Polyethylene Glycol

MiraLax®

OTC

Uses: Occasional constipation

MOA: Osmotic laxative

Dose: 17-g powder (1 heaping teaspoonful) in 8 oz (1 cup) of water & drink, max 14 d

Caution: C, ?, rule out bowel obst before use

CI: GI obst, allergy to PEG

Disp: Powder for reconstitution, bottle cap holds 17 g

SE: Upset stomach, bloating, cramping, gas, severe, D, hives

Notes: Can add to water, juice, soda, coffee, or tea

Meclizine HCl

Antivert®, Bonine®, Dramamine®

RX/OTC

Uses: Motion sickness, vertigo

MOA: Antiemetic, anticholinergic, antihistaminic properties

Dose: Motion sickness: 12.5-25 mg PO 1 hr before travel, repeat PRN q12-24. Vertigo: 25-100 mg/d ÷ doses

Caution: B, ?/-, NAG, BPH, BOO, elderly, asthma

Disp: Tabs 12.5, 25, 50 mg; chew tabs 25 mg; caps 25, 30 mg (OTC)

SE: Drowsiness, xerostomia, blurred vision, thickens bronchial secretions

Acyclovir

Zovirax®

Uses: Herpes simplex virus (HSV) (genital/mucocutaneous, encephalitis, keratitis), Varicella zoster, Herpes zoster (shingles) infxns

MOA: Interfers w/ viral DNA synth

Dose: Dose on IBW if obese (>125% IBW) PO: Initial genital HSV: 200 mg PO q4h while awake (5 caps/d) x 10 d or 400 mg PO TID x 7-10 d. Chronic HSV suppression: 400 mg PO BID. Intermitten HSV treatment: As initial, except treatment x 5 d, or 800 mg PO BID, at prodrome. Topical: Initial Herpes genitalis: Apply q3h (6x/d) for 7 d. HSV encephalitis: 10 mg/kg IV q8h x 10 d. Herpes zoster: 800 mg PO 5x/d for 7-10 d, IV: 5-10 mg/kg/dose IV q8h

Caution: B, +

CI: Component hypersens

Disp: Caps 200 mg; tabs 400, 800 mg; susp 200 mg/5 mL, Inj 500 & 1000 mg/vial; Inj soln 25 mg/mL, 50 mg/mL; oint, cream 5%

SE: Dizziness, lethargy, malaise, confusion, rash, IV site inflammation, transient ↑ Cr/BUN

Notes: PO better than topical for herpes genitalis

Fentanyl, transdermal

Duragesic®

Schedule: C-II

BBW: Potential for abuse and fatal OD

Uses: Persistent mod-severe chronic pain in pts already tolerant to opioids

MOA: Narcotic

Dose: Apply patch to upper torso q72h, dose based on narcotic requirements in previous 24 h, start 25 mcg/h patch q72h, ↓ in renal impair

Caution: B, +, w/ CYP3A4 inhib may ↑ fentanyl effect, w/ history of substance abuse

CI: Not opioid tolerant, short term pain management, post-op out-patient pain in outpatient surgery, mild pain, PRN use, ↑ ICP, resp depression, severe hepatic/renal impair, peds < 2yr

Disp: Patches 12.5, 25, 50, 75, 100 mgc/h

SE: Resp depression (fatal), sedation, ↓ BP, ↓ HR, constipation, N, miosis

Notes: 0.1 mg fentanyl= 10 mg morphine IM; do not cut patch, peak level in PRG 24-72 h

Methotrexate

Trexall®

BBW: Administration only by experienced physician; do not use in women of childbearing age unless absolutely absolutely necessary (teratogenic); impaired elimination w/ impaired renal fxns, ascites, pleural effusion, severe ↓ BM w/ NSAIDs, hepatotoxic, occasionally fatal; can induce induce life-threatening pneumonitis; D and ulcerative stomatitis require DC; lymphoma risk; may cause tumor lysis synd; can cause severe skin rxns, opportunistic infxns; w/ RT can ↑ tissue necrosis risk; Preservatives make this agent unsuitable for intrathecal IT or higher dose use

Uses: ALL, AML, Leukemic meningitis, trophoblastic tumors (choriocarcinoma, hydatidiform mole), breast, lung, head & neck cancer, Burkitt lymphoma, mycosis, fungoides, osteosarcoma, Hodgkin disease, NHL, psoriasis, RA, JRA, SLE

MOA: ↓ dihydrofolate reductase-mediated prod of tetrahydrofolate, causes ↓ DNA synthesis

Dose: CA: Per protocol; RA: 7.5 mg/wk PO 1/wk 1 or 2.5 mg q12h PO for 3 doses/wk. Psoriasis: 2.5-5 mg PO q12h x 3d/wk or 10-25 mg PO/IM qwk. Chronic: 15-25 mg IM/SQ qwk, then 15 mg/wk

Caution: D, -, w/ other nephro-/hepatotoxic meds, multiple interactions, w/ seizures, profound ↓ BM other than CA related

CI: Severe renal/hepatic impair, PRG/lactation

Disp: Dose pack 2.5 mg in 8, 12, 16, 20, or 24 doses; tabs 2.5, 5, 7.5, 10, 15 mg; inj 25 mg/mL; Inj powder 20 mg, 1 g

SE: ↓ BM, N/V/D, anorexia, mucositis, hepatotox (transient & reversible; may progress to atrophy, necrosis, fibrosis, cirrhosis), rashes, dizziness, malaise, blurred vision, alopecia, photosens, renal failure, pneumonitis, rare pulm fibrosis, chemical arachnoiditis, & HA w/ IT delivery

Notes: Monitor CBC, LFTs, Cr, MTX levels & CXR, "high dose" >500 mg/m2 requires leucovorin rescue to ↓ tox; w/ IT use preservative/alcohol free soln; systemic levels; therapeutic: > 0.01 micromole; toxic: >10 micromoles over 24 hrs

Finasteride

Proscar®, Propecia®

Uses: BPH, Androgenetic alopecia

MOA: ↓ 5-alpha reductase

Dose: BPH: 5 mg/d PO. Alopecia: 1mg/d PO; food ↓ absorption

Caution: X, -, hepatic impair

CI: Pregnant women should avoid handling pills, teratogen to male fetus

Disp: Tabs 1 mg (Propecia), 5 mg (Proscar)

SE: ↓ libido, vol ejaculate, ED, gynecomastia

Notes: ↓ PSA by ~ 50%; reestablish PSA baseline 6 mo (double PSA for "true" reading); 3-6 mo for effect on urinary symtoms; continue to maintain new hair, not for use in women; potential chemoprevention for PCa; no role in diagnosed PCa

Drospirenone/Ethinyl Estradiol

Ocella®, Yasmin®

BBW: Cigarette smoking incr. risk of serious CV side effects from combination OCPs; incr risk w/ age (particularly for women > 35) and w/ number of cigarettes smoked; CI in smokers >35 yo

Uses: *Contraception,* acne vulgaris, dysfunctional uterine bleeding, dysmenorrhea, endometriosis, polycystic ovary syndrome

MOA: Supresses LH and FSH, inhibiting ovulation, alters cervical mucus and endometrium

Dose: 3 mg drospirenone/30 mcg ethinyl estradiol PO QD x 21 days, then inert tabs PO x 7 days

Caution: X, ?, hyperlipidemia, DM, IBS, gallbladder disease, depression, obesity

CI: Pregnancy, severe HTN, breast cancer, renal impairment, smoking > age 35, thromboembolism, MI, hyperkalemia, undiagnosed vaginal bleeding

Disp: Monophasic pack; 3 mg drospirenone/30 mcg ethinyl estradiol per active tablet

SE: Bleeding irregularities, N/V, breast tenderness, HA, edema, wgt changes, acne, incr cholesterol, incr BP, impaired glucose intolerance, libido changes

Ferrous Sulfate

No Brand Name

OTC

Uses: Fe-deficiency anemia & Fe supl

Acts: Dietary supl

Dose: 100-200 mg elemental Fe/d in ÷ doses, on empty stomach (OK w/ meals if GI upset occurs); avoid antacids

Caution: A, ?, ↑ absorption w/  vit C, ↓ absorption w/ tetracycline, fluoroquinolones, antacids, H2 blockers, proton pump inhib

CI: Hemochromatosis, hemolytic anemia

Disp: Tabs 187 (60 mg Fe), 200 (65 mg Fe), 324 (65 mg Fe), 325 (65 mg Fe); SR caplets & tabs 160 (50 mg Fe), 200 mg (65 mg Fe); gtt 75 mg/0.6 mL (15 mg Fe/0.6 mL); Elixir 220 mg/5 mL (44 mg Fe/5 mL); syrup 90 mg/5 mL (18 mg Fe/5 mL)

SE: GI upset, constipation, dark stools, discolored urine

Benzonatate

Tessalon® Perles

Uses: Symptomatic relief of cough

MOA: Anesthetizes the stretch receptors in the resp passages

Dose: 100 mg PO TID (max 600 mg/d)

Caution: C, ?

Disp: Caps 100, 200 mg

SE: Sedation, dizziness, GI upset

Notes: Do not chew or puncture the caps

Bupropion SR

Wellbutrin® SR

BBW: All pts being treated w/ bupropion for smoking cessation treatment should be observed for neuropsychiatric signs and symptoms (hospitality, agitation, depressed mood, and suicide-related events) most during/after Zyban; Symptoms may persist following D/C; Closely monitor for worsening depression or emergence of suicidality, increased suicidal behavior in young adults

Uses: Depression, smoking cessation adjunct

MOA: Weak inhib of neuronal uptake of serotonin & NE; ↓ neuronal dopamine reuptake

Dose: 150-200 mg BID, ↓ dose with renal/hepatic impair

Caution: C, ?/-

CI: Seizure disorder, history of anorexia nervosa or bulimia, MAOI w/ or w/in 14 days; abrupt DC of EtOH or sedatives, inhibitors/inducers of CYP 2B6, w/ lopinavir/ritonavir

Disp: SR Tabs 100, 150, 200 mg

SE: Seizures, agitation, insomnia, HA, tachycardia, ↓ wgt

Notes: Avoid EtOH & other CNS depressants, do not crush/cut/chew, may ↑ adverse events including seizures