxin, grapefruit juice, L-asparaginase
NC/PT Do not give IM, subcut. Monitor renal function. Not for use in pregnancy. Pt
should use laxative for constipation, take safety precautions w/ CNS effects, cover head
at temp extremes (hair loss possible), avoid sun exposure, report pain at injection site,
swelling, severe constipation. Name confusion between vinblastine and vincristine; use
caution.

DANGEROUS DRUG
vinorelbine tartrate (Navelbine)
CLASS Antineoplastic, mitotic inhibitor
PREG/CONT D/NA

BBW Do not give IM, subcut due to severe local reaction, tissue necrosis. Fatal if given
intrathecally; use extreme caution. Watch for irritation, infiltration; extravasation can
cause tissue damage, necrosis. If it occurs, stop injection immediately; arrange for
hyaluronidase injection into local area, after which apply moderate heat to disperse
drug, minimize pain. Check CBC before each dose; severe granulocytosis possible.
Adjust, delay dose as appropriate.
IND & DOSE First-line tx of ambulatory pts w/ unresectable advanced non-small-cell
lung cancer; tx of stage IV non-small-cell lung cancer. Adult: 30 mg/m2 as single IV
dose; repeat once/wk until disease progresses or toxicity limits use. Tx of stage III, IV
non-small-cell lung cancer, w/ cisplatin. Adult: 25 mg/m2 IV w/ cisplatin 100 mg/m2
q 4 wk, or 30 mg/m2 w/ cisplatin 120 mg/m2 on days 1 and 29, then q 6 wk.
ADJUST DOSE Hepatic impairment
ADV EFF Alopecia, anorexia, headache, hepatic impairment, severe bone marrow
suppression, paresthesia, vesiculation of GI tract
INTERACTIONS Cisplatin, mitomycin, paclitaxel
NC/PT Check CBC before each dose; adjustment may be needed. Give antiemetic if
needed. Not for use in pregnancy (contraceptives advised). Pt should mark calendar of
tx days; cover head at temp extremes (hair loss possible); take safety precautions w/
CNS effects; avoid exposure to infection, injury; report pain at injection site, unusual
bleeding, signs of infection.

vismodegib (Erivedge)
 CLASSAntineoplastic, hedgehog pathway inhibitor
PREG/CONT D/NA

BBW Risk of embryo-fetal death, severe birth defects; men, women advised to use barrier
contraceptives.
IND & DOSE Tx of pts w/ metastatic or locally advanced basal cell carcinoma not
candidates for surgery or radiation. Adult: 150 mg/day PO.
ADV EFF Alopecia, anorexia, arthralgia, constipation, fatigue, muscle spasms, n/v/d
NC/PT Rule out pregnancy before tx; advise men, women to use barrier contraceptives
(due to risk of fetal toxicity). Not for use in breast-feeding. Advise pt not to donate
blood. Pt should take as directed; not donate blood during and for 7 mo after tx; know
that hair loss possible; report weight loss, severe GI complaints.

voriconazole (Vfend)
CLASS Triazole antifungal
PREG/CONT D/NA

IND & DOSE Tx of invasive aspergillosis, serious infections caused by susceptible

fungi strains; candidemia in nonneutropenic pts w/ disseminated skin infections
and abd, kidney, bladder wall, and wound infections. Adult: Loading dose, 6 mg/kg
IV q 12 hr for two doses, then 3–4 mg/ kg IV q 12 hr or 200 mg PO q 12 hr. Switch to
PO as soon as possible. 40 kg or more, 200 mg PO q 12 hr; may increase to 300 mg PO q
12 hr if needed. Under 40 kg, 100 mg PO q 12 hr; may increase to 150 mg PO q 12 hr if
needed. Tx of esophageal candidiasis. Adult: 200–300 mg PO q 12 hr (100–150 mg PO
q 12 hr if under 40 kg) for 14 days or for at least 7 days after sx resolution.
ADV EFF Anaphylactic reaction, BP changes, dizziness, headache, hepatotoxicity,
n/v/d, photosensitivity, QT prolongation, rash, Stevens-Johnson syndrome, visual
disturbances
INTERACTIONS Benzodiazepine, calcium channel blockers, cyclosporine, omeprazole, oral
anticoagulants, phenytoin, protease inhibitors, statins, St. John’s wort, sulfonylureas,
tacrolimus, vinblastine, vincristine, warfarin. Do not use w/ carbamazepine, ergot
alkaloids, mephobarbital, phenobarbital, pimozide, quinidine, rifabutin, rifampin,
sirolimus.
NC/PT Obtain baseline ECG, LFTs before, periodically during tx. Review drug list
carefully; many interactions possible. Not for use in pregnancy (contraceptives advised).
Pt should take oral drug on empty stomach 1 hr before or 2 hr after meals; avoid sun
exposure, St. John’s wort; report all drugs/herbs being used, vision changes, urine/stool
color changes.

DANGEROUS DRUG
vorinostat (Zolinza)
CLASS Antineoplastic, histone deacetylase inhibitor
 PREG/CONT D/NA

BBW Monitor for bleeding, excessive n/v, thromboembolic events.

IND & DOSE Tx of cutaneous manifestations in cutaneous T-cell lymphoma. Adult: 400
mg/day PO w/ food; continue until disease progression or unacceptable toxicity.
ADJUST DOSE Hepatic impairment
ADV EFF Anorexia, dehydration, dizziness, GI bleeding, hyperglycemia, n/v/d,
thromboembolic events
INTERACTIONS Warfarin
NC/PT Monitor CBC, electrolytes, serum blood glucose. Give antiemetics if needed.
Encourage fluid intake of 2 L/day to prevent dehydration. Not for use in pregnancy
(barrier contraceptives advised), breast-feeding. Pt should take safety precaution w/
dizziness, use caution in hot environments, maintain hydration, report bloody diarrhea,
numbness/tingling, chest pain, difficulty breathing.

vortioxetine (Brintellix)
CLASS Antidepressant, SSRI
PREG/CONT C/NA

BBW Increased risk of suicidality in children, adolescents, young adults, severely

depressed pts. Limit quantity; monitor pt.
IND & DOSE Tx of major depressive disorder. Adult: 10 mg/day PO. Increase to 20
mg/day PO as tolerated.
ADV EFF Abnormal dreams, activation of mania, constipation, dizziness, dry mouth,
hyponatremia, n/v/d, pruritus, serotonin syndrome, suicidality
INTERACTIONS Antihypertensives, aprepitant, aspirin, bupropion, carbamazepine,
fluoxetine, linezolid, MAOIs, methylene blue (IV), NSAIDs, opioids, paroxetine,
phenytoin, quinidine, rifampin, SSRIs, St. John’s wort
NC/PT Monitor for hyponatremia, activation of mania. Taper when discontinuing. Pt
should take in a.m.; not stop suddenly; avoid pregnancy, breast-feeding, St. John’s wort;
take safety precautions w/ CNS effects; eat small, frequent meals for GI upset; report
rash, mania, severe n/v, thoughts of suicide.

DANGEROUS DRUG
warfarin sodium (Coumadin, Jantoven)
CLASS Coumarin derivative, oral anticoagulant
PREG/CONT X/NA

BBW Evaluate pt regularly for signs of blood loss (petechiae, bleeding gums, bruises,
dark stools, dark urine). Maintain INR of 2–3, 3–4.5 w/ mechanical prosthetic valves or
recurrent systemic emboli; risk of serious to fatal bleeding.
IND & DOSE Tx, px of PE, venous thrombosis; tx of thromboembolic complications of
atrial fibrillation; px of systemic embolization after acute MI. Adult: 2–5 mg/day
PO or IV. Adjust according to PT response. Maint, 2–10 mg/day PO based on INR.
ADJUST DOSE Elderly pts
ADV EFF Alopecia, dermatitis, hemorrhage, n/v/d, priapism, red-orange urine
INTERACTIONS Acetaminophen, alcohol, allopurinol, amiodarone, androgens, angelica,
azole antifungals, barbiturates, carbamazepine, cat’s claw, cefazolin, cefotetan,
cefoxitin, ceftriaxone, chamomile, chloramphenicol, cholestyramine, chondroitin,
cimetidine, clofibrate, co-trimoxazole, danazol, disulfiram, erythromycin, famotidine,
feverfew, fish oil, fluvastatin, garlic, ginkgo, glucagon, goldenseal, grape seed extract,
green leaf tea, griseofulvin, horse chestnut seed, lovastatin, meclofenamate, mefenamic
acid, methimazole, metronidazole, nalidixic acid, nizatidine, NSAIDs, phenytoin,
propylthiouracil, psyllium, quinidine, quinine, quinolones, ranitidine, rifampin,
simvastatin, sulfinpyrazone, thyroid drugs, turmeric, vitamins E, K
NC/PT Genetic testing can help determine reasonable dose. Decreased clearance w/
CYP2C9*2, CYP2C9*3 variant alleles. Monitor blood clotting; target, INR of 2–3. IV use
reserved for situations in which oral warfarin not feasible. Have vitamin K and/or
prothrombin complex concentrate on hand for overdose. Check pt’s drug regimen
closely; many interactions possible. Carefully add, remove drugs from regimen; dose
adjustment may be needed. Not for use in pregnancy (contraceptives advised). Urine
may turn red-orange. Pt should not start, stop any drug, herb without consulting health
care provider (dose adjustments may be needed); have regular blood tests; avoid injury.

zafirlukast (Accolate)
CLASS Antiasthmatic, leukotriene receptor antagonist
PREG/CONT B/NA

IND & DOSEPx, long-term tx of bronchial asthma. Adult, child 12 yr and over: 20 mg PO
bid on empty stomach 1 hr before or 2 hr after meals. Child 5–11 yr: 10 mg PO bid on
empty stomach.
ADV EFF Headache, Churg-Strauss syndrome, dizziness, n/v/d
INTERACTIONS Calcium channel blockers, corticosteroids, cyclosporine, erythromycin,
theophylline, warfarin
NC/PT Not for acute asthma attack. Pt should take on empty stomach q day, consult
health care provider before using OTC products, take safety precautions w/ dizziness,
report severe headache, fever, increased acute asthma attacks.

zaleplon (Sonata)
CLASS Sedative-hypnotic (nonbenzodiazepine)
PREG/CONT C/C-IV

IND & DOSE Short-term tx of insomnia. Adult: 10 mg PO at bedtime. Pt must remain in

bed for 4 hr after taking. Max, 20 mg/day.
ADJUST DOSE Elderly, debilitated pts; hepatic impairment
ADV EFF Anaphylaxis, angioedema, depression, dizziness, drowsiness, headache, short-
term memory impairment, sleep disorders
INTERACTIONS Alcohol, CNS depressants, cimetidine, CYP3A4 inhibitors, rifampin
NC/PT Rule out medical causes for insomnia; institute sleep hygiene protocol. Pt will feel
drug’s effects for 4 hr; after 4 hr, pt may safely become active again. Pt should take dose
immediately before bedtime; avoid alcohol, OTC sleeping aids; take safety precautions
w/ CNS effects; report difficulty breathing, swelling, sleep-related behaviors.

zanamivir (Relenza)
CLASS Antiviral, neuraminidase inhibitor
PREG/CONT C/NA

IND & DOSE Tx of uncomplicated acute illness due to influenza virus. Adult, child 7 yr
and over: 2 inhalations (one 5-mg blister/inhalation administered w/ Diskhaler, for total
10 mg) bid at 12-hr intervals for 5 days. Should start within 2 days of onset of flu sx;
give two doses on first tx day, at least 2 hr apart; separate subsequent doses by 12 hr.
Px of influenza. Adult, child 5 yr and over: Two inhalations (10 mg)/day for 28 days w/
community outbreak, 10 days for household exposure.
ADV EFF Anorexia, bronchospasm, cough, diarrhea, dizziness, headache, nausea, serious
respiratory effects
NC/PT Caution COPD, asthma pts of bronchospasm risk; pt should have fast-acting
bronchodilator on hand. Review proper use of Diskhaler delivery system. Pt should take
full course; if using bronchodilator, use before this drug; take safety precautions w/
dizziness; report worsening of sx.

ziconotide (Prialt)
CLASS Analgesic, N-type calcium channel blocker
PREG/CONT C/NA

BBW Severe neuropsychiatric reactions, neurologic impairment; monitor pt closely. Do

not use w/ hx of psychosis.
IND & DOSE Mgt of severe chronic pain in pts who need intrathecal tx. Adult: 2.4
mcg/day by continuous intrathecal pump; may titrate to max 19.2 mcg/day (0.8
mcg/hr).
ADV EFF Confusion, dizziness, meningitis, nausea, neurologic impairment, nystagmus,
psychotic behavior
NC/PT Teach pt proper care of pump, injection site. Not for use in pregnancy, breast-
feeding. Pt should take safety precautions w/ CNS effects, report changes in mood/
behavior, muscle pain/weakness, rash.

zidovudine (Retrovir)
 CLASSAntiviral
PREG/CONT C/NA

BBW Monitor hematologic indices q 2 wk; hematologic toxicity has occurred. Monitor
LFTs; lactic acidosis w/ severe hepatomegaly possible. Increased risk of symptomatic
myopathy; monitor accordingly.
IND & DOSE Tx of HIV, w/ other antiretrovirals. Adult, child over 12 yr: 600 mg/day PO
in divided doses as either 200 mg tid or 300 mg bid. Monitor hematologic indices q 2
wk. If significant anemia (Hgb under 7.5 g/dL, reduction over 25%) or granulocyte
reduction over 50% below baseline occurs, dose interruption necessary until evidence of
bone marrow recovery. Or, 1 mg/kg five to six times/day IV infused over 1 hr. Child 6
wk–12 yr: 30 kg and over, 600 mg/day PO in two to three divided doses. 9 to under
30 kg, 18 mg/kg/day PO in two to three divided doses. 4 to under 9 kg, 24 mg/kg/day
PO in two to three divided doses. Infant born to HIV-infected mother: 2 mg/kg PO q 6 hr
starting within 12 hr of birth to 6 wk of age, or 1.5 mg/kg IV over 30 min q 6 hr until
able to take oral form. Px of maternal-fetal transmission. Adult: 100 mg PO five
times/day until start of labor.
ADV EFF Agranulocytosis, anorexia, asthenia, diarrhea, flulike sx, GI pain, headache,
nausea, rash
INTERACTIONS Acyclovir, bone marrow suppressants, cyclosporine, cytotoxic drugs,
ganciclovir, interferon alfa, methadone, nephrotoxic drugs, phenytoin, probenecid, St.
John’s wort
NC/PT Do not infuse IV w/ blood product. Pt should take drug around the clock; take
precautions to prevent transmission (drug not a cure); avoid exposure to infection, St.
John’s wort; take w/ other antivirals; report signs of infection, difficulty breathing,
severe headache. Name confusion between Retrovir (zidovudine) and ritonavir; use
caution.

zileuton (Zyflo)
CLASS Antiasthmatic leukotriene synthesis inhibitor
PREG/CONT C/NA

IND & DOSE Px, long-term tx of asthma. Adult, child 12 yr and over: CR tablets, 1,200 mg
(2 tablets) PO bid within 1 hr after a.m., p.m. meals for total daily dose of 2,400 mg.
Tablets, 600 mg PO qid for total daily dose of 2,400 mg.
ADJUST DOSE Hepatic impairment
ADV EFF Diarrhea, dizziness, headache, liver enzyme elevations, neuropsychiatric
events, pain, rash
INTERACTIONS Propranolol, theophylline, warfarin
NC/PT Not for acute asthma attack. Monitor LFTs, mood, behavior. Pt should take daily;
take CR tablets on empty stomach 1 hr before or 2 hr after meals; swallow tablet whole
and not cut, crush, or chew it; take safety precaution w/ CNS effects; report acute
asthma attacks, urine/stool color changes, rash.

ziprasidone (Geodon)
CLASS Atypical antipsychotic, benzisoxazole
PREG/CONT C/NA

BBW Increased risk of death if used in elderly pts w/ dementia-related psychosis. Do not
use in these pts; not approved for this use.
IND & DOSE Tx of schizophrenia. Adult: Initially, 20 mg PO bid w/ food; range, 20–
100 mg PO bid. Rapid control of agitated behavior. Adult: 10–20 mg IM; may repeat
10-mg doses q 2 hr; may repeat 20-mg doses in 4 hr. Max, 40 mg/day. Tx of bipolar
mania. Adult: 40 mg PO bid w/ food. May increase to 60–80 mg PO bid w/ food.
ADV EFF Arrhythmias, constipation, drowsiness, dyspepsia, fever, headache,
hyperglycemia, hypotension, QT prolongation, weight gain
INTERACTIONS Antihypertensives, QT-prolonging drugs, St. John’s wort
NC/PT Obtain baseline, periodic ECG; monitor serum glucose, weight. Not for use in
pregnancy (contraceptives advised). Pt should take safety precautions w/ CNS effects,
avoid St. John’s wort, report palpitations, sx return.

ziv-aflibercept (Zaltrap)
CLASS Antineoplastic, ligand binding factor
PREG/CONT C/NA

BBW Risk of hemorrhage; do not administer w/ active bleeding. Risk of GI perforation,

compromised wound healing. Stop at least 4 wk before elective surgery; do not start
until all surgical wounds healed.
IND & DOSE Tx of metastatic colorectal cancer resistant to oxaliplatin, w/ 5-FU,
leucovorin, irinotecan. Adult: 4 mg/kg IV over 1 hr q 2 wk.
ADV EFF Abd pain, anorexia, dehydration, diarrhea, dysphonia, epistaxis, fatigue,
headache, hepatic impairment, hypertension, neutropenia, proteinuria, RPLS,
thrombotic events
NC/PT Not for use w/ active bleeding; do not use within 4 wk of surgery. Monitor urine
protein, BP, hydration status; watch for s&sx of CV events. Not for use in pregnancy
(barrier contraceptives advised for men, women during and for 3 mo after tx), breast-
feeding. Pt should mark calendar for infusion dates; avoid exposure to infection; report
chest pain, fever, s&sx of infection, difficulty breathing, numbness/tingling, severe
diarrhea.

zoledronic acid (Reclast, Zometa)

CLASS Bisphosphonate, calcium regulator
PREG/CONT D/NA
IND & DOSE Tx of hypercalcemia of malignancy; bone metastases w/ multiple
myeloma. Adult: 4 mg IV as single-dose infusion of not less than 15 min for
hypercalcemia of malignancy w/ albumin-corrected serum calcium of 12 mg/dL or
more. May retreat w/ 4 mg IV if needed. Minimum of 7 days should elapse between
doses w/ careful monitoring of serum creatinine. Pts w/ solid tumors should receive
4 mg IV q 3–4 wk to treat bone metastasis (Zometa). Tx of Paget disease,
postmenopausal osteoporosis, osteoporosis in men; px of new clinical fractures in
pts w/ low-trauma hip fractures; tx, px of glucocorticoid-induced osteoporosis; px
of osteoporosis in postmenopausal women. Adult: 5 mg IV infused via vented
infusion line over at least 15 min. May consider retreatment as needed once q 2 yr for
osteoporosis (Reclast).
ADJUST DOSE Renal impairment
ADV EFF Constipation; coughing; decreased phosphate, magnesium, potassium, calcium
levels; dyspnea; fever; hypotension; infections; insomnia, nephrotoxicity,
osteonecrosis of the jaw
INTERACTIONS Aminoglycosides, loop diuretics, nephrotoxic drugs
NC/PT Do not confuse Reclast, Zometa; dosage varies. Pt should have dental exam before
tx; mark calendar of infusion dates; drink plenty of fluids; take supplemental vitamin D,
calcium; avoid exposure to infection; report difficulty breathing, swelling, jaw pain.

zolmitriptan (Zomig)
CLASS Antimigraine drug, triptan
PREG/CONT C/NA

IND & DOSE Tx of acute migraine attacks. Adult: 2.5 mg PO at onset of headache or w/
beginning of aura; may repeat if headache persists after 2 hr. Max, 10 mg/24 hr. Or, 1
spray in nostril at onset of headache or beginning of aura; may repeat in 2 hr if needed.
Max, 10 mg/24 hr (2 sprays).
ADJUST DOSE Hepatic impairment
ADV EFF BP changes, burning/pressure sensation, chest pain, dizziness, drowsiness,
numbness, QT prolongation, vertigo, weakness
INTERACTIONS Cimetidine, ergots, hormonal contraceptives, MAOIs, QT-prolonging drugs,
sibutramine
NC/PT For acute attack, not for px. Not for use in pregnancy (may make hormonal
contraceptives ineffective; barrier contraceptives advised). Pt should use right after
removing from blister pack; not break, crush, or chew tablet; place orally disintegrating
tablet on tongue, let dissolve; use one spray only if using nasal spray (may repeat after
2 hours if needed); take safety precautions w/ CNS effects; report chest pain, swelling,
palpitations.

zolpidem tartrate (Ambien, Edluar, Intermezzo, Zolpimist)

CLASS Sedative-hypnotic
 PREG/CONT C/C-IV

BBW Risk of suicidality; limit amount dispensed to depressed or suicidal pt.

IND & DOSE Short-term tx of insomnia. Adult: 10 mg PO at bedtime; max, 10 mg/day. ER
tablets, 12.5 mg/day PO. Oral spray, two to three sprays in mouth, over tongue at
bedtime. Short-term tx of insomnia w/ middle-of-night awakening when pt has at
least 4 hr of bedtime left (Intermezzo). Adult: 1.75 mg (women) or 3.5 mg (men)
sublingually; limit to 1.75 mg if also on CNS depressants.
ADJUST DOSE Elderly pts
ADV EFF Anaphylaxis, angioedema, dizziness, drowsiness, hangover, headache, sleep
disorders, suicidality, suppression of REM sleep, vision disorders
NC/PT Limit amount of drug given to depressed pts. Withdraw gradually after long-term
use. Review proper administration of various forms. Pt should take safety precautions
w/ CNS effects, report difficulty breathing, swelling, thoughts of suicide.

zonisamide (Zonegran)
CLASS Antiepileptic
PREG/CONT C/NA

BBW Increased risk of suicidal ideation, suicidality; monitor accordingly.

IND & DOSE Adjuvant tx for partial seizures. Adult, child 16 and over: 100 mg PO daily as
single dose, not divided; may divide subsequent doses. May increase by 100 mg/day q
2 wk to achieve control. Max, 600 mg/day.
ADJUST DOSE Renal impairment
ADV EFF Anorexia, ataxia, decrease in mental functioning, dizziness, dry mouth,
metabolic acidosis, nausea, renal calculi, suicidality, unusual taste
INTERACTIONS Carbamazepine, phenobarbital, phenytoin, primidone
NC/PT Withdraw gradually after long-term use. Pt should drink plenty of fluids, take
safety precautions w/ CNS effects, wear medical ID, report flank pain, urine/stool color
changes, thoughts of suicide.
Patient Safety and Medication Administration
The seven rights of medication administration
Keeping patients safe
Patient and family teaching
Special populations
Avoiding dangerous abbreviations
Reporting medication errors
Guidelines for safe disposal of medications
The seven rights of medication administration

In the clinical setting, the monumental task of ensuring medication safety can be
managed by consistently using the seven rights of drug administration: right drug, right
route, right dose, right time, right patient, right response, and right documentation.

Right drug: Always review a drug order before administering the drug.
Do not assume that a computer system is always right. Always double-check.
Make sure the drug name is correct. Ask for a brand name and a generic name; the
chance of reading the name incorrectly is greatly reduced if both generic and brand
names are used.
Avoid taking verbal or telephone orders whenever possible. If you must, have a
second person listen in to verify and clarify the order.
Consider whether the drug makes sense for the patient’s diagnosis.

Right route: Review the available forms of a drug to make sure the drug can be
given according to the order.
Check the routes available and the appropriateness of the route.
Make sure the patient is able to take the drug by the route indicated.
Do not use abbreviations for routes.

Right dose: Make sure the dose about to be delivered is the dose the prescriber
ordered.
There should always be a 0 to the left of a decimal point, and there should never be
a 0 to the right of a decimal point. If you see an ordered dose that starts with a
decimal point, question it. And if a dose seems much too big, question that.
Double-check drug calculations, even if a computer did the calculations.
Check the measuring devices used for liquid drugs. Advise patients not to use
kitchen teaspoons or tablespoons to measure drug doses.
Do not cut tablets in half to get the correct dose without checking the warnings that
come with the drug.

Right time
Ensure the timely delivery of the patient’s drugs by scheduling dosing with other
drugs, meals, or other consistent events to maintain the serum level.
Teach patients the importance of timing critical drugs. As needed, make detailed
medication schedules and prepare pill boxes.

Right patient: Check the patient’s identification even if you think you know who
the patient is.
Review the patient’s diagnosis, and verify that the drug matches the diagnosis.
Make sure all allergies have been checked before giving a drug.
Ask patients specifically about OTC drugs, vitamin and mineral supplements, herbal
remedies, and routine drugs that they may not think to mention.
 Review the patient’s drug regimen to prevent potential interactions between the
drug you are about to give and drugs the patient already takes.

Right response
Monitor the patient’s response to the drug administered to make sure that the response
is what is anticipated.

Right Documentation: Document according to facility policy.

Include the drug name, dose, route, and time of administration.
Note special circumstances, such as the patient having difficulty swallowing or the
site of the injection.
Include the patient’s response to the drug and any special nursing interventions
that were used.
Remember, “if it isn’t written, it didn’t happen.” Accurate documentation provides
continuity of care and helps prevent medication errors.
The bottom line in avoiding medication errors is simple: “If in doubt, check it out.” A
strange abbreviation, a drug or dosage that is new to you, and a confusing name are all
examples that signal a need for follow-up. Look up the drug in your drug guide or call
the prescriber or the pharmacy to double-check. Never give a drug until you have
satisfied yourself that it is the right drug, given by the right route, at the right dose, at
the right time, and to the right patient.
Keeping patients safe

Patient and family teaching

In today’s world, the patient is usually left to manage on his or her own. The most
important safety check after all is said and done is the patient. Only the patient actually
knows what health care providers he or she is seeing; what prescription drugs, OTC
drugs, and herbal remedies are actually being used; and how they are being used.
Today’s patient needs to be educated about all drugs being taken and empowered to
speak up and protect himself or herself against medication errors.
Medication errors present a constant risk, particularly for patients who take multiple
drugs prescribed by multiple health care providers. Educating the patient is key to
preventing errors.

Patient teaching to prevent medication errors

When being prescribed medications, patients should learn these key points to reduce
the risk of medication errors.
Keep a list: Keep a written list of all the drugs you take, including over-the-
counter drugs, herbal products, and other supplements; carry this list with you
and show it to all your health care providers, including dentists and emergency
personnel. If traveling in a different country, the brand name you are using may
be used for a very different drug; it is important to known the generic name as
well as the brand name. Refer to your list for safety.
Know your drugs: Make sure you know why you take each of your drugs.
Follow the directions: Carefully read the label of each of your drugs, and follow
the directions for taking it safely. Do not stop taking a drug without first
consulting the prescriber. Make a calendar if you take drugs on alternating days.
Using a weekly pillbox may also help to keep things straight.
Store carefully: Always store drugs in a dry place safely out of the reach of
children and pets and away from humidity and heat (the bathroom is a bad
storage area). Make sure to keep all drugs in their original, labeled containers.
Speak up: You, the patient, are the most important member of your health care
team. Never be afraid to ask questions about your health or your treatments.

Special populations
Keeping children safe
Children present unique challenges related to medication errors. Advise the child’s
caregiver to take these steps to prevent medication errors:
Keep a list of all medications you are giving your child, including prescription,
over-the-counter, and herbal medications. Share this list with any health care
provider who cares for your child.
Never use adult medications to treat a child.
Read all labels before giving your child a drug. Check the ingredients and dosage to
 avoid overdose.
Measure liquid medications using appropriate measuring devices.
Call your health care provider immediately if your child seems to get worse or
seems to be having trouble with a drug.
When in doubt, do not hesitate to ask questions. You are your child’s best advocate.

Protecting elderly patients

The elderly population is the most rapidly growing group in our country. Frequently,
these patients have chronic diseases, are on multiple drugs, and have increasing health
problems that can be a challenge to following a drug regimen. They are also more likely
to suffer adverse reactions to drugs and drug combinations.
Advise them to keep a medication list with them to share with all health care
providers and to post a list somewhere in their home for easy access by emergency
personnel.
Prepare drug boxes for the week, draw up injectables (if stable) for the week, and
provide daily reminders to take their medications.
Be an advocate for elderly patients by asking questions, supplying information to
providers, and helping elderly patients stay on top of their drug regimen and
monitor their response.

Protecting women of childbearing age

As a general rule, it is best to avoid taking any drugs while pregnant.
Advise women who may be pregnant to avoid Pregnancy Category X drugs (statins,
hormones) that could cause serious harm to the fetus.
Advise pregnant women to avoid all over-the-counter drugs and herbal therapies
until they have checked with the obstetrician for safety.
Advise pregnant women to question all prescribed drugs and to check carefully to
make sure that the drugs are safe for the fetus.
Advise breast-feeding women to question the safety of prescribed drugs, over-the-
counter drugs, or herbal therapies to make sure that the drugs or therapies will not
adversely affect the baby.
Encourage pregnant women to ask questions. Supply information and be an
advocate for the fetus or newborn child.
Avoiding dangerous abbreviations

Although abbreviations can save time, they also raise the risk of misinterpretation,
which can lead to potentially disastrous consequences, especially when dealing with
drug administration. To help reduce the risk of being misunderstood, always take the
time to write legibly and to spell out anything that could be misread. This caution
extends to how you write numbers as well as drug names and other drug-related
instructions. The Joint Commission is enforcing a growing list of abbreviations that
should not be used in medical records to help alleviate this problem. It is important to
be familiar with the abbreviations used in your clinical area and to avoid the use of any
other abbreviations.

Common dangerous abbreviations

Try to avoid these common—and dangerous—abbreviations, especially those that
appear in bold.
Reporting medication errors

Due to increases in the number of drugs available, the aging population, and more
people taking many drugs, the possibilities for medication errors seem to be increasing.
Institutions have adopted policies for reporting errors, but it is also important to submit
information about errors to national programs. These national programs, coordinated
by the US Pharmacopeia (USP), help to gather and disseminate information about
errors, to prevent their recurrence at other sites and by other providers.

Witnessing an error
If you witness or participate in an actual or potential medication error, it is important
to report that error to the national clearinghouse to ultimately help other professionals
avoid similar errors. The USP maintains one central reporting center, from which it
disseminates information to the FDA, drug manufacturers, and the Institute for Safe
Medication Practices (ISMP). You can report an actual error or potential error by calling
1-800-23-ERROR, the USP Medication Errors Reporting Program. Their office will send
you a mailer to fill out and return to them. Or, you can log on to www.usp.org to report
an error online or to print out the form to mail or fax back to the USP. You may request
to remain anonymous. If you are not sure about what you want to report, you may
report errors to the USP through the ISMP website at www.ismp.org, which also offers a
discussion forum on medication errors.

What kind of errors should be reported?

Errors (or potential errors) to report include administration of the wrong drug or the
wrong strength or dose of a drug, incorrect routes of administration, miscalculations,
misuse of medical equipment, mistakes in prescribing or transcribing (misunderstanding
of verbal orders), and errors resulting from sound-alike or look-alike names. In your
report, you will be asked to include the following:
1. A description of the error or preventable adverse drug reaction. What went
wrong?
2. Was this an actual medication accident or are you expressing concern about a
potential error or writing about an error that was discovered before it reached
the patient?
3. Patient outcome. Did the patient suffer any adverse effects?
4. Type of practice site where the event occurred
5. Generic and brand names of all products involved
6. Dosage form, concentration or strength, and so forth
7. If the error was based on a communication problem, is a sample of the order
available? Are package label samples or pictures available if requested?
8. Your recommendations for error prevention.
The ISMP publishes case studies and publicizes warnings and alerts based on clinician
reports of medication errors. Their efforts have helped to increase recognition of the
many types of errors, such as those involving sound-alike names, look-alike names and
packaging, instructions on equipment and delivery devices, and others.
Guidelines for safe disposal of medications

The White House Office of National Drug Control Policy, the Department of Health and
Human Services, and the Environmental Protection Agency have established guidelines
for the proper disposal of unused, unneeded, or expired medications to promote
consumer safety, block access to them by potential abusers, and protect the water
supply and the environment from possible contamination.

Medical disposal guidelines

Disposing in trash
Take unused, unneeded, or expired medications out of their original containers.
Mix the medication with an undesirable substance, such as coffee grounds or used
kitty litter, and place it in an impermeable, nondescript container, such as an
empty can or a sealable storage bag. These steps help keep the medication from
being diverted for illicit use or being accidentally ingested by children or animals.
Place the closed container in your household trash.

Disposing in toilet
Flush prescription drugs down the toilet only if the accompanying patient
information specifically instructs you to do so.

Disposing at a hospital or government-sponsored site

You may be able to return unused, unneeded, or expired prescription drugs to a
pharmaceutical take-back location that offers safe disposal. Check with your local
hospital, health department, or local government for a site near you.
Appendices
Appendix A: Alternative and complementary therapies
Appendix B: Topical drugs
Appendix C: Ophthalmic drugs
Appendix D: Laxatives
Appendix E: Combination products by therapeutic class
Appendix F: Hormonal contraceptives
Appendix G: Commonly used biologicals
Appendix H: Drugs commonly used to treat specific disorders
Appendix A
Alternative and complementary therapies

Many pts are now using herbs and alternative therapies. Some of these products may
contain ingredients that interact with prescribed drugs. Pt hx of alternative therapy use
may explain unexpected reactions to some drugs. In the chart below, drugs that the
substance interacts with are in bold.

Substance Reported uses, possible risks

acidophilus Oral: px, tx of uncomplicated diarrhea; restoration of intestinal flora.
(probiotics) RISK: warfarin.
alfalfa Topical: healing ointment, relief of arthritis pain.
Oral: tx of arthritis, hot flashes; strength giving; to reduce cholesterol
level.
RISK: warfarin, chlorpromazine, antidiabetics, hormonal
contraceptives, hormone replacement.
allspice Topical: anesthetic for teeth, gums; soothes sore joints, muscles.
Oral: tx of indigestion, flatulence, diarrhea, fatigue.
RISK: iron.
aloe leaves Topical: tx of burns, healing of wounds.
Oral: tx of chronic constipation.
RISK: hypokalemia; spontaneous abortion if used in third trimester.
androstenedione Oral, spray: anabolic steroid to increase muscle mass/strength.
RISK: CV disease, certain cancers.
angelica Oral: “cure all” for gynecologic problems, headaches, backaches,
appetite loss, GI spasms; increases circulation in periphery.
RISK: anticoagulants.
anise Oral: relief of dry cough, tx of flatulence, bloating.
RISK: iron.
apple Oral: blood glucose control, constipation, cancer, heart problems.
RISK: antidiabetics, fexofenadine.
arnica Topical: relief of pain from muscle, soft-tissue injury.
 Oral: immune system stimulant; very toxic to children.
RISK: antihypertensives, anticoagulants, antiplatelet drugs.
ashwagandha Oral: to improve mental, physical functioning; general tonic; to
protect cells during cancer chemotherapy, radiation therapy.
RISK: anticoagulants; thyroid replacement.
astragalus Oral: to increase stamina, energy; to improve immune function,
resistance to disease; tx of URI, common cold.
RISK: antihypertensives.
barberry Oral: antidiarrheal, antipyretic, cough suppressant.
RISK: antihypertensives, antiarrhythmics; spontaneous abortion
if taken during pregnancy.
basil Oral: analgesic, anti-inflammatory, hypoglycemic.
RISK: antidiabetics.
bayberry Topical: to promote wound healing.
Oral: stimulant, emetic, antidiarrheal.
RISK: antihypertensives.
bee pollen Oral: to treat allergies, asthma, ED, prostatitis; suggested use to
decrease cholesterol levels, premenstrual syndrome.
RISK: antidiabetics; bee allergy.
betel palm Oral: mild stimulant, digestive aid.
RISK: MAOIs; beta blockers, digoxin, antiglaucoma drugs.
bilberry Oral: tx of diabetes, diabetic retinopathy, CV problems, cataracts,
night blindness; lowers cholesterol, triglycerides.
RISK: anticoagulants, alcohol.
birch bark Topical: tx of infected wounds, cuts; very toxic to children.
Oral: as tea for relief of stomachache.
blackberry Oral: generalized healing; tx of diabetes.
RISK: antidiabetics.
black cohosh Oral: tx of PMS, menopausal disorders, rheumatoid arthritis.
root Contains estrogen-like components.
RISK: hormone replacement, hormonal contraceptives,
sedatives, antihypertensives, anesthetics, immunosuppressants.
bromelain Oral: tx of inflammation, sports injuries, URI, PMS; adjunct in cancer
treatment.
RISK: n/v/d, menstrual disorders.
burdock Oral: tx of diabetes; atropine-like adverse effects; uterine stimulant.
RISK: antidiabetics.
capsicum Topical: external analgesic.
Oral: tx of bowel disorders, chronic laryngitis, peripheral vascular
disease.
RISK: warfarin, aspirin, ACE inhibitors, MAOIs, sedatives.
catnip leaves Oral: tx of bronchitis, diarrhea.
cat’s claw Oral: tx of allergies, arthritis; adjunct in tx of cancers, AIDS.
Discourage use by transplant recipients, during pregnancy, breast-
feeding.
RISK: oral anticoagulants, antihypertensives.
cayenne pepper Topical: tx of burns, wounds; relief of toothache.
celery Oral: lowers blood glucose, acts as diuretic; may cause potassium
depletion.
RISK: antidiabetics.
chamomile Topical: tx of wounds, ulcers, conjunctivitis.
Oral: tx of migraines, gastric cramps; relief of anxiety, inflammatory
diseases. Contains coumarin; closely monitor pts taking
anticoagulants.
RISK: antidepressants; ragweed allergies.
chaste-tree Oral: tx of PMS, menopausal problems; to stimulate lactation.
berry Progesterone-like effects.
RISK: hormone replacement, hormonal contraceptives.
chicken soup Oral: breaks up respiratory secretions; bronchodilator; relieves
 anxiety.

chicory Oral: tx of digestive tract problems, gout; stimulates bile secretions.

Chinese Oral: general tonic; tx of anemias, PMS, menopausal sx,
angelica (dong antihypertensive, laxative. Use caution with flu, hemorrhagic
quai) diseases.
RISK: antihypertensives, vasodilators, anticoagulants, hormone
replacement.
chondroitin Oral: tx of osteoarthritis, related disorders (usually w/ glucosamine).
RISK: anticoagulants.
chong cao fungi Oral: antioxidant; promotes stamina, sexual function.
Coleus forskohlii Oral: tx of asthma, hypertension, eczema.
RISK: antihypertensives, antihistamines; peptic ulcer.
comfrey Topical: tx of wounds, cuts, ulcers.
Oral: gargle for tonsillitis.
RISK: eucalyptus; monitor LFTs.
coriander Oral: weight loss, lowers blood glucose.
RISK: antidiabetics.
creatine Oral: to enhance athletic performance.
monohydrate RISK: insulin, caffeine.
dandelion root Oral: tx of liver, kidney problems; decreases lactation (after delivery,
w/ weaning); lowers blood glucose.
RISK: antidiabetics, antihypertensives, quinolone antibiotics.
DHEA Oral: slows aging, improves vigor (“Fountain of Youth”); androgenic
side effects.
RISK: alprazolam, calcium channel blockers, antidiabetics.
di huang Oral: tx of diabetes mellitus.
RISK: antidiabetics.
dried root bark Oral: lowers cholesterol, blood glucose.
of Lycium RISK: antidiabetics.
chinense Miller
echinacea (cone Oral: tx of colds, flu; stimulates immune system, attacks viruses;
flower) causes immunosuppression if used long-term. May be hepatotoxic;
discourage use for longer than 12 wk. Discourage use by patients
with SLE, TB, AIDS.
RISK: hepatotoxic drugs, immunosuppressants, antifungals.
elder bark and Topical: gargle for tonsillitis/pharyngitis.
flowers Oral: tx of fever, chills.
ephedra Oral: increases energy, relieves fatigue.
RISK: serious complications, including death; increased risk of
hypertension, stroke, MI; interacts w/ many drugs; banned by
FDA.
ergot Oral: tx of migraine headaches, menstrual problems, hemorrhage.
RISK: antihypertensives.
eucalyptus Topical: tx of wounds.
Oral: decreases respiratory secretions; suppresses cough. Very toxic
in children.
RISK: comfrey.
evening Oral: tx of PMS, menopause, rheumatoid arthritis, diabetic
primrose neuropathy. Discourage use by pts with epilepsy, schizophrenia.
RISK: phenothiazines, antidepressants.
false unicorn Oral: tx of menstrual, uterine problems. Not for use in pregnancy,
root breast-feeding.
fennel Oral: tx of colic, gout, flatulence; enhances lactation.
RISK: ciprofloxacin.
fenugreek Oral: lowers cholesterol level; reduces blood glucose; aids in healing.
RISK: antidiabetics, anticoagulants.
feverfew Oral: tx of arthritis, fever, migraine. Not for use if surgery planned.
RISK: anticoagulants.
fish oil Oral: tx of coronary diseases, arthritis, colitis, depression,
aggression, attention deficit disorder.
garlic Oral: tx of colds; diuretic; px of CAD; intestinal antiseptic; lowers
blood glucose; anticoagulant effects; decreases BP; anemia.
RISK: antidiabetics.
ginger Oral: tx of nausea, motion sickness, postop nausea (may increase
risk of miscarriage).
RISK: anticoagulants.
ginkgo Oral: vascular dilation; increases blood flow to brain, improving
cognitive function; tx of Alzheimer disease; antioxidant. Can inhibit
blood clotting. Seizures reported w/ high doses.
RISK: anticoagulants, aspirin, NSAIDs, phenytoin,
carbamazepine, phenobarbital, TCAs, MAOIs, antidiabetics.
ginseng Oral: aphrodisiac, mood elevator, tonic; antihypertensive; decreases
cholesterol levels; lowers blood glucose; adjunct in cancer
chemotherapy, radiation therapy. May cause irritability if used w/
caffeine. Inhibits clotting.
RISK: anticoagulants, aspirin, NSAIDs, phenelzine, MAOIs,
estrogens, corticosteroids, digoxin, antidiabetics.
glucosamine Oral: tx of osteoarthritis, joint diseases; usually w/ chondroitin.
RISK: diabetic pts.
goldenrod Oral: tx of renal disease, rheumatism, sore throat, eczema.
leaves RISK: diuretics.
goldenseal Oral: lowers blood glucose, aids healing; tx of bronchitis, colds,
flulike sx, cystitis. May cause false-negative results in pts using drugs
such as marijuana, cocaine. Large amounts may cause paralysis;
overdose can cause death.
RISK: anticoagulants, antihypertensives, acid blockers,
barbiturates, sedatives.
gotu kola Topical: chronic venous insufficiency.
 RISK: antidiabetics, cholesterol-lowering drugs, sedatives.

grape seed Oral: tx of allergies, asthma; improves circulation; decreases platelet

extract aggregation.
RISK: anticoagulants.
green tea leaf Oral: antioxidant; to prevent cancer, CV disease; to increase
cognitive function (caffeine effects).
RISK: anticoagulants, milk.
guarana Oral: decreases appetite; promotes weight loss; increases BP, risk of
CV events.
guayusa Oral: lowers blood glucose; promotes weight loss.
RISK: antihypertensives, iron, lithium.
hawthorn Oral: tx of angina, arrhythmias, BP problems; decreases cholesterol.
RISK: digoxin, ACE inhibitors, CNS depressants.
hop Oral: sedative; aids healing; alters blood glucose.
RISK: CNS depressants, antipsychotics.
horehound Oral: expectorant; tx of respiratory problems, GI disorders.
RISK: antidiabetics, antihypertensives.
horse chestnut Oral: tx of varicose veins, hemorrhoids, venous insufficiency.
seed RISK: anticoagulants.
hyssop Topical: tx of cold sores, genital herpes, burns, wounds.
Oral: tx of coughs, colds, indigestion, flatulence. Toxic in children,
pets.
RISK: pregnancy, pts w/ seizures.
jambul Oral: tx of diarrhea, dysentery; lowers blood glucose.
RISK: CNS depressants, Java plum.
Java plum Oral: tx of diabetes mellitus.
RISK: antidiabetics.
jojoba Topical: promotion of hair growth; relief of skin problems. Toxic if
ingested.
juniper berries Oral: increases appetite, aids digestion; diuretic; urinary tract
disinfectant; lowers blood glucose.
RISK: Antidiabetics; pregnancy.
kava Oral: tx of nervous anxiety, stress, restlessness; tranquilizer. Warn
against use with alprazolam; may cause coma. Advise against use
with Parkinson disease, hx of stroke. Risk of serious hepatotoxicity.
RISK: St. John’s wort, anxiolytics, alcohol.
kudzu Oral: reduces alcohol craving (undergoing research for use w/
alcoholics).
RISK: anticoagulants, aspirin, antidiabetics, CV drugs.
lavender Topical: astringent for minor cuts, burns. Oil potentially poisonous.
Oral: tx of insomnia, restlessness.
RISK: CNS depressants.
ledum tincture Topical: tx of insect bites, puncture wounds; dissolves some blood
clots, bruises.
licorice Oral: px of thirst; soothes coughs; treats “incurable” chronic fatigue
syndrome; tx of duodenal ulcer. Acts like aldosterone. Blocks
spironolactone effects. Can lead to digoxin toxicity because of
aldosterone-lowering effects; advise extreme caution.
RISK: thyroid drugs, antihypertensives, hormonal
contraceptives; renal/liver disease, hypertension, CAD, pregnancy,
breast-feeding.
ma huang Oral: tx of colds, nasal congestion, asthma. Contains ephedrine.
RISK: antihypertensives, antidiabetics, MAOIs, digoxin.
mandrake root Oral: tx of fertility problems.
marigold leaves Oral: relief of muscle tension; increases wound healing.
and flowers RISK: pregnancy, breast-feeding.
melatonin Oral: relief of jet lag; tx of insomnia.
RISK: antihypertensives, benzodiazepines, beta blockers,
methamphetamine.
milk thistle Oral: tx of hepatitis, cirrhosis, fatty liver caused by alcohol/drug use.
RISK: drugs using CP450, CYP3A4, CYP2C9 systems.

milk vetch Oral: improves resistance to disease; adjunct in cancer

chemotherapy, radiation therapy.
mistletoe leaves Oral: promotes weight loss; relief of s&sx of diabetes.
RISK: antihypertensives, CNS depressants, immunosuppressants.
Momordica Oral: blocks intestinal absorption of glucose; lowers blood glucose;
charantia weight loss.
(Karela) RISK: antidiabetics.
nettle Topical: stimulation of hair growth, tx of bleeding.
Oral: tx of rheumatism, allergic rhinitis; antispasmodic; expectorant.
RISK: diuretics; pregnancy, breast-feeding.
nightshade Oral: stimulates circulatory system; tx of eye disorders.
leaves and roots
octacosanol Oral: tx of parkinsonism, enhancement of athletic performance.
RISK: carbidopa-levodopa; pregnancy, breast-feeding.
parsley seeds Oral: tx of jaundice, asthma, menstrual difficulties, urinary
and leaves infections, conjunctivitis.
RISK: SSRIs, lithium, opioids, antihypertensives.
passionflower Oral: sedative-hypnotic.
vine RISK: CNS depressants, MAOIs, alcohol, anticoagulants.
peppermint Topical: rubbed on forehead to relieve tension headaches.
leaves Oral: tx of nervousness, insomnia, dizziness, cramps, coughs.
psyllium Oral: tx of constipation; lowers cholesterol. Can cause severe gas,
stomach pain. May interfere w/ nutrient absorption.
RISK: warfarin, digoxin, lithium, oral drugs, laxatives.
raspberry Oral: healing of minor wounds; control, tx of diabetes, GI disorders,
upper respiratory disorders.
RISK: antidiabetics; alcohol.
red clover Oral: estrogen replacement in menopause; suppresses whooping
cough; asthma.
RISK: anticoagulants, antiplatelets; pregnancy.
red yeast rice Oral: lowers cholesterol.
RISK: cyclosporine, fibric acid, niacin, lovastatin, grapefruit
juice.
rose hips Oral: laxative; to boost immune system, prevent illness.
RISK: estrogens, iron, warfarin.
rosemary Topical: relief of rheumatism, sprains, wounds, bruises, eczema.
Oral: gastric stimulation; relief of flatulence, colic; stimulation of bile
release.
RISK: alcohol.
rue extract Topical: relief of pain associated w/ sprains, groin pulls, whiplash.
RISK: antihypertensives, digoxin, warfarin.
saffron Oral: tx of menstrual problems; abortifacient.
sage Oral: lowers BP, blood glucose.
RISK: antidiabetics, anticonvulsants, alcohol.
SAM-e (adomet) Oral: promotion of general well-being, health. May cause frequent
GI complaints, headache.
RISK: antidepressants.
sarsaparilla Oral: tx of skin disorders, rheumatism.
RISK: anticonvulsants.
sassafras Topical: tx of local pain, skin eruptions.
Oral: enhancement of athletic performance, “cure” for syphilis. Oil
may be toxic to fetus, children, adults when ingested. Interacts
with many drugs.
saw palmetto Oral: tx of BPH.
RISK: estrogen-replacement, hormonal contraceptives, iron,
finasteride.
schisandra Oral: health tonic, liver protectant; adjunct in cancer chemotherapy,
radiation therapy.
RISK: drugs metabolized in liver; pregnancy (causes uterine
stimulation).
squaw vine Oral: diuretic, tonic; aid in labor, delivery; tx of menstrual problems.
RISK: digoxin, alcohol.
St. John’s wort Topical: tx of puncture wounds, insect bites, crushed fingers/toes.
Oral: tx of depression, PMS symptoms; antiviral. Discourage
tyramine-containing foods; hypertensive crisis possible.
Thrombocytopenia has occurred. Can increase light sensitivity;
advise against taking w/ drugs causing photosensitivity. Severe
photosensitivity possible in light-skinned people.
RISK: SSRIs, MAOIs, kava, digoxin, theophylline, AIDS
antivirals, sympathomimetics, antineoplastics, hormonal
contraceptives.
sweet violet Oral: tx of respiratory disorders; emetic.
flowers RISK: laxatives.
tarragon Oral: weight loss; prevents cancer; lowers blood glucose.
RISK: antidiabetics.
tea tree oil Topical: antifungal, antibacterial; tx of burns, insect bites, irritated
skin, acne; mouthwash.
thyme Topical: liniment, gargle; tx of wounds.
Oral: antidiarrheal; relief of bronchitis, laryngitis. May increase light
sensitivity; warn against using w/ photosensitivity-causing drugs.
RISK: MAOIs, SSRIs.
turmeric Oral: antioxidant, anti-inflammatory; tx of arthritis. May cause GI
distress. Warn against use w/ known biliary obstruction.
RISK: oral anticoagulants, NSAIDs, immunosuppressants.

valerian Oral: sedative-hypnotic; reduces anxiety, relaxes muscles. Can cause

 severe liver damage.
RISK: barbiturates, alcohol, CNS depressants, benzodiazepines,
antihistamines.
went rice Oral: cholesterol-, triglyceride-lowering effects. Warn against use in
pregnancy, liver disease, alcoholism, acute infection.
white willow Oral: tx of fevers.
bark RISK: anticoagulants, NSAIDs, diuretics.
xuan shen Oral: lowers blood glucose; slows heart rate; tx of HF.
RISK: antidiabetics.
yohimbe Oral: tx of ED. Can affect BP; CNS stimulant. Has cardiac effects.
Manic episodes have occurred in psychiatric pts.
RISK: SSRIs, tyramine-containing foods, TCAs.
Appendix B
Topical drugs

Topical drugs are intended for surface use, not ingestion or injection. They may be very
toxic if absorbed into the system, but they serve several purposes when used topically.
PREG/CONT C
ADV EFF Burning, dermatitis, local irritation (common), stinging, toxic effects if absorbed
systemically
NC/PT Apply sparingly to affected area as directed. Do not use w/ open wounds, broken
skin. Avoid contact w/ eyes. Pt should report local irritation, allergic reaction,
worsening of condition.

Acne, rosacea, melasma products

adapalene (Differin): Not for use under 12 yr. Avoid use on sunburned skin, w/ other
products, sun exposure. Apply thin film to affected area after washing q night at
bedtime. Available as cream, gel; 0.1%, 0.3% conc.

alitretinoin (Panretin): Tx of lesions of Kaposi sarcoma (1% gel). Apply as needed bid
to cover lesions. Photosensitivity common. Inflammation, peeling, redness possible.
Pregnancy Category D.

azelaic acid (Azelex, Finacea): Wash, dry skin. Massage thin layer into affected area
bid. Wash hands thoroughly after applying. Improvement usually within 4 wk. Initial
irritation usual; passes with time.

brimonidine (Mirvaso): Tx of persistent facial erythema of rosacea in adult. Apply

pea-size amount to forehead, chin, cheeks daily. Risk of vascular insufficiency. Wash
hands immediately after application; do not ingest.

clindamycin (Clindesse, Evoclin): Tx of bacterial vaginitis (2% vaginal cream): One

applicatorful (100 mg) vaginally at any time of day. Tx of acne vulgaris (1% foam):
Apply once daily to affected areas that have been washed, are fully dry.

clindamycin/benzoyl peroxide (Acanya, BenzaClin): Apply gel to affected areas bid.

Wash area, pat dry before applying.

clindamycin/tretinoin (Veltin, Ziana): Rub pea-size amount over entire face once
daily at bedtime. Not for use in colitis. Avoid sun exposure.

dapsone (Aczone Gel): Apply thin layer to affected areas bid. Closely follow Hgb,
reticulocyte count in pts w/ G6PD deficiencies.

fluocinolone acetonide/hydroquinone/tretinoin (Tri-Luma): Do not use in

pregnancy. Apply to depigmented area of melasma once each p.m. at least 30 min
before bedtime after washing, patting dry; avoid occlusive dressings. Use sunscreen,
protective clothing if outside (skin dryness, peeling possible).

ingenol mebutate (Picato): Tx of acne: Apply 0.015% gel once daily to face/scalp for
5 days. Apply 0.05% gel once daily to trunk/extremities for 2 days.

metronidazole (MetroCream, MetroGel, MetroLotion, Noritate): Tx of rosacea.

Apply cream to affected area bid.

sodium sulfacetamide (Klaron): Apply thin film to affected area bid. Wash affected
area w/ mild soap, water; pat dry. Avoid use in denuded, abraded areas.

tazarotene (Fabior, Tazorac): Tx of psoriasis. Avoid use in pregnancy. Apply thin film
once daily in p.m. Do not use with irritants, products w/ high alcohol content. Drying
causes photosensitivity.

tretinoin 0.025% cream (Avita): Apply thin layer once daily. Discomfort, peeling,
redness possible first 2–4 wk. Worsened acne possible in first few wk.

tretinoin 0.05% cream (Renova): To remove fine wrinkles. Apply thin coat in p.m.

tretinoin gel (Retin-A* Micro): Apply to cover once daily after washing. Inflammation
exacerbation possible initially. Therapeutic effects usually seen in first 2 wk.

Analgesics
capsaicin (Axsain, Capsin, Capzasin, Icy Hot PM, No Pain-HP, Pain Doctor, Zostrix,
Zostrix-HP): Local pain relief for osteoarthritis, rheumatoid arthritis, neuralgias. Apply
no more than tid–qid. Do not bandage tightly. Consult physician if condition worsens or
persists after 14–28 days. Qutenza: Apply patch to relieve postherpetic neuralgia pain.

Antibiotics
ciprofloxacin/dexamethasone (Ciprodex), ciprofloxacin/hydrocortisone (Cipro-HC
Otic Drops): Apply to ears of child w/ acute otitis media and tympanostomy tubes;
apply to outer ear canal for acute otitis externa. Use bid for 7 days.

mupirocin (Bactroban, Centany): Tx of impetigo caused by susceptible strains. Apply

small amt to affected area tid; may cover with gauze dressing. Risk of superinfection.

mupirocin calcium (Bactroban Nasal): To eradicate nasal colonization of MRSA.

Apply ½ of oint from single-use tubes between nostrils bid for 5 days.

retapamulin (Altabax): Tx of impetigo in pts 9 mo and older. Apply thin layer to

affected area bid for 5 days.

Anti-diaper-rash drug

miconazole/zinc oxide/petrolatum (Vusion): Culture for Candida before tx. Apply

gently for 7 days; change diapers frequently, wash gently.

Antifungals
butenafine hydrochloride (Mentax): Tx of athlete’s foot; tinea corporis, cruris;
ringworm. Apply once/day for 4 wk.

ciclopirox (Loprox, Penlac Nail Lacquer): Tx of onychomycosis of fingernails, toenails

in immunosuppressed pts. Apply directly to nails.

clotrimazole (Cruex, Desenex, Lotrimin, Mycelex): Clean area; gently massage in up

to bid for max 4 wk.

econazole (Spectazole): Apply daily or bid for 2–4 wk. Clean area before applying.
Change socks at least once/day for athlete’s foot.

gentian violet (generic): Apply locally up to bid. Do not apply to active lesions. Will
stain skin, clothing.

ketoconazole (Extina, Nizoral, Xolegel): Available as cream, foam, gel, shampoo. Use
as shampoo daily.

luliconazole (Luzu): Tx of tinea cruris, tinea corporis. Apply to affected area once a
day for 1 wk, 2 wk for interdigital tinea pedis.

naftifine hydrochloride (Naftin): Gently massage in bid for no more than 4 wk. Avoid
occlusive dressings. Wash hands thoroughly after applying.

oxiconazole (Oxistat): Apply q day to bid for max 1 mo.

sertaconazole (Ertaczo): Apply between toes, to surrounding tissue bid for 4 wk.

terbinafine (Lamisil): Apply bid for 1–4 wk. Avoid occlusive dressings. Stop if local
irritation.

tolnaftate (Absorbine, Tinactin): Apply small amount bid for 2–3 wk; 4–6 wk if skin
very thick. Clean, dry area before use. Change socks qid.

Antihistamine
azelastine hydrochloride (Astelin, Astepro): 2 sprays/nostril bid. Do not use w/
alcohol, OTC antihistamines; dizziness, sedation possible.

Antipsoriatics
anthralin (Balnetar, Dritho-Cream HP, Fototar, Zithranol): Apply daily; use
protective dressings. Avoid contact w/ eyes. May stain fabric, skin, hair, fingernails.

calcipotriene (Dovonex): Apply thin layer q day or bid. Monitor calcium with extended
use.

calcipotriene/betamethasone (Taclonex, Taclonex Scalp): Apply q day for 4 wk.

Max, 100 g/wk. Avoid occlusive dressings. Limit to 30% of body area.

Antiseborrheic
selenium sulfide (Selsun Blue): Massage 5–10 mL into scalp, leave on 2–3 min, rinse;
repeat. May damage jewelry.

Antiseptics
benzalkonium chloride (Benza, Mycocide NS, Zephiran): Mix in sol. Spray preop
area; store instruments in sol (add antirust tablets). Rinse detergents, soaps from skin
before use.

chlorhexidine gluconate (BactoShield, Dyna-Hex, Exidine, Hibistat): For surgical

scrub, preop skin prep, wound cleansing. Scrub, leave on for 15 sec (3 min for surgical
scrub), rinse.

hexachlorophene (pHisoHex): For surgical wash, scrub. Do not use on mucous

membranes, w/ burns. Rinse thoroughly. Not for routine bathing of infants.

iodine (generic): Wash area w/ sol. Highly toxic. Avoid occlusive dressings. Stains skin,
clothing.

povidone iodine (ACU-Dyne, Betadine, Betagen, Exodine, Iodex, Minidyne,

Operand, Polydine): Less irritating than iodine. May bandage area. May inactivate
HIV.

sodium hypochlorite (Dakin’s solution): Apply as antiseptic. Chemical burns possible.

Antivirals
acyclovir (Zovirax): Apply 0.5-inch ribbon, rub in gently six times/day for 7 days.
acyclovir/hydrocortisone (Xerese): Tx of cold sores in pts 6 yr and older. Apply five
times/day for 5 days.

docosanol (Abreva): Tx of oral, facial herpes simplex cold sores. Apply five times/day
for 10 days. Do not overuse.

imiquimod (Aldara): Tx of external genital, perianal warts: Apply thin layer three
times/week at bedtime for up to 16 wk; remove with soap, water after 6–10 hr. Tx of
nonhyperkeratotic actinic keratosis on face, scalp in immunosuppressed pts: Apply
before bed for 16 wk. Tx of superficial basal cell carcinoma in immunosuppressed pts:
10–40 mg applied to lesion five times/wk at bedtime for 6 wk.

imiquimod (Zyclara): Tx of nonhyperkeratotic, nonhypertrophic actinic keratoses on

face, balding scalp: Apply daily at bedtime for 2 wk, then 2 wk of no tx. May repeat. Tx
of genital, perianal warts in pts 12 yr and older: Apply daily.

kunecatechins (Veregen): External tx of genital, perianal warts in pts 18 yr and older.

Apply to each wart tid for 16 wk. Do not cover tx area.

penciclovir (Denavir): Tx of cold sores on lips, face. Apply thin layer q 2 hr while
awake for 4 days.

Burn tx
mafenide (Sulfamylon): Apply to clean, dry, debrided wound q day or bid. Cover at all
times w/ drug. Monitor for infection, acidosis. Pretreat for pain.

silver sulfadiazine (Silvadene, SSD Cream, Thermazene): Apply q day to bid using
1/16-inch thickness. Dressings not necessary. Monitor for fungal infection.

Corticosteroids for inflammatory disorders

alclometasone dipropionate (Aclovate): 0.05% oint, cream

beclomethasone (Beconase AQ, Qnasl): Nasal spray for rhinitis

betamethasone dipropionate: 0.05% oint, cream, gel, lotion, aerosol

betamethasone dipropionate augmented (Diprolene, Diprolene AF): 0.05% oint,

cream, lotion

betamethasone valerate (Beta-Val, Luxiq, Valisone): 0.1% oint, cream, lotion;

0.12% foam

ciclesonide (Alvesco, Omnaris, Zetonna): 80 or 160 mcg/actuation as nasal spray or

for inhalation

clobetasol propionate (Clobex, Cormax, Olux, Temovate): 0.05% spray, oint, cream,
foam, gel

clocortolone pivalate (Cloderm): 0.1% cream

desonide (DesOwen, Verdeso): 0.05% oint, lotion, cream, foam

desoximetasone (Topicort): 0.25% oint, cream

dexamethasone (Aeroseb-Dex): 0.05% cream, gel

diflorasone diacetate (Florone, Florone E, Maxiflor, Psorcon E): 0.1% cream

fluocinolone acetate (Fluonid, Synalar): 0.05% oint, cream; 0.01% sol

fluocinonide (Fluonex, Lidex, Vanos): 0.025% cream, oint; 0.01% cream; 0.05%
cream, oint, gel, sol, 0.1% cream

flurandrenolide (generic): 0.05% cream, lotion, oint; tape, 4 mcg/cm2

fluticasone fumarate (Veramyst): 35 mcg/spray nasal spray

fluticasone propionate (Cutivate): 0.05% cream, 0.005% oint

halcinonide (Halog): 0.1% oint, cream, sol

halobetasol propionate (Ultravate): 0.05% oint, cream

hydrocortisone (Bactine Hydrocortisone, Cort-Dome, Dermolate, Dermtex HC,

Cortizone-10, Hycort, Tegrin-HC, Hytone): 0.25%, 0.5%, 1%, 2%, 2.5 % cream,
lotion, oint, sol

hydrocortisone acetate (Anusol-HCL, Cortaid, Cortaid with Aloe, Gynecort,

Lanacort-5): 0.5%, 1% cream, oint

hydrocortisone buteprate (generic): 0.1% cream

hydrocortisone butyrate (Locoid): 0.1% oint, cream

hydrocortisone valerate (Westcort): 0.2% oint, cream

mometasone furoate (Asmanex Twisthaler, Elocon, Nasonex): 220 mcg/actuation

powder for oral inhalation; 0.1% oint, cream, lotion; 0.2% nasal spray
prednicarbate (Dermatop): 0.1% cream

triamcinolone acetonide (Triacet, Triderm): 0.1% cream, lotion; 0.025% lotion

Emollients
dexpanthenol (Panthoderm): To relieve itching, aids in healing skin irritation; q day
to bid.

urea (Aquacare; Carmol 10, 20, 40; Gordon’s Urea 40%; Nutraplus; Ureacin 10,
20): Rub in bid–qid.

vitamins A, D (generic): To relieve minor burns, chafing, skin irritation. bid–qid for up
to 7 days.

zinc oxide (Borofax Skin Protectant): To relieve burns, abrasions, diaper rash. Apply
PRN.

Estrogen
estradiol hemihydrate (Vagifem): Tx of atrophic vaginitis. One tablet/day vaginally
for 2 wk, then 1 tablet two times/wk. Taper over 3–6 mo.

Growth factor
becaplermin (Regranex): Adjunct tx of diabetic foot ulcers. Must have adequate blood
supply. Risk of cancer with long-term use.

Hair removal product

eflornithine (Vaniqa): For women only. Apply to unwanted facial hair bid for 24 wk;
do not wash treated area for 4 hr.

Hemostatics
absorbable gelatin (Gelfoam): Add 3–4 mL sterile saline to contents of jar; smear or
press to cut surface. Assess for infection; do not use if area infected.

absorbable fibrin sealant (TachoSil): For CV surgery when usual techniques to control
bleeding ineffective. Apply yellow side of patches directly to bleeding area. Do not use
intravascularly or with known hypersensitivity to human blood products, horse protein.

human fibrin sealant (Artiss, Evicel, Tisseel): Adjunct to decrease bleeding in

vascular, liver surgery; to adhere autologous skin grafts for burns. Spray or drip onto
tissue in short bursts to produce thin layer; may use second layer.
microfibrillar collagen (Hemopad): Apply dry directly to bleeding source. Monitor for
infection. Remove any excess material once bleeding stopped.

thrombin (Thrombinar, Thrombostat): 100–1,000 units/mL. Prepare in sterile

distilled water or isotonic saline. Mix freely with blood on surface of injury; watch for
allergic reactions.

thrombin, recombinant (Recothrom): Apply directly to bleeding site w/ absorbable

gelatin sponge; reserve for minor bleeds. Not for use w/ hamster, snake protein
allergies.

Immunomodulator
pimecrolimus (Elidel): Tx of mild to moderate atopic dermatitis in
nonimmunosuppressed pts over 2 yr. Apply bid.

Keratolytics
podofilox (Condylox): Apply to dry skin q 12 hr for 3 days.

podophyllum resin (Podocon-25, Podofin): Use minimum possible for wart removal;
very toxic.

Local anesthetic
lidocaine/tetracaine (Synera): Dermal analgesia for superficial venous access,
dermatologic procedures. One patch to intact skin 20–30 min before procedure.

Lotions, solutions

Burow’s solution aluminum acetate (Domeboro Powder): Astringent wet dressing

for inflammatory conditions, insect bites, athlete’s foot, bruises. Dissolve packet, tablet
in pint of water; apply q 15–30 min for 4–8 hr.

calamine lotion (generic): To relieve topical itching. Apply tid–qid.

hamamelis water (A-E-R, Witch Hazel): To relieve itching of vaginal infection,

hemorrhoids; post-episiotomy, post hemorrhoidectomy care. Apply locally six times/day.

Nasal corticosteroid
fluticasone propionate (Flonase, Flovent Diskus, Flovent HFA): Px of asthma in pts
over 4 yr. Two sprays/nostril/day or 88–220 mcg bid using inhalation device, nasal
inhalation.
Oral preparation

amlexanox (Aphthasol): Apply sol or mucoadhesive disc to each aphthous ulcer qid for
10 days. Consult dentist if not healed in 10 days.

Pediculicides, scabicides

benzyl alcohol (generic): Tx of head lice in pts 6 mo and older. Apply 5% lotion to
scalp, hair near scalp.

crotamiton (Eurax): Massage into skin of entire body; repeat in 24 hr. Bathe 48 hr
after use. Change bed linens, clothing; wash in hot water, dry clean.

ivermectin (Sklice): Tx of head lice in pts 6 mo and older. Apply 0.5% lotion once to
head for 10 min; no need for nit picking.

lindane (generic): Apply thin layer to entire body, leave on 8–12 hr, then wash
thoroughly. For shampoo, 2 oz into dry hair, leave on 4 min, then rinse. Reapply in 7
days if needed.

malathion (Ovide Lotion): Apply to dry hair, leave on 8–12 hr, rinse. Repeat in 7–9
days. Contains flammable alcohol.

permethrin (Acticin, Elimite, Nix): Thoroughly massage into skin, wash off after 8–14
hr. For shampoo, work into freshly washed, towel-dried hair, leave on 10 min, then
rinse.

spinosad (Natroba): Tx of head lice in pts 4 yr and older. Apply to dry scalp, leave on
10 min, rinse. May repeat q 7 days.
Appendix C
Ophthalmic drugs

Ophthalmic drugs are intended for direct administration into the conjunctiva of the eye.
IND & DOSE Tx of glaucoma; to aid in dx of eye problems; tx of local ophthalmic
infection, inflammation; to relieve s&sx of allergic reactions. Adult, child: 1–2 drops
to each eye bid–qid, or 0.25–0.5 inch oint to each eye.
PREG/CONT C/NA
ADV EFF Blurred vision (prolonged w/ oint), burning, local irritation, stinging, tearing;
headache
NC/PT Sol, drops: Wash hands thoroughly before giving; do not touch dropper to eye or
other surface; have pt tilt head back or lie down and stare upward. Gently grasp lower
eyelid; pull eyelid away from eyeball. Instill drop(s) into pouch formed by eyelid;
release lid slowly. Have pt close eye, look downward. Apply gentle pressure to inside
corner of eye for 3–5 min to retard drainage. Pt should not rub eyes, rinse eyedropper;
avoid eyedrops that have changed color; separate administration by 5 min if more than
one type of eyedrop used.
Oint: Wash hands thoroughly before giving; hold tube between hands for several min to
warm; discard first cm of oint when opening tube for first time. Have pt tilt head back
or lie down and stare upward. Gently pull out lower lid to form pouch; place 0.25–0.5
inch oint inside lower lid. Have pt close eyes for 1–2 min, roll eyeball in all directions.
Remove excess oint from around eye. Separate administration by 10 min if using more
than one kind of oint. Transient stinging, burning, blurred vision possible; pt should
take appropriate safety measures. Sun sensitivity w/ mydriatic agents (pupils will
dilate); pt may need sunglasses. Pt should report severe eye discomfort, palpitations,
nausea, headache.

alcaftadine (Lastacaft): Px of itching associated w/ allergic conjunctivitis. 1 drop in

each eye daily. Remove contacts. Not for tx of contact lens irritation.

apraclonidine (Iopidine): To control, prevent postop IOP elevation after argon-laser

surgery; short-term adjunct tx in pts on max tolerated tx who need additional IOP
reduction. Monitor for possible vasovagal attack. Do not give to pts w/ clonidine
allergy.

azelastine hydrochloride (Optivar): Tx of ocular itching associated w/ allergic

conjunctivitis in pts 3 yr and older. Antihistamine, mast cell stabilizer. 1 drop bid. Rapid
onset, 8-hr duration.

azithromycin (Azasite): Tx of bacterial conjunctivitis in pts 1 yr and older. 1 drop bid

8–12 hr apart for 2 days, then once/day for 5 days.

bepotastine besilate (Bepreve): Tx of ocular itching from allergic rhinitis in pts 2 yr

and older. Apply bid.

besifloxacin (Besivance): Tx of pink eye: 1 drop tid for 7 days (Besivance).

bimatoprost (Latisse, Lumigan): Tx of open-angle glaucoma, ocular hypertension: 1

drop daily in p.m. Tx of hypertrichosis of eyelashes: 1 drop each p.m.; iris darkening
possible (Latisse).

brimonidine tartrate (Alphagan P): Tx of open-angle glaucoma, ocular hypertension.

1 drop tid. May stain contacts. Do not use w/ MAOIs.

brimonidine/timolol (Combigan): Tx of increased IOP. 1 drop q 12 hr. Do not wear

contacts.

brinzolamide (Azopt): To decrease IOP in open-angle glaucoma. 1 drop tid; give 10

min apart from other drops.

bromfenac (Bromday, Xibrom): Tx of postop inflammation, pain after cataract

extraction. 1 drop bid starting 24 hr after surgery and for 2 wk; once/day w/ Bromday.

carbachol (Miostat): Tx of glaucoma, miosis during surgery. 1–2 drops tid for
glaucoma, one dose before surgery.

carteolol (generic): Tx of elevated IOP in open-angle glaucoma. 1 drop bid; monitor

IOP closely.

ciprofloxacin (Ciloxan): Tx of ocular infections, conjunctivitis: Apply ¼-inch ribbon to

eye sac tid for 2 days, then bid for 5 days, or 1–2 drops q 2 hr while awake for 2 days,
then q 4 r for 5 days.

cyclopentolate (AK-Pentolate, Cyclogyl, Paremyd): Diagnostic procedures. Pts w/

dark irises may need higher doses. Compress lacrimal sac for 2–3 min after giving.

cyclosporine emulsion (Restasis): To increase tear production. 1 drop in each eye bid
approximately 12 hr apart. Remove contacts before use.

dexamethasone intravitreal (Ozurdex): Tx of macular edema after branch retinal

artery, central retinal vein occlusion; tx of noninfectious uveitis of posterior segment of
eye. Intravitreal injection. Monitor for infection, retinal detachment.

diclofenac sodium (Voltaren): Tx of photophobia in pts undergoing incisional

refractive surgery; tx of postop ocular inflammation. 1 drop qid starting 24 hr after
surgery and for 2 wk, or 1–2 drops within 1 hour of corneal surgery, then 1–2 drops 15
min after surgery, then qid for max 3 days.
diflupredate (Durezol): Tx of postop ocular pain, inflammation: 1 drop qid starting 24
after surgery and for 2 wk.

dorzolamide (Trusopt): Tx of increased IOP, open-angle glaucoma. 1 drop tid.

dorzolamide/timolol (Cosopt): To reduce IOP. 1 drop bid. Monitor for HF if absorbed

systemically.

echothiophate (generic): Tx of open-angle glaucoma, accommodative estropia. Give q

day or bid. Long-acting irreversible cholinesterase inhibitor; tolerance possible.

emedastine (Emadine): To relieve s&sx of allergic conjunctivitis in pts 3 yr and older.

1 drop q day to qid. Do not wear contacts. May cause headache, blurred vision.

epinastine hydrochloride (Elestat): Px of allergic conjunctivitis itching. 1 drop bid for

entire time of exposure. Remove contacts.

fluocinolone acetonide (Retisert): Tx of chronic noninfectious uveitis of posterior

segment of eye. 1 surgically implanted insert replaced after 30 mo if needed.

fluorometholone (Flarex, Fluor-Op, FML): Tx of inflammatory eye conditions. Stop if

swelling; monitor IOP after 10 days.

ganciclovir (Zirgan): Tx of acute herpetic keratitis. 1 drop five times/day until ulcer
heals, then 1 drop tid for 7 days.

gatifloxacin (Zymar, Zymaxid): Tx of conjunctivitis caused by susceptible strains. 1

drop q 2 hr while awake up to eight times/day on days 1 and 2; then 1 drop q 4 hr
while awake up to four times/day for 5 days. Pt should not wear contact lenses; may
cause blurred vision.

homatropine (Homatropine HBr, Isopto-Homatropine): Refraction; tx of

inflammatory conditions, preop and postop when mydriasis needed. 5–10 min needed
for refraction; dark irises may require bigger doses.

ketorolac (Acuvail): Tx of pain, inflammation after cataract surgery. 1 drop bid.

ketotifen (Alaway, Zaditor): Temporary relief of itching due to allergic conjunctivitis

in pts 3 yr and older. 1 drop q 8–12 hr; remove contacts for 10 min.

latanoprost (Xalatan): Tx of open-angle glaucoma, ocular hypertension. Remove

contacts before and for 15 min after drops. Allow 5 min between this and other drops.

levobunolol (AKBeta, Betagon Liquifilm): Tx of bacterial conjunctivitis caused by

susceptible strains. 1–2 drops q 2 hr while awake on days 1, 2; then q 4 hr while awake
on days 3–7.

levofloxacin (Quixin): Tx of conjunctivitis caused by susceptible strains. 1 or 2 drops q

2 hr while awake up to eight times/day on days 1 and 2; then 1 drop q 4 hr while
awake up to four times/day for 3–7 days.

lodoxamide tromethamine (Alomide): Tx of vernal conjunctivitis, keratitis in pts over

2 yr. Do not wear contacts. Stop if stinging, burning persists.

loteprednol etabonate (Alrex, Lotemax): Tx of postop inflammation, ocular disease.

1–2 drops qid. Discard after 14 days. Prolonged use can cause eye nerve damage.

loteprednol etabonate/tobramycin (Zylet): Tx of ocular conditions w/ risk of

bacterial ocular infection. 1–2 drops q 4–6 hr for 24–48 hr.

metipranolol (OptiPranolol): Tx of chronic open-angle glaucoma, ocular

hypertension. Vision changes possible; may need to use w/ other drugs.

mitomycin-C (Mitosol): Adjunct to ab externo glaucoma surgery. Apply fully saturated

sponges to tx area for 2 min. Topical only; biohazard disposal.

moxifloxacin (Moxeza, Vigamox): Tx of bacterial conjunctivitis caused by susceptible

strains. Moxeza (pts 4 mo and older), 1 drop bid for 7 days. Vigamox (pts 1 yr and
older), 1 drop tid for 7 days. Do not wear contacts. Can cause blurred vision.

natamycin (Natacyn): Tx of fungal blepharitis, conjunctivitis, keratitis. 1–2 drops/day

for 7 days.

nedocromil sodium (Alocril): Tx of allergic conjunctivitis itching. 1–2 drops bid

through entire allergy season.

olopatadine hydrochloride (Pataday, Patanol): Tx of allergic conjunctivitis itching in

pts 3 yr and older. 1–2 drops q 6–8 hr. Not for use w/ contacts. Headache common.

pemirolast potassium (Alamast): Tx of allergic conjunctivitis itching. 1–2 drops qid.

pilocarpine (Adsorbocarpine, Piloptic, Pilostat): Tx of chronic, acute glaucoma;

mydriasis caused by drugs. 1–2 drops up to six times/day.

polydimethylsiloxane (AdatoSil 5000): Tx of retinal detachment. Inject into aqueous

humor. Monitor for cataract.

rimexolone (Vexol): Tx of anterior uveitis; postop. Corticosteroid. Monitor for systemic

absorption.
sulfacetamide (Bleph-10): Tx of ocular infections. 1–2 drops q 2–3 hr; gradually taper
over 7–10 days.

tafluprost (Zioptan): Tx of elevated IOP in open-angle glaucoma/ocular hypertension.

1 drop in p.m.; permanent changes in eyelashes, iris color.

timolol maleate (Timoptic XE): Tx of increased IOP. 1 drop/day in a.m.

travoprost (Travatan Z): Tx of open-angle glaucoma, ocular hypertension. 1 drop each

p.m.; iris darkening, eyelash growth common.

trifluridine (Viroptic): Tx of keratoconjunctivitis, recurrent epithelial keratitis due to

herpes simplex 1, 2. Max, 9 drops/day in affected eye(s) no longer than 21 days.

tropicamide (Mydral, Mydriacyl, Tropicacyl): Refraction. 1–2 drops, repeat in 5 min.

May repeat again in 30 min if needed.
Appendix D
Laxatives

Laxative use has been replaced by proper diet and exercise in many clinical situations.
Most laxatives are available as OTC preparations and are often abused by people who
become dependent on them for GI movement.
IND & DOSE Short-term relief of constipation; to prevent straining; to evacuate bowel for
diagnostic procedures; to remove ingested poisons from lower GI tract; as adjunct in
anthelmintic tx.
PREG/CONT C/NA
ADV EFF Abd cramps, cathartic dependence, dizziness, excessive bowel activity, perianal
irritation, weakness
NC/PT Use as temporary measure. Swallow tablets whole. Do not take within 1 hr of
other drugs. Report sweating, flushing, muscle cramps, excessive thirst.

bisacodyl (Bisa-Lax, Correctol, Dulcolax): Stimulant. 5–15 mg PO; 2.5 g in water via
enema. Onset, 6–12 hr; rapid. Tartrazine in Dulcolax tablets. May discolor urine. Not for
child under 6 yr.

cascara: Stimulant. 325 mg–6 g PO. Onset, 6–10 hr. Use caution if pt taking
prescription drugs. May discolor urine. Not for children younger than 18 yr.

castor oil: Stimulant. 15–60 mL PO. Onset, 2–6 hr. May be very vigorous; may cause
abd cramping.

docusate (Colace, Ex-Lax Stool Softener, Genasoft, Phillips’ Liqui-Gels, Silace):

Detergent, softener. 50–300 mg PO. Onset, 12–72 hr. Gentle; beneficial w/ painful
anorectal conditions, dry or hard feces.

glycerin (Fleet Babylax, Fleet Liquid Glycerin Suppository, Sani-Supp):

Hyperosmolar agent. Rectal suppository; 4 mL liquid by rectum (child rectal liquid).
Onset, 15–60 min. Insert suppository high into rectum, retain 15 min. Insert liquid
dispenser. Apply gentle, steady pressure until all liquid gone; then remove.

lactulose (Constilac, Constulose): Hyperosmolar agent. 15–30 mL PO. Onset, 24–48

hr. Also used for tx of portal system encephalopathy. More palatable if mixed w/ fruit
juice, milk, water.

lubiprostone (Amitiza): Chloride channel activator. 24 mcg PO bid w/ food, water.

Onset, 1–2 hr. Also used for tx of women w/ IBS w/ constipation. Contains sorbitol; may
cause nausea, diarrhea.

magnesium citrate (Citrate of Magnesia): Saline. 1 glassful PO. Onset, 0.5–3 hr. For
child dose, reduce by half.
magnesium (Milk of Magnesia, MOM, Phillip’s MOM): Saline. 30–60 mL PO at
bedtime; 15–30 mL of conc PO. Onset, 0.5–3 hr. Take w/ liquids. Flavored forms
available.

magnesium sulfate (Epsom Salts): Saline. 5–10 mL PO. Onset, 0.5–3 hr. Take mixed
w/ full glass of water. Child dose, reduce to 2.5–5 mL PO in ½ glass water.

mineral oil (Kondremul Plain): Emollient. 5–45 mL PO. Onset, 6–8 hr. May decrease
absorption of fat-soluble vitamins. Child 6 yr and older, reduce dose to 5–15 mL.

polycarbophil (Equalactin, FiberCon, Konsyl Fiber): Bulk. 1–2 tablets PO up to qid.

Onset, 12–72 hr. Good w/ IBS, diverticulitis. Swallow w/ full glass of water to prevent
sticking in esophagus, choking.

polyethylene glycol (MiraLax): Bulk. 17 g PO in 8 oz water daily for up to 2 wk.

Onset, 48–72 hr. Do not use w/ bowel obstruction. Diarrhea common.

polyethylene glycolelectrolyte solution (CoLyte, GoLytely, NuLytely): Bulk. 4 L oral

sol PO before exam. Onset, 1 hr. Used as bowel evacuant before exam. Do not use w/ GI
obstruction, megacolon.

polyethylene glycol, sodium sulfate, sodium chloride, potassium chloride, sodium

ascorbate, ascorbic acid (MoviPrep): Osmotic. 1 L PO, then 16 oz fluid p.m. before
colonoscopy. Or, 2 L PO, then 32 oz fluid p.m. before colonoscopy. Onset, 1 hr.
Maintain hydration. Monitor pt w/ hx of seizures.

psyllium (Fiberall, Hydrocil Instant, Konsyl, Metamucil): Bulk. 1 tsp or packet in

water, juice 1–3 times/day PO. Onset, 12–72 hr. Swallow w/ full glass of water to
prevent esophageal sticking, choking.

senna (Agoral, Black Draught, Fletcher’s Castoria, Senna-Gen, Senokot):

Stimulant. 1–8 tablets/day PO at bedtime; suppository/syrup, 10–30 mL PO. Onset, 6–
10 hr. May cause abd cramps, discomfort.

sodium picosulfate, magnesium oxide, anhydrous citric acid (Prepopik): Bowel

cleansing before colonoscopy. Reconstitute w/ cold water, swallow immediately, follow
w/ clear liquids; repeat. Risk of fluid/electrolyte abnormalities.
Appendix E
Combination products by therapeutic class

AMPHETAMINES

dextroamphetamine and amphetamine

CONTROLLED SUBSTANCE C-II
Adderall, Adderall XR

Tablets: 1.25 mg (5-mg tablet), 2.5 mg (10-mg tablet), 5 mg (20-mg tablet), 7.5 mg (30-
mg tablet) each of dextroamphetamine sulfate and saccharate, amphetamine aspartate,
and sulfate.
ER capsules: 1.25 mg (5-mg capsule), 1.875 (7.5-mg tablet), 2.5 mg (10-mg capsule),
3.125 (12.5-mg tablet), 3.75 mg (15-mg capsule), 5 mg (20-mg capsule), 6.25 mg (25-mg
capsule), 7.5 mg (30-mg capsule) of each component.
Usual adult, child dose: 5–60 mg/day PO in divided doses to control sx of narcolepsy,
ADHD. ER capsules: 10–30 mg/day.

ANALGESICS

acetaminophen and codeine

CONTROLLED SUBSTANCE C-III
Tylenol with Codeine

Elixir: 12 mg codeine, 120 mg acetaminophen/5 mL.

Tablets: No. 2: 15 mg codeine, 300 mg acetaminophen. No. 3: 30 mg codeine, 300 mg
acetaminophen. No. 4: 60 mg codeine, 300 mg acetaminophen.
Usual adult dose: 1 or 2 tablets PO q 4–6 hr as needed, or 15 mL q 4–6 hr.

aspirin and codeine

CONTROLLED SUBSTANCE C-III
Empirin with Codeine

Tablets: No. 3: 30 mg codeine, 325 mg aspirin. No. 4: 60 mg codeine, 325 mg aspirin.

Usual adult dose: 1 or 2 tablets PO q 4–6 hr as needed.

codeine, aspirin, caffeine, and butalbital

CONTROLLED SUBSTANCE C-III
Fiorinal with Codeine
Capsules: 30 mg codeine, 325 mg aspirin, 40 mg caffeine, 50 mg butabarbital.
Usual adult dose: 1 or 2 capsules PO q 4 hr as needed for pain, up to 6/day.

diclofenac sodium and misoprostol

PREGNANCY CATEGORY X
Arthrotec

Tablets: ‘50’: 50 mg diclofenac, 200 mcg misoprostol. ‘75’: 75 mg diclofenac, 200 mcg
misoprostol.
Usual adult dose: Osteoarthritis: Arthrotec 50, PO tid. Arthrotec 50 or 75, PO bid.
Rheumatoid arthritis: Arthrotec 50, PO tid or qid; Arthrotec 50 or 75, PO bid.

famotidine and ibuprofen

Duexis

Tablets: 26.6 mg famotidine, 800 mg ibuprofen.

Usual adult dose: 1 tablet PO daily for arthritis pain.

hydrocodone and aspirin

CONTROLLED SUBSTANCE C-III
Damason-P

Tablets: 5 mg hydrocodone, 500 mg aspirin.

Usual adult dose: 1 tablet PO q 4–6 hr as needed.

hydrocodone bitartrate and acetaminophen

CONTROLLED SUBSTANCE C-III
Lortab Tablets, Norco, Stagesic, Zydone

Elixir: 2.5 mg hydrocodone, 167 mg acetaminophen/5 mL.

Capsules, tablets: 2.5 mg hydrocodone, 500 mg acetaminophen; 5 mg hydrocodone,
500 mg acetaminophen; 5, 7.5, 10 mg hydrocodone, 400 mg acetaminophen; 7.5 mg
hydrocodone, 500 mg acetaminophen; 7.5 mg hydrocodone, 650 mg acetaminophen; 10
mg hydrocodone, 650 mg acetaminophen.
Norco tablets: 5 mg hydrocodone, 325 mg acetaminophen; 7.5 mg hydrocodone, 325
mg acetaminophen; 10 mg hydrocodone, 325 mg acetaminophen.
Usual adult dose: Check brand-name products to determine specific dose combinations
available. One or two tablets, capsules PO q 4–6 hr, up to 8/day.

hydrocodone and ibuprofen

 CONTROLLED SUBSTANCE C-III
Reprexain, Vicoprofen

Tablets: 2.5 mg hydrocodone, 200 mg ibuprofen; 7.5 mg hydrocodone, 200 mg

ibuprofen; 10 mg hydrocodone, 200 mg ibuprofen.
Usual adult dose: 1 tablet PO q 4–6 hr as needed.

methylsalicylate and menthol

Salonpas

Dermal patch: 10% methylsalicylate, 3% menthol.

Usual adult dose: Apply 1 patch to clean, dry affected area; leave on for 8–12 hr.
Remove patch, apply another as needed. To relieve pain from sprains, bruises, strains,
backache.

morphine and naltrexone

CONTROLLED SUBSTANCE C-II
Embeda

ER capsules: 20 mg morphine, 0.8 mg naltrexone; 30 mg morphine, 1.2 mg naltrexone;

50 mg morphine, 2 mg naltrexone; 60 mg morphine, 2.4 mg naltrexone; 80 mg
morphine, 3.2 mg naltrexone; 100 mg morphine, 4 mg naltrexone.
Usual adult dose: 1 or 2 tablets PO daily when continuous, around-the-clock analgesic
needed long-term. May open capsules, sprinkle over applesauce. Pt should not cut,
crush, or chew capsule.

naproxen and esomeprazole

Vimovo

DR tablets: 375 mg naproxen, 20 mg esomeprazole; 500 mg naproxen, 20 mg

esomeprazole.
Usual adult dose: 1 tablet PO bid. Not recommended in moderate to severe renal
insufficiency, severe hepatic insufficiency; reduce w/ mild to moderate hepatic
insufficiency.

oxycodone and acetaminophen

CONTROLLED SUBSTANCE C-II
Percocet, Roxicet, Roxilox, Tylox

Tylox capsules: 5 mg oxycodone, 500 mg acetaminophen.

Tablets: 2.25, 4.5, 5 mg oxycodone, 325 mg acetaminophen.
Usual adult dose: 1 or 2 tablets PO q 4–6 hr as needed.

oxycodone and aspirin

CONTROLLED SUBSTANCE C-II
Percodan, Roxiprin

Tablets: 4.5 mg oxycodone, 325 mg aspirin.

Usual adult dose: 1 or 2 tablets PO q 6 hr as needed.

oxycodone and ibuprofen

CONTROLLED SUBSTANCE C-II
generic

Tablets: 5 mg oxycodone, 400 mg ibuprofen.

Usual adult dose: 1 tablet PO q 6 hr as needed for moderate to severe pain. Max, 4
tablets/24 hr for no more than 7 days.

pentazocine and acetaminophen

CONTROLLED SUBSTANCE C-IV
generic

Tablets: 25 mg pentazocine, 650 mg acetaminophen.

Usual adult dose: 1 tablet PO q 4 hr; max, 6 tablets/day.

tramadol hydrochloride and acetaminophen

Ultracet

Tablets: 37.5 mg tramadol, 325 mg acetaminophen.

Usual adult dose: 2 tablets PO q 4–6 hr as needed; max, 8 tablets/day. Reduce in
elderly/renally impaired pts.

ANTIACNE DRUGS

ethinyl estradiol and norethindrone

Estrostep Fe

Tablets: 1 mg norethindrone, 20 mcg ethinyl estradiol; 1 mg norethindrone, 30 mcg

ethinyl estradiol; 1 mg norethindrone, 35 mcg ethinyl estradiol.
Usual adult dose: 1 tablet PO each day (21 tablets have active ingredients; 7 are inert).

norgestimate and ethinyl estradiol

 Ortho Tri-Cyclen

Tablets: 0.18 mg norgestimate, 35 mcg ethinyl estradiol (7 tablets); 0.215 mg

norgestimate, 35 mcg ethinyl estradiol (7 tablets); 0.25 mg norgestimate, 35 mcg ethinyl
estradiol (7 tablets).
Usual adult dose: For women over 15 yr, 1 tablet/day PO. Birth control agent used
cyclically (21 tablets have active ingredients, 7 are inert).

ANTIBACTERIALS

amoxicillin and clavulanic acid

Augmentin, Augmentin ES-600, Augmentin XR

Tablets: ‘250’: 250 mg amoxicillin, 125 mg clavulanic acid; ‘500’: 500 mg amoxicillin,
125 mg clavulanic acid; ‘875’: 875 mg amoxicillin, 125 mg clavulanic acid.
Powder for oral suspension: ‘125’: 125 mg amoxicillin, 31.25 mg clavulanic acid;
‘250’: 250 mg amoxicillin, 62.5 mg clavulanic acid; ‘400’: 400 mg amoxicillin, 57 mg
clavulanic acid. Sol (Augmentin ES-600): 600 mg amoxicillin, 42.9 mg clavulanic acid/5
mL.
Chewable tablets: ‘125’: 125 mg amoxicillin, 31.25 mg clavulanic acid; ‘200’: 200 mg
amoxicillin, 28.5 mg clavulanic acid; ‘400’: 400 mg amoxicillin, 57 mg clavulanic acid.
XR tablets: 1,000 mg amoxicillin, 62.5 mg clavulanic acid.
Usual adult dose: 1 250-mg tablet or one 500-mg tablet PO q 8 hr. For severe
infections, 875-mg tablet PO q 12 hr. W/ difficulty swallowing, substitute 125-mg/5 mL
or 250-mg/5 mL for 500-mg tablet, or 200-mg/5 mL or 400-mg/5 mL for 875-mg tablet.
Usual child dose: Under 40 kg, 20–40 mg amoxicillin/kg/day PO in divided doses q 8
hr (dose based on amoxicillin content) or q 12 hr; 90 mg/kg/day PO oral sol divided q
12 hr (Augmentin ES-600).

co-trimoxazole (TMP-SMZ)
Bactrim, Bactrim DS, Septra, Septra DS, Sulfatrim Pediatric

Tablets: 80 mg trimethoprim (TMP), 400 mg sulfamethoxazole (SMZ); 160 mg TMP,

800 mg SMZ.
Oral suspension: 40 mg TMP, 200 mg SMZ/5 mL.
Usual adult dose: UTIs, shigellosis, acute otitis media: 160 mg TMP/800 mg SMZ PO q 12
hr. Up to 14 days (UTI) or 5 days (shigellosis). Acute exacerbations of chronic bronchitis:
160 mg TMP/800 mg SMZ PO q 12 hr for 14 days. Pneumocystis jiroveci pneumonitis: 20
mg/kg TMP/100 mg/kg SMZ q 24 hr PO in divided doses q 6 hr for 14 days. Traveler’s
diarrhea: 160 mg TMP/800 mg SMZ PO q 12 hr for 5 days.
Usual child dose: UTIs, shigellosis, acute otitis media: 8 mg/kg/day TMP/40 mg/kg/day
SMZ PO in two divided doses q 12 hr. For 10–14 days (UTIs, acute otitis media), 5 days
(shigellosis). Pneumocystis jiroveci pneumonitis: 20 mg/kg TMP/100 mg/kg SMZ q 24 hr
PO in divided doses q 6 hr for 14 days.

erythromycin and sulfisoxazole

generic

Granules for oral suspension: Erythromycin ethylsuccinate (equivalent of 200 mg

erythromycin activity) and 600 mg sulfisoxazole/5 mL when reconstituted according to
manufacturer’s directions.
Usual child dose: Otitis media: 50 mg/kg/day erythromycin and 150 mg/kg/day
sulfisoxazole PO in divided doses qid for 10 days. Give without regard to meals.
Refrigerate after reconstitution; use within 14 days.

imipenem and cilastatin

Primaxin

Powder for injection (IV): 250 mg imipenem, 250 mg cilastatin; 500 mg imipenem,
500 mg cilastatin.
Powder for injection (IM): 500 mg imipenem, 500 mg cilastatin. Follow
manufacturer’s instructions for reconstituting, diluting drug. Give each 250- to 500-mg
dose by IV infusion over 20–30 min; infuse each 1-g dose over 40–60 min. Give 500–
750 mg IM q 12 hr. Max, 1,500 mg/day.
Usual adult dose: Dose recommendations based on imipenem. Initially based on type,
severity of infection; later on illness severity, degree of susceptibility of pathogens, and
age, weight, CrCl. For adults w/ normal renal function, 250 mg–1 g IV q 6–8 hr. Max,
50 mg/kg/day or 4 g/day, whichever less. Adjust in renal impairment.

piperacillin sodium and tazobactam sodium

Zosyn

Powder for injection: 2 g piperacillin, 0.25 g tazobactam; 3 g piperacillin, 0.375 g

tazobactam; 4 g piperacillin, 0.5 g tazobactam,
Usual adult dose: 12 g/1.5 g IV as 3.375 g q 6 hr over 30 min. Recommended for
appendicitis; peritonitis; postpartum endometritis, PID; community-acquired
pneumonia; nosocomial pneumonia if agent responsive in sensitivity testing. Adjust in
renal impairment.

quinupristin and dalfopristin

 Synercid

Streptogramin antibiotics available only in combination.

Sol for IV use: 500-mg/10-mL vial (150 mg quinupristin, 350 mg dalfopristin).
Dose in pts over 16 yr: Complicated skin infections due to Staphylococcus. aureus,
Streptococcus pyogenes: 7.5 mg/kg IV q 12 hr for 7 days. Tx of life-threatening,
susceptible infections associated w/ VREF: 7.5 mg/kg IV q 8 hr. Dangerous when used w/
QT-prolonging drugs.

sulbactam and ampicillin

Unasyn

Powder for injection: 1.5-g vial (1 g ampicillin, 0.5 g sulbactam); 3-g vial (2 g
ampicillin, 1 g sulbactam). Usual adult dose: 0.5–1 g sulbactam w/ 1–2 g ampicillin IM
or IV q 6–8 hr.
Usual child dose: 40 kg or more, adult dosage; max, 4 g/day. Under 40 kg, 300
mg/kg/day IV in divided doses q 6 hr.

ticarcillin and clavulanic acid

Timentin

Powder, sol for injection: 3.1-g vial (3 g ticarcillin, 0.1 g clavulanic acid).
Usual adult dose: 60 kg, 3.1 g (3 g ticarcillin, 0.1 g clavulanic acid) IV over 30 min q
4–6 hr. Under 60 kg, 200–300 mg ticarcillin/kg/day IV over 30 min in divided doses q
4–6 hr. UTIs: 3.1 g (3 g ticarcillin, 0.1 g clavulanic acid) IV q 8 hr.
Child 3 mo and over: 3.1 g (3 g ticarcillin, 0.1 g clavulanic acid) IV over 30 min q 4–6
hr, or 200–300 mg/kg/day IV in divided doses q 4–6 hr. Adjust in elderly pts, pts w/
renal impairment.

ANTI–CORONARY ARTERY DISEASE DRUG

amlodipine besylate and atorvastatin calcium

Caduet

Tablets: 2.5 mg amlodipine w/ 10, 20, 40 mg atorvastatin; 5 mg amlodipine w/ 10, 20,

40, 80 mg atorvastatin; 10 mg amlodipine w/ 10, 20, 40, 80 mg atorvastatin.
Usual adult dose: 1 tablet PO daily in p.m. Adjust using individual products, then
switch to appropriate combination product.

ANTIDEPRESSANTS
 chlordiazepoxide and amitriptyline
Controlled Substance C-IV
Limbitrol, Limbitrol DS 10–25

Tablets: 5 mg chlordiazepoxide, 12.5 mg amitriptyline; 10 mg chlordiazepoxide, 25 mg

amitriptyline.
Usual adult dose: 10 mg chlordiazepoxide w/ 25 mg amitriptyline PO tid–qid up to six
times/day. For pts intolerant of higher doses, 5 mg chlordiazepoxide w/ 12.5 mg
amitriptyline PO tid–qid.

olanzapine and fluoxetine

Symbyax

Capsules: 6 mg olanzapine, 25 mg fluoxetine; 6 mg olanzapine, 50 mg fluoxetine; 12

mg olanzapine, 25 mg fluoxetine; 12 mg olanzapine, 50 mg fluoxetine.
Usual adult dose: 1 capsule PO daily in p.m.

perphenazine and amitriptyline

Etrafon, Etrafon-A, Etrafon-Forte

Tablets: 2 mg perphenazine, 10 mg amitriptyline; 2 mg perphenazine, 25 mg

amitriptyline; 4 mg perphenazine, 10 mg amitriptyline; 4 mg perphenazine, 25 mg
amitriptyline; 4 mg perphenazine, 50 mg amitriptyline.
Usual adult dose: 2–4 mg perphenazine w/ 10–50 mg amitriptyline PO tid–qid.

ANTIDIABETICS

alogliptin and metformin

Kazano

Tablets: 12.5 mg alogliptin, 500 mg metformin; 12.5 mg alogliptin, 1,000 mg

metformin.
Usual adult dose: Base on pt response, PO bid w/ food; max, 25 mg alogliptin, 2,000
mg metformin/day.

alogliptin and pioglitazone

Oseni

Tablets: 12.5 mg alogliptin, 15 mg pioglitazone; 12.5 mg alogliptin, 30 mg

pioglitazone; 12.5 mg alogliptin, 45 mg pioglitazone; 25 mg alogliptin, 15 mg
pioglitazone; 25 mg alogliptin, 30 mg pioglitazone; 25 mg alogliptin, 45 mg
pioglitazone. Usual adult dose: Base on pt response, PO once daily. Max, 25 mg
alogliptin, 45 mg pioglitazone. Limit w/ HF, renal impairment.

glyburide and metformin

Glucovance

Tablets: 1.25 mg glyburide, 250 mg metformin; 2.5 mg glyburide, 500 mg metformin; 5

mg glyburide, 500 mg metformin.
Usual adult dose: 1 tablet/day PO w/ meal, usually in a.m.

linagliptin and metformin

Jentadueto

Tablets: 2.5 mg linagliptin, 500 mg metformin; 2.5 mg linagliptin, 850 mg metformin;

2.5 mg lingagliptin, 1,000 mg metformin.
Usual adult dose: Base on current use of each drug, PO bid w/ meals.

pioglitazone and glimepiride

Duetact

Tablets: 30 mg pioglitazone w/ 2 or 4 mg glimepiride.

Usual adult dose: 1 tablet/day PO w/ first meal of day.

pioglitazone and metformin

ActoPlus Met, ActoPlus Met XR

Tablets: 15 mg pioglitazone, 500 mg metformin; 15 mg pioglitazone, 850 mg

metformin.
ER tablets: 5 mg pioglitazone, 1,000 mg metformin; 30 mg pioglitazone, 1,000 mg
metformin.
Usual adult dose: 1 tablet PO once/day or bid w/ meals; ER tablets, once/day.

repaglinide and metformin

PrandiMet

Tablets: 1 mg repaglinide, 500 mg metformin; 2 mg repaglinide, 500 mg metformin.

Usual adult dose: 1 tablet PO once/day or in divided doses.

rosiglitazone and glimepiride

Avandaryl
Tablets: 4 mg rosiglitazone, 1 mg glimepiride; 4 mg rosiglitazone, 2 mg glimepiride; 4
mg rosiglitazone, 4 mg glimepiride; 8 mg rosiglitazone, 2 mg glimepiride; 8 mg
rosiglitazone, 4 mg glimepiride.
Usual adult dose: 4 mg rosiglitazone w/ 1 or 2 mg glimepiride PO once/day w/ first
meal of day. Available through limited-access program only.

rosiglitazone and metformin

Avandamet

Tablets: 1 mg rosiglitazone, 500 mg metformin; 2 mg rosiglitazone, 500 mg metformin;

2 mg rosiglitazone, 1 g metformin; 4 mg rosiglitazone, 500 mg metformin; 4 mg
rosiglitazone, 1 g metformin.
Usual adult dose: 4 mg rosiglitazone w/ 500 mg metformin PO once/day or in divided
doses. Available through limited-access program only.

saxagliptin and metformin

Kombiglyze XR

Tablets: 5 mg saxagliptin, 500 mg metformin; 5 mg saxagliptin, 1,000 mg metformin;

2.5 mg saxagliptin, 1,000 mg metformin.
Usual adult dose: 1 tablet PO daily. Do not cut, crush, or allow pt to chew tablets.

sitagliptin and metformin

Janumet, Janumet XR

Tablets: 50 mg sitagliptin, 500 or 1,000 mg metformin.

ER tablets: 50 mg sitagliptin, 500 mg or 1 g metformin; 100 mg sitagliptin, 1 g
metformin
Usual adult dose: 1 tablet PO bid w/ meals; max, 100 mg sitagliptin, 2,000 mg
metformin/day.

ANTIDIABETIC/LIPID-LOWERING DRUG

sitagliptin and simvastatin

Juvisync

Tablets: 100 mg sitagliptin, 10 mg simvastatin; 100 mg sitagliptin, 20 mg simvastatin;

100 mg sitagliptin, 40 mg simvastatin.
Usual adult dose: Initially, 100 mg sitagliptin/40 mg simvastatin PO in p.m. Use w/
diet, exercise program.
ANTIDIARRHEAL

diphenoxylate hydrochloride and atropine sulfate

CONTROLLED SUBSTANCE C-V
Logen, Lomanate, Lomotil, Lonox

Tablets: 2.5 mg diphenoxylate hydrochloride, 0.025 mg atropine sulfate.

Liquid: 2.5 mg diphenoxylate hydrochloride, 0.025 mg atropine sulfate/ 5 mL.
Usual adult dose: 5 mg PO qid.
Usual child dose (use only liquid in child 2–12 yr): 0.3–0.4 mg/kg PO daily in four
divided doses.

ANTIHYPERTENSIVES

aliskiren and amlodipine

Tekamlo

Tablets: 150 mg aliskiren, 5 mg amlodipine; 150 mg aliskiren, 10 mg amlodipine; 300

mg aliskiren, 5 mg amlodipine; 300 mg aliskiren, 10 mg amlodipine.
Usual adult dose: 1 tablet/day PO; may give w/ other antihypertensives.

aliskiren and amlodipine and hydrochlorothiazide

Amturnide

Tablets: 150 mg aliskiren, 5 mg amlodipine, 12.5 mg hydrochlorothiazide; 300 mg

aliskiren, 5 mg amlodipine, 12.5 mg hydrochlorothiazide; 300 mg aliskiren, 5 mg
amlodipine, 25 mg hydrochlorothiazide; 150 mg aliskiren, 10 mg amlodipine, 12.5 mg
hydrochlorothiazide; 150 mg aliskiren, 10 mg amlodipine, 25 mg hydrochlorothiazide.
Usual adult dose: 1 tablet/day PO.

aliskiren and hydrochlorothiazide

Tekturna HCT

Tablets: 150 mg aliskiren, 12.5 mg hydrochlorothiazide; 150 mg aliskiren, 25 mg

hydrochlorothiazide; 300 mg aliskiren, 12.5 mg hydrochlorothiazide; 300 mg aliskiren,
25 mg hydrochlorothiazide.
Usual adult dose: 1 tablet/day PO.

aliskiren and valsartan

Valturna
Tablets: 150 mg aliskiren, 160 mg valsartan; 300 mg aliskiren, 320 mg valsartan.
Usual adult dose: 1 tablet/day PO.

amlodipine and benazepril

Lotrel

Capsules: 2.5 mg amlodipine, 10 mg benazepril; 5 mg amlodipine, 10 mg benazepril; 5

mg amlodipine, 20 mg benazepril; 5 mg amlodipine, 40 mg benazepril; 10 mg
amlodipine, 20 mg benazepril; 10 mg amlodipine, 40 mg benazepril.
Usual adult dose: 1 tablet/day PO in a.m.

amlodipine and olmesartan

Azor

Tablets: 5 mg amlodipine, 20 mg olmesartan; 10 mg amlodipine, 20 mg olmesartan; 5

mg amlodipine, 40 mg olmesartan; 10 mg amlodipine, 40 mg olmesartan.
Usual adult dose: 1 tablet/day PO.

amlodipine and valsartan

Exforge

Tablets: 5 mg amlodipine, 160 mg valsartan; 5 mg amlodipine, 320 mg valsartan; 10

mg amlodipine, 160 mg valsartan; 10 mg amlodipine, 320 mg valsartan.
Usual adult dose: 1 tablet/day PO.

amlodipine, valsartan, and hydrochlorothiazide

Exforge HCT

Tablets: 5 mg amlodipine, 160 mg valsartan, 12.5 mg hydrochlorothiazide; 10 mg

amlodipine, 160 mg valsartan, 12.5 mg hydrochlorothiazide; 5 mg amlodipine, 160 mg
valsartan, 25 mg hydrochlorothiazide; 10 mg amlodipine, 320 mg valsartan, 25 mg
hydrochlorothiazide.
Usual adult dose: 1 tablet /day PO.

atenolol and chlorthalidone

Tenoretic

Tablets: 50 mg atenolol, 25 mg chlorthalidone; 100 mg atenolol, 25 mg chlorthalidone.

Usual adult dose: 1 tablet/day PO in a.m.

azilsartan and chlorthalidone

 Edarbyclor

Tablets: 40 mg azilsartan, 12.5 mg chlorthalidone; 40 mg azilsartan, 25 mg

chlorthalidone.
Usual adult dose: 1 tablet/day PO. Not for use in pregnancy, renal failure. Monitor
potassium level.

bisoprolol and hydrochlorothiazide

Ziac

Tablets: 2.5 mg bisoprolol, 6.25 mg hydrochlorothiazide; 5 mg bisoprolol, 6.25 mg

hydrochlorothiazide; 10 mg bisoprolol, 6.25 mg hydrochlorothiazide.
Usual adult dose: 1 tablet/day PO in a.m. Initially, 2.5/6.25-mg tablet/day PO. May
need 2–3 wk for optimal antihypertensive effect.

candesartan and hydrochlorothiazide

Atacand HCT

Tablets: 16 mg candesartan, 12.5 mg hydrochlorothiazide; 32 mg candesartan, 12.5 mg

hydrochlorothiazide.
Usual adult dose: 1 tablet/day PO in a.m.

chlorthalidone and clonidine

Clorpres

Tablets: 15 mg chlorthalidone, 0.1 mg clonidine hydrochloride; 15 mg chlorthalidone,

0.2 mg clonidine hydrochloride; 15 mg chlorthalidone, 0.3 mg clonidine hydrochloride.
Usual adult dose: 1 or 2 tablets/day PO in a.m.; may give once/day or bid.

enalapril and hydrochlorothiazide

Vaseretic

Tablets: 5 mg enalapril maleate, 12.5 mg hydrochlorothiazide; 10 mg enalapril

maleate, 25 mg hydrochlorothiazide.
Usual adult dose: 1 or 2 tablets/day PO in a.m.

eprosartan and hydrochlorothiazide

Teveten HCT

Tablets: 600 mg eprosartan, 12.5 mg hydrochlorothiazide; 600 mg eprosartan, 25 mg

hydrochlorothiazide.
Usual adult dose: 1 tablet/day PO.

fosinopril and hydrochlorothiazide

Monopril-HCT

Tablets: 10 mg fosinopril, 12.5 mg hydrochlorothiazide; 20 mg fosinopril, 12.5 mg

hydrochlorothiazide.
Usual adult dose: 1 tablet/day PO in a.m.

hydrochlorothiazide and benazepril

Lotensin HCT

Tablets: 6.25 mg hydrochlorothiazide, 5 mg benazepril; 12.5 mg hydrochlorothiazide, 10

mg benazepril; 12.5 mg hydrochlorothiazide, 20 mg benazepril; 25 mg
hydrochlorothiazide, 20 mg benazepril.
Usual adult dose: 1 tablet/day PO in a.m.

hydrochlorothiazide and captopril

generic

Tablets: 15 mg hydrochlorothiazide, 25 mg captopril; 15 mg hydrochlorothiazide, 50 mg

captopril; 25 mg hydrochlorothiazide, 25 mg captopril; 25 mg hydrochlorothiazide, 50
mg captopril.
Usual adult dose: 1 or 2 tablets/day PO 1 hr before or 2 hr after meals.

hydrochlorothiazide and propranolol

generic

Tablets: 25 mg hydrochlorothiazide, 40 mg propranolol; 25 mg hydrochlorothiazide, 80

mg propranolol.
Usual adult dose: 1 or 2 tablets PO bid.

irbesartan and hydrochlorothiazide

Avalide

Tablets: 150 mg irbesartan, 12.5 mg hydrochlorothiazide; 300 mg irbesartan, 12.5 mg

hydrochlorothiazide; 300 mg irbesartan, 25 mg hydrochlorothiazide.
Usual adult dose: 1 or 2 tablets/day PO.

lisinopril and hydrochlorothiazide

(Prinzide, Zestoretic)
Tablets: 10 mg lisinopril, 12.5 mg hydrochlorothiazide; 20 mg lisinopril, 12.5 mg
hydrochlorothiazide; 20 mg lisinopril, 25 mg hydrochlorothiazide.
Usual adult dose: 1 tablet/day PO in a.m.

losartan and hydrochlorothiazide

Hyzaar

Tablets: 50 mg losartan, 12.5 mg hydrochlorothiazide; 100 mg losartan, 12.5 mg

hydrochlorothiazide; 100 mg losartan, 25 mg hydrochlorothiazide.
Usual adult dose: 1 tablet/day PO in a.m. Also used to reduce stroke incidence in
hypertensive pts w/ left ventricular hypertrophy (not effective for this use in black pts).

metoprolol and hydrochlorothiazide

Dutoprol, Lopressor HCT

Tablets: 50 mg metoprolol, 25 mg hydrochlorothiazide; 100 mg metoprolol, 25 mg

hydrochlorothiazide; 100 mg metoprolol, 50 mg hydrochlorothiazide.
ER tablets: 25 mg metoprolol, 12.5 mg hydrochlorothiazide; 50 mg metoprolol, 12.5 mg
hydrochlorothiazide, 100 mg metoprolol, 12.5 mg hydrochlorothiazice.
Usual adult dose: 1 tablet/day PO. Pt should not cut, crush, or chew ER form
(Dutoprol).

moexipril and hydrochlorothiazide

Uniretic

Tablets: 7.5 mg moexipril, 12.5 mg hydrochlorothiazide; 15 mg moexipril, 25 mg

hydrochlorothiazide.
Usual adult dose: 1 or 2 tablets/day PO 1 hr before or 2 hr after meal.

nadolol and bendroflumethiazide

Corzide

Tablets: 40 mg nadolol, 5 mg bendroflumethiazide; 80 mg nadolol, 5 mg

bendroflumethiazide.
Usual adult dose: 1 tablet/day PO in a.m.

olmesartan, amlodipine, and hydrochlorothiazide

Tribenzor

Tablets: 40 mg olmesartan, 10 mg amlodipine, 25 mg hydrochlorothiazide.

Usual adult dose: 1 tablet/day PO.

olmesartan medoxomil and hydrochlorothiazide

Benicar HCT

Tablets: 20 mg olmesartan, 12.5 mg hydrochlorothiazide; 40 mg olmesartan, 12.5 mg

hydrochlorothiazide; 40 mg olmesartan, 25 mg hydrochlorothiazide.
Usual adult dose: 1 tablet/day PO in a.m.

quinapril and hydrochlorothiazide

Accuretic

Tablets: 10 mg quinapril, 12.5 mg hydrochlorothiazide; 20 mg quinapril, 12.5 mg

hydrochlorothiazide.
Usual adult dose: 1 tablet/day PO in a.m.

telmisartan and amlodipine

Twynsta

Tablets: 40 mg telmisartan, 5 mg amlodipine; 40 mg telmisartan, 10 mg amlodipine; 80

mg telmisartan, 5 mg amlodipine; 80 mg telmisartan, 10 mg amlodipine.
Usual adult dose: 1 tablet/day PO.

telmisartan and hydrochlorothiazide

Micardis HCT

Tablets: 40 mg telmisartan, 12.5 mg hydrochlorothiazide; 80 mg telmisartan, 12.5 mg

hydrochlorothiazide; 80 mg telmisartan, 25 mg hydrochlorothiazide.
Usual adult dose: 1 tablet/ day PO; max, 160 mg telmisartan and 25 mg
hydrochlorothiazide/day.

trandolapril and verapamil

Tarka

Tablets: 1 mg trandolapril, 240 mg verapamil; 2 mg trandolapril, 180 mg verapamil; 2

mg trandolapril, 240 mg verapamil; 4 mg trandolapril, 240 mg verapamil.
Usual adult dose: 1 tablet/day PO w/ food. Pt should not cut, crush, or chew tablet.

valsartan and hydrochlorothiazide

Diovan HCT
Tablets: 80 mg valsartan, 12.5 mg hydrochlorothiazide; 160 mg valsartan, 12.5 mg
hydrochlorothiazide; 160 mg valsartan, 25 mg hydrochlorothiazide; 320 mg valsartan,
12.5 mg hydrochlorothiazide; 320 mg valsartan, 25 mg hydrochlorothiazide.
Usual adult dose: 1 tablet/day PO.

ANTIMIGRAINE DRUGS

acetaminophen, caffeine, and isometheptene

MigraTen

Capsules: 325 mg acetaminophen, 100 mg caffeine.

Usual adult dose: 2 capsules PO at onset of migraine, then 1 capsule PO q hr until
resolved; max, 5 capsules in 12 hr. For tension headache, 1–2 capsules PO q 4 hr; max, 8
capsules/day.

ergotamine and caffeine

Cafergot, Migergot

Tablets: 1 mg ergotamine tartrate, 100 mg caffeine.

Suppositories: 2 mg ergotamine tartrate, 100 mg caffeine.
Usual adult dose: 2 tablets PO at first sign of attack, then 1 tablet q 30 min, if needed.
Max, 6/attack, 10/wk. Or, 1 suppository at first sign of attack, then second dose after
1 hr, if needed. Max, 2/attack, 5/wk. Do not use w/ ritonavir, nelfinavir, indinavir,
erythromycin, clarithromycin, troleandomycin; serious vasospasm possible.

sumatriptan and naproxen sodium

Treximet

Tablets: 85 mg sumatriptan, 500 mg naproxen.

Usual adult dose: 1 tablet PO at onset of acute migraine.

ANTINAUSEA DRUG

doxylamine and pyridoxine

Diclegis

DR tablets: 10 mg doxylamine, 10 mg pyridoxine

Usual adult dose: 1 tablet PO at bedtime; max 4 tablets/day. Tx of n/v in pregnancy in
pts not responding to other tx.
ANTIPARKINSONIANS

levodopa and carbidopa

Parcopa, Sinemet, Sinemet CR

Tablets: 100 mg levodopa, 10 mg carbidopa; 100 mg levodopa, 25 mg carbidopa; 250

mg levodopa, 25 mg carbidopa.
Orally disintegrating tablets: 100 mg levodopa, 10 mg carbidopa; 100 mg levodopa,
25 mg carbidopa; 250 mg levodopa, 25 mg carbidopa.
CR tablets: 100 mg levodopa, 25 mg carbidopa; 200 mg levodopa, 50 mg carbidopa.
Usual adult dose: Start w/ lowest dose; titrate based on response, tolerance.

levodopa, carbidopa, and entacapone

Stalevo 50, Stalevo 75, Stalevo 100, Stalevo 125, Stalevo 150, Stalevo 200

Tablets: 50 mg levodopa, 12.5 mg carbidopa, 200 mg entacapone; 75 mg levodopa,

18.75 mg carbidopa, 200 mg entacapone; 100 mg levodopa, 25 mg carbidopa, 200 mg
entacapone; 125 mg levodopa, 31.25 mg carbidopa, 200 mg entacapone; 150 mg
levodopa, 37.5 mg carbidopa, 200 mg entacapone; 200 mg levodopa, 50 mg carbidopa,
200 mg entacapone.
Usual adult dose: 1 tablet PO q 3–8 hr.

ANTIPLATELET

aspirin and dipyridamole

Aggrenox

Capsules: 25 mg aspirin, 200 mg dipyridamole.

Usual adult dose: 1 capsule PO bid to decrease risk of stroke in pts w/ known
cerebrovascular disease.

ANTIULCER DRUGS

bismuth subsalicylate, metronidazole, and tetracycline

Helidac

Tablets: 262.4 mg bismuth subsalicylate, 250 mg metronidazole, 500 mg tetracycline

hydrochloride.
Usual adult dose: 1 tablet PO qid for 14 days w/ prescribed histamine-2 antagonist.
For tx of active duodenal ulcers associated w/ Helicobacter pylori infection. Do not use in
pregnancy, breast-feeding, children.

lansoprazole, amoxicillin, and clarithromycin

Prevpac

Daily administration pack: Two 30-mg lansoprazole capsules, four 500-mg amoxicillin
capsules, two 500-mg clarithromycin tablets.
Usual adult dose: Divide pack equally to take PO bid, a.m. and p.m., for 10–14 days.

ANTIVIRALS

abacavir and lamivudine

Epzicom

Tablets: 600 mg abacavir w/ 300 mg lamivudine.

Usual adult dose: 1 tablet PO daily w/ other antiretrovirals for tx of HIV infection.

abacavir, zidovudine, and lamivudine

Trizivir

Tablets: 300 mg abacavir, 300 mg zidovudine, 150 mg lamivudine.

Usual adult dose: 1 tablet PO bid for tx of HIV infection. Carefully monitor for
hypersensitivity reactions; potential increased risk of MI.

efavirenz, emtricitabine, and tenofovir

Atripla

Tablets: 600 mg efavirenz, 200 mg emtricitabine, 300 mg tenofovir.

Usual adult dose: 1 tablet PO at bedtime on empty stomach for tx of HIV infection. Not
recommended w/ moderate or severe renal impairment.

elvitegravir, cobicistat, emtricitabine, and tenofovir

Stribild

Tablets: 150 mg elvitegravir, 150 mg cobicistat, 200 mg emtricitabine, 300 mg

tenofovir.
Usual adult dose: 1 tablet PO/day for pts never treated for HIV.

emtricitabine, rilpivirine, and tenofovir

Complera
Tablets: 200 mg emtricitabine, 25 mg rilpivirine, 300 mg tenofovir.
Usual adult dose: 1 tablet/day PO for tx of HIV infection in tx-naive pts.

emtricitabine and tenofovir disoproxil fumarate

Truvada

Tablets: 200 mg emtricitabine w/ 300 mg tenofovir.

Usual adult dose: 1 tablet PO daily w/ other antiretrovirals for tx of HIV infection.

lamivudine and zidovudine

Combivir

Tablets: 150 mg lamivudine, 300 mg zidovudine.

Usual adult dose: 1 tablet PO bid for tx of HIV infection. Not recommended for adult,
child under 50 kg.

BPH DRUG

dutasteride and tamsulosin

Jalyn

Capsules: 0.5 mg dutasteride, 0.4 mg tamsulosin.

Usual adult dose: 1 capsule/day PO.

DIURETICS

amiloride and hydrochlorothiazide

Moduretic

Tablets: 5 mg amiloride, 50 mg hydrochlorothiazide.

Usual adult dose: 1 or 2 tablets/day PO w/ meals.

hydrochlorothiazide and triamterene

Dyazide

Capsules: 25 mg hydrochlorothiazide, 37.5 mg triamterene.

Usual adult dose: 1 or 2 capsules PO once/day or bid after meals.

hydrochlorothiazide and triamterene

Maxzide, Maxzide-25
Tablets: 25 mg hydrochlorothiazide, 37.5 mg triamterene; 50 mg hydrochlorothiazide,
75 mg triamterene.
Usual adult dose: 1 or 2 tablets/day PO.

spironolactone and hydrochlorothiazide

Aldactazide

Tablets: 25 mg spironolactone, 25 mg hydrochlorothiazide; 50 mg spironolactone, 50

mg hydrochlorothiazide.
Usual adult dose: 1–8 tablets/day PO (25/25). 1–4 tablets/day PO (50/50).

HF DRUG

isosorbide dinitrate and hydralazine hydrochloride

BiDil

Tablets: 20 mg isosorbide dinitrate, 37.5 mg hydralazine.

Usual adult dose: 1 tablet PO tid; may increase to 2 tablets tid. For adjunct tx in self-
identified black pts to improve functional survival.

LIPID-LOWERING DRUGS

ezetimibe and atorvastatin

Liptruzet

Tablets: 10 mg ezetimibe w/ 10, 30, 40, or 80 mg atorvastatin

Usual adult dose: 1 tablet PO in p.m. w/ diet, exercise. If using bile acid sequestrant,
give this drug 2 hr before or 4 hr after bile acid sequestrant.

ezetimibe and simvastatin

Vytorin

Tablets: 10 mg ezetimibe, 10 mg simvastatin; 10 mg ezetimibe, 20 mg simvastatin; 10

mg ezetimibe, 40 mg simvastatin;10 mg ezetimibe, 80 mg simvastatin.
Usual adult dose: 1 tablet/day PO in p.m. w/ cholesterol-lowering diet, exercise. Must
give at least 2 hr before or 4 hr after bile sequestrant (if used).

niacin and lovastatin

Advicor

Tablets: 500 mg niacin, 20 mg lovastatin; 750 mg niacin, 20 mg lovastatin; 1,000 mg

niacin, 20 mg lovastatin.
Usual adult dose: 1 tablet/day PO in p.m.

simvastatin and niacin

Simcor

Tablets: 20 mg simvastatin, 500 mg niacin; 20 mg simvastatin, 750 mg niacin; 20 mg

simvastatin, 1,000 mg niacin.
Usual adult dose: 1 tablet/day PO. Max, 2,000 mg niacin w/ 40 mg simvastatin/day.

MENOPAUSE DRUGS

conjugated estrogen and bazedoxifene

Duavee

Tablets: 0.45 mg conjugated estrogen, 20 mg bazedoxifene

Usual adult dose: 1 tablet/day PO. BBW Risk of endometrial cancer, stroke, DVT,
dementia. Not for use to decrease CAD.

drospirenone and estradiol

Angeliq

Tablets: 0.5 mg drospirenone, 1 mg estradiol.

Usual adult dose: 1 tablet/day PO. Monitor potassium level closely.

drospirenone and ethinyl estradiol

YAZ

Tablets: 3 mg drospirenone, 0.02 mg ethinyl estradiol.

Usual adult dose: 1 tablet/day PO. Monitor potassium level closely.

estradiol and norethindrone (transdermal)

CombiPatch

Patch: 0.05 mg/day estradiol, 0.14 mg/ day norethindrone; 0.05 mg/day estradiol, 0.25
mg/day norethindrone.
Usual adult dose: Change patch twice/wk.

estradiol and norethindrone (oral)

Activella
Tablets: 0.5 mg estradiol, 0.1 mg norethindrone; 1 mg estradiol, 0.5 mg norethindrone.
Usual adult dose: 1 tablet/day PO.

estradiol and norgestimate

Ortho-Prefest

Tablets: 1 mg estradiol, 0.09 mg norgestimate.

Usual adult dose: 1 tablet/day PO (3 days of pink tablets [estradiol alone], then 3 days
of white tablets [estradiol and norgestimate combination]); continue cycle
uninterrupted.

estrogens, conjugated, and medroxyprogesterone

Premphase

Tablets: 0.625 mg conjugated estrogens, 5 mg medroxyprogesterone.

Usual adult dose: 1 tablet/day PO. Use in women w/ intact uterus.

estrogens, conjugated, and medroxyprogesterone

Prempro

Tablets: 0.3 mg conjugated estrogen, 1.5 mg medroxyprogesterone; 0.45 mg conjugated

estrogen, 1.5 mg medroxyprogesterone; 0.625 mg conjugated estrogen, 2.5 mg
medroxyprogesterone; 0.625 mg conjugated estrogen, 5 mg medroxyprogesterone.
Usual adult dose: 1 tablet/day PO. Use in women w/ intact uterus.

ethinyl estradiol and norethindrone acetate

Femhrt

Tablets: 2.5 mcg ethinyl estradiol, 0.5 mg norethindrone acetate; 5 mcg ethinyl
estradiol, 1 mg norethindrone acetate.
Usual adult dose: 1 tablet/day PO. Use in women w/ intact uterus.

OPIOID AGONISTS

buprenorphine and naloxone

CONTROLLED SUBSTANCE C-III
Suboxone

Sublingual tablets: 2 mg buprenorphine, 0.5 mg naloxone; 8 mg buprenorphine, 2 mg

naloxone.
Usual adult dose: 12–16 mg/day sublingually after induction w/ sublingual
buprenorphine for tx of opioid dependence.

buprenorphine and naloxone

Zubsolv

Sublingual tablets: 1.4 mg buprenorphine, 0.36 mg naloxone; 5.7 mg buprenorphine,

1.4 mg naloxone.
Usual adult dose: 1 tablet/day sublingually.

PSYCHIATRIC DRUG

dextromethorphan and quinidine

Nuedexta

Capsules: 20 mg dextromethorphan, 10 mg quinidine.

Usual adult dose: 1 capsule/day PO for 7 days; maint, 1 capsule PO q 12 hr. For tx of
pseudobulbar affect associated w/ neurologic conditions.

RESPIRATORY DRUGS

azelastine and fluticasone

Dymista

Nasal spray: 137 mcg azelastine, 50 mcg fluticasone.

Usual dose in pts 12 yr and older: 1 spray in each nostril bid for relief of sx of
seasonal allergic rhinitis.

budesonide and formoterol fumarate

Symbicort 80/4.5, Symbicort 160/4.5

Inhalation: 80 mcg budesonide, 4.5 mcg formoterol fumarate; 160 mcg budesonide, 4.5
mcg formoterol fumarate.
Usual dose in pts 12 yr and older: Two inhalations bid, a.m. and p.m. For long-term
maint of asthma, not for acute attacks.

fluticasone and salmeterol

Advair Diskus, Advair HFA

Inhalation: 100 mcg fluticasone, 50 mcg salmeterol; 250 mcg fluticasone, 50 mcg
salmeterol; 500 mcg fluticasone, 50 mcg salmeterol.
Usual dose in pts 12 yr and older: 1 inhalation bid to manage asthma.
Usual dose in child 4–11 yr: 1 inhalation (100 mcg fluticasone, 50 mcg salmeterol)
bid, a.m. and p.m. about 12 hr apart.

fluticasone and vilanterol

Breo Ellipta

Powder for inhalation: 100 mcg fluticasone, 25 mcg vilanterol.

Usual adult dose: One oral inhalation daily. BBW Long-acting beta agonists are
associated with asthma-related deaths; not for use in asthma or tx of acute
bronchospasm.

hydrocodone and chlorpheniramine

Vituz

Oral sol: 5 mg hydrocodone, 4 mg chlorpheniramine/5-mL sol.

Usual adult dose: 5 mL PO q 4–6 hr; max, four doses/day.

hydrocodone and pseudoephedrine

Rezira

Oral sol: 5 mg hydrocodone, 60 mg pseudoephedrine/5-mL sol.

Usual adult dose: 5 mL PO q 4–6 hr as needed; max, four doses in 24 hr.

hydrocodone and pseudoephedrine and chlorpheniramine

Zutripro

Oral sol: 5 mg hydrocodone, 60 mg pseudoephedrine, 4 mg chlorpheniramine in 5-mL

sol.
Usual adult dose: 5 mL PO q 4–6 hr as needed; max, four doses in 24 hr.

ipratropium and albuterol

Combivent

Metered-dose inhaler: 18 mcg ipratropium bromide, 90 mcg albuterol.

Usual adult dose: 2 inhalations four times/day. Not for use during acute attack. Use
caution w/ known sensitivity to atropine, soy beans, soya lecithin, peanuts.

loratadine and pseudoephedrine

Claritin-D
ER tablets: 5 mg loratadine, 120 mg pseudoephedrine.
Usual adult dose: 1 tablet PO q 12 hr.

loratadine and pseudoephedrine

Claritin-D 24 Hour

ER tablets: 10 mg loratadine, 240 mg pseudoephedrine.

Usual adult dose: 1 tablet/day PO.

mometasone and formoterol

Dulera 100/5, Dulera 200/5

Metered aerosol inhaler: 100 mcg mometasone, 5 mcg formoterol; 200 mcg
mometasone, 5 mcg formoterol.
Usual adult dose: For maint tx of asthma, 2 inhalations bid, a.m. and p.m. Rinse mouth
after use. Not for children.

umeclidinium and vilanterol

Anoro Ellipta

Inhalation powder: 62.5 mcg umeclidinium, 25 mcg vilanterol.

Usual adult dose: One oral inhalation/day for maint of COPD.
BBW Long-acting beta agonists associated with asthma-related deaths, not for use in
asthma or acute bronchospasm.

TENSION HEADACHE DRUG

butalbital, acetaminophen, and caffeine

Esgic-Plus

Capsules: 50 mg butalbital, 500 mg acetaminophen, 40 mg caffeine.

Usual adult dose: 1 capsule PO q 4 hr as needed; max, 6/day. May be habit-forming; pt
should avoid driving, dangerous tasks.

WEIGHT LOSS DRUGS

phentermine and topiramate

Qsymia

Capsules: 3.75 mg phentermine, 23 mg topiramate; 7.5 mg phentermine, 46 mg

topiramate; 11.25 mg phentermine, 69 mg topiramate; 15 mg phentermine, 92 mg
topiramate.
Usual adult dose: 1 capsule/day PO in a.m. w/ diet/exercise. Hormonal contraceptives
may be ineffective; cardiac issues, suicidality.
Appendix F
Hormonal contraceptives

IND & DOSE Take 1 tablet PO daily for 21 days, starting within 5 days of first day of
menstrual bleeding (day 1 of cycle is first day of menstrual bleeding). Take inert tablets
or no tablets for next 7 days. Then start new course of 21 days. Sunday start: Take first
tablet on first Sunday after menstruation begins.
NC/PT Suggested measures for missed doses: One tablet missed: Take tablet as soon as
possible, or take 2 tablets next day. Two consecutive tablets missed: Take 2 tablets daily
for next 2 days, then resume regular schedule. Three consecutive tablets missed: If
Sunday starter, take 1 pill q day until Sunday; then discard pack and start new pack on
that day. If day 1 starter, discard rest of pack and start new pack that same day. Use
additional birth control method until start of next menstrual period. Increased risk of
thromboembolic events if combined w/ smoking.
Postcoital contraception (“morning after” pills): Safe, effective for emergency
contraception. Regimen starts within 72 hr of unprotected intercourse w/ follow-up dose
of same number of pills 12 hr after first dose. Ovral: 2 white tablets. Nordette: 4 light
orange tablets. Lo/Ovral: 4 white tablets. Plan B: 0.75 mg levonorgestrel; take 1 tablet
within 72 hr of sexual intercourse, take second tablet 12 hr later. Plan B One-Step: 1.5
mg levonorgestrel; take 1 tablet within 72 hr of unprotected sexual intercourse.
Available OTC. Ella (ulipristal; progesterone agonist/antagonist): 30 mg tablet; take
within 5 days of unprotected sexual intercourse.

ORAL CONTRACEPTIVES
Trade name Combination
MONOPHASIC
Aviane, Lessina, Lutera, Orsythia, Sronyx 20 mcg ethinyl estradiol/0.10 mg
levonorgestrel
Altavera, Jolessa, Levora 0.15/30, Nordette, 30 mcg ethinyl estradiol/0.15 mg
Portia levonorgestrel
Apri, Desogen, Emoquette, Ortho-Cept, 30 mcg ethinyl estradiol/0.15 mg
Reclipsen, Solia desogestrel
Balziva, Femcon Fe chewable tablets, Ovcon- 35 mcg ethinyl estradiol/0.4 mg
35, Zenchent norethindrone
Beyaz 3 mg drospirenone/20 mcg ethinyl
estradiol/0.45 mg levomefolate; must
 monitor potassium levels.
Brevicon, Modicon, Necon 0.5/35, Zenchent 35 mcg ethinyl estradiol/0.5 mg
norethindrone
Cryselle, Lo/Ovral, Low-Ogestrel 30 mcg ethinyl estradiol/0.3 mg norgestrel
Estarylla, Mononessa, Ortho-Cyclen, 35 mcg ethinyl estradiol/0.25 mg
Previfem, Sprintec norgestimate
Gianvi, Loryna, Yaz 30 mg drospirenone/20 mcg ethinyl
estradiol
Kelnor 1/35, Zovia 1/35E 35 mcg ethinyl estradiol/1 mg ethynodiol
diacetate
Junel Fe 1/20, Junel 21 Day 1/20, Loestrin 20 mcg ethinyl estradiol/1 mg
21 1/20, Loestrin Fe 21 1/20, Loestrin 24 norethindrone
Fe, Microgestin Fe 1/20, Minastrin 24 FE
Junel Fe 1.5/30, Junel 21 Day 1.5/30, 30 mcg ethinyl estradiol/1.5 mg
Loestrin 21 1.5/30, Loestrin Fe 1.5/30, norethindrone acetate
Microgestin Fe 1.5/30
Lybrel 0.09 mg levonorgestrel/20 mcg ethinyl
estradiol in continual use to eliminate
menstrual periods
Necon 1/35, Norinyl 1+35, Ortho-Novum 35 mcg ethinyl estradiol/1 mg
1/35 norethindrone
Necon 1/50, Norinyl 1+50 50 mcg mestranol/1 mg norethindrone
Ocella, Syeda, Yasmin, Zaran 3 mg drospirenone/30 mcg ethinyl
estradiol; must monitor potassium level
Ogestrel, Ovral-28 50 mcg ethinyl estradiol/0.5 mg norgestrel
Ovcon-50 50 mcg ethinyl estradiol/1 mg
norethindrone acetate
Quasense, Seasonale, Seasonique 0.15 levonorgestrel/30 mcg ethinyl
estradiol taken as 84 days active tablets, 7
 days inactive

Safyral 3 mg drospirenone/30 mcg ethinyl

estradiol/45 mcg levomefolate
Zovia 1/50E 50 mcg ethinyl estradiol/1 mg ethynodiol
diacetate
BIPHASIC
Azurette, Kariva, Mircette phase 1: 21 tablets, 0.15 mg desogestrel/
20 mcg ethinyl estradiol.
phase 2: 5 tablets, 10 mcg ethinyl
estradiol
Lo Loestrin Fe phase 1: 24 tablets, 1 mg norethindrone/
10 mcg ethinyl estradiol.
phase 2: 2 tablets, 10 mcg ethinyl
estradiol
LoSeasonique phase 1: 84 tablets, 0.15 mg
levonorgestrel/20 mcg ethinyl estradiol.
phase 2: 7 tablets, 10 mcg ethinyl
estradiol
Seasonique phase 1: 84 tablets, 0.15 mg
levonorgestrel/30 mcg ethinyl estradiol.
phase 2: 7 tablets, 10 mcg ethinyl
estradiol
Necon 10/11 phase 1: 10 tablets, 0.5 mg
norethindrone/ 35 mcg ethinyl estradiol.
phase 2: 11 tablets, 1 mg norethindrone/
35 mcg ethinyl estradiol
TRIPHASIC
Aranelle, Leena, Tri-Norinyl phase 1: 7 tablets, 0.5 mg norethindrone
(progestin)/35 mcg ethinyl estradiol
 (estrogen).
phase 2: 9 tablets, 1 mg norethindrone
(progestin)/35 mcg ethinyl estradiol
(estrogen).
phase 3: 5 tablets, 0.5 mg norethindrone
(progestin)/35 mcg ethinyl estradiol
(estrogen)

Caziant, Cesia, Cyclessa, Velivet phase 1: 7 tablets, 0.1 mg desogestrel/ 25

mcg ethinyl estradiol.
phase 2: 7 tablets, 0.125 mg desogestrel/
25 mcg ethinyl estradiol.
phase 3: 7 tablets, 0.15 mg desogestrel/
25 mcg ethinyl estradiol
Enpresse phase 1: 6 tablets, 0.05 mg levonorgestrel
(progestin)/30 mcg ethinyl estradiol
(estrogen).
phase 2: 5 tablets, 0.075 mg
levonorgestrel (progestin)/40 mcg ethinyl
estradiol (estrogen).
phase 3: 10 tablets, 0.125 mg
levonorgestrel (progestin)/30 mcg ethinyl
estradiol (estrogen)
Estrostep Fe, Tilia Fe, Tri-Legest Fe phase 1: 5 tablets, 1 mg norethindrone/
20 mcg ethinyl estradiol; w/ 75 mg ferrous
fumarate.
phase 2: 7 tablets, 1 mg norethindrone/
30 mcg ethinyl estradiol; w/ 75 mg ferrous
fumarate.
phase 3: 9 tablets, 1 mg norethindrone/
35 mcg ethinyl estradiol; w/ 75 mg ferrous
 fumarate
Ortho-Novum 7/7/7, Necon 7/7/7 phase 1: 7 tablets, 0.5 mg norethindrone
(progestin)/35 mcg ethinyl estradiol
(estrogen).
phase 2: 7 tablets, 0.75 mg norethindrone
(progestin)/35 mcg ethinyl estradiol
(estrogen).
phase 3: 7 tablets, 1 mg norethindrone
(progestin)/35 mcg ethinyl estradiol
(estrogen)
Ortho Tri-Cyclen, Tri-Estarylla, TriNessa, Tri- phase 1: 7 tablets, 0.18 mg norgestimate/
Previfem, Tri-Sprintec 35 mcg ethinyl estradiol.
phase 2: 7 tablets, 0.215 mg
norgestimate/ 35 mcg ethinyl estradiol.
phase 3: 7 tablets, 0.25 mg norgestimate/
35 mcg ethinyl estradiol
Ortho Tri-Cyclen Lo phase 1: 7 tablets, 0.18 mg norgestimate/
25 mcg ethinyl estradiol.
phase 2: 7 tablets, 0.215 mg
norgestimate/ 25 mcg ethinyl estradiol.
phase 3: 7 tablets, 0.25 mg norgestimate/
25 mcg ethinyl estradiol
Tri-Legest phase 1: 5 tablets, 1 mg norethindrone/
20 mcg ethinyl estradiol.
phase 2: 7 tablets, 1 mg norethindrone/
30 mcg ethinyl estradiol.
phase 3: 9 tablets, 1 mg norethindrone/
35 mcg ethinyl estradiol
Trivora-28 phase 1: 6 tablets, 0.5 mg levonorgestrel
(progestin)/30 mcg ethinyl estradiol
 (estrogen).
phase 2: 5 tablets, 0.075 mg
levonorgestrel (progestin)/40 mcg ethinyl
estradiol (estrogen).
phase 3: 10 tablets, 0.125 mg
levonorgestrel (progestin)/30 mcg ethinyl
estradiol (estrogen)
4-PHASIC
Natazia phase 1: 2 tablets, 3 mg estradiol
valerate.
phase 2: 5 tablets, 2 mg estradiol
valerate/ 2 mg dienogest.
phase 3: 17 tablets, 2 mg estradiol
valerate/3 mg dienogest.
phase 4: 2 tablets, 1 mg estradiol valerate
Quartette phase 1: 42 tablets, 0.15 mg
levonorgestrel, 0.02 mg ethinyl estradiol
phase 2: 21 tablets, 0.15 mg
levonorgestrel, 0.025 mg ethinyl estradiol
phase 3: 21 tablets, 0.15 mg
levonorgestrel, 0.03 mg ethinyl estradiol
phase 4: 7 tablets, 0.01 mg ethinyl
estradiol
PROGESTIN ONLY
Camila, Errin, Heather 0.35 mg norethindrone

IMPLANTABLE SYSTEM
Trade name Combination
Implanon, Nexplanon 68 mg etonogestrel implanted subdermally
in inner aspect of nondominant upper
arm. Left in place for no longer than 3 yr,
 then must be removed. May then insert
new implants.

INJECTABLE CONTRACEPTIVES
Trade name Combination
Depo-Provera 150, 400 mcg/mL medroxyprogesterone.
Give 1-mL injection deep IM; repeat every
3 mo.
BBW Risk of significant bone loss.
depo-sub Q provera 104 104 mg medroxyprogesterone. Give 0.65
mL subcut into anterior thigh, abdomen.
BBW   Risk of significant bone loss.

INTRAUTERINE SYSTEM
Trade name Combination
Mirena 52 mg levonorgestrel inserted into uterus
for up to 5 yr. (Also approved to treat
heavy menstrual bleeding in women using
intrauterine system for contraception.)
Releases 20 mcg/day.
Skyla 13.5 mg levonorgestrel inserted into
uterus for up to 3 yr.

TRANSDERMAL SYSTEM
Trade name Combination
Ortho Evra BBW   Higher risk of thromboembolic
events, death if combined w/ smoking. 6
mg norelgestromin/0.75 ethinyl estradiol
in patch form; releases 150 mcg
norelgestromin/20 mcg ethinyl estradiol
each 24 hr for 1 wk. Patch applied on
same day of wk for 3 consecutive wk,
 followed by patch-free wk.

VAGINAL RING

Trade name Combination

NuvaRing 0.12 mg etonogestrel (progestin)/0.015
mg ethinyl estradiol (estrogen)/day. Insert
into vagina on or before 5th day of
menstrual period; remove after 3 wk.
Insert new ring after 1-wk rest.
Appendix G
Commonly used biologicals

IND & DOSE Vaccines provide inactivated or attenuated antigens to stimulate production

of antibodies; provides active immunity. Immune globulin provides acute, passive
immunity by providing preformed antibodies to specific antigen; not long-term
protection.
ADV EFF Anorexia, drowsiness, injection-area edema (w/ redness, swelling, induration,
pain that may persist for few days), fretfulness, generalized aches/pains,
hypersensitivity reactions, malaise, transient fever, vomiting
NC/PT Pregnancy Category C. Use caution in pregnancy; safety not established. Defer
administration of routine immunizing or booster doses if acute infection present.
Usually not indicated for pts on immunosuppressants or w/ cancer, active infections.
Have epinephrine 1:1,000 on hand during injection for hypersensitivity reactions.
Provide comfort measures for discomforts of injection. Give pt written record of
immunization, booster reminder if needed.

diphtheria and tetanus toxoids and acellular pertussis vaccine, adsorbed

(DTaP, Tdap)
Adacel, Boostrix, Daptacel, Infanrix, Tripedia

Primary immunization: 3 IM doses of 0.5 mL at 4- to 8-wk intervals. Start doses by 6–8 wk

of age; finish by 7th birthday. Use same vaccine for all three doses. Fourth dose: 0.5 mL
IM at 15–20 mo at least 6 mo after previous dose. Fifth dose: 0.5 mL IM at 4–6 yr or
preferably before entry into school (Infanrix, Daptacel, Tripedia). If fourth dose given
after 4-yr birthday, may omit preschool dose. Booster injections: 11–64 yr (Adacel),
0.5 mL IM. 10 yr and older (Boostrix), 0.5 mL IM. Allow at least 5 yr between last of
series and booster dose.

diphtheria and tetanus toxoids and acellular pertussis adsorbed, hepatitis B

(recombinant), and inactivated poliovirus vaccine combined (DTaP-HePB-IPV)
Pediarix

Infants w/ hepatitis B surface antigen (HBsAG)–negative mothers: Three 0.5-mL doses IM at

6- to 8-wk intervals (preferably 8) stating at 2 mo. Children previously vaccinated w/ one
dose of hepatitis B vaccine: Should receive three-dose series. Children previously vaccinated
w/ one or more doses of Infanrix or IPV: May use Pediarix to complete series.

diphtheria and tetanus toxoids and acellular pertussis adsorbed and

inactivated poliovirus vaccine (DTaP-IIPV)
Kinrix

Fifth dose in diphtheria, tetanus, acellular pertussis series and fourth dose in inactivated
poliovirus series in children 4–6 yr whose previous immunizations have been w/ Infanrix
or Pediarix for first three doses and Infanrix for fourth dose. One IM injection of 0.5 mL.

diphtheria and tetanus toxoids and acellular pertussis adsorbed, inactivated

poliovirus vaccine, and Haemophilus b conjugate (tetanus toxoid conjugate)
vaccine (DTaP-IPV/Hib)
Pentacel

Four-dose series of IM injections of 0.5 mL at 2, 4, and 6 mo, followed by booster at

18 mo. Give between 6 wk and 4 yr.

Haemophilus b conjugate vaccine

ActHIB, Hiberix, Liquid PedvaxHIB

Active immunization of infants, children against H. influenzae b for primary

immunization, routine recall; 2–71 mo (PedvaxHIB), 2–18 mo (ActHIB w/ DPT), or 15–
18 mo (ActHIB, Hiberix w/ Tripedia).
ActHIB: Reconstitute w/ DTP, Tripedia, or saline. 2–6 mo, 3 IM injections of 0.5 mL at 2,
4, and 6 mo; 0.5 mL at 15–18 mo and DPT alone at 4–6 yr. 7–11 mo, 2 IM injections of
0.5 mL at 8-wk intervals; booster dose at 15–18 mo. 12–14 mo, 0.5 mL IM w/ a booster
2 mo later. 15–18 mo, 0.5 mL IM, booster of Tripedia at 4–6 yr.
Hiberix: 15 mo–4 yr, booster dose of 0.5 mL IM as single dose. Booster dose at 15 mo or
older but not less than 2 mo from last dose. Unvaccinated children 15–71 mo, 0.5 mL
IM.
PedvaxHIB: 2–14 mo, 2 IM injections of 0.5 mL at 2 mo and 2 mo later; 0.5-mL booster at
12 mo (if two doses complete before 12 mo, not less than 2 mo after last dose). 15 mo or
older, 0.5 mL IM single injection.

Haemophilus b conjugate vaccine w/ hepatitis B surface antigen

(recombinant)
Comvax

Infants w/ hepatitis B surface antigen (HBsAg)–negative mothers: Three 0.5-mL IM doses at

2, 4, and 12–15 mo. Children previously vaccinated w/ one or more doses of hepatitis B
vaccine or Haemophilus b vaccine: 0.5-mL IM doses at 2, 4, and 12–15 mo. Give only to
children of HBsAg-negative mothers.

hepatitis A vaccine, inactivated

Havrix, Vaqta

Adult: Havrix, 1,440 ELISA units (1 mL) IM; same dose booster in 6–12 mo. Vaqta, 50
units (1 mL) IM; same dose booster in 6–18 mo.
Child 12 mo–18 yr: Vaqta, 25 units /0.5 mL IM, w/ repeat dose in 6–18 mo. Havrix, 720
ELISA units (0.5 mL) IM; repeat dose in 6–12 mo.

hepatitis A inactivated and hepatitis B recombinant vaccine

Twinrix

Three doses (1 mL by IM injection) on 0-, 1-, and 6-month schedule. Accelerated dosage:
Four doses (1 mL by IM injection) on days 0, 7, 21, 30, followed by booster dose at
12 mo. Safety in pts under 18 yr not established.

hepatitis B immune globulin (HBIG)

HepaGam B, HyperHEP B S/D, Nabi-HB

Perinatal exposure: 0.5 mL IM within 12 hr of birth; repeat dose at 1 mo and 6 mo after

initial dose. Percutaneous exposure: 0.06 mL/kg IM immediately (within 7 days); repeat
28–30 days after exposure. Usual adult dose, 3–5 mL. Pts at high risk for infection:
0.06 mL/kg IM at same time (but at different site) as hepatitis B vaccine is given.
HepaGam B after liver transplant: 20,000 international units IV at 2 mL/min. Give first
dose w/ liver transplant, then daily on days 1–7, q 2 wk from day 14 through 12 wk,
and monthly from mo 4 onward. Sexual exposure: Single dose of 0.06 mL/kg IM within
14 days of last sexual contact.

hepatitis B vaccine
Engerix-B, Recombivax HB

Adults: Initial dose, 1 mL IM, then 1 mL IM at 1 mo and 6 mo after initial dose, all
types. Child 11–19 yr: 1 mL IM, then 1 mL IM at 1 mo and 6 mo after initial dose. Birth–
10 yr: Initial dose, 0.5 mL IM, then 0.5 mL IM at 1 mo and 6 mo after initial dose.
Dialysis, predialysis pts: Initial dose, 40 mcg (2 mL) IM; repeat at 1, 2, and 6 mo after
initial dose (Engerix-B). Or, 40 mcg (1 mL) IM; repeat at 1 and 6 mo (Recombivax HB).
Revaccination (consider booster dose w/ anti-HBs level under 10 milli-international
units/mL 1–2 mo after third dose). Adult, child older than 10 yr: 20 mcg. Child under
10 yr: 10 mcg. Hemodialysis pts (when antibody testing indicates need): Two 20-mcg doses.

human papillomavirus recombinant vaccine, bivalent types 16 and 18

(Cervarix)

Young girls, women 10–25 yr: Three doses of 0.5 mL IM at 0, 1, and 6 mo.

human papillomavirus recombinant vaccine, quadrivalent

Gardasil

Pts 9–26 yr: Three separate IM injections of 0.5 mL each, second dose 2 mo after initial
dose, last dose 6 mo after first dose. For px of cervical cancer, precancerous genital
lesions, genital warts, vaginal/vulvar/anal cancer in women; px of genital warts, anal
cancer, precancerous lesions in males.

immune globulin intramuscular (IG; gamma globulin; IGIM)

GamaSTAN S/D
immune globulin intravenous (IGIV)
Carimune NF, Flebogamma 5%, Flebogamma 10%, Gammagard Liquid, Privigen
immune globulin subcutaneous (IGSC, SCIG)
Gamunex-C, Hizentra, Vivaglobin

BBW Risk of renal dysfunction, renal failure, death; monitor accordingly.

Hepatitis A: 0.02 mL/kg IM for household, institutional contacts. Persons traveling to
areas where hepatitis A common, 0.02 mL/kg IM if staying less than 2 mo; 0.06 mL/kg
IM repeated q 5 mo for prolonged stay. Measles (rubeola): 0.25 mL/kg IM if exposed less
than 6 days previously; immunocompromised child exposed to measles, 0.5 mL/kg to
max 15 mL IM immediately. Varicella: 0.6–1.2 mL/kg IM promptly if zoster immune
globulin unavailable. Rubella: 0.55 mL/kg IM to pregnant women exposed to rubella but
not considering therapeutic abortion; may decrease likelihood of infection, fetal
damage. Immunoglobulin deficiency: Initially, 1.3 mL/kg IM, followed in 3–4 wk by
0.66 mL/kg IM q 3–4 wk; some pts may need more frequent injections. Carimune NF:
0.4–0.8 g/kg by IV infusion q 3–4 wk. Flebogamma: 300–600 mg/kg IV q 3–4 wk. Primary
immune deficiency, idiopathic thrombocytopenic purpura, chronic inflammatory demyelinating
polyneuropathy: 100–200 mg/kg subcut q wk. Or initially, 1.37 × previous IGIV dose
(grams)/number of wk between IGIV doses (Gamunex-C). Adjust based on response.

influenza type A (H5N1) virus monovalent vaccine, adjuvanted

generic

Adult: 0.5 mL IM into deltoid muscle; then 0.5 mL IM 21 days later. Prepare by mixing
one vial AS03 adjuvant with one vial H5N1 adjuvant just before administration; do not
mix in syringe w/ other vaccines. Virus grown in chicken eggs; use caution w/ chicken
allergies. Use caution in pregnancy. Give pt written record.

influenza type A and B virus vaccine

Afluria, Agriflu, Fluarix, FluLaval, Fluvirin, Fluzone, Fluzone High Dose, Fluzone
Quadrivalent

Do not give w/ sensitivity to eggs, chicken, chicken feathers, chicken dander;

hypersensitivity to vaccine components; hx of Guillain-Barré syndrome. Do not give to
infants, children at same time as diphtheria, tetanus toxoid, pertussis vaccine (DTP) or
within 14 days after measles virus vaccine. 6–35 mo: 0.25 mL IM; repeat in 4 wk
(Afluria, Fluzone). 3 yr and older: 0.5 mL IM (Afluria, Fluzone, Fluarix). If under 9 yr and
receiving vaccine for first time or received only one dose last year, give repeat dose in 4
wk. 4 yr and older: 0.5 mL IM (Fluvirin). If under 8 yr and receiving vaccine for first time
or received only one dose last year, give repeat dose in 4 wk. 18 yr and older: 0.5 mL
IM. Shake prefilled syringe before use (Agriflu, Afluria, Fluarix, FluLaval, Fluzone, Fluvirin).
18–64 yr: 0.1 mL intradermally (Fluzone Intradermal). 65 yr and older: 0.5 mL IM
(Fluzone High Dose).

influenza type A and B virus vaccine, live, intranasal

FluMist

2–8 yr, not previously vaccinated: Two doses (0.2 mL each) intranasally as one spray
(0.1 mL)/nostril at least 1 mo apart. 2–8 yr, previously vaccinated: One dose (0.2 mL)
intranasally as one spray (0.1 mL)/nostril. 9–49 yr: One dose of one spray (0.1 mL) in
each nostril/flu season. 5–8 yr not previously vaccinated w/ FluMist: Two doses (0.5 mL
each) 60 days apart ± 14 days. 5–8 yr previously vaccinated w/ FluMist: One dose
(0.5 mL)/flu season.

influenza virus vaccine, H5N1

H5N1

Adult 18–64 yr: 1 mL IM into deltoid muscle of upper arm, then 1 mL IM 21–35 days
later. Virus grown in chicken eggs; use caution in pts w/ chicken allergy.

measles (rubeola) virus vaccine, live, attenuated

Attenuvax

Inject total volume of reconstituted vaccine or 0.5 mL of multidose vial subcut into outer
aspect of upper arm; dose same for all pts. Recommended age for primary vaccination,
12–15 mo. Use caution if giving to pt w/ hx of sensitivity to eggs, chicken, chicken
feathers. Do not give within 1 mo of immunization w/ other live virus vaccines, mumps
vaccine. Do not give for at least 3 mo after blood, plasma transfusions or serum immune
globulin administration.

measles, mumps, rubella vaccine, live (MMR)

M-M-R II

Inject 0.5 mL reconstituted vaccine subcut into outer aspect of upper arm. Dose same for
all pts. Booster dose recommended on entry into elementary school. Use caution if
giving to pt w/ hx of sensitivity to eggs, chicken, chicken feathers. Do not give within
1 mo of immunization w/ other live virus vaccines. Do not give for at least 3 mo after
blood, or plasma transfusions or serum immune globulin administration.

measles, mumps, rubella, and varicella virus vaccine, live

ProQuad
12 mo–12 yr: 0.5 mL subcut. Allow 1 mo between administration of vaccines containing
measles antigens and administration of ProQuad. If second varicella vaccine needed,
allow 3 mo between administration of the two doses.

meningococcal groups C and Y, Haemophilus b tetanus toxoid conjugate

vaccine
MenHibrix

Four doses, 0.5 mL IM each; first as early as 6 wk, 4th as late as 18 mo. Usual timing, 2,
4, 6, and 12–15 mo.

meningococcal vaccine
Menactra, Menomune A/C/Y/W-135, Menveo

Menactra: 9 mo–55 yr, 0.5 mL IM in deltoid region as one dose. Menomune: 2–55 yr,
0.5 mL IM; may give booster in 3–5 yr. Menveo: 2 mo–55 yr, 0.5 mL IM as one dose.
Children 2–5 yr may receive second dose 2 mo after first dose.

pneumococcal vaccine, polyvalent

Pneumovax 23

One 0.5-mL dose subcut, IM. Not recommended for children under 2 yr. Give at least 2
wk before initiation of cancer chemotherapy, other immunosuppressive therapy.

pneumococcal 13-valent conjugate vaccine (diphtheria CRM197 protein)

Prevnar-13

0.5 mg IM, preferably in anterolateral aspect of thigh in infants, deltoid muscle of upper
arm in older children. 6 wk–5 yr: Four-dose series given 4–8 wk apart at 2, 4, 6 mo; then
at 12–15 mo. Catch-up schedule for children 7 mo and older: 7–11 mo, three doses, first
two doses at least 4 wk apart; third dose after first birthday. 12–23 mo, two doses at
least 2 mo apart. 24 mo–5 yr, one dose (before 6th birthday).

poliovirus vaccine, inactivated (IPV, Salk)

IPOL

Do not give w/ known hypersensitivity to streptomycin, neomycin (each dose contains

under 25 mcg of each). Adults: Not usually needed in adults in United States.
Recommended if unimmunized adult is exposed, traveling to high-risk area, or household
contact of children receiving IPV. Give 0.5 mL subcut: two doses at 1- to 2-mo intervals,
third dose 6–12 mo later. Previously vaccinated adults at risk for exposure should
receive 0.5-mL dose. Children: 0.5 mL subcut at 2, 4, and 6–18 mo. Booster dose needed
at time of entry into elementary school.
 RHo (D) immune globulin
HyperRHO S/D Full Dose, RhoGAM, Ultra-Filtered Plus
RHo (D) immune globulin micro-dose
HyperRHO S/D minidose, MICRhoGAM, Ultra-Filtered Plus
RHo (D) immune globulin IV (human) (RHo D IGIV)
Rhophylac, WinRho SDF

BBW Risk of intravascular hemolysis, death when used for idiopathic thrombocytopenia
purpura (ITP; WinRho). monitor dipstick urinalysis at baseline, then at 2, 4, 8 hr. Ask pt
to report back pain, chills, discolored urine.
Postpartum prophylaxis: 1 vial IM, IV (WinRho SDF) within 72 hr of delivery. Antepartum
prophylaxis: 1 vial IM, IV (WinRho SDF) at 26–28 wk’ gestation; 1 vial within 72 hr after
Rh-incompatible delivery to prevent Rh isoimmunization during pregnancy. After
amniocentesis, miscarriage, abortion, ectopic pregnancy at or beyond 13 wk’ gestation: 1 vial
IM, IV. Transfusion accidents: Multiply volume in mL of Rh-positive whole blood given by
Hct of donor unit; divide this volume (in mL) by 15 to obtain number of vials to be
given. If results of calculation are fraction, give next whole number of vials. ITP: 250
international units/kg IV at 2 mL/ 15–60 sec. Spontaneous/induced abortion, termination
of ectopic pregnancy up to and including 12 wk’ gestation (unless father Rh negative): 1 vial
microdose IM as soon as possible after pregnancy termination.

rotavirus vaccine, live, oral pentavalent

Rotarix, RotaTeq

Three ready-to-use liquid pouch doses (2 mL each) PO starting at age 6–12 wk, w/
subsequent doses at 4- to 10-wk intervals (do not give third dose after age 32 wk)
(RotaTeq). Two doses of 1 mL each PO starting at age 6 wk. Allow 4 wk before second
dose. Must complete Series by age 24 wk (Rotarix).

typhoid vaccine
Typhim Vi, Vivotif Berna

Complete vaccine regimen 1–2 wk before potential exposure.

Parenteral Older than 10 yr: 2 doses of 0.5 mL subcut at intervals of 4 wk or longer. 10 yr
or younger: Two doses of 0.25 mL subcut at intervals of 4 wk or longer.
Booster dose. Given q 3 yr in cases of continued exposure. Older than 10 yr: 0.5 mL subcut
or 0.1 mL intradermally. 6 mo–10 yr: 0.25 mL subcut or 0.1 mL intradermally.
Parenteral (Typhim Vi). Children 2 yr and older: 0.5 mL IM. Booster dose q 2 yr; 0.5 mL
IM.
Oral (Vivotif Berna). Pts over 6 yr: 1 capsule on days 1, 3, 5, 7 1 hr before meal w/ cold,
lukewarm drink. No data on need for booster dose; 4 capsules on alternating days once
q 5 yr suggested.
 varicella virus vaccine, live
Varivax

Adult, child 13 yr and older: 0.5 mL subcut in deltoid area, then 0.5 mL 4–8 wk later.
Child 1–12 yr: Single 0.5-mL dose subcut.

zoster vaccine, live

Zostavax

Adult 50 yr and older: 1 injection of single-dose vaccine subcut in upper arm. Vaccine
should be frozen and reconstituted, using supplied diluent, immediately after removal
from freezer. Give immediately after reconstituting.

OTHER BIOLOGICALS

Name Indications Instructions

IMMUNE GLOBULINS
anti-thymocyte globulin Tx of renal transplant acute 1.5 mg/kg/day for 7–
(Thymoglobulin) rejection 14 days as 6-hr IV infusion
w/immunosuppression for first dose and at least 4
hr each subsequent dose.
Give through 0.22-micron
filter. Store in refrigerator;
use within 4 hr of
reconstitution.
botulism immune globulin Tx of pts under 1 yr w/ 1 mL/kg as single IV
(BabyBIG) infant botulism caused by infusion as soon as dx
toxin A or B made.
cytomegalovirus immune Px of CMV disease after 15 mg/kg IV over 30 min;
globulin IV (CMV-IGIV) renal, lung, liver, pancreas, increase to 30 mg/kg IV for
(CytoGam) heart transplant 30 min, then 60 mg/kg IV
to max 150 mg/kg. Infuse
at 72 hr, 2 wk, then 4, 6, 8,
12, 16 wk. monitor for
 allergic reactions. Use
within 6 hr of entering vial.
Give through IV line w/ in-
line filter (15 micron).
lymphocyte, immune Mgt of allograft rejection in 10–30 mg/kg/day IV adult
globulin (Atgam) renal transplant; tx of transplant; 5–
aplastic anemia 25 mg/kg/day IV child
transplant; 10–
20 mg/kg/day IV for 8–
14 days for aplastic
anemia. Stable for up to 12
hr after reconstitution. Give
skin test before first dose.
rabies immune globulin Passive protection against 20 international units/kg
(HyperRab S/D, Imogam rabies in nonimmunized pts IM as single dose at same
Rabies-HT) w/ exposure to rabies time as rabies vaccine.
Infuse wound area if
possible. Never give in
same site as vaccine.
Refrigerate vial.
vaccinia immune globulin Tx, modification of vaccinia 2 mL/kg (100 mg/kg) IV.
IV (VIGIV) infections
varicella zoster immune Decrease severity of 125 units/10 kg IV or IM
globulin (VZIG) chickenpox sx in high-risk given within 96 hr of
pts exposure.
ANTITOXINS, ANTIVENINS
antivenin (Micrurus fulvius) Neutralization of venom of 3–5 vials by slow IV
U.S. coral snakes injection. Give first 1 to
2 mL over 3–5 min; observe
for allergic reaction. Flush
 w/ IV fluids after antivenin
infused. May need up to
100 mL.
black widow spider species Tx of sx of black widow 2.5 mL IM. May give IV in
antivenin (Antivenin spider bites 10–50 mL saline over
Latrodectus mactans) 15 min. Ensure supportive
tx, muscle relaxant use.
botulism antitoxin (Botulism Tx of suspected/known For pts 1 yr and older, base
antitoxin heptavalent exposure to botulinum dose on CDC protocol and
[HBAT]) neurotoxin exposure.
centruroides (scorpion) Tx of scorpion stings Initially, 3 vials infused IV
immune fab (Anascorp) over 10 min; then 1 vial at
a time at intervals of 30–
60 min until clinically
stable. Begin as soon as
possible after sting. Severe
hypersensitivity reactions,
delayed serum sickness
reaction possible (contains
equine proteins).
crotalidae polyvalent Tx of rattlesnake bites 4–6 vials IV; may repeat
immune fab (ovine) based on response. Dilute
(CroFab) each vial w/ 10 mL sterile
water, then w/ 250 mL
0.9% normal saline. Give
each 250 mL over 60 min.
Contains specific antibody
fragments that bind to four
different rattlesnake toxins.
Venom removal should be
done at once. monitor
 carefully for
hypersensitivity
reaction. most effective if
given within first 6 hr after
snake bite.

varicella zoster immune Decrease severity of 1.25 mL diluted IM or

globulin (VariZIG) chickenpox; used within 2.5 mL diluted IV over 3–
4 days of exposure 5 min. Do not give w/
varicella vaccine.
BACTERIAL VACCINES
BCG (TICE BCG) Exposure to TB of skin test 0.2–0.3 mL percutaneously
negative infants and using sterile multipuncture
children; tx of groups w/ disc. Refrigerate, protect
high rates of TB; travel to from light. Keep
areas w/ high endemic TB vaccination site clean until
rates reaction disappears.
VIRAL VACCINES
Japanese encephalitis Active immunization in pts 3 subcut doses of 1 mL
vaccine (JE-VAX) older than 1 yr who will on days 0, 7, 30. Child 1–
reside, travel in endemic or 3 yr, 3 subcut doses of
epidemic areas 0.5 mL. Refrigerate vial. Do
not remove rubber stopper.
Pt should not travel within
10 days of vaccination.
Japanese encephalitis virus Active immunization in pts 2 doses of 0.5 mL each IM
(JEV) vaccine, inactivated, 17 yr and older 28 days apart. Should
adsorbed (Ixiaro) complete series at least 1
wk before exposure to JEV.
Contains protamine sulfate.
Use only if clearly needed
 in pregnancy, breast-
feeding.

rabies vaccine (Imovax Preexposure rabies Preexposure: 1 mL IM

Rabies, RabAvert) immunization for pts in on days 0, 7, and 21 or 28.
high-risk area; postexposure Postexposure: 1 mL IM
antirabies regimen w/ on days 0, 3, 7, 14, 28.
rabies immunoglobulin Refrigerate. If titers low,
may need booster.
yellow fever vaccine (YF- Immunization of pts 9 mo 0.5 mL subcut. Booster dose
Vax) and older living in or suggested q 10 yr. Use
traveling to endemic areas cautiously w/ allergy to
chicken, egg products.
Appendix H
Drugs commonly used to treat specific disorders

The list below includes 50 common disorders and the medications most commonly
prescribed to treat them.

ADHD

Stimulants
dexmethylphenidate (Focalin)
dextroamphetamine (Dexedrine)
lisdexamphetamine (Vyvanse)
methylphenidate (Concerta, Ritalin)
mixed amphetamines (Adderall)

Nonstimulants
atomoxetine (Strattera)
guanfacine (Intuniv)

Alzheimer disease

Cholinergics
donepezil (Aricept)
galantamine (Razadyne)
rivastigmine (Exelon)

NMDA receptor antagonist

memantine (Namenda)

Angina

Nitrates
isosorbide dinitrate (Isordil)
isosorbide mononitrate (Imdur)
nitroglycerin (Nitro-Bid, Nitrostat, others)

Beta blockers
metoprolol (Toprol)
nadolol (Corgard)
propranolol (Inderal)

Calcium channel blockers

amlodipine (Norvasc)
diltiazem (Cardizem)
nicardipine (Cardene)
nifedipine (Adalat)
verapamil (Calan)

Piperazine-acetamide
ranolazine (Ranexa)

Anxiety disorder

Benzodiazepines
alprazolam (Xanax)
chlordiazepoxide
clonazepam (Klonopin)
clorazepate (Tranxene)
diazepam (Valium)
lorazepam (Ativan)
oxazepam

Barbiturates
mephobarbital (Mebaral)

Others
buspirone
meprobamate

Arthritis, rheumatoid

Pain relief
aspirin (generic)
capsaicin (Qutenza)
celecoxib (Celebrex)
diclofenac (Cataflam)

Immunomodulators
abatacept (Orencia)
adalimumab (Humira)
anakinra (Kineret)
auranofin (Ridaura)
aurothioglucose (Solganal)
azathioprine (Imuran)
certolizumab (Cimzia)
cyclosporine (Sandimmune)
etanercept (Enbrel)
hydroxychloroquine (Plaquenil)
infliximab (Remicade)
leflunomide (Arava)
methotrexate
penicillamine (Cuprimine)
prednisone (Rayos)
rituximab (Rituxan)

Asthma

Xanthines
aminophylline (Truphylline)
diphylline (Lufyllin)
theophylline (Elixophyllin, others)

Sympathomimetics
albuterol (Proventil)
epinephrine (Adrenaclick)
formoterol (Foradil)
isoetharine
isoproterenol (Isuprel)
levalbuterol (Xopenex)
metaproterenol (Alupent)
pirbuterol (Maxair)
salmeterol (Serevent)
terbutaline

Inhaled steroids
beclomethasone (Beclovent)
budesonide (Pulmicort)
ciclesonide (Alvesco)
fluticasone (Flovent)
triamcinolone (Azmacort)

Leukotriene
montelukast (Singulair)

Receptor antagonists
zafirlukast (Accolate)
zileuton (Zyflo)

BPH
Alpha 1 blockers
alfuzosin (UroXatral)
doxazosin (Cardura)
tamsulosin (Flomax)
terazosin (Hytrin)

Androgen inhibitors
dutasteride (Avodart)
finasteride (Proscar)

Cancer, breast

Antineoplastics
anastrozole (Arimidex)
capecitabine (Xeloda)
cyclophosphamide
docetaxel (Taxotere)
doxorubicin
epirubicin (Ellence)
eribulin (Halaven)
exemestane (Aromasin)
fluorouracil (Efudex, Fluoroplex)
fulvestrant (Faslodex)
gemcitabine (Gemzar)
ixabepilone (Ixempra)
lapatinib (Tykerb)
letrozole (Femara)
methotrexate (Trexall)
paclitaxel (Abraxane, Taxol)
tamoxifen (Soltamox)
toremifene (Fareston)

Cancer, colon

Antineoplastics
bevacizumab (Avastin)
capecitabine (Xeloda)
cetuximab (Erbitux)
irinotecan (Camptosar)
leucovorin (Fusilev)
oxaliplatin (Eloxatin)
panitumumab (Vectibix)
Cancer, lung

Antineoplastics
bevacizumab (Avastin)
carboplatin
cisplatin
docetaxel (Taxotere)
erlotinib (Tarceva)
etoposide
gemcitabine (Gemzar)
irinotecan (Camptosar)
paclitaxel (Taxol)
pemetrexed (Alimta)
vinorelbine (Navelbine)

Cancer, prostate

LH-RH agonists
degarelix (Firmagon)
goserelin (Zoladex)
histrelin (Vantas)
leuprolide (Lupron)
triptorelin (Trelstar)

Anti-androgens
bicalutamide (Casodex)
flutamide
nilutamide (Nilandron)

Antineoplastics
abiraterone (Zytiga)
cabazitaxel (Jevtana)

Immunotherapy
sipuleucel-T (Provenge)

Constipation

Chemical stimulants
bisacodyl (Dulcolax)
cascara
castor oil (Neolid)
senna (Senokot)
Bulk stimulants
lactulose
magnesium citrate (Citrate of Magnesia)
magnesium hydroxide (Milk of Magnesia)
magnesium sulfate (Epsom Salts)
polycarbophil (FiberCon)
polyethylene glycol (Miralax)
polyethylene glycol electrolyte solution (GoLYTELY, others)
psyllium (Metamucil)

Lubricants
docusate (Colace)
glycerin (Sani-Supp)
mineral oil

COPD

Xanthines
aminophylline
diphylline (Lufyllin)
theophylline (Elixophyllin, others)

Sympathomimetics
arformoterol (Brovana)
indacaterol (Arcapta)

Anticholinergics
aclidinium (Tudorza Pressair)
ipratropium (Atrovent)
tiotropium (Spiriva)

Phosphodiesterase inhibitor
roflumilast (Daliresp)

Crohn disease

Salicylates
mesalamine (Apriso, Asacol)
sulfasalazine (Azulfidine)

Antibiotics
ciprofloxacin (Cipro)
metronidazole (Flagyl)
Corticosteroids
budesonide (Entocort EC)
prednisone (Rayos)

Immunomodulators
azathioprine (Imuran)
mercaptopurine (Purinethol)

Monoclonal antibodies
adalimumab (Humira)
infliximab (Remicade)

Cystic fibrosis

Bronchodilators
albuterol
salmeterol (Serevent)

Mucolytic
acetylcysteine

Digestive enzyme
pancrelipase (Creon, Pancrease)

Others
dornase alfa: dornase (Pulmozyme)

Depression

TCAs
amitriptyline
amoxapine (Ascendin)
clomipramine (Anafranil)
desipramine (Norpramin)
doxepin (Silenor)
imipramine (Tofranil)
maprotiline
nortriptyline (Aventyl)
protriptyline (Vivactil)
trimipramine (Surmontil)

MAOIs
isocarboxazid (Marplan)
phenelzine (Nardil)
tranylcypromine (Parnate)

SSRIs
citalopram (Celexa)
escitalopram (Lexapro)
fluoxetine (Prozac)
fluvoxamine (Luvox)
paroxetine (Paxil)
sertraline (Zoloft)
vilazodone (Viibryd)

Others
bupropion (Wellbutrin)
desvenlafaxine (Pristiq)
duloxetine (Cymbalta)
milnacipran (Remeron)
nefazodone
selegiline (Emsam)
trazodone (Desyrel)
venlafaxine (Effexor)

Diabetes mellitus

Insulin
insulin (Humulin, others)

Sulfonylureas
chlorpropamide (Diabinese)
glimepiride (Amaryl)
glipizide (Glucotrol)
glyburide (DiaBeta)
tolazamide (Tolinase)
tolbutamide (Orinase)

Alpha-glucosidase inhibitors
acarbose (Precose)
miglitol (Glyset)

Biguanide
metformin (Glucophage)

DPP-4 inhibitors
alogliptin (Nesina)
linagliptin (Tradjenta)
saxagliptin (Onglyza)
sitagliptin (Januvia)

Human amylin
pramlintide (Symlin)

Incretin mimetics
exenatide (Bydureon, Byetta)
liraglutide (Victoza)

Meglitinides
nateglinide (Starlix)
repaglinide (Prandin)

Sodium-glucose transport inhibitors

canagliflozin (Invokana)
dapagliflozin (Forxiga)

Thiazolidinediones
pioglitazone (Actos)
rosiglitazone (Avandia)

Diarrhea

Antidiarrheals
bismuth subsalicylate (Pepto-Bismol)
loperamide (Imodium)
opium derivatives (Paregoric)

ED

Prostaglandin
alprostadil (Caverject)

Phosphodiesterase inhibitors
avanafil (Stendra)
sildenafil (Viagra)
tadalafil (Cialis)
vardenafil (Levitra)

GERD
Antacids
aluminum salts (ALternaGEL)
calcium salts (Tums)
magnesium salts (Milk of Magnesia)
sodium bicarbonate (Bells/ans)

Histamine-2 antagonists
cimetidine (Tagamet)
famotidine (Pepcid)
nizatidine (Axid)
ranitidine (Zantac)

Proton pump inhibitors

dexlansoprazole (Dexilant)
esomeprazole (Nexium)
lansoprazole (Prevacid)
omeprazole (Prilosec)
pantoprazole (Protonix)
rabeprazole (AcipHex)

Glaucoma

Ophthalmic agents
acetazolamide (Diamox)
apraclonidine (Iopidine)
betaxolol (Betoptic)
bimatoprost (Lumigan)
brimonidine (Alphagan P)
carteolol (Ocupress)
dipivefrin (Propine)
dorzolamide (Trusopt)
echothiophate (Phospholine)
latanoprost (Xalatan)
levobunolol (Betagan)
metipranolol (OptiPranolol)
pilocarpine (Isopto Carpine)
timolol (Timoptic)
travoprost (Travatan)

Hepatitis B

Antivirals
adefovir (Hepsera)
entecavir (Baraclude)
telbivudine (Tyzeka)

Hepatitis C
boceprevir (Victrelis)
simeprevir (Olysio)
sofosbuvir (Sovaldi)
telaprevir (Incivek)

HF

Cardiac glycoside
digoxin (Lanoxin)

Phosphodiesterase inhibitors
milrinone

Nitrates
isosorbide dinitrate (Isordil)
isosorbide mononitrate (Imdur)
nitroglycerin (Nitro-Bid, Nitrostat, others)

Beta-adrenergic blockers
metoprolol (Toprol)
nadolol (Corgard)
propranolol (Inderal)

ACE inhibitors
benazepril (Lotensin)
captopril (Capoten)
enalapril (Vasotec)
fosinopril (Monopril)
lisinopril (Zestril)
moexipril (Univasc)
perindopril (Aceon)
quinapril (Accupril)
ramipril (Altace)
trandolapril (Mavik)

Diuretics
bumetanide (Bumex)
furosemide (Lasix)
torsemide (Demadex)
Natriuretic peptide
nesiritide (Natrecor)

HIV/AIDS

Nonnucleoside reverse transcriptase inhibitors

delavirdine (Rescriptor)
efavirenz (Sustiva)
etravirine (Intelence)
nevirapine (Viramune)
rilpivirine (Edurant)

Nucleoside reverse transcriptase inhibitors

abacavir (Ziagen)
didanosine (Videx)
emtricitabine (Emtriva)
lamivudine (Epivir)
stavudine (Zerit XR)
tenofovir (Viread)
zidovudine (Retrovir)

Protease inhibitors
atazanavir (Reyataz)
darunavir (Prezista)
fosamprenavir (Lexiva)
indinavir (Crixivan)
lopinavir (Kaletra)
nelfinavir (Viracept)
ritonavir (Norvir)
saquinavir (Invirase)
tipranavir (Aptivus)

Fusion inhibitor
enfuvirtide (Fuzeon)

CCR5 coreceptor antagonist

maraviroc (Selzentry)

Integrase inhibitor
raltegravir (Isentress)

Hyperlipidemia
Bile acid sequestrants
cholestyramine (Prevalite)
colesevelam (Welchol)
colestipol (Colestid)

Statins
atorvastatin (Lipitor)
fluvastatin (Lescol)
lovastatin (Altoprev)
pitavastatin (Livalo)
pravastatin (Pravachol)
rosuvastatin (Crestor)
simvastatin (Zocor)

Cholesterol absorption inhibitor

ezetimibe (Zetia)

Fibrates
fenofibrate (TriCor)
fenofibric acid (Trilipix)
gemfibrozil (Lopid)

Vitamin B
niacin (Niaspan)

Other
omega-3-acid ethyl esters (Lovaza)

Hypertension

ACE inhibitors
benazepril (Lotensin)
captopril (Capoten)
enalapril (Vasotec)
fosinopril
lisinopril (Zestril)
moexipril (Univasc)
perindopril (Aceon)
quinapril (Accupril)
ramipril (Altace)
trandolapril (Mavik)

ARBs
azilsartan (Edarbi)
candesartan (Atacand)
eprosartan (Teveten)
irbesartan (Avapro)
losartan (Cozaar)
olmesartan (Benicar)
telmisartan (Micardis)
valsartan (Diovan)

Calcium channel blockers

amlodipine (Norvasc)
clevidipine (Cleviprex)
diltiazem (Cardizem)
felodipine (Plendil)
isradipine (DynaCirc)
nicardipine (Cardene)
nifedipine (Procardia XL)
nisoldipine (Sular)
verapamil (Calan SR)

Renin inhibitor
aliskiren (Tekturna)

Thiazide diuretics
chlorothiazide (Diuril)
hydrochlorothiazide (HydroDIURIL)

Adrenergic blockers
acebutolol (Sectral)
atenolol (Tenormin)
betaxolol
bisoprolol (Zebeta)
metoprolol (Lopressor)
nadolol (Corgard)
nebivolol (Bystolic)
propranolol (Inderal)
timolol

Infertility

Hormones
cetrorelix (Cetrotide)
chorionic gonadotropin
clomiphene (Clomid)
follitropin alfa (Gonal-F)
follitropin beta (Follistim)
ganirelix (Antagon)
menotropins (Repronex)
urofollitropin (Bravelle)

Influenza

Antivirals
amantadine (Symmetrel)
oseltamivir (Tamiflu)
ribavirin (Rebetron)
rimantadine (Flumadine)
zanamivir (Relenza)

Insomnia

Benzodiazepines
estazolam
flurazepam
quazepam (Doral)
temazepam (Restoril)
triazolam (Halcion)

Other
diphenhydramine (Benadryl)
eszopiclone (Lunesta)
ramelteon (Rozerem)
zaleplon (Sonata)
zolpidem (Ambien)

Irritable bladder syndrome

Anticholinergics
darifenacin (Enablex)
fesoterodine (Toviaz)
flavoxate (Urispas)
oxybutynin (Ditropan, Gelnique, Oxytrol)
solifenacin (VESIcare)
tolterodine (Detrol)
trospium (Sanctura)
Beta agonist
mirabegron (Myrbetriq)

Menopause

Estrogens
estradiol (Estrace)
estrogens, conjugated (Premarin)
estrogens, esterified (Menest)
estropipate (Ortho-Est)

Progestins
drospirenone (Yasmin with ethinyl estradiol)

Estrogen receptor modulator

raloxifene (Evista)

MI

Platelet inhibitors
abciximab (ReoPro)
aspirin
clopidogrel (Plavix)
eptifibatide (Integrilin)
prasugrel (Effient)
ticagrelor (Brilinta)
ticlopidine (Ticlid)
tirofiban (Aggrastat)

Anticoagulants
dalteparin (Fragmin)
enoxaparin (Lovenox)
heparin

Pain relief
morphine

Nitrates
isosorbide dinitrate (Isordil)
isosorbide mononitrate (Imdur)
nitroglycerin (Nitro-Bid, Nitrostat, others)

Beta-adrenergic blockers
metoprolol (Toprol)
nadolol (Corgard)
propranolol (Inderal)

Calcium channel blockers

amlodipine (Norvasc)
diltiazem (Cardizem)
nicardipine (Cardene)
nifedipine (Adalat)
verapamil (Calan)

Migraine headache

Ergots
dihydroergotamine (Migranal)
ergotamine (Ergomar)

Triptans
almotriptan (Axert)
eletriptan (Relpax)
frovatriptan (Frova)
naratriptan (Amerge)
rizatriptan (Maxalt)
sumatriptan (Imitrex)

Nausea, vomiting

Phenothiazines
chlorpromazine
prochlorperazine
promethazine
perphenazine

Nonphenothiazines
metoclopramide (Reglan)

Anticholinergics/antihistamines
meclizine (Antivert)

5HT3 receptor blockers

dolasetron (Anzemet)
granisetron
ondansetron (Zofran)
palonosetron (Aloxi)

Substance P/neurokinin 1 receptor antagonist

aprepitant (Emend)

Other
dronabinol (Marinol)
hydroxyzine (Vistaril)
nabilone (Cesamet)
trimethobenzamide (Tigan)

OCD

TCA
clomipramine (Anafranil)

SSRIs
citalopram (Celexa)
fluoxetine (Prozac)
fluvoxamine (Luvox)
paroxetine (Paxil)
sertraline (Zoloft)

Osteoporosis

Bisphosphonates
alendronate (Fosamax)
etidronate (Didronel)
ibandronate (Boniva)
pamidronate (Aredia)
risedronate (Actonel)
tiludronate (Skelid)
zoledronic acid (Reclast, Zometa)

Calcitonin
calcitonin, salmon (Fortical, Miacalcin)

Parathyroid hormone
teriparatide (Forteo)

Estrogen modulator
raloxifene (Evista)
Otitis media

Analgesics
acetaminophen (Tylenol)
ibuprofen (Advil, Motrin)
benzocaine, topical (Cylex)

Antibiotics
amoxicillin (Amoxil)
amoxicillin/clavulanate (Augmentin)
cefdinir (Omnicef)
ofloxacin (Floxin)

Parkinson disease

Dopaminergics
amantadine (Symmetrel)
apomorphine (Apokyn)
bromocriptine (Parlodel)
carbidopa/levodopa (Sinemet)
levodopa (Dopar)
pramipexole (Mirapex)
rasagiline (Azilect)
ropinirole (Requip)
rotigotine (Neupro)

Anticholinergics
benztropine (Cogentin)
diphenhydramine (Benadryl)
trihexyphenidyl

Adjuncts
entacapone (Comtan)
selegiline (Carbex, Eldepryl)
tolcapone (Tasmar)

Peptic ulcers

Histamine-2 antagonists
cimetidine (Tagamet)
famotidine (Pepcid)
ranitidine (Zantac)
Proton pump inhibitors
dexlansoprazole (Dexilant)
esomeprazole (Nexium)
lansoprazole (Prevacid)
omeprazole (Prilosec)
pantoprazole (Protonix)
rabeprazole (AcipHex)

GI protectant
sucralfate (Carafate)

Prostaglandin
misoprostol (Cytotec)

PTSD

SSRIs
citalopram (Celexa)
escitalopram (Lexapro)
fluoxetine (Prozac)
paroxetine (Paxil)
sertraline (Zoloft)
venlafaxine (Effexor)

TCA
amitriptyline

Antipsychotics
aripiprazole (Abilify)
olanzapine (Zyprexa)
quetiapine (Seroquel)
risperidone (Risperdal)
ziprasidone (Geodon)

Pulmonary artery hypertension

Endothelin receptor antagonist

ambrisentan (Letairis)
bosentan (Tracleer)
macitentan (Opsumit)
treprostinil (Remodulin)

Phosphodiesterase inhibitors
sildenafil (Revatio)
tadalafil (Adcirca)

Prostaglandin
epoprostenol (Flolan)

Prostacyclin
iloprost (Ventavis)
riociguat (Adempas)

Renal failure

ACE inhibitors
benazepril (Lotensin)
captopril (Capoten)
enalapril (Vasotec)
fosinopril (Monopril)
lisinopril (Zestril)
moexipril (Univasc)
perindopril (Aceon)
quinapril (Accupril)
ramipril (Altace)
trandolapril (Mavik)

ARBs
azilsartan (Edarbi)
candesartan (Atacand)
eprosartan (Teveten)
irbesartan (Avapro)
losartan (Cozaar)
olmesartan (Benicar)
telmisartan (Micardis)
valsartan (Diovan)

Diuretics
bumetanide
furosemide (Lasix)

Erythropoietins
darbepoetin (Aranesp)
epoetin alfa (Procrit)
peginesatide (Omontys)
Vitamins
doxercalciferol (Hectorol)
paricalcitol (Zemplar)

Iron
ferumoxytol (Feraheme)
iron sucrose (Venofer)
sodium ferric gluconate complex (Ferrlecit)

Phosphate binder
lanthanum (Fosrenol)

Rhinitis (allergic/seasonal)

Topical nasal decongestants

ephedrine (Pretz-D)
tetrahydrozoline (Tyzine)

Nasal steroids
beclomethasone (Becloven, QNASL)
budesonide (Pulmicort Flexhaler)
flunisolide (AeroBid)
fluticasone (Flonase, Flovent)
triamcinolone (Azmacort)

Antihistamines
brompheniramine (Veltane)
carbinoxamine (Karbinal ER)
chlorpheniramine (Chlor-Trimeton, others)
clemastine (Tavist-1)
cyclizine (Marezine)
cyproheptadine
dexchlorpheniramine
dimenhydrinate (Dimentabs)
diphenhydramine (Benadryl)
hydroxyzine (Vistaril)
phenindamine (Nolahist)
promethazine (Phenergan)
triprolidine (Zymine)

Nonsedating antihistamines
azelastine (Astelin)
cetirizine (Zyrtec)
desloratadine (Clarinex)
fexofenadine (Allegra)
levocetirizine (Xyzal)
loratadine (Claritin)

Oral decongestant
pseudoephedrine (Sudafed 12 Hour)

Schizophrenia

Typical antipsychotics
chlorpromazine
fluphenazine
haloperidol (Haldol)
loxapine
perphenazine
pimozide (Orap)
prochlorperazine
thioridazine
thiothixene (Navane)
trifluoperazine

Atypical antipsychotics
aripiprazole (Abilify)
clozapine (Clozaril)
iloperidone (Fanapt)
lurasidone (Latuda)
olanzapine (Zyprexa)
paliperidone (Invega)
quetiapine (Seroquel)
risperidone (Risperdal)
ziprasidone (Geodon)

Seizure disorder

Hydantoins
ethotoin (Peganone)
fosphenytoin
phenytoin (Dilantin)

Barbiturates
phenobarbital (Solfoton)
primidone (Mysoline)
Benzodiazepines
clobazam (Onfi)
clonazepam (Klonopin)
diazepam (Valium)

Glutamate antagonist
perampanel (Fycompa)

Potassium channel blocker

ezogabine (Potiga)

Succinimides
ethosuximide (Zarontin)
methsuximide (Celontin)

GABA modulators
acetazolamide (Diamox)
valproic acid (Depakene)
zonisamide (Zonegran)

Drugs for partial seizures

carbamazepine (Tegretol)
clorazepate (Tranxene)
felbamate (Felbatol)
gabapentin (Neurontin)
lacosamide (Vimpat)
lamotrigine (Lamictal)
levetiracetam (Keppra)
oxcarbazepine (Trileptal)
pregabalin (Lyrica)
rufinamide (Banzel)
tiagabine (Gabitril)
topiramate (Topamax)

Shock

Vasopressors
dobutamine
dopamine
ephedrine
epinephrine (Adrenalin)
isoproterenol (Isuprel)
norepinephrine (Levophed)
TB, first line

Antimycobacterial antibiotics
ethambutol (Myambutol)
isoniazid (Nydrazid)
pyrazinamide
rifampin (Rifadin)
rifapentine (Priftin)
streptomycin

TB, second line

Antimycobacterial antibiotics
bedaquiline (Sirturo)
capreomycin (Capastat)
cycloserine (Seromycin)
ethionamide (Trecator)
rifabutin (Mycobutin)

Thromboembolic disorders

Heparins
dalteparin (Fragmin)
enoxaparin (Lovenox)
heparin

Oral anticoagulants
apixaban (Elliquis)
dabigatran (Pradaxa)
rivaroxaban (Xarelto)
warfarin (Coumadin)

Thyroid dysfx

Replacement
levothyroxine (Synthroid, Levoxyl, others)
liothyronine (Cytomel)
liotrix (Thyrolar)
thyroid, desiccated (Armour Thyroid)

Antithyroid
methimazole (Tapazole)
propylthiouracil
sodium iodide/potassium iodide (Thyro-Block)

UTIs

Anti-infectives
cinoxacin (Cinobac)
co-trimoxazole (Bactrim, Septra)
fosfomycin (Monurol)
methenamine (Hiprex)
nitrofurantoin (Furadantin)
norfloxacin (Noraxin)
Bibliography

Aschenbrenner, D., & Venable, S. (2011). Drug therapy in nursing (4th ed.). Philadelphia,
PA: Lippincott Williams & Wilkins.
Brunton, L., Chabner, B., & Khollman, B. (2010). Goodman and Gilman’s the
pharmacological basis of therapeutics (12th ed.). New York, NY: McGraw-Hill.
Carpenito-Moyet, L. J. (2012). Nursing diagnosis: Application to clinical practice (14th ed.).
Philadelphia, PA: Lippincott Williams & Wilkins.
Drug evaluations subscription. (2014). Chicago, IL: American Medical Association.
Drug facts and comparisons. (2014). St. Louis, MO: Facts and Comparisons.
Drug facts update: Physicians on-line. (2014). Multimedia.
Fetrow, C. W., & Avila, J. (2003). Professional handbook of complementary and alternative
medicines (3rd ed.). Springhouse, PA: Lippincott Williams & Wilkins.
Griffiths, M. C. (Ed.). (2012). USAN and the USP 2012 dictionary of drug names. Rockville,
MD: United States Pharmacopeial Convention.
Handbook of adverse drug interactions. (2012). New Rochelle, NY: The Medical Letter.
ISMP medication safety alert! (2014). Huntingdon Valley, PA: Institute for Safe
Medication Practices.
Karch, A. M. (2013). Focus on nursing pharmacology (6th ed.). Philadelphia, PA:
Lippincott Williams & Wilkins.
The medical letter on drugs and therapeutics. (2014). New Rochelle, NY: Medical Letter.
PDR for nonprescriptive drugs. (2014). Oradell, NJ: Medical Economics.
PDR for ophthalmic medications. (2014). Oradell, NJ: Medical Economics.
Physicians’ desk reference (68th ed.). (2014). Oradell, NJ: Medical Economics.
Smeltzer, S. C., & Bare, B. G. (2009). Brunner and Suddarth’s textbook of medical-surgical
nursing (12th ed.). Philadelphia, PA: Lippincott Williams & Wilkins.
Tatro, D. S. (Ed.). (2014). Drug interaction facts. St. Louis, MO: Facts and Comparisons.
Index

A
abacavir, 1
abatacept, 1
Abbreviations, guide to, ix–xi
abciximab, 1
Abelcet, 18
Abilify, 22–23
Abilify Discmelt, 22–23
abiraterone, 1–2
Abortifacients
carboprost tromethamine, 49
dinoprostone, 97
mifepristone, 215
Abraxane, 247
Abreva, 377
absorbable fibrin sealant, 378
absorbable gelatin, 378
Absorbine, 376
Abstral, 130–131
acamprosate calcium, 2
Acanya, 374
acarbose, 2
Accolate, 349
Accuneb, 7
Accupril, 280–281
Accuretic, 397
acebutolol hydrochloride, 2
ACE inhibitors
benazepril hydrochloride, 32
captopril, 47
enalaprilat, 110
enalapril maleate, 110
fosinopril sodium, 143
lisinopril, 190
moexipril, 220
perindopril erbumine, 258
quinapril hydrochloride, 280–281
ramipril, 283–284
trandolapril, 332–333
Aceon, 258
Acephen, 2–3
Acetadote, 3–4
acetaminophen, 2–3
acetazolamide, 3
acetylcysteine, 3–4
acidophilus (probiotics), 364
AcipHex, 282
acitretin, 4
aclidinium bromide, 4
Aclovate, 377
Acne products
adapalene, 374
alitretin, 374
azelaic acid, 374
clindamycin, 374
dapsone, 82
fluocinolone acetonide, 377
ingenol mebutate, 347
isotretinoin, 173–174
metronidazole, 212, 375
sodium sulfacetamide, 375
tazarotene, 375
tretinoin, 335
tretinoin 0.025% cream, 375
tretinoin 0.05% cream, 375
tretinoin gel, 375
Actemra, 327–328
ActHib, 412
Acticin, 380
Actidose-Aqua, 58
Actigall, 339
Actimmune, 169
Actiq, 130–131
Activase, 11
Activella, 402
Actonel, 289
ActoPlus Met, 393
ActoPlus Met XR, 393
Actos, 263–264
ACU-Dyne, 376
Acular LS, 177
Acuvail, 177, 383
acyclovir, 4–5, 376
acyclovir/hydrocortisone, 377
Aczone Gel, 374
Adacel, 411
Adalat, 230
adalimumab, 5
adapalene, 374
Adasuve, 194–195
AdatoSil 5000, 384
Adcetris, 39
Adcirca, 312
Adderall, 387
Adderall XR, 387
adefovir dipivoxil, 5
Adempas, 259
Adenocard, 5–6
Adenoscan, 5–6
adenosine, 5–6
adomet, 372
ado-trastuzumab, 6
ADP receptor antagonist
clopidogrel bisulfate, 71
Adrenaclick, 112–113
Adrenergic blocker
amiodarone hydrochloride, 15–16
Adrucil, 137
Adsorbocarpine, 384
Advair Diskus, 403
Advair HFA, 403
Advate, 20
Advicor, 401
Advil, 161
A-E-R, 379
Aeroseb-Dex, 377
Aerosorb-Dex, 88–89
Aerospan HFA, 136–137
afatinib, 6
Afinitor, 125–126
aflibercept, 6–7
Afluria, 414
Afrin, 245
Aftate, 376
agalsidase beta, 7
Aggrastat, 326
Aggrenox, 399
Agoral, 414
Agrylin, 19
AKBeta, 383
AK-Pentolate, 382
Alamast, 384
Alavert, 192–193
Alaway, 383
Albuminar, 7
albumin (human), 7
albuterol sulfate, 7
alcaftadine, 381
alclometasone dipropionate, 377
Aldactazide, 400–401
Aldactone, 307
Aldara, 377
aldesleukin, 7–8
Aldosterone antagonist
spironolactone, 307
Aldosterone receptor blocker
eplerenone, 113–114
Aldurazyme, 181
alendronate sodium, 8
Aleve, 225
alfalfa, 364
alfuzosin hydrochloride, 8
alglucosidase alfa, 8
Alimta, 253
Alinia, 231
aliskiren, 9
alitretinoin, 374
Alkeran, 201
Alkylating agents
bendamustine hydrochloride, 32–33
busulfan, 42–43
carboplatin, 48–49
carmustine (BCNU), 50
cisplatin (CDDP), 66
cyclophosphamide, 77
dacarbazine hydrochloride, 80
ifosfamide, 163
lomustine, 191
mechlorethamine hydrochloride, 198–199
 melphalan, 201
streptozocin, 308
thiotepa, 322
Allegra, 132
Aller-Chlor Allergy, 61
Alli, 240–241
allopurinol, 9
allspice, 364
Allylamine
terbinafine hydrochloride, 318
almotriptan malate, 9
Alocril, 383
aloe leaves, 364
alogliptin, 9–10
Alomide, 383
Aloprim, 9
alosetron, 10
Aloxi, 248
Alpha-adrenergic blockers
alfuzosin hydrochloride, 8
doxazosin mesylate, 102
tamsulosin hydrochloride, 313
Alpha agonists
midodrine, 214–215
phenylephrine hydrochloride, 260–261
tetrahydrozoline hydrochloride, 321
tizanidine, 326–327
Alpha and beta blocker
carvedilol, 50–51
Alpha blockers
phentolamine mesylate, 260
prazosin hydrochloride, 270–271
silodosin, 300
terazosin hydrochloride, 317
Alphagan P, 382
Alpha-glucosidase inhibitors
acarbose, 2
miglitol, 215
AlphaNine SD, 127
alpha 1-proteinase inhibitor, 10
alprazolam, 10–11
alprostadil, 11
Alrex, 383
Alsuma, 310–311
Altabax, 375
Altace, 283–284
Altarussin, 153
Altavera, 405
alteplase recombinant, 11
Alternvative and complementary therapies, 364–373
Altoprev, 194
altretamine, 11–12
aluminum hydroxide gel, 12
Alvesco, 377
alvimopan, 12
Alzheimer disease drugs
donepezil hydrochloride, 101
galantamine hydrobromide, 145
memantine hydrochloride, 201
rivastigmine tartrate, 290–291
amantadine, 12
Amaryl, 149
Ambien, 352
AmBisome, 18
ambrisentan, 12–13
Amebicides
chloroquine phosphate, 60
iodoquinol, 170
metronidazole, 212
Amerge, 225
Amicar, 14
amifostine, 13
Amigesic, 296
amikacin sulfate, 13
Amikin, 13
amiloride hydrochloride, 13
amino acids, 14
aminocaproic acid, 14
Aminoglycosides
amikacin sulfate, 13
neomycin sulfate, 227
aminolevulinic acid hydrochloride, 14
aminophylline, 14–15
4–aminoquinoline
chloroquine phosphate, 60
Aminosyn, 14
amiodarone hydrochloride, 15–16
Amitiza, 385
amitriptyline hydrochloride, 16
amlexanox, 379
amlodipine besylate, 16
Ammonia-reducing drugs
lactulose, 178
sodium phenylacetate/sodium benzoate, 304
ammonium chloride, 16–17
Ammonul, 304
Amnesteem, 173–174
amoxapine, 17–18
Amoxil, 17–18
Amphadase, 155
Amphetamines
Adderall, 387
Adderall XR, 387
dextroamphetamine sulfate, 91–92
lisdexamfetamine dimesylate, 189–190
Amphotec, 18
amphotericin B, 18
amphotericin B cholesteryl sulfate, 18
amphotericin B, liposome, 18
ampicillin, 18–19
Ampyra, 81
Amrix, 77
Amturnide, 394
Amylinomimetic agent
pramlintide acetate, 269
Amyotrophic lateral sclerosis (ALS) drug
riluzole, 288
Anabolic steroids
oxandrolone, 242–243
oxymetholone, 245–246
Anadrol-50, 245–246
Anafranil, 70
anagrelide, 19
anakinra, 19
Analeptic drugs
caffeine, 44
caffeine citrate, 44
doxapram hydrochloride, 102
Analgesics
 acetaminophen, 2–3
Arthrotec, 387
aspirin, 24–25
capsaicin, 375
Damason-P, 388
diclofenac epolamine, 93
diclofenac potassium, 93
diclofenac sodium, 93, 382
diflunisal, 94
Duexis, 388
Embeda, 388
Empirin with Codeine, 387
etodolac, 124–125
fenoprofen calcium, 130
Fiorinal with Codeine, 387
flurbiprofen, 139
ibuprofen, 161
Lortab Tablets, 388
naproxen, 225
naproxen sodium, 225
Norco, 388
Percocet, 389
Percodan, 389
phenazopyridine hydrochloride, 259
Reprexain, 388
Roxicet, 389
Roxilox, 389
Roxiprin, 389
Salonpas, 388
salsalate, 296
Stagesic, 388
Tylenol with Codeine, 387
Tylox, 389
Ultracet, 389
Vicoprofen, 388
Vimovo, 388–389
ziconotide, 349–350
Zydone, 388
Anaprox, 225
Anascorp, 419
anastrozole, 19–20
Ancobon, 135
Androderm, 319–320
AndroGel, 319–320
Androgen
testosterone, 319–320
Androgen hormone inhibitors
dutasteride, 106
enzalutamide, 112
finasteride, 133
androstenedione, 364
Anestacon, 187
Anesthetic, general
droperidol, 105
Anesthetics, local
lidocaine, 187
lidocaine hydrochloride, 187
angelica, 364
Angeliq, 401
Angiomax, 36
Angiotensin receptor blockers
azilsartan medoxomil, 28
candesartan cilexetil, 46
eprosartan mesylate, 115
irbesartan, 170–171
losartan potassium, 194
olmesartan medoxomil, 237–238
telmisartan, 315–316
valsartan, 341
anidulafungin, 20
anise, 364
Anoro Ellipta, 404
Ansaid, 139
Antabuse, 98–99
Antacids
aluminum hydroxide gel, 12
calcium carbonate, 45
calcium chloride, 45
calcium glubionate, 45
calcium gluconate, 45
calcium lactate, 45
magnesia, 196
magnesium citrate, 196, 385
magnesium hydroxide, 196, 385
magnesium oxide, 196, 385
magnesium salts, 196, 385
 sodium bicarbonate, 302–303
Antagon, 146
Antara, 129–130
Anterior pituitary hormone
corticotropin (ACTH), 75
Anthelmintic drugs
ivermectin, 175
praziquantel, 270
pyrantel pamoate, 279
anthralin, 376
Antiacne drugs
Estrostep Fe, 389
Ortho Tri-Cyclen, 389
Antialcoholic drugs
acamprosate calcium, 2
disulfiram, 98–99
Antiallergy drug
cromolyn sodium, 76
Antiandrogens
bicalutamide, 35
flutamide, 139
Antianemic drug
lenalidomide, 182
Antianginal drugs
amlodipine besylate, 16
atenolol, 25
diltiazem hydrochloride, 96
dipyridamole, 98
isosorbide dinitrate, 173
isosorbide mononitrate, 173
nadolol, 223
niCARdipine hydrochloride, 229
NIFEdipine, 230
nitroglycerin, 232
propranolol hydrochloride, 276–277
ranolazine, 284
verapamil hydrochloride, 344
Antiarrhythmic drugs
acebutolol hydrochloride, 2
adenosine, 5–6
amiodarone hydrochloride, 15–16
disopyramide phosphate, 98
dofetilide, 100
 dronedarone, 105
esmolol hydrochloride, 118
flecainide, 134
ibutilide fumarate, 161
lidocaine hydrochloride, 187
mexiletine hydrochloride, 213
phenytoin, 261–262
propafenone hydrochloride, 275
propranolol hydrochloride, 276–277
quinidine gluconate, 281
quinidine sulfate, 281
sotalol hydrochloride, 307
Antiarthritic drugs
abatacept, 1
adalimumab, 5
anakinra, 19
etanercept, 122
leflunomide, 181
Antiasthmatic drugs
albuterol sulfate, 7
epinephrine bitartrate, 112–113
epinephrine hydrochloride, 112–113
formoterol fumarate, 142
isoproterenol hydrochloride, 173
levalbuterol hydrochloride, 183
levalbuterol tartrate, 183
metaproterenol sulfate, 204
montelukast sodium, 220–221
omalizumab, 238
salmeterol xinafoate, 295–296
terbutaline sulfate, 318
zafirlukast, 349
Antiasthmatic leukotriene synthesis inhibitor
zileuton, 350
Antibacterial agents
Augmentin, 389–390
Augmentin ES-600, 389–390
Augmentin XR, 389–390
Bactrim, 390
Bactrim DS, 390
ciprofloxacin, 65–66, 375, 382
fosfomycin tromethamine, 143
methenamine, 205–206
 methenamine hippurate, 205–206
nitrofurantoin, 232
Primaxin, 390
Septra, 390
Septra DS, 390
Sulfatrim Pediatric, 390
Synercid, 391
Timentin, 391
Unasyn, 391
Zosyn, 391
Antibiotics (see also lincosamide antibiotics; macrolide antibiotics)
amoxicillin trihydrate, 17–18
ampicillin, 18–19
bacitracin, 29
bleomycin sulfate, 36–37
capreomycin, 47
chloramphenicol sodium succinate, 59–60
ciprofloxacin, 65–66, 375, 382
cycloSERINE, 77
dactinomycin, 80
decitabine, 84–85
dexamethasone, 88–89, 377
hydrocortisone, 156–157
linezolid, 188
metronidazole, 212, 375
mupirocin, 375
mupirocin calcium, 375
polymyxin B sulfate, 265–266
retapamulin, 375
rifabutin, 286–287
rifampin, 287
rifapentine, 287
Antibiotics (continued)
rifaximin, 287–288
streptomycin sulfate, 308
telavancin, 314–315
tetracycline hydrochloride, 320–321
tigecycline, 324
trimethoprim, 337–338
vancomycin hydrochloride, 341–342
Anticataplectic agent
sodium oxybate, 304
Anticholinergic agents
 aclidinium bromide, 4
atropine sulfate, 26–27
benztropine mesylate, 33
cyclizine, 76–77
dicyclomine hydrochloride, 94
dimenhyDRINATE, 96
glycopyrrolate, 151
hyoscyamine sulfate, 159
ipratropium bromide, 170
meclizine hydrochloride, 199
methscopolamine bromide, 208
oxybutynin chloride, 244
propantheline bromide, 275–276
scopolamine hydrobromide, 298
tiotropium bromide, 325–326
Anticholinesterase
edrophonium chloride, 108
Anticholinesterase inhibitor
donepezil hydrochloride, 101
Anti-chorea drug
tetrabenazine, 320
Anticoagulants
apixaban, 21
argatroban, 22
bivalirudin, 36
dabigatran etexilate mesylate, 79
dalteparin sodium, 81
desirudin, 87
heparin sodium, 154
lepirudin, 182
protein C concentrate, 277
rivaroxaban, 290
tinzaparin sodium,
Anti–coronary artery disease drug
Caduet, 391
Antidepressants
amitriptyline hydrochloride, 16
buPROPion hydrobromide, 41–42
buPROPion hydrochloride, 41–42
citalopram hydrobromide, 66–67
desipramine hydrochloride, 87
desvenlafaxine succinate, 88
doxepin hydrochloride, 102–103
 duloxetine hydrochloride, 106
escitalopram oxalate, 117–118
Etrafon, 392
Etrafon-A, 392
Etrafon-Forte, 392
fluoxetine hydrochloride, 137–138
fluvoxamine maleate, 140
imipramine hydrochloride, 164
imipramine pamoate, 164
levomilnacipran, 185–186
Limbitrol, 391–392
Limbitrol DS 10-25, 391–392
mirtazapine, 218
nefazodone, 226
paroxetine hydrochloride, 250
paroxetine mesylate, 250
phenelzine sulfate, 259
selegiline hydrochloride, 299
sertraline hydrochloride, 299–300
Symbyax, 392
tranylcypromine sulfate, 333
trazodone hydrochloride, 334
venlafaxine hydrochloride, 343–344
vortioxetine, 348
Antidiabetic agents
acarbose, 2
ActoPlus Met, 393
ActoPlus Met XR, 393
alogliptin, 9–10
Avandamet, 393
Avandaryl, 393
bromocriptine mesylate, 39
canagliflozin, 46
chlorproPAMIDE, 62
dapagliflozin, 82
Duetact, 392
exenatide, 126
glimepiride, 149
glipiZIDE, 149–150
Glucovance, 392
glyBURIDE, 150
Janumet, 393
Janumet XR, 393
 Jentadueto, 392
Kazano, 392
Kombiglyze XR, 393
Juvisync, 393
linagliptin, 187–188
liraglutide, 189
metformin hydrochloride, 204
miglitol, 215
nateglinide, 226
Oseni, 392
pioglitazone, 263–264
pramlintide acetate, 269
PrandiMet, 393
repaglinide, 286
rosiglitazone, 293–294
saxagliptin, 297–298
sitagliptin phosphate, 302
TOLAZamide, 328
TOLBUTamide, 328–329
Anti-diaper-rash drugs
miconazole/petrolatum/zinc oxide, 375
Antidiarrheal drugs
bismuth subsalicylate, 35–36
crofelemer, 76
Logen, 394
Lomanate, 394
Lomotil, 394
Lonox, 394
loperamide hydrochloride, 191–192
octreotide acetate, 236
opium preparations, 240
rifaximin, 287–288
Antidotes
acetylcysteine, 3–4
atropine sulfate, 26–27
charcoal, activated, 58–59
digoxin immune fab, 95
dimercaprol, 96
edetate calcium disodium, 107
edrophonium chloride, 108
flumazenil, 136
fomepizole, 141
hydroxocobalamin, 158
 methylene blue, 208–209
neostigmine bromide, 228
neostigmine methylsulfate, 228
pralidoxime chloride, 268
Antiemetic agents
aprepitant, 21–22
chlorpromazine hydrochloride, 61–62
cyclizine, 76–77
dolasetron mesylate, 100
dronabinol, 104–105
granisetron hydrochloride, 152–153
hydrOXYine hydrochloride, 159
hydrOXYine pamoate, 159
meclizine hydrochloride, 199
metoclopramide, 210–211
nabilone, 222–223
ondansetron hydrochloride, 239–240
palonosetron hydrochloride, 248
prochlorperazine, 273–274
prochlorperazine edisylate, 273–274
prochlorperazine maleate, 273–274
promethazine hydrochloride, 274–275
scopolamine hydrobromide, 298
trimethobenzamide hydrochloride, 337
Antiepileptic agents
acetazolamide, 3
carbamazepine, 48
clobazam, 69
clonazepam, 70
clorazepate dipotassium bisulfate, 71–72
diazepam, 92–93
divalproex sodium, 340–341
eslicarbazepine, 118
ethosuximide, 123
ethotoin, 124
ezogabine, 127
fosphenytoin sodium, 143–144
gabapentin, 145
lacosamide, 177–178
lamotrigine, 178–179
levetiracetam, 184
magnesium sulfate, 196–197
methsuximide, 208
 oxcarbazepine, 243–244
pentobarbital, 256–257
perampanel, 257–258
phenobarbital, 259–260
phenobarbital sodium, 259–260
phenytoin, 261–262
pregabalin, 272
primidone, 272
rufinamide, 294–295
secobarbital sodium, 298–299
sodium valproate, 340–341
tiagabine hydrochloride, 323
topiramate, 330
valproic acid, 340–341
vigabatrin, 344–345
zonisamide, 352
Antiestrogen drugs
anastrozole, 19–20
letrozole, 182
tamoxifen citrate, 312–313
Antifibrinolytic agent
tranexamic acid, 333
Antiflatulent
simethicone, 301
Antifolate antineoplastic agent
pemetrexed, 253
Antifungal drugs
amphotericin B, 18
amphotericin B cholesteryl sulfate, 18
amphotericin B, liposome, 18
anidulafungin, 20
butenafine hydrochloride, 375
caspofungin acetate, 51
ciclopirox, 375
clotrimazole, 72, 375
econazole, 375
fluconazole, 134–135
flucytosine, 135
gentian violet, 376
itraconazole, 174–175
ketoconazole, 176, 376
luliconazole, 376
micafungin sodium, 213
 miconazole nitrate, 213–214
naftifine hydrochloride, 376
nystatin, 235
oxiconazole, 376
posaconazole, 267
sertaconazole, 376
terbinafine, 318, 376
terbinafine hydrochloride, 318
tolnaftate, 376
Antiglaucoma drugs
acetazolamide, 3
betaxolol hydrochloride valerate, 34
timolol maleate, 324–325, 384
Antigout drugs
allopurinol, 9
colchicine, 73–74
febuxostat, 129
probenecid, 272–273
Antihemophilic agents
antihemophilic factor, 20
coagulation factor VIIa (recombinant), 73
coagulation factor IX (recombinant), 73
factor IX concentrates, 127
antihemophilic factor, 20
Antihistamines
azelastine hydrochloride, 376, 381
brompheniramine maleate, 40
carbinoxamine maleate, 48
cetirizine hydrochloride, 57
chlorpheniramine maleate, 61
clemastine fumarate, 68
cyclizine, 76–77
cyproheptadine hydrochloride, 78
desloratadine, 87–88
dexchlorpheniramine maleate, 89
dimenhyDRINATE, 96
diphenmhydrAMINE, 97–98
fexofenadine hydrochloride, 132
hydroxyzine hydrochloride, 159
hydrOXYzine pamoate, 159
levocetirizine dihydrochloride, 184
levodopa, 184
loratadine, 192–193
 meclizine hydrochloride, 199
promethazine hydrochloride, 274–275
Anti-HIV drug
enfuvirtide, 110
Antihyperlipidemic agents
atorvastatin calcium, 26
cholestyramine, 63
colesevelam hydrochloride, 74
colestipol hydrochloride, 74–75
fenofibrate, 129–130
fluvastatin sodium, 139–140
gemfibrozil, 147
lovastatin, 194
mipomersen, 217–218
niacin, 229
pitavastatin, 264
pravastatin sodium, 270
rosuvastatin calcium, 294
simvastatin, 301
Antihypertensives
Accuretic, 397
acebutolol hydrochloride, 2
aliskiren, 9
ambrisentan, 12–13
amlodipine besylate, 16
Amturnide, 394
Atacand, 46
Atacand HCT, 395
atenolol, 25
Avalide, 396
azilsartan medoxomil, 28
Azor, 394
benazepril hydrochloride, 32
Benicar, 237–238
Benicar HCT, 397
betaxolol hydrochloride valerate, 34
bisoprolol fumarate, 36
candesartan cilexetil, 46
captopril, 47
carteolol, 382
carvedilol, 50–51
clevidipine butyrate, 68
clonidine hydrochloride, 70–71
Clorpres, 395
Corzide, 397
diltiazem hydrochloride, 96
Diovan HCT, 398
doxazosin mesylate, 102
Dutoprol, 397
Edarbyclor, 395
enalaprilat, 110
enalapril maleate, 110
eplerenone, 113–114
eprosartan mesylate, 115
Exforge, 395
Exforge HCT, 395
felodipine, 129
fosinopril sodium, 143
guanfacine hydrochloride, 153
hydralazine hydrochloride, 155–156
Hyzaar, 396
irbesartan, 170–171
isradipine, 174
labetalol hydrochloride, 177
lisinopril, 190
Lopressor, 211
Lopressor HCT, 397
losartan potassium, 194
Lotensin HCT, 396
Lotrel, 394
methyldopa, 208
methyldopate hydrochloride, 208
metoprolol, 211
metoprolol succinate, 211
metoprolol tartrate, 211
Micardis HCT, 397
minoxidil, 217
moexipril, 220
Monopril-HCT, 396
nadolol, 223
nebivolol, 226
niCARdipine hydrochloride, 229
NIFEdipine, 230
nisoldipine, 231
nitroprusside sodium, 232–233
olmesartan medoxomil, 237–238
 penbutolol sulfate, 253
perindopril erbumine, 258
pindolol, 263
prazosin hydrochloride, 270–271
Prinzide, 396
propranolol hydrochloride, 276–277
quinapril hydrochloride, 280–281
ramipril, 283–284
Tarka, 398
Tekamlo, 394
Tekturna, 9
Tekturna HCT, 394
telmisartan, 315–316
Tenoretic, 395
terazosin hydrochloride, 317
Teveten HCT, 396
timolol maleate, 324–325, 384
trandolapril, 332–333
Tribenzor, 397
Twynsta, 397
Uniretic, 397
valsartan, 341
Valturna, 394
Vaseretic, 395
verapamil hydrochloride, 344
Zestoretic, 396
Ziac, 395
Antihypertriglyceridemic ethyl ester
icosapent ethyl, 162
Antihypotensive drug
midodrine, 214–215
Anti-infective drugs, urinary tract
fosfomycin tromethamine, 143
methenamine, 205–206
methenamine hippurate, 205–206
methylene blue, 208–209
nitrofurantoin, 232
norfloxacin, 234
Anti-inflammatory drugs
balsalazide disodium, 30
diflunisal, 94
mesalamine, 203
olsalazine sodium, 238
 prednisoLONE, 271
prednisoLONE acetate, 271
prednisoLONE sodium phosphate, 271
rilonacept, 288
sulfasalazine, 310
Antilithic agent
cellulose sodium phosphate (CSP), 56–57
Antimalarial drugs
chloroquine phosphate, 60
quinine sulfate, 281–282
Antimanic drugs
lithium carbonate, 190–191
lithium citrate, 190–191
Antimetabolites
capecitabine, 46–47
cladribine, 67
clofarabine, 69
cytarabine, 78–79
floxuridine, 134
fludarabine phosphate, 135–136
fluorouracil, 137
gemcitabine hydrochloride, 147
mercaptopurine, 202–203
methotrexate, 206–207
thioguanine, 322
Antimigraine drugs
almotriptan malate, 9
Cafergot, 398
dihydroergotamine mesylate, 95
eletriptan hydrobromide, 109
ergotamine tartrate, 115
frovatriptan succinate, 144
Migergot, 398
MigraTen, 398
naratriptan, 225
rizatriptan, 292
sumatriptan succinate, 310–311
topiramate, 330
Treximet, 398
zolmitriptan, 352
Antimitotic drugs
nelarabine, 227
paclitaxel, 247
Anti–motion sickness drugs
cyclizine, 76–77
dimenhyDRINATE, 96
diphenhydrAMINE hydrochloride, 97–98
meclizine hydrochloride, 199
promethazine hydrochloride, 274–275
scopolamine hydrobromide, 298
Antimuscarinic agents
fesoterodine fumarate, 132
tolterodine tartrate, 329–330
trospium chloride, 338–339
Antimyasthenic agents
pyridostigmine bromide, 279
Antinausea agent
Diclegis, 398
doxylamine/pyridoxine, 398
Antineoplastic agents
abiraterone, 1–2
ado-trastuzumab, 6
afatinib, 6
aldesleukin, 7–8
altretamine, 11–12
anastrozole, 19–20
arsenic trioxide, 23
asparaginase Erwinia chrysantheni, 24
axitinib, 27–28
azacitidine, 28
BCG, 419
BCG intravesical, 30–31
bendamustine hydrochloride, 32–33
bevacizumab, 35
bexarotene, 35
bleomycin sulfate, 36–37
bortezomib, 37
bosutinib, 38
busulfan, 42–43
cabazitaxel, 43
cabozantinib, 44
capecitabine, 46–47
carboplatin, 48–49
carfilzomib, 49
carmustine (BCNU), 50
cetuximab, 58
chlorambucil, 59
cisplatin (CDDP), 66
cladribine, 67
clofarabine, 69
crizotinib, 75–76
cyclophosphamide, 77
cytarabine, 78–79
dabrafenib, 79–80
dacarbazine hydrochloride, 80
dactinomycin, 80
dasatinib, 84
DAUNOrubicin citrate, 84
decitabine, 84–85
degarelix, 85
docetaxel, 99–100
DOXOrubicin hydrochloride, 103–104
enzalutamide, 112
epirubicin hydrochloride, 113
eribulin mesylate, 115–116
erlotinib, 116
etoposide (VP-16), 125
everolimus, 125–126
exemestane, 126
floxuridine, 134
fludarabine phosphate, 135–136
fluorouracil, 137
flutamide, 139
fulvestrant, 144
gemcitabine hydrochloride, 147
goserelin acetate, 152
histrelin implant, 155
hydroxyurea, 158
ibritumomab, 160
ibrutinib, 160
idarubicin hydrochloride, 162
ifosfamide, 163
imatinib mesylate, 164
interferon alfa-2b, 168
irinotecan hydrochloride, 171
ixabepilone, 175
lapatinib, 180–181
letrozole, 182
lomustine, 191
mechlorethamine hydrochloride, 198–199
medroxyPROGESTERone, 199–200
megestrol acetate, 200
melphalan, 201
mercaptopurine, 202–203
methotrexate, 206–207
mitomycin, 219
mitomycin-C, 383
Mitosol, 383
mitotane, 219
mitoxantrone hydrochloride, 219
nelarabine, 227
nilotinib, 231
obinutuzumab, 235
ofatumumab, 236
omacetaxine, 238
oxaliplatin, 242
paclitaxel, 247
panitumumab, 249
pazopanib, 250–251
pegaspargase, 251–252
pentostatin, 257
pertuzumab, 258
pomalidomide, 266
ponatinib, 266
porfimer sodium, 267
pralatrexate, 268
procarbazine hydrochloride, 273
radium Ra 223 dichloride, 282
regorafenib, 285–286
rituximab, 291
romidepsin, 292–293
sorafenib tosylate, 306
streptozocin, 308
sunitinib, 311
tamoxifen citrate, 312–313
temozolomide, 316
temsirolimus, 316
thioguanine, 322
thiotepa, 322
topotecan hydrochloride, 330–331
toremifene citrate, 331
tositumomab and iodine I-131/
 tositumomab, 331–332
trametinib, 332
trastuzumab, 334
tretinoin, 335
triptorelin pamoate, 338
vemurafenib, 343
vinBLAStine sulfate, 345
vinCRIStine sulfate, 346
vinorelbine tartrate, 346
vismodegib, 347
vorinostat, 347–348
ziv-aflibercept, 351
Antiparkinson drugs
amantadine, 12
apomorphine, 21
benztropine mesylate, 33
bromocriptine mesylate, 39
diphenhydrAMINE hydrochloride, 97–98
entacapone, 111
Parcopa, 398–399
pramipexole dihydrochloride, 269
rasagiline, 284–285
ropinirole hydrochloride, 293
rotigotine, 294
scopolamine hydrobromide, 298
selegiline hydrochloride, 299
Sinemet, 398–399
Sinemet CR, 398–399
Stalevo 50, 399
Stalevo 75, 399
Stalevo 100, 399
Stalevo 125, 399
Stalevo 150, 399
Stalevo 200, 399
tolcapone, 329
trihexyphenidyl hydrochloride, 337
Antiplatelet drugs
abciximab, 1
Aggrenox, 399
anagrelide, 19
aspirin, 24–25
cilostazol, 64
clopidogrel bisulfate, 71
 dipyridamole, 98
eptifibatide, 115
ticagrelor, 323–324
ticlopidine hydrochloride, 324
tirofiban hydrochloride, 326
Antiprotozoal drugs
atovaquone, 26
metronidazole, 212
nitazoxanide, 231
pentamidine isethionate, 256
tinidazole, 325
Antipsoriatic drugs
acitretin, 4
anthralin, 376
betamethasone, 377
calcipotriene, 376
methotrexate, 206–207
Antipsychotic drugs
chlorproMAZINE hydrochloride, 61–62
clozapine, 72
fluphenazine decanoate, 138
fluphenazine hydrochloride, 138
haloperidol, 153–154
haloperidol decanoate, 153–154
haloperidol lactate, 153–154
loxapine succinate, 194–195
olanzapine, 237
pimozide, 263
prochlorperazine, 273–274
prochlorperazine edisylate, 273–274
prochlorperazine maleate, 273–274
quetiapine fumarate, 280
risperidone, 290
Antipsychotic drugs, atypical
aripiprazole, 22–23
asenapine, 23–24
iloperidone, 163
lurasidone hydrochloride, 195
paliperidone, 247–248
ziprasidone, 350–351
Antipyretic drugs
acetaminophen, 2–3
aspirin, 24–25
 diflunisal, 94
ketorolac tromethamine, 177
Antiretroviral drugs
atazanavir sulfate, 25
raltegravir, 283
Antirheumatic drugs
auranofin, 27
etanercept, 122
gold sodium thiomalate, 151–152
methotrexate, 206–207
penicillamine, 253–254
sulfasalazine, 310
tocilizumab, 327–328
tofacitinib, 328
Antiseborrheic drug
selenium sulfide, 376
Antisecretory drugs
dexlansoprazole, 89–90
esomeprazole magnesium, 118–119
Antiseptics
benzalkonium chloride, 376
chlorhexidine gluconate, 376
hexachlorophene, 376
iodine, 376
povidone iodine, 376
sodium hypochlorite, 376
Antispasmodics
dicyclomine hydrochloride, 94
glycopyrrolate, 151
hyoscyamine sulfate, 159
methscopolamine bromide, 208
propantheline bromide, 275–276
tizanidine, 326–327
tobramycin sulfate, 327
trospium chloride, 338–339
Antispasmodic drugs, urinary
darifenacin hydrobromide, 83
flavoxate hydrochloride, 134
oxybutynin chloride, 244
solifenacin succinate, 305
antithrombin III, 21
antithrombin, recombinant, 20
Antithrombotic drug
 fondaparinux, 141
Antithyroid drugs
methimazole, 206
propylthiouracil (PTU), 277
anti-thymocyte globulin, 417
Antitriglyceride drug
lomitapide, 191
Antituberculotic drugs
bedaquiline, 31
capreomycin, 47
cycloSERINE, 77
ethambutol hydrochloride, 123
ethionamide, 123
isoniazid, 172–173
pyrazinamide, 279
rifampin, 287
rifapentine, 287
Antitussive drugs
benzonatate, 33
codeine phosphate, 73
Antiulcer drugs
Helidac, 399
Prevpac, 399
sucralfate, 309
antivenin (Micrurus fulvius), 418
Antivenin Lactrodectus mactans, 418
Antivert, 199
Antiviral drugs
abacavir, 1
acyclovir, 4–5, 376
adefovir dipivoxil, 5
amantadine, 12
Atripla, 399–400
boceprevir, 37
cidofovir, 64
Combivir, 400
Complera, 400
delavirdine mesylate, 85–86
didanosine (ddI, dideoxyinosine), 94
docosanol, 377
dolutegravir, 100–101
efavirenz, 108
emtricitabine, 109–110
 Emtriva, 109–110
entecavir, 111–112
Epzicom, 399
etravirine, 125
famciclovir sodium, 128
fosamprenavir, 142
ganciclovir sodium, 146
hydrocortisone, 156–157
imiquimod, 377
indinavir sulfate, 165
kunecatechins, 377
lamivudine, 178
lopinavir, 192
maraviroc, 198
nelfinavir mesylate, 227
nevirapine, 228–229
oseltamivir phosphate, 241
palivizumab, 248
penciclovir, 377
ribavirin, 286
rilpivirine, 288
rimantadine hydrochloride, 288–289
ritonavir, 290
saquinavir mesylate, 296–297
stavudine (d4T), 308
Stribild, 400
telaprevir, 314
telbivudine, 315
tenofovir disoproxil fumarate, 317
tipranavir, 326
Trizivir, 399
Truvada, 400
valacyclovir hydrochloride, 340
valganciclovir hydrochloride, 340
zanamivir, 349
zidovudine, 350
Antiviral drug/protease inhibitor
darunavir, 83–84
Antizol, 141
Anusol-HCL, 378
Anxiolytic drugs
alprazolam, 10–11
amoxapine, 17
 busPIRone, 42
chlordiazepoxide, 60
chlorproMAZINE hydrochloride, 61–62
clomiPRAMINE hydrochloride, 70
clorazepate dipotassium bisulfate, 71–72
diazepam, 92–93
hydrOXYzine hydrochloride, 159
hydrOXYzine pamoate, 159
lorazepam, 193
meprobamate, 202
oxazepam, 243
venlafaxine hydrochloride, 343–344
Anzemet, 100
Aphthasol, 379
Apidra, 167
apixaban, 21
Aplenzin, 41–42
Apokyn, 21
apomorphine, 21
Appetite suppressant
dronabinol, 104–105
apple, 364
apraclonidine, 381
aprepitant, 21–22
Apresoline, 155–156
Apri, 405
Apriso, 203
Aptiom, 118
Aptivus, 326
Aquacare, 378
Aralast NP, 10
Aralen Phosphate, 60
Aranelle, 407
Aranesp, 181
ARBs
azilsartan medoxomil, 28
candesartan cilexetil, 46
eprosartan mesylate, 115
irbesartan, 170–171
losartan potassium, 194
olmesartan medoxomil, 237–238
telmisartan, 315–316
valsartan, 341
Arcalyst, 288
Arcapta Neohaler, 165
Aredia, 248–249
Arestin, 216–217
arformoterol tartrate, 22
argatroban, 22
Argesic-SA, 296
Aricept, 101
Aricept ODT, 101
Arimidex, 19–20
aripiprazole, 22–23
Aristospan, 335–336
Arixtra, 141
armodafinil, 23
Armour Thyroid, 323
arnica, 364
Aromasin, 126
Aromatase inhibitors
anastrozole, 19–20
letrozole, 182
Arranon, 227
arsenic trioxide, 23
Arthrotec, 387
Artiss, 378–379
Arzerra, 236
Asacol, 203
Asclera, 265
asenapine, 23–24
ashwagandha, 365
Asmanex Twisthaler, 378
asparaginase Erwinia chrysantheni, 24
aspirin, 24–25
Astelin, 376
Astepro, 376
AsthmaNefrin, 112–113
astragalus, 365
Atacand, 46
Atacand HCT, 395
atazanavir sulfate, 25
Atelvia, 289
atenolol, 25
Atgam, 418
Ativan, 193
atomoxetine hydrochloride, 25–26
atorvastatin calcium, 26
atovaquone, 26
Atralin, 335
Atridox, 104
Atripla, 399–400
AtroPen, 26–27
atropine sulfate, 26–27
Atrovent, 170
ATryn, 20
Attenuvax, 415
Aubagio, 318–319
Augmentin ES-600, 389
Augmentin XR, 389
auranofin, 27
Aurolate, 151–152
Avalide, 396
avanafil, 27
Avandamet, 393
Avandaryl, 393
Avandia, 293–294
Avapro, 170–171
Avastin, 35
Avelox, 221–222
Aventyl, 235
Aviane, 405
Avinza, 221
Avita, 335, 375
Avodart, 106
Avoiding dangerous abbreviations, 358–359
Avonex, 169
Axert, 10
Axid, 233
Axiron, 319–320
axitinib, 27–28
Axsain, 375
Aygestin, 233–234
azacitidine, 28
Azactam, 29
Azasan, 28
AzaSite, 28–29, 381
azathioprine, 28
azelaic acid, 374
azelastine hydrochloride, 376, 381
Azelex, 374
Azilect, 284–285
azilsartan medoxomil, 28
azithromycin, 28–29, 381
Azopt, 382
Azor, 394
Azo-Standard, 259
aztreonam, 29
Azulfidine, 310
Azurette, 407
B
Baby BIG, 417
Baci-IM, 29
bacitracin, 29
baclofen, 30
Bactine Hydrocortisone, 378
BactoShield, 376
Bactrim, 390
Bactrim DS, 390
Bactroban, 375
Bactroban Nasal, 375
BAL in Oil, 96
Balnetar, 376
balsalazide disodium, 30
Balziva, 405
Banflex, 241
Banzel, 294–295
Baraclude, 111–112
barberry, 365
Barbiturates
pentobarbital, 256–257
phenobarbital, 259–260
phenobarbital sodium, 259–260
secobarbital sodium, 298–299
Baridium, 259
basil, 365
basiliximab, 30
bayberry, 365
Bayer, 24–25
B-cell activating factor inhibitor
belimumab, 32
BCG intravesical, 30–31
Bebulin VH, 127
becaplermin, 378
beclamethasone, 31
beclomethasone dipropionate, 31, 377
beclomethasone dipropionate monohydrate, 31
Beconase AQ, 31, 377
bedaquiline, 31
bee pollen, 365
belatacept, 32
belimumab, 32
Belladonna alkaloids
atropine sulfate, 26–27
hyoscyamine sulfate, 159
scopolamine hydrobromide, 298
Bell/ans, 302–303
Bellatal, 259–260
Belviq, 193
Benadryl Allergy, 97–98
benazepril hydrochloride, 32
bendamustine hydrochloride, 32–33
BeneFix, 127
Benicar, 237–238
Benicar HCT, 397
Benlysta, 32
Bentyl, 94
Benza, 376
BenzaClin, 374
benzalkonium chloride, 376
Benzisoxazoles
paliperidone, 247–248
risperidone, 290
ziprasidone, 350–351
Benzodiazepines
alprazolam, 10–11
chlordiazepoxide, 60
clobazam, 69
clonazepam, 70
clorazepate dipotassium bisulfate, 71–72
diazepam, 92–93
estazolam, 119
flurazepam hydrochloride, 138–139
lorazepam, 193
midazolam hydrochloride, 214
oxazepam, 243
quazepam, 280
temazepam, 316
triazolam, 336–337
Benzodiazepine receptor antagonist
flumazenil, 136
benzonatate, 33
benztropine mesylate, 33
benzyl alcohol, 379
bepotastine besilate, 381
Bepreve, 381
beractant (natural lung surfactant), 33
besifloxacin, 381
Besivance, 381
Beta-adrenergic blocker
acebutolol hydrochloride, 2
Beta-adrenergic blocker
atenolol, 25
Beta agonists
albuterol, 7
arformoterol tartrate, 22
formoterol fumarate, 142
isoproterenol hydrochloride, 173
levalbuterol hydrochloride, 183
levalbuterol tartrate, 183
mirabegron, 218
Beta agonist, long-acting
arformoterol tartrate, 22
indacaterol, 165
Beta blockers
metoprolol, 211
metoprolol succinate, 211
metoprolol tartrate, 211
nadolol, 223
nebivolol, 226
penbutolol sulfate, 253
pindolol, 263
propranolol hydrochloride, 276–277
sotalol hydrochloride, 307
timolol maleate, 324–325, 384
Betadine, 376
Betagen, 376
Betagon Liquifilm, 383
betamethasone, 34
betamethasone dipropionate, 34, 377
betamethasone dipropionate augmented, 377
betamethasone sodium phosphate and acetate, 34
betamethasone valerate, 34, 377
Betapace, 307
Betapace AF, 307
Beta-selective adrenergic agonist
DOBUTamine hydrochloride, 99
Beta-selective adrenergic blockers
 bisoprolol fumarate, 36
esmolol hydrochloride, 118
Beta selective agonists
salmeterol xinafoate, 295–296
terbutaline sulfate, 318
Beta-selective agonist
metaproterenol sulfate, 204
Beta-selective blocker
betaxolol hydrochloride valerate, 34
Betaseron, 169
Beta-Val, 34, 377
betaxolol hydrochloride valerate, 34
betel palm, 365
bethanechol chloride, 34
Betimol, 324–325
Betoptic, 34
bevacizumab, 35
bexarotene, 35
Bexxar, 331–332
Beyaz, 405
Biaxin, 67
Bibliography, 432
bicalutamide, 35
Bicillin L-A, 254
BiCNU, 50
BiDil, 401
bilberry, 365
Bile acid sequestrants
cholestyramine, 63
colesevelam hydrochloride, 74
colestipol hydrochloride, 74–75
Biltricide, 270
bimatoprost, 382
Binosto, 8
Biological agents (vaccines), 411–420
Biological protein
denileukin diftitox, 86
birch bark, 365
bisacodyl, 385
Bisa-Lax, 385
bismuth subsalicylate, 35–36
bisoprolol fumarate, 36
Bisphosphonates
 alendronate sodium, 8
etidronate disodium, 124
ibandronate sodium, 160
pamidronate disodium, 248–249
risedronate sodium, 289
tiludronate disodium, 324
zoledronic acid, 351
bivalirudin, 36
blackberry, 365
black cohosh root, 365
Black Draught, 386
black widow spider species antivenin, 418
Bladder protectant
pentosan polysulfate sodium, 257
bleomycin sulfate, 36–37
Bleph-10, 384
BLM, 36–37
Blocadren, 324–325
Blood products
albumin, human, 7
alpha 1-proteinase inhibitor, 10
C1-inhibitor (human), 43
plasma protein fraction, 264
protein C concentrate, 277
boceprevir, 37
Bonine, 199
Boniva, 160
Boostrix, 411
Borofax, 378
Borofax Skin Protectant, 378
bortezomib, 37
bosentan, 37–38
Bosulif, 38
bosutinib, 38
Botox, 38
Botox Cosmetic, 38
botulism antitoxin, 418
Botulism antitoxin heptavalent (HBAT), 418
botulism immune globulin, 417
botulinum toxin type A, 38
botulinum toxin type B, 39
BPH drugs
alfuzosin hydrochloride, 8
 dutasteride, 106
Jalyn, 400
silodosin, 300
terazosin hydrochloride, 317
Bradykinin receptor antagonist
icatibant, 161–162
Bravelle, 339
Breeze Mist, 213–214
brentuximab, 39
Breo Ellipta, 403
Brevibloc, 118
Brevicon, 406
Brilinta, 323–324
brimonidine, 374
brimonidine tartrate, 382
brimonidine/timolol, 382
Brintellix, 348
brinzolamide, 382
Brisdelle, 250
Bromday, 382
bromelain, 365
bromfenac, 382
bromocriptine mesylate, 39
brompheniramine maleate, 40
Bronchodilators
aclidinium bromide, 4
albuterol sulfate, 7
aminophylline, 14–15
arformoterol tartrate, 22
dyphylline, 106–107
ephedrine sulfate, 112
indacaterol, 165
ipratropium bromide, 170
isoproterenol hydrochloride, 173
levalbuterol hydrochloride, 183
levalbuterol tartrate, 183
terbutaline sulfate, 318
theophylline, 321–322
tiotropium bromide, 325–326
Brovana, 22
BroveX, 40
budesonide, 40–41
Bufferin, 24–25
bumetanide, 41
Buminate, 7
Buprenex, 41
buprenorphine hydrochloride, 41
buPROPion hydrobromide, 41–42
buPROPion hydrochloride, 41–42
burdock, 365
Burn treatment
mafenide, 377
silver sulfadiazine, 377
Burow’s solution aluminum acetate, 379
busPIRone, 42
busulfan, 42–43
Busulfex, 42–43
butenafine hydrochloride, 375
butorphanol tartrate, 43
Butrans Transdermal, 41
Bydureon, 126
Byetta, 126
Bystolic, 226
C
cabazitaxel, 43
cabozantinib, 44
Caduet, 391
Cafcit, 44
Cafergot, 398
Caffedrine, 44
caffeine, 44
caffeine citrate, 44
calamine lotion, 379
Calan, 344
Calcibind, 56–57
Calcimar, 44–45
Calcimimetic
cinacalcet hydrochloride, 65
Calcionate, 45
calcipotriene, 376
calcipotriene/betamethasone, 376
Calciquid, 45
calcitonin, salmon, 44–45
calcium carbonate, 4
Calcium channel blockers
amlodipine besylate, 16
clevidipine butyrate, 68
diltiazem hydrochloride, 96
felodipine, 129
isradipine, 174
niCARdipine hydrochloride, 229
NIFEdipine, 230
nimodipine, 231
nisoldipine, 231
verapamil hydrochloride, 344
ziconotide, 349–350
Calcium channel modulator
pregabalin, 272
calcium chloride, 45
Calcium Disodium Versenate, 107
calcium glubionate, 45
calcium gluconate, 45
calcium lactate, 45
Calcium-lowering drug
cinacalcet hydrochloride, 65
Calcium-phosphate binder
sevelamer hydrochloride, 300
Calcium regulators
alendronate sodium, 8
calcitonin, 44–45
etidronate disodium, 124
ibandronate sodium, 160
pamidronate disodium, 248–249
teriparatide, 319
zoledronic acid, 351
Caldolor, 161
calfactant (natural lung surfactant), 45
Cal-G, 45
Cal-Lac, 45
Calorie agents
amino acids, 14
fat emulsion, intravenous, 128–129
Caltrate, 45
Cambia, 93
Camila, 409
Campral, 2
Camptosar, 171
canagliflozin, 46
canakinumab, 46
Cancidas, 51
candesartan cilexetil, 46
Cannabinoid
nabilone, 222–223
Capastat Sulfate, 47
capecitabine, 46–47
capreomycin, 47
capsaicin, 375
capsicum, 366
Capsin, 375
captopril, 47
Capzasin, 375
Carac, 137
Carafate, 309
carbachol, 382
Carbaglu, 49–50
carbamazepine, 48
Carbamoyl phosphate synthetase 1 activator
carglumic acid, 49–50
Carbapenem antibiotics
doripenem, 101–102
ertapenem, 116
meropenem, 203
Carbatrol, 48
carbinoxamine maleate, 48
Carbonic anhydrase inhibitors
acetazolamide, 3
methazolamide, 205
carboplatin, 48–49
carboprost tromethamine, 49
Carboxypeptidase enzyme
glucarpidase, 150
Cardene, 229
Cardiac glycoside
digoxin, 94–95
Cardiac stimulants
epinephrine bitartrate, 112–113
epinephrine hydrochloride, 112–113
norepinephrine bitartrate, 233
Cardizem, 96
Cardura, 102
Cardura XL, 102
carfilzomib, 49
carglumic acid, 49–50
Carimune NF, 413–414
carisoprodol, 50
Carmol 10, 378
Carmol 20, 378
Carmol 40, 378
carmustine (BCNU), 50
carteolol, 382
carvedilol, 50–51
cascara, 385
Casodex, 35
caspofungin acetate, 51
castor oil, 385
Cataflam, 93
Catapres, 70–71
Cathflo Activase, 11
catnip leaves, 366
cat’s claw, 366
Caverject, 11
cayenne pepper, 366
Cayston, 29
Caziant, 407
CCR5 coreceptor antagonist
maraviroc, 198
Ceclor, 51
Cedax, 55
CeeNU, 191
cefaclor, 51
cefadroxil, 51–52
cefdinir, 52
cefditoren pivoxil, 52
cefepime hydrochloride, 52–53
cefotaxime sodium, 53
cefoxitin sodium, 53
cefpodoxime proxetil, 54
cefprozil, 54
ceftaroline fosamil, 54
ceftazidime, 54–55
ceftibuten, 55
Ceftin, 56
ceftriaxone sodium, 55
cefuroxime axetil, 56
cefuroxime sodium, 56
Celebrex, 56
celecoxib, 56
celery, 366
Celestone Soluspan, 34
Celexa, 66–67
CellCept, 222
Cellular immunotherapy agent
sipuleucel-T, 301–302
cellulose sodium phosphate (CSP), 56–57
Celontin, 208
Cenestin, 120–121
Centany, 375
Central analgesic
clonidine hydrochloride, 70–71
Centrally acting skeletal muscle relaxants
baclofen, 30
carisoprodol, 50
chlorzoxazone, 62–63
cyclobenzaprine hydrochloride, 77
centruroides (scorpion) immune fab, 419
cephalexin, 57
Cephalosporins
cefaclor, 51
cefadroxil, 51–52
cefdinir, 52
cefditoren pivoxil, 52
cefepime hydrochloride, 52–53
cefotaxime sodium, 53
cefoxitin sodium, 53
cefpodoxime proxetil, 54
cefprozil, 54
ceftaroline fosamil, 54
ceftazidime, 54–55
ceftibuten, 55
ceftriaxone sodium, 55
cefuroxime axetil, 56
cefuroxime sodium, 56
cephalexin, 57
Cephulac, 178
Ceprotin, 277
Ceptaz, 54–55
Cerebyx, 143–144
certolizumab, 57
Cervarix, 413
Cervidil, 97
Cesamet, 222–223
Cesia, 407
cetirizine hydrochloride, 57
cetrorelix acetate, 58
Cetrotide, 58
cetuximab, 58
cevimeline hydrochloride, 58
chamomile, 366
Chantix, 342–343
CharcoAid, 58–59
charcoal, activated, 58–59
chaste-tree berry, 366
Chelates
deferasirox, 85
deferoxamine mesylate, 85
dimercaprol, 96
penicillamine, 253–254
 succimer, 308–309
trientine hydrochloride, 337
Chemet, 308–309
Chenix, 59
Chenodal, 59
chenodiol, 59
chicken soup, 366
chicory, 366
Chinese angelica (dong quai), 366
ChiRhoStim, 299
chlorambucil, 59
chloramphenicol sodium succinate, 59–60
chlordiazepoxide, 60
chlorhexidine gluconate, 376
chloroquine phosphate, 60
chlorothiazide, 60–61
chlorothiazide sodium, 60–61
chlorpheniramine maleate, 61
chlorproMAZINE hydrochloride, 61–62
chlorproPAMIDE, 62
chlorthalidone, 62
Chlor-Trimeton Allergy, 61
chlorzoxazone, 62–63
Cholesterol-absorption inhibitor
ezetimibe, 126–127
Cholesterol-lowering drug
ezetimibe, 126–127
cholestyramine, 63
choline magnesium trisalicylate, 63
Cholinergic agent
bethanechol chloride, 34
Cholinesterase inhibitors
galantamine hydrobromide, 145
pyridostigmine bromide, 279
rivastigmine tartrate, 290–291
chondroitin, 366
chong cao fungi, 366
Chooz, 45
chorionic gonadotropin, 63–64
chorionic gonadotropin alfa, 64
Chronulac, 178
Cialis, 312
ciclesonide, 377
ciclopirox, 375
cidofovir, 64
cilostazol, 64
Ciloxan, 65–66, 382
cimetidine, 64–65
Cimzia, 57
cinacalcet hydrochloride, 65
Cinchonan
quinine sulfate, 281–282
C1-inhibitor (human), 43
Cinryze, 43
Cipro, 65–66
Ciprodex, 375
ciprofloxacin, 65–66, 375, 382
ciprofloxacin/dexamethasone, 375
ciprofloxaxin/hydrocortisone, 375
Cipro-HC Otic Drops, 375
cisplatin (CDDP), 66
citalopram hydrobromide, 66–67
Citrate of Magnesia, 385
Citroma, 196
cladribine, 67
Claforan, 53
Claravis, 173–174
Clarinex, 87–88
Clarinex Reditabs, 87–88
clarithromycin, 67
Claritin, 192–193
Claritin-D, 404
Claritin-D 24 Hour, 404
clemastine fumarate, 68
Cleocin, 68–69
Cleocin Pediatric, 68–69
Cleocin T, 68–69
clevidipine butyrate, 68
Cleviprex, 68
Clindagel, 68–69
ClindaMax, 68–69
clindamycin, 68–69, 374
clindamycin/benzoyl peroxide, 374
clindamycin/tretinoin, 374
clindamycin hydrochloride, 374
clindamycin palmitate hydrochloride, 68–69
clindamycin phosphate, 68–69
Clindesse, 374
Clinoril, 310
clobazam, 69
clobetasol propionate, 377
Clobex, 377
clocortolone pivalate, 377
Cloderm, 377
clofarabine, 69
Clolar, 69
Clomid, 69
clomiPHENE citrate, 69
clomiPRAMINE hydrochloride, 70
clonazepam, 70
clonidine hydrochloride, 70–71
clopidogrel bisulfate, 71
clorazepate dipotassium bisulfate, 71–72
Clorpres, 395
clotrimazole, 72, 375
Clotting factor
factor XIII concentrate (human), 127–128
clozapine, 72
Clozaril, 72
CMV-IGIV, 418
CNS depressants
midazolam hydrochloride, 214
sodium oxybate, 304
CNS stimulants
armodafinil, 23
caffeine, 44
caffeine citrate, 44
dexmethylphenidate hydrochloride, 90
dextroamphetamine sulfate, 91–92
lisdexamfetamine dimesylate, 189–190
methylphenidate hydrochloride, 209–210
modafinil, 220
Coagulation factor
fibrinogen concentrate, human, 132
coagulation factor VIIa (recombinant), 73
coagulation factor IX (recombinant), 73
Coagulation inhibitors
antithrombin III, 21
antithrombin, recombinant, 20
codeine phosphate, 73
Coenzyme factor
sapropterin dihydrochloride, 296
Cogentin, 33
Colace, 385
Colazal, 30
colchicine, 73–74
Colcrys, 73–74
colesevelam hydrochloride, 74
Colestid, 74–75
colestipol hydrochloride, 74–75
Coleus forskohlii, 366
collagenase clostridium histolyticum, 75
Colloid
hydroxyethyl starch, 154–155
Colony-stimulating factors
filgrastim, 133
pegfilgrastim, 251
sargramostim, 297
CoLyte, 386
Combigan, 382
CombiPatch, 402
Combivent, 404
Combivir, 400
Cometriq, 44
comfrey, 366
Complement inhibitor
eculizumab, 107
Complera, 400
Compro, 273–274
Comtan, 111
COMT inhibitor
tolcapone, 329
Comvax, 412
Concerta, 209–210
Condylox, 379
cone flower, 367
Constilac, 178, 385
Constulose, 385
Contraceptive
medroxyPROGESTERone, 199–200
Contrast agent
gadobutrol, 145
ConZip, 332
Copaxone, 149
Copegus, 286
Cordarone, 15–16
Coreg, 50–51
Corgard, 223
coriander, 367
Corifact, 127–128
Cormax, 377
Correctol, 385
Cortaid, 156–157, 378
Cortaid with Aloe, 378
Cort-Dome, 378
Corticosteroids
alclometasone dipropionate, 377
beclomethasone dipropionat, 31
beclomethasone dipropionate monohydrate, 31
betamethasone, 34
betamethasone dipropionate, 34, 377
betamethasone dipropionate augmented, 377
betamethasone sodium phosphate and acetate, 34
betamethasone valerate, 34, 377
budesonide, 40–41
ciclesonide, 377
clobetasol propionate, 377
clocortolone pivalate, 377
desonide, 377
desoximetasone, 377
dexamethasone, 88–89, 377
dexamethasone sodium phosphate, 88–89, 377
Corticosteroids (continued)
florone diacetate, 377
fludrocortisone acetate, 136
flunisolide, 136–137
fluocinolone acetate, 377
fluocinonide, 377
flurandrenolide, 378
fluticasone fumarate, 378
fluticasone propionate, 378, 379
halcinonide, 378
halobetasol propionate, 378
hydrocortisone, 156–157, 378
hydrocortisone acetate, 156–157, 378
 hydrocortisone buteprate, 156–157, 378
hydrocortisone butyrate, 156–157, 378
hydrocortisone salts, 156–157
hydrocortisone valerate, 156–157, 378
methylPREDNISolone, 210
methyLPREDNISolone acetate, 210
methyLPREDNISolone sodium succinate, 210
mometasone, 378
prednicarbate, 378
prednisoLONE, 271
prednisoLONE acetate, 271
prednisoLONE sodium phosphate, 271
predniSONE, 271–272
triamcinolone acetonide, 335–336
triamcinolone diacetate, 335–336
triamcinolone hexacetonide, 335–336
corticotropin (ACTH), 75
cortisone, 375
Cortizone-10, 378
Cortrosyn, 75
Corvert, 161
Corzide, 397
Cosmegen, 80
Cosopt, 382
cosyntropin, 75
co-trimoxazole, 390
Coumadin, 348
Coumarin derivative
warfarin sodium, 348
Cox-2 specific inhibitor
celecoxib, 56
Cozaar, 194
creatine monohydrate, 367
Creon, 249
Creo-Terpin, 92
Crestor, 294
Crinone, 274
Crixivan, 165
crizotinib, 75–76
CroFab, 419
crofelemer, 76
Crolom, 76
cromolyn sodium, 76
crotalidae polyvalent immune fab, 419
crotamiton, 379
Cruex, 72, 375
Cryselle, 406
Cubicin, 82–83
Cuprimine, 253–254
Curosurf, 266–267
Cutivate, 378
Cuvposa, 151
cyanocobalamin, intranasal, 76
Cyanokit, 158
Cyclase stiumlator
riociguat, 289
Cyclessa, 407
Cyclic-lipopeptide antibiotic
daptomycin, 82–83
cyclizine, 76–77
cyclobenzaprine hydrochloride, 77
Cyclogyl, 382
cyclopentolate, 382
cyclophosphamide, 77
cycloSERINE, 77
Cycloset, 39
cycloSPORINE, 78
cyclosporine emulsion, 382
Cymbalta, 106
CYP17 inhibitor
abiraterone, 1–2
cyproheptadine hydrochloride, 78
Cystic fibrosis drugs
dornase alfa, 102
ivacaftor, 175
cytarabine, 78–79
CytoGam, 418
cytomegalovirus immune globulin IV, 418
Cytomel, 188–189
Cytoprotective drugs
amifostine, 13
mesna, 203–204
cytosine arabinoside, 78
Cytotec, 218–219
Cytotoxic drug
ofatumumab, 236
Cytotoxic T-cell antigen 4- blocking antibody
ipilimumab, 170
Cytovene, 146
D
dabigatran etexilate mesylate, 79
dabrafenib, 79–80
dacarbazine hydrochloride, 80
Dacogen, 84–85
dactinomycin, 80
Dakin’s solution, 376
dalfampridine, 81
Daliresp, 292
dalteparin sodium, 81
Damason-P, 388
dandelion root, 367
Dantrium, 81–82
dapagliflozin, 82
dantrolene sodium, 81–82
dapsone, 82
Daptacel, 411
daptomycin, 82–83
darbepoetin alfa, 83
darifenacin hydrobromide, 83
darunavir, 83–84
dasatinib, 84
DAUNOrubicin citrate, 84
DaunoXome, 84
Dayhist-1, 68
Daypro, 243
Daypro Alta, 243
Daytrana, 209–210
DDAVP, 88
decitabine, 84–85
Decongestants
oxymetazoline, 245
phenylephrine hydrochloride, 260–261
pseudoephedrine sulfate, 278–279
tetrahydrozoline hydrochloride, 321
deferasirox, 85
deferoxamine mesylate, 85
degarelix, 85
Delatestryl, 319–320
delavirdine mesylate, 85–86
Delestrogen, 119–120
Delsym, 92
delta-9-tetrahydrocannabinol, 104–105
delta-9-THC, 104–105
Demadex, 331
demeclocycline hydrochloride, 86
Demerol, 202
Demser, 212
Denavir, 377
denileukin diftitox, 86
denosumab, 86–87
Depacon, 340–341
Depakene, 340–341
Depakote, 340–341
Depen, 253–254
DepoCyt, 78–79
DepoDur, 221
Depo-Medrol, 210
Depo-Provera, 199–200, 409
depo-sub Q provera 104, 199–200, 410
Dermatop, 378
Dermolate, 378
Dermtex HC, 378
Desenex, 72, 375
Desferal, 85
desipramine hydrochloride, 87
desirudin, 87
desloratadine, 87–88
desmopressin acetate, 88
Desogen, 405
desonide, 377
DesOwen, 377
desoximetasone, 377
desvenlafaxine succinate, 88
Detrol, 329–330
DexAlone, 92
dexamethasone, 88–89, 377
dexamethasone intravitreal, 382
dexamethasone sodium phosphate, 88–89
dexchlorpheniramine maleate, 89
Dexedrine Spansule, 91–92
Dexferrum, 171–172
Dexilant, 89–90
dexlansoprazole, 89–90
dexmedetomidine hydrochloride, 90
dexmethylphenidate hydrochloride, 90
DexPak TaperPak, 88–89
dexpanthenol, 90, 378
dexrazoxane, 90–91
Dextran 40, 91
Dextran 70, 91
dextran, high–molecular-weight, 91
dextran, low–molecular-weight, 91
dextroamphetamine sulfate, 91–92
dextromethorphan hydrobromide, 92
D.H.E. 45, 95
DHEA, 367
DiaBeta, 150
Diabetic Tussin, 153
Diagnostic agents
adenosine, 5–6
corticotropin (ACTH), 75
cosyntropin, 75
dipyridamole, 98
edrophonium chloride, 108
glucagon, 150
mannitol, 197
methylene blue, 208–209
naloxone hydrochloride, 224
phentolamine mesylate, 260
secretin, 299
Diamox Sequels, 3
Diastat AcuDial, 92–93
diazepam, 92–93
diazoxide, 93
Diclegis, 398
diclofenac epolamine, 93
diclofenac potassium, 93
diclofenac sodium, 93
dicyclomine hydrochloride, 94
didanosine (ddI, dideoxyinosine), 94
Didronel, 124
Differin, 374
Dificid, 132–133
diflorasone diacetate, 377
Diflucan, 134–135
diflunisal, 94
diflupredate, 382
Digestive enzyme
pancrelipase, 249
DigiFab, 95
digoxin, 94–95
digoxin immune fab, 95
di huang, 367
dihydroergotamine mesylate, 95
Dilantin, 261–262
Dilatrate SR, 173
Dilaudid, 157
Dilaudid-HP, 157
diltiazem hydrochloride, 96
Diltzac, 96
dimenhyDRINATE, 96
dimercaprol, 96
dimethyl fumarate, 97
Dimetabs, 96
dinoprostone, 97
Diovan, 341
Diovan HCT, 398
Dipentum, 238
Dipeptidyl peptidase-enzyme (DPP4) inhibitors
alogliptin, 9–10
linagliptin, 187–188
saxagliptin, 297–298
sitagliptin phosphate, 302
Diphen AF, 97–98
Diphenhist, 97–98
diphenhydrAMINE hydrochloride, 97–98
Diphenylbutylpiperidine
pimozide, 263
diphtheria CRM197 protein, 416
diphtheria/tetanus toxoid/acellular pertussis vaccine, 411
diphtheria/tetanus toxoid/acellular pertussis/hepatitis B vaccine, 411
diphtheria/tetanus toxoid/acellular pertussis/poliovirus vaccine, 412
diphtheria/tetanus toxoid/acellular pertussis/poliovirus/ Haemophilus B vaccine, 412
Diprivan, 276
Diprolene, 377
Diprolene AF, 34, 377
dipyridamole, 98
Disalcid, 296
disopyramide phosphate, 98
Disposal of medications guidelines, 362
disulfiram, 98–99
Ditropan, 244
Diuretics
acetazolamide, 3
Aldactazide, 400–401
chlorothiazide, 60–61
chlorothiazide sodium, 60–61
chlorthalidone, 62
Dyazide, 400
hydrochlorothiazide, 156
indapamide, 165
mannitol, 197
metolazone, 211
Moduretic, 400
Diuril, 60–61
Divalproex, 340–341
divalproex sodium, 340–341
DNA topoisomerase inhibitor
irinotecan hydrochloride, 171
DOBUTamine hydrochloride, 99
Docefrez, 99–100
docetaxel, 99–100
docosanol, 37
docusate, 385
dofetilide, 100
dolasetron mesylate, 100
Dolophine, 205
dolutegravir, 100–101
Domeboro Powder, 379
donepezil hydrochloride, 101
dong quai, 366
DOPamine hydrochloride, 101
Dopaminergic agents
apomorphine, 21
bromocriptine mesylate, 39
DOPamine hydrochloride, 101
metoclopramide, 210–211
pramipexole dihydrochloride, 269
ropinirole hydrochloride, 293
rotigotine, 294
Dopaminergic blockers
chlorproMAZINE hydrochloride, 61–62
clozapine, 72
 fluphenazine decanoate, 138
fluphenazine hydrochloride, 138
haloperidol, 153–154
haloperidol decanoate, 153–154
haloperidol lactate, 153–154
loxapine hydrochloride, 194–195
olanzapine, 237
prochlorperazine, 273–274
prochlorperazine edisylate, 273–274
prochlorperazine maleate, 273–274
promethazine hydrochloride, 274–275
thiothixene, 322–323
Dopamine/serotonin agonist and antagonist
aripiprazole, 22–23
Dopamine/serotonin antagonist
asenapine, 23–24
Dopram, 102
Doral, 280
Doribax, 101–102
doripenem, 101–102
dornase alfa, 102
Doryx, 104
dorzolamide, 382
dorzolamide/timolol, 382
Dovonex, 376
doxapram hydrochloride, 102
doxazosin mesylate, 102
doxepin hydrochloride, 102–103
doxercalciferol, 103
Doxil, 103–104
DOXOrubicin hydrochloride, 103–104
Doxy100, 104
doxycycline, 104
doxylamine/pyridoxine, 398
DPP-4 inhibitors
alogliptin, 9–10
linagliptin, 187–188
saxagliptin, 297–298
sitagliptin phosphate, 302
Dramamine, 199
Dramanate, 96
dried root bark of Lycium chinense Miller, 367
Dristan, 245
Dritho-Cream HP, 376
dronabinol, 104–105
dronedarone, 105
droperidol, 105
Droxia, 158
droxidopa, 105–106
Drugs commonly used to treat specific disorders, 421–431
DTaP, 411
DTaP-HePB-IPV, 411
DTaP-IIPV, 412
DTaP-IPV/Hib, 412
DTIC Dome, 80
Duavee, 401
Duetact, 392
Duexis, 388
Dulcolax, 385
Dulera 100/5, 404
Dulera 200/5, 404
duloxetine hydrochloride, 106
Duraclon, 70–71
Duragesic, 130–131
Duramorph, 221
Durezol, 382
dutasteride, 106
Dutoprol, 397
Dyazide, 400
Dymenate, 96
Dymista, 403
Dynacin, 216–217
DynaCirc CR, 174
Dyna-Hex, 376
dyphylline, 106–107
Dyrenium, 336
Dysport, 38
E
ecallantide, 107
echinacea (cone flower), 367
Echinocandin drugs
anidulafungin, 20
caspofungin acetate, 51
micafungin sodium, 213
echothiophate, 382
econazole, 375
eculizumab, 107
Edarbi, 28
Edarbyclor, 395
ED drugs
avanafil, 27
sildenafil citrate, 300
tadalafil, 312
vardenafil hydrochloride, 342
Edecrin, 122–123
edetate calcium disodium, 107
Edluar, 352
edrophonium chloride, 108
Edurant, 288
efavirenz, 108
Effexor XR, 343–344
Effient, 269–270
Efidac/24, 278–279
eflornithine, 378
Efudex, 137
Egrifta, 319
Elaprase, 162
Eldepryl, 299
elder bark and flowers, 367
Electrolytes
ammonium chloride, 16–17
calcium carbonate, 45
calcium chloride, 45
calcium glubionate, 45
calcium gluconate, 45
calcium lactate, 45
magnesium sulfate, 196–197
potassium acetate, 267–268
potassium chloride, 267–268
 potassium gluconate, 267–268
sodium bicarbonate, 302–303
Elelyso, 312
Elestat, 382
eletriptan hydrobromide, 109
Elidel, 379
Eligard, 183
Elimite, 380
Eliquis, 21
Elitek, 285
Elixophyllin, 321–322
Ella, 405
Ellence, 113
Elmiron, 257
Elocon, 378
elosulfase alfa, 109
Eloxatin, 242
eltrombopag, 109
Emadine, 382
Embeda, 388
emedastine, 382
Emend, 21–22
Emend for injection, 21–22
Emollients
dexpanthenol, 90, 378
urea, 378
vitamins A&D, 378
zinc oxide, 378
Emoquette, 405
Empirin with Codeine, 387
Emsam, 299
emtricitabine, 109–110
Emtriva, 109–110
Enablex, 83
enalaprilat, 110
enalapril maleate, 110
Enbrel, 122
Endometrin, 274
Endothelial growth factor
aflibercept, 6–7
Endothelin receptor antagonists
ambrisentan, 12–13
bosentan, 37–38
 treprostinil sodium, 334–335
Enerjets, 44
enfuvirtide, 110
Engerix-B, 413
Enjuvia, 120–121
Enlon, 108
enoxaparin, 110–111
Enpresse, 408
entacapone, 111
entecavir, 111–112
Entereg, 12
Entertainer’s Secret, 295
Entocort EC, 40–41
Enulose, 178
enzalutamide, 112
Enzymes
agalsidase beta, 7
alglucosidase alfa, 8
elosulfase, 109
galsulfase, 146
hyaluronidase, 155
idursulfase, 162
laronidase, 181
rasburicase, 285
sacrosidase, 295
taliglucerase, 312
Enzyme inhibitors
disulfiram, 98–99
metyrosine, 212–213
miglustat, 216
Epaned, 110
ephedra, 367
ephedrine sulfate, 112
epinastine hydrochloride, 382
epinephrine bitartrate, 112–113
epinephrine hydrochloride, 112–113
EpiPen Auto-Injector, 112–113
epirubicin hydrochloride, 113
Epivir, 178
Epivir-HBV, 178
eplerenone, 113–114
epoetin alfa (EPO, erythropoietin), 114
Epogen, 114
epoprostenol sodium, 114–115
eprosartan mesylate, 115
Epsom Salts, 386
eptifibatide, 115
Epzicom, 399
Equalactin, 386
Equetro, 48
Eraxis, 20
Erbitux, 58
Erectile disfunction drugs
avanafil, 27
sildenafil citrate, 300
tadalafil, 312
vardenafil hydrochloride, 342
Ergomar, 115
ergot, 367
Ergots
dihydroergotamine mesylate, 95
ergotamine tartrate, 115
ergotamine tartrate, 115
eribulin mesylate, 115–116
Erivedge, 347
erlotinib, 116
Errin, 409
Ertaczo, 376
ertapenem, 116
Erwinaze, 24
Eryderm, 116–117
Eryped, 116–117
Erythrocin, 116–117
erythromycin salts, 116–117
erythromycin/sulfisoxazole, 390
Erythropoiesis stimulators
darbepoetin alfa, 83
epoetin alfa, 114
escitalopram oxalate, 117–118
Esgic-Plus, 404
eslicarbazepine acetate, 118
esmolol hydrochloride, 118
esomeprazole magnesium, 118–119
Estarylla, 406
estazolam, 119
Estrace, 119–120
estradiol, 119–120
estradiol acetate, 119–120
estradiol cypionate, 119–120
estradiol hemihydrate, 119–120, 378
estradiol valerate, 119–120
Estring, 119–120
Estrogens
estradiol, 119–120
estradiol acetate, 119–120
estradiol cypionate, 119–120
estradiol hemihydrate, 119–120, 378
estradiol valerate, 119–120
estrogens, conjugated, 120–121
estrogens, esterified, 121
estropipate, 121–122
Estrogen receptor antagonist
fulvestrant, 144
Estrogen receptor modulators
ospemifene, 241–242
raloxifene hydrochloride, 282
toremifene citrate, 331
estrogens, conjugated, 120–121
estrogens, esterified, 121
estropipate, 121–122
Estrostep Fe, 389, 408
eszopiclone, 122
etanercept, 122
ethacrynic acid, 122–123
ethambutol hydrochloride, 123
ethionamide, 123
ethosuximide, 123
ethotoin, 124
Ethyol, 13
etidronate disodium, 124
etodolac, 124–125
Etopophos, 125
etoposide (VP-16), 125
Etrafon, 392
Etrafon-A, 392
Etrafon-Forte, 392
etravirine, 125
eucalyptus, 367
Euflexxa, 155
Eurax, 379
Evamist, 119–120
evening primrose, 367
everolimus, 125–126
Evicel, 378–379
Evista, 282
Evoclin, 374
Evoxac, 58
Exalgo, 157
Exelon, 290–291
exemestane, 126
exenatide, 126
Exforge, 395
Exforge HCT, 395
Exidine, 376
Exjade, 85
Ex-Lax Stool Softener, 385
Exodine, 376
Expectorant
guaifenesin, 153
Extina, 176, 376
Eylea, 6–7
ezetimibe, 126–127
ezogabine, 127
F
Fabior, 375
Fabrazyme, 7
Factive, 147–148
factor IX concentrates, 127
Factor Xa inhibitor
rivaroxaban, 290
factor XIII concentrate (human), 127–128
false unicorn root, 367
famciclovir sodium, 128
famotidine, 128
Famvir, 128
Fanapt, 163
Fareston, 331
Farxiga, 82
Faslodex, 144
fat emulsion, intravenous, 128–129
FazaClo, 72
febuxostat, 129
Feldene, 264
felodipine, 129
Femara, 182
Femcon Fe chewable tablets, 405
femHRT, 402
Femiron, 131
Femring, 119–120
fennel, 368
fenofibrate, 129–130
Fenoglide, 129–130
fenoprofen calcium, 130
fentanyl, 130–131
Fentora, 130–131
fenugreek, 368
Feosol, 131
Feraheme, 131–132
Fer-In-Sol, 131
Ferric hexacyanoferrate
insoluble Prussian blue, 166
Ferrlecit, 303
Ferro-Sequels, 131
ferrous asparate, 131
ferrous fumarate, 131
ferrous gluconate, 131
ferrous salts, 131
ferrous sulfate, 131
ferrous sulfate exsiccated, 131
Fertility drugs
cetrorelix acetate, 58
chorionic gonadotropin alfa, 64
clomiPHENE citrate, 69
follitropin alfa, 140–141
follitropin beta, 141
ganirelix acetate, 146
menotropins, 201–202
urofollitropin, 339
ferumoxytol, 131–132
fesoterodine fumarate, 132
Fetzima, 185–186
feverfew, 368
fexofenadine hydrochloride, 132
Fiberall, 386
Fiber-Con, 386
fibrinogen concentrate, human, 132
fidaxomicin, 132–133
filgrastim, 133
Finacea, 374
finasteride, 133
fingolimod, 133–134
Fiorinal with Codeine, 387
Firazyr, 161–162
fish oil, 368
Flagyl, 212
Flarex, 383
Flatulex, 301
flavoxate hydrochloride, 134
Flebogamma 5%, 413–414
Flebogamma 10%, 413–414
flecainide acetate, 134
Flector, 93
Fleet Babylax, 385
Fleet Liquid Glycerin Suppository, 385
Fletcher’s Castoria, 386
Flexeril, 77
Flexon, 241
Flolan, 114–115
Flomax, 313
Flonase, 379
Florinef Acetate, 136
Florone, 377
Florone E, 377
Flovent Diskus, 379
Flovent HFA, 379
Floxin, 236–237
floxuridine, 134
Fluarix, 414
fluconazole, 134–135
flucytosine, 135
Fludara, 135–136
fludarabine phosphate, 135–136
fludrocortisone acetate, 136
FluLaval, 414
Flumadine, 288–289
flumazenil, 136
Flumist, 414–415
flunisolide, 136–137
fluocinolone acetonide, 382
fluocinolone acetonide/hydroquinone/
tretinoin, 374
fluocinolone acetate, 377
fluocinonide, 377
Fluonex, 377
Fluonid, 377
Fluoritab, 303
fluorometholone, 383
Fluor-Op, 383
Fluoroplex, 137
Fluoroquinolone antibiotics
ciprofloxacin, 65–66, 375, 382
gemifloxacin mesylate, 147–148
gentamicin sulfate, 148
levofloxacin, 185, 383
moxifloxacin hydrochloride, 221–222
norfloxacin, 234
ofloxacin, 236–237
fluorouracil, 137
fluoxetine hydrochloride, 137–138
fluphenazine decanoate, 138
fluphenazine hydrochloride, 138
Flura, 303
flurandrenolide, 378
flurazepam hydrochloride, 138–139
flurbiprofen, 139
flutamide, 139
fluticasone fumarate, 378
fluticasone propionate, 378, 379
fluvastatin sodium, 139–140
Fluvirin, 414
fluvoxamine maleate, 140
Fluzone, 414
Fluzone High Dose, 414
Fluzone Quadrivalent, 414
FML, 383
Focalin, 90
Focalin XR, 90
Folate analogue
levoleucovorin, 185
Folate analogue metabolic inhibitor
pralatrexate, 268
folic acid, 140
Folic acid derivative
leucovorin calcium, 182–183
Follistim, 141
follitropin alfa, 140–141
follitropin beta, 141
Folotyn, 268
Folvite, 140
fomepizole, 141
fondaparinux, 141
Foradil Aerolizer, 142
formoterol fumarate, 142
Fortamet, 204
Fortaz, 54–55
Forteo, 319
Fortesta, 319–320
Fosamax, 8
fosamprenavir, 142
fosaprepitant, 21–22
fosfomycin tromethamine, 143
fosinopril sodium, 143
fosphenytoin sodium, 143–144
Fosrenol, 180
Fototar, 376
Fragmin, 81
FreAmine, 14
Frova, 144
frovatriptan succinate, 144
FUDR, 134
fulvestrant, 144
Fulyzaq, 76
Fungoid Tincture, 213–214
Furadantin, 232
furosemide, 144
Fusilev, 185
Fusion inhibitor
enfuvirtide, 110
Fuzeon, 110
Fycompa, 257–258
G
GABA analogue
acamprosate calcium, 2
GABA Inhibitor
vigabatrin, 344–345
gabapentin, 145
Gabitril Filmtabs, 323
Gablofen, 30
gadobutrol, 145
Gadavist, 145
galantamine hydrobromide, 145
Gallstone solubilizers
chenodiol, 59
ursodiol, 339
galsulfase, 146
GamaSTAN S/D, 413–414
Gammagard Liquid, 413–414
gamma globulin, 413–414
Gamunex, 413–414
Gamunex-C, 413–414
ganciclovir, 146
ganciclovir sodium, 146
ganirelix acetate, 146
Gardasil, 413
garlic, 368
Gastric acid secretion inhibitor
ranitidine hydrochloride, 284
Gas-X, 301
gatifloxacin, 383
Gattex, 314
Gazyva, 235
Gelfoam, 378
Gelnique, 244
gemcitabine hydrochloride, 147
gemfibrozil, 147
gemifloxacin mesylate, 147–148
Gemzar, 147
Genaphed, 278–279
Genasoft, 385
Gengraf, 78
Genotropin, 305–306
Gentak, 148
gentamicin sulfate, 148
gentian violet, 376
Gentran 40, 91
Gentran 70, 91
Geodon, 350–351
GHRF analogue
tesamorelin, 319
Gianvi, 406
Giazo, 30
Gilenya, 133–134
Gilotrif, 6
ginger, 368
ginkgo, 368
ginseng, 368
GI stimulants
dexpanthenol, 90
metoclopramide, 210–211
glatiramer acetate, 149
Glaucoma drug
methazolamide, 205
Gleevec, 164
Gliadel, 50
glimepiride, 149
glipiZIDE, 149–150
GlucaGen Diagnostic Kit, 150
GlucaGen HypoKit, 150
glucagon, 150
Glucagon Emergency Kit, 150
Glucagon-like peptide receptor agonist
liraglutide, 189
teduglutide, 314
glucarpidase, 150
Glucocorticoid
dexamethasone sodium phosphate, 88–89, 377
Glucophage, 204
glucosamine, 368
Glucosamine polysaccharide
hyaluronic acid derivatives, 155
Glucose-elevating drugs
diazoxide, 93
glucagon, 150
Glucotrol, 149–150
Glucovance, 392
Glumetza, 204
Glutamate receptor antagonist
perampanel, 257–258
glyBURIDE, 150
glycerin, 385
glycerol phenylbutyrate, 151
Glycoprotein IIb/IIIa inhibitor
abciximab, 1
Glycoprotein IIb/IIIa receptor agonist
eptifibatide, 115
glycopyrrolate, 151
Glynase, 150
Glyset, 215
GnRH
histrelin implant, 155
nafarelin acetate, 223
GnRH analogue
leuprolide acetate, 183
Gold compound
gold sodium thiomalate, 151–152
goldenrod leaves, 368
goldenseal, 368
Gold salt
auranofin, 27
gold sodium thiomalate, 151–152
golimumab, 152
GoLytely, 386
Gonal-F, 140–141
Gordon’s Urea 40%, 378
goserelin acetate, 152
gotu kola, 369
Gralise, 145
granisetron hydrochloride, 152–153
grape seed extract, 369
green tea leaf, 369
Growth factor
becaplermin, 378
Growth hormone (GH) inhibitor
lanreotide acetate, 179–180
guaifenesin, 153
guanfacine hydrochloride, 153
Guanylate cyclase-C agonist
linaclotide, 187
guarana, 369
guayusa, 369
Guide to abbreviations, ix–xi
Gynecort, 378
Gyne-Lotrimin, 72
H
H5N1, 415
Haemophilus b vaccine, 412
Haemophilus B/hepatitis B vaccine, 412
Hair removal product
eflornithine, 378
Halaven, 115–116
halcinonide, 378
Halcion, 336–337
Haldol, 153–154
halobetasol propionate, 378
Halog, 378
haloperidol, 153–154
haloperidol decanoate, 153–154
haloperidol lactate, 153–154
hamamelis water, 379
Havrix, 412–413
hawthorn, 369
HBIG, 413
Headache drug
Esgic-Plus, 404
Heart failure drug
BiDil, 401
Heartline, 24–25
Heather, 409
Hectorol, 103
Hedgehog pathway inhibitor
vismodegib, 347
Helidac, 399
Hemabate, 49
Hematopoietic stem-cell mobilizer
plerixafor, 265
Hemofil, 20
Hemopad, 379
Hemorrheologic agent
pentoxifylline, 257
Hemostatic agents
absorbable fibrin sealant, 378
absorbable gelatin, 379
aminocaproic acid, 14
human fibrin sealant, 378–379
microfibrillar collagen, 379
 thrombin, 379
thrombin, recombinant, 379
HepaGam B, 413
Heparin antagonist
protamine sulfate, 277
heparin sodium, 154
HepatAmine, 14
hepatitis A vaccine, 412–413
hepatitis A and hepatitis B vaccine, 413
hepatitis B immune globulin, 413
hepatits B vaccine, 413
Hepatitis C drugs
simeprevir, 301
sofosbuvir, 305
Hepsera, 5
HER2/NEU receptor antagonist
pertuzumab, 258
Herceptin, 334
Hespan, 154–155
hetastarch, 154–155
Hetlioz, 314
hexachlorophene, 376
Hexalen, 11–12
HF drug
BiDil, 401
Hiberix, 412
Hibistat, 376
Hiprex, 205–206
Histamine-2 receptor antagonists
cimetidine, 64–65
famotidine, 128
nizatidine, 233
ranitidine hydrochloride, 284
Histone deacetylase inhibitors
romidepsin, 292–293
vorinostat, 347–348
histrelin implant, 155
Hizentra, 413–414
HMG-CoA inhibitor
atorvastatin calcium, 26
fluvastatin sodium, 139–140
lovastatin, 194
pitavastatin, 264
 pravastatin sodium, 270
rosuvastatin calcium, 294
simvastatin, 301
Hold DM, 92
homatropine, 383
Homatropine HBr, 383
hop, 369
horehound, 369
Horizant, 145
Hormonal contraceptive
norgestrel, 234
Hormonal contraceptives, 405–410
Hormones
calcitonin, 44–45
chorionic gonadotropin, 63–64
clomiPHENE citrate, 69
desmopressin acetate, 88
dexamethasone, 88–89, 377
dexamethasone sodium phosphate, 88–89, 377
goserelin acetate, 152
insulin, 167
insulin aspart, 167
insulin detemir, 167
insulin glargine, 167
insulin glulisine, 167
insulin lispro, 167
isophane insulin, 167
medroxyPROGESTERone, 199–200
megestrol acetate, 200
menotropins, 201–202
methylPREDNISolone, 210
methyLPREDNISolone acetate, 210
methyLPREDNISolone sodium succinate, 210
octreotide acetate, 236
oxytocin, 246
progesterone, 274
somatropin, 305–306
testosterone, 319–320
horse chestnut seed, 369
H.P. Acthar Gel, 75
5-HT3 receptor antagonist
alosetron, 10
granisetron hydrochloride, 152–153
Humalog, 167
Human B-type natriuretic peptide
nesiritide, 228
human fibrin sealant, 378–379
Human growth hormone analogue
pegvisomant, 253
human papillomavirus vaccine types 16/18, 413
human papillomavirus recombinant vaccine, quadrivalent, 413
Humate-P, 20
Humatrope, 305–306
Humira, 5
Hyalgan, 155
hyaluronic acid derivatives, 155
hyaluronidase, 155
Hycamtin, 330–331
Hycort, 378
Hydantoins
ethotoin, 124
fosphenytoin sodium, 143–144
phenytoin, 261–262
hydrALAZINE hydrochloride, 155–156
Hydrea, 158
hydrochlorothiazide, 156
hydrochlorothiazine/captopril, 396
hydrochlorothiazide/propranolol, 396
Hydrocil Instant, 386
hydrocodone bitartrate, 156
hydrocortisone, 156–157, 378
hydrocortisone acetate, 156–157, 378
hydrocortisone buteprate, 156–156, 378
hydrocortisone butyrate, 156–157, 378
hydrocortisone salts, 156–157
hydrocortisone valerate, 156–157, 378
Hydrocortone, 271
HydroDIURIL, 156
hydromorphone hydrochloride, 157
Hydro-Par, 156
hydroxocobalamin, 158
hydroxyethyl starch, 154–155
hydroxyprogesterone caproate, 158
hydroxyurea, 158
hydrOXYzine hydrochloride, 159
hydrOXYzine pamoate, 159
Hylenex, 155
hyoscyamine sulfate, 159
HyperHEP B S/D, 413
HyperRab S/D, 418
HyperRHO S/D Full Dose, 416
HyperRHO S/D Mini Dose, 416
hyssop, 369
Hytone, 378
Hytrin, 317
Hyzaar, 396
I
ibandronate sodium, 160
ibritumomab, 160
ibrutinib, 160
IBS drug
alosetron, 10
IB-Stat, 159
ibuprofen, 161
ibutilide fumarate, 161
icatibant, 161–162
Iclusig, 266
icosapent ethyl, 162
Icy Hot PM, 375
Idamycin PFS, 162
idarubicin hydrochloride, 162
idursulfase, 162
Ifex, 163
ifosfamide, 163
IG, 413–414
IGIM, 413–414
IGIV, 413–414
IGSC, 413–414
Ilaris, 46
iloperidone, 163
iloprost, 163
imatinib mesylate, 164
Imbruvica, 160
Imdur, 173
imipramine hydrochloride, 164
imipramine pamoate, 164
imiquimod, 377
Imitrex, 310–311
immune globulin, 413–414
immune globulins, 413–414
Immunomodulators
abatacept, 1
aldesleukin, 7–8
certolizumab, 57
interferon alfacon-1, 168
interferon beta-1a, 169
interferon beta-1b, 169
interferon gamma-1b, 169
 lenalidomide, 182
pimecrolimus, 379
thalidomide, 321
Immunosuppressants
azathioprine, 28
basiliximab, 30
mycophenolate mofetil, 222
mycophenolate sodium, 222
sirolimus, 302
tacrolimus, 311–312
Imodium, 191–192
Imogam Rabies-HT, 418
Imovax Rabies, 420
Implanon, 409
impotence drug
tadalafil, 312
Imuran, 28
Incivek, 314
Increlex, 198
Incretin mimetic drug
exenatide, 126
indacaterol, 165
indapamide, 165
Inderal, 276–277
indinavir sulfate, 165
Indocin, 165–166
indomethacin, 165–166
indomethacin sodium trihydrate, 165–166
Infanrix, 411
Infasurf, 45
INFeD, 171–172
Infergen, 168
infliximab, 166
influenza virus tyoe A and B vaccine, 414
influenza virus vaccine, H5N1, 415
influenze virus type A and B vaccine, intranasal, 414–415
Infumorph, 221
ingenol, 374
Inlyta, 27–28
InnoPran XL, 276–277
Inotropic drugs
milrinone lactate, 216
insoluble Prussian blue, 166
Inspra, 113–114
insulin, 167
insulin aspart, 167
insulin detemir, 167
insulin glargine, 167
insulin glulisine, 167
Insulin-like growth factor
mecasermin, 198
insulin lispro, 167
integrase inhibitor
dolutegravir, 100
raltegravir, 283
Integrelin, 115
Intelence, 125
Interferons
peginterferon alfa-2a, 251–252
peginterferon alfa-2b, 252
interferon alfa-2b, 168
interferon alfacon-1, 168
interferon beta-1a, 169
interferon beta-1b, 169
interferon gamma-1b, 169
Interleukin
oprelvekin, 240
Interleukin blockers
canakinumab, 46
rilonacept, 288
Interleukin-1 receptor antagonist
anakinra, 19
Interleukin-6 receptor inhibitor
tocilizumab, 327–328
Intermezzo, 352
Intralipid, 128–129
Intron-A, 168
Intuniv, 153
Invanz, 116
Invokana, 46
Invega, 247–248
Invirase, 296–297
Iodex, 376
iodine, 376
iodine thyroid products, 169–170
iodoquinol, 170
Iopidine, 381
Iosat, 169–170
ipilimumab, 170
IPOL, 416
ipratropium bromide, 170
Iprivask, 87
IPV, 416
irbesartan, 170–171
irinotecan hydrochloride, 171
iron dextran, 171–172
Iron preparations
ferrous asparate, 131
ferrous fumarate, 131
ferrous gluconate, 131
ferrous salts, 131
ferrous sulfate, 131
ferumoxytol, 131–132
iron dextran, 171–172
iron sucrose, 172
sodium ferric gluconate complex, 303
iron sucrose, 172
Isentress, 283
ISMO, 173
isocarboxazid, 172
Isochron, 173
isoniazid, 172–173
isophane insulin, 167
Isopoto Atropine, 26–27
isoproterenol hydrochloride, 173
Isopto-Homatropine, 383
Isordil Titradose, 173
isosorbide dinitrate, 173
isosorbide mononitrate, 173
isotretinoin, 173–174
isradipine, 174
Istalol, 324–325
Istodax, 292–293
Isuprel, 173
itraconazole, 174–175
ivacaftor, 175
ivermectin, 17, 379
ixabepilone, 175
Ixempra, 175
Ixiaro, 420
J
Jakafi, 295
Jalyn, 400
jambul, 369
Jantoven, 348
Janumet, 393
Janumet XR, 393
Januvia, 302
Japanese encephalitis vaccine, 419
Japanese encephalitis virus (JEV)vaccine, 420
Java plum, 369
Jentadueto, 392
JE-VAX, 419
Jevtana, 43
jojoba, 369
Jolessa, 405
J-Tan, 40
Junel 21 Day 1/20, 406
Junel 21 Day 1.5/30, 406
Junel Fe 1/20, 406
Junel Fe 1.5/30, 406
juniper berries, 369
Juvisync, 393
Juxtapid, 191
K
Kadcyla, 6
Kadian, 221
Kalbitor, 107
Kaletra, 192
Kalexate, 304–305
Kalydeco, 175
Kaon-Cl, 267–268
Kaopectate, 35–36
Kapvay, 70–71
karala, 370
Karbinal ER, 48
karela, 370
Karigel, 303
Kariva, 407
kava, 369
Kayexalate, 304–305
Kaylixir, 267–268
Kazano, 392
Kcentra, 278
K-Dur, 267–268
Keflex, 57
Kelnor 1/35, 406
Kenalog, 335–336
Kepivance, 247
Keppra, 184
Keratinocyte growth factor
palifermin, 247
Keratolytics
podofilox, 379
podophyllum resin, 379
Kerlone, 34
Ketalar, 175–176
ketamine, 175–176
Ketek, 315
ketoconazole, 176, 376
Ketolide antibiotic
telithromycin, 315
ketoprofen, 176–177
ketorolac, 177, 383
ketorolac tromethamine, 177
ketotifen, 383
K-G Elixir, 267–268
Kinase inhibitors
afatinib, 6
axitinib, 27–28
bosutinib, 38
cabozantinib, 44
crizotinib, 75–76
dabrafenib, 79–80
dasatinib, 84
everolimus, 125–126
ibrutinib, 160
lapatinib, 180–181
nilotinib, 231
pazopanib, 250–251
ponatinib, 266
regorafenib, 285–286
ruxolitinib, 295
sorafenib tosylate, 306
sunitinib, 311
temsirolimus, 316
tofacitinib, 328
trametinib, 332
vemurafenib, 343
Kineret, 19
Kinrix, 412
Kionex, 304–305
Klaron, 375
Klonopin, 70
Klorvess, 267–268
Klotrix, 267–268
Kombiglyze XR, 393
Kondremul Plain, 386
Konsyl, 386
Konsyl Fiber, 386
Korlym, 215
Krystexxa, 252
kudzu, 370
kunecatechins, 377
Kuvan, 296
Kynamro, 217–218
Kyprolis, 49
Kytril, 152–153
L
labetalol hydrochloride, 177
lacosamide, 177–178
lactulose, 178, 385
Lamictal, 178–179
Lamisil, 318, 376
lamivudine, 178
lamotrigine, 178–179
Lanacort-5, 378
Lanoxin, 94–95
lanreotide acetate, 179–180
lansoprazole, 180
lanthanum carbonate, 180
Lantus, 167
lapatinib, 180–181
laronidase, 181
Lasix, 144
Lastacaft, 381
latanoprost, 383
Latisse, 195, 382
lavender, 370
Laxatives, 385–386
bisacodyl, 385
cascara, 385
castor oil, 385
docusate, 385
glycerin, 385
lactulose, 178, 385
lubiprostone, 385
magnesia, 196
magnesium citrate, 196, 385
magnesium salts, 196, 385
magnesium sulfate, 196–197, 386
methylnaltrexone bromide, 209
mineral oil, 386
polycarbophil, 386
polyethylene glycol, 386
polyethylene glycoelectrolyte solution, 386
polyethylene glycol with electrolytes, 386
psyllium, 386
senna, 386
sodium picosulfate, magnesium oxide, anhydrous citric acid, 386
Lazanda, 130–131
ledum tincture, 370
Leena, 407
leflunomide, 181
lenalidomide, 182
lepirudin, 182
Leprostatic agent
dapsone, 82
Leptin analogue
metreleptin, 212
Lescol, 139–140
Lessina, 405
Letairis, 12–13
letrozole, 182
leucovorin calcium, 182–183
Leukeran, 59
Leukine, 297
Leukotriene receptor antagonists
montelukast sodium, 220–221
zafirlukast, 349
leuprolide acetate, 183
levalbuterol hydrochloride, 183
levalbuterol tartrate, 183
Levaquin, 185
Levatol, 253
Levbid, 159
Levemir, 167
levetiracetam, 184
Levitra, 342
levobunolol, 383
levocetirizine dihydrochloride, 184
levodopa, 184
levofloxacin, 185, 383
levoleucovorin, 185
levomilnacipran, 185–186
Levophed, 233
Levora 0.15/30, 405
levorphanol tartrate, 186
Levothroid, 186–187
levothyroxine sodium, 186–187
Levoxine, 186–187
Levoxyl, 186–187
Levsin/SL, 159
Levulan Kerastick, 14
Lexapro, 117–118
Lexiva, 142
LHRH analogue
triptorelin pamoate, 338
Lialda, 203
Librium, 60
licorice, 370
Lidex, 377
lidocaine, 187
lidocaine hydrochloride, 187
lidocaine/tetracaine, 379
Ligand binding factor
ziv-aflibercept, 351
Limbitrol, 391
Limbitrol DS 10–25, 391
linaclotide, 187
linagliptin, 187–188
Lincocin, 188
lincomycin hydrochloride, 188
Lincosamide antibiotics
clindamycin hydrochloride, 68–69
clindamycin palmitate hydrochloride, 68–69
clindamycin phosphate, 68–69
lincomycin hydrochloride, 188
lindane, 379
linezolid, 188
Linzess, 187
Lioresal, 30
liothyronine, 188–189
liotrix, 189
Lipase inhibitor
orlistat, 240–241
Lipid-lowering drugs
Advicor, 401
Liptruzet, 401
omega-3–acid ethyl esters, 238–239
Simcor, 401
Vytorin, 401
Lipitor, 26
Lipofen, 129–130
Lipoglycopeptide
telavancin, 314–315
Liposyn, 128–129
Liptruzet, 401
Liqui-Char, 58
Liquid Pedvax HIB, 412
liraglutide, 189
lisdexamfetamine dimesylate, 189–190
lisinopril, 190
lithium carbonate, 190–191
lithium citrate, 190–191
Lithobid, 190–191
Lithonate, 190–191
Lithotabs, 190–191
Livalo, 64
10% LMD, 91
Local anesthetics
lidocaine, 187
lidocaine hydrochloride, 187
lidocaine/tetracaine, 379
Locoid, 378
lodoxamide tromethamine, 383
Loestrin 21 1/20, 406
Loestrin 21 1.5/30, 406
Loestrin Fe 21 1/20, 406
Loestrin FE 1.5/30, 406
Loestrin 24 Fe, 406
Lofibra, 129–130
Logen, 394
Lo-Hist 12, 40
Lo Loestrin Fe, 407
Lomanate, 394
lomitapide, 191
Lomotil, 394
lomustine, 191
Lonox, 394
Loop diuretics
bumetanide, 41
ethacrynic acid, 122–123
furosemide, 144
torsemide, 331
Lo/Ovral, 405, 406
loperamide hydrochloride, 191–192
Lopid, 147
lopinavir/rotinavir, 192
Lopressor, 211
Lopressor HCT, 397
Loprox, 375
loratadine, 192–193
lorazepam, 193
lorcaserin hydrochloride, 193
Lortab Tablets, 388
Loryna, 406
losartan potassium, 194
LoSeasonique, 407
Lotemax, 383
Lotensin, 32
Lotensin HCT, 396
loteprednol etabonate, 383
loteprednol etabonate/tobramycin, 383
Lotions, solutions
Burow’s solution aluminum acetate, 379
calamine lotion, 379
hamamelis water, 379
Lotrel, 394
Lotrimin, 72, 375
Lotrimin AF, 213–214
Lotronex, 10
lovastatin, 194
Lovaza, 238–239
Lovenox, 110–111
Low-molecular-weight heparins
dalteparin sodium, 81
enoxaparin, 110–111
fondaparinux, 141
Low-Ogestrel, 406
loxapine hydrochloride, 194–195
loxapine succinate, 194–195
Loxitane, 194–195
lubiprostone, 385
Lucentis, 284
lucinactant, 195
Lufyllin, 106–107
Lufyllin-400, 106–107
Lugol’s Solution, 169–170
luliconazole, 376
Lumigan, 382
Luminal Sodium, 259–260
Lumizyme, 8
Lunesta, 122
Lung surfactants
beractant, 33
calfactant, 45
lucinactant, 195
poractant alfa, 266–267
Lupron, 183
lurasidone hydrochloride, 195
Lutera, 405
Luvox, 140
Luxiq, 34, 377
Luzu, 376
Lybrel, 406
lymphocyte immune globulin, 418
Lyophilizate
dexrazoxane, 90–91
Lyrica, 272
Lysodren, 219
Lysosomal enzyme
velaglucerase, 343
Lysteda, 333
M
Macrobid, 232
Macrodantin, 232
Macrodex, 91
Macrolide antibiotics
azithromycin, 28–29
clarithromycin, 67
erythromycin salts, 116–117
fidaxomicin, 132–133
Macugen, 251
mafenide, 377
magnesia, 196
magnesium, 196
magnesium citrate, 196, 385
magnesium hydroxide, 196, 385
magnesium oxide, 196, 385
magnesium salts, 196, 385
magnesium sulfate, 196–197, 386
Mag-Ox, 196
ma huang, 370
Makena, 158
malathion, 380
mandrake root, 370
mannitol, 197
MAOIs
isocarboxazid, 172
phenelzine sulfate, 259
tranylcypromine sulfate, 333
MAO type B inhibitors
rasagiline, 284–285
selegiline hydrochloride, 299
maprotiline hydrochloride, 197
maraviroc, 198
Marezine, 76–77
marigold leaves and flowers, 370
Marinol, 104–105
Marplan, 172
Marqibo, 346
Marthritic, 296
Matulane, 273
Mavik, 332–333
Maxalt, 292
Maxiflor, 377
Maxivate, 34
Maxzide, 400
Maxzide-25, 400
measles virus vaccine, 415
measles, mumps, rubella vaccine, 415
measles, mumps, rubella, varicella virus vaccine, 415
mecasermin, 198
mechlorethamine hydrochloride, 198–199
meclizine hydrochloride, 199
Medrol, 210
medroxyPROGESTERone, 199–200
mefenamic acid, 200
Megace, 200
megestrol acetate, 200
Meglitinides
nateglinide, 226
Mekinist, 332
Melasma products
adapalene, 374
alitretinoin, 374
azelaic acid, 374
clindamycin, 374
dapsone, 82
fluocinolone acetonide/
hydroquinone/tretinoin, 374
metronidazole, 212, 375
sodium sulfacetamide, 375
tazarotene, 375
tretinoin, 335
tretinoin 0.025% cream, 375
tretinoin 0.05% cream, 375
tretinoin gel, 375
melatonin, 370
Melatonin receptor agonist
ramelteon, 283
tasimelteon, 314
meloxicam, 200–201
melphalan, 201
memantine hydrochloride, 201
Menactra, 415
Menest, 121
MenHibrix, 415
meningococcal groups C and Y, Haemophilus b, tetanus toxioid vaccine, 415
meningococcal vaccine, 415
Menomune A/C/Y/W-135, 415
Menopause drugs
Activella, 402
Angeliq, 401
CombiPatch, 402
Duavee, 401
femHRT, 402
Ortho-Prefest, 402
Premphase, 402
Prempro, 402
YAZ, 401–402
Menopur, 201–202
menotropins, 201–202
Mentax, 375
Menveo, 415
meperidine hydrochloride, 202
meprobamate, 202
Mepron, 26
mercaptopurine, 202–203
meropenem, 203
Merrem IV, 203
mesalamine, 203
mesna, 203–204
Mesnex, 203–204
Mestinon, 279
Metadate, 209–210
Metamucil, 386
metaproterenol sulfate, 204
metaxalone, 204
metformin hydrochloride, 204
methadone hydrochloride, 205
Methadose, 205
methazolamide, 205
Methblue 65, 208–209
methenamine, 205–206
methenamine hippurate, 205–206
methimazole, 206
methocarbamol, 206
methotrexate, 206–207
methoxsalen, 207–208
methscopolamine bromide, 208
methsuximide, 208
methyldopa, 208
methyldopate hydrochloride, 208
methylene blue, 208–209
methylergonovine maleate, 209
Methylin, 209–210
methylnaltrexone bromide, 209
methylphenidate hydrochloride, 209–210
methylPREDNISolone, 210
methyLPREDNISolone acetate, 210
methyLPREDNISolone sodium succinate, 210
metipranolol, 383
metoclopramide, 210–211
metolazone, 211
metoprolol, 211
metoprolol succinate, 211
metoprolol tartrate, 211
metreleptin, 212
MetroCream, 212, 375
MetroGel, 212, 375
MetroLotion, 375
metronidazole, 212, 375
metyrosine, 212–213
Mevacor, 194
mexiletine hydrochloride, 213
Mexitil, 213
Miacalcin, 44–45
micafungin sodium, 213
Micardis, 315–316
Micardis HCT, 397
miconazole, 213–214
miconazole nitrate, 213–214
microfibrillar collagen, 379
Microgestin Fe 1/20, 406
Microgestin Fe 1.5/30, 406
Microzide Capsules, 156
MICRhoGAM, 416
Microtubular inhibitors
ado-trastuzumab, 6
cabazitaxel, 43
eribulin, 115–116
ixabepilone, 175
Midamor, 13
midazolam hydrochloride, 214
midodrine, 214–215
Mifeprex, 215
mifepristone, 215
Migergot, 398
miglitol, 215
miglustat, 216
Migranal, 95
MigraTen, 398
Milk of Magnesia, 196, 385
milk thistle, 370
milk vetch, 370
milnacipran, 216
milrinone lactate, 206
Minastrin 24 FE, 406
Mineral
sodium fluoride, 303
mineral oil, 386
Minidyne, 376
Minipress, 270–271
Minitran, 232
Minocin, 216–217
minocycline hydrochloride, 216–217
minoxidil, 217
Miostat, 382
mipomersen sodium, 217–218
mirabegron, 218
MiraLax, 386
Mirapex, 269
Mircette, 407
Mirena, 410
mirtazapine, 218
Mirvaso, 374
misoprostol, 218–219
mistletoe leaves, 370
mitomycin, 219
mitomycin-C, 383
mitotane, 219
Mitotic inhibitors
etoposide (VP-16), 125
vinBLAStine sulfate, 345
vinCRIStine sulfate, 346
vinorelbine tartrate, 346
mitoxantrone hydrochloride, 219
M-M-R II, 415
Mobic, 200–201
modafinil, 220
Modicon, 406
Moduretic, 400
moexipril, 220
Moi-Stir, 295
MOM, 385
mometasone furoate, 378
Momordica charantia (karela), 370
Monistat, 213–214
Monoamine depletor
tetrabenazine, 320
Monobactam antibiotic
aztreonam, 29
Monoclonal antibodies
bevacizumab, 35
brentuximab, 39
cetuximab, 58
eculizumab, 107
erlotinib, 116
golimumab, 152
ibritumomab, 160
infliximab, 166
natalizumab, 225–226
obinutuzumab, 235
omalizumab, 238
palivizumab, 248
panitumumab, 249
pegaptanib, 251
ranibizumab, 284
raxibacumab, 285
tositumomab and iodine I-131/
tositumomab, 331–332
trastuzumab, 334
ustekinumab, 339
Monoket, 173
MonoNessa, 406
Mononine, 127
Monopril, 143
Monopril-HCT, 396
montelukast sodium, 220–221
Monurol, 143
8-MOP, 207–208
morphine sulfate, 221
Motrin, 161
MouthKote, 295
MoviPrep, 386
Moxatag, 17–18
Moxeza, 221–222, 383
moxifloxacin, 221–222, 383
moxifloxacin hydrochloride, 221–222
M-oxy, 244–245
Mozobil, 265
MS Contin, 221
MS drugs
dimethyl fumarate, 97
fingolimod, 133–134
glatiramer acetate, 149
interferon beta-1a, 169
interferon beta-1b, 169
mitoxantrone hydrochloride, 219
natalizumab, 225–226
teriflunomide, 318–319
Mucinex, 153
Mucolytic agent
acetylcysteine, 3–4
Multaq, 105
Multiple sclerosis drugs. See MS drugs
Mu-opioid receptor antagonist, peripheral
alvimopan, 12
mupirocin, 375
mupirocin calcium, 375
Murine Plus, 321
Muscarinic receptor antagonists
darifenacin hydrobromide, 83
solifenacin succinate, 305
Muse, 11
Mustargen, 198–199
Myalept, 212
Myambutol, 123
Mycamine, 213
Mycelex, 375
Mycifradin, 227
Mycobutin, 286–287
Mycocide NS, 376
mycophenolate mofetil, 222
mycophenolate sodium, 222
Mycostatin, 235
Mydral, 384
Mydriacyl, 384
Mydriatic agent
tetrahydrozoline hydrochloride, 321
Myfortic, 222
Myleran, 42–43
Myobloc, 39
Myozyme, 8
Myrbetriq, 218
Mysoline, 272
N
Nabi-HB, 413
nabilone, 222–223
nabumetone, 223
nadolol, 223
nafarelin acetate, 223
naftifine hydrochloride, 376
Naftin, 376
Naglazyme, 146
nalbuphine hydrochloride, 224
Nalfon, 130
naloxone hydrochloride, 224
naltrexone hydrochloride, 224–225
Namenda, 201
Naprelan, 225
Naprosyn, 225
naproxen, 225
naproxen sodium, 225
naratriptan, 225
Narcolepsy drugs
armodafinil, 23
modafinil, 220
Nardil, 259
Nasacort, 335–336
Nasal corticosteroid
fluticasone propionate, 379
Nasal decongestants. See decongestants
Nascobal, 76
Nasonex, 378
Natacyn, 383
natalizumab, 225–226
natamycin, 383
Natazia, 409
nateglinide, 226
Natrecor, 228
Natroba, 380
Nature Thyroid, 323
Navane, 322–323
Navelbine, 346
nebivolol, 226
NebuPent, 256
Necon 0.5/35, 406
Necon 1/35, 406
Necon 1/50, 406
Necon 7/7/7, 408
Necon 10/11, 407
nedocromil sodium, 383
nefazodone, 226
nelarabine, 227
nelfinavir mesylate, 227
Nembutal, 256–257
Neo-fradin, 227
neomycin sulfate, 227
Neoral, 78
neostigmine bromide, 228
neostigmine methylsulfate, 228
Neo-Synephrine, 260–261
Neo-Synephrine 12 Hour Extra Moisturizing, 245
Neo-Tabs, 227
Nesina, 9–10
nesiritide, 228
nettle, 370
Neulasta, 251
Neumega, 240
Neupogen, 133
Neupro, 294
Neuraminidase inhibitors
oseltamivir phosphate, 241
zanamivir, 349
Neuronal potassium channel opener
ezogabine, 127
Neurontin, 145
Neurotoxins
botulinum toxin type A, 38
botulinum toxin type B, 39
Neut, 302–303
nevirapine, 228–229
Nexavar, 306
Nexium, 118–119
Nexplanon, 409
niacin, 229
Niacor, 229
Niaspan, 229
niCARdipine hydrochloride, 229
Nicoderm, 229–230
Nicorette, 230
nicotine, 229–230
Nicotine Gum, 230
nicotine polacrilex, 230
Nicotine receptor antagonist
varenicline tartrate, 342–343
Nicotinic receptor agonist
dimethyl fumarate, 97
Nicotrol, 229–230
Nifediac, 230
NIFEdipine, 230
nightshade leaves and roots, 371
nilotinib, 231
Nilstat, 235
nimodipine, 231
Nipent, 257
Niravam, 10–11
nisoldipine, 231
nitazoxanide, 231
Nitrates
isosorbide dinitrate, 173
isosorbide mononitrate, 173
nitroglycerin, 232
Nitrek, 232
Nitro-Bid, 232
Nitro-Dur, 232
nitrofurantoin, 232
Nitrogen binding agent
glycerol phenylbutyrate, 151
Nitrogen mustards
chlorambucil, 59
cyclophosphamide, 77
ifosfamide, 163
mechlorethamine hydrochloride, 198–199
melphalan, 201
nitroglycerin, 232
Nitrolingual Pumpspray, 232
Nitropress, 232–233
nitroprusside sodium, 232–233
Nitrostat, 232
Nitro-Time, 232
Nix, 380
nizatidine, 233
Nizoral, 376
Nizoral A-D, 176
N-methyl-D-aspartate receptor antagonist
memantine hydrochloride, 201
NoDoz, 44
Nonbarbiturate anesthetic
ketamine, 175–176
Nonbenzodiazepine hypnotic
eszopiclone, 122
Nonnucleoside reverse transcriptase inhibitors (NNRTIs)
delavirdine mesylate, 85–86
efavirenz, 108
etravirine, 125
nevirapine, 228–229
rilpivirine, 288
Nonopioid antitussive drug
dextromethorphan hydrobromide, 92
No Pain-HP, 375
Norco, 388
Nordette, 405
Norditropin, 305–306
norepinephrine bitartrate, 233
Norepinephrine precursor
droxidopa, 105–106
Norepinephrine reuptake inhibitor
tapentadol, 313
norethindrone acetate, 233–234
Norflex, 241
norfloxacin, 234
norgestrel, 234
Norinyl 1+35, 406
Norinyl 1+50, 406
Noritate, 375
Noroxin, 234
Norpace, 98
Norpace CR, 98
Norpramin, 87
Northera, 105–106
nortriptyline hydrochloride, 235
Norvasc, 16
Norvir, 290
Norwich, 24–25
Novarel, 63–64
NovoLog, 167
NovoSeven RT, 73
Noxafil, 267
Nplate, 293
NRTI (nucleoside reverse transcriptase inhibitor)
abacavir, 1
NSAIDs
celecoxib, 56
choline magnesium trisalicylate, 63
diflunisal, 94
etodolac, 124–125
fenoprofen calcium, 130
flurbiprofen, 139
ibuprofen, 161
indomethacin, 165–166
indomethacin sodium trihydrate, 165–166
ketoprofen, 176–177
ketorolac tromethamine, 177
mefenamic acid, 200
meloxicam, 200–201
nabumetone, 223
naproxen, 225
naproxen sodium, 225
oxaprozin potassium, 243
piroxicam, 264
salsalate, 296
sulindac, 310
tolmetin sodium, 329
Nubain, 224
Nucleoside
telbivudine, 315
Nucleoside analogue
entecavir, 111–112
Nucleoside analogue inhibitor
sofosbuvir, 305
Nucleoside metabolic inhibitor
azacitidine, 28
Nucleoside reverse transcriptase inhibitors
emtricitabine, 109–110
stavudine (d4T), 308
tenofovir disoproxil fumarate, 317
Nucynta, 313
Nucynta ER, 313
Nuedexta, 403
Nulojix, 32
NuLytely, 386
Numby Stuff, 187
Nutraplus, 378
Nutritional drug
fat emulsion, intravenous, 128–129
Nutropin, 305–306
NuvaRing, 410
Nuvigil, 23
Nydrazid, 172–173
Nymalize, 231
NySert, 235
nystatin, 235
O
obinutuzumab, 235
Ocella, 406
octacosanol, 371
Octaplex, 278
octreotide acetate, 236
Ocufen, 139
Ocuflox, 236–237
ofatumumab, 236
Ofirmev, 2–3
ofloxacin, 236–237
Ogestrel, 406
olanzapine, 237
Oleptro, 334
Oligonucleotide inhibitor
mipomersen, 217–218
olmesartan medoxomil, 237–238
olopatadine hydrochloride, 383–384
olsalazine sodium, 238
Olux, 377
Olysio, 301
omacetaxine mepesuccinate, 238
omalizumab, 238
omega-3-acid ethyl esters, 238–239
omega-3 fatty acid
omega-3-acid ethyl esters, 238–239
omeprazole, 239
Omnaris, 377
Omnitrope, 305–306
Oncaspar, 251
ondansetron hydrochloride, 239–240
Onfi, 69
Onglyza, 297–298
Onsolis, 130–131
Ontak, 86
Opana, 246
Operand, 376
Ophthalmic agents
aflibercept, 6–7
phenylephrine hydrochloride, 260–261
ranibizumab, 284
tetrahydrozoline hydrochloride, 321
 verteporfin, 344
Opthalmic drugs, 381–384
Opioid agonists
codeine phosphate, 73
fentanyl, 130–131
hydrocodone bitratrate, 156
hydromorphone hydrochloride, 157
levorphanol tartrate, 186
meperidine hydrochloride, 202
methadone hydrochloride, 205
morphine sulfate, 221
oxycodone hydrochloride, 244–245
oxycodone/ibuprofen, 389
oxymorphone hydrochloride, 246
Suboxone, 402
sufentanil citrate, 309
tapentadol, 313
tramadol hydrochloride, 332
Zubsolv, 402
Opioid agonist-antagonist analgesics
buprenorphine hydrochloride, 41
butorphanol tartrate, 43
nalbuphine hydrochloride, 224
pentazocine, 256
Opioid antagonists
methylnaltrexone bromide, 209
naloxone hydrochloride, 224
naltrexone hydrochloride, 224–225
opium preparations, 240
Opium Tincture Deodorized, 240
oprelvekin, 240
Opticlear, 321
Optigene 3, 321
OptiPranolol, 383
Optivar, 381
Oracea, 104
Orap, 263
Orapred, 271
OraVerse, 260
OrbeShield, 31
Orencia, 1
Orinase, 328–329
orlistat, 240–241
orphenadrine citrate, 241
Orsythia, 405
Ortho-Cept, 405
Ortho-Cyclen, 406
Ortho Evra, 410
Ortho-Novum 1/35, 406
Ortho-Novum 7/7/7, 408
Ortho-Prefest, 402
Ortho Tri-Cyclen, 389, 408
Ortho Tri-Cyclen Lo, 408
oseltamivir phosphate, 241
Oseni, 392
Osmitrol, 197
ospemifene, 241–242
Osphena, 241–242
Osteocalcin, 44–45
Osymia, 404
Otocaine, 187
Ovcon-35, 405
Ovcon-50, 406
Ovide Lotion, 380
Ovidrel, 64
Ovral, 405
Ovral-28, 406
oxacillin sodium, 242
oxaliplatin, 242
Oxandrin, 242–243
oxandrolone, 242–243
oxaprozin, 243
oxaprozin potassium, 243
oxazepam, 243
Oxazolidinone antibiotic
linezolid, 188
oxcarbazepine, 243–244
Oxecta, 244–245
oxiconazole, 376
Oxistat, 376
Oxsoralen, 207–208
Oxtellar XR, 243–244
oxybutynin chloride, 244
oxycodone hydrochloride, 244–245
OxyContin, 244–245
OxyFAST, 244–245
OxyIR, 244–245
oxymetazoline, 245
oxymetholone, 245–246
oxymorphone hydrochloride, 246
Oxytocic agents
methylergonovine maleate, 209
oxytocin, 246
oxytocin, 246
Oxytrol, 244
Ozurdex, 382
P
Pacerone, 15–16
paclitaxel, 247
Pain Doctor, 375
palifermin, 247
paliperidone, 247–248
palivizumab, 248
palonosetron hydrochloride, 248
Pamelor, 235
pamidronate disodium, 248–249
Pamine, 208
Pancreaze, 249
pancrelipase, 249
Pandel, 156–157
panitumumab, 249
Panretin, 374
Panthoderm, 90, 378
pantoprazole, 249–250
Paraflex, 62–63
Parafon Forte DSC, 62–63
Parasympathetic blocker
flavoxate hydrochloride, 134
Parasympatholytic agents
dicyclomine hydrochloride, 94
glycopyrrolate, 151
propantheline bromide, 275–276
scopolamine hydrobromide, 298
Parasympathomimetic agents
bethanechol chloride, 34
cevimeline hydrochloride, 58
neostigmine bromide, 228
neostigmine methylsulfate, 228
pilocarpine hydrochloride, 262–263
Parathyroid hormone
teriparatide, 319
Parcopa, 398–399
Paregoric, 240
Paremyd, 382
paricalcitol, 250
Parlodel, 39
Parnate, 333
paroxetine hydrochloride, 250
paroxetine mesylate, 250
parsley seeds and leaves, 371
passionflower vine, 371
Pataday, 383–384
Patanol, 383–384
Patient and family teaching points, 356–357
Patient Safety and Medication Administration, 354–361
Paxil, 250
pazopanib, 250–251
PediaCare Children’s Decongestant, 260–261
Pediarix, 411
Pediatric Gentamicin Sulfate, 148
Pediculicides
benzyl alcohol, 379
crotamiton, 379
ivermectin, 175, 379
lindane, 379
malathion, 380
permethrin, 380
spinosad, 380
Peganone, 124
pegaptanib, 251
pegaspargase, 251
Pegasys, 251–252
pegfilgrastim, 251
peginterferon alfa-2a, 251–252
peginterferon alfa-2b, 252
Peg-Intron, 252
pegloticase, 252
pegvisomant, 253
PEGylated uric-acid specific enzyme
pegloticase, 252
pemetrexed, 253
pemirolast potassium, 384
penbutolol sulfate, 253
penciclovir, 377
penicillamine, 253–254
Penicillin antibiotics
ampicillin, 18–19
penicillin G benzathine, 254
penicillin G potassium, 254–255
penicillin G procaine, 255
penicillin G sodium, 254–255
 penicillin V, 255
Penicillinase-resistant penicillin
oxacillin sodium, 242
penicillin G benzathine, 254
penicillin G potassium, 254–255
penicillin G procaine, 255
penicillin G sodium, 254–255
penicillin V, 255
Penlac Nail Lacquer, 375
Pentacel, 412
Pentam 300, 256
pentamidine isethionate, 256
Pentasa, 203
pentazocine, 256
pentazocine/acetaminophen, 389
pentobarbital, 256–257
pentosan polysulfate sodium, 257
pentostatin, 257
pentoxifylline, 257
Pepcid, 128
peppermint leaves, 371
Pepto-Bismol, 35–36
Pepto Diarrhea Control, 191–192
perampanel, 257–258
Percocet, 389
Percodan, 389
Perforomist, 142
perindopril erbumine, 258
Peripheral mu-opioid receptor antagonist
alvimopan, 12
Perjeta, 258
Permapen, 254
permethrin, 380
Persantine, 98
pertuzumab, 258
Pertyze, 249
Pexeva, 250
Pfizerpen, 254–255
Pharmaflur, 303
Phazyme, 301
Phenadoz, 274–275
phenazopyridine hydrochloride, 259
phenelzine sulfate, 259
Phenergan, 274–275
phenobarbital, 259–260
phenobarbital sodium, 259–260
Phenothiazines
chlorproMAZINE hydrochloride, 61–62
fluphenazine decanoate, 138
fluphenazine hydrochloride, 138
prochlorperazine, 273–274
prochlorperazine edisylate, 273–274
prochlorperazine maleate, 273–274
promethazine hydrochloride, 274–275
phentolamine mesylate, 260
Phenylalanine reducer
sapropterin dihydrochloride, 296
phenylephrine hydrochloride, 260–261
Phenytek, 261–262
phenytoin, 261–262
Phillips’ Liqui-Gels, 385
Phillip’s MOM, 385
pHisoHex, 376
Phosphate binder
lanthanum carbonate, 180
Phosphodiesterase-5 inhibitors
avanafil, 27
roflumilast, 292
sildenafil citrate, 300
tadalafil, 312
vardenafil hydrochloride, 342
Photofrin, 267
Photosensitizer
aminolevulinic acid hydrochloride, 14
Picato, 374
pilocarpine, 384
pilocarpine hydrochloride, 262–263
Piloptic, 384
Pilostat, 384
Pima, 169–170
pimecrolimus, 379
pimozide, 263
pindolol, 263
Pink Bismuth, 35–36
Pin-Rid, 279
Pin-X, 279
pioglitazone, 263–264
Piperazine acetamide
ranolazine, 284
piroxicam, 264
pitavastatin, 264
Pitocin, 246
Plan B, 405
Plan B One-Step, 405
Plasbumin, 7
Plasma expanders
hetastarch, 154–155
hydroxyethyl starch, 154–155
Plasma kallikrein inhibitor
ecallantide, 107
Plasmanate, 264
Plasma-Plex, 264
Plasma protein
albumin, human, 7
plasma protein fraction, 264
plasma protein fraction, 264
Plasma volume expanders
dextran, high–molecular-weight, 91
dextran, low–molecular-weight, 91
Platelet inhibitor
prasugrel, 269–270
Platinum agent
cisplatin (CDDP), 66
Plavix, 71
Plendil, 129
plerixafor, 265
Pletal, 64
pneumococcal vaccine, polyvalent, 415–416
pneumococcal 13-valent conjugate vaccine, 416
Pneumovax 23, 415–416
Podocon-25, 379
podofilox, 379
Podofin, 379
podophyllum resin, 379
polidocanol, 265
poliovirus vaccine, inactivated, 416
polycarbophil, 386
polydimethylsiloxane, 384
Polydine, 376
polyethylene glycol, 386
polyethylene glycolelectrolyte solution, 386
polyethylene glycol with electrolytes, 386
poly-L-lactic acid, 265
Polymer
poly-L-lactic acid, 265
polymyxin B sulfate, 265–266
pomalidomide, 266
Pomalyst, 266
Pompe’s disease drug
alglucosidase alfa, 8
ponatinib, 266
Ponstel, 200
poractant alfa, 266–267
porfimer sodium, 267
Portia, 405
posaconazole, 267
potassium acetate, 267–268
Potassium channel blockers
dalfampridine, 81
potassium chloride, 267–268
potassium gluconate, 267–268
Potassium-removing resin
sodium polystyrene sulfonate, 304–305
Potassium-sparing diuretics
amiloride hydrochloride, 13
spironolactone, 307
triamterene, 336
Potiga, 127
povidone iodine, 376
Pradaxa, 79
pralatrexate, 268
pralidoxime chloride, 268
pramipexole dihydrochloride, 269
pramlintide acetate, 269
PrandiMet, 393
Prandin, 286
prasugrel, 269–270
Pravachol, 270
pravastatin sodium, 270
praziquantel, 270
prazosin hydrochloride, 270–271
Precedex, 90
Precose, 2
Pred Forte, 271
Pred Mild, 271
prednicarbate, 378
prednisoLONE, 271
prednisoLONE acetate, 271
prednisoLONE sodium phosphate, 271
predniSONE, 271–272
Prednisone Intensol Concentrate, 271–272
pregabalin, 272
Pregnyl, 63–64
Prelone, 271
Premarin, 120–121
Premphase, 402
Prempro, 402
Prepidil, 97
Prepopik, 386
Prevacid, 180
Prevacid 24Hr, 180
Prevalite, 63
Previfem, 406
Prevnar-13, 416
Prevpac, 399
Prezista, 83–84
Prialt, 349–350
Priftin, 287
Prilosec, 239
Primatene Mist, 112–113
Primaxin, 390
primidone, 272
Primsol, 337–338
Principen, 18–19
Prinivil, 190
Prinzide, 396
Pristiq, 88
Privigen, 413–414
Probalan, 272–273
probenecid, 272–273
probiotics, 364
ProcalAmine, 14
procarbazine hydrochloride, 273
Procardia, 230
prochlorperazine, 273–274
prochlorperazine edisylate, 273–274
prochlorperazine maleate, 273–274
Procomp, 273–274
Procrit, 114
progesterone, 274
Progestins
hydroxyprogesterone caproate, 158
medroxyPROGESTERone, 199–200
megestrol acetate, 200
norethindrone acetate, 233–234
norgestrel, 234
progesterone, 274
Proglycem, 93
Prograf, 311–312
Prolastin, 10
Proleukin, 7–8
Prolia, 86–87
Promacta, 109
promethazine hydrochloride, 274–275
Promethegan, 274–275
Prometrium, 274
propafenone hydrochloride, 275
propantheline bromide, 275–276
Propecia, 133
propofol disodium, 276
propranolol hydrochloride, 276–277
propylthiouracil (PTU), 277
ProQuad, 415
Proscar, 133
Prostaglandins
alprostadil, 11
carboprost tromethamine, 49
dinoprostone, 97
epoprostenol sodium, 114–115
misoprostol, 218–219
Prostigmin, 228
Prostin E2, 97
Prostin VR Pediatric, 11
protamine sulfate, 277
Protease inhibitors
atazanavir sulfate, 25
boceprevir, 37
carfilzomib, 49
 fosamprenavir, 142
indinavir sulfate, 165
lopinavir, 192
nelfinavir mesylate, 227
saquinavir mesylate, 296–297
simeprevir, 301
telaprevir, 314
tipranavir, 326
Proteasome inhibitor
bortezomib, 37
Proteinase enzyme
collagenase clostridium histolyticum, 75
Proteinase inhibitor
C1-inhibitor (human), 43
protein C concentrate, 277
Protein substrate
amino acids, 14
Protein synthesis inhibitor
omacetaxine, 238
Protein tyrosine kinase inhibitors
imatinib mesylate, 164
Protenate, 264
prothrombin complex concentrate, 278
Protonix, 249–250
Proton pump inhibitors
dexlansoprazole, 89–90
esomeprazole magnesium, 118–119
lansoprazole, 180
omeprazole, 239
pantoprazole, 249–250
rabeprazole sodium, 282
Protopam Chloride, 268
Protopic, 311–312
protriptyline hydrochloride, 278
Provenge, 301–302
Proventil HFA, 7
Provera, 199–200
Provigil, 220
Prozac, 137–138
Prudoxin, 102–103
pseudoephedrine hydrochloride, 278–279
pseudoephedrine sulfate, 278–279
Psoralen
 methoxsalen, 207–208
Psorcon E, 377
psyllium, 371, 386
PTU, 277
Pulmicort, 40–41
Pulmonary antihypertensive
bosentan, 37–38
riociguat, 289
Pulmozyme, 102
Purine analogues
allopurinol, 9
cladribine, 67
Purine nucleoside analogue
acyclovir, 4–5
Purinethol, 202–203
pyrantel pamoate, 279
pyrazinamide, 279
Pyridium, 259
pyridostigmine bromide, 279
Pyrimidine synthesis inhibitor
leflunomide, 181
Pyrimidine synthesase inhibitor
teriflunomide, 318–319
Q
QDALL-AR, 61
QNASL, 31, 377
QVAR, 31
Qualaquin, 281–282
Quartette, 409
Quasense, 406
quazepam, 280
Questran, 63
quetiapine fumarate, 280
quinapril hydrochloride, 280–281
quinidine gluconate, 281
quinidine sulfate, 281
quinine sulfate, 281–282
Quixin, 383
R
Rabavert, 420
rabeprazole sodium, 282
rabies immune globulin, 418
rabies vaccine, 420
Radioactive particle-emitting agent
Radium Ra 223 dichloride, 282
Radiogardase, 166
radium Ra 223 dichloride, 282
raloxifene hydrochloride, 282
raltegravir, 283
ramelteon, 283
ramipril, 283–284
Ranexa, 284
ranibizumab, 284
ranitidine hydrochloride, 284
RANK ligand inhibitor
denosumab, 86–87
ranolazine, 284
Rapaflo, 300
Rapamune, 302
rasagiline, 284–285
rasburicase, 285
raspberry, 371
Ravicti, 151
raxibacumab, 285
Rayos, 271–272
Razadyne, 145
Rebetol, 286
Rebif, 169
Reclast, 351
Reclipsen, 405
Recombivax HB, 413
Recothrom, 379
Rectiv, 232
red clover, 371
red yeast rice, 371
Reese’s Pinworm, 279
ReFacto, 20
Refludan, 182
Reglan, 210–211
Regonol, 279
regorafenib, 285–286
Regranex, 378
Relenza, 349
Relistor, 209
Relpax, 109
Remeron, 218
Remicade, 166
Remodulin, 334–335
Remular-S, 62–63
Renagel, 300
Renin inhibitor
aliskiren, 9
Renova, 355, 375
ReoPro, 1
repaglinide, 286
Reporting medication errors, 360–361
Reprexain, 388
Repronex, 201–202
Requip, 293
Rescriptor, 85–86
Resin exchange drug
cellulose sodium phosphate (CSP), 56–57
Respa AR, 40
Respiratory drugs
Advair Diskus, 403
Advair HFA, 403
Anoro Ellipta, 404
Breo Ellipta, 403
Claritin-D, 404
Claritin-D 24 Hour, 404
Combivent, 404
doxapram hydrochloride, 102
Dulera 100/5, 404
Dulera 200/5, 404
Dymista, 403
Rezira, 403
Symbicort 80/4.5, 403
Symbicort 160/4.5, 403
Vituz, 403
Zutripro, 403
Restasis, 382
Restoril, 316
retapamulin, 375
Retin-A, 335
Retin-A Micro, 375
Retinoic acid
acitretin, 4
Retinoids
isotretinoin, 173–174
tretinoin, 335
Retisert, 382
Retrovir, 350
Revatio, 300
Reverse transcriptase inhibitors
adefovir dipivoxil, 5
lamivudine, 178
Reversol, 108
ReVia, 224–225
Revlimid, 182
Reyataz, 25
Rezira, 403
Rheomacrodex, 91
Rheumatrex, 206–207
Rhinocort Aqua, 40–41
Rho D IGIV, 416
RHo (D) immune globulin, 416
RHo (D) immune globulin micro-dose 416
RHo (D) immune globulin IV, 416
RhoGam, 416
Rhophylac, 416
RiaSTAP, 132
Ribasphere, 286
ribavirin, 286
Ridaura, 27
rifabutin, 286–287
Rifadin, 287
rifampin, 287
rifapentine, 287
rifaximin, 287–288
Rights of medication administration, 354–355
rilonacept, 288
Rilutek, 288
riluzole, 288
rimantadine hydrochloride, 288–289
rimexolone, 384
riociguat, 289
Riomet, 204
risedronate sodium, 289
Risperdal, 290
risperidone, 290
Ritalin, 209–210
ritonavir, 290
Rituxan, 291
rituximab, 291
rivaroxaban, 290
rivastigmine tartrate, 290–291
Rixubis, 73
rizatriptan, 292
Robaxin, 206
Robinul, 151
Rocephin, 55
roflumilast, 292
Rogaine, 217
Romazicon, 136
romidepsin, 292–293
romiplostim, 293
ropinirole hydrochloride, 293
Rosacea products
adapalene, 374
alitretinoin, 374
azelaic acid, 374
brimonidine, 374
clindamycin, 374
dapsone, 82, 374
fluocinolone acetonide/
hydroquinone/tretinoin, 374
metronidazole, 212, 375
sodium sulfacetamide, 375
tazarotene, 375
tretinoin, 335
tretinoin 0.025% cream, 375
tretinoin 0.05% cream, 375
tretinoin gel, 375
rose hips, 371
rosemary, 371
rosiglitazone, 293–294
rosuvastatin calcium, 294
Rotarix, 417
rotavirus vaccine, live, oral, 417
RotaTeq, 417
rotigotine, 294
Rowasa, 203
Roxanol, 221
Roxicet, 389
Roxicodone, 244–245
Roxilox, 389
Roxiprin, 389
Rozerem, 283
rue extract, 371
rufinamide, 294–295
ruxolitinib, 295
Rybix ODT, 332
Rythmol, 275
Ryzolt, 332
S
Sabril, 344–345
sacrosidase, 295
Safe disposal of medications guidelines, 362
saffron, 371
Safyral, 406
sage, 371
Saizen, 305–306
Salagen, 262–263
Salflex, 296
Salicylates
aspirin, 24–25
choline magnesium trisalicylate, 63
salsalate, 296
saliva substitute, 295
Salivart, 295
Salk, 416
salmeterol xinafoate, 295–296
Salmonine, 44–45
Salonpas, 388
salsalate, 296
Salsitab, 296
SAM-e (adomet), 372
Samsca, 330
Sanctura, 338–339
Sancuso, 152–153
Sandimmune, 78
Sandostatin, 236
Sani-Supp, 385
Saphris, 23–24
sapropterin dihydrochloride, 296
saquinavir mesylate, 296–297
Sarafem, 137–138
sargramostim, 297
sarsaparilla, 372
sassafras, 372
Savella, 216
saw palmetto, 372
saxagliptin, 297–298
Scabicide drugs
benzyl alcohol, 379
crotamiton, 379
 ivermectin, 175, 379
lindane, 379
malathion, 380
permethrin, 380
spinosad, 380
SCIG, 413–414
schisandra, 372
Sclerosing agents
polidocanol, 265
talc, USP, 312
scopolamine hydrobromide, 298
Sculptra, 265
Seasonale, 406
Seasonique, 406, 407
secobarbital sodium, 298–299
Seconal Sodium, 298–299
secretin, 299
Sectral, 2
Sedative
diphenhydrAMINE hydrochloride, 97–98
Sedative-hypnotic agents
dexmedetomidine hydrochloride, 90
estazolam, 119
eszopiclone, 122
flurazepam hydrochloride, 138–139
fospropofol disodium,
lorazepam, 193
pentobarbital, 256–257
phenobarbital, 259–260
phenobarbital sodium, 259–260
promethazine hydrochloride, 274–275
propofol, 276
quazepam, 280
ramelteon, 283
secobarbital sodium, 298–299
temazepam, 316
triazolam, 336–337
zaleplon, 349
zolpidem tartrate, 352
Selective norepinephrine reuptake inhibitor
atomoxetine hydrochloride, 25–26
Selective serotonin and norepinephrine reuptake inhibitor
milnacipran, 216
Selective serotonin receptor antagonist
palonosetron hydrochloride, 248
selegiline hydrochloride, 299
selenium sulfide, 376
Selsun Blue, 376
Selzentry, 198
senna, 386
Senna-Gen, 386
Senokot, 386
Sensipar, 65
Septra, 390
Septra DS, 390
Serevent Diskus, 295–296
Seromycin Pulvules, 77
Serophene, 69
Seroquel, 280
Serostim, 305–306
Serotonin-norepinephrine reuptake inhibitors
desvenlafaxine succinate, 88
duloxetine hydrochloride, 106
levomilnacipran, 185–186
Serotonin receptor agonist
lorcaserin, 193
Serotonin receptor blocker
dolasetron mesylate, 100
Serotonin selective agonists
almotriptan malate, 9
rizatriptan, 292
sertaconazole, 376
sertraline hydrochloride, 299–300
sevelamer hydrochloride, 300
sildenafil citrate, 300
Silenor, 102–103
silodosin, 300
Siltussin, 153
Silvadene, 377
silver sulfadiazine, 377
Simcor, 401
simeprevir, 301
simethicone, 301
Simponi, 152
Simulect, 30
simvastatin, 301
Sinemet, 398–399
Sinemet CR, 398–399
Sinequan, 102–103
Singulair, 220–221
sipuleucel-T, 301–302
sirolimus, 302
Sirturo, 31
sitagliptin phosphate, 302
Skelaxin, 204
Skeletal muscle relaxants
dantrolene sodium, 81–82
metaxalone, 204
methocarbamol, 206
orphenadrine citrate, 241
Skelid, 324
Sklice, 379
Skyla, 410
Slo-Niacin, 229
Slow Fe, 131
Slow Release Iron, 131
Smoking deterrents
buPROPion hydrobromide, 41–42
buPROPion hydrochloride, 41–42
nicotine, 229–230
nicotine polacrilex, 230
varenicline tartrate, 342–343
sodium bicarbonate, 302–303
Sodium channel blocker
eslicarbazepine, 118
rufinamide, 294–295
sodium ferric gluconate complex, 303
sodium fluoride, 303
Sodium-glucose co-transporter 2 inhibitors
canagliflozin, 46
dapagliflozin, 82
sodium hypochlorite, 376
sodium oxybate, 304
sodium phenylacetate/sodium benzoate, 304
sodium picosulfate, magnesium oxide, anhydrous citric acid, 386
sodium polystyrene sulfonate, 304–305
sodium sulfacetamide, 375
sodium valproate, 340–341
sofosbuvir, 305
Solaraze, 93
Solfoton, 259–260
Solia, 405
solifenacin succinate, 305
Soliris, 107
Soltamox, 312–313
Solu-Cortef, 156–157
Solu-Medrol, 210
Soma, 50
somatropin, 305–306
Somatuline Depot, 179–180
Somavert, 253
Sonata, 349
sorafenib tosylate, 306
Soriatane, 4
Sorine, 307
sotalol hydrochloride, 307
Sotret, 173–174
Sovaldi, 305
Spectazole, 375
Spectracef, 52
spinosad, 380
Spiriva, 325–326
spironolactone, 307
Sporanox, 174–175
Sprintec, 406
Sprix, 177
Sprycel, 84
squaw vine, 372
Sronyx, 405
SSD Cream, 377
SSKI, 169–170
SSRIs
citalopram hydrobromide, 66–67
escitalopram oxalate, 117–118
fluoxetine hydrochloride, 137–138
fluvoxamine maleate, 140
paroxetine hydrochloride, 250
paroxetine mesylate, 250
sertraline hydrochloride, 299–300
vilazodone hydrochloride, 345
vortioxetine, 348
Stadol, 43
Stagesic, 388
Stalev 50, 399
Stalevo 75, 399
Stalevo 100, 399
Stalevo 125, 399
Stalevo 150, 399
Stalevo 200, 399
Starlix, 226
Statins
atorvastatin, 26
fluvastatin sodium, 139–140
lovastatin, 194
pitavastatin, 264
pravastatin sodium, 270
rosuvastatin calcium, 294
simvastatin, 301
stavudine (d4T), 308
Stavzor, 340–341
Staxyn, 342
Stelara, 339
Stendra, 27
Sterile Talc Powder, 312
Stimate, 88
Stivarga, 285–286
St. John’s wort, 372
St. Joseph’s, 24–25
Stop, 303
Strattera, 25–26
streptomycin sulfate, 308
streptozocin, 308
Striant, 319–320
Stribild, 400
Stromectol, 175
Strong Iodine Solution, 169–170
Suboxone, 402
Substance P and neurokinin receptor antagonist
aprepitant, 21–22
fosaprepitant, 21–22
SUBSYS, 130–131
succimer, 308–306
Succinimides
ethosuximide, 123
methsuximide, 208
Sucraid, 295
sucralfate, 309
Sudafed, 278–279
Sudafed PE, 260–261
Sufenta, 309
sufentanil citrate, 309
Sular, 231
sulfacetamide, 384
sulfADIAZINE, 309–310
Sulfamylon, 377
sulfasalazine, 310
Sulfatrim Pediatric, 390
Sulfonamide antibiotics
sulfADIAZINE, 309–310
sulfasalazine, 310
torsemide, 331
Sulfonylureas
chlorproPAMIDE, 62
glimepiride, 149
glipiZIDE, 149–150
glyBURIDE, 150
TOLAZamide, 328
TOLBUTamide, 328–329
sulindac, 310
sumatriptan succinate, 310–311
sunitinib, 311
Surfaxin, 195
Surmontil, 338
Survanta, 33
Sustiva, 108
Sutent, 311
sweet violet flowers, 372
Syeda, 406
Sylatron, 252
Symax, 159
Symbyax, 392
Symbicort 80/4.5, 403
Symbicort 160/4.5, 403
Symlin, 269
Symmetrel, 12
Sympathetic blocker
labetalol hydrochloride, 177
Sympatholytics
 clonidine hydrochloride, 70–71
guanfacine hydrochloride, 153
methyldopa, 208
methyldopate hydrochloride, 208
Sympathomimetics
albuterol sulfate, 7
DOBUTamine hydrochloride, 99
DOPamine hydrochloride, 101
ephedrine sulfate, 112
epinephrine bitartrate, 112–113
epinephrine hydrochloride, 112–113
norepinephrine bitartrate, 233
phenylephrine hydrochloride, 260–261
pseudoephedrine sulfate, 278–279
terbutaline sulfate, 318
Synagis, 248
Synalar, 377
Synarel, 223
Synera, 379
Synercid, 391
Synthetic vitamin
cyanocobalamin, intranasal, 76
Synthroid, 186–187
Synvisc, 155
Syprine, 337
Synribo, 238
T
Tabloid, 322
TachoSil, 378
Taclonex, 376
Taclonex Scalp, 376
tacrolimus, 311–312
tadalafil, 312
Tafinlar, 79–80
tafluprost, 384
Tagamet, 64–65
talc, USP, 312
taliglucerase alfa, 312
Talwin, 256
Tambocor, 134
Tamiflu, 241
tamoxifen citrate, 312–313
tamsulosin hydrochloride, 313
Tapazole, 206
tapentadol, 313
Tarabine PFS, 78–79
Tarceva, 116
Targretin, 35
Tarka, 398
tarragon, 372
Tasigna, 231
tasimelteon, 314
Tasmar, 329
Tavist Allergy, 68
Taxotere, 99–100
tazarotene, 375
Tazicef, 54–55
Tazorac, 375
TCAs
amitriptyline hydrochloride, 16
amoxapine, 17
clomiPRAMINE hydrochloride, 70
desipramine hydrochloride, 87
doxepin hydrochloride, 102–103
imipramine hydrochloride, 164
imipramine pamoate, 164
maprotiline hydrochloride, 197
nortriptyline hydrochloride, 235
 protriptyline hydrochloride, 278
trimipramine maleate, 338
T-cell costimulation blocker
belatacept, 32
Tdap, 411
tea tree oil, 372
Tecfideral, 97
teduglutide, 314
Teflaro, 54
Tegretol, 48
Tegrin-HC, 378
Tekamlo, 394
Tekturna, 9
Tekturna HCT, 394
telaprevir, 314
telavancin, 314–315
telbivudine, 315
telithromycin, 315
telmisartan, 315–316
temazepam, 316
Temodar, 316
Temovate, 377
temozolomide, 316
temsirolimus, 316
tenecteplase, 317
Tenex, 153
tenofovir disoproxil fumarate, 317
Tenoretic, 395
Tenormin, 25
Tension headache drug
Esgic-Plus, 404
terazosin hydrochloride, 317
terbinafine, 318, 376
terbinafine hydrochloride, 318
terbutaline sulfate, 318
teriflunomide, 318–319
teriparatide, 319
tesamorelin, 319
Tessalon, 33
Testim, 319–320
Testopel, 319–320
testosterone, 319–320
tetrabenazine, 320
Tetracyclines
demeclocycline hydrochloride, 86
doxycycline, 104
minocycline hydrochloride, 216–217
tetracycline hydrochloride, 320–321
tetrahydrozoline hydrochloride, 321
Teveten, 115
Teveten HCT, 396
Tev-Tropin, 305–306
thalidomide, 321
Thalidomide analogue
pomalidomide, 266
Thalitone, 62
Thalomid, 321
Theo-21, 321–322
Theochron, 321–322
theophylline, 321–322
TheraCys, 30–31
Thermazene, 377
Thiazide diuretics
chlorothiazide, 60–61
chlorothiazide sodium, 60–61
hydrochlorothiazide, 156
metolazone, 211
Thiazide-like diuretics
chlorthalidone, 62
indapamide, 165
Thiazolidinediones
pioglitazone, 263–264
rosiglitazone, 293–294
thioguanine, 322
Thiola, 325
Thiol compound
tiopronin, 325
Thioplex, 322
thiotepa, 322
thiothixene, 322–323
Thioxanthene
thiothixene, 322–323
Thrombate III, 21
thrombin, 379
thrombin, recombinant, 379
Thrombinar, 379
Thrombin inhibitors
apixaban, 21
bivalirudin, 36
dabigatran etexilate mesylate, 79
desirudin, 87
Thrombolytic enzymes
alteplase recombinant, 11
tenecteplase, 317
Thrombopoietin receptor agonists
eltrombopag, 109
romiplostim, 293
Thrombostat, 379
thyme, 372
Thymoglobulin, 417
thyroid, desiccated, 323
Thyroid hormones
levothyroxine sodium, 186–187
liothyronine, 188–189
liotrix, 189
thyroid, desiccated, 323
Thyroid suppressant
iodine thyroid products, 169–170
Thyroid USP, 323
Thyrolar, 189
ThyroSafe, 169–170
ThyroShield, 169–170
Thyro-Tabs, 186–187
tiagabine hydrochloride, 323
ticagrelor, 323–324
Tice BCG, 30–31, 419
Ticlid, 324
ticlopidine hydrochloride, 324
Tigan, 337
tigecycline, 324
Tikosyn, 100
Tilia Fe, 408
tiludronate disodium, 324
Timentin, 391
timolol maleate, 324–325, 384
Timoptic, 324–325
Timoptic XE, 384
Tinactin, 376
Tindamax, 325
tinidazole, 325
tiopronin, 325
tiotropium bromide, 325–326
tipranavir, 326
tirofiban hydrochloride, 326
Tisseel, 378–379
Tissue plasminogen activator
alteplase recombinant, 11
Tivicay, 100–101
tizanidine, 326–327
TMP-SMZ, 390
TNF blockers
adalimumab, 5
certolizumab, 57
TNF inhibitor
golimumab, 152
TNKase, 317
TOBI, 327
tobramycin sulfate, 327
Tobrex Ophthalmic, 327
tocilizumab, 327–328
tofacitinib, 328
Tofranil, 164
TOLAZamide, 328
TOLBUTamide, 328–329
tolcapone, 329
tolmetin sodium, 329
tolnaftate, 376
tolterodine tartrate, 329–330
tolvaptan, 330
Topamax, 330
Topiragen, 330
topiramate, 330
Toposar, 125
topotecan hydrochloride, 330–331
Topical drugs, 374–380
toremifene citrate, 331
Torisel, 316
torsemide, 331
tositumomab and iodine I-131/
tositumomab, 331–332
Totect, 90–91
Toviaz, 132
TPA
alteplase recombinant, 11
Tracleer, 37–38
Tradjenta, 187–188
tramadol hydrochloride, 332
trametinib, 332
Trandate, 177
trandolapril, 332–333
tranexamic acid, 333
Transderm-Scop, 298
Tranxene-T-tab, 71–72
tranylcypromine sulfate, 333
trastuzumab, 334
Travasol, 14
Travatan Z, 384
travoprost, 384
trazodone hydrochloride, 334
Treanda, 32–33
Trecator, 123
Trelstar, 338
Trental, 257
treprostinil sodium, 334–335
tretinoin, 335, 375
tretinoin 0.025% cream, 375
tretinoin 0.05% cream, 375
tretinoin gel, 375
Tretin-X, 335
Trexall, 206–207
Treximet, 398
Triacet, 378
triamcinolone acetonide, 335–336, 378
triamcinolone diacetate, 335–336
triamcinolone hexacetonide, 335–336
triamterene, 336
triazolam, 336–337
Triazole antifungal agent
voriconazole, 347
Tribenzor, 397
TriCor, 129–130
Tricosal, 63
Triderm, 378
trientine hydrochloride, 337
Tri-Estarylla, 408
trifluridine, 384
Triglide, 129–130
trihexyphenidyl hydrochloride, 337
Tri-K, 267–268
Tri-Legest, 408
Tri-Legest Fe, 408
Trileptal, 243–244
Trilipix, 129–130
Tri-Luma, 374
trimethobenzamide hydrochloride, 337
trimethoprim, 337–338
trimipramine maleate, 338
Trimox, 17–18
TriNessa, 408
Tri-Norinyl, 407
Triostat, 188–189
Tripedia, 411
Tri-Previfem, 408
Triptans
almotriptan malate, 9
eletriptan hydrobromide, 109
frovatriptan succinate, 144
naratriptan, 225
sumatriptan succinate, 310–311
zolmitriptan, 352
triptorelin pamoate, 338
Trisenox, 23
Tri-Sprintec, 408
Trivora-28, 409
Trizivir, 399
Tropicacyl, 384
tropicamide, 384
trospium chloride, 338–339
Trusopt, 382
Truvada, 400
Tudorza Pressair, 4
Tumor necrosis factor blockers. See TNF blockers
Tumor necrosis factor inhibitors. See TNF inhibitor
Tums, 45
turmeric, 373
Twinrix, 413
Twynsta, 397
Tygacil, 324
Tykerb, 180–181
Tylenol, 2–3
Tylenol with Codeine, 387
Tylox, 389
Typhim Vi, 417
typhoid vaccine, 417
Tysabri, 225–226
Tyvaso, 334–335
Tyzeka, 315
Tyzine, 321
U
ulipristal, 405
Uloric, 129
Ultracet, 389
Ultra-Filtered Plus, 416
Ultram, 332
Ultravate, 378
Ultresa, 249
Unasyn, 391
Unifed, 278–279
Uniretic, 397
Univasc, 220
urea, 378
Ureacin 10, 378
Ureacin 20, 378
Urea substitute
sodium phenylacetate/sodium benzoate, 304
Urecholine, 34
Urex, 205–206
Uricosuric agent
probenecid, 272–273
Urinary analgesic
phenazopyridine hydrochloride, 259
Urinary antispasmodic agents
darifenacin hydrobromide, 83
flavoxate hydrochloride, 134
oxybutynin chloride, 244
solifenacin succinate, 305
Urinary irrigant
mannitol, 197
Urinary Pain Relief, 259
Urinary tract anti-infective agents
fosfomycin tromethamine, 143
methenamine, 205–206
methenamine hippurate, 205–206
methylene blue, 208–209
nitrofurantoin, 232
norfloxacin, 234
Urinary tract drugs
ammonium chloride, 16–17
darifenacin hydrobromide, 83
flavoxate hydrochloride, 134
 fosfomycin tromethamine, 143
methenamine, 205–206
methenamine hippurate, 205–206
methylene blue, 208–209
neostigmine bromide, 228
neostigmine methylsulfate, 228
nitrofurantoin, 232
norfloxacin, 234
oxybutynin chloride, 244
phenazopyridine hydrochloride, 259
solifenacin succinate, 305
Urine acidifier
ammonium chloride, 16–17
Urine alkalinizer
sodium bicarbonate, 302–303
urofollitropin, 339
Uroxatral, 8
URSO, 339
ursodiol, 339
ustekinumab, 339
Uvadex, 207–208
V
vaccinia immune globulin IV, 418
Vagifem, 119–120, 378
valacyclovir hydrochloride, 340
Valchlor, 198–199
Valcyte, 340
valerian, 373
valganciclovir hydrochloride, 340
Valisone, 377
Valium, 92–93
valproic acid, 340–341
valsartan, 341
Valtrex, 340
Valturna, 394
Vancocin, 341–342
vancomycin hydrochloride, 341–342
Vaniqa, 378
Vanos, 377
Vantas, 155
Vaqta, 412–413
vardenafil hydrochloride, 342
varenicline tartrate, 342–343
varicella virus vaccine, 417
varicella zoster immune globulin, 418
Varivax, 417
Vascepa, 395
Vasodilators
hydrALAZINE hydrochloride, 155–156
iloprost, 163
minoxidil, 217
nesiritide, 228
nitroprusside sodium, 232–233
treprostinil sodium, 334–335
Vasopressin receptor antagonist
ephedrine sulfate, 112
epinephrine bitartrate, 112–113
epinephrine hydrochloride, 112–113
isoproterenol hydrochloride, 173
norepinephrine bitartrate, 233
tolvaptan, 330
Vasotec, 110
Vasotec I.V., 110
VaZol, 40
Vectibix, 249
velaglucerase, 343
Velban, 37
Veletri, 114–115
Velivet, 407
Veltin, 374
vemurafenib, 343
venlafaxine hydrochloride, 343–344
Venofer, 172
Ventavis, 163
Ventolin, 7
Veramyst, 378
verapamil hydrochloride, 344
Verdeso, 377
Veregen, 377
Verelan, 344
verteporfin, 344
VESIcare, 305
Vexol, 384
Vfend, 347
Viagra, 300
Vibativ, 314–315
Vibramycin, 104
Vicks Sinex 12-Hour, 245
Vicks Sinex Ultra Fine Mist, 260–261
Vicoprofen, 388
Victoza, 189
Victrelis, 37
Vidaza, 28
Videx, 94
Videx EC, 94
vigabatrin, 344–345
Vigamox, 221–222, 383
VIGIV, 418
Viibryd, 345
vilazodone hydrochloride, 345
Vimizim, 109
Vimovo, 388–389
Vimpat, 177–178
vinBLAStine, 345
vinCRIStine sulfate, 346
vinorelbine tartrate, 346
Viokace, 249
Viracept, 227
Viramune, 228–229
Virazole, 286
Viread, 317
Viroptic, 384
Visine, 321
Visken, 263
vismodegib, 347
Vistaril, 159
Vistide, 64
Visudyne, 344
Vitamins
folic acid, 140
niacin, 229
paricalcitol, 250
vitamins A & D, 378
Vitamin D analogues
doxercalciferol, 103
Vitamin K anticoagulant reversal agent
prothrombin complex concentrate, 278
Vitrase, 155
Vitrasert, 146
Vituz, 403
Vivactil, 278
Vivaglobin, 413–414
Vivarin, 44
Vivitrol, 224–225
Vivotif Berna, 417
Voltaren, 93, 382
Voluven, 154–155,
Voraxaze, 150
voriconazole, 347
vorinostat, 347–348
vortioxetine, 348
VoSpire ER, 7
Votrient, 250–251
VPRIV, 343
Vusion, 375
Vytorin, 401
Vyvanse, 189–190
VZIG, 418
W
warfarin sodium, 348
Weight loss drug
lorcaserin, 193
orlistat, 240–241
Osymia, 404
WelChol, 74
Wellbutrin, 41–42
went rice, 373
Westcort, 156–157, 378
Westhroid, 323
white willow bark, 373
Wilate, 20
WinRho SDF, 416
Witch Hazel, 379
Wycillin, 255
X
Xalatan, 383
Xalkori, 75–76
Xanax, 10–11
Xanthines
aminophylline, 14–15
caffeine, 44
caffeine citrate, 44
dyphylline, 106–107
pentoxifylline, 257
theophylline, 321–322
Xanthine oxidase inhibitor
febuxostat, 129
Xarelto, 290
Xeljanz, 328
Xeloda, 46–47
Xenazine, 320
Xenical, 240–241
Xeomin, 38
Xerese, 377
Xgeva, 86–87
Xiaflex, 75
Xibrom, 382
Xifaxan, 287–288
Xofigo, 282
Xolair, 238
Xolegel, 176, 376
Xopenex, 183
Xopenex HFA, 183
Xtandi, 112
xuan shen, 373
Xylocaine, 187
Xyntha, 20
Xyrem, 304
Xyzal, 184
Y
Yasmin, 406
YAZ, 401–402
Yaz, 406
yellow fever vaccine, 420
Yervoy, 170
YF-Vax, 420
Yodoxin, 170
yohimbe, 373
Z
Zaditor, 383
zafirlukast, 349
zaleplon, 349
Zaltrap, 351
Zanaflex, 326–327
zanamivir, 349
Zanosar, 308
Zantac, 284
Zaran, 406
Zarontin, 123
Zaroxolyn, 211
Zavesca, 216
Zebeta, 36
Zecuity, 310–311
Zegerid, 239
Zelapar, 299
Zelboraf, 343
Zemaira, 10
Zemplar, 250
Zenchent, 405
Zephiran, 376
Zerit, 308
Zestril, 190
Zetia, 126–127
Zetonna, 377
Zevalin, 160
Ziac, 395
Ziagen, 1
Ziana, 374
ziconotide, 349–350
zidovudine, 350
zileuton, 350
Zinacef, 56
zinc oxide, 378
Zioptan, 384
ziprasidone, 350–351
Zipsor, 93
Zirgan, 146
Zithranol, 376
Zithromax, 28–29
ziv-aflibercept, 351
Zmax, 28–29
Zocor, 301
Zofran, 239–240
Zohydro ER, 156
Zoladex, 152
zoledronic acid, 351
Zolinza, 347–348
zolmitriptan, 352
Zoloft, 299–300
zolpidem tartrate, 352
Zolpimist, 352
Zometa, 351
Zomig, 352
Zonalon, 102–103
Zonatuss, 33
Zonegran, 352
zonisamide, 352
Zorbtive, 305–306
Zortress, 125–126
Zostavax, 417
zoster vaccine, live, 417
Zostrix, 375
Zostrix-HP, 375
Zosyn, 391
Zovia 1/35E, 406
Zovia 1/50E, 407
Zovirax, 4–5, 376
Zubsolv, 402
Zuplenz, 239–240
Zutripro, 403
Zyban, 41–42
Zyclara, 377

ERRNVPHGLFRVRUJ
Zydone, 388
Zyflo, 350
Zylet, 383
Zyloprim, 9
Zymar, 383
Zymaxid, 383
Zyprexa, 237
Zyprexa Relprevv, 237
Zyrtec, 57
Zytiga, 1–2
Zyvox, 188
Entries in boldface are drug classes.