Dactinomycin
Trade Name(s): Cosmegen
Pregnancy Category: C
Medical Category: Antineoplastic
Accepted Indications:
Unaccepted Indications: Infectious diseases
Mechanism of Action: May bind with DNA by intercalation
Absorption/Distribution: Does not cross blood-brain barrier
Half life: 36 h
Metabolism: Minimal
Elimination: Biliary, fecal, renal
Adult Dosage: IV, 10–{endash}15 m{mu}g/kg/d for maximum of 5 d every 4–{endash}6 w
Elderly Dosage: Same as adult dose
Child Dosage: Same as adult dose
Infant Dosage: Not recommended
Dosage Forms: Injection: 0.5 mg
Warnings: Do not expose to skin
Frequent Side Effects: Skin darkening, acne, anemia, GI, ulceration, leukopenia, thrombocytopenia, ulcerative stomatitis, nausea, vomiting, skin redness, unusual tiredness
Occasional Side Effects: Hair loss
Rare Side Effects: Bone marrow depression, anaphylaxis, phlebitis, hepatotoxicity, hyperuricemia
Contraindications: Bone marrow depression, chickenpox, herpes zoster
Disease States: Infection, liver impairment
Other Drugs: Radiation therapy, probenecid, sulfinpyrazone, bone marrow depressants, live virus vaccines
Lab Tests: Hemocrit, platelet count
Danazol
Trade Name(s): Danocrine
Chemically Related To: Androgens
Pregnancy Category: X
Medical Category: Gonadotropin inhibition
Accepted Indications: Endometriosis, fibrocystic breast disease
Mechanism of Action: Inhibits output of FSH and LH, reducing ovarian estrogen production
Half life: 4.5 h (variable)
Metabolism: Hepatic
Elimination: Renal
Research Notes: Ovulation and cyclic bleeding usually returns 60–{endash}90 d after therapy is discontinued
Adult Dosage: Up to 800 mg/d
Elderly Dosage: Treatment of elderly male patients increases risk of prostatic hypertrophy or prostatic carcinoma
Child Dosage: Not established
Infant Dosage: Not established
Dosage Forms: Capsules: 50 mg, 100 mg, and 200 mg
By System: Endocrine
Warnings: May alter blood glucose levels
Precautions: May cause photosensitivity reactions
Frequent Side Effects: Amenorrhea, decreased breast size, weight gain, irregular menstrual periods
Occasional Side Effects: Edema, muscle cramps, acne, oily skin and hair
Rare Side Effects: Blood in urine, bleeding gums, cataracts, carpal tunnel syndrome, leukocytosis, testicular atrophy, photosensitivity, vaginal burning or itching
Disease States: Cardiac impairment, epilepsy, migraine headache, renal and hepatic impairment, diabetes mellitus, vaginal bleeding
Other Drugs: Anticoagulants, oral antidiabetic agents, insulin, cyclosporine
Lab Tests: Blood pressure, cholic acid concentration, glucose tolerance, HDLs, blood glucose concentration, thyroid function
Administrative Notes: In the treatment of endometriosis and fibrocystic breast disease, it is recommended that therapy begin on the first day of the menstrual cycle after pregnancy has been ruled out
Dantrolene Sodium
Trade Name(s): Dantrium
Chemically Related To: EDTA
Pregnancy Category: Not documented
Medical Category: Malignant hyperthermia therapy; antispastic; Duchenne muscular dystrophy therapy adjunct
Accepted Indications: Malignant hyperthermia, spasticity
Unaccepted Indications: Muscle spasm caused by rheumatic disorders
Mechanism of Action: Interferes with release of Ca2+{plus}, reducing increase in myoplasmic Ca2+{plus} concentration that is associated with malignant hyperthermia and muscle spasms
Half life:
IV: 5 h
Metabolism: Hepatic
Elimination: Renal
Adult Dosage: 25–{endash}400 mg/d
Child Dosage: Up to 400 mg/d
Infant Dosage: Same as child dose
Dosage Forms: Capsules: 25 mg, 50 mg, and 100 mg; injection: 20 mg
By System: CNS, skeletal
Warnings: May cause drowsiness
Precautions: Avoid alcohol
Frequent Side Effects: Mild diarrhea, dizziness, drowsiness, muscle weakness, nausea and vomiting, extreme tiredness
Occasional Side Effects: Severe diarrhea, respiratory depression, abdominal or stomach cramps, blurred or double vision, chills, fever
Contraindications: Hepatic disease
Antidotal Therapy: May include supportive therapy
Disease States: Cardiac, hepatic and pulmonary function impairment, pre-existing myopathy, neuromuscular disease
Other Drugs: CNS depressants, calcium channel blockers
Lab Tests: Liver function
Administrative Notes: Must be discontinued if symptoms of hepatitis develop during therapy
Daunorubicin Hydrochloride
Trade Name(s): Cerubidine
Pregnancy Category: D
Medical Category: Antineoplastic
Accepted Indications: Acute leukemia,
Mechanism of Action: Antibacterial/immunosuppressant
Absorption/Distribution: Rapidly distributed, does not cross blood-brain barrier
Half life: 45 min (distribution), 18.5 h (elimination)
Metabolism: Hepatic
Elimination: Biliary
Adult Dosage: Acute lymphocytic leukemia: IV: 45 mg/m2 on d 1–{endash}3 of 32 d course (and possibly d 1–{endash}2 of second course) in combination with vincristine, prednisone, asparaginase, and/or cytarabine. Lifetime maximum of 550 mg/m2.
Elderly Dosage: 60 y and older: IV, 30 mg/m2, as in adult administration
Child Dosage: IV, 25 mg/m2 once/w in combination with vincristine and prednisone
Infant Dosage: Not established
Dosage Forms: Injection: 20 mg
Frequent Side Effects: Stomatitis, leukopenia, esophagitis, infection, nausea, vomiting, hair loss, reddish urine
Occasional Side Effects: Cardiotoxicity in form of CHF, extravasation, hyperuricemia, thrombocytopenia, skin darkening, diarrhea
Rare Side Effects: Pericarditis/myocarditis, allergic reaction
Contraindications: Bone marrow depression, chickenpox, herpes zoster, heart disease
Disease States: Gout, infection, hepatic function impairment
Other Drugs: Probenecid, live virus vaccines, sulfinpyrazone, bone marrow depressants
Lab Tests: Chest x-ray, EKG, platelet count
Deferoxamine Mesylate
Trade Name(s): Desferal
Pregnancy Category: C
Medical Category: Chelating agent
Accepted Indications: Acute iron toxicity, chronic iron toxicity, aluminum toxicity
Unaccepted Indications: Removal of iron deposits from cornea and subconjunctiva
Mechanism of Action: Binds with iron to form ferrioxamine
Absorption/Distribution:
Half life: 1 h (distribution), 6 h (elimination)
Metabolism: Unknown
Elimination: Renal, fecal
Adult Dosage: Acute iron toxicity: IM, initially 90 mg/kg, followed by 45 mg/kg up to maximum of 1 g/dose q4–{endash}12h, not to exceed 6 g/d
Elderly Dosage: Use with caution
Child Dosage: Under 3 y: IV, 15 mg/kg/h. 3 y and over: same as adult dose.
Infant Dosage: Under 3 y: IV, 15 mg/kg/h
Dosage Forms: Sterile injection: 500 mg
Warnings: May be stored for only 1 w
Frequent Side Effects: Auditory neurotoxicity, tachycardia, shock, allergic reaction, seizures, flushing, ocular toxicity, pain at site of injection, respiratory distress syndrome
Occasional Side Effects: Diarrhea, difficult urination, fever, hypocalcemia, leg cramps, thrombocytopenia, urine color change
Contraindications: Anuria, renal disease, oliguria
Other Drugs: Ascorbic acid, epoetin
Lab Tests: Total iron-binding capacity, ferritin concentrations
Demeclocycline Hydrochloride
Trade Name(s): Declomycin
Chemically Related To: Tetracycline
Pregnancy Category: D
Medical Category: Antibacterial, diuretic
Accepted Indications: Acne, actinomycosis, anthrax, bronchitis, brucellosis, conjunctivitis, GI infections, psittacosis, Q fever, typhus
Mechanism of Action: Inhibits cell protein synthesis
Absorption/Distribution: 66% absorbed
Half life: 10–{endash}17 h
Metabolism: Hepatic
Elimination: Renal, fecal
Research Notes: Onset of action in SIADH, 24–{endash}48 h
Adult Dosage: 150 mg q.i.d. up to 2.4 g/d
Elderly Dosage: No specific information known
Child Dosage: Up to 8 y: not recommended because may cause permanent discoloration of teeth; 8 y and over: 1.65–{endash}3.3 mg/kg q.i.d.
Infant Dosage: Not recommended because may cause permanent discoloration of teeth
Dosage Forms: Capsules: 150 mg; tablets: 150 mg and 300 mg
By System: Release of ADH
Warnings: May cause photosensitivity; may interfere with oral contraception
Precautions: Take entire prescription even if symptoms disappear
Frequent Side Effects: Discoloration of children's teeth, photosensitivity, CNS toxicity
Occasional Side Effects: Nephrogenic diabetes insipidus, discolored tongue
Rare Side Effects: Liver problems, pancreatitis
Disease States: Kidney or liver problems, nephrogenic diabetes insipidus
Nutrition: Do not take within 3 h after consumption of milk and other dairy products
Other Drugs: Antacids, calcium supplements, cholestyramine, penicillins, estrogen–{endash}containing contraceptives, vitamin A
Lab Tests: BUN, bilirubin, catecholamines
Deserpidine/Methyclothiazide
Trade Name(s): Enduronyl
Pregnancy Category: C
Medical Category: Antihypertensive
Accepted Indications: Hypertension
Adult Dosage: ½–{endash}1 tablet/d as determined by individual titration
Child Dosage: Not established
Dosage Forms: Tablets: 0.25 mg/5 mg and 0.5 mg/5 mg
Warnings: Elderly may be more sensitive to drug's effects
Desipramine Hydrochloride
Trade Name(s): Norpramin
Chemically Related To: Tricyclic depressants
Pregnancy Category: C
Medical Category: Antidepressant
Accepted Indications: Mental depression; anxiety, neurogenic pain; attention deficit disorder; narcolepsy; bulimia; cocaine withdrawal
Mechanism of Action: Predominantly inhibits the reuptake of norepinephrine
Absorption/Distribution: Rapidly absorbed
Half life: 12–{endash}24 h
Peak activity: Onset of action, 2-3 w
Metabolism: Hepatic
Elimination: Renal over several days
Research Notes: Not dialyzable
Adult Dosage: 100–{endash}300 mg/d
Elderly Dosage: Up to 150 mg/d
Child Dosage: 6–{endash}12 y: 1–{endash}5 mg/kg, adolescents: 25-100 mg/d
Dosage Forms: Tablets:10 mg, 25 mg, 50 mg, 75 mg, 100 mg, and 150 mg
By System: CNS
Precautions: Children are more sensitive to acute overdosage (potentially fatal) than adults
Frequent Side Effects: Anticholinergic effects, nausea, weight gain, dizziness
Occasional Side Effects: Diarrhea, excessive sweating, heartburn, arrhythmia, nervousness
Rare Side Effects: Agranulocytosis, alopecia, anxiety, cholestatic jaundice, galactorrhea, seizures, SIADH, tinnitus
Overdosage: Confusion, convulsions, drowsiness, enlarged pupils, tachycardia or bradycardia, fever, hallucinations, vomiting
Disease States: Alcoholism, asthma, bipolar disorder, blood disorders, cardiovascular disorders, GI disorders, glaucoma, hepatic or renal function impairment, hyperthyroidism, schizophrenia, seizure disorders, urinary retention
Other Drugs: Alcohol, CNS depressants, antithyroid agents, cimetidine, clonidine, guanadrel, guanethidine, phenothiazines, metrizamide, MAO inhibitors, sympathomimetics
Lab Tests: Metyrapone test
Administrative Notes: May cause photosensitivity; avoid alcoholic beverages
Desmopressin Acetate
Trade Name(s): DDAVP, Stimate
Chemically Related To: Biogenic peptide
Pregnancy Category: B
Medical Category: Antidiuretic (central diabetes insipidus, primary nocturnal enuresis), antihemorrhagic
Accepted Indications: Central diabetes insipidus, primary nocturnal enuresis, hemophilia A, von Willebrand's disease
Mechanism of Action: Increases permeability of renal tubular epithelium to water
Absorption/Distribution: Less than 20% absorbed from nasal mucosa
Half life: Fast phase, 7.8 min; slow phase, 75.5 min
Peak activity: Intranasal 1–{endash}5 h
Metabolism: Renal
Elimination: Renal
Research Notes: Onset of action as an antihemorrhagic is within several min, 15–{endash}30 min for von Willebrand factor levels, if given IV
Adult Dosage: Maintenance: 10–{endash}40 m{mu}g/d
Elderly Dosage: Restrict of fluid intake
Child Dosage: 3 m–{endash}12 y: maintenance: 2–{endash}4 m{mu}g/kg/d
Infant Dosage: Up to 3 m: not established
Dosage Forms: Nasal solution: 10 and 100 m{mu}g, injection: 4 m{mu}g/mL
By System: Cardiovascular
Occasional Side Effects: Abdominal cramps, headache, nausea
Rare Side Effects: Pain in vulva, hypertension, water intoxication
Antidotal Therapy: May include reduction of dosage, furosemide
Disease States: Allergic rhinitis, nasal congestion, coronary artery disease
Other Drugs: Lithium, norepinephrine, clofibrate, carbamazepine, demeclocycline
Administrative Notes: Refrigerate nasal solution
Desonide
Trade Name(s): Desowen, Tridesilon
Chemically Related To: Corticosteroids
Pregnancy Category: C
Medical Category: Steroidal anti-inflammatory
Accepted Indications: Skin disorders, contact dermatitis, eczema, pruritus, psoriasis, xerosis
Unaccepted Indications: Acne
Mechanism of Action: Augments synthesis of inhibitory enzymes responsible for anti-inflammatory action
Absorption/Distribution: Absorbed systemically and transdermally
Metabolism: Hepatic
Elimination: Renal
Adult Dosage: Topical to skin b.i.d. to q.i.d.
Elderly Dosage: Watch frequency because of skin atrophy
Child Dosage: Topical to skin once daily
Infant Dosage: Same as child dose
Dosage Forms: Cream: 0.05%; ointment: 0.05%
By System: Dermal
Warnings: For external use only; do not use in and around the eyes
Precautions: Do not bandage the treated skin area
Occasional Side Effects: Burning sensation, dryness, irritation, itching, rash
Rare Side Effects: Acneiform eruptions, cataracts, Cushing's syndrome, hirsutism, contact dermatitis, numbness in fingers
Disease States: Infection, pre-existing skin atrophy, cataracts, diabetes mellitus, glaucoma, tuberculosis
Lab Tests: Glucose, total eosinophil count, corticotropin test
Desoxyribonuclease
Trade Name(s): Not available a a single agent
Chemically Related To: Nucleic acids; proteolytic enzyme extracted from bovine pancreas
Medical Category: Skin and mucous membrane agent; debridement agent
Accepted Indications: Skin lesions, wounds, vaginitis, irrigating agent
Mechanism of Action: Attacks DNA in blood clots and fibrinous wound exudate
Desoxyribonuclease/Fibrinolysin
Trade Name(s): Elase
Medical Category: Topical debridement enzyme
Accepted Indications: Debridement of surgical wounds, ulcerative lesions, second- and third-degree burns, circumcision episiotomy; cervicitis and vaginitis; infected wounds, otorhinolaryngologic wounds, superficial hematomas
Adult Dosage: Adjusted on individual basis
Elderly Dosage: Adjusted on individual basis
Child Dosage: Adjusted on individual basis
Infant Dosage: Adjusted on individual basis
Dosage Forms: Ointment: 666.6 units/1 unit/g; lyophilized powder: 15,000 units/25 units/30 mL vial
By System: Dermal
Dexamethasone
Trade Name(s): Aeroseb-Dex, A/K-Dex, Baldex, Decaderm, Decadron, Decaspray, Dexair, I-Methasone, Maxidex, Ocu-Dex
Chemically Related To: Beclomethasone
Pregnancy Category: C
Medical Category: Corticosteroid, inhalation anti-inflammatory, nasal steroidal anti-inflammatory, ophthalmic steroidal anti-inflammatory; otic steroidal anti-inflammatory, topical steroidal anti-inflammatory
Accepted Indications: Psoriasis, eczema, xerosis, mild to moderate atopic dermatitis, intertrigo, lichen planus, contact dermatitis, ophthalmic disorders, chronic bronchial asthma, rhinitis, nasal allergic disorders, nasal inflammatory conditions, nasal polyps, otitis externa, infective otitis, polymorphous light eruption, pruritus
Unaccepted Indications: Acne, gingivitis, acute bronchospasm, non-asthmatic bronchitis, degenerative ocular disorders
Mechanism of Action: Stimulates synthesis of DNA and inhibitory enzymes that stabilize cell membranes responsible for inflammation
Absorption/Distribution: Rapidly and extensively absorbed from nasal mucosa; readily absorbed from GI mucosa; absorbed into aqueous humor, cornea, iris, choroid ciliary body, and retina; absorbed systemically across the stratum corneum
Half life: 190 min
Peak activity: 1–{endash}2 h
Metabolism: Hepatic
Elimination: Renal
Adult Dosage: Nasal aerosol: initially 200 m{mu}g in each nostril b.i.d. or t.i.d., dosage decreased according to response; ophthalmic suspension: topical, to the conjunctiva, 1–{endash}2 drops 4–{endash}6 times/d; sodium phosphate ophthalmic ointment: topical, to the conjunctiva, a thin strip t.i.d. or q.i.d.; sodium phosphate ophthalmic solution: topical, to the conjunctiva, 1–{endash}2 drops up to 6 times/d; topical, to the skin, t.i.d. or q.i.d.; topical aerosol: topical, to the skin, b.i.d. to q.i.d.; cream: topical, to the skin, t.i.d. to q.i.d.; tablets: 500 m{mu}g–{endash}9 mg/d
Elderly Dosage: Reduce dosage because of pre-existing skin atrophy; ophthalmic suspension, sodium phosphate ophthalmic ointment and sodium phosphate ophthalmic solution: same as adult dose
Child Dosage: Nasal aerosol: under 6 y: not recommended; 6–{endash}12 y: 100–{endash}200 m{mu}g in each nostril b.i.d.; ophthalmic suspension, sodium phosphate ophthalmic ointment and sodium phosphate ophthalmic solution: same as adult dose; gel: topical to the skin 0.1% once daily or b.i.d.; topical aerosol: topical, to the skin, 0.01% or 0.04% once daily or b.i.d.; cream: topical to the skin, once daily
Infant Dosage: Same as child dose
Dosage Forms: Gel: 0.1%; aerosol: 0.01% and 0.04%; inhalation aerosol: 100 m{mu}g/metered spray; sodium phosphate nasal aerosol: 100 m{mu}g/metered spray; ophthalmic suspension: 0.1%; sodium phosphate ophthalmic ointment: 0.05%; sodium phosphate ophthalmic solution: 0.1%; cream: 0.1%
By System: Dermal, respiratory
Warnings: Topical forms for external use only
Precautions: If symptoms do not improve within 1 w or become worse, contact physician; do not bandage or otherwise wrap skin areas treated with topical forms
Frequent Side Effects: Cough, dry mouth, dysphonia, throat irritation, blurred vision
Occasional Side Effects: Contact dermatitis, numbness in fingers, purpura, skin atrophy, oropharyngeal candidiasis, dry throat, headache, nausea, skin bruising, unpleasant taste, crusting inside nose, sore throat, sores inside nose, allergic reaction, sneezing, corneal thinning, secondary ocular infection, burning or stinging of eyes or ears, secondary skin infection
Rare Side Effects: Acneiform eruptions, cataracts, Cushing's syndrome, glaucoma, hirsutism, increased bronchospasm, esophageal candidiasis, nasal candidiasis, nasal septal perforation, ocular hypertension, menstrual changes, perioral dermatitis, ecchymosis, edema, gastric ulcer, hypertension, hypopigmentation, skin maceration, unusual scalp hair loss
Contraindications: Diabetes, systemic infections
Antidotal Therapy: May include proper withdrawal and dosage decreasing methods
Disease States: Infection at treatment site, pre-existing skin atrophy, cataracts, glaucoma, tuberculosis, osteoporosis, ocular herpes simplex, ocular fungal diseases, herpes simplex keratitis, acute viral disease, aural fungal diseases, chronic otitis media, perforation of eardrum membrane, acute ear infection
Other Drugs: Antiglaucoma agents, anticholinergics, contact lenses
Lab Tests: Glucose, total eosinophil count, adrenal function as assessed by corticotropin, nitroblue tetrazolium test for bacterial infection, hypothalamic-pituitary-adrenal axis function
Dexamethasone Sodium Phosphate
Trade Name(s): AK-Dex, Baldex, Decadron, Maxidex, OcuDex
Chemically Related To: Corticosteroids
Pregnancy Category: C
Medical Category: Adrenocorticoid (ophthalmic); anti-inflammatory (steroidal), ophthalmic
Accepted Indications: Treatment of ophthalmic disorders
Unaccepted Indications: Degenerative ocular disorders
Mechanism of Action: Inhibits mediators of inflammation
Absorption/Distribution: Absorbed into aqueous humor, cornea, iris, ciliary body, and retina. Some small systemic absorption can occur
Research Notes: Long-term therapy should be avoided
Adult Dosage: Topical to conjunctiva t.i.d. or q.i.d.
Elderly Dosage: See adult dose
Child Dosage: See adult dose
Infant Dosage: Use with caution in children under 2 y
Dosage Forms: Ophthalmic ointment .05%, ophthalmic solution .1%
By System: Ocular
Warnings: For the eye; do not contaminate applicator tip
Precautions: Have ophthalmological examinations during long-term therapy
Frequent Side Effects: Mild blurred vision
Occasional Side Effects: Optic nerve damage, ocular hypertension, corneal thinning, secondary ocular infection
Rare Side Effects: Burning, redness, or watering of eyes
Contraindications: Ocular fungal disorders, herpes simplex, ocular TB, acute viral disease
Antidotal Therapy: May include dilution with fluids
Disease States: Cataracts, diabetes mellitus, thinning of cornea, infections of cornea, chronic glaucoma
Other Drugs: Antiglaucoma agents, anticholinergics, contact lenses
Administrative Notes: Dispense in original unopened container
Dexamethasone Sodium Phosphate/Neomycin Sulfate (Ophthalmic)
Trade Name(s): Ak-Neo-Dex, Neodecadron, Neo-Dex, Neo Dexair
Medical Category: Topical anti-infective
Accepted Indications: Inflammatory ocular conditions; conjunctivitis; chronic anterior uveitis and corneal injury from chemical, radiation, or thermal burns or from penetration by foreign bodies
Adult Dosage: Ointment: thin coating in eye t.i.d.–{endash}q.i.d.; solution: initial dose, 1–{endash}2 drops in eye/h during day and q2h at night, reduce to 1 drop q4h
Dosage Forms: Ophthalmic solution: 1 mg/3.5 mg/mL; ophthalmic ointment: 0.05 mg/3.5 mg/g
Dexamethasone/Neomycin Sulfate/Polymyxin B Sulfate
Trade Name(s): Ak-Trol, Dexacidin, Dex-Ide, Dexamycin, Dexasporin, Maxitrol, Ocu-Trol
Pregnancy Category: Adequate studies have not been done
Medical Category: Topical anti-infective
Accepted Indications: Inflammatory ocular conditions; conjunctivitis; chronic anterior uveitis and corneal injury from chemical, radiation, or thermal burns or from penetration by foreign bodies
Adult Dosage: Suspension: 1–{endash}2 drops in conjunctival sac q3–{endash}4h; ointment: small amount in conjunctival sac q3–{endash}4h
Dosage Forms: Ophthalmic ointment: 0.1%/0.35%/10,000 units/g; ophthalmic suspension: 0.1%/0.35%/10,000 units/mL
Dexamethasone/Tobramycin
Trade Name(s): Tobradex
Medical Category: Topical anti-infective
Accepted Indications: Inflammatory ocular conditions; conjunctivitis; chronic anterior uveitis and corneal injury from chemical, radiation, or thermal burns or from penetration by foreign bodies
Adult Dosage: Suspension: 1–{endash}2 drops q4–{endash}6h; ointment: small amount up to t.i.d.–{endash}q.i.d.
Child Dosage: Safety and effectiveness not established
Dosage Forms: Ointment: 0.1%/0.3%; suspension: 0.1%/0.3%
Dexchlorpheniramine Maleate
Trade Name(s): Dexchlor, Poladex, Polaramine, Polaramine Repetabs
Chemically Related To: Diphenhydramine
Pregnancy Category: B
Medical Category: Antihistaminic (H1-receptor)
Accepted Indications: Rhinitis, conjunctivitis, pruritus, urticaria, angioedema, urticarial transfusion reactions, sneezing, rhinorrhea
Mechanism of Action: Competes with histamine for receptor site
Absorption/Distribution: Well absorbed
Half life: 20 h
Metabolism: Hepatic
Elimination: Renal
Adult Dosage: 2–{endash}24 mg/d
Elderly Dosage: May be more sensitive to the effects of usual adult dosage
Child Dosage: 2–{endash}4 mg/d
Dosage Forms: Tablets: 2 mg; syrup: 2 mg/5 mL; extended-release tablets: 4 mg and 6 mg
By System: Respiratory
Warnings: May cause drowsiness; avoid alcohol
Precautions: May mask ototoxic effects of large doses of salicylates; dry mouth possible
Frequent Side Effects: Drowsiness, thickening of mucus
Occasional Side Effects: Blood dyscrasias, cardiac arrhythmias
Rare Side Effects: Blurred vision, confusion, difficulty in urination, dizziness, dry mouth, tachycardia, increased sweating, loss of appetite, photosensitivity, tinnitus, rash
Contraindications: Impairment of hepatic function
Overdosage: Anticholinergic effects, cardiac arrhythmias, hallucinations
Antidotal Therapy: May include symptomatic and supportive treatment
Disease States: Urinary retention, bladder neck obstruction, glaucoma, prostatic hypertrophy
Other Drugs: CNS depressants, anticholinergics, erythromycin, MAO inhibitors, ototoxic medications, photosensitizing medication
Lab Tests: Skin tests with allergen extracts
Dexchlorpheniramine/Guaifenesin/Pseudoephedrine
Trade Name(s): Polaramine Expectorant
Pregnancy Category: C
Medical Category: Antihistamine, decongestant, expectorant
Accepted Indications: Allergies, colds
Adult Dosage: 5–{endash}10 mL q6–{endash}8h
Child Dosage: 2–{endash}6 y: 1.25–{endash}2.5 mL; 6–{endash}12 y: 2.5–{endash}5 mL q6–{endash}8h
Dosage Forms: Oral solution: 2 mg/100 mg/20 mg
Dextran
Trade Name(s): Dextran 40, Dextran 70, Dextran 75
Chemically Related To: Glucose
Pregnancy Category: C
Medical Category: Fluid replacement preparation
Accepted Indications: Early fluid replacement, plasma volume expander, venous thrombosis (prophylaxis), pulmonary embolism, poor circulation
Mechanism of Action: Expands plasma volume, provides fluid replacement
Elimination: Renal, fecal
Research Notes: Use of dextran sulfate sodium in treatment of AIDS is under sponsor Ueno Fine Chemicals Industry, Ltd., of
Adult Dosage: Dextran 40: 10 mL/kg initially, up to 20 mL/kg in first 24 h; Dextran 70 and 75: 500–{endash}1000 mL IV, not to exceed 20 mL/kg in first 24 h
Child Dosage: Do not exceed 20 mL/kg (total dosage)
Dosage Forms: Dextran 40: parenteral injection for IV 10%; Dextran 70: parenteral injection for IV 6%; Dextran 75: parenteral injection for IV 6%
Warnings: Assess hydration before beginning therapy
Precautions: Monitor urine flow; check hemoglobin and hematocrit
Side/Adverse Effects: Nausea/vomiting, urticaria, fever, nasal congestion, anaphylaxis, wheezing, tightness in the chest, mild hypotension
Contraindications: Pulmonary edema, kidney problems, extreme dehydration
Disease States: Hemorrhage, heart problems
Lab Tests: Blood glucose determinations, tests with turbidimetric measurements
Administrative Notes: These compounds do not contain preservatives; therefore, partially used containers should be discarded
Dextroamphetamine Sulfate
Trade Name(s): Dexedrine
Scheduled Class: II
Pregnancy Category: C
Accepted Indications: Narcolepsy, attention deficit disorder (ADD)
Unaccepted Indications: Appetite suppressants, fatigue, rest replacement
Mechanism of Action: Increased motor activity and alertness
Half life: 10–{endash}12 h
Metabolism: Hepatic
Elimination: Renal
Adult Dosage: 5–{endash}60 mg once daily or in divided doses
Elderly Dosage: Same as adult dose
Child Dosage: ADD: under 3 y: not recommended; 3–{endash}6 y: 2.5 mg once daily, dose increased as needed; 6 y and over: 5 mg once daily, dose increased as needed. Narcolepsy: under 3 y: not recommended; 3–{endash}6 y: not established; 6–{endash}12 y: 5 mg once daily, dose increased as needed; 12 y and over: 10 mg once daily, dose increased as needed
Infant Dosage: Not recommended
Dosage Forms: Capsules: 5 mg, 10 mg, and 15 mg; tablets: 5 mg and 10 mg
Frequent Side Effects: CNS stimulation, arrhythmia, irritability, nervousness
Occasional Side Effects: Blurred vision, dizziness, diarrhea, constipation, anorexia, stomach cramps, nausea, headache, dry mouth, increased sweating, unpleasant taste
Rare Side Effects: Chest pain, Tourette's syndrome, changes in libido, tachycardia, hyperthermia
Contraindications: Arteriosclerosis, glaucoma, hypertension, drug abuse, Tourette's syndrome
Antidotal Therapy: May include emesis, gastric lavage, IV fluids
Disease States: Agitation, cardiovascular disease, hyperthyroidism
Other Drugs: Acidifiers, meperidine, MAO inhibitors, beta-blockers, CNS stimulants, thyroid hormones, tricyclic antidepressants, digitalis glycosides
Lab Tests: Urinary steroid determinations
Dextromethorphan Hydrobromide
Trade Name(s): Benylin DM, Children's Hold, Creo-Terpin, Drixoral Cough Liquid Tablets, Hold, Pertussin CS, Pertussin ES, Robitussin Cough Calmers, Robitussin Pediatric, Sucrets Cough Control, Vicks Formula 44-Pediatric
Chemically Related To: Levorphanol
Pregnancy Category: Problems in humans not documented
Medical Category: Antitussive
Accepted Indications: Cough
Unaccepted Indications: Chronic cough associated with smoking, emphysema, or asthma
Mechanism of Action: Acts on cough center in medulla oblongata
Absorption/Distribution: Rapidly absorbed
Metabolism: Hepatic
Elimination: Renal
Research Notes: Onset of action usually within 0.5 h; duration of action, up to 6 hours
Adult Dosage: 10–{endash}20 mg/4 h to 120 mg/d
Elderly Dosage: Same as adult dose
Child Dosage: 2–{endash}6 y: 2.5–{endash}5 mg/4 h, not to exceed 30 mg/d; 6-12 y: 5–{endash}10 mg/4 h, not to exceed 60 mg/d
Infant Dosage: Up to 2 y: not recommended
Dosage Forms: Lozenges: 5 mg and 7.5 mg; syrup: USP 3.5 mg/5 mL, 7.5 mg/5 mL, 10 mg/5 mL, 15 mg/5 mL; chewable tablets: 15 mg; capsules: 30 mg
By System: Respiratory
Warnings: Chew chewable tablets well before swallowing
Precautions: Check with physician if cough continues for more than 7 d
Occasional Side Effects: Dizziness, drowsiness, GI upset
Overdosage: Confusion, drowsiness, nausea/vomiting, excitement, nervousness, irritability
Antidotal Therapy: May include naloxone HCl, supportive measures
Disease States: Asthma, liver problems, atopy (in children)
Other Drugs: CNS depressants, MAO inhibitors, penicillins, tetracyclines, salicylates, phenobarbital
Dextromethorphan Hydrobromide/Iodinated Glycerol
Trade Name(s): Iodur DM, Iophen DM, Tusso-DM
Pregnancy Category: X
Medical Category: Antitussive, expectorant
Adult Dosage: 5–{endash}10 mL q4h
Child Dosage: 2–{endash}6 y: 1.25–{endash}2.5 mL; 6–{endash}12 y: 2.5–{endash}5 mL q4h
Dosage Forms: Liquid: 10 mg/30 mg/5 mL; oral solution: 10 mg/30 mg/5 mL
Dextromethorphan Hydrobromide/Promethazine Hydrochloride
Trade Name(s): Phenameth DM, Phenergan with Dextromethorphan, Pherazine DM, Prometh with Dextromethorphan, Promethazine DM
Pregnancy Category: C
Medical Category: Antitussive, antihistamine
Accepted Indications: Cough and cold
Adult Dosage: 5 mL q4–{endash}6h up to 30 mL/d
Child Dosage: 2–{endash}6 y: 1.25–{endash}2.5 mL q4–{endash}6h up to 10 mL/d; 6–{endash}12 y: 2.5–{endash}5 mL q4–{endash}6h up to 20 mL/d
Dosage Forms: Syrup: 15 mg/6.25 mg/5 mL
Dezocine
Trade Name(s): Dalgan
Chemically Related To: Opioids
Pregnancy Category: C
Medical Category: Analgesic
Accepted Indications: Short-term pain
Unaccepted Indications: Chronic pain
Mechanism of Action: Opioid agonist/antagonist
Absorption/Distribution: Rapid and complete
Half life: IM: 2.2 h (elimination); IV: 1.7–{endash}2.8 h (elimination)
Peak activity: 1–{endash}2 h
IM: 10–{endash}90 min
Metabolism: Hepatic
Elimination: Renal
Adult Dosage: IM: 5–{endash}20 mg q3–{endash}6h; IV: 2.5–{endash}10 mg q2–{endash}4h
Elderly Dosage: Same as adult dose
Child Dosage: Up to 18 y: not established
Infant Dosage: Not established
Dosage Forms: Injection: 5 mg/mL, 10 mg/mL, and 15 mg/mL
Warnings: Avoid alcohol
Frequent Side Effects: Drowsiness, GI upset
Occasional Side Effects: CNS effects, flushing or redness of skin
Rare Side Effects: Difficult or decreased urination, arrhythmia, respiratory depression, chest pain, edema, hypertension, hypotension, thrombophlebitis, atelectasis, CNS toxicity
Contraindications: Asthma, respiratory disease, opioid dependence
Overdosage: Cold, clammy skin; severe dizziness; confusion, nervousness, restlessness, convulsions, drowsiness, hypotension, pinpoint pupils, troubled breathing, and weakness; bradycardia; unconsciousness
Antidotal Therapy: May include 0.4–{endash}2 mg naloxone, IV fluids
Disease States: Cardiovascular disease, emotional instability, recent GI surgery, head injury, liver and renal function impairment
Other Drugs: CNS depressants, naltrexone, opioid analgesics, monoamine oxidase inhibitor
Administrative Notes: May be habit forming
Diazepam
Trade Name(s): T-Quil, Valium, Vazepam
Chemically Related To: Benzodiazepines
Scheduled Class: IV
Abuse Potential: Mild
Pregnancy Category: C
Medical Category: Antianxiety agent, sedative-hypnotic, amnestic, anticonvulsant, skeletal muscle relaxant adjunct
Accepted Indications: Anxiety
Mechanism of Action: Depresses CNS at limbic and other levels of brain
Absorption/Distribution: Rapidly absorbed
Half life: 20–{endash}70 h
IM: 0.5–{endash}1.5 h
IV: Within 0.25 h
Metabolism: Hepatic
Elimination: Renal
Research Notes: Preanesthetic administration can impair recent memory
Adult Dosage: Oral solution: 2–{endash}10 mg b.i.d. to q.i.d.
Elderly Dosage: 2–{endash}2.5 mg once daily or b.i.d.
Child Dosage: 6 m and over: 1–{endash}2.5 mg t.i.d. or q.i.d.
Infant Dosage: Up to 6 m: not recommended
Dosage Forms: Extended-release capsules: 15 mg; oral solution: 5 mg/mL, 5 mg/5 mL; tablets: 2 mg, 5 mg, 10 mg; injection: 5 mg/mL; sterile emulsion; rectal solution
By System: CNS, subcortical nuclei
Warnings: May cause drowsiness; avoid alcohol
Frequent Side Effects: Clumsiness, dizziness, drowsiness, slurred speech, irritability, insomnia
Occasional Side Effects: Abdominal cramps, diarrhea, headache, trembling, tachycardia
Rare Side Effects: Blood dyscrasias, liver problems, seizures, hallucinations, withdrawal symptoms
Overdosage: Confusion, decreased reflexes, drowsiness, bradycardia, respiratory problems, slurred speech, staggering
Antidotal Therapy: May include emesis/gastric lavage, activated charcoal, oxygen and IV fluids, IV vasopressor, flumazenil
Disease States: Acute alcohol intoxication, coma, shock, convulsions, glaucoma, liver problems, mental depression, myasthenia gravis
Other Drugs: Erythromycin, antihypertensives, CNS depressants, zidovudine, levodopa, estrogen–{endash}containing contraceptives
Lab Tests: Metyrapone, sodium iodide
Administrative Notes: If IM injection used, penetrate deep into deltoid muscle
Diazoxide
Trade Name(s): Proglycem, Hyperstat
Chemically Related To: Thiazides
Pregnancy Category: C
Medical Category: Antihypoglycemic, antihypertensive
Accepted Indications: (Oral) hypoglycemia, (IV) hypertension
Unaccepted Indications: Chronic hypertension, functional hypoglycemia
Mechanism of Action: Inhibition of insulin release, arteriolar vasodilatation and decreased peripheral resistance
Absorption/Distribution: Rapidly absorbed; high protein binding
Half life: 20–{endash}36 h
IV: 2–{endash}5 min
Metabolism: Hepatic
Elimination: Renal; 50% unchanged
Research Notes:
Adult Dosage: Capsules and suspension: 1 mg/kg t.i.d., initially; 3–{endash}8 mg/kg/d, maintenance; injection: IV up to 150 mg, repeated every 5–{endash}15 min if necessary, up to 1.2 g/d
Elderly Dosage: Same as adult dose
Child Dosage: Capsules and oral suspension: same as adult dose; injection: 1–{endash}3 mg/kg, repeated in 5–{endash}15 min if necessary
Infant Dosage: Capsules and oral suspension, initial: 3.3 mg/kg t.i.d.; maintenance: 8–{endash}15 mg/kg/d
Dosage Forms: Capsules: 50 mg; oral suspension: 50 mg/mL, injection: 15 mg/mL
Precautions: Protect oral suspension and injection from freezing and from light, shake oral suspension well
Frequent Side Effects: Edema
Occasional Side Effects: Tachycardia, hyperglycemia, changes in ability to taste, ileus, loss of appetite, nausea, stomach pain, vomiting
Rare Side Effects: Allergic reaction, angina pectoris, ischemia, myocardial infarction, transient focal cerebral ischemic attacks, thrombocytopenia
Contraindications: Acute aortic dissection, coronary or cerebral insufficiency
Overdosage: Hyperglycemia, ketoacidosis
Antidotal Therapy: May include insulin, fluids, patient monitoring
Disease States: Gout, hypokalemia, renal function impairment, compensatory hypertension, inadequate cardiac reserve
Other Drugs: Hydantoin anticonvulsants, vasodilators, hypotension–{endash}producing medications
Lab Tests: Uric acid, hematocrit, glucose, BUN
Administrative Notes: Extrapyramidal effects and hypertrichosis may appear with long-term use
Dibucaine
Trade Name(s): Nupercainal
Pregnancy Category: Studies in humans have not been done
Medical Category: Local anesthetic, mucosal-local anesthetic
Accepted Indications: Minor skin disorders, anorectal disorders
Mechanism of Action: Blocks the initiation and conduction of nerve impulses
Absorption/Distribution: Readily absorbed through mucous membranes
Metabolism: Hepatic, renal
Elimination: Renal
Research Notes: Onset of action up to 15 min, duration of action 2–{endash}4 h
Adult Dosage: Topical, to the skin, t.i.d. or q.i.d.
Elderly Dosage: Same as adult dose
Child Dosage: Same as adult dose
Infant Dosage: Dosage must be individualized
Dosage Forms: Cream: 0.5%. Ointment: 1%.
Occasional Side Effects: Angioedema, dermatitis
Rare Side Effects: CNS depression, methemoglobinemia
Contraindications: Local infection, severe skin disorders
Antidotal Therapy: May include vasopressor, IV fluids
Dichloralphenazone
Trade Name(s): Not available as a single agent
Medical Category: Sedative, hypnotic
Mechanism of Action: Reduces emotional reaction to pain
Metabolism: Hepatic, renal
Elimination: Renal
Research Notes: A complex of chloral hydrate and antipyrine
By System: CNS
Dichlorphenamide
Trade Name(s): Daranide
Chemically Related To: Acetazolamide
Pregnancy Category: Problems not documented
Medical Category: Antiglaucoma agent
Accepted Indications: Glaucoma
Mechanism of Action: Carbonic anhydrase inhibitor. Decreases production of aqueous humor by decreasing bicarbonate ion concentration
Absorption/Distribution: Well absorbed
Research Notes: Onset of action, 0.5–{endash}1 h; duration of action, 6–{endash}12 h
Adult Dosage: Initial dose: 100–{endash}200 mg; maintenance: 25–{endash}50 mg 1–{endash}3 times daily
Elderly Dosage: Kidney problems may necessitate a reduction in dosage
Child Dosage: Not established
Infant Dosage: Not established
Dosage Forms: Tablets: 50 mg
By System: Aqueous humor
Warnings: May cause drowsiness or hypokalemia
Frequent Side Effects: Tiredness; diarrhea; increase in urination; loss of appetite; metallic taste; weight loss
Occasional Side Effects: Crystalluria, depression, dizziness
Rare Side Effects: Acidosis, blood dyscrasias, confusion, seizures, constipation, headache
Disease States: Adrenal gland failure, diabetes mellitus, respiratory acidosis, liver or kidney problems
Other Drugs: Quinidine, antidiabetic agents, anticholinergics, digitalis, diuretics
Lab Tests: Urine protein, blood glucose, serum potassium, plasma bicarbonate
Administrative Notes: If potassium supplement is required, dispense a supplement that does not contain chloride. Need ample fluid intake to prevent kidney stones; take with meals or food to lessen GI upset.
Diclofenac
Trade Name(s): Cataflam, Voltaren
Chemically Related To: Similar to aspirin
Pregnancy Category: B
Medical Category: Anti-inflammatory, analgesic, nonsteroidal
Accepted Indications: Rheumatic inflammations; bursitis and other nonrheumatic inflammations
Mechanism of Action: Decreases peripheral inflammatory mechanisms through prostaglandin inhibition
Absorption/Distribution: Well absorbed
Half life: Up to 6 h
Peak activity: 3 h
Metabolism: Hepatic
Elimination: Renal
Adult Dosage: 25–{endash}150 mg/d
Child Dosage: 2 mg/kg/d
Dosage Forms: Tablets: 25 mg, 50 mg, and 75 mg
By System: Anti-inflammatory analgesic (nonsteroidal) systemic
Warnings: May cause bronchoconstriction; elderly patients may require decreased dosage
Precautions: Caution in patients who must restrict sodium intake
Frequent Side Effects: Increased blood pressure, headache, weight gain, constipation, stomach cramps
Occasional Side Effects: GI bleeding; bloating; chest pain associated with angina; arrhythmia
Rare Side Effects: Bloody or cloudy urine, blurred vision, decreased hearing, altered liver function tests, renal impairment
Overdosage: GI distress, renal failure
Antidotal Therapy: May include emesis or gastric lavage, activated charcoal
Disease States: Blood dyscrasias; bone marrow depression; symptoms of nasal polyps
Other Drugs: Acetaminophen, adrenocorticoids, antidiabetics
Lab Tests: Liver function, serum uric acid concentrations
Dicloxacillin Sodium
Trade Name(s): Dycill, Dynapen, Pathocil
Chemically Related To: Penicillin
Pregnancy Category: B
Medical Category: Antibacterial
Accepted Indications: Pneumonia (staphylococcal), sinusitis, skin and soft tissue infections, biliary tract infections
Unaccepted Indications: Meningitis
Mechanism of Action: Bactericidal; inhibits bacterial cell wall synthesis
Absorption/Distribution: 37%–{endash}50% oral absorption, decreased by food; very high protein binding
Half life: 0.5–{endash}1 h
Metabolism: Hepatic
Elimination: Renal
Research Notes: Penicillinase-resistant penicillin
Adult Dosage: 1–{endash}6 g/d
Child Dosage: Up to 40 kg: 3.125–{endash}6.25 mg/kg/d; 40 kg and over: same as adult dosage
Infant Dosage: Neonates: not established; infants up to 40 kg: 3.125–{endash}6.25 mg/kg/d
Dosage Forms: Tablets: 125 mg, 250 mg, and 500 mg
Warnings: Do not take unprescribed antidiarrheals
Frequent Side Effects: GI reactions, oral candidiasis
Rare Side Effects: Unusual bleeding
Antidotal Therapy: No specific antidote
Disease States: Asthma, eczema, seasonal allergic rhinitis, hives, GI disease, infectious mononucleosis, kidney problems
Other Drugs: Anticoagulants, thrombolytic agents, potassium supplements, tetracyclines, estrogen–{endash}containing contraceptives, probenecid
Lab Tests: Coombs' test, aspartate aminotransferase
Administrative Notes: Patients with kidney problems may require a reduction in dose
Dicumarol
Trade Name(s): Generic only
Chemically Related To: Warfarin
Pregnancy Category: X
Medical Category: Anticoagulant
Accepted Indications: Thrombosis, thromboembolism, pulmonary embolism
Mechanism of Action: Inhibits vitamin K-dependent precursors that prevent the formation of active coagulation factors
Absorption/Distribution: Slowly and incompletely absorbed from GI tract
Half life: 1–{endash}4 d dose dependent
Metabolism: Hepatic
Elimination: Renal
Research Notes: Patient compliance is essential to the safe use of this medication
Adult Dosage: Oral 25–{endash}200 mg/d as indicated by prothrombin-time measurement
Elderly Dosage: Decrease dosage
Child Dosage: Not established
Infant Dosage: Not established
Dosage Forms: Tablets: 25 mg and 50 mg
By System: Liver cells
Warnings: Carry identification indicating use of anticoagulant; elderly may require decreased dosage
Precautions: Have regular prothrombin time tests; keep a record of missed doses
Frequent Side Effects: Diarrhea, bloated stomach or gas
Occasional Side Effects: Leukopenia, nausea or vomiting, stomach cramps, loss of appetite, unusual hair loss
Rare Side Effects: Acute adrenal insufficiency, agranulocytosis, hepatotoxicity, renal damage
Contraindications: Active bleeding, cerebrovascular hemorrhage, hemophilia, severe hypertension, major surgery
Overdosage: Bleeding from gums during tooth brushing; unexplained bruising; unexplained bleeding episodes
Antidotal Therapy: May include administration of vitamin K
Disease States: Severe diabetes, GI ulceration, renal impairment, active tuberculosis, vitamin C or K deficiency
Nutrition: Avoid green, leafy vegetables
Other Drugs: Acetaminophen, anabolic steroids, aspirin, oral contraceptives, chloramphenicol, estrogens, methyldopa, quinidine, allopurinol, antibiotics, disulfiram, NSAIDs, metromidazole, rifampin
Administrative Notes: Seek professional advice before taking vitamin K containing vitamins or nutritional supplements because of alteration of anticoagulant effects
Dicyclomine Hydrochloride
Trade Name(s): Antispas, A-Spas, Bentyl, Di-Spaz, Dibent, Neoquess, Or-Tyl, Spasmoject
Chemically Related To: Antihistamines
Medical Category: Anticholinergic, antispasmodic
Accepted Indications: Irritable bowel syndrome
Unaccepted Indications: Peptic ulcer
Mechanism of Action: Affects smooth muscle in GI tract to reduce tone and motility
Half life: 1.8 h elimination (initial phase), 9–{endash}10 h (secondary phase)
Metabolism: Hepatic
Elimination: Renal, fecal
Adult Dosage: Capsules or tablets: 10–{endash}20 mg t.i.d. or q.i.d., up to 160 mg/d; syrup: 10-20 mg t.i.d. or q.i.d., up to 160 mg/d; injection: 20 mg every 4–{endash}6 h
Elderly Dosage: Same as adult dose
Child Dosage: Capsules or tablets, up to 6 y: not recommended; 6 y and over: 10 mg t.i.d. or q.i.d. Syrup: 10 mg t.i.d. or q.i.d. Injection: not established.
Infant Dosage: Capsules or tablets: not recommended; Syrup: up to 6 m: not recommended; 6 m–{endash}2 y: 5–{endash}10 mg t.i.d. or q.i.d. Injection: not established.
Dosage Forms: Capsules: 10 mg and 20 mg: syrup: 10 mg/5 mL; tablets: 20 mg; injection: 10 mg/mL
By System: GI tract
Precautions: Not recommended in infants under 3 m because respiratory symptoms, as well as seizures, syncope, asphyxia, pulse rate fluctuations, hypotonia, and coma, have been reported in some infants 3 m and under
Frequent Side Effects: Constipation; decreased sweating; dry mouth; redness or other signs of irritation at injection site
Occasional Side Effects: Decreased flow of breast milk; decreased salivary secretion; difficulty in accommodation of the eye; mydriatic effect
Rare Side Effects: Confusion, increased intraocular pressure; orthostatic hypotension; sensation of bloating; difficulty in urination; drowsiness; headache; lightheadedness; loss of memory; nausea; extreme tiredness; allergic reaction
Overdosage: Blurred vision; clumsiness; confusion; difficulty in breathing; dizziness; drowsiness; dry mouth, nose, or throat; tachycardia; fever; hallucinations; severe muscle weakness; seizures; slurred speech; extreme tiredness; extreme excitement, restlessness, or irritability; unusual warmth; dryness and flushing of skin
Disease States: Cardiac disease, brain damage in children, reflux esophagitis, Down syndrome, fever, GI tract obstructive disease, glaucoma, acute hemorrhage, hiatal hernia, intestinal atony, hepatic function impairment, hypertension, hyperthyroidism, myasthenia gravis, prostatic hypertrophy, urinary retention, uropathy, pyloric obstruction, tachycardia, ulcerative colitis, paralytic ileus, chronic lung disease, autonomic neuropathy, renal function impairment, spastic paralysis, toxemia of pregnancy, xerostomia
Other Drugs: Antacids, antidiarrheals, anticholinergics, carbonic anhydrase inhibitors, citrates, sodium bicarbonate, antimyasthenics, holoperidol, metoclopramide, opioid analgesics, cyclopropane, ketoconazole, potassium chloride
Lab Tests: Gastric acid secretion test
Didanosine
Trade Name(s): Videx
Pregnancy Category: B
Medical Category: Systemic antiviral
Accepted Indications: Advanced HIV, AIDS
Mechanism of Action: Inhibits HIV DNA polymerase
Half life: 1.5 h
Metabolism: Intracellular
Elimination: Renal
Adult Dosage: Oral solution and tablets: 125–{endash}200 mg b.i.d. Buffered oral suspension: not used by adults and adolescents.
Elderly Dosage: May require lower dose
Child Dosage: Buffered oral suspension and tablets: 25–{endash}125 mg b.i.d. or t.i.d. Oral solution: not prescribed for children.
Infant Dosage: Same as child dose
Dosage Forms: Oral solution: 100 mg, 167 mg, 250 mg, and 375 mg. Buffered oral suspension: 2000 mg/200 mL and 4000 mg/400 mL. Tablets: 25 mg, 50 mg, 100 mg, and 150 mg.
Warnings: Do not swallow tablets whole
Frequent Side Effects: Peripheral neuropathy, CNS toxicity, dry mouth, GI disturbances
Occasional Side Effects: Pancreatitis
Rare Side Effects: Anemia, leukopenia, seizures, cardiomyopathy, hepatitis, thrombocytopenia, hypersensitivity, retinal depigmentation
Contraindications: Alcoholism, pancreatitis
Disease States: Gout, renal impairment, liver impairment, hypertriglyceridemia, sodium-restriction conditions, peripheral neuropathy
Other Drugs: Lithium, alcohol, estrogens, ketoconazole, asparaginase, azathioprine, furosemide, methyldopa, sulindac, valproic acid, nitrofurantoin, pentamidine, sulfonamides, tetracycline, thiazide diuretics, fluoroquinolone antibiotics, itraconazole, dapsone, chloramphenicol, cisplatin, ethambutol, ethionamide, isoniazid, hydralazine, metronidazole, nitrous oxide, phenytoin, stavudine, zalcitabine
Lab Tests: Serum amylase, lipase, potassium
Dienestrol
Trade Name(s): Dv, Ortho Dienestrol
Chemically Related To: Diethylstilbestrol
Pregnancy Category: X
Medical Category: Estrogen (vaginal)
Accepted Indications: Atrophic vaginitis, vulvar squamous hyperplasia
Mechanism of Action: Reduces release of FSH and LH
Absorption/Distribution: Extensively absorbed (50%) into the systemic circulation; distributed to most tissues; high affinity for adipose tissue
Metabolism: Hepatic
Elimination: Renal
Research Notes: Estrogen therapy should be administered at lowest effective dose
Adult Dosage: Initial: intravaginal, 1 applicatorful once daily or b.i.d. for 1–{endash}2 w
Elderly Dosage: Same as adult dose
Dosage Forms: Cream, 0.01%
By System: Vaginal
Precautions: Use medication at bedtime to increase effectiveness; wear sanitary napkin to protect clothing
Frequent Side Effects: Breast pain or tenderness, enlargement of breasts, abdominal cramping, anorexia
Occasional Side Effects: Diarrhea, dizziness, headache, migraine headache
Rare Side Effects: Amenorrhea, breakthrough bleeding, breast tumors
Contraindications: Breast cancer, abnormal vaginal bleeding
Disease States: Endometriosis, gallbladder disease, hepatic dysfunction, thrombophlebitis, uterine fibroids
Other Drugs: Adrenocorticoids, bromocriptine, cyclosporine, tamoxifen, hepatotoxic medication
Lab Tests: Fasting blood glucose, glucose tolerance, thyroid function, calcium, prolactin, prothrombin, renin substrate, antithrombin III
Diethylpropion Hydrochloride
Trade Name(s): M-Orexic, Tenuate, Tepanil
Chemically Related To: Amphetamines
Scheduled Class: IV
Abuse Potential: Minor
Pregnancy Category: B
Medical Category: Appetite suppressant
Accepted Indications: Exogenous obesity, infantile autism
Mechanism of Action: Releases norepinephrine from nerve terminals in the brain
Half life: 4–{endash}6 h
Metabolism: Hepatic
Elimination: Renal
Research Notes: Duration of action 4 h
Adult Dosage: 25 mg t.i.d., 1 h before meals
Elderly Dosage: No information available
Child Dosage: Up to 12 y: not recommended
Infant Dosage: Not recommended
Dosage Forms: Tablets: 25 mg; extended-release tablets: 75 mg
By System: CNS
Warnings: May cause dizziness; elderly may require decreased dose
Precautions: Caution if surgery required
Frequent Side Effects: Elevated blood pressure, CNS stimulation
Occasional Side Effects: Blood dyscrasias, mental depression, pulmonary hypertension
Rare Side Effects: Blurred vision, constipation, nausea/vomiting
Contraindications: Agitated states, alcoholism, arteriosclerosis, drug abuse, glaucoma, hyperthyroidism
Overdosage: Stomach cramps, arrhythmias, confusion, diarrhea, fever, hallucinations, nausea/vomiting, tremor
Antidotal Therapy: No specific antidote; supportive measures including emesis/gastric lavage, barbiturates, IV fluids, IV phentolamine
Disease States: Cardiovascular disease, diabetes mellitus, epilepsy, psychosis
Other Drugs: Alcohol, hydrocarbon anesthetics, insulin, antihypertensives, CNS-stimulating hormones, MAO inhibitors, phenothiazines
Administrative Notes: If tolerance develops, medication should be discontinued
Diethylstilbestrol
Trade Name(s): Generic only
Chemically Related To: Ethinyl estradiol
Pregnancy Category: X; daughters of women who took diethylstilbestrol during pregnancy have developed cancer of the vagina in later life
Medical Category: Estrogen, antineoplastic, antiosteoporotic
Accepted Indications: Estrogen deficiency, atrophic vaginitis, ovarian failure, breast cancer, prostatic cancer
Unaccepted Indications: Postpartum breast engorgement, postcoital contraception
Mechanism of Action: Estrogen replacement and reduces the release of FSH and LH
Metabolism: Hepatic
Elimination: Renal
Research Notes: Also known as DES; may predispose patient to gingival bleeding
Adult Dosage: 1–{endash}15 mg/d
Dosage Forms: Enteric-coated tablets: 1 mg and 5 mg
By System: Endocrine system
Warnings: If pregnancy is suspected, stop medication immediately
Precautions: Possibility of dental problems, bleeding gums
Frequent Side Effects: Breast pain or tenderness, peripheral edema, anorexia, abdominal cramping, nausea
Occasional Side Effects: Diarrhea, dizziness, headache, migraine headaches, menstrual alteration
Rare Side Effects: Amenorrhea, gallbladder obstruction, hepatitis, breast tumors, thrombophlebitis
Contraindications: Breast cancer, abnormal vaginal bleeding
Disease States: Endometriosis, gallbladder disease, jaundice, thrombophlebitis, uterine fibroids
Other Drugs: Adrenocorticoids, bromocriptine, corticotropin, cyclosporine, hepatotoxic medications, tamoxifen
Lab Tests: Fasting blood glucose; glucose tolerance; calcium; coagulation factors VII, VIII, IX, and X; glucose
Administrative Notes: The use of large doses of estrogens in males to treat breast and prostate cancer has been associated with an increased risk of myocardial infarction, pulmonary embolism, and thrombophlebitis
Difenoxin Hydrochloride
Trade Name(s): Not available as a single agent
Chemically Related To: Diphenoxylate
Scheduled Class: IV
Abuse Potential: Minor
Pregnancy Category: C
Medical Category: Antidiarrheal
Accepted Indications: Diarrhea
Mechanism of Action: Reduces intestinal motility
Half life: 4.5 hours
Metabolism: Hepatic
Elimination: Renal/fecal
By System: GI tract
Diflorasone Diacetate
Trade Name(s): Florone, Maxiflor, Psorcon
Pregnancy Category: C
Medical Category: Topical corticosteroid, topical steroidal anti-inflammatory
Accepted Indications: Skin disorders
Unaccepted Indications: Acne, rosacea
Metabolism: Skin, hepatic
Adult Dosage: Topical, to the skin once daily–{endash}q.i.d.
Elderly Dosage: Lower dose may be required
Child Dosage: Topical, to the skin, once daily
Dosage Forms: Cream: 0.05%. Ointment: 0.05%.
Occasional Side Effects: Folliculitis, numbness in fingers, skin atrophy, contact dermatitis, furunculosis, purpura, secondary skin infection
Rare Side Effects: Cushing's syndrome, gastric ulcer, hirsutism, acneiform eruptions, cataracts, glaucoma, perioral dermatitis, ecchymosis, edema, hypertension, hypopigmentation, skin maceration, loss of scalp hair
Contraindications: Infection at site, skin atrophy, herpes simplex
Disease States: Cataracts, diabetes, glaucoma, tuberculosis
Lab Tests: ACTH, hypothalamic-pituitary-adrenal axis
Diflunisal
Trade Name(s): Dolobid
Chemically Related To: Aspirin
Pregnancy Category: C
Medical Category: Antirheumatic, analgesic, vascular headache suppressant, antigout agent
Accepted Indications: Rheumatoid arthritis, osteoarthritis, ankylosing spondylitis, pain, vascular headache, gouty arthritis
Mechanism of Action: Inhibits formation of precursors of prostaglandins
Absorption/Distribution: Rapid and complete absorption
Half life: 1.2–{endash}2 h (elimination)
Metabolism: Hepatic
Elimination: Renal, biliary
Research Notes: Onset of action, 1 h; duration of action, 8–{endash}12 h
Adult Dosage: 250 mg–{endash}500 mg b.i.d.
Elderly Dosage: Lower dose may be required
Child Dosage: Safety and efficacy not established
Infant Dosage: Safety and efficacy not established
Dosage Forms: Tablets: 250 mg and 500 mg
By System: CNS and peripheral pain receptors
Warnings: Enhances GI ulceration and bleeding; avoid alcohol
Frequent Side Effects: Rash, headache, stomach cramps, diarrhea, heartburn, nausea
Occasional Side Effects: Tinnitus; dizziness; drowsiness; insomnia; extreme tiredness; gas; constipation; vomiting; dry mouth
Rare Side Effects: Gastritis, cystitis, agranulocytosis, thrombocytopenia, hepatitis, muscle cramps or pain, blurred vision, fluid retention, shortness of breath, chest pain, confusion, hallucinations, disorientation, mental depression, peripheral neuropathy, syncope, dermatitis, erythema multiforme, Stevens-Johnson syndrome, toxic epidermal necrolysis, GI bleeding, GI perforation, GI ulceration, dysuria, cloudy urine, hemolytic anemia, anaphylaxis, angioedema, hypersensitivity, stomatitis, interstitial nephritis, nephrotic syndrome, renal impairment, increased sweating, pounding heartbeat, vertigo, nervousness, photosensitivity, decreased appetite, Reye's syndrome in children
Contraindications: Symptoms of nasal polyps associated with bronchospasm or angioedema induced by aspirin or other NSAIDs
Antidotal Therapy: May include support of vital functions and treatment of symptoms
Disease States: Anemia, hypertension, sepsis, hemophilia, hepatic and/or renal impairment, stomatitis, systemic lupus erythematosus, GI inflammatory disease
Other Drugs: Acetaminophen, potassium supplements, antacids, anticoagulants, antidiabetic agents, antihypertensives, colchicine, gold compounds, heparin, thrombolytic agents, indomethacin, aspirin, cefamandole, cefoperazone, cefotetan, plicamycin, valproic acid, cyclosporine
Lab Tests: BUN, liver function tests, ophthalmologic examinations, upper GI diagnostic tests, hematologic determinations, hematocrit
Digitoxin
Trade Name(s): Crystodigin
Chemically Related To: Digitalis
Pregnancy Category: C
Medical Category: Antiarrhythmic, cardiotonic
Accepted Indications: Cardiac arrhythmias, CHF, cardiogenic shock
Unaccepted Indications: Obesity
Mechanism of Action: Positive inotropic action, decreased conduction rate
Absorption/Distribution: Almost completely absorbed
Half life: 120–{endash}216 h
Metabolism: Hepatic
Elimination: Renal
Research Notes: Onset of action, 1–{endash}4 h; duration of action, 14 h
Adult Dosage: Digitalization: up to 1.6 mg over 1–{endash}2 d. Maintenance dose: 50–{endash}300 m{mu}g/d
Elderly Dosage: Lower doses required
Child Dosage: Other digitalis glycosides should be considered
Infant Dosage: Premature and immature infants especially sensitive
Dosage Forms: Tablets: 100 m{mu}g and 200 m{mu}g
By System: Cardiovascular
Warnings: Keep out of reach of children; do not take other medicines without advice from physician
Precautions: Carry medical identification card; caution if medical or dental surgery or emergency treatment is required
Frequent Side Effects: Headache, nausea
Occasional Side Effects: Loss of appetite, nausea/vomiting, diarrhea, electrolyte imbalance, blurred vision, drowsiness, mental depression, headache, fainting, arrhythmia
Rare Side Effects: Rash
Contraindications: Ventricular fibrillation
Antidotal Therapy: May include sodium bicarbonate; protection of patient's airway; activated charcoal. Correct arrhythmias, correct hypokalemia, consider digoxin immune Fab for serious overdose
Disease States: Hyperkalemia, myocardial infarction, hypokalemia, premature ventricular contractions, ventricular tachycardia, atrioventricular block
Other Drugs: Diuretics, adrenocorticoids, carbonic anhydrase inhibitors, sympathomimetics, calcium channel blockers, potassium salts, quinidine, spironolactone, verapamil, quinidine
Lab Tests: EKG
Administrative Notes: Store in sealed container; dosage calculations should be based on lean body weight because drug is not taken up by adipose tissue; monitor patient
Digoxin
Trade Name(s): Lanoxicaps, Lanoxin
Chemically Related To: Digitoxin
Pregnancy Category: C
Medical Category: Antiarrhythmic, cardiotonic
Accepted Indications: Arrhythmias, CHF, cardiogenic shock
Unaccepted Indications: Obesity
Mechanism of Action: Increases intracellular myocardial Ca2+{plus}, decreases the conduction rate, and increases the effective refractory period of the AV node, resulting in increased contractile force and slower rate
Absorption/Distribution: Bioavailability is 60–{endash}80% (tablets), 70–{endash}85% (oral elixir or IM injection), 90–{endash}100% (capsules)
Half life: IV 36–{endash}48 hours; oral 4–{endash}6 days
IV: 5–{endash}30 minutes
Metabolism: Minimal hepatic
Elimination: Renal
Research Notes: In some patients, digoxin is converted to inactive products by colonic bacteria in the gut. Onset of action is 5–{endash}30 min after IV, 30 min–{endash}2 h after oral administration
Adult Dosage: Digitalization 50–{endash}350 m{mu}g/d in divided doses for 2 d; maintenance 50–{endash}350 m{mu}g/d
Elderly Dosage: May require decreased doses to avoid toxicity; loss of appetite is a risk
Child Dosage: Digitalizing dose: 2–{endash}5 years: oral, 25–{endash}35 m{mu}g/kg/d; 5–{endash}10 years: oral, 15–{endash}30 m{mu}g/kg/d; 10 years and over: oral 8–{endash}12 m{mu}g/kg/d. Maintenance dose: up to 10 years: oral, 25–{endash}35% of the digitalizing dose divided and administered in 2 or 3 equal doses/d; 10 years and over: oral, 25–{endash}35% of the digitalizing dose administered once a day
Infant Dosage: Digitalizing dose: premature neonates: oral, 15–{endash}25 m{mu}g/kg/d; full-term neonates: oral, 20–{endash}30 m{mu}g/kg/d; 1 month–{endash}2 years: oral 30–{endash}50 m{mu}g/kg/d. Maintenance dose: premature neonates: oral, 20–{endash}30% of the total digitalizing dose, divided and administered in 2 or 3 equal doses/d; full-term neonates, infants: oral, 25–{endash}35% of the digitalizing dose divided and administered in 2 or 3 equal doses/d
Dosage Forms: Capsules: 50 m{mu}g, 100 m{mu}g, and 200 m{mu}g; elixir: 50 m{mu}g/mL; tablets: 125 m{mu}g, 250 m{mu}g, and 500 m{mu}g; injection: 100 m{mu}g/mL and 250 m{mu}g/mL
By System: Cardiovascular
Precautions: Carry medical identification card; caution if medical or dental surgery or emergency treatment is required
Frequent Side Effects: Dizziness, nausea, and vomiting; arrhythmia
Occasional Side Effects: Halo vision
Rare Side Effects: Gynecomastia
Contraindications: Ventricular fibrillation
Overdosage: Nausea and vomiting, lower stomach pain, diarrhea, electrolyte imbalance, bradycardia or arrhythmia, visual disturbances such as halo vision
Antidotal Therapy: May include activated charcoal, potassium salts; lidocaine or similar drug to correct arrhythmias; digoxin Immune Fab for serious overdose
Disease States: AV block, hepatic function impairment, myocardial infarction, severe pulmonary disease, ventricular tachycardia
Other Drugs: Beta-adrenergic blocking agents or other antiarrhythmics may cause additive bradycardia. Half-life is increased with spironolactone. Antacids, kaolin-pectin, cholestyramine, or colestipol may decrease absorption. Therapeutic effects may be decreased by thyroid hormones. Potassium-depleting diuretics, antacids, sympathomimetics, calcium channel blockers, captopril, heparin, erythromycin, potassium salts, thyroid hormones, propafenone, quinidine
Lab Tests: EKG
Dihydroergotamine Mesylate
Trade Name(s): D.H.E. 45
Chemically Related To: Ergotamine
Pregnancy Category: Use not recommended
Medical Category: Vascular headache suppressant
Accepted Indications: Vascular headache, cluster headache, thrombosis, prophylaxis adjunct, hypotension
Unaccepted Indications: Migraine, long-term therapy
Mechanism of Action: Causes constriction of arteries and veins, depresses vasomotor centers
Absorption/Distribution: Rapid
Half life: Distribution 1–{endash}4 min (IV), 1 h (SQ); elimination half-life 18–{endash}32 h
IM: 15 min–{endash}2 h
IV: 15 min–{endash}2 h
Metabolism: Hepatic
Elimination: Hepatic, biliary
Research Notes: IM onset of action, 15–{endash}30 min; IV onset of action, 5 min; IV and SQ duration of action, 8 h
Adult Dosage: Acute migraine or cluster headache, IM: 1 mg at start of attack, may repeat in 1 h, maximal dose of 3 mg; IV: 0.5 mg at start of attack, may repeat in 1 h, maximal dose of 2 mg, 6 mg/w maximum. Chronic intractable headache, IV: 0.5 mg administered over 1 min, 3–{endash}5 min after IV administration of an antiemetic, up to 1 mg may be given for subsequent doses if needed, regimen may be repeated q8h
Elderly Dosage: Caution recommended
Child Dosage: 6 y and over: IM, 0.5 mg at start of attack, may be repeated in 1 h; IV, 0.25 mg at start of attack, may be repeated in 1 h. Under 6 y: not recommended
Infant Dosage: Not recommended
Dosage Forms: Injection: 1 mg/mL
By System: Vascular
Frequent Side Effects: Edema, CNS effects, dry mouth, diarrhea, nausea, vomiting, peripheral vascular effects
Occasional Side Effects: Angina; tachycardia or bradycardia; hypertension or hypotension; rapid, weak pulse; ischemia; ocular vasospasm
Overdosage: CNS toxicity, vomiting, diarrhea, respiratory depression, stomach pain or bloating
Antidotal Therapy: May include discontinuation, benzodiazepines, volume expanders
Disease States: Coronary artery disease, angina, hypertension, sepsis, trauma, angioplasty, vascular surgery, hepatic function impairment, pruritus, renal function impairment
Other Drugs: Macrolides, vasoconstrictors, ergot alkaloids, nitroglycerin, beta blockers
Dihydrotachysterol
Trade Name(s): DHT, DHT Intensol, Hytakerol
Chemically Related To: Vitamin D
Pregnancy Category: C
Medical Category: Antihypocalcemic, antihypoparathyroid
Accepted Indications: Hypocalcemia, hypophosphatemia, osteodystrophy, rickets
Unaccepted Indications: Psoriasis
Mechanism of Action: Increases serum calcium; mobilizes calcium from bones
Absorption/Distribution: Readily absorbed from small intestine
Metabolism: Hepatic
Elimination: Biliary/renal
Research Notes: Dihydrotachysterol is stored mainly in the liver and other fat depots
Adult Dosage: All forms: 200 m{mu}g–{endash}2.5 mg/d
Child Dosage: All forms: 500 m{mu}g–{endash}5 mg/d
Infant Dosage: Some infants may be sensitive even to small doses
Dosage Forms: Capsules: 125 m{mu}g; oral solution: 200 m{mu}g/ml; tablets: 125 m{mu}g, 200 m{mu}g, and 400 m{mu}g
Contraindications: Hypercalcemia, hypervitaminosis D, renal osteodystrophy with hyperphosphatemia
Overdosage: Dry mouth, headache, cardiac arrhythmia, metallic taste, nausea or vomiting
Antidotal Therapy: May include small doses of potassium for cardiac arrhythmias
Disease States: Arteriosclerosis, cardiac and renal impairment, hyperphosphatemia, sarcoidosis
Other Drugs: Aluminum–{endash}containing antacids; anticonvulsants; barbiturates; diuretics; corticosteroids; digitalis glycosides
Lab Tests: Serum cholesterol, calcium, magnesium, alkaline phosphatase
Administrative Notes: The effectiveness of megadoses for treatment of various medical conditions is unproven, and their use should be discouraged
Diltiazem Hydrochloride
Trade Name(s): Cardizem
Chemically Related To: Benzothiazepines
Scheduled Class: N/A
Pregnancy Category: C
Medical Category: Antihypertensive, antianginal agent, antiarrhythmic
Accepted Indications: Hypertension, angina pectoris, supraventricular tachycardia
Mechanism of Action: Relaxes blood vessels, which decreases tone; slows heart rate; decreases contractile force as a result of less Ca2+{plus} activity inside cell
Absorption/Distribution: Well absorbed; undergoes first-pass effect
Half life: Early phase, 20–{endash}30 min; terminal phase, 3.5 h
Peak activity: 2–{endash}3 h
IV: Immediate
Metabolism: Hepatic
Elimination: Biliary and renal
Adult Dosage: Tablets and capsules, 120–{endash}360 mg/d, injection 250 m{mu}g/kg, followed by 350 m{mu}g/kg 15 min after initial dose if necessary
Elderly Dosage: May require decreased dose
Child Dosage: Not established
Infant Dosage: Not established
Dosage Forms: Tablets: 30 mg, 60 mg, 80 mg, and 120 mg; extended-release capsules: 60 mg, 90 mg, 120 mg, 180 mg, 240 mg, and 300 mg; injection: 5 mg/mL
By System: Vasodilator, cardiac depressant
Precautions: Caution in patients with impaired hepatic or renal function and patients with arrhythmias
Frequent Side Effects: Constipation, dizziness, flushing, headache, nausea and vomiting
Occasional Side Effects: Dyspnea; bradycardia; swelling of ankles, feet, etc.
Rare Side Effects: Tender or swollen gums, fainting, chest pain, swollen joints
Contraindications: Sick sinus syndrome
Overdosage: Hypotension, bradycardia
Antidotal Therapy: May include supportive measures
Disease States: Renal or hepatic disease, heart or vessel disorder
Other Drugs: Carbamazepine, cyclosporine, quinidine, digitalis
Lab Tests: SGOT/SGPT
Dimenhydrinate
Trade Name(s): Calm X, Dimetabs, Dinate, Dramamine, Dramanate, Dramoject, Dymenate, Hydrate, Marmine, Triptone, Vertab
Chemically Related To: Ethanolamine
Pregnancy Category: B
Medical Category: Antihistaminic, antiemetic, antivertigo, sedative-hypnotic
Accepted Indications: Rhinitis, pruritus, urticaria, vertigo, conjunctivitis, angioedema, dermatographism, sneezing, rhinorrhea, anaphylactic reactions, motion sickness
Mechanism of Action: Competes for H1 receptors, diminishes vestibular stimulation
Absorption/Distribution: Well absorbed after oral administration
Metabolism: Hepatic, renal
Elimination: Renal
Adult Dosage:
Elderly Dosage: May require lower dose
Child Dosage:
Infant Dosage: Same as child dose
Dosage Forms: Capsules: 50 mg; elixir: 12.5 mg/5mL; tablets: 50 mg; syrup: 12.5 mg/4 mL and 15.62 mg/mL; chewable tablets: 50 mg; injection: 50 mg/mL
Frequent Side Effects: Drowsiness, thickening of mucus
Occasional Side Effects: Arrhythmias, blood dyscrasis, blurred vision, confusion, painful urination, dry mouth, tachycardia, increased sweating, loss of appetite, paradoxical reaction, photosensitivity, tinnitus, rash, GI upset
Contraindications: Urinary retention, glaucoma
Overdosage: Anticholingeric effects, cardiac arrhythmias, CNS depression, CNS stimulation, hypotension
Antidotal Therapy: May include emesis, gastric lavage, saline cathartics, vasopressors
Disease States: Bladder neck obstruction, prostatic hypertrophy
Other Drugs: Alcohol, CNS depressants, anticholinergics, MAO inhibitors, ototoxic medications
Lab Tests: Amylase, prolactin
Dimercaprol
Trade Name(s): BAL in oil
Pregnancy Category: C
Medical Category: Chelating agent
Accepted Indications: Arsenic toxicity, gold toxicity, mercury toxicity, lead toxicity (treatment adjunct)
Unaccepted Indications: Iron, cadmium, selenium, silver, or uranium poisoning, methylmercury intoxication, arsine gas poisoning
Mechanism of Action: Chelates metal and prevents or reverses its toxic effects
Absorption/Distribution: Distribution to all tissues
Elimination: Renal, biliary
Research Notes: Onset of action 30 min, duration of action 4 h
Adult Dosage: 3 mg/kg q4h for 2 d, 4 times on day 3, then b.i.d. for 10 d
Child Dosage: IM: 75 mg/m>sup>2 q4h for 5 d
Dosage Forms: Injection: 100 mg/mL
Frequent Side Effects: Tachycardia, fever, increased blood pressure, burning feeling, conjunctivitis, nausea, vomiting, runny nose, sweating, watery eyes and mouth, unpleasant breath odor
Occasional Side Effects: Injection abscesses, abdominal pain, tremors
Contraindications: Arsine gas poisoning, organic mercury poisoning, iron, cadmium, silver, selenium, or uranium poisoning
Overdosage: Convulsions, severe vomiting, severe drowsiness
Disease States: Hypertension, hepatic function impairment, renal function impairment, renal insufficiency
Other Drugs: Iron salts
Lab Tests: BUN, fluid balance
Dinoprostone
Trade Name(s): Prepidil, Prostin E2
Pregnancy Category: C
Medical Category: Prostaglandin, abortifacient, oxytocic, antihemorrhagic
Accepted Indications: Elective abortion, cervical ripening, postpartum hemorrhage, labor inducement, incomplete abortion, hydatidiform mole
Mechanism of Action: Stimulates myometrial contraction
Half life: Less than 1 min (elimination)
Peak activity: Mean abortion time 12–{endash}24 h
Metabolism: Local tissues, maternal lungs, kidney, spleen
Elimination: Renal
Adult Dosage: Intravaginal, 20 mg repeated q3–{endash}5h; maximum cumulative dose of 240 mg
Dosage Forms: Vaginal suppositories: 20 mg
Frequent Side Effects: Nausea, vomiting, abdominal cramps, diarrhea, fever
Occasional Side Effects: Chills, headache, anaphylaxis, peripheral vasoconstriction, bradycardia, bronchoconstriction, uterine pain, tachycardia, uterine hypertonus, substernal pressure
Rare Side Effects:
Contraindications: Asthma, fetal malpresentation, active cardiac disease
Disease States: Pelvic inflammatory disease, anemia, hypertension, glaucoma, hepatic disease, renal disease, pulmonary disease
Other Drugs: Oxytocin
Lab Tests: Blood pressure
Diphenhydramine Hydrochloride
Trade Name(s): Banophen, Benadryl, Genahist, Nordryl
Chemically Related To: Ethanolamines
Pregnancy Category: B
Medical Category: Antihistaminic (H1-receptor), antidyskinetic, antiemetic, antitussive, antivertigo, sedative-hypnotic
Accepted Indications: Rhinitis, conjunctivitis, pruritus, urticaria, angioedema, anaphylactic reactions, anxiety, extrapyramidal reactions, cough, vertigo, insomnia,
Mechanism of Action: Competes with histamine for receptor site (H1)
Absorption/Distribution: Well absorbed
Half life: 1–{endash}4 h
Metabolism: Hepatic, renal
Elimination: Renal
Research Notes: Duration of action 6–{endash}8 h
Adult Dosage: 25–{endash}50 mg every 4–{endash}6 h up to 300 mg/d
Elderly Dosage: Half the adult dosage
Child Dosage: Up to 6 y: 6.25–{endash}12.5 mg every 4–{endash}6 h; 6–{endash}12 y: 12.5–{endash}25 mg every 4–{endash}6 h not to exceed 100 mg
Infant Dosage: Not recommended in newborn or premature infants
Dosage Forms: Capsules: 25 mg and 50 mg; elixir: 12.5 mg/5 mL; syrup 12.5 mg/5 mL; tablets: 25 mg and 50 mg; injection: 10 mg/mL and 50 mg/mL
By System: Systemic
Warnings: May cause drowsiness; avoid alcohol
Precautions: Use sugarless gum or candy for dry mouth
Frequent Side Effects: Drowsiness, thick mucus
Occasional Side Effects: Blood dyscrasias, cardiac arrhythmias
Rare Side Effects: Blurred vision, confusion, dry mouth, loss of appetite, tinnitus, excitement
Contraindications: Liver problems
Overdosage: Anticholinergic effects, cardiac arrhythmias, CNS depression/stimulation, hypotension
Antidotal Therapy: No specific antidote; may include emesis/gastric lavage, saline cathartics, vasopressors, oxygen, IV fluids
Disease States: Glaucoma, bladder neck obstruction, urinary retention, prostatic hypertrophy
Other Drugs: CNS depressants, anticholinergics, erythromycin, MAO inhibitors, ototoxic medications, ketoconazole
Lab Tests: Skin tests with allergen extracts
Administrative Notes: Protect elixir and injection solution from light
Diphenidol Hydrochloride
Trade Name(s): Vontrol
Chemically Related To: Indolamines
Pregnancy Category: Safety not established
Medical Category: Antiemetic, antivertigo
Accepted Indications: Vertigo, nausea and vomiting associated with disease states
Unaccepted Indications: Treatment of ventricular tachyarrhythmias, nausea and vomiting associated with pregnancy
Mechanism of Action: Diminishes vestibular stimulation and depresses labyrinthine function
Absorption/Distribution: Well absorbed
Half life: 4 h
Elimination: Renal
Research Notes: Has little sedative, tranquilizing, or antihistaminic action; a weak peripheral anticholinergic effect
Adult Dosage: 100–{endash}300 mg/d in 4–{endash}6 divided doses
Child Dosage: Up to 22.8 kg: not recommended; 22.8–{endash}45.6 kg: 25 mg every 4 h; 22.8 kg and over: 5.5 mg/kg/d
Infant Dosage: Not recommended
Dosage Forms: Tablets: 25 mg
By System: CNS subcortical nuclei
Warnings: May cause drowsiness; avoid CNS depressants
Precautions: Because of its potential to cause hallucinations, disorientation, and confusion, use should be limited
Frequent Side Effects: Drowsiness
Occasional Side Effects: Blurred vision, dizziness, dry mouth, headache, nervousness, restlessness
Rare Side Effects: Confusion, hallucinations, weakness
Contraindications: Anuria
Overdosage: Drowsiness, shortness of breath, extreme tiredness or weakness
Antidotal Therapy: May include supportive measures
Disease States: GI tract obstructive disease, glaucoma, hypotension, renal impairment
Other Drugs: Anticholinergics, apomorphine, CNS depressants
Diphenoxylate Hydrochloride
Trade Name(s): Not available as a single agent
Chemically Related To: Opioids
Scheduled Class: V
Abuse Potential: Low
Pregnancy Category: C
Medical Category: Antidiarrheal
Accepted Indications: Diarrhea management adjunct
Unaccepted Indications: Diarrhea caused by poisoning until poison eliminated
Mechanism of Action: Slows movement of the intestine
Absorption/Distribution: Well absorbed from GI tract
Half life: 2.5 h, 12–{endash}14 elimination
Metabolism: Hepatic, into difenoxin active metabolite
Elimination: Fecal/renal
By System: GI
Warnings: May cause drowsiness or dizziness; avoid alcohol
Antidotal Therapy: May include emesis/gastric lavage, respiratory support, naloxone
Disease States: Liver problems, drug abuse or dependency, gallbladder disease, hypothyroidism
Other Drugs: MAO inhibitors, barbiturates, tranquilizers, alcohol, naltrexone, opioid analgesics
Diphenoxylate/Atropine
Trade Name(s): Lomotil
Chemically Related To: Meperidine
Scheduled Class: V
Abuse Potential: Low
Pregnancy Category: C
Medical Category: Antidiarrheal
Dipyridamole
Trade Name(s): Dipridacot, Persantine
Chemically Related To: Pyrimidines
Pregnancy Category: B
Medical Category: Platelet aggregation inhibitor, antithrombotic adjunct, diagnostic aid adjunct, myocardial reinfarction, prophylatic adjunct
Accepted Indications: Platelet aggregation prophylaxis, myocardial perfusion imaging adjunct
Unaccepted Indications: Chronic angina pectoris long term treatment
Mechanism of Action: Inhibits platelet adhesion, relaxes coronary vessels
Absorption/Distribution: Low and variable; high protein binding
Half life: 10–{endash}15 h elimination
IV: 2 min after 4-min infusion
Metabolism: Hepatic
Elimination: Biliary
Adult Dosage: 75–{endash}100 mg q.i.d.
Elderly Dosage: Same as adult dosage
Dosage Forms: Tablets: 25 mg, 50 mg and 75 mg; injection: 5 mg/mL
By System: Hematopoietic, coronary vasculature
Warnings: May increase bleeding
Precautions: May cause hypotension
Frequent Side Effects: Angina, dizziness
Occasional Side Effects:
Rare Side Effects: Bronchospasm, migraine
Overdosage: Hypotension
Antidotal Therapy: May include 50–{endash}250 mg aminophylline IV
Disease States: Angina, hypotension
Nutrition: May be taken with meals, which will slow absorption
Other Drugs: Streptokinase, urokinase, anticoagulants, NSAIDs, platelet aggregation inhibitors, valproic acid, adenosine, xanthines
Disopyramide Phosphate
Trade Name(s): Norpace, Rythmodan
Chemically Related To: Anticholinergics
Pregnancy Category: C
Medical Category: Antiarrhythmic
Accepted Indications: Ventricular arrhythmia, supraventricular tachycardia
Mechanism of Action: Stabilizes membrane of heart; prolongs action of potential
Absorption/Distribution: Rapid, complete absorption; moderate protein binding
Half life: 7 h
Metabolism: Hepatic
Elimination: Renal/biliary
Research Notes: Duration of action: 1.5–{endash}8.5 h
Adult Dosage: Maintenance: 150 mg q.i.d. up to 800 mg/d
Child Dosage: 1–{endash}4 y: 10–{endash}20 mg/kg/d; 4–{endash}12 y: 10–{endash}15 mg/kg/d; 12–{endash}18 y: 6–{endash}15 mg/kg/d
Infant Dosage: Up to 1 y: 10–{endash}30 mg/kg/d
Dosage Forms: Capsules: 100 mg and 150 mg; extended-release capsules: 100 mg, 150 mg, and 250 mg
By System: Cardiovascular
Warnings: May cause blurred vision; avoid alcohol; elderly patients and patients with impaired renal function may require decreased dosage
Precautions: Children should be hospitalized during early part of therapy
Frequent Side Effects: Anticholinergic effects
Occasional Side Effects: Chest pain, confusion, CHF, fluid retention, sensation of bloating, loss of appetite
Rare Side Effects: Agranulocytosis, headache, hunger, tachycardia, tiredness
Contraindications: AV block, cardiogenic shock
Overdosage: Apnea, loss of consciousness, cardiac arrhythmias, respiratory distress
Antidotal Therapy: No specific antidote; may include EKG monitoring, mechanical respirator, cardiac glycosides
Disease States: Bladder neck obstruction, CHF, diabetes mellitus, myasthenia gravis, liver and kidney problems, glaucoma
Other Drugs: Antiarrhythmics, anticoagulants, insulin, hepatic enzyme inducers, pimozide
Lab Tests: Blood glucose concentrations, EKG changes
Disulfiram
Trade Name(s): Antabuse
Chemically Related To: Sulfonamides
Pregnancy Category: Adequate studies in humans have not been done
Medical Category: Antialcoholism agent
Accepted Indications: Treatment of alcoholism
Mechanism of Action: Irreversible inhibition of enzyme aldehyde dehydrogenase, which increases concentration of acetaldehyde in blood, causing severe nausea
Absorption/Distribution: Absorption is slow
Half life: 8 h
Metabolism: Hepatic
Elimination: Renal
Research Notes: Disulfiram-alcohol reactions may occur up to 14 d after last dose of disulfiram
Adult Dosage: Initial: Up to 500 mg/d; maintenance: 125–{endash}500 mg (average 250 g) once daily
Elderly Dosage: May be more sensitive to effects of adult doses; hypotension possible; overdose may be fatal
Child Dosage: Safety and efficacy not established
Infant Dosage: Safety and efficacy not established
Dosage Forms: Tablets: 250 mg and 500 mg
By System: Hepatic enzymes
Warnings: Do not take this medication if blood alcohol level is not zero
Precautions: Check all liquid medications for presence of alcohol; patient should carry medical identification card during therapy
Frequent Side Effects: Drowsiness
Occasional Side Effects: Neurotoxicity, psychotic reaction, optic neuritis, numbness or tingling sensation in hands or feet
Rare Side Effects: Mental changes, hepatitis, headache, impotence, rash, extreme tiredness
Overdosage: Disulfiram-alcohol reaction: blurred vision, chest pain, confusion, dizziness or faintness, tachycardia, flushing, increased sweating, nausea and vomiting, throbbing headache, dyspnea, weakness
Antidotal Therapy: May include supportive measures
Disease States: Allergic eczematous contact dermatitis, cardiovascular disorders, depression, diabetes mellitus, epilepsy, hypothyroidism, psychosis, pulmonary insufficiency, hepatic and renal function impairment
Other Drugs: Alcohol, anticoagulants, anticonvulsants, tricyclic antidepressants
Lab Tests: Cholesterol concentrations
Administrative Notes: The patient should be made fully aware of the nature of this medicine and the disulfiram-alcohol reaction
Divalproex Sodium
Trade Name(s): Depakote
Chemically Related To: Valproic acid
Pregnancy Category: D
Medical Category: Anticonvulsant
Accepted Indications: Epilepsy, bipolar disorders
Mechanism of Action: Increases levels of inhibitory GABA
Absorption/Distribution: Enteric coating on tablet delays absorption by 1–{endash}4 h
Half life: 6–{endash}16 h
Metabolism: Hepatic
Elimination: Renal, fecal, respiratory
Adult Dosage: Delayed-release capsules: initally, 5–{endash}30 mg/kg/d, dosage increased at 1-w intervals up to 60 mg/kg/d
Elderly Dosage: Increased concentrations and lowered clearance
Child Dosage: 1–{endash}12 y: 15–{endash}100 mg/kg/d, dosage increased at 1-w intervals
Infant Dosage: 10–{endash}15 mg/kg/d
Dosage Forms: Capsules: the equivalent of valproic acid 125 mg; delayed-release tablets: the equivalent of valproic acid 125 mg, 250 mg, and 500 mg
By System: CNS
Warnings: May cause drowsiness; avoid alcohol
Precautions: Caution if surgery required
Frequent Side Effects: Stomach cramps, diarrhea, anorexia, hair loss, indigestion, nausea/vomiting, change in menstrual periods, trembling, unusual weight loss or gain
Occasional Side Effects: Clumsiness, constipation, dizziness, thrombocytopenia, liver problems, headache
Rare Side Effects: Drowsiness, rash, excitement, diplopia, nystagmus, pancreatitis
Contraindications: Liver problems
Antidotal Therapy: Supportive: may include emesis/gastric lavage; maintenance of urinary output; naloxone; hemodialysis; hemoperfusion
Disease States: Blood dyscrasias, organic brain disease, hypoalbuminemia, kidney problems, renal function impairment
Other Drugs: Alcohol, CNS depressants, heparin, thrombolytic agents, tricyclic antidepressants, phenothiazines, mefloquine, phenytoin, platelet aggregation inhibitors, barbiturates, primidone, carbamazepine, hepatotoxic medications
Lab Tests: Thyroid function, urine ketone, amino acid screening, metyrapone, serum bilirubin
Administrative Notes: Do not chew tablets or capsules
Dobutamine Hydrochloride
Trade Name(s): Dobutrex
Chemically Related To: Dopamine
Pregnancy Category: Adequate studies have not been done.
Medical Category: Cardiac stimulant
Accepted Indications: Cardiogenic shock
Mechanism of Action: Stimulates beta receptors of the heart
Half life: 2 min
Metabolism: Hepatic
Elimination: Renal
Research Notes: Onset of action, within 1–{endash}2 min; duration of action, several min
Adult Dosage: 2.5–{endash}15 m{mu}g/kg/min adjusted to individual patients
Child Dosage: 5–{endash}20 m{mu}g/kg/min adjusted to individual patients
Infant Dosage: Dosage not established
Dosage Forms: Injection: 12.5 mg/mL
By System: Cardiovascular
Warnings: Dosage must be adjusted to individual's requirements
Precautions: Monitor patient for blood pressure and cardiac output
Occasional Side Effects: Chest pain, shortness of breath, headache, nausea
Contraindications: Idiopathic hypertrophic subaortic stenosis
Antidotal Therapy: Because of short duration of action, no treatment other than withdrawal of drug is indicated
Disease States: Atrial fibrillation, hypertension, myocardial infarction, premature ventricular heartbeats, mechanical obstruction
Other Drugs: Beta-adrenergic blockers, hydrocarbon anesthetics, rauwolfia alkaloids, nitroprusside, guanethidine
Administrative Notes: Incompatible with alkaline solutions
Docusate Sodium
Trade Name(s): Afko-Lube, Colace, Diocto, Diosuccin, Pro-Sof
Chemically Related To: Sulfosuccinates
Pregnancy Category: C
Medical Category: Laxative
Accepted Indications: Constipation
Mechanism of Action: Stool softener–{endash}reduces surface film tension
Absorption/Distribution: Some absorption in duodenum and jejunum
Elimination: Bile, fecal
Research Notes: Softening usually occurs within 1–{endash}3 d; rectal dose works within 15 min
Adult Dosage: 50–{endash}360 mg/d
Child Dosage: 2–{endash}12 y: 50–{endash}150 mg/d
Infant Dosage: Less than 2 y: 25 mg/d
Dosage Forms: Capsules: 50 mg, 100 mg, 240 mg, and 250 mg; tablets: 50 mg and 100 mg; solution: 10 mg/mL and 50 mg/mL; syrup: 16.7 mg/5 mL and 20 mg/5 mL; rectal suspension: 283 mg/4 mL
By System: GI
Warnings: Overuse could lead to bowel movement dependency
Precautions: Do not use if symptoms of appendicitis are present
Occasional Side Effects: Intestinal cramping
Rare Side Effects: Rash
Contraindications: Appendicitis, rectal bleeding, CHF, diabetes mellitus, intestinal obstruction
Nutrition: Take liquid in milk or fruit juice
Other Drugs: Diuretics, potassium supplements, mineral oil, phenolphthalein, danthron
Lab Tests: Blood glucose concentrations, sodium potassium
Administrative Notes: Do not give within 2 h of other laxatives
Docusate Sodium/Ferrous Fumarate/Folic Acid/Multivitamins
Trade Name(s): Hemaferrin, Tabron Filmseal
Pregnancy Category: C
Medical Category: Hematinic
Accepted Indications: Anemia, vitamin/mineral supplement
Dosage Forms: Hemaferrin tablets: 25 mg/150 mg/0.4 mg/various amounts; Tabron Filmseal tablets: 50 mg/304.2 mg/1 mg/various amounts
Dopamine Hydrochloride
Trade Name(s): Intropin
Pregnancy Category: C
Medical Category: Vasopressor
Accepted Indications: Acute hypotension, cardiogenic shock, low cardiac output, CHF
Mechanism of Action: Stimulates adrenergic receptors
Absorption/Distribution: Widely distributed in the body
Half life: 2 min (plasma), 9 min (elimination)
Metabolism: Hepatic, renal
Elimination: Renal
Research Notes: Onset of action within 5 min; duration of action <10>
Adult Dosage: IV infusion: 0.5–{endash}10 m{mu}g/kg/min
Child Dosage: IV infusion: 5–{endash}20 m{mu}g/kg/min
Dosage Forms: Injection: 40 mg/mL, 80 mg/mL, and 160 mg/mL; dopamine HCl and dextrose injection: 800 m{mu}g/mL and 5% dextrose, 1.6 mg/mL and 5% dextrose, and 3.2 mg/mL and 5% dextrose
Frequent Side Effects: Headache, nausea, vomiting
Occasional Side Effects: Bradycardia, hypertension, angina, dyspnea, hypotension, tachycardia, ventricular arrhythmias, nervousness, restlessness
Rare Side Effects: Polyuria
Contraindications: Pheochromocytoma
Overdosage: Severe hypertension
Antidotal Therapy: May include reduction of rate of administration
Disease States: Acidosis, hypoxia, Raynaud's disease, asymmetric septal hypertrophy, tachyarrhythmias, ventricular fibrillation, hypovolemia, myocardial infarction, diabetes mellitus
Other Drugs: Doxapram, ergotamine, MAO inhibitors, levodopa, phenytoin, alpha-adrenergic blockers, hydrocarbon inhalation anesthetics, halothane, tricyclic antidepressants, beta-adrenergic blockers, cocaine, digitalis glycosides
Lab Tests: EKG, blood pressure
Doxacurium Chloride
Trade Name(s): Nuromax
Pregnancy Category: C
Medical Category: Neuromuscular blocking agent
Accepted Indications: Muscle relaxation for surgery
Unaccepted Indications: Prolonged mechanical ventilation
Mechanism of Action: Competes with acetylcholine
Half life: 86–{endash}123 min (elimination)
Elimination: Renal, biliary
Research Notes: Onset of action 4–{endash}5 min; duration of action varies by dosage and patient age
Adult Dosage: Initial: IV, 50–{endash}80 m{mu}g/kg; maintenance, IV, 5–{endash}10 m{mu}g/kg. Doses must be individualized
Elderly Dosage: May require lower dose
Child Dosage: Under 2 y: not established. 2–{endash}12 y: 3 m{mu}g/kg.
Infant Dosage: Not established
Dosage Forms: Injection: 1 mg/mL
Rare Side Effects: Double vision, fever, urticaria, cardiovascular effects, respiratory effects
Contraindications: Renal impairment
Antidotal Therapy: May include neostigmine, respiratory support
Disease States: Hypothermia, respiratory depression
Other Drugs: Procainamide, quinidine, calcium channel blockers, aminoglycosides, capreomycin, citrate-anticoagulated blood, lincomycin, polymyxins
Doxapram Hydrochloride
Trade Name(s): Dopram
Pregnancy Category: B
Medical Category: Respiratory stimulant
Accepted Indications: Respiratory depression
Unaccepted Indications: Respiratory depression caused by drug overdose
Mechanism of Action: Affects peripheral carotid chemoreceptors
IV: 1–{endash}2 min
Elimination: Fecal, renal
Research Notes: Onset of action 20–{endash}40 sec; duration of action 5–{endash}12 min
Adult Dosage: IV: 0.5 mg–{endash}1mg/kg, not to exceed 1.5 mg/kg as a single dose; may be repeated up to a maximum total dose of 2 mg/kg. IV infusion: initially, 5 mg/min, then reduce to 1–{endash}3 mg/min, not to exceed 4 mg/kg as total dose.
Elderly Dosage: May require lower dosage
Child Dosage: Under 12 y: not recommended
Infant Dosage: Under 12 y: not recommended
Dosage Forms: Injection: 20 mg/mL
Occasional Side Effects: Confusion, dizziness, increased sweating, nausea, vomiting, urination problems, diarrhea, headache, coughing
Rare Side Effects: Chest pain, hemolysis, thrombophlebitis, wheezing, trouble breathing
Contraindications: Cerebrovascular accidents, CHF, pulmonary disease
Overdosage: Convulsions, tachycardia, trembling
Disease States: Asthma, cerebral edema, cardiac disease, seizure disorders, hypertension, hyperthyroidism, pheochromocytoma, hepatic function impairment, renal function impairment
Other Drugs: Anesthetics, CNS stimulants, MAO inhibitors, vasopressors
Lab Tests: Deep tendon reflexes
Doxazosin Mesylate
Trade Name(s): Cardura
Chemically Related To: Prazosin
Pregnancy Category: B
Medical Category: Antihypertensive
Accepted Indications: Hypertension, benign prostatic hypertrophy
Mechanism of Action: Alpha-adrenergic blocker
Absorption/Distribution: Well absorbed from GI tract
Half life: 19–{endash}22 h
Metabolism: Hepatic
Elimination: Fecal/renal
Research Notes: Onset of action, 1–{endash}2 h; duration of action, 24 h
Adult Dosage: 1 mg once daily, before bedtime
Elderly Dosage: Greater hypotensive effect may indicate need for decreased dosage
Dosage Forms: Tablets: 1 mg, 2 mg, 4 mg, and 8 mg
By System: Cardiovascular
Warnings: May cause drowsiness and/or dizziness; do not take other medicines
Precautions: Use caution when driving and when arising suddenly
Frequent Side Effects: Dizziness, headache, tiredness
Occasional Side Effects: Arrhythmias, shortness of breath, tachycardia, swelling of lower extremities, nausea
Overdosage: Circulatory failure: hypotension
Antidotal Therapy: May include volume expanders; monitor fluids and electrolytes
Disease States: Liver and kidney problems
Nutrition: Control of diet and salt intake
Other Drugs: NSAIDs, estrogens, sympathomimetics, antihypertensives
Administrative Notes: May be used with a thiazide or beta-adrenergic blocker
Doxepin Hydrochloride
Trade Name(s): Sinequan
Chemically Related To: Tricyclic antidepressants
Pregnancy Category: Adequate studies have not been done
Medical Category: Antidepressant, antipanic agent, antineuralgic
Accepted Indications: Mental depression, panic disorder, neurogenic pain, headache (prophylaxis), pruritus
Mechanism of Action: Blocks reuptake of norepinephrine and serotonin
Absorption/Distribution: High protein binding; rapid absorption
Half life: 11–{endash}23 h
Metabolism: Hepatic
Elimination: Renal
Research Notes: Onset of action as an antidepressant, 2–{endash}3 w
Adult Dosage: 25 mg t.i.d. up to 150 mg/d for outpatients; 300 mg/d for hospitalized patients
Elderly Dosage: 25–{endash}50 mg/d
Child Dosage: Up to 12 y: not established
Infant Dosage: Not established
Dosage Forms: Capsules: 10 mg, 25 mg, 50 mg, and 75 mg; oral solution: 10 mg/mL
By System: CNS
Warnings: May cause drowsiness; avoid alcohol
Precautions: Caution if surgery required; avoid sun lamps, tanning booths, and prolonged exposure to the sun without sunscreen
Frequent Side Effects: Dizziness, drowsiness, headache, increased appetite, nausea, weight gain
Occasional Side Effects: Anticholinergic effects, arrhythmia, hypotension, nervousness, sexual function problems, diarrhea
Rare Side Effects: Agranulocytosis, allergic reaction, tinnitus, gum problems, seizures
Contraindications: Acute recovery period after myocardial infarction
Overdosage: Confusion, convulsion, drowsiness, enlarged pupils, hallucinations, dyspnea, vomiting
Antidotal Therapy: May include gastric lavage, activated charcoal, maintenance of body temperature and of respiratory and cardiac function, digitalization if necessary
Disease States: Asthma, bipolar disorders, blood disorders, glaucoma, liver and kidney problems, schizophrenia
Nutrition: May need additional riboflavin
Other Drugs: Sympathomimetics, MAO inhibitors, estrogens, antithyroid agents, CNS depressants, anticonvulsants
Lab Tests: Blood glucose concentrations, metyrapone, EKG
Administrative Notes: Oral solution must be diluted before being taken; when oral solution is dispensed, the manufacturer-provided graduated dropper should be included
Doxorubicin Hydrochloride
Trade Name(s): Adriamycin, Rubex
Chemically Related To: Anthracene
Pregnancy Category: Safety not established
Medical Category: Antineoplastic
Accepted Indications: Leukemia, neuroblastoma, Wilms' tumor, lymphomas, sarcomas, solid state carcinomas
Mechanism of Action: Interferes with RNA-DNA synthesis
Absorption/Distribution: Does not cross blood-brain barrier; not absorbed from GI tract
Half life: Alpha phase, 0.6 h; beta phase, 16.7 h
Metabolism: Hepatic
Elimination: Biliary, renal
Research Notes: 30 sec after IV administration, drug is present in liver, heart, and kidneys
Adult Dosage: Total cumulative dosage of 550 mg/m2
Elderly Dosage: Over 70 y: cardiotoxicity more frequent
Child Dosage: IV: 30 mg/m2/d on 3 successive days every 4 w
Infant Dosage: Up to 2 y: cardiotoxicity more frequent
Dosage Forms: Injection: 2 mg/mL; powder for injection: USP 10 mg, 20 mg, 50 mg, 100 mg, and 150 mg
Warnings: Do not inhale particles of drug or expose skin to drug
Precautions: Avoid immunizations; continue medication even if GI distress
Frequent Side Effects: Leukopenia, stomatitis, nausea and vomiting, loss of hair, reddish urine
Occasional Side Effects: Cardiotoxicity, tissue necrosis, GI ulceration, thrombocytopenia, diarrhea, postirradiation erythema
Rare Side Effects: Rash, wheezing
Disease States: Bone marrow depression, gout, heart or liver problems, chickenpox, herpes zoster
Nutrition: Need ample fluid intake
Other Drugs: Live virus vaccines, bone marrow depressants, probenecid, daunorubicin, sulfinpyrazone
Lab Tests: EKG; QRS reduction; uric acid concentrations
Administrative Notes: Do not mix with heparin, dexamethasone, fluorouracil, hydrocortisone, sodium succinate, aminophylline, or cephalothin
Doxycycline
Trade Name(s): Doryx, Doxy, Doxy-Caps, Monodox, Vibramycin, Vibra-Tabs
Chemically Related To: Tetracycline
Pregnancy Category: D
Medical Category: Antibacterial
Accepted Indications: Acne vulgaris, bronchitis, GI tract infections, pneumonia, Q fever, sinusitis, skin and soft tissue infection
Mechanism of Action: Inhibits bacterial protein synthesis at 50S ribosome
Absorption/Distribution: Well absorbed; achieves therapeutic concentrations in the eye; prostatic concentrations are approximately 60% of serum concentrations
Half life: 12–{endash}22 h
IV: 15–{endash}30 min
Metabolism: Hepatic
Elimination: Renal/fecal
Research Notes: GI secretion is an important route of excretion when doxycycline is administered to patients with impaired renal function
Adult Dosage: 50–{endash}300 mg/d
Elderly Dosage: Same as adult dose
Child Dosage: Up to 8 y: not recommended
Infant Dosage: Not recommended
Dosage Forms: For oral suspension: 25 mg/5 mL and 50 mg/5 mL; capsules: 50 mg and 100 mg; delayed-release capsules: 100 mg; tablets: 100 mg; injection: 100 mg (base) and 200 mg (base)
Warnings: Possible photosensitivity reactions
Precautions: Caution if dizziness, lightheadedness, or unsteadiness occurs
Frequent Side Effects: Discoloration of children's teeth, photosensitivity, CNS toxicity, GI disturbances (cramps)
Occasional Side Effects: Nephrogenic diabetes insipidus, pigmentation of skin and mucous membranes, fungal overgrowth, discolored tongue
Rare Side Effects: Benign intracranial hypertension, hepatotoxicity, pancreatitis
Disease States: Nephrogenic diabetes insipidus, hepatic and renal impairment
Other Drugs: Antacids, phenytoin, cholestyramine, oral contraceptives, penicillins, methoxyflurane, vitamin A
Lab Tests: BUN, bilirubin
Administrative Notes: Discard outdated or decomposed drug: it might be toxic
Dronabinol
Trade Name(s): Marinol
Chemically Related To: Cannabis
Scheduled Class: II
Abuse Potential: Slight
Pregnancy Category: C
Medical Category: Antiemetic
Accepted Indications: Cancer chemotherapy-induced nausea and vomiting
Mechanism of Action: Possible inhibition of vomiting control mechanism in the medulla oblongata
Absorption/Distribution: Present in breast milk
Half life: Alpha phase, 4 h; terminal phase, 25–{endash}36 h
Metabolism: Hepatic
Elimination: Fecal
Research Notes: May increase central sympathomimetic activity; may increase heart rate
Adult Dosage: 5–{endash}15 mg/m2
Elderly Dosage: 5–{endash}10 mg/m2
Child Dosage: Same as elderly dose
Infant Dosage: 5 mg/m2
Dosage Forms: Capsules: 2.5 mg, 5 mg, and 10 mg
By System: CNS subcortical nuclei
Warnings: Caution if dizziness, drowsiness, lightheadedness, or false sense of well-being occurs
Precautions: Avoid use of alcohol or other CNS depressants during therapy; be careful when arising suddenly from a supine, prone, or sitting position
Frequent Side Effects: Dizziness, drowsiness, loss of coordination
Occasional Side Effects: Tachycardia, changes in mood, confusion, delusions, hallucinations
Rare Side Effects: Blurred vision, dry mouth, orthostatic hypotension, restlessness
Overdosage: Change in mood, confusion, hallucinations, mental depression, nervousness, anxiety, tachycardia
Antidotal Therapy: May include supportive therapy, continuous blood pressure monitoring, treatment of hypotension or hypertension, cardiac monitoring
Disease States: Cardiac disorders, drug abuse, hypertension, manic or depressed state, schizophrenia
Other Drugs: Alcohol, other CNS depressants, apomorphine
Administrative Notes: Rebound of REM sleep has been reported after discontinuation of high doses
Droperidol/Fentanyl Citrate Droperidol/Fentanyl Citrate
Trade Name(s): Innovar Innovar
Scheduled Class: II II
Pregnancy Category: C C
Medical Category: Opioid analgesic, tranquilizer Opioid analgesic, tranquilizer
Accepted Indications: Anxiety and pain for surgical and diagnostic procedures, anesthetic premedication, anesthesia adjunct Anxiety and pain for surgical and diagnostic procedures, anesthetic premedication, anesthesia adjunct
Adult Dosage: Must be individualized Must be individualized
Elderly Dosage: May require lower dose May require lower dose
Child Dosage: 2 y and over: must be individualized 2 y and over: must be individualized
Infant Dosage: Under 2 y: safety and efficacy not established Under 2 y: safety and efficacy not established
Dosage Forms: Injection: 2.5 mg/0.05 mg/mL Injection: 2.5 mg/0.05 mg/mL
Frequent Side Effects: No incidence given for hypotension, muscle rigidity, respiratory depression, hypovolemia, bradycardia, apnea, tachycardia, dysphoria, postoperative drowsiness, restlessness, anxiety, extrapyramidal effects, hallucinations, mental depression, anaphylaxis, chills, dizziness, blurred vision, twitching, bronchospasm, laryngospasm, nausea, vomiting, diaphoresis, emergence delirium, increased blood pressure No incidence given for hypotension, muscle rigidity, respiratory depression, hypovolemia, bradycardia, apnea, tachycardia, dysphoria, postoperative drowsiness, restlessness, anxiety, extrapyramidal effects, hallucinations, mental depression, anaphylaxis, chills, dizziness, blurred vision, twitching, bronchospasm, laryngospasm, nausea, vomiting, diaphoresis, emergence delirium, increased blood pressure
Rare Side Effects: Neuroleptic malignant syndrome Neuroleptic malignant syndrome
Disease States: Head injury, brain tumor, cardiac dysrhythmia, anoxia, hypercarbia, electrolyte disturbances, alcohol withdrawal, COPD, respiratory problems, impaired hepatic function, impaired renal function, pheochromocytoma, bradyarrhythmia Head injury, brain tumor, cardiac dysrhythmia, anoxia, hypercarbia, electrolyte disturbances, alcohol withdrawal, COPD, respiratory problems, impaired hepatic function, impaired renal function, pheochromocytoma, bradyarrhythmia
Other Drugs: CNS depressants CNS depressants
Administrative Notes: Do not use if discolored or contains precipitate Do not use if discolored or contains precipitate
Dyclonine Hydrochloride
Trade Name(s): Dyclone, Sucrets
Pregnancy Category: C
Medical Category: Mucosal-local anesthetic
Accepted Indications: Esophageal pain, pharyngeal pain, laryngeal pain, mouth pain, tracheal pain, urinary tract pain, vaginal pain, gag reflex suppression, perioral lesions
Mechanism of Action: Blocks initiation of nerve impulses
Absorption/Distribution: Readily absorbed through mucous membranes
Research Notes: Onset of action up to 10 min, duration of action 30–{endash}60 min
Adult Dosage: Lozenges: 1 lozenge/2 h. Topical solution: topical, 40–{endash}200 mg, up to 300 mg per procedure.
Elderly Dosage: Same as adult dose
Child Dosage: Lozenges: 2 y and over: one 1.2 mg lozenge/2 h. Topical solution: not established.
Infant Dosage: Not established
Dosage Forms: Lozenges: 1.2 mg, 2 mg, and 3 mg. Topical solution: 0.5% and 1%.
Occasional Side Effects: Contact dermatitis, angioedema, burning, stinging, swelling
Contraindications: Infection at area of treatment, severe traumatized mucosa
Overdosage: CNS effects, methemoglobinemia
Dyphylline
Trade Name(s): Dilor, Dyflex, Lufyllin, Neothylline
Chemically Related To: Theophylline
Pregnancy Category: C
Medical Category: Bronchodilator
Accepted Indications: Asthma, bronchitis, emphysema, chronic obstructive pulmonary disease
Mechanism of Action: Relaxes bronchial smooth muscle
Absorption/Distribution: Rapidly absorbed from GI tract
Half life: 2–{endash}2.5 h
Metabolism: Hepatic
Elimination: Excreted primarily as unchanged drug in the urine
Adult Dosage: Elixir and tablets: up to 15 mg/kg q.i.d. Injection: IM 500 mg initially, followed by 250–{endash}500 mg q2–{endash}6h
Elderly Dosage: Lower dose may be required
Child Dosage: Must be individualized
Infant Dosage: Must be individualized
Dosage Forms: Elixir: 33.3 mg/5 mL and 53.3 mg/5 mL. Tablets: 200 mg and 400 mg. Injection: 250 mg/mL
Frequent Side Effects: Nausea, nervousness, restlessness
Occasional Side Effects: Gastric reflux
Contraindications: Gastritis, peptic ulcer, renal failure
Overdosage: Convulsions, arrhythmia, severe vomiting
Antidotal Therapy: May include supportive and symptomatic treatment
Disease States: Hypertension, renal disease
Other Drugs: Beta blockers, probenecid
Lab Tests: Pulmonary function measurements
Administrative Notes: Do not switch brands without physician's permission; not metabolized to theophylline
Dyphylline/Ephedrine/Guaifenesin/Phenobarbital
Trade Name(s): Lufyllin-EPG
Medical Category: Bronchodilator
Accepted Indications: Asthma
Adult Dosage: Elixir: 10–{endash}20 mL q.i.d.; tablets: 1–{endash}2 tablets q.i.d.
Dosage Forms: Elixir: 150 mg/24 mg/300 mg/24 mg; tablets: 100 mg/16 mg/200 mg/16 mg
Dyphylline/Guaifenesin
Trade Name(s): Bronkolate G, Dilor-G, Dyflex-G, Dyline-G.G., Lufyllin-GG
Medical Category: Bronchodilator
Accepted Indications: Asthma
Adult Dosage: Liquid: 5–{endash}10 mL t.i.d. or q.i.d.; elixir: 30 mL q.i.d.; tablets: 1–{endash}2 q.i.d.
Dosage Forms: Liquid 300 mg/300 mg; elixir: 100 mg/100 mg; tablets: 200 mg/200 mg
Echothiophate Iodide
Trade Name(s): Phospholine Iodide
Chemically Related To: Irreversible cholinesterase inhibitors
Pregnancy Category: C
Medical Category: Antiglaucoma agent, cyclostimulant, diagnostic aid
Accepted Indications: Glaucoma, esotropia (diagnosis and treatment)
Mechanism of Action: Cholinesterase inhibitor
Peak activity: Miosis: 2 h
Research Notes: Onset of miosis: less than 1 h; duration of miosis: up to 1 m
Adult Dosage: Antiglaucoma: to conjunctiva, 1 drop of 0.03%–{endash}0.25% solution 1–{endash}2 times daily
Elderly Dosage: Decreased concentration
Child Dosage: 2 y and over: same as adult dosage
Dosage Forms: For ophthalmic solution: 0.03%, 0.06%, 0.125%, and 0.25%
By System: Ocular
Warnings: For the eye only–{endash}decreases night vision
Precautions: Carry medical identification
Frequent Side Effects: Frequencies not given for stinging of eyes, headache, miosis
Rare Side Effects: Retinal detachment
Overdosage: Bradycardia, bronchospasm, hypotension, increased sweating, nausea/vomiting, diarrhea
Antidotal Therapy: May include atropine sulfate injection, IV pralidoxime CL, diazepam
Disease States: Glaucoma, peptic ulcer, myasthenia gravis, epilepsy, bronchial asthma, Down syndrome, hypertension
Other Drugs: Cholinesterase inhibitors, cocaine, succinylcholine, ophthalmic belladonna alkaloids, anticholinergics
Administrative Notes: Reconstituted solution is stable for 3–{endash}4 w at room temperature
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