Chlordiazepoxide (Librium) [C] COMMON USES: Anxiety, tension, alcohol withdrawal, and preoperative apprehension ACTIONS: Benzodiazepine; antianxiety agent DOSAGE: Adults. Mild anxiety: 5–10 mg PO tid–qid or PRN. Severe anxiety: 25–50 mg IM, IV, or PO 3–4×/d or PRN. Alcohol withdrawal: 50–100 mg IM or IV; repeat in 2–4 h if needed, up to 300 mg in 24 h; gradually taper the daily dosage. Peds. >6 y: 0.5 mg/kg/24h PO or IM ÷ q6–8h SUPPLIED: Caps 5, 10, 25 mg; tabs 10, 25 mg; inj 100 mg NOTES: ↓ Dose in the elderly; absorption of IM doses can be erratic Chlorothiazide (Diuril) COMMON USES: HTN, edema, and CHF ACTIONS: Thiazide diuretic DOSAGE: Adults. 500 mg–1.0 g PO or IV qd–bid. Peds. 20–30 mg/kg/24h PO ÷ bid SUPPLIED: Tabs 250, 500 mg; susp 250 mg/5 mL; inj 500 mg/vial NOTES: Contra in anuria Chlorpheniramine (Chlor-Trimeton, etc) COMMON USES: Allergic reactions ACTIONS: Antihistamine DOSAGE: Adults. 4 mg PO q4–6h or 8–12 mg PO bid of SR. Peds. 0.35 mg/kg/24h PO ÷ q4–6h or 0.2 mg/kg/24h SR SUPPLIED: Tabs 4 mg; chewable tabs 2 mg; SR tabs 8, 12 mg; syrup 2 mg/5 mL; inj 10, 100 mg/mL NOTES: Anticholinergic side effects and sedation common Chlorpromazine (Thorazine) COMMON USES: Psychotic disorders, apprehension, intractable hiccups, and control of nausea and vomiting ACTIONS: Phenothiazine antipsychotic; antiemetic DOSAGE: Adults. Psychosis: 10–25 mg PO or PR bid–tid. (Usual dose 30–800 mg/d in ÷ doses). Children. Psychosis & N+V: 0.5–1 mg/kg/dose PO q or IM/IV q6–8h. Severe symptoms: 25 mg IM; can repeat in 1 h; then 25–50 mg PO or PR tid. Hiccups: 25–50 mg PO bid–tid SUPPLIED: Tabs 10, 25, 50, 100, 200 mg; SR caps 30, 75, 150 mg; syrup 10 mg/5 mL; conc 30, 100 mg/mL; supp 25, 100 mg; inj 25 mg/mL NOTES: Beware of extrapyramidal side effects and sedation; has α-adrenergic-blocking properties Chlorpropamide (Diabinese) COMMON USES : Type 2 DM ACTION : Sulfonylurea. Stimulates the release of insulin from the pancreas; increases insulin sensi- tivity at peripheral sites; reduces glucose output from the liver DOSAGE : 100–500 mg/d SUPPLIED : Tabs 100, 250 mg NOTES : Use with caution in renal insufficiency Chlorthalidone (Hygroton, others) COMMON USES: HTN, edema associated with CHF ACTIONS: Thiazide diuretic DOSAGE: Adults. 50–100 mg/d PO qd. Peds. 2 mg/kg/dose PO 3×/wk or 1–2 mg/kg/d PO SUPPLIED: Tabs 15, 25, 50, 100 mg NOTES: Contra in anuric patients Chlorzoxazone (Paraflex, Parafon Forte DSC, others) COMMON USES: Adjunct to rest and physical therapy for the relief of discomfort associated with acute, painful musculoskeletal conditions ACTIONS: Centrally acting skeletal muscle relaxant 22 Commonly Used Medications 515 22 DOSAGE: Adults. 250–500 mg PO tid–qid. Peds. 20 mg/kg/d in 3–4 ÷ doses SUPPLIED: Tabs 250, 500 mg; caps 250, 500 mg Cholecalciferol [Vitamin D 3 ] (Delta-D) COMMON USES: Dietary supplement for treatment of vitamin D deficiency ACTIONS: Enhances intestinal calcium absorption DOSAGE: 400–1000 IU/d PO SUPPLIED: Tabs 400, 1000 IU NOTES: 1 mg of cholecalciferol = 40,000 IU of vitamin D activity Cholestyramine (Questran) COMMON USES: Adjunctive therapy for the reduction of serum cholesterol in patients with primary hypercholesterolemia; Rx pruritus associated with partial biliary obstruction ACTIONS: Binds bile acids in the intestine to form insoluble complexes DOSAGE: Adults. Individualize the dose:4 g/d–bid (↑ to max 24 g/d and 6 doses/d). Peds. 240 mg/kg/d in 3 ÷ doses SUPPLIED: 4 g of cholestyramine resin/9 g of powder; with aspartame: 4 g resin/5 g of powder NOTES: Mix 4 g of cholestyramine in 2–6 oz of noncarbonated beverage; take other medications 1–2 h before or 6 h after cholestyramine Ciclopirox (Loprox) COMMON USES: Tinea pedis, tinea cruris, tinea corporis, cutaneous candidiasis, tinea versicolor ACTIONS: Antifungal antibiotic DOSAGE: Adults & Peds. >10: Massage into affected area bid SUPPLIED: Cream; gel; lotion 1% Cidofovir (Vistide) COMMON USES: CMV retinitis ACTIONS: Selective inhibition of viral DNA synthesis DOSAGE: Rx: 5 mg/kg IV once/wk for 2 wk; administered with probenecid. Maintenance: 5 mg/kg IV once/2 wk; administered with probenecid. Probenecid: 2 g PO 3 h prior to Cidofovir, and then 1 g PO at 2 h and 8 h after Cidofovir SUPPLIED: Inj 75 mg/mL NOTES: Dose adjust in renal impairment, hydrate patient with NS prior to each infusion; causes renal toxicity Cimetidine (Tagamet, others) COMMON USES: Duodenal ulcer; ulcer prophylaxis in hypersecretory states, eg, trauma, burns, surgery, ZE; and GERD ACTIONS: Histamine-2 receptor antagonist DOSAGE: Adults. Active ulcer: 2400 mg/d IV cont inf or 300 mg IV q6; 400 mg PO bid or 800 mg hs. Maintenance therapy: 400 mg PO hs. GERD: 800 mg PO bid; maintenance 800 mg PO hs. Peds. Infants: 10–20 mg/kg/24h PO or IV ÷ q6–12h. Children: 20–40 mg/kg/24h PO or IV ÷ q6h SUPPLIED: Tabs 200, 300, 400, 800 mg; liq 300 mg/5 mL; inj 300 mg/2 mL NOTES: Extend dosing interval with renal insufficiency; ↓ dose in the elderly Ciprofloxacin (Cipro) COMMON USES: Broad-spectrum activity against a variety of gram (+) and gram (−) aerobic bacteria ACTIONS: Quinolone antibiotic; inhibits DNA gyrase DOSAGE: Adults. 250–750 mg PO q12h or 200–400 mg IV q12h. Peds. NOT recommended for children <18 y old SUPPLIED: Tabs 100, 250, 500, 750 mg; susp 5 g/100 mL, 10 g/100 mL; inj 200, 400 mg NOTES: Little activity against streptococci; drug interactions with theophylline, caffeine, sucralfate, and antacids; nausea, vomiting, and abdominal discomfort common side effects; contra in PRG 516 Clinician’s Pocket Reference, 9th Edition 22 Ciprofloxacin, Ophthalmic (Ciloxan) COMMON USES: Rx and prevention of ocular infections eg, conjunctivitis, blepharitis, corneal abra- sions ACTIONS: Quinolone antibiotic; inhibits DNA gyrase, antiinflammatory DOSAGE: Instill 1–2 gtt in eye(s) q2h while awake for 2 d, then 1–2 gtt q4h while awake for 5 more d SUPPLIED: Soln 3.5 mg/mL Ciprofloxacin, Otic (Cipro HC Otic) COMMON USES: Otitis externa ACTIONS: Quinolone antibiotic; inhibits DNA gyrase DOSAGE: Adult and Peds >1 mo. 1–2 gtt in ear(s) bid for 7 d SUPPLIED: Susp ciprofloxacin 0.2% and hydrocortisone 1% Cisplatin (Platinol) COMMON USES: Testicular, small-cell and non-small-cell lung, bladder, ovarian, breast, head and neck, and penile cancers; osteosarcoma; and pediatric brain tumors ACTIONS: DNA-binding; intrastrand cross-linking; formation of DNA adducts DOSAGE: 20 mg/m 2 /d for 5 d q 3 wk; 120 mg/m 2 q 3–4 wk; 100 mg/m 2 on days 1 and 8 q 20 d. (Refer to specific protocols) SUPPLIED: Inj 1 mg/mL NOTES: Toxicity symptoms: Allergic reactions, nausea and vomiting, nephrotoxicity (exacerbated by concurrent administration of other nephrotoxic drugs and minimized by saline infusion and mannitol diuresis), high-frequency hearing loss in approximately 30%, peripheral “stocking glove”-type neuropathy, cardiotoxicity (ST-T-wave changes), hypomagnesemia, mild myelosup- pression, and hepatotoxicity. Renal impairment is dose-related and cumulative Citalopram (Celexa) COMMON USES : Depression ACTIONS: SSRI DOSAGE: Initial 20 mg/d, may be ↑ to 40 mg/d SUPPLIED: Tabs 20, 40 mg Cladribine (Leustatin) COMMON USES: HCL ACTIONS: Induces DNA strand breakage and interference with DNA repair enzymes and DNA syn- thesis DOSAGE: 0.09 mg/kg/d cont IV inf for 7 d. (Refer to specific protocols) SUPPLIED: Inj 1 mg/mL NOTES: Toxicity symptoms: Myelosuppression; T-lymphocyte suppression may be prolonged (26–34 wk). Fever occur in 46% (probably related to tumor lysis); infections common (especially at lung and IV catheter sites); rash common (50%) in patients treated for HCL Clarithromycin (Biaxin) COMMON USES: Upper and lower respiratory tract infections, skin and skin structure infections, H. pylori infections, and infections caused by nontuberculosis (atypical) Mycobacterium. Preven- tion of MAC infections in HIV-infected individuals. ACTIONS: Macrolide antibiotic; inhibits protein synthesis DOSAGE: Adults. 250–500 mg PO bid or 1000 mg (2 × 500 mg ER tab)/d. Mycobacterium: 500–1000 mg PO bid. Peds. 7.5 mg/kg/dose PO bid SUPPLIED: Tabs 250, 500 mg; susp 125, 250 mg/5 mL; 500 mg ER tab NOTES: Increases theophylline and carbamazepine levels; avoid concurrent use with cisapride; causes metallic taste 22 Commonly Used Medications 517 22 Clemastine Fumarate (Tavist) COMMON USES: Allergic rhinitis ACTIONS: Antihistamine DOSAGE: Adults & Peds. >12 y: 1.34 mg bid to 2.68 mg tid; max 8.04 mg/d. <12 y: 0.4 mg PO bid SUPPLIED: Tabs 1.34, 2.68 mg; syrup 0.67 mg/5 mL Clindamycin (Cleocin, Cleocin-T) COMMON USES: Susceptible strains of streptococci, pneumococci, staphylococci, and gram (+) and gram (−) anaerobes; no activity against gram (−) aerobes and bacterial vaginosis; topical for severe acne and vaginal infections ACTIONS: Bacteriostatic; interferes with protein synthesis DOSAGE: Adults. 150–450 mg PO qid; 300–600 mg IV q6h or 900 mg IV q8h. Vaginal: 1 applica- torful hs for 7 d. Topical: Apply 1% gel, lotion, or soln bid. Peds. Neonates: 10–15 mg/kg/24h ÷ q8–12h. Children >1 mo: 10–30 mg/kg/24h ÷ q6–8h, to a max of 1.8 g/d oral or 4.8 g/d IV. Topical: Apply 1%, gel, lotion, or soln bid SUPPLIED: Caps 75, 150, 300 mg; susp 75 mg/5 mL; inj 300 mg/2 mL; vaginal cream 2% NOTES: Beware of diarrhea that may represent pseudomembranous colitis caused by Clostridium difficile Clofazimine (Lamprene) COMMON USES: Leprosy and as part of combination therapy for MAC in AIDS patients ACTIONS: Bactericidal; inhibits DNA synthesis DOSAGE: Adults. 100–300 mg PO qd. Peds. 1 mg/kg/d SUPPLIED: Caps 50 mg NOTES: Take with meals; may change skin pigmentation pink to brownish black; may cause skin dryness and GI intolerance Clonazepam (Klonopin) [C] COMMON USES: Lennox–Gastaut syndrome, akinetic and myoclonic seizures, and absence seizures ACTIONS: Benzodiazepine; anticonvulsant DOSAGE: Adults. 1.5 mg/d PO in 3 ÷ doses; ↑ by 0.5–1.0 mg/d q 3 d PRN up to 20 mg/d. Peds. 0.01–0.03 mg/kg/24h PO ÷ tid; ↑ to 0.1–0.2 mg/kg/24h ÷ tid SUPPLIED : Tabs 0.5, 1.0, 2.0 mg NOTES : CNS side effects, including sedation Clonidine, Oral (Catapres) COMMON USES : HTN; opioid and tobacco withdrawal ACTIONS : Centrally acting α-adrenergic stimulant DOSAGE: Adults. 0.10 mg PO bid adjusted daily by 0.1- to 0.2-mg increments (max 2.4 mg/d). Peds. 5–10 µg/kg/d ÷d q8–12h (max 0.9 mg/d) SUPPLIED: Tabs 0.1, 0.2, 0.3 mg NOTES: Dry mouth, drowsiness, and sedation frequent; more effective for HTN when combined with diuretics; rebound HTN can occur with abrupt cessation of doses >0.2 mg bid. (See TD dose.) Clonidine, Transdermal (Catapres TTS) COMMON USES: HTN ACTIONS: Centrally acting α-adrenergic stimulant DOSAGE: Apply 1 patch q 7 d to a hairless area on the upper arm or torso; titrate according to indi- vidual therapeutic requirements SUPPLIED: TTS-1, TTS-2, TTS-3 (programmed to deliver 0.1, 0.2, 0.3 mg, respectively, of cloni- dine/d for 1 wk) NOTES: Doses >2 TTS-3 usually not associated with increased efficacy 518 Clinician’s Pocket Reference, 9th Edition 22 Clopidogrel (Plavix) COMMON USES: Reduction of atherosclerotic events ACTIONS: Inhibits platelet aggregation DOSAGE: 75 mg/d SUPPLIED: Tabs 75 mg NOTES: Prolongs bleeding time, use with caution in persons at risk of bleeding from trauma, etc Clorazepate (Tranxene) [C] COMMON USES: Acute anxiety disorders, acute alcohol withdrawal symptoms, and adjunctive ther- apy in partial seizures ACTIONS: Benzodiazepine; antianxiety agent DOSAGE: Adults. 15–60 mg/d PO in single or ÷ doses. Elderly and debilitated patients: Initiate therapy at 7.5–15 mg/d in ÷ doses. Alcohol withdrawal: Day 1: Initially, 30 mg; followed by 30–60 mg in ÷ doses. Day 2: 45–90 mg in ÷ doses. Day 3: 22.5–45 mg in ÷ doses. Day 4: 15–30 mg in ÷ doses. Peds. 3.75–7.5 mg/dose bid, to a max of 60 mg/d ÷ bid–tid SUPPLIED: Tabs 3.75, 7.5, 11.25, 15, 22.5 mg NOTES: Monitor patients with renal and hepatic impairment because drug may accumulate; CNS depressant effects Clotrimazole (Lotrimin, Mycelex) COMMON USES: Candidiasis and tinea infections ACTIONS: Antifungal agent; alters cell wall permeability DOSAGE: Oral: One troche dissolved slowly in the mouth 5 (times)/d for 14 d. Vaginal: Cream 1 applicatorful hs for 7–14 d. Tabs 100 mg vaginally hs for 7 d or 200 mg (2 tabs) vaginally hs for 3 d or 500-mg tabs vaginally hs once. Topical: Apply bid for 10–14 d SUPPLIED: 1% cream; soln; lotion; troche 10 mg; vaginal tabs 100, 500 mg; vaginal cream 1% NOTES: Oral prophylaxis commonly used in immunosuppressed patients Clotrimazole and Betamethasone (Lotrisone) COMMON USES: Fungal skin infections ACTIONS: Imidazole antifungal and antiinflammatory DOSAGE: Apply and gently massage into the area bid from 2–4 wk SUPPLIED: Cream 15, 45 g NOTES: Contra in children and varicella Cloxacillin (Cloxapen, Tegopen) COMMON USES : Infections caused by susceptible strains of S. aureus and Streptococcus ACTIONS : Bactericidal; inhibits cell wall synthesis DOSAGE : Adults. 250–500 mg PO qid. Peds. 50–100 mg/kg/d ÷ qid SUPPLIED : Caps 250, 500 mg; soln 125 mg/5 mL NOTES : Take on an empty stomach Clozapine (Clozaril) COMMON USES: Refractory severe schizophrenia ACTIONS: Tricyclic “atypical” antipsychotic agent DOSAGE: Initially, 25 mg qd–bid; ↑ dose to 300–450 mg/d over 2 wk. Maintain the patient at the lowest dose possible SUPPLIED: Tabs 25, 100 mg NOTES: Monitor blood counts frequently (weekly for the first 6 mo; then every other week) because of the risk of agranulocytosis. Drowsiness and seizures possible Cocaine [C] COMMON USES: Topical anesthetic for mucous membranes ACTIONS: Narcotic analgesic, local vasoconstrictor 22 Commonly Used Medications 519 22 DOSAGE: Apply topically lowest amount of topical soln that provides relief; 1 mg/kg max SUPPLIED: Topical soln and viscous preparations 4, 10% powder, soluble tabs (135 mg) for soln Codeine [C-II] COMMON USES : Mild to moderate pain; symptomatic relief of cough ACTIONS: Narcotic analgesic; depresses cough reflex DOSAGE: Adults. Analgesic: 15–60 mg PO or IM qid PRN. Antitussive: 10–20 mg PO q4h PRN; max 12 mg/d. Peds. Analgesic: 0.5–1.0 mg/kg/dose PO or IM q4–6h PRN. Antitussive: 1.0–1.5 mg/kg/24h PO ÷ q4h; max 30 mg/24h SUPPLIED: Tabs 15, 30, 60 mg; soln 15 mg/5 mL; inj 30, 60 mg/mL NOTES: Most often combined with acetaminophen for pain or with agents, eg, terpin hydrate as an antitussive; 120 mg IM = to 10 mg of morphine IM Colchicine COMMON USES: Acute gout ACTIONS: Inhibits migration of leukocytes; reduces production of lactic acid by leukocytes DOSAGE: Initially: 0.5–1.2 mg PO, then 0.5–0.6 mg q 1–2 h until relief or GI side effects develop (max 8 mg/d). Do not repeat for 3 d. IV: 1–3 mg, then 0.5 mg q6h until relief (max 4 mg/d) do not repeat for 7 d. Prophylaxis: PO: 0.5–0.6 mg/d or 3–4 d/wk SUPPLIED: Tabs 0.5, 0.6 mg; inj 1 mg/2 mL NOTES: Use caution in elderly and in renal impairment. Colchicine 1–2 mg IV within 24–48 h of an acute attack can be diagnostic and therapeutic in monoarticular arthritis Colesevelam (Welchol) COMMON USES : Reduction of LDL and total cholesterol ACTIONS : Bile acid sequestrant DOSAGE: 3 tabs PO bid with meals SUPPLIED: Tabs 625 mg Colestipol (Colestid) COMMON USES: Adjunctive for ↓ serum cholesterol in primary hypercholesterolemia ACTIONS: Binds bile acids in the intestine to form an insoluble complex DOSAGE: Granules: 5–30 g/d ÷ into 2–4 doses; tabs: 2–16 g/d qd–bid SUPPLIED: Tabs 1 g; granules NOTES: Do not use dry powder; mix with beverages, soups, cereals, etc Colfosceril Palmitate (Exosurf Neonatal) COMMON USES: Prophylaxis and Rx for RSD in infants ACTIONS: Synthetic lung surfactant DOSAGE: 5 mL/kg/dose administered through the endotracheal tube as soon after birth as possible and again at 12 and 24 h SUPPLIED: Suspension 108 mg NOTES: Monitor pulmonary compliance and oxygenation carefully. Pulmonary hemorrhage possi- ble in infants weighing <700 g at birth. Mucous plugging of endotracheal tube possible Cortisone See Steroids pages 628–630. (See Table 22–5, page 627 and Table 22–6, page 627.) Cromolyn Sodium (Intal, Nasalcrom, Opticrom) COMMON USES: Adjunct to the Rx of asthma; prevention of exercise-induced asthma; allergic rhinitis; ophth allergic manifestations ACTIONS: Antiasthmatic; mast cell stabilizer DOSAGE: Adults & Children >12 y. Inhal: 20 mg (as powder in caps) inhaled qid or met-dose in- haler 2 puffs qid. Oral: 200 mg qid 15–20 min ac, up to 400 mg qid. Nasal instillation: Spray once 520 Clinician’s Pocket Reference, 9th Edition 22 in each nostril 2–6 ×/d. Ophth: 1–2 gtt in each eye 4–6×/d. Peds. Inhal: 2 puffs qid of met-dose in- haler. Oral: Infants <2 y: 20 mg/kg/d in 4 ÷ doses. 2–12 y: 100 mg qid ac SUPPLIED: Oral conc 100 mg/5 mL; soln for neb 20 mg/2 mL; met-dose inhaler; nasal soln 40 mg/mL; ophth soln 4% NOTES: No benefit in acute situations; may require 2–4 wk for maximal effect in perennial allergic disorders Cyanocobalamin [Vitamin B 12 ] COMMON USES: Pernicious anemia and other vitamin B 12 deficiency states ACTIONS: Dietary supplement of vitamin B 12 DOSAGE: Adults. 100 µg IM or SC qd for 5–10 d, then 100 µg IM 2×/wk for 1 mo, then 100 µg IM monthly. Peds. 100 µg/d IM or SC for 5–10 d, then 30–50 µg IM q 4 wk SUPPLIED: Tabs 25, 50, 100, 250, 500, 1000 µg; inj 30, 100, 1000 µg/mL NOTES: Oral absorption highly erratic, altered by many drugs and not recommended; for use with hyperalimentation (see Chapter 12) Cyclobenzaprine (Flexeril) COMMON USES: Adjunct to rest and physical therapy for the relief of muscle spasm associated with acute painful musculoskeletal conditions ACTIONS: Centrally acting skeletal muscle relaxant; reduces tonic somatic motor activity DOSAGE: 10 mg PO 2–4×/d SUPPLIED: Tabs 10 mg NOTES: Do not use for longer than 2–3 wk; has sedative and anticholinergic properties Cyclopentolate (Cyclogyl) COMMON USES: Diagnostic procedures requiring cycloplegia and mydriasis ACTIONS: Cycloplegia and mydriatic agent (can last up to 24 h) DOSAGE: 1 gtt followed by another in 5 min SUPPLIED: Soln, 0.5, 1, 2% Cyclophosphamide (Cytoxan, Neosar) COMMON USES : Hodgkin’s and non-Hodgkin’s lymphomas, multiple myeloma, breast and ovarian cancers, mycosis fungoides, neuroblastoma, retinoblastoma, acute leukemias, small-cell lung can- cer, and allogeneic and ABMT in high doses; severe rheumatologic disorders ACTIONS : Converted to acrolein and phosphoramide mustard, the active alkylating moieties DOSAGE : 500–1500 mg/m 2 as a single dose at 2–4-wk intervals; 1.8 g/m 2 to 160 mg/kg (or ≈12 g/m 2 in a 75-kg individual) in the BMT setting. (Refer to specific protocols) SUPPLIED : Tabs 25, 50 mg; inj 100 mg NOTES : Toxicity symptoms: Myelosuppression (leukopenia and thrombocytopenia); sterile hemor- rhagic cystitis, SIADH, alopecia, and anorexia; nausea and vomiting common. Hepatotoxicity and rarely interstitial pneumonitis possible. Irreversible testicular atrophy possible. Cardiotoxicity rare. Second malignancies (bladder cancer and acute leukemias); cumulative risk of 3.5% at 8 y, 10.7% at 12 y. Preventive measures to avoid hemorrhagic cystitis often applied in high-dose regimens and may include continuous bladder irrigation and MESNA uroprotection (see page 567) Cyclosporine (Sandimmune, Neoral) COMMON USES: Organ rejection in kidney, liver, heart, and BMT in conjunction with adrenal corti- costeroids ACTIONS: Immunosuppressant; reversible inhibition of immunocompetent lymphocytes DOSAGE: Adults & Peds. Oral: 15 mg/kg/d beginning 12 h prior to transplant; after 2 wk, taper the dose by 5 mg/wk to 5–10 mg/kg/d. IV: If the patient is unable to take the drug orally, give 1 ⁄2 the oral dose IV SUPPLIED: Caps 25, 50 mg, 100 mg; oral soln 100 mg/mL; inj 50 mg/mL 22 Commonly Used Medications 521 22 NOTES: May elevate BUN and creatinine, which may be confused with renal transplant rejection; should be administered in glass containers; many drug interactions; Neoral and Sandimmune not interchangeable. (See Table 22–7 pages 631–634.) Cyproheptadine (Periactin) COMMON USES: Allergic reactions; especially good for itching ACTIONS: Phenothiazine antihistamine DOSAGE: Adults. 4–20 mg PO ÷ q8h; max 0.5 mg/kg/d. Peds. 2–6 y: 2 mg bid–tid (max 12 mg/24h). 7–14 y: 4 mg bid–tid SUPPLIED: Tabs 4 mg; syrup 2 mg/5 mL NOTES: Anticholinergic side effects and drowsiness common; may stimulate appetite in some pa- tients Cytarabine [Ara-C] (Cytosar-U) COMMON USES: Acute leukemias, CML, non-Hodgkin’s lymphoma; IT administration for leukemic meningitis or prophylaxis ACTIONS: Antimetabolite; interferes with DNA synthesis DOSAGE: 100–150 mg/m 2 /d for 5–10 d (low-dose); 3 g/m 2 q12h for 8–12 doses (high-dose); 1 mg/kg 1–2×/wk (SC maintenance regimens); 5–70 mg/m 2 up to 3×/wk IT. (Refer to specific pro- tocols) SUPPLIED: Inj 100 mg, 500 mg, 1 g, 2 g NOTES: Toxicity symptoms: Myelosuppression, nausea and vomiting, diarrhea, stomatitis, flu-like syndrome, rash of the palms and soles of the feet, and hepatic dysfunction. Toxicity of high-dose regimens (conjunctivitis) ameliorated by corticosteroid ophth soln, cerebellar dysfunction, and noncardiogenic pulmonary edema Cytarabine Liposomal (Depocyt) COMMON USES: Lymphomatous meningitis ACTIONS: Antimetabolite; interferes with DNA synthesis DOSAGE: 50 mg IT q 14 d for 5 doses; followed by 50 mg IT q 28 d for 4 doses SUPPLIED: IT inj 50 mg/5 mL Cytomegalovirus Immune Globulin [CMV-GIV] (Cytogam) COMMON USES : Attenuation of primary CMV disease associated with transplantation ACTIONS : Provides exogenous IgG antibodies to CMV DOSAGE : Administered for 16 wk posttransplant, 15 mg/kg/hr, ↑Q30 min to 60 mg/kg/hr, max 75 mL/hr IV SUPPLIED : Inj 50±10 mg/mL Dacarbazine (DTIC-Dome) COMMON USES: Melanoma, Hodgkin’s disease, sarcoma ACTIONS: Alkylating agent; antimetabolite activity as a purine precursor; inhibits synthesis of pro- tein, RNA, and especially DNA DOSAGE: 2–4.5 mg/kg/d for 10 consecutive d or 250 mg/m 2 /d for 5 d. (Refer to specific protocols) SUPPLIED: Inj 100, 200, 500 mg NOTES: Toxicity symptoms: Moderate myelosuppression, severe nausea and vomiting, hepatotoxic- ity, flu-like syndrome, hypotension with high-dose therapy, photosensitivity, alopecia, facial flush- ing, facial paresthesias, urticaria, and phlebitis at the inj site Daclizumab (Zenapax) COMMON USES: Prevention of acute organ rejection ACTIONS: IL-2 receptor antagonists DOSAGE: 1 mg/kg IV/dose; first dose before transplant then 4 doses 14 d apart posttransplant SUPPLIED : Inj 5 mg/mL 522 Clinician’s Pocket Reference, 9th Edition 22 Dactinomycin (Cosmegen) COMMON USES: Choriocarcinoma, Wilms’ tumor, Kaposi’s sarcoma, Ewing’s sarcoma, rhab- domyosarcoma, testicular cancer ACTIONS: DNA intercalating agent DOSAGE: 0.5 mg/d for 5 d; 2 mg/wk for 3 consecutive wk; 15 µg/kg or 0.45 mg/m 2 /d (max 0.5 mg) for 5 d q 3–8 wk in pediatric sarcoma. (Refer to specific protocols) SUPPLIED: Inj 0.5 mg NOTES: Toxicity symptoms: Myelosuppression, immunosuppression, nausea and vomiting, alope- cia, acne-form skin changes and hyperpigmentation, radiation recall phenomenon, phlebitis and tis- sue damage with extravascular extravasation, and hepatotoxicity Dalteparin (Fragmin) COMMON USES: Unstable angina, non-Q-wave MI, prevention of ischemic complications due to clot formation in patients on concurrent aspirin, prevention of DVT following surgery ACTIONS: Low-molecular-weight heparin DOSAGE: Angina/MI: 120 IU/kg (max 10,000 IU) SC q12h with aspirin. DVT prophylaxis: 2500–5000 IU SC 1–2 h prior to surgery, then qd for 5–10 d. Systemic anticoagulation: 200 IU/kg/d SC or 100 IU/kg bid SC SUPPLIED: Inj 2500 IU (16 mg/0.2 mL), 5000 IU (32 mg/0.2 mL), 10,000 (64 mg/mL) NOTES: Predictable antithrombotic effects eliminates need for laboratory monitoring Dantrolene (Dantrium) COMMON USES: Clinical spasticity resulting from upper motor neuron disorders, eg, spinal cord in- juries, strokes, CP, or MS; Rx of malignant hyperthermic crisis ACTIONS: Skeletal muscle relaxant DOSAGE: Adults. Spasticity: Initially, 25 mg PO qd; ↑ to effect by 25 mg to a max dose of 100 mg PO qid PRN. Peds. Initially, 0.5 mg/kg/dose bid; ↑ by 0.5 mg/kg to effectiveness to a max dose of 3 mg/kg/dose qid PRN. Adults & Peds. Malignant hyperthermia: Treatment: Continuous rapid IV push beginning at 1 mg/kg until symptoms subside or 10 mg/kg is reached. Postcrisis follow-up: 4–8 mg/kg/d in 3–4 ÷ doses for 1–3 d to prevent recurrence SUPPLIED: Caps 25, 50, 100 mg; powder for inj 20 mg/vial NOTES: Monitor ALT and AST closely Dapsone [DDS] (Avlosulfon) COMMON USES : Rx and prevention of PCP; toxoplasmosis prophylaxis; leprosy ACTIONS : Unknown; bactericidal DOSAGE : Adults. Prophylaxis of PCP 50–100 mg/d PO. Rx of PCP 100 mg/d PO with TMP 5 mg/kg for 21 d. Peds. Prophylaxis of PCP 1–2 mg/kg/24h PO qd; max 100 mg/d SUPPLIED : Tabs 25 mg, 100 mg NOTES : Absorption enhanced by an acidic environment; leprosy therapy in combination with ri- fampin and other agents Daunorubicin (Daunomycin, Cerubidine) COMMON USES: Acute leukemias ACTIONS: DNA intercalating agent; inhibits topoisomerase II; generates oxygen free radicals DOSAGE: 45–60 mg/m 2 /d for 3 consecutive d; 25 mg/m 2 /wk. (Refer to specific protocols) SUPPLIED: Inj 20 mg NOTES: Toxicity symptoms: Myelosuppression, mucositis, nausea and vomiting, alopecia, radiation recall phenomenon, hepatotoxicity (hyperbilirubinemia), tissue necrosis on extravascular extrava- sation, and cardiotoxicity (1–2% risk of CHF with a cumulative dose of 550 mg/m 2 ) Delavirdine (Rescriptor) COMMON USES: HIV infection ACTION: Nonnucleoside reverse transcriptase inhibitor 22 Commonly Used Medications 523 22 DOSAGE: 400 mg PO tid SUPPLIED: Tabs 100 mg NOTES: Inhibits cytochrome P-450 enzymes. Numerous drug interactions Demeclocycline (Declomycin) COMMON USES: SIADH ACTIONS: Antagonizes the action of ADH on renal tubules DOSAGE: 300–600 mg PO q12h SUPPLIED: Caps 150 mg; tabs 150, 300 mg NOTES: ↓ Dose in renal failure. DI possible Desipramine (Norpramin) COMMON USES: Endogenous depression, chronic pain, and peripheral neuropathy ACTIONS: Tricyclic antidepressant; increases synaptic concentration of serotonin or norepinephrine in CNS DOSAGE: 25–200 mg/d in single or ÷ doses; usually as a single hs dose. (Max 300 mg/d) SUPPLIED: Tabs 10, 25, 50, 75, 100, 150 mg; caps 25, 50 mg NOTES: Many anticholinergic side effects, including blurred vision, urinary retention, and dry mouth Desmopressin (DDAVP, Stimate) COMMON USES: DI (intranasal and parenteral); bleeding caused by hemophilia A and type I von Willebrand’s disease (parenteral), nocturnal enuresis ACTIONS: Synthetic analogue of vasopressin, a naturally occurring human ADH; increases factor VIII DOSAGE: DI: Intranasal: Adults. 0.1–0.4 mL (10–40 µg)/d in 1–4 ÷ doses. Peds 3 mo–12 y. 0.05–0.3 mL/d in 1 or 2 doses. Parenteral: Adults. 0.5–1 mL (2–4 µg)/d in 2 ÷ doses. If converting from intranasal to parenteral dosing, use 1 ⁄10 of the intranasal dose. Oral: Adults. 0.05 mg bid; may be ↑ to max of 1.2 mg. Hemophilia A and von Willebrand’s disease (type I): Adults & Peds >10 kg. 0.3 µg/kg diluted to 50 mL with NS infused slowly over 15–30 min. Peds <10 kg. Same as above with dilution to 10 mL with NS. Nocturnal enuresis: Peds >6 y. 20 µg intranasally hs. SUPPLIED: Tabs 0.1, 0.2 mg; inj 4 µg/mL; nasal soln 0.1, 1.5 mg/mL NOTES: In very young and old patients adjust fluid intake to avoid water intoxication and hypona- tremia NOTES: Must be used in conjunction with a glucocorticoid Dexamethasone, Nasal (Dexacort Phosphate Turbinaire) COMMON USES: Chronic nasal inflammation or allergic rhinitis ACTIONS: Antiinflammatory corticosteroid DOSAGE: Adult and Peds > 12 y. 2 sprays/nostril bid–tid, max 12 sprays/d. Peds 6–12 y. 1–2 sprays/nostril, bid, max 8 sprays/d SUPPLIED: Aerosol, 84 µg/activation Dexamethasone, Ophthalmic (AK-DEX Ophthalmic, Decadron Ophthalmic, others) COMMON USES: Inflammatory or allergic conjunctivitis ACTIONS: Antiinflammatory corticosteroid DOSAGE: Instill 1–2 gtt tid–qid SUPPLIED: Susp and soln 0.1%; oint 0.05% Dexamethasone, Systemic, Topical (Decadron) See Steroids (Table 22–5, page 627 and Table 22–6, pages 628–630) 524 Clinician’s Pocket Reference, 9th Edition 22 [...]... DOSAGE: Enoxaparin (Lovenox) COMMON USES: Prevention and Rx of DVT; Rx PE; unstable angina and non-Q-wave MI Low-molecular-weight heparin DOSAGE: Prevention: 30 mg bid SC or 40 mg SC q24h DVT/PE: 1 mg/kg SC q12h or 1.5 mg/kg SC q24h Angina: 1 mg/kg SC q12h SUPPLIED: Inj 10 mg/0.1 mL (3 0-, 4 0-, 6 0-, 8 0-, 100-mg syringes) NOTES: Does not significantly affect bleeding time, platelet function, PT, or APTT... increments SUPPLIED: Inj 10 mg/mL NOTES: Avoid concurrent use with β-blockers ACTIONS: Fenoprofen (Nalfon) COMMON USES: ACTIONS: Arthritis and pain NSAID 22 5 38 DOSAGE: SUPPLIED: Clinician’s Pocket Reference, 9th Edition 200–600 mg q4–8h, to a max of 3200 mg/d Caps 200, 300 mg; tabs 600 mg Fentanyl (Sublimaze) [C-II] COMMON USES: Short-acting analgesic used in conjunction with anesthesia Narcotic DOSAGE:... Pseudoephedrine (Entuss-D, Histussin-D, others) [C-III] COMMON USES: Cough and nasal congestion Narcotic cough suppressant with decongestant DOSAGE: 5 mL qid, PRN SUPPLIED: Entuss-D 5-mg hydrocodone/30 mg pseudoephedrine/5 mL; Histussin-D 5-mg hydrocodone/60 mg pseudoephedrine/5 mL ACTIONS: Hydrocodone, Chlorpheniramine, Phenylephrine, Acetaminophen, and Caffeine (Hycomine Compound) [C-III] COMMON USES:... acetaminophen/5 mL ACTIONS: Hydrocodone and Aspirin (Lortab ASA, others) [C-III] COMMON USES: Moderate-to-severe pain Narcotic analgesic with NSAID 1–2 PO q4–6h PRN SUPPLIED: 5 mg hydrocodone/500 mg aspirin/tab ACTIONS: DOSAGE: 22 550 Clinician’s Pocket Reference, 9th Edition Hydrocodone and Guaifenesin (Hycotuss Expectorant, others) [C-III] COMMON USES: Nonproductive cough associated with respiratory infection... q6–8h, 10 mL/d max; 6–12 y: 5 mL q6–8h, 20 mL max/d ACTIONS: Guanabenz (Wytensin) COMMON USES: HTN Central α-adrenergic agonist Adults Initially, 4 mg PO bid; ↑ by 4 mg/d increments at 1–2-wk intervals up to 32 mg bid Peds >12 y Initially, 0.5–4 mg/d; ↑ by increments of 0.5–2 mg/d at 1-wk intervals up to 24 mg/d ÷ bid ACTIONS: DOSAGE: 22 22 Commonly Used Medications 547 SUPPLIED: NOTES: Tabs 4, 8 mg... Life-threatening digoxin intoxication Antigen-binding fragments bind digoxin, rendering it inactive DOSAGE: Adults & Peds Based on serum level and patient’s weight See dosing charts provided with the drug SUPPLIED: Inj 38 mg/vial NOTES: Each vial binds ≅0.6 mg of digoxin; in renal failure, may require redosing in several days because of breakdown of the immune complex ACTIONS: 22 5 28 Clinician’s Pocket. .. (Anzemet) COMMON USES: ACTIONS: Prevention of nausea and vomiting associated with chemotherapy 5-HT3 receptor antagonists 22 530 Clinician’s Pocket Reference, 9th Edition DOSAGE: Adults & Peds 1 .8 mg/kg IV as a single dose 30 min prior to chemotherapy Adults 100 mg PO as a single dose 1 h prior to chemotherapy Peds 1 .8 mg/kg PO to max 100 mg as a single dose SUPPLIED: Tabs 50, 100 mg; Inj 20 mg/mL NOTES:... DOSAGE: See also Aminoglycoside dosing (page 620) Adults 3–5 mg/kg/24h IV ÷ q8–24h Peds Infants 7 d: 2.5 mg/kg/dose IV q8–12h Children: 2.5 mg/kg/d IV q8h SUPPLIED: Inj 10, 40 mg/mL, IT preservative-free 2 mg/mL NOTES: Nephrotoxic and ototoxic; ↓ dose with renal insufficiency; monitor CrCl and serum concentration for dosage... localized prostate cancer; endometriosis ACTIONS: Slow-release form of LHRH agonist, thereby inhibiting the release of gonadotropin, decreasing testosterone levels DOSAGE: 3.6 mg SC (implant) q 28 d or 10 .8 mg SC q 3 mo SUPPLIED: Subcutaneous implant 3.6, 10 .8 mg NOTES: Toxicity symptoms: Hot flashes, ↓ libido, gynecomastia, and transient exacerbation of cancer-related bone pain (“flare reaction” 7–10 d after... of the dose at 8 12 h Maintenance: 6–10 µg/kg/24h PO or 5 8 µg/kg/24h ÷ q12h 1 mo–2 y: Digitalization: 35–60 µg/kg PO or 30–50 µg/kg IV; give 1⁄2 the dose initially, then 1⁄4 of the dose at 8 12h intervals for 2 doses Maintenance: 10–15 µg/kg/24h PO or 7.5–15 µg/kg/24h IV ÷ q12h 2–10 y: Digitalization: 30–40 µg/kg PO or 25 µg/kg IV; give 1⁄2 dose initially, then 1⁄4 of the dose at 8 12-h intervals for . Atropine-type side effects Dipivefrin (Propine) COMMON USES: Open-angle glaucoma ACTIONS: α-Adrenergic agonist DOSAGE: 1 gtt into eye q12h SUPPLIED: 0.1% soln 5 28 Clinician’s Pocket Reference, . 0.1, 0.2, 0.3 mg, respectively, of cloni- dine/d for 1 wk) NOTES: Doses >2 TTS-3 usually not associated with increased efficacy 5 18 Clinician’s Pocket Reference, 9th Edition 22 Clopidogrel (Plavix) COMMON. mg/kg SC q12h or 1.5 mg/kg SC q24h. Angina: 1 mg/kg SC q12h SUPPLIED: Inj 10 mg/0.1 mL (3 0-, 4 0-, 6 0-, 8 0-, 100-mg syringes) NOTES: Does not significantly affect bleeding time, platelet function,