Caffeine
Trade Name(s): Caffedrine, NoDoz, Vivarin, Quick Pep
Chemically Related To: Xanthine
Pregnancy Category: B
Medical Category: Cerebral stimulant, analgesia adjunct, respiratory stimulant
Accepted Indications: Fatigue, drowsiness, vascular headache
Mechanism of Action: Phosphodiesterase inhibitor; CNS stimulant
Absorption/Distribution: Excellent absorption, rapid distribution
Half life: 3–{endash}7 hours
Metabolism: Hepatic
Elimination: Renal
Adult Dosage: Extended release capsules: 200-250 mg every 3–{endash}4 h, not to exceed 1 g/d; tablets: 100–{endash}200 mg every 3–{endash}4 h, not to exceed 1 g/d
Elderly Dosage: Same as adult dose
Child Dosage: Not recommended
Infant Dosage: For sleep apnea, 10 mg/kg as a loading dose then 2.5 mg/d
Dosage Forms: Extended-release capsules: 200 mg and 250 mg; tablets: 75 mg, 100 mg, 150 mg, and 200 mg
By System: CNS
Precautions: Check with physician if drowsiness occurs
Frequent Side Effects: CNS stimulation, nausea/vomiting
Overdosage: GI pain, delirium, insomnia, dehydration, fever
Antidotal Therapy: May include short-acting barbiturates, gastric emesis/lavage, diazepam
Disease States: Anxiety disorders, heart and liver problems, hypertension, insomnia, peptic ulcer
Other Drugs: Theophylline, beta-adrenergic agonists, MAO inhibitors, lithium, oral contraceptives, adenosine
Lab Tests: Blood glucose, serum urate measurements, catecholamines, 5-hydroxyindoleacetic acid, vanillylmandelic acid
Administrative Notes: Caffeine tablets may be made into a suspension when used in neonatal apnea
Caffeine/Ergotamine Tartrate
Trade Name(s): Cafergot, Cafermine, Cafetrate, Ercaf, Ergo-Caff, Gotamine, Migergot, Wigraine
Pregnancy Category: C
Medical Category: Antimigraine
Accepted Indications: Migraine headache
Adult Dosage: Tablets: 2 tablets initially, followed by 1 tablet every 0.5 h, not to exceed 6 tablets/episode or 10 tablets/w; suppositories: maximal dose of 2 suppositories/episode or 5 suppositories/w
Child Dosage: Not recommended
Dosage Forms: Tablets: 100 mg/1 mg; suppositories: 100 mg/2 mg
Calcitriol
Trade Name(s): Calcijex, Rocaltrol
Chemically Related To: Vitamin D
Pregnancy Category: C
Medical Category: Antihypocalcemic, nutritional supplement
Accepted Indications: Chronic hypocalcemia, hypophosphatemia, rickets, vitamin D deficiency
Mechanism of Action: Binds to a specific receptor in the GI tract cell cytoplasm that results in increased absorption of calcium from the intestine
Absorption/Distribution: Readily absorbed
Half life: 3–{endash}6 h
Elimination: Biliary/renal
Research Notes: Stored mainly in the liver
Adult Dosage: Capsules: 0.25m{mu}g/d initially, dosage increased to 2–{endash}3 m{mu}g/d; injection: 0.5 m{mu}g/kg 3 times/w initially, dosage then increased
Child Dosage: Capsules: 0.25 m{mu}g/d initially, dosage then increased; injection: not established
Infant Dosage: Not established
Dosage Forms: Capsules 0.25 m{mu}g and 0.5 m{mu}g, injection 1 m{mu} g/mL and 2 m{mu}/mL
By System: Vitamin replacement
Precautions: Megadoses not recommended
Contraindications: Hypercalcemia, hypervitaminosis D
Overdosage: Constipation, dry mouth, headache, increased thirst, loss of appetite, metallic taste, nausea or vomiting, weakness, bone pain, muscle pain
Antidotal Therapy: May include withdrawal of the vitamin, low-calcium diet, generous fluid intake, prednisone
Disease States: Arteriosclerosis, cardiac function impairment, hyperphosphatemia, sarcoidosis
Other Drugs: Antacids, anticonvulsants, barbiturates, calcitonin, thiazide diuretics, digitalis glycosides, phosphorus–{endash}containing preparations
Lab Tests: Alkaline phosphatase, serum cholesterol, magnesium, calcium, and phosphate concentrations
Administrative Notes: To be most effective, give in divided doses
Calcium Acetate
Trade Name(s): PhosLo
Chemically Related To: Ion element
Pregnancy Category: C
Medical Category: Antihyperphosphatemic
Accepted Indications: Hyperphosphatemia
Mechanism of Action: Combines with dietary phosphate to form insoluble phosphorus, which is excreted in feces
Absorption/Distribution: 40% systemically absorbed
Elimination: Fecal
Research Notes: Does not promote aluminum absorption
Adult Dosage: 2 tablets t.i.d. with meals up to 3–{endash}4 tablets/meal
Dosage Forms: Tablets: 667 mg (169 mg of calcium)
By System: Serum ion levels
Warnings: Follow diet
Precautions: Avoid antacids
Frequent Side Effects: Hypercalcemia
Occasional Side Effects: Nausea
Rare Side Effects: Pruritus
Overdosage: Hypercalcemia
Antidotal Therapy: May include acute hemodialysis
Other Drugs: Tetracycline, digitalis
Administrative Notes: Take with meals; reduce dietary intake of phosphate
Calcium Carbonate
Trade Name(s): Alka-Mints, Calcium 600, Dicarbosil, Gencalc, Titralac, Tums
Chemically Related To: Unique compound
Pregnancy Category: C
Medical Category: Antihypocalcemic, nutritional supplement, antihyperphosphatemic, antacid
Accepted Indications: Hypocalcemia, calcium deficiency, hyperacidity, hyperphosphatemia, GI hyperacidity
Mechanism of Action: Elevates gastric pH
Absorption/Distribution: 33% absorbed in the small intestine; moderate protein binding
Elimination: Fecal, renal
Research Notes: Contains equivalent of 400 mg of calcium ion/g
Adult Dosage: 1.5 g once daily to t.i.d.
Elderly Dosage: May need increased dose
Dosage Forms: Capsules: 1.5 g; oral suspension 1 g/5 mL and 1.25 g/5 mL; tablets: 650 g, 667 g, 1.25 g, and 1.5 g; chewable tablets: 420 g, 500 g, 550 g, 625 g, 750 g, l.25 g, and 1.5 g
By System: GI tract
Warnings: Avoid excessive intake of alcohol, tobacco, or caffeine
Precautions: Monitor serum calcium; take with a full glass of water
Rare Side Effects: Drowsiness, nausea/vomiting, weakness, renal calculi
Contraindications: Severe renal disease, renal calculi (calcium), hypercalcemia, hypercalciuria
Overdosage: Constipation, dry mouth, headache, irritability, depression, weakness, confusion
Antidotal Therapy: May include hydration with IV 0.9% sodium chloride injection; force diuresis with furosemide; EKG monitoring; beta-adrenergic blockers
Disease States: Achlorhydria, diarrhea, dehydration, GI malabsorption
Other Drugs: Tetracyclines, cellulose sodium phosphate, digitalis, gallium nitrate, magnesium sulfate, phenytoin, ciprofloxacin
Lab Tests: Serum phosphate
Administrative Notes: If taken as a phosphate binder in renal dialysis, do not take with glass of water; do not take with milk and foods high in vitamin D
Calcium Iodide
Trade Name(s): Not available as single agent
Medical Category: Expectorant
Accepted Indications: Cough
Calcium Iodide/Codeine Phosphate
Trade Name(s): Calcidrine
Scheduled Class: V
Pregnancy Category: D
Medical Category: Antitussive, expectorant
Accepted Indications: Cough
Adult Dosage: Syrup: 5–{endash}10 mL every 4h
Child Dosage: Syrup: 2–{endash}6 y: 2.5 mL; 6–{endash}10 y: 2.5–{endash}5 mL every 4 h
Dosage Forms: Syrup: 152 mg/8.4 mg
By System: Respiratory
Warnings: Use during pregnancy could result in fetal goiter and respiratory problems in neonates
Precautions: Thyroid function tests
Frequent Side Effects: Metallic taste, acne-like lesions, irritation of mucous membranes, GI problems
Rare Side Effects: Severe and sometimes fatal skin eruptions, thyroid function abnormalities
Contraindications: Pregnancy, Iodism
Overdosage: Respiratory and CNS depression, pinpoint pupils, coma, decreased blood pressure, decreased body temperature, GI irritation, angioedema with laryngeal swelling, shock
Antidotal Therapy: May include establishment of patent airway, gastric lavage, treatment for shock, supportive measures, naloxone
Lab Tests: Thyroid function tests, protein-bound iodine, benzidine testing
Administrative Notes: Keep tightly closed and protected from light
Captopril
Trade Name(s): Capoten
Chemically Related To: Enalapril
Pregnancy Category: C in 1st trimester; D in 2nd and 3rd trimesters
Medical Category: Antihypertensive
Accepted Indications: Hypertension, CHF, proteinuria in diabetes
Mechanism of Action: Inhibits ACE and decreases peripheral vascular resistance
Absorption/Distribution: 75% from GI tract
Half life: <>
Metabolism: Hepatic
Elimination: Renal
Adult Dosage: 6.25–{endash}450 mg/d
Elderly Dosage: Decrease dose
Child Dosage: Dosage not established
Infant Dosage: May cause neonatal hypertension
Dosage Forms: Tablets: 12.5 mg, 25 mg, 50 mg, and 100 mg
By System: Vasodilator
Warnings: Caution in use with antiarrhythmic medication
Precautions: May cause dizziness
Frequent Side Effects: Cough, headache, nausea, dizziness
Occasional Side Effects: Rash, joint pain, loss of taste, hypotension
Rare Side Effects: Chest pain, angioedema, agranulocytosis, hyperkalemia
Antidotal Therapy: May include hemodialysis
Disease States: Renal impairment, bone marrow depression
Nutrition: Food delays absorption
Other Drugs: Alcohol, diuretics, estrogens, NSAIDs
Lab Tests: BUN, hemoglobin, hematocrit
Captopril/Hydrochlorothiazide
Trade Name(s): Capozide 25/15, 25/25, 50/15, 50/25
Pregnancy Category: C
Medical Category: Antihypertensive
Accepted Indications: Hypertension
Dosage Forms: Tablets: 25 mg/15 mg, 25 mg/25 mg, 50 mg/15 mg, and 50 mg/25 mg
Caramiphen Edisylate/Phenylpropanolamine Hydrochloride
Trade Name(s): De-Tuss, Ordrine AT, Tuss-Allergine, Tuss Vernade
Pregnancy Category: C
Medical Category: Decongestant-antitussive
Accepted Indications: Cough and cold symptoms
Dosage Forms: Capsules: 40 mg/75 mg; sustained-action liquid: 6.7 mg/12.5 mg
Caramiphen/Phenylpropanolamine
Trade Name(s): Tuss-Ornade Spansule
Chemically Related To: Phenylethylamine/noscapine
Medical Category: Decongestant-antitussive
Accepted Indications: Cough and cold symptoms
Mechanism of Action: Helps to restrict blood vessels to alleviate nasal congestion. Also helps to loosen mucus in the respiratory tract
Absorption/Distribution: Readily absorbed
Elimination: Hepatic
Research Notes: Renal
Adult Dosage: 1 capsule q 12 h
Elderly Dosage: See adult
Child Dosage: Not available
Dosage Forms: Capsules
By System: Respiratory
Precautions: Postpartum women may be at greater risk than rest of population of developing psychiatric disorders with the use of phenylpropanolamine
Occasional Side Effects: Dryness of mouth, insomnia
Rare Side Effects: Headache, increased blood pressure, painful urination
Overdosage: Abdominal pain, fast heartbeat, headache, nausea
Disease States: Cardiovascular disease, diabetes, hypertension, thyroid disease
Other Drugs: Antidepressants, antihypertensives, beta-adrenergic blocking agents, CNS stimulants, MAO inhibitors, rauwolfia alkaloids
Administrative Notes: Caution when taking phenylpropanolamine–{endash}containing appetite suppressants; possible insomnia
Carbachol
Trade Name(s): Isopto Carbachol, Miostat
Chemically Related To: Acetylcholine
Pregnancy Category: Not documented
Medical Category: Antiglaucoma agent, miotic
Accepted Indications: Open-angle glaucoma, miotic
Mechanism of Action: Stimulates cholinergic receptors
Half life: 2–{endash}12 h
Peak activity: Intraocular solution 2–{endash}5 min; topical solution within 4 h
Research Notes: Intraocular duration of miotic action 24 h; topical duration of action 4–{endash}8 h
Adult Dosage: 1 drop of a 0.75% to 3% solution t.i.d.
Elderly Dosage: Same as adult dose
Child Dosage: Same as adult dose
Infant Dosage: Same as adult dose
Dosage Forms: Intraocular solution 0.1%, ophthalmic solution 0.75%, 1.5%, 2.25%, and 3%
By System: Ophthalmic parasympathomimetic
Warnings: Discard unused portion
Precautions: Caution if blurred vision occurs
Frequent Side Effects: Blurred vision, eye pain
Occasional Side Effects: Headache, ocular irritation, eyelid twitching
Overdosage: Systemic absorption, diarrhea, stomach cramps, flushing of face, increased sweating, excessive salivation
Antidotal Therapy: May include atropine sulfate injection
Disease States: Bronchial asthma, acute cardiac failure, corneal abrasion, GI spasm, iritis, urinary tract obstruction
Other Drugs: Belladonna alkaloids (ophthalmic), cyclopentolate, ophthalmic flurbiprofen
Administrative Notes: Tolerance possible with prolonged use
Carbamazepine
Trade Name(s): Tegretol
Chemically Related To: Tricyclic antidepressants
Pregnancy Category: C
Medical Category: Anticonvulsant, antineuralgic
Accepted Indications: Epilepsy, neuralgia
Unaccepted Indications: Epileptic atonic seizures
Mechanism of Action: Blocks action of neurotransmitters
Absorption/Distribution: Slow but complete absorption from GI tract
Half life: 25–{endash}65 h
Metabolism: Hepatic
Elimination: Renal, fecal
Research Notes: Onset of action in treatment of mania: 7–{endash}10 d
Adult Dosage: 200 mg b.i.d. up to 1.6 g/d
Elderly Dosage: Because of decreased kidney function in elderly patients, a decrease in dosage recommended; confusion, agitation, and heart block possible
Child Dosage: 250–{endash}350 mg up to 6 y; 400–{endash}800 mg up to 12 y
Infant Dosage: Same as child dose
Dosage Forms: Oral suspension 100 mg/5 mL, tablets 200 mg, chewable tablets 100 mg
By System: CNS
Warnings: Possible anticholinergic side effects
Precautions: Cross-sensitivity with tricyclic antidepressants
Frequent Side Effects: Blurred vision
Occasional Side Effects: Lightheadedness, gastric upset, confusion, unsteadiness
Rare Side Effects: Systemic lupus erythematosus, changes in behavior, blood dyscrasias
Contraindications: Cardiac disorders, such as heart block; atonic seizures; blood disorders; bone marrow depression
Overdosage: Tachycardia, hypotension, hypertension, breathing difficulties, shock, seizures
Antidotal Therapy: May include gastric lavage, activated charcoal, diuresis
Disease States: CNS or heart disorders, kidney problems
Nutrition: Take with food to reduce GI distress
Other Drugs: Anticonvulsants, tricyclic antidepressants, anticoagulants, erythromycins, MAO inhibitors
Lab Tests: Metyrapone
Administrative Notes: Protect drug from moisture; store in a dry place
Carbenicillin Indanyl Sodium
Trade Name(s): Geocillin
Chemically Related To: Penicillin
Pregnancy Category: B
Medical Category: Antibacterial, antipseudomonal penicillin
Accepted Indications: Urinary tract infections, prostatitis
Mechanism of Action: Bactericidal, cell wall synthesis inhibited
Absorption/Distribution: 30%–{endash}50% absorbed; moderate protein binding; oral carbenicillin at therapeutic concentrations only in the urine
Half life: 1–{endash}1.5 h
Elimination: 60%–{endash}90% excreted unchanged renal
Research Notes: In severely impaired renal function, therapeutic urine concentrations of carbenicillin not achieved
Adult Dosage: Oral: 382–{endash}764 mg q.i.d.
Child Dosage: Not established
Infant Dosage: Not established
Dosage Forms: Tablets: 382 mg
Warnings: Bleeding time determinations suggested before and during prolonged therapy in patients with renal function impairment; in elderly, with decrease in renal function, dosage adjustment suggested
Frequent Side Effects: GI reactions, oral candidiasis
Rare Side Effects: Allergic reactions, especially anaphylaxis, serum sickness–{endash}like or hematologic reactions, rash, platelet dysfunction, interstitial nephritis
Disease States: History of bleeding disorders, GI disease, infectious mononucleosis, renal function impairment
Other Drugs: Coumarin anticoagulants, NSAIDs, captopril, potassium–{endash}sparing diuretics, potassium supplements, sulfinpyrazone, platelet aggregation inhibitors
Lab Tests: Bleeding time; antiglobulin test; alanine aminotransferase aspartate aminotransferase levels; hypernatremia; hypokalemia
Administrative Notes: Oral absorption increased by food; for severe diarrhea, check with physician before taking any antidiarrheals
Carbetapentane Tannate
Trade Name(s): Not available as single agent
Chemically Related To: Antihistamines
Pregnancy Category: C
Medical Category: Antitussive
Accepted Indications: Cough
Infant Dosage: Avoid in newborns
Carbidopa
Trade Name(s): Not available as a single agent
Chemically Related To: Dopamine
Pregnancy Category: C
Medical Category: Decarboxylase inhibitor
Accepted Indications: None. Has no effect when given alone; indicated only for use with levodopa.
Mechanism of Action: Inhibits peripheral decarboxylation of levodopa
Absorption/Distribution: Complete and rapid absorption; widely distributed
Half life: 1–{endash}2 h
Metabolism: Little metabolism, actually slows metabolism of levodopa in GI tract
Elimination: Renal
Research Notes: Used primarily in combination with levodopa, as it allows less levodopa to be used
Other Drugs: Tricyclic antidepressants
Carbidopa
Trade Name(s): Not available as a single agent
Chemically Related To: Dopamine
Pregnancy Category: C
Medical Category: Decarboxylase inhibitor
Accepted Indications: None. Has no effect when given alone; indicated only for use with levodopa.
Mechanism of Action: Inhibits peripheral decarboxylation of levodopa
Absorption/Distribution: Complete and rapid absorption; widely distributed
Half life: 1–{endash}2 h
Metabolism: Little metabolism, actually slows metabolism of levodopa in GI tract
Elimination: Renal
Research Notes: Used primarily in combination with levodopa, as it allows less levodopa to be used
Other Drugs: Tricyclic antidepressants
Carbidopa/Levodopa
Trade Name(s): Sinemet, Sinemet CR
Pregnancy Category: C
Medical Category: Antidyskinetic
Accepted Indications: Parkinsonism
Mechanism of Action: Carbidopa inhibits peripheral decarboxylation of levodopa, thus slowing its conversion peripherally and increasing its availability centrally
Absorption/Distribution: Complete and rapid absorption; widely distributed
Half life: 1–{endash}2 h
Peak activity: Tablets: 0.7 h; extended-release tablets: 2.4 h
Elimination: Renal
Adult Dosage: 10 mg/100 mg t.i.d. or 25 mg/100 mg t.i.d. initially, then increase dosage
Elderly Dosage: Lower dose may be required
Child Dosage: Safety and efficacy not established
Infant Dosage: Safety and efficacy not established
Dosage Forms: Tablets: 10 mg/100 mg, 25 mg/100 mg, and 25 mg/250 mg; extended-release tablets: 25 mg/100 mg and 50 mg/200 mg
By System: CNS
Warnings: May darken urine or perspiration
Precautions: Caution if surgery required
Frequent Side Effects: Mental depression, uncontrolled movement, anxiety, nervousness
Occasional Side Effects: Difficulty in urination, orthostatic hypotension, anorexia, constipation, headache, insomnia, irregular heartbeat, nausea, vomiting, blurred vision, diarrhea, dry mouth, flushing, muscle twitching, unusual tiredness, nightmares, dark urine
Rare Side Effects: Duodenal ulcer, hemolytic anemia, hypertension
Antidotal Therapy: No specific antidote; may include gastric lavage, antiarrhythmics
Disease States: Asthma, emphysema, myocardial infarction, heart disease, psychotic states, glaucoma
Other Drugs: Anticonvulsants, phenothiazines, cocaine, MAO inhibitors, haloperidol, hydrocarbon anesthetics, selegiline
Administrative Notes: Take food after medication. Store in a light-resistant container.
Carbinoxamine Maleate
Trade Name(s): Not available as a single agent
Chemically Related To: Ethanolamine
Pregnancy Category: C
Medical Category: Antihistamine
Accepted Indications: Rhinitis, allergy symptoms
Mechanism of Action: Competes for H1 receptor site
Carbinoxamine Maleate/Dextromethorphan Hydrobromide/Pseudoephedrine Hydrochloride
Trade Name(s): Carbodec-DM, Cardec-DM, Pseudo-Car DM, Rondamine-DM, Rondec-DM, Tussafed
Pregnancy Category: C
Medical Category: Antihistamine, antitussive
Accepted Indications: Coughs and colds
Adult Dosage: Syrup: 5 mL every 4–{endash}6 h
Child Dosage: 18 m–{endash}6 y: syrup, 2.5 mL; over 6 y: syrup, 5 mL every 4–{endash}6 h
Infant Dosage: 1–{endash}3 m: 0.25 mL drops; 3–{endash}6 m: 0.50 mL drops; 6–{endash}9 m: 0.75 mL drops; 9-18 m: 1 mL drops every 4–{endash}6 h
Dosage Forms: Oral solution: 2 mg/mL/4 mg/mL/25 mg/mL; syrup: 4 mg/5 mL 15 mg/5 mL 60 mg/5 mL
Carbinoxamine Maleate/Pseudoephedrine Hydrochloride
Trade Name(s): Carbiset-TR, Carbodec, Carbodec TR, Cardec-S, Rondec, Rondec Drops, Rondec-TR
Pregnancy Category: C
Medical Category: Antihistamine, decongestant
Accepted Indications: Coughs, colds, and allergies
Adult Dosage: Tablets: 1 tablet q.i.d.; extended-release tablets: 1 tablet b.i.d.; syrup: 5 mL q.i.d.
Child Dosage: 6–{endash}12 y, tablets: 1 tablet q.i.d.; syrup, 5 mL q.i.d. 18 m–{endash}6 y, syrup: 2.5 mL q.i.d.
Infant Dosage: Drops, 1–{endash}3 m: 0.25 mL q.i.d., 3–{endash}6 m: 0.5 mL q.i.d., 6–{endash}9 m: 0.75 mL q.i.d., 9–{endash}18 m: 1 mL q.i.d.
Dosage Forms: Syrup: 4 mg/60 mg; tablets 4 mg/60 mg; extended-release tablets: 8 mg/120 mg; drops: 2 mg/mL and 25 mg/mL
Carboplatin
Trade Name(s): Paraplatin, Paraplatin-AQ
Chemically Related To: Cisplatin
Pregnancy Category: D
Medical Category: Antineoplastic
Accepted Indications: Ovarian, lung, head and neck, and testicular carcinomas
Mechanism of Action: Inhibits DNA
Half life: Alpha 1.1–{endash}2 h; beta 2.6–{endash}5.9 h
Elimination: Renal
Research Notes: Not cell-cycle or phase specific
Adult Dosage: Ovarian carcinoma: initial IV 300 mg/m2 every 4 w for 6 cycles, in combination with IV 600 mg/m2 cyclophosphamide every 4 w for 6 cycles. If refractory to other chemotherapy, IV 360 mg/m2 once every 4 w
Elderly Dosage: Peripheral neurotoxicity and severity of myelotoxicity increased; may require lower doses
Child Dosage: Not established
Dosage Forms: Injection: 50 mg, 150 mg, and 450 mg
By System: Growing cells
Warnings: Avoid immunizations; be monitored by physician
Precautions: Caution if taking combination therapy; take medication even if GI distress occurs
Frequent Side Effects: Anemia, leukopenia, pain at injection site, nausea and vomiting, thrombocytopenia
Occasional Side Effects: Tingling in extremities, tinnitus, constipation, diarrhea, appetite or hair loss
Rare Side Effects: Blurred vision, stomatitis
Disease States: Bleeding, bone marrow depression, infection, kidney problems, ascites
Other Drugs: Bone marrow depressants, cisplatin, vaccines, ototoxic or nephrotoxic medications, live virus vaccines.
Lab Tests: BUN, bilirubin, calcium, magnesium, potassium and sodium serum concentrations, creatinine
Administrative Notes: Often given with cyclophosphamide in 6 cycles
Carisoprodol
Trade Name(s): Soma
Chemically Related To: Meprobamate
Abuse Potential: Increasing
Pregnancy Category: Not documented
Medical Category: Skeletal muscle relaxant
Accepted Indications: Skeletal muscle spasm
Mechanism of Action: Acts in CNS to depress activity and block interneuronal activity
Absorption/Distribution: Partially absorbed; distributed in all body tissues
Half life: 8 h
Peak activity: 4 h
Metabolism: Hepatic
Elimination: Renal
Research Notes: Psychological dependence and abuse reported rarely; withdrawal symptoms possible if drug is discontinued abruptly
Adult Dosage: 350 mg q.i.d.
Elderly Dosage: Same as adult dosage
Child Dosage: Under 5 y: not established; 5–{endash}12 y: 6.25 mg/kg q.i.d.
Infant Dosage: Not established
Dosage Forms: Tablets: 350 mg
By System: CNS
Precautions: Excreted in breast milk; causes sedation in breastfed infant
Frequent Side Effects: Drowsiness
Occasional Side Effects: Tachycardia, mental depression, angioedema, bronchospastic allergic reaction, fever, burning sensation in eyes, dizziness, trembling, GI irritation, hiccups, nausea
Rare Side Effects: Anemia, leukopenia, eosinophilia, erythema multiforme, blurred vision, clumsiness
Contraindications: Porphyria
Overdosage: Drowsiness, tachycardia, flushing, hypotension, coma
Antidotal Therapy: May include emesis or gastric lavage; supportive treatment; respiratory assistance, CNS stimulants, and pressor agents used cautiously, if necessary; hemodialysis; monitor urinary output
Disease States: Porphyria
Other Drugs: CNS depression–{endash}producing medications
Lab Tests: Urine
Administrative Notes: Avoid alcohol
Casanthranol
Trade Name(s): Black-Draught
Medical Category: Stimulant or contact laxative
Accepted Indications: Constipation, bowel evacuation
Mechanism of Action: Affects smooth intestinal musculature
Adult Dosage: Syrup: 30 mL/d maximum
Dosage Forms: Syrup: 30 mg/5 mL
Occasional Side Effects: Belching, cramping, diarrhea, nausea, rectal irritation
Rare Side Effects: Rash, electrolyte imbalance
Contraindications: CHF, diabetes, hypertension, appendicitis
Disease States: Intestinal obstruction, rectal bleeding
Nutrition: Do not drink milk
Other Drugs: H2 blockers, milk, potassium–{endash}sparing diuretics, potassium supplements, antacids
Lab Tests: PSP test
Cascara Sagrada
Trade Name(s): Generic only
Medical Category: Stimulant or contact laxative
Accepted Indications: Constipation, evacuation
Mechanism of Action: Affects smooth intestinal musculature
Adult Dosage: Tablets: 1 tablet/d maximum; oral solution: 5 mL/d, up to 15 mL/d
Elderly Dosage: Use with caution
Child Dosage: Tablets: not recommended; oral solution: over 2 y: 1–{endash}3 mL/d
Infant Dosage: Not recommended
Dosage Forms: Tablets: 150 mg; oral solution; 1 g/mL
Occasional Side Effects: Bloating, belching, rectal irritation, cramping, diarrhea, nausea
Rare Side Effects: Rash, electrolyte imbalance, urine discoloration
Contraindications: Diabetes, CHF, hypertension, appendicitis
Disease States: Intestinal obstruction, rectal bleeding
Other Drugs: H2 blockers, potassium–{endash}sparing diuretics, potassium supplements, antacids, milk
Lab Tests: PSP test
Cefaclor
Trade Name(s): Ceclor
Chemically Related To: Cephalosporins; second-generation cephalosporin
Pregnancy Category: B
Medical Category: Antibacterial, second-generation cephalosporin
Accepted Indications: Haemophilus influenzae infections, septicemia, bone and joint infections, gram-negative pneumonia, skin and soft tissue infections, bacterial urinary tract infections, amoxicillin-resistant otitis media and sinusitis
Unaccepted Indications: Enterococcal, listerial, clostridial, and methicillin-resistant staphylococcal infections
Mechanism of Action: Prevents formation of peptidoglycan chains; destroys bacterial cell wall integrity
Absorption/Distribution: Well absorbed in all body tissues
Peak activity: 1–{endash}3 h
Elimination: Renal
Adult Dosage: 500–{endash}1500 mg/d
Elderly Dosage: Do not exceed 1 g/d
Child Dosage: 60 mg/kg/d
Infant Dosage: Up to 40 mg/kg/d
Dosage Forms: Capsules: 250 mg and 500 mg; suspension: 125 mg/5 mL and 250 mg/5 mL
Warnings: Severe diarrhea
Frequent Side Effects: GI cramps, diarrhea
Occasional Side Effects: Stomach cramps, rash, allergy
Rare Side Effects: Thrombophlebitis, hepatitis, CNS disturbance
Contraindications: Allergy to compound
Disease States: Bleeding disorders, GI disease, hepatic or renal impairment
Other Drugs: Alcohol, anticoagulants, and heparin
Cefadroxil
Trade Name(s): Duricef
Chemically Related To: Cephalosporins
Pregnancy Category: B
Medical Category: Antibacterial, first-generation cephalosporin
Accepted Indications: Gram-positive bacteria, E. coli, Proteus mirabilis, and Klebsiella species
Unaccepted Indications: Staphylococcal, listerial, or clostridial infections
Mechanism of Action: Blocks materials necessary for building of bacterial cell wall
Absorption/Distribution: Well absorbed with food; widely distributed
Half life: 1.2–{endash}1.5 h
Metabolism: 10% metabolized
Elimination: Renal
Research Notes: Prolonged half-life reported in neonates
Adult Dosage: 500 mg b.i.d. up to 4 g/d; decrease dose with kidney problems
Elderly Dosage: Same as adult dose
Child Dosage: 15 mg/kg b.i.d.
Infant Dosage: Same as child dose
Dosage Forms: Capsules: 500 mg; tablets: 1 g; oral suspension: 125 mg/5 mL, 250 mg/5 mL and 500 mg/5 mL
Warnings: Possible cross-sensitivity with penicillins
Precautions: Do not take antidiarrheal preparations without consulting physician
Frequent Side Effects: Sores in mouth, diarrhea, nausea and vomiting
Occasional Side Effects: Bleeding and bruising, stomach cramps, fever
Rare Side Effects: Hypotension, kidney problems, hypersensitivity
Contraindications: Sensitivity to penicillins
Disease States: Hepatic or renal impairment, bleeding disorders, GI problems
Other Drugs: Anticoagulants, thrombolytics, probenecid, alcohol
Lab Tests: Urine and blood glucose, prothrombin time, Coombs' test
Administrative Notes: With food, increased drug blood level. Calibrated liquid-measuring device available.
Cefixime
Trade Name(s): Suprax
Chemically Related To: Cephalosporins
Pregnancy Category: B
Medical Category: Antibacterial, third-generation cephalosporin
Accepted Indications: Infections caused by Streptococcus pyogenes, Streptococcus pneumoniae, gram-negative bacteria
Unaccepted Indications: Infections caused by Pseudomonas aeruginosa, staphylococci
Mechanism of Action: Disturbs bacterial cell wall integrity
Absorption/Distribution: Almost 50% bioavailability; does not cross into CSF
Half life: 3–{endash}4 h
Metabolism: Not metabolized
Elimination: Renal
Research Notes: One of 2 third-generation cephalosporins
Adult Dosage: 200 mg b.i.d. to a limit of 400 mg/d
Elderly Dosage: Lower dose with kidney problems
Child Dosage: 4 mg/kg b.i.d. or 8 mg/kg once daily
Infant Dosage: Over 6 m: same as child dose
Dosage Forms: Oral suspension: 100 mg/5 mL; tablets: 200 mg and 400 mg
Warnings: Do not take antidiarrheal medications without consulting physician
Precautions: Do not stop medication until treatment course is ended
Frequent Side Effects: Diarrhea
Occasional Side Effects: GI disturbances, colitis, sore mouth and tongue
Rare Side Effects: Vaginitis
Contraindications: Allergic reactions to penicillins
Antidotal Therapy: No specific antidote; may include supportive treatment
Disease States: Renal function impairment, GI disease, bleeding disorders
Other Drugs: Anticoagulants, thrombolytic agents, alcohol
Lab Tests: Coombs' test, prothrombin time
Administrative Notes: Take with food to lessen GI distress. Reconstituted suspension retains potency for 14 d.
Cefmetazole Sodium
Trade Name(s): Zefazone
Chemically Related To: Cephalosporins
Pregnancy Category: B
Medical Category: Second-generation cephalosporin
Accepted Indications: Septicemia, bone and joint infections, gram-negative pneumonia, skin and soft tissue infections, urinary tract infections, Bacteroides fragilis infections, aspiration pneumonia, diabetic foot infections, intra-abdominal and pelvic infections, perioperative infection prophylaxis, gonorrhea, lower respiratory infections
Unaccepted Indications: Infections caused by Listeria, Chlamydia, Clostridium difficile, methicillin-resistant Staphylococcus epidermis or S. aureus, or enterococci
Mechanism of Action: Interferes with cell wall synthesis
Absorption/Distribution: Widely distributed throughout body
Half life: 0.8–{endash}1.8 h
IV: End of infusion
Metabolism: Not metabolized
Elimination: Renal
Adult Dosage: Antibacterial: IV, 2 g b.i.d. to q.i.d. for 5–{endash}14 d; gonorrhea: IM, 1 g as a single dose concurrent with 1 g of probenecid; perioperative prophylaxis: IV, 2 g 30–{endash}90 min before surgery or 1–{endash}2 g 30–{endash}90 min before surgery and repeat in 8 and 16 h
Elderly Dosage: Lower dosage may be required
Child Dosage: Not established
Infant Dosage: Not established
Dosage Forms: For injection: 1 g and 2 g
Warnings: Adjust dose for renal impairment; comply with full course of therapy
Frequent Side Effects: GI reactions, oral candidiasis, vaginal candidiasis
Occasional Side Effects: Hypothrombinemia, pseudomembranous colitis
Rare Side Effects: Allergic reaction, thrombophlebitis, Stevens-Johnson syndrome, hemolytic anemia, hypersensitivity, renal dysfunction, serum sickness–{endash}like syndrome, seizures
Antidotal Therapy: May include metronidazole, vancomycin for C. difficile infections
Compatibility of Solutions: Incompatible with heparin, aminoglycosides
Disease States: Bleeding disorders, GI disease, renal function impairment
Other Drugs: Alcohol, anticoagulants, probenecid, heparin, thrombolytic agents, platelet aggregation inhibitors
Lab Tests: Prothrombin time
Cefoperazone Sodium
Trade Name(s): Cefobid
Chemically Related To: Cephalosporins
Pregnancy Category: B
Medical Category: Third-generation cephalosporin
Accepted Indications: Septicemia, bone and joint infections, pelvic infections, intra-abdominal infections, gram-negative pneumonia, skin and soft tissue infections, uncomplicated urinary tract infections
Unaccepted Indications: Infections by Enterococci, Listeria, Chlamydia, Clostridium difficile, methicillin-resistant Staphylococcus epidermis or S. aureus
Mechanism of Action: Interferes with cell wall synthesis
Half life: 1.6–{endash}2.6 h
IM: 1–{endash}2 h
IV: End of infusion
Metabolism: Not metabolized
Elimination: Renal
Adult Dosage: Up to 12 g/d in 2 or 3 divided doses
Elderly Dosage: Lower dosage may be required
Child Dosage: Not established
Infant Dosage: Not established
Dosage Forms: Injection: 1 g/50 mL and 2 g/50 mL; sterile injection: 1 g (base), 2 g (base), and 10 g (base)
Frequent Side Effects: Oral candidiasis, GI reactions, vaginal candidiasis
Occasional Side Effects: Hypoprothrombinemia, pseudomembranous colitis
Rare Side Effects: Allergic reactions, Stevens-Johnson syndrome, hemolytic anemia, hypersensitivity, renal dysfunction, serum sickness–{endash}like reactions, seizures, thrombophlebitis
Contraindications: Renal impairment, hepatic impairment
Antidotal Therapy: May include use of vancomycin for colitis caused by C. difficile infection
Compatibility of Solutions: Not compatible with aminoglycosides
Other Drugs: Alcohol, anticoagulants, heparin, thrombolytic agents, platelet aggregation inhibitors, nephrotoxic medications
Lab Tests: Urine glucose, Coombs' test
Cefotaxime Sodium
Trade Name(s): Claforan
Chemically Related To: Cephalosporins
Pregnancy Category: B
Medical Category: Third-generation cephalosporin
Accepted Indications: Gram-negative pneumonia, septicemia, bone and joint infections, pelvic infections, intra-abdominal infections, skin and soft tissue infections, complicated urinary tract infections, meningitis
Unaccepted Indications: Infections caused by enterococci, Listeria, Chlamydia, Clostridium difficile, methicillin-resistant Staphylococcus epidermis or S. aureus
Mechanism of Action: Interferes with cell wall synthesis
Absorption/Distribution: Widely distributed throughout the body
Half life: 1 h
IM: 0.5 h
Metabolism: Hepatic, renal
Elimination: Renal
Adult Dosage: Up to 12 g/d in 3 divided doses
Elderly Dosage: Lower dosage may be required
Child Dosage: Up to 50 kg: up to 180 mg/kg/d in 2–{endash}4 divided doses; 50 kg and over: same as adult dose
Infant Dosage: Same as child dose
Dosage Forms: Injection: 1 g (base)/50 mL and 2 g (base)/50 mL; sterile injection: 500 mg (base), 1 g (base), 2 g (base), and 10 g (base)
Warnings: Do not use if solution is cloudy or contains precipitate
Precautions: Solution may change color–{endash}does not affect potency
Frequent Side Effects: Oral candidiasis, GI reactions, vaginal candidiasis
Occasional Side Effects: Hypoprothrombinemia, pseudomembranous colitis
Rare Side Effects: Allergic reactions, Stevens-Johnson syndrome, hemolytic anemia, hypersensitivity, renal dysfunction, serum sickness–{endash}like reactions, seizures, thrombophlebitis
Contraindications: Renal impairment, hepatic impairment
Antidotal Therapy: May include use of vancomycin for colitis caused by C. difficile infection
Compatibility of Solutions: Incompatible with aminoglycosides
Other Drugs: Alcohol, anticoagulants, heparin, thrombolytic agents, platelet aggregation inhibitors, probenecid, nephrotoxic medications
Lab Tests: BUN, Coombs' test
Cefotetan Disodium
Trade Name(s): Cefotan
Chemically Related To: Cephalosporins
Pregnancy Category: B
Medical Category: Second-generation cephalosporin
Accepted Indications: Septicemia, bone and joint infections, gram-negative pneumonia, skin and soft tissue infections, Bacteroides fragilis infections, aspiration pneumonia, diabetic foot infections, intra-abdominal and pelvic infections, perioperative infection prophylaxis, gonorrhea
Unaccepted Indications: Infections caused by Listeria, Chlamydia, Clostridium difficile, methicillin-resistant Staphylococcus epidermis or S. aureus, or enterococci
Mechanism of Action: Inhibits cell wall synthesis
Absorption/Distribution: Widely distributed throughout body
Half life: 3–{endash}4.6 h
IM: 1–{endash}3 h
IV: End of infusion
Metabolism: Not metabolized
Elimination: Renal
Adult Dosage: Mild to moderate infections: IV or IM, 1–{endash}2 g b.i.d. for 5–{endash}10 d; severe infections: IV, 2 g b.i.d.; life-threatening infections: IV, 3 g b.i.d.; perioperative prophylaxis: IV, 1–{endash}2 g 0.5–{endash}1 h before surgery; urinary tract infections: IM or IV, 500 mg–{endash}2 g b.i.d. or 1–{endash}2 g once daily
Elderly Dosage: Lower dose may be required
Child Dosage: Not established
Infant Dosage: Not established
Dosage Forms: Sterile injection: 1 g, 2 g, and 10 g
Warnings: Adjust dose for renal impairment; comply with full course of therapy
Precautions: Solutions range in color
Frequent Side Effects: GI reactions, oral candidiasis, vaginal candidiasis
Occasional Side Effects: Hypothrombinemia, pseudomembranous colitis
Rare Side Effects: Allergic reaction, thrombophlebitis, Stevens-Johnson syndrome, hemolytic anemia, hypersensitivity, renal dysfunction, serum sickness–{endash}like syndrome, seizures
Antidotal Therapy: May include metronidazole, vancomycin for C. difficile infections
Compatibility of Solutions: Incompatible with aminoglycosides
Disease States: Bleeding disorders, GI disease, renal function impairment
Other Drugs: Alcohol, anticoagulants, probenecid, heparin, thrombolytic agents, platelet aggregation inhibitors
Lab Tests: Prothrombin time
Cefoxitin Sodium
Trade Name(s): Mefoxin
Chemically Related To: Cephalosporins
Pregnancy Category: B
Medical Category: Antibacterial, second-generation cephalosporin
Accepted Indications: Infections by anaerobic organisms, including septicemia, bone and joint infections, gram-negative pneumonia, skin and soft tissue infections, burn wound infections, and urinary tract infections; mixed aerobic-anaerobic bacterial infections, including aspiration pneumonia, diabetic foot infections, colorectal and appendectomy perioperative infections, and penicillin-resistant strains of gonorrhea
Unaccepted Indications: Infections caused by enterococci, Listeria species, Chlamydia
Mechanism of Action: Bactericidal, inhibits cell wall synthesis
Absorption/Distribution: Widely distributed, moderate protein binding
Half life: 0.7–{endash}1.1 h
IM: 0.3–{endash}0.5 h
IV: End of infusion
Metabolism: Hepatic
Elimination: Renal
Adult Dosage: IV injection 1 g t.i.d. or q.i.d. up to 12 g/d
Elderly Dosage: May require changes in dosage
Child Dosage: 3 m and over: 13.3–{endash}26.7 mg/kg q4h
Infant Dosage: Up to 3 m: not established
Dosage Forms: Injection: 1 g/50 mL and 2 g/50 mL; sterile: 1 g, 2 g and 10 g
Warnings: Avoid alcohol
Precautions: Check with physician before taking antidiarrheals
Frequent Side Effects: Oral candidiasis, GI problems
Occasional Side Effects: Hypoprothrombinemia, pseudomembranous colitis, vaginitis
Rare Side Effects: Stevens-Johnson syndrome
Contraindications: Allergic reaction to penicillins or penicillin derivatives
Disease States: History of bleeding disorders; GI, liver, and kidney problems
Other Drugs: Alcohol, nephrotoxic medications, platelet-aggregation inhibitor, heparin, probenecid
Lab Tests: Coombs' test, blood glucose, prothrombin time, CBC, platelet count
Administrative Notes: Take with food if there is GI distress
Cefpodoxime
Trade Name(s): Vantin
Chemically Related To: Cephalosporins
Pregnancy Category: B
Medical Category: Third-generation cephalosporin
Accepted Indications: Gram-negative pneumonia, septicemia, bone and joint infections, pelvic infections, intra-abdominal infections, skin and soft tissue infections, complicated urinary tract infections, gonorrhea
Unaccepted Indications: Infections caused by enterococci, Listeria, Chlamydia, Clostridium difficile, methicillin-resistant Staphylococcus epidermis or S. aureus
Mechanism of Action: Interferes with cell wall synthesis
Absorption/Distribution: Widely distributed throughout the body
Half life: 2.1–{endash}2.8 h
Elimination: Renal
Adult Dosage: Bacterial bronchitis: 200 mg b.i.d. for 10 d; uncomplicated gonorrhea: 200 mg as a single dose; bacterial pharyngitis: 100 mg b.i.d. for 10 d; uncomplicated pneumonia: 200 mg b.i.d. for 14 d; skin and soft tissue infections: 400 mg b.i.d. for 7–{endash}14 d; uncomplicated urinary tract infections: 100 mg b.i.d. for 7 d
Elderly Dosage: Lower dosages may be required
Child Dosage: Up to 12 y: 5 mg/kg b.i.d. for 10 d
Infant Dosage: Up to 6 m: not established; 6 m and over: same as child dose
Dosage Forms: Tablets: 100 mg and 200 mg; oral suspension: 50 mg/5 mL and 100 mg/5 mL
Precautions: Take with food. Adjust dose for renal impairment, comply with full course of therapy
Frequent Side Effects: Oral candidiasis, GI reactions, vaginal candidiasis
Occasional Side Effects: Hypoprothrombinemia, pseudomembranous colitis
Rare Side Effects: Allergic reactions, Stevens-Johnson syndrome, hemolytic anemia, hypersensitivity, renal dysfunction, serum sickness–{endash}like reaction, seizures, thrombophlebitis
Antidotal Therapy: May include metronidazole, vancomycin for colitis caused by C. difficile infection
Disease States: GI disease, renal function impairment
Other Drugs: Antacids, histamine H2-receptor agonists, platelet aggregation inhibitors, probenecid
Lab Tests: BUN, Coombs' test
Cefprozil
Trade Name(s): Cefzil
Chemically Related To: Cephalosporins
Pregnancy Category: B
Medical Category: Antibacterial, second-generation cephalosporin
Accepted Indications: Wide number of infections, including those caused by Escherichia coli, Klebsiella, and Proteus mirabilis; septicemia; bone and joint infections; gram-negative pneumonia
Unaccepted Indications: Infections caused by enterococci, Listeria species, Chlamydia
Mechanism of Action: Bactericidal, inhibits cell wall synthesis
Absorption/Distribution: High bioavailability
Half life: 1.3 h
Elimination: Renal
Adult Dosage: Oral 500 mg b.i.d. for 10 d
Elderly Dosage: Same as adult dose
Child Dosage: 6 m–{endash}12 y: 15 mg/kg every 12 h for 10 d (otitis media)
Infant Dosage: Up to 6 m: not established
Dosage Forms: For oral suspension: 125 mg/5 mL and 250 mg/5 mL; tablets: 250 mg and 500 mg
Warnings: Do not take antidiarrheals
Frequent Side Effects: Oral candidiasis
Occasional Side Effects: Unusual bleeding or bruising, vaginitis, rash
Rare Side Effects: Stevens-Johnson syndrome, serumlike sickness, itching, hypersensitivity
Contraindications: Reaction to penicillins
Antidotal Therapy: No specific antidote; may include supportive and symptomatic treatment
Disease States: Bleeding disorders, GI and liver/kidney problems, phenylketonuria
Other Drugs: Alcohol, thrombolytic agents, probenecid, platelet-aggregation inhibitors
Lab Tests: Coombs' test, blood glucose, prothrombin time, BUN, CBC, bilirubin
Administrative Notes: Include calibrated device with oral suspension
Ceftazidime
Trade Name(s): Ceptaz, Fortaz, Tazicef, Tazidime
Chemically Related To: Cephalosporins
Pregnancy Category: B
Medical Category: Antibacterial, third-generation cephalosporin
Accepted Indications: Wide spectrum of gram-negative bacterial infections, including septicemia, bone and soft tissue infections, burn wounds, urinary tract infections
Unaccepted Indications: Infections caused by enterococcal, Listeria species, Chlamydia
Mechanism of Action: Bactericidal; inhibits cell wall synthesis
Absorption/Distribution: Low protein binding; widely distributed, including CNS
Half life: 2 h
IM: 1 h
IV: End of infusion
Elimination: Renal
Research Notes: 3rd generation cephalosporin
Adult Dosage: 250 mg–{endash}2 g b.i.d. to t.i.d. by IV or IM
Elderly Dosage: Adjust dosage if renal impairment
Child Dosage: 1 m–{endash}12 y: IV infusion 30–{endash}50 mg/kg t.i.d.
Infant Dosage: Neonates up to 4 w: IV infusion 30 mg/kg b.i.d.
Dosage Forms: Injection: 1 g/50 mL or 2 g/50 mL; for injection 500 mg, 1 g, 2 g, 6 g and 10 g
By System: Systemic
Warnings: Avoid alcohol; do not miss doses
Precautions: Do not take antidiarrheals
Frequent Side Effects: Oral candidiasis
Occasional Side Effects: Hypoprothrombinemia, vaginitis
Rare Side Effects: Stevens-Johnson syndrome
Contraindications: Previous allergic reaction to penicillins and penicillamines
Antidotal Therapy: No specific antidote; may include supportive treatment
Disease States: Bleeding disorders; GI, liver, and kidney problems; phenylketonuria
Other Drugs: Thrombolytic agents, alcohol, probenecid, nephrotoxic medications, anticoagulants
Lab Tests: Blood and urine glucose, BUN, CBC, platelet count, Coombs' test
Administrative Notes: Incompatible with vancomycin; if given with aminoglycosides, do not mix together; take with food after GI upset.
Ceftizoxime Sodium
Trade Name(s): Cefizox
Pregnancy Category: B
Medical Category: Systemic antibacterial, third-generation cephalosporin
Accepted Indications: Serious gram-negative bacterial infections, septicemia, bone and joint infections, pelvic infections, intra-abdominal infections, gram-negative pneumonia, skin and soft tissue infections, complicated urinary tract infections, Enterococci, Listeria, Chlamydia, Clostridium difficile, methicillin-resistant Staphylococcus epidermis or S. aureus
Mechanism of Action: Inhibits bacterial cell wall synthesis
Absorption/Distribution: Widely distributed throughout most tissues
Half life: 1.7 h (IM)
IM: 1 h
IV: End of infusion
Elimination: Renal
Adult Dosage: IV: 1–{endash}4 g t.i.d.
Child Dosage: 50 mg/kg t.i.d. to q.i.d.
Infant Dosage: Under 6 m: not established; 6 m and over: IV, 50 mg/kg t.i.d. to q.i.d.
Dosage Forms: Injection: 1 g/50 mL and 2 g/50 mL; sterile injection: 1 g, 2 g, and 10 g
Compatibility of Solutions: Incompatible with aminoglycosides
Other Drugs: Alcohol
Administrative Notes: Do not use if cloudy or contains precipitate
Ceftriaxone Sodium
Trade Name(s): Rocephin
Chemically Related To: Cephalosporins
Pregnancy Category: B
Medical Category: Antibacterial, third-generation cephalosporin
Accepted Indications: Wide spectrum of gram-negative bacterial infections, including septicemia, soft tissue and bone infections, burn wounds, urinary tract infections
Unaccepted Indications: Infections caused by enterococci, Listeria species, Chlamydia
Mechanism of Action: Bactericidal; inhibits cell wall synthesis
Half life: IM, 5.8–{endash}8.7 h; IV, 4.3–{endash}4.6 h
IM: 2.3 h
IV: End of infusion
Elimination: Renal
Research Notes: 3rd generation cephalosporin
Adult Dosage: IV: 1–{endash}2 g once daily up to limit of 4 g
Elderly Dosage: Adjust dosage if renal impairment
Child Dosage: IV: 25–{endash}37.5 mg/kg every 12 h
Infant Dosage: Same as child dose
Dosage Forms: Injection: 1 g/50 mL and 2 g/50 mL; sterile ceftriaxone sodium: 250 mg, 500 mg, 1 g, 2 g, and 10 g
Warnings: Avoid alcohol
Precautions: Do not take antidiarrheals
Frequent Side Effects: Oral candidiasis
Occasional Side Effects: Hypoprothrombinemia, vaginitis
Rare Side Effects: Stevens-Johnson syndrome, rash, hypersensitivity, formation of biliary sludge
Contraindications: Previous allergic reaction to penicillin and penicillamine
Antidotal Therapy: No specific antidote; may include supportive treatment
Disease States: Bleeding disorders; GI, liver and kidney problems; phenylketonuria
Other Drugs: Thrombolytic agents, alcohol, probenecid, nephrotoxic medications, anticoagulants
Lab Tests: Blood and urine glucose, BUN, CBC, platelet count, Coombs' test
Administrative Notes: Do not mix with antibacterials in IV bag
Cefuroxime Cefuroxime
Trade Name(s): Ceftin, Kefurox, Zinacef
Chemically Related To: Cephalosporins
Scheduled Class: Systemic antibacterial
Pregnancy Category: B
Medical Category: Second-generation cephalosporin
Accepted Indications: Septicemia, bone and joint infections, gram-negative pneumonia, skin and soft tissue infections, urinary tract infections, community-acquired pneumonia, meningitis, otitis media, sinusitis, bronchitis, gonococcal urethritis
Unaccepted Indications: Infections caused by enterococci, Listeria, Chlamydia, Clostridium difficile, and methicillin-resistant Staphylococcus epidermidis, Staphylococcus aureus
Mechanism of Action: Bactericidal; inhibits protein synthesis
Absorption/Distribution: Widely distributed, including CSF
Half life: 1.3 h
IM: 0.75 h
IV: End of infusion
Metabolism: Not metabolized
Elimination: Renal
Adult Dosage: Tablets: 250–{endash}500 mg b.i.d.; injection and sterile: IM or IV, 750 mg–{endash}1.5 g t.i.d.
Elderly Dosage: Lower dosage may be required
Child Dosage: Tablets up to 12 y: 125 mg b.i.d., 12 y and over: same as adult dose; injection and sterile: 3 m and over: IM or IV, 16.7–{endash}33.3 mg.kg t.i.d.
Infant Dosage: Tablets: up to 3 m: not established; 3 m and over: 125 mg b.i.d.; injection and sterile: neonates: IM or IV, 10–{endash}33.3 mg/kg t.i.d.; 3 m and over: IM or IV, 16.7–{endash}33.3 mg/kg t.i.d.
Dosage Forms: Tablets: 125 mg, 250 mg, and 500 mg; injection: 750 mg/50 mL and 1.5 g/50 mL; sterile: 750 mg, 1.5 g, and 7.5 g
Frequent Side Effects: Oral candidiasis, GI upset, vaginal candidiasis
Occasional Side Effects: Hypoprothrombinemia, pseudomembranous colitis, stomach cramps, vaginitis
Rare Side Effects: Allergic reactions, Stevens–{endash}Johnson syndrome, convulsions, thrombophlebitis, hemolytic anemia, hypersensitivity, renal dysfunction, serum sickness–{endash}like reactions
Contraindications: Allergic reactions to penicillins, penicillamine
Antidotal Therapy: May include symptomatic and supportive treatment
Compatibility of Solutions: Incompatible with aminoglycosides
Disease States: Bleeding disorders; GI, liver, or kidney problems
Other Drugs: Probenecid, platelet-aggregation inhibitors
Lab Tests: Coombs' test, blood glucose, BUN, CBC, platelet count, bilirubin
Administrative Notes: Take with food if there is GI discomfort. If convulsions occur, discontinue drug.
Cephalexin
Trade Name(s): Cefanex, Keflex
Chemically Related To: Cephalosporins
Pregnancy Category: B
Medical Category: Antibacterial, first-generation cephalosporin
Accepted Indications: Septicemia, bone and joint infections, otitis media, pneumonia, skin and soft tissue infections, burn wound infections, urinary tract infections
Unaccepted Indications: Infections caused by enterococci, Listeria, Chlamydia, Clostridium difficile
Mechanism of Action: Bactericidal
Absorption/Distribution: High bioavailability; widely distributed
Half life: 0.9–{endash}1.2 h
Elimination: Renal
Research Notes: First generation cephalosporin
Adult Dosage: 250–{endash}500 mg q.i.d. up to 4 g/d
Elderly Dosage: Dosage adjustment suggested
Child Dosage: 6.25–{endash}25 mg/kg q.i.d.
Infant Dosage: Prolonged half-life in infants
Dosage Forms: Capsules: 250 mg and 500 mg; tablets: 250 mg and 500 mg; oral suspension: 100 mg/mL, 125 mg/5 mL, and 250 mg/5 mL
Warnings: Continue medication for full time of treatment
Precautions: If seizures occur, discontinue medication
Frequent Side Effects: Oral candidiasis, GI problems
Occasional Side Effects: Hypoprothrombinemia, pseudomembranous colitis, vaginitis
Rare Side Effects: Stevens-Johnson syndrome, convulsions, thrombophlebitis, allergy
Contraindications: Allergic reaction to penicillin, penicillamine
Antidotal Therapy: May include symptomatic and supportive treatment
Disease States: History of bleeding disorders or GI problems, liver and kidney problems, phenylketonuria
Nutrition: Take with food if GI irritation occurs
Other Drugs: Alcohol, thrombolytic agents, probenecid, anticoagulants, nephrotoxic medications
Lab Tests: Prothrombin time, urine protein, blood glucose, antiglobulin tests, platelet count, BUN
Administrative Notes: Suspensions retain their potency for 14 d if refrigerated
Cephalothin Sodium
Trade Name(s): Keflin
Chemically Related To: Cephalosporins
Pregnancy Category: B
Medical Category: First-generation cephalosporin
Accepted Indications: Septicemia, skin and soft tissue infections, pneumonia, otitis media, bone and joint infections, urinary tract infections
Unaccepted Indications: Infections caused by Listeria, Chlamydia, Clostridium difficile, methicillin-resistant Staphylococcus epidermidis, or S. aureus or enterococci
Mechanism of Action: Interferes with cell wall synthesis
Absorption/Distribution: Widely distributed throughout body
Half life: 0.5–{endash}1 h
IM: 0.5 h
IV: 0.25–{endash}0.5 h
Metabolism: Hepatic, renal
Elimination: Renal
Adult Dosage: Antibacterial: IV infusion, 500 mg–{endash}2 g q4–{endash}6h; perioperative prophylaxis: IV infusion, 1–{endash}2 g 0.5–{endash}1 h before surgery, 1–{endash}2 g during surgery, 1–{endash}2 g q.i.d. for up to 24 h; pneumonia, furunculosis, and urinary tract infections: IV infusion, 500 mg q.i.d.
Elderly Dosage: Lower dosage may be needed
Child Dosage: Antibacterial: IV infusion, 13.3–{endash}26.6 mg/kg q4h or 20–{endash}40 mg/kg q.i.d.; perioperative prophylaxis: IV infusion, 20–{endash}30 mg/kg 0.5–{endash}1 h before surgery, 20–{endash}30 mg/kg during surgery, 20–{endash}30 mg/kg q.i.d. for up to 24 h
Dosage Forms: Injection: 1 g/50 mL and 2 g/50 mL; for injection: 1 g and 2 g
Warnings: Adjust dose for renal impairment; comply with full course of therapy
Frequent Side Effects: GI reactions, oral candidiasis, vaginal candidiasis
Occasional Side Effects: Hypoprothrombinemia, pseudomembranous colitis
Rare Side Effects: Allergic reaction, thrombophlebitis, Stevens-Johnson syndrome, hemolytic anemia, hypersensitivity, renal dysfunction, serum sickness–{endash}like syndrome, seizures
Antidotal Therapy: May include metronidazole, vancomycin for C. difficile infections
Compatibility of Solutions: Incompatible with aminoglycosides
Disease States: GI disease, renal function impairment
Other Drugs: Nephrotoxic medications, platelet aggregation inhibitors, probenecid
Lab Tests: Prothrombin time
Administrative Notes: If precipitate forms, shake solution
Cephapirin Sodium
Trade Name(s): Cefadyl
Chemically Related To: Cephalosporins
Pregnancy Category: B
Medical Category: First-generation cephalosporin
Accepted Indications: Septicemia, skin and soft tissue infections, pneumonia, otitis media, bone and joint infections, urinary tract infections
Unaccepted Indications: Infections caused by Listeria, Chlamydia, Clostridium difficile, methicillin-resistant Staphylococcus epidermidis or S. aureus, or enterococci
Mechanism of Action: Inhibits cell wall synthesis
Absorption/Distribution: Widely distributed throughout body
Half life: 0.5–{endash}0.8 h
IM: 0.5–{endash}1 h
IV: End of infusion
Metabolism: Hepatic, renal
Elimination: Renal
Adult Dosage: Antibacterial: IV or IM, 500 mg–{endash}1 g q4–{endash}6h; perioperative prophylaxis: IM or IV, 1–{endash}2 g 0.5–{endash}1 h before surgery, 1–{endash}2 g during surgery, 1–{endash}2 g q.i.d. for up to 24 h
Elderly Dosage: Lower dosage may be required
Child Dosage: IM or IV: 10–{endash}20 mg/kg q.i.d.
Infant Dosage: Up to 3 m: not established; 3 m and over: IM or IV, 10–{endash}20 mg/kg q.i.d.
Dosage Forms: Sterile injection: 500 mg, 1 g, 2 g, 4 g, and 20 g
Warnings: Adjust dose for renal impairment; comply with full course of therapy
Frequent Side Effects: GI reactions, oral candidiasis, vaginal candidiasis
Occasional Side Effects: Hypoprothrombinemia, pseudomembranous colitis
Rare Side Effects: Allergic reaction, thrombophlebitis, Stevens-Johnson syndrome, hemolytic anemia, hypersensitivity, renal dysfunction, serum sickness–{endash}like syndrome, seizures
Antidotal Therapy: May include metronidazole, vancomycin for C. difficile infections
Compatibility of Solutions: Incompatible with aminoglycosides
Disease States: GI disease
Other Drugs: Platelet aggregation inhibitors, probenecid
Lab Tests: Prothrombin time
Cephradine
Trade Name(s): Velosef
Chemically Related To: Cephalosporins
Pregnancy Category: B
Medical Category: Antibacterial, first-generation cephalosporin
Accepted Indications: Septicemia, bone infections, otitis media, pneumonia, skin infections, burn infections, and urinary tract infections
Unaccepted Indications: Infections caused by enterococci, Listeria species, Chlamydia, Clostridium difficile, or methicillin-resistant staphylococcal infections
Mechanism of Action: Inhibits cell wall synthesis of bacteria; cell growth and division also inhibited
Absorption/Distribution: Well absorbed
Half life: 0.8–{endash}1.3 h (8–{endash}15 h with impaired renal function)
Peak activity: 1 h
IM: 0.8–{endash}2 h
IV: End of infusion
Metabolism: Mostly excreted unchanged
Elimination: Renal 60%–{endash}80%
Research Notes: With impaired renal function, reduction in dose suggested
Adult Dosage: 1–{endash}4 g/d
Elderly Dosage: Same as adult dose
Child Dosage: 6.25–{endash}25 mg/kg q.i.d.
Infant Dosage: 25 mg/kg q.i.d. up to 4 g/d
Dosage Forms: Capsules: 250 mg and 500 mg; oral suspension: 125 mg/5 mL and 250 mg/5 mL; for injection: 250 mg, 500 mg, 1g, and 2 g
Precautions: For severe diarrhea, check with physician before taking any antidiarrheals; if seizures occur, discontinue medication
Frequent Side Effects: Oral candidiasis, GI reaction
Occasional Side Effects: Vaginitis
Rare Side Effects: Hypoprothrombinemia, pseudomembranous colitis, seizures
Antidotal Therapy: No specific antidote; may include symptomatic and supportive treatment
Disease States: Bleeding disorders, GI disease, renal function impairment
Nutrition: Take with food if GI irritation occurs
Other Drugs: Alcohol, anticoagulants, heparin, thrombolytic agents, platelet–{endash}aggregation inhibitors, probenecid
Lab Tests: Coombs' test, glucose, prothrombin time
Administrative Notes: In some patients, antibiotic–{endash}associated pseudomembranous colitis possible during or after administration; in mild cases, discontinue drug; in moderate to severe cases, fluids, electrolytes, and protein replacement suggested
Chenodiol
Trade Name(s): Chenix
Pregnancy Category: X
Medical Category: Anticholelithic
Accepted Indications: Gallstone disease (small, radiolucent stones with functioning gallbladder)
Mechanism of Action: Evokes desaturation of the bile by increasing the ratio of bile acids to cholesterol
Absorption/Distribution: Well absorbed from small intestine
Metabolism: Hepatic; first-pass hepatic clearance
Elimination: Fecal
Research Notes: More likely to be successful if stones are small and floatable
Adult Dosage: 13–{endash}16 mg/kg/d
Elderly Dosage: Same as adult dose
Dosage Forms: Tablets: 250 mg
By System: Hepatic, bile
Precautions: Do not take aluminum–{endash}containing antacids
Frequent Side Effects: Diarrhea
Occasional Side Effects: Constipation, gas, indigestion, nausea and vomiting, stomach cramps or pain
Rare Side Effects: Diarrhea, severe dehydration
Overdosage: Severe diarrhea
Antidotal Therapy: May include gastric lavage followed by 50 mL of aluminum hydroxide suspension
Disease States: Atherosclerosis, bile duct abnormalities, gallstone complications, hepatic function impairment
Other Drugs: Aluminum–{endash}containing antacids, cholestyramine, estrogens, neomycin, progestins, antihyperlipidemics
Lab Tests: Cholesterol
Administrative Notes: Chenodiol therapy considered failed if dissolution has not occurred after 9–{endash}12 m of treatment
Chloral Hydrate
Trade Name(s): Noctec
Chemically Related To: Ethyl alcohol
Scheduled Class: IV
Abuse Potential: Low
Pregnancy Category: C
Medical Category: Sedative-hypnotic
Accepted Indications: Preoperative anxiety (adjunct anesthesia); postoperative analgesia (adjunctive management); insomnia; short-term sedation (has generally been replaced by safer, more effective agents)
Mechanism of Action: CNS depressant
Absorption/Distribution: Readily absorbed from GI tract
Half life: Metabolite: 7–{endash}10 h
Metabolism: Liver to active metabolites: trichloro-ethanol
Elimination: Renal
Adult Dosage: Hypnotic: 500 mg–{endash}1 g 15–{endash}30 min before bedtime, sedative AM, 250 t.i.d. after meals, preoperative 500 mg–{endash}1 g 30 min before surgery
Elderly Dosage: Age-related hepatic and renal function impairment may require reduction in dose
Child Dosage: Premedication before dental or medical procedures, 50 mg/kg up to a maximum of 1 g per single dose. Total dose should not exceed 100 mg/kg or 2 g; premedication before EEG evaluation, 25 mg/kg
Infant Dosage: Same as child dose
Dosage Forms: Capsules 250 and 500 mg, syrup 250 and 500 mg
By System: CNS depressant
Warnings: Tolerance with continual administration
Precautions: Avoid use of alcohol or other CNS depressants
Frequent Side Effects: Nausea, stomach pain, vomiting
Occasional Side Effects: Clumsiness or unsteadiness, diarrhea, drowsiness
Rare Side Effects: Confusion, hallucinations, unusual excitement, allergic reaction
Overdosage: Confusion; convulsions; difficulty in swallowing, drowsiness, hypothermia; severe nausea, vomiting, or stomach pain; arrhythmia
Antidotal Therapy: May include gastric lavage; maintain respiration, circulation, and normal body temperature; continuous cardiac monitoring; appropriate fluid and electrolyte therapy
Disease States: Severe cardiac disease, gastritis, severe hepatic function impairment, colitis
Other Drugs: Alcohol, CNS depressants, anticoagulants, IV furosemide
Lab Tests: Urine glucose determinations
Chlorambucil
Trade Name(s): Leukeran
Chemically Related To: Nitrogen mustard
Pregnancy Category: D
Medical Category: Antineoplastic, immunosuppressant
Accepted Indications: Chronic lymphocytic leukemia, Hodgkin's or non-Hodgkin's lymphomas
Mechanism of Action: Cross-linking of DNA and RNA; inhibition of protein synthesis
Absorption/Distribution: Completely absorbed from GI tract
Half life: 1.5 h; metabolite, 2.5 h
Metabolism: Hepatic
Elimination: Renal
Adult Dosage: 100–{endash}200 m{mu}g/kg/d as a single dose or in divided doses; maximum recommended cumulative dose of 14 mg/kg or maximum duration of treatment 12 w
Elderly Dosage: Same as adult dose
Child Dosage: Same as adult dose
Dosage Forms: Tablets: 2 mg
By System: Hematopoietic
Warnings: Withdraw if signs of pulmonary toxicity occur
Precautions: Avoid immunizations
Frequent Side Effects: Pancytopenia, immunosuppression, thrombocytopenia
Occasional Side Effects: Black, tarry stools; cough or hoarseness; fever or chills; sores in mouth and on lips; joint pain; itching
Rare Side Effects: Agitation, confusion, convulsions, hallucinations, muscle twitching, jaundiced eyes or skin, drug fever, hepatic necrosis, pulmonary fibrosis
Overdosage: Reversible pancytopenia, ataxia, agitation, seizures
Antidotal Therapy: May include supportive and symptomatic treatment; monitoring of blood counts 3 times/w for at least 3 w
Disease States: Viral and bacterial infections, convulsions, head injury, gout, kidney stones, bone marrow depression
Other Drugs: Corticosteroids, probenecid, amphotericin B, colchicine, interferon, zidovudine, live virus vaccines
Lab Tests: Alkaline phosphatase, uric acid in blood and urine
Chloramphenicol
Trade Name(s): Chloromycetin
Pregnancy Category: Not documented, but not recommended
Medical Category: Systemic antibacterial
Accepted Indications: Infections caused by gram-positive and gram-negative bacteria, anaerobic bacteria, rickettsiae, spirochetes, Chlamydia
Unaccepted Indications: Routine typhoid carrier states, trivial infections, colds, influenza, or throat infections
Mechanism of Action: Bacteriostatic; inhibits protein synthesis
Absorption/Distribution: Rapidly and completely absorbed; widely distributed
Half life: 1.5–{endash}3.5 h
IV: 1–{endash}1.5 h
Metabolism: Hepatic
Elimination: Renal, fecal/biliary
Research Notes: Should be reserved for serious infections
Adult Dosage: 12.5 mg/kg up to 4 g systemically; otic solution: 2 or 3 drops to the ear canal q6–{endash}8h
Elderly Dosage: Same as adult dose
Child Dosage: Over 2 w: 12.5 mg/kg q.i.d.
Infant Dosage: Up to 2 w: 6.25 mg/kg q.i.d.
Dosage Forms: Capsules: 250 mg; oral suspension: 150 mg/5 mL; sterile USP: 1 g; otic solution: 0.5%
Precautions: In neonates or fetus, can cause gray baby syndrome, which can be fatal
Occasional Side Effects: Blood dyscrasias, diarrhea, nausea/vomiting
Rare Side Effects: Gray baby syndrome, neurotoxic reactions, rash
Disease States: Bone marrow depression, liver problems, radiation therapy
Other Drugs: Erythromycin, hepatic enzyme inducers, warfarin, estrogen–{endash}containing contraceptives, bone marrow depressants, warfarin, phenobarbitone, phenytoin
Lab Tests: Urine glucose determination, bentiromide
Chloramphenicol/Desoxyribonuclease/Fibrinolysin
Trade Name(s): Elase-Chloromycetin
Medical Category: Wound debridement
Accepted Indications: Wound healing
Adult Dosage: Apply at least once daily
Dosage Forms: Ointment: 10 mg/666.6 units/1 unit/g
Chloramphenicol/Hydrocortisone Acetate/Polymyxin B Sulfate
Trade Name(s): Ophthocort
Medical Category: Anti-infective
Accepted Indications: Ophthalmic infections
Adult Dosage: Apply ointment to the eye every 3–{endash}4 h
Dosage Forms: Ointment, ophthalmic: 1%/0.5%/10,000 units
Chlorcyclizine Hydrochloride
Trade Name(s): Not available as a single agent
Chemically Related To: Antihistamines
Pregnancy Category: C
Medical Category: Antihistamine
Mechanism of Action: H1 histamine receptor antagonist
By System: Dermal
Contraindications: Tuberculosis of skin, herpes simplex
Chlorcyclizine Hydrochloride/Hydrocortisone Acetate
Trade Name(s): Mantadil
Pregnancy Category: C
Medical Category: Anti-inflammatory, antipruritic, anesthetic
Accepted Indications: Inflammation
Adult Dosage: Apply to skin 2–{endash}5 times/d
Dosage Forms: Cream: 2%/0.5%
Chlordiazepoxide Hydrochloride Chlordiazepoxide Hydrochloride
Trade Name(s): Libritabs, Librium, Lipoxide
Chemically Related To: Benzodiazepines
Scheduled Class: IV
Abuse Potential: Minor
Pregnancy Category: Not established
Medical Category: Antianxiety agent, sedative-hypnotic, antipanic agent, antitremor agent
Accepted Indications: Anxiety, alcohol withdrawal, anesthesia (adjunctive management), panic disorder, tension headache, tremor
Mechanism of Action: Enhances inhibitory GABA
Absorption/Distribution: Well absorbed
Half life: 5–{endash}30 h
Metabolism: Hepatic
Elimination: Renal
Research Notes: Accumulation of drug significant during repeated dosing
Adult Dosage: 5–{endash}25 mg t.i.d. or q.i.d. up to 400 mg/d
Elderly Dosage: 5 mg b.i.d. to q.i.d.
Child Dosage: Up to 6 y: safety not established; over 6 y: 5 mg b.i.d. to q.i.d. up to 10 mg b.i.d. or t.i.d.
Infant Dosage: Safety not established
Dosage Forms: Tablets: 5 mg, 10 mg, and 25 mg; capsules 5 mg, 10 mg, and 25 mg; sterile USP: 100 mg
By System: CNS
Warnings: May cause drowsiness; avoid alcohol
Frequent Side Effects: Ataxia, dizziness, drowsiness, slurred speech, irritability, insomnia
Occasional Side Effects: Depression, stomach cramps, headache, nausea/vomiting, trembling, weakness
Rare Side Effects: Blood dyscrasias, neutropenia, anemia, muscle weakness, memory impairment, dependence, withdrawal symptoms
Overdosage: Confusion, decreased reflexes, drowsiness, bradycardia, slurred speech, weakness
Antidotal Therapy: Supportive treatment: may include emesis/gastric lavage, activated charcoal; monitoring respiration and blood pressure; oxygen administration; IV vasopressors, flumazenil
Disease States: Alcohol, coma, seizures, glaucoma, liver or kidney problems, myasthenia gravis, depression, sleep apnea
Other Drugs: CNS depressants, tricyclic antidepressants, zidovudine, scopolamine, rifampin, levodopa
Lab Tests: Metyrapone, sodium iodide I 123 and sodium iodide I 131
Administrative Notes: After reconstitution, use sterile USP solution at once; do not heat
Chlordiazepoxide Hydrochloride/Clidinium Bromide
Trade Name(s): CDP Plus, Cl, Clinoxide, Librax, Lidox, Lidoxide, Spazmate, Zebrax
Pregnancy Category: Use not recommended
Medical Category: Antispasmodic, anxiolytic
Accepted Indications: Peptic ulcer, gastrointestinal irritability (possibly effective)
Adult Dosage: 1–{endash}2 capsules once daily to q.i.d., 30–{endash}60 min before food
Elderly Dosage: Maximum of 1 capsule b.i.d.
Child Dosage: Not established
Dosage Forms: Capsules: 5 mg/2.5 mg
Side/Adverse Effects: Agranulocytosis, granulocytopenia, leukopenia, allergic reaction, increased intraocular pressure, CNS depression, jaundice, paradoxical reaction
Disease States: Cardiac disease, glaucoma, hiatal hernia with reflux, esophagitis, hepatic disease, myasthenia gravis, ulcerative colitis, intestinal atony, obstruction in GI or urinary tract
Other Drugs: Anticholinergics, antacids, CNS depressants, antidiarrheals, ketoconazole, potassium chloride
Chlordiazepoxide/Estrogens, Esterified
Trade Name(s): Menrium 5-2, 5-4, 10-4
Pregnancy Category: C
Medical Category: Antianxiety, estrogen replacement
Accepted Indications: Menopause
Adult Dosage: 1 tablet t.i.d. in 21 d courses, followed by a 1 w rest period
Dosage Forms: Tablets: 5 mg/0.2 mg, 5 mg/0.4 mg, and 10 mg/0.4 mg
Chlorhexidine Gluconate
Trade Name(s): Peridex
Chemically Related To: Hexachlorophene
Pregnancy Category: B
Medical Category: Dental antibacterial
Accepted Indications: Gingivitis, mouth infections, denture stomatitis, some staphylococcal infections, dental plaque
Mechanism of Action: Bacteriostatic; leakage of cell wall parts
Absorption/Distribution: 30% released into oral fluids; poorly absorbed from GI tract
Elimination: Fecal/renal
Research Notes: Once drug is discontinued, plaque returns to normal levels
Adult Dosage: Topical to gingival membranes 15 mL for 0.5 min b.i.d.
Elderly Dosage: Same as adult dose
Child Dosage: Not established
Dosage Forms: Oral rinse: 0.12%
By System: Oral cavity
Warnings: Do not swallow or dilute
Precautions: Use medication after brushing and flossing; swish drug around in mouth for 30 sec
Frequent Side Effects: Change in taste, staining of teeth
Occasional Side Effects: Mouth irritation, irritation of tip of tongue
Disease States: Front-tooth fillings, periodontitis
Administrative Notes: Give patient package insert; dispense in original container; protect from light
Chlormezanone
Trade Name(s): Trancopal
Chemically Related To: Meprobamate
Medical Category: Antianxiety agent
Accepted Indications: Anxiety
Mechanism of Action: Inhibits Cl-{minus} movement into cells
Absorption/Distribution: Rapidly absorbed from GI tract
Half life: 24 h
Metabolism: Hepatic
Elimination: Renal, fecal
Research Notes: Duration of action up to 6 h or longer
Adult Dosage: 100–{endash}800 mg/d in 2 or 3 divided doses
Elderly Dosage: Age-related liver and kidney malfunction may necessitate lower dose
Child Dosage: 100–{endash}300 mg/d
Infant Dosage: Not established
Dosage Forms: Tablets: 100 mg and 200 mg
By System: Subcortical nuclei of the CNS
Warnings: May cause drowsiness; avoid alcoholic beverages
Frequent Side Effects: Drowsiness
Occasional Side Effects: Confusion, mental depression, difficult urination, dizziness, headache, nausea, trembling
Rare Side Effects: Cholestatic jaundice, swelling of feet or lower legs, extreme excitement
Overdosage: Confusion, drowsiness, loss of reflexes, continuing tiredness or weakness
Antidotal Therapy: May include general supportive therapy
Disease States: Hepatic or renal function impairment
Other Drugs: Alcohol or CNS depressants
Administrative Notes: Withdrawal symptoms have been reported rarely
Chloroquine Hydrochloride
Trade Name(s): Aralen HCl
Chemically Related To: Quinine
Pregnancy Category: Not recommended
Medical Category: Antiprotozoal
Accepted Indications: Malaria, amebic liver abscess, solar urticaria, chronic cutaneous vasculitis, lupus erythematosus, rheumatoid arthritis
Unaccepted Indications: Prevention of Plasmodium virax or P. ovale malaria relapse, acute amebic dysentery or asymptomatic carriers
Mechanism of Action: Inhibits the erythrocytic stage of the development of plasmodia
Absorption/Distribution: Almost completely absorbed from GI tract; widely distributed in body tissues
Half life: 1–{endash}2 m (terminal elimination)
IM: 0.5 h
IV: 0.5 h
Metabolism: Hepatic
Elimination: Renal
Adult Dosage: Varies by indication
Elderly Dosage: Same as adult dose
Child Dosage: Varies by indication
Infant Dosage: Same as child dose
Dosage Forms: Injection: 50 mg/mL
Warnings: Children are especially sensitive to chloroquine effects
Frequent Side Effects: Ciliary muscle dysfunction, GI irritation, headache, itching
Occasional Side Effects: Ocular toxicity, hair loss, bleaching of hair, rash
Rare Side Effects: Blood dyscrasias, aplastic anemia, neutropenia, thrombocytopenia, cardiovascular toxicity, psychosis, neuromyopathy, ototoxicity, seizures
Overdosage: Cardiovascular toxicity, neurotoxicity, respiratory and cardiac arrest, visual disturbances
Antidotal Therapy: May include securing of airway, oxygen, gastric lavage, activated charcoal, cathartic, diazepam, fluids
Disease States: Severe blood disorders, severe GI disorders, G6PD deficiency, hepatic function impairment, neurological disorders, psoriasis, porphyria, retinal or visual field changes
Other Drugs: Penicillamine
Administrative Notes: Toxic symptoms within 30 min; fatalities reported as soon as 3 h post ingestion
Chloroquine Phosphate
Trade Name(s): Aralen Phosphate
Chemically Related To: Quinine
Pregnancy Category: Not recommended
Medical Category: Antiprotozoal, antihypercalcemic, antirheumatic, lupus erythematosus suppressant, polymorphous light eruption suppressant, porphyria cutanea tarda suppressant
Accepted Indications: Malaria, amebic liver abscess, juvenile arthritis, rheumatoid arthritis, hypercalcemia, lupus erythematosus, polymorphous light eruption, porphyria cutanea tarda, solar urticaria, chronic cutaneous vasculitis
Unaccepted Indications: Prevention of Plasmodium virax or P. ovale malaria relapse, acute amebic dysentery or asymptomatic carriers
Mechanism of Action: Inhibits the erythrocytic stage of the development of plasmodia
Absorption/Distribution: Almost completely absorbed from GI tract, widely distributed in body tissues
Half life: 1–{endash}2 m (terminal elimination)
Metabolism: Hepatic
Elimination: Renal
Research Notes: Doses as small as 300 mg in children and 2.5 g in adults potentially fatal
Adult Dosage: Varies by indication
Elderly Dosage: Varies by indication
Child Dosage: Varies by indication
Infant Dosage: Same as child dose
Dosage Forms: Tablets: 250 mg and 500 mg
Warnings: Children are especially sensitive to chloroquine effects
Frequent Side Effects: Ciliary muscle dysfunction, GI irritation, headache, itching
Occasional Side Effects: Ocular toxicity, hair loss, bleaching of hair, blue-black skin discoloration, rash
Rare Side Effects: Blood dyscrasias, aplastic anemia, neutropenia, thrombocytopenia, cardiovascular toxicity, psychosis, neuromyopathy, ototoxicity, seizures
Overdosage: Cardiovascular toxicity, neurotoxicity, respiratory and cardiac arrest, visual disturbances
Antidotal Therapy: May include securing of airway, oxygen, gastric lavage, activated charcoal, cathartic, diazepam, fluids
Disease States: Severe blood disorders, severe GI disorders, G6PD deficiency, hepatic function impairment, neurological disorders, porphyria, psoriasis, retinal or visual field changes
Other Drugs: Penicillamine
Administrative Notes: Toxic symptoms occur within 30 min; fatalities reported as soon as 3 h post ingestion
Chlorothiazide
Trade Name(s): Diuril
Chemically Related To: Hydrochlorothiazide
Pregnancy Category: B
Medical Category: Diuretic, antihypertensive, antidiuretic (diabetes insipidus), antiurolithic (calcium calculi)
Accepted Indications: Edema, hypertension, diabetes insipidus, renal calcium calculi (prophylaxis)
Mechanism of Action: Inhibits sodium reabsorption in nephron
Absorption/Distribution: Rapid absorption
Half life: 13 h
Peak activity: 4 h
Elimination: Renal, bile
Research Notes: Onset of action, 2 h; duration of action, 6–{endash}12 h
Adult Dosage: 250 mg–{endash}1 g/d
Elderly Dosage: More sensitive to hypotensive effect
Child Dosage: Over
Infant Dosage: Up to
Dosage Forms: Oral suspension 50 mg/mL, tablets 250 and 500 mg
By System: Renal
Warnings: Shake suspension well; avoid sun/sun lamp
Precautions: Take medication even if symptoms disappear; may increase blood glucose levels
Frequent Side Effects: Electrolyte imbalance, hypokalemia
Occasional Side Effects: Anorexia, diarrhea, photosensitivity, orthostatic hypotension, nausea
Rare Side Effects: Agranulocytosis, thrombocytopenia, gout, glucose intolerance, rash
Antidotal Therapy: May include emesis/gastric lavage, monitor serum electrolytes and kidney function
Disease States: Anuria or severe renal impairment, lupus erythematosus, hypercalcemia
Other Drugs: Lithium, sympathomimetics, digitalis glycosides, NSAIDs, antihypertensives, neuromuscular blocking agents
Lab Tests: Uric acid, bilirubin, phentolamine, tyramine, glucose (blood and urine), cholesterol
Administrative Notes: Sodium restriction
Chlorothiazide/Methyldopa
Trade Name(s): Aldoclor 150, 250
Pregnancy Category: B
Medical Category: Antihypertensive
Accepted Indications: Hypertension
Adult Dosage: 2–{endash}4 tablets once daily
Child Dosage: As determined by individual titration
Dosage Forms: Tablets: 150 mg/250 mg, 250 mg/250 mg
Chlorotrianisene
Trade Name(s): Tace
Chemically Related To: Steroids
Pregnancy Category: X
Medical Category: Systemic estrogen, antineoplastic
Accepted Indications: Estrogen deficiency, atropic vaginitis, female hypogonadism, prostatic carcinoma, vulvar squamous hyperplasia, primary ovarian failure, symptoms of menopause
Unaccepted Indications: Reduction of postpartum breast engorgement
Mechanism of Action: Estrogen replacement and reduces release of gonadotropin–{endash}releasing hormone
Absorption/Distribution: Distributed to all tissues, especially fat; moderate protein binding
Metabolism: Hepatic, muscle, kidneys, gonads
Elimination: Renal, fecal
Research Notes: Chlorotrianisene has a long–{endash}lasting effect, interfering with cyclical therapy
Adult Dosage: 12–{endash}25 mg/d
Elderly Dosage: Same as adult dose
Dosage Forms: Capsules: 12 mg, 25 mg
By System: Hormonal
Warnings: Possible dental problems; do not share medication
Precautions: Stop medication if pregnancy suspected
Frequent Side Effects: Breast tenderness, gynecomastia, cramping
Occasional Side Effects: Diarrhea, headache, vomiting, migraine headache
Rare Side Effects: Amenorrhea, breast tumors, chorea, hepatitis, thromboembolism, altered menstrual cycle
Contraindications: Breast cancer, abnormal vaginal bleeding
Disease States: Endometriosis, liver and gallbladder problems, thrombophlebitis, jaundice
Other Drugs: Adrenocorticoids, bromocriptine, liver-damaging drugs, tamoxifen
Lab Tests: Fasting blood glucose, metyrapone, thyroid function, serum folate, calcium, clotting factors, glucose tolerance
Chloroxine
Trade Name(s): Capitrol
Chemically Related To: Unique compound
Pregnancy Category: C
Medical Category: Antiseborrheic
Accepted Indications: Dandruff, seborrheic dermatitis
Mechanism of Action: Slows mitotic action in skin
Research Notes: Onset of action 14 d
Adult Dosage: To scalp 2 times/w
Elderly Dosage: Same as adult dose
Dosage Forms: Lotion shampoo: 2%
By System: Topical
Warnings: Do not use on blistered or raw scalp; avoid eyes
Precautions: Possible discoloration of light-colored hair
Occasional Side Effects: Burning feeling on scalp, itching scalp
Rare Side Effects: Eye irritation
Disease States: Acutely inflamed lesions of scalp
Administrative Notes: Wet hair with warm water and lather for 3 min
Chlorphenesin Carbamate
Trade Name(s): Maolate
Chemically Related To: Meprobamate
Pregnancy Category: C
Medical Category: Skeletal muscle relaxant
Accepted Indications: Skeletal muscle spasm
Mechanism of Action: Reduces impulses from spinal cord to skeletal muscles
Absorption/Distribution: Rapid, complete absorption
Half life: 2.5–{endash}5 h
Metabolism: Hepatic
Elimination: Renal
Research Notes: Relationship between GI bleeding and chlorphenesin reported but not verified
Adult Dosage: 800 mg t.i.d.
Elderly Dosage: Same as adult dose
Dosage Forms: Tablets: 400 mg
Warnings: May cause drowsiness; avoid alcohol
Occasional Side Effects: Confusion, dizziness, drowsiness
Rare Side Effects: GI bleeding, agranulocytosis, leukopenia, thrombocytopenia, allergic dermatitis
Antidotal Therapy: May include saline cathartics or gastric lavage; supportive therapy
Disease States: CNS depression, liver and kidney problems
Other Drugs: CNS depressants
Administrative Notes: Drug use for more than 8 w not recommended
Chlorpheniramine Maleate
Trade Name(s): Aller-Chlor, Chlo-Amine, Chlor-Trimeton
Chemically Related To: Diphenhydramine
Pregnancy Category: B
Medical Category: Antihistaminic
Accepted Indications: Rhinitis, allergic conjunctivitis, pruritus, urticaria, angioedema, sneezing, anxiety
Mechanism of Action: Antihistamine
Absorption/Distribution: Well absorbed
Half life: 14–{endash}25 h
Metabolism: Hepatic, renal
Elimination: Renal
Research Notes: May inhibit lactation
Adult Dosage: 4 mg every 4–{endash}6 h
Elderly Dosage: More likely to have dizziness, sedation, and confusion
Child Dosage: Up to 6 y: not recommended; 6-12 y: 2 mg t.i.d. or q.i.d. up to 12 mg/d
Infant Dosage: Not recommended
Dosage Forms: Syrup: 1 mg/5 mL and 2 mg/5 mL; tablets: 4 mg; extended-release capsules: 8 mg and 12 mg; tablets (chewable): 2 mg; extended-release tablets: 8 mg and 12 mg; injection: 10 mg/mL and 100 mg/mL
By System: Systemic
Warnings: May cause drowsiness; avoid alcohol
Precautions: May mask ototoxic effects of salicylates
Frequent Side Effects: Drowsiness, thick mucus
Occasional Side Effects: Blurred vision, confusion, painful urination, dry mouth, tinnitus, stomach pain
Rare Side Effects: Blood dyscrasias, cardiac arrhythmias
Contraindications: Liver problems
Overdosage: Anticholinergic effects, cardiac arrhythmias, drowsiness, hallucinations, convulsions, hypotension
Antidotal Therapy: No specific antidote; may include emesis, gastric lavage, saline cathartics, vasopressors, IV fluids
Disease States: Bladder neck obstruction, prostatic hypertrophy, urinary retention, glaucoma
Other Drugs: Alcohol, anticholinergics, erythromycin, MAO inhibitors, ketoconazole, photosensitive medications
Lab Tests: Skin tests with allergen extracts
Administrative Notes: Take oral doses with food. 100-mg/mL solution for IM or SQ administration only
Chlorpheniramine Maleate/Codeine Phosphate/Guaifenesin
Trade Name(s): Tussar Sf, Tussar-2
Scheduled Class: V
Abuse Potential: Low
Pregnancy Category: C
Medical Category: Antitussive, decongestant
Accepted Indications: Cough and cold
Dosage Forms: Syrup 6%/2 mg/10 mg/100 mg and 12%/2 mg/10 mg/100 mg
Chlorpheniramine Maleate/Codeine Phosphate/Phenylephrine Hydrochloride/Potassium Iodide
Trade Name(s): Pediacof, Pedituss
Scheduled Class: V
Abuse Potential: Low
Pregnancy Category: C
Medical Category: Antitussive, antihistamine
Accepted Indications: Allergies, coughs, and colds
Child Dosage: 6 m–{endash}1 y: 1.25 mL; 1–{endash}3 y: 2.5–{endash}5 mL; 3–{endash}6 y: 5–{endash}10 mL; 6–{endash}12 y 10 mL every 4–{endash}6 h
Dosage Forms: Syrup: 0.75 mg/5 mg/2.5 mg/75 mg
Chlorpheniramine Maleate/Codeine Phosphate/Pseudoephedrine Hydrochloride
Trade Name(s): Alamine-C, Bayhistine DH, Codehist DH, Decohistine DH, Dihistine DH, Myhistine DH, Novahistine DH, Phenhist DH w/Codeine, Ryna-C Liquid
Scheduled Class: V
Abuse Potential: Low
Pregnancy Category: C
Medical Category: Antitussive, antihistamine
Accepted Indications: Allergies, coughs, and colds
Adult Dosage: 10 mL every 4h
Child Dosage: 2–{endash}6 y: 1.25–{endash}2.5 mL q4h; 6–{endash}12 y: 2.5–{endash}5 mL q.i.d. q4h
Dosage Forms: Elixir 2 mg/10 mg/30 mg/5 mL; oral solution 2 mg/10 mg/30 mg
Chlorpheniramine Maleate/Guaifenesin/Phenylephrine Hydrochloride
Trade Name(s): Donatussin Drops (pediatric)
Pregnancy Category: C
Medical Category: Antihistamine, decongestant
Accepted Indications: Allergies, colds
Child Dosage: Under 3 m: 2–{endash}3 drops/m of age; 3–{endash}6 m: 0.3–{endash}0.6 mL; 6 m–{endash}1 y: 0.6–{endash}1 mL; 1–{endash}2 y: 1–{endash}2 mL every 4–{endash}6 h
Dosage Forms: Drops: 1 mg/20 mg/2 mg/mL
Chlorpheniramine Maleate/Methscopolamine Nitrate/Phenylephrine Hydrochloride
Trade Name(s): Ah-Chew, Dallergy, Extendryl, Histafed, Nasec, Rolatuss, Sinovan
Pregnancy Category: C
Medical Category: Antitussive, antihistamine
Accepted Indications: Allergies, coughs, and colds
Adult Dosage: Chewable tablet: 1–{endash}2 tablets q4h; syrup: 5–{endash}10 mL q4–{endash}6h; tablets: 1 q4–{endash}6h; extended-release tablets: 1 b.i.d.
Child Dosage: 6–{endash}12 y: chewable tablets 1 tablet q4h
Dosage Forms: Chewable tablets: 2 mg/1.25 mg/10 mg; syrup: 2 mg/0.625 mg/10 mg; tablets: 4 mg/1.25 mg/10 mg; extended-release caplets: 8 mg/2.5 mg/20 mg
Chlorpheniramine Maleate/Phenindamine Tartrate/Phenylpropanolamine Hydrochloride
Trade Name(s): Amilon Tr, Fenaclor, Nolamine, Norphenamine
Pregnancy Category: C
Medical Category: Antihistamine, decongestant
Accepted Indications: Coughs and colds
Adult Dosage: 1 tablet b.i.d. or t.i.d.
Dosage Forms: Tablets: 4 mg/24 mg/50 mg
Chlorpheniramine Maleate/Phenylephrine Hydrochloride/Phenylpropanolamine/Pyrilamine
Trade Name(s): Duohist Forte, Histalet Forte, Lantuss Forte, Poly Hist Forte, Prop-A-Hist, Vanex Forte
Pregnancy Category: C
Medical Category: Antihistamine, decongestant
Accepted Indications: Allergic rhinitis, allergic bronchitis, bronchospasm, hay fever, common cold, sinusitis, skin allergies
Adult Dosage: 1 tablet b.i.d. or t.i.d.
Child Dosage: Under 6 y: only as directed by physician; 6–{endash}12 y: ½ tablet b.i.d. or t.i.d.
Dosage Forms: Tablets: 4 mg/10 mg/50 mg/25 mg
Chlorpheniramine Maleate/Phenylpropanolamine Hydrochloride
Trade Name(s): Allerest 12-Hour Capsules, Condrin-LA, Contac Maximum Strength 12-Hour Caplets, Ornade Spansules, Ru-Tuss II Capsules
Pregnancy Category: C
Medical Category: Antihistamine, decongestant
Accepted Indications: Congestion, sneezing, rhinorrhea
Mechanism of Action: Competes with H1 receptors to prevent the histamine response; also acts on the mucous membrane of the respiratory tract to produce vasoconstriction, which reduces swelling
Absorption/Distribution: Well absorbed from GI tract
Half life: 21–{endash}27 h for chlorpheniramine; 3–{endash}4 for phenylpropanolamine
Peak activity: 2–{endash}6 h and 15–{endash}30 min
Metabolism: Hepatic
Elimination: Renal
Adult Dosage: 1 capsule b.i.d.
Elderly Dosage: Same as adult dose
Child Dosage: Under 12 y: not recommended
Dosage Forms: Capsules 12 mg/75 mg
By System: Respiratory tract
Warnings: Administer b.i.d.; otherwise, tolerance develops
Precautions: In infants of breast-feeding mothers, patients at high risk from sympathomimetic agents
Frequent Side Effects: Drowsiness, thickening of bronchial secretions
Occasional Side Effects: Anticholinergic effects, palpitation, rash, stomach upset
Rare Side Effects: Blood dyscrasias, tachycardia, mood changes, tightness in chest
Overdosage: Anticholinergic effects, CNS stimulation, drowsiness, hypertension, extrapyramidal effects
Disease States: Bladder obstruction, urinary retention, cardiovascular disease, diabetes mellitus, hypertension, hyperthyroidism, prostatic hypertrophy
Other Drugs: Alcohol, CNS depressants or stimulants, anticholinergics, antidepressants, maprotiline, beta-adrenergic blocking agents, MAO inhibitors, rauwolfia alkaloids
Lab Tests: Skin tests with allergen extracts, glucose tolerance, immunologic urine pregnancy
Administrative Notes: Avoid alcoholic beverages; food, water, or milk should be taken to minimize gastric irritation
Chlorpheniramine Maleate/Pseudoephedrine Hydrochloride
Trade Name(s): Anamine, Anamine T.D., Anaplex, Brexin-L.A., Chlorafed H.S., Chlorafed Timecelles, Chlordine H.R., Chlorphedrine HR, Codimal-L.A, Colfed-A, Cophene No. 2, Deconamine, Deconamine SR, Duralex, Dura-Tap PD, Fedahist Gyrocaps, Fedahist Timecaps, Histalet, Isoclor, Klerist-D, Kronofed-A Jr. Kronocaps, Kronofed-A Kronocaps, ND Clear T.D., Novafed A, Pseudo-Chlor, Rescon, Rescon-ED, Rescon JR, Rhinosyn, Rhinosyn PD, Rinade B.I.D., T-Dry Junior
Pregnancy Category: C
Medical Category: Antihistamine, decongestant
Accepted Indications: Allergies, colds
Adult Dosage: Varies by dosage form
Dosage Forms: Tablets: 4 mg/60 mg, 8 mg/120 mg; Syrup: 2 mg/12.5 mg, 2 mg/30 mg, 3 mg/45 mg; Oral solution: 2 mg/12.5 mg, 2 mg/30 mg, 4 mg/60 mg; Extended-release capsules: 4 mg/60 mg, 8 mg/120 mg, 10 mg/65 mg, 12 mg/120 mg; Capsules: 4 mg/60 mg
Chlorpheniramine Polistirex
Trade Name(s): Not available as a single agent
Medical Category: Antihistamine
Accepted Indications: Hypersensitivity reactions, including urticaria and angioedema, rhinitis, conjunctivitis, and pruritic skin disorders
Chlorpheniramine Polistirex/Hydrocodone Polistirex
Trade Name(s): Tussionex
Scheduled Class: III
Abuse Potential: Moderate
Pregnancy Category: C
Medical Category: Antitussive, antihistamine
Accepted Indications: Cough and upper respiratory symptoms associated with allergy or cold
Adult Dosage: 5 mL b.i.d.; do not exceed 10 mL in 24 h
Child Dosage: Under 6 y: not recommended; 6–{endash}12 y: 2.5 mL b.i.d., not to exceed 5 mL in 24 h
Infant Dosage: Not recommended
Dosage Forms: Oral suspension: 8 mg/10 mg per 5 mL
Chlorpheniramine Tannate
Trade Name(s): Not available as a single agent
Medical Category: Antihistamine
Accepted Indications: Hypersensitivity reactions, including urticaria and angioedema, rhinitis, conjunctivitis, and pruritic skin disorders
Chlorpheniramine Tannate/Phenylephrine Tannate/Pyrilamine Tannate
Trade Name(s): Equitan, Histatan, Rynatan, Tanoral, Tri-Tannate, Tritan
Pregnancy Category: C
Medical Category: Antihistamine, decongestant
Accepted Indications: Allergies, colds
Adult Dosage: 1–{endash}2 tablets b.i.d.
Child Dosage: Under 2 y, suspension: titrate dose individually; 2–{endash}6 y, suspension: 2.5–{endash}5 mL; over 6 y, suspension: 5–{endash}10 mL b.i.d.
Dosage Forms: Suspension: 2 mg/5 mg/12.5 mg; tablets: 8 mg/25 mg/25 mg
Chlorpheniramine/Phenylpropanolamine
Trade Name(s): Ornade Spansule
Chemically Related To: Antihistamines and decongestants
Pregnancy Category: C
Medical Category: Antihistaminic-decongestant
Accepted Indications: Congestion, sneezing, rhinorrhea
Mechanism of Action: Competes with H1-receptors to prevent the histamine response. Also acts on the mucous membrane of the respiratory tract to produce vasoconstriction which reduces swelling.
Absorption/Distribution: Well absorbed from GI tract
Half life: 14-25 h for chlorpheniramine and 3-4 h for phenylpropanolamine
Peak activity: 2-6 h/15-30 min
Metabolism: Hepatic
Elimination: Renal
Adult Dosage: 1 capsule q 12 h
Elderly Dosage: Same as adult dose
Dosage Forms: Capsules
By System: Respiratory tract
Warnings: Keep within every 12 h or tolerance develops
Precautions: Mothers breast feeding should be aware that there is a high risk for infants from sympathomimetic agents
Frequent Side Effects: Drowsiness, thickening of bronchial secretions
Occasional Side Effects: Anticholinergic effects, pounding heartbeat, skin rash, stomach upset
Rare Side Effects: Blood dyscrasias, fast heartbeat, mood changes, tightness in chest
Overdosage: Anticholinergic effects, CNS stimulation, drowsiness, hypertension, extrapyramidal effects
Disease States: Bladder neck obstruction, urinary retention, cardiovascular disease, diabetes mellitus, hypertension, hyperthyroidism, prostatic hypertrophy
Other Drugs: Alcohol, CNS depression–{endash}producing medications, anticholinergics, antidepressants, maprotiline, beta-adrenergic blocking agents, CNS stimulation–{endash}producing medications, MOA inhibitors, rauwolfia alkaloids
Lab Tests: Skin tests using allergen extracts, glucose tolerance tests and immunologic urine pregnancy tests
Administrative Notes: Avoid alcoholic beverages. Food, water, or milk should be taken to minimize gastric irritation.
Chlorpromazine Hydrochloride
Trade Name(s): Thorazine
Chemically Related To: Phenothiazines
Pregnancy Category: Sufficient studies not done; potential for embryotoxicity
Medical Category: Antipsychotic, antiemetic, antidyskinetic
Accepted Indications: Psychotic disorders, nausea and vomiting, tetanus adjunctive management, acute porphyria, intractable hiccups, Huntington's disease
Mechanism of Action: Blocks dopamine receptors
IM: 24 h
Metabolism: Hepatic
Elimination: Renal, biliary
Research Notes: Onset of action as an antipsychotic takes several weeks
Adult Dosage: 10–{endash}50 mg t.i.d. or q.i.d. up to 1 g/d
Elderly Dosage: Require lower initial dosage
Child Dosage: Over 6 m: 550 m{mu}g/kg every 4–{endash}6 h
Infant Dosage: Up to 6 m: dosage not established
Dosage Forms: Extended-release capsules: 30 mg, 75 mg, 150 mg, 200 mg, and 300 mg; oral concentrate: 30 mg/mL and 100 mg/mL; syrup: 10 mg/mL; tablets: 10 mg, 25 mg, 50 mg, 100 mg, and 200 mg; injection USP: 25 mg/mL; suppositories 25 mg and 100 mg
By System: CNS, subcortical nuclei
Warnings: May cause drowsiness; avoid alcohol
Precautions: Caution if surgery required; caution during exercise or hot weather
Frequent Side Effects: Akathisia, hypotension, anticholinergic effects, tardive dyskinesia
Occasional Side Effects: Changes in menstrual period, weight gain, dizziness, nausea and vomiting, trembling upper extremities, photosensitivity
Rare Side Effects: Agranulocytosis, heat stroke, melanosis, neuroleptic malignant syndrome, hepatitis
Contraindications: Cardiovascular problems, CNS depression, coma
Antidotal Therapy: Symptomatic and supportive treatment; may include gastric lavage, activated charcoal slurry, saline cathartics
Disease States: Blood dyscrasias, glaucoma, liver problems, Reye's syndrome, peptic ulcer, vomiting, convulsions, breast cancer
Other Drugs: CNS depressants, antithyroid agents, epinephrine, levodopa, antihypertensives, lithium, anticonvulsants, narcotics
Lab Tests: Bilirubin, EKG, metyrapone, immunologic urine pregnancy, gonadorelin
Administrative Notes: More riboflavin may be required in diet
Chlorpropamide
Trade Name(s): Diabinese, Glucamide
Chemically Related To: Sulfonylureas
Pregnancy Category: C
Medical Category: Antidiabetic agent
Accepted Indications: Diabetes mellitus, neurogenic diabetes insipidus
Mechanism of Action: Stimulates insulin release from pancreatic beta cells
Absorption/Distribution: Readily absorbed from GI tract; high protein binding
Half life: 36 h
Metabolism: Hepatic
Elimination: Renal
Research Notes: Approximately 6 times as potent as tolbutamide; isoluble in water; soluble in alcohol
Adult Dosage: 250 mg/d
Elderly Dosage: 100–{endash}125 mg/d
Dosage Forms: Tablets: 100 mg and 250 mg
By System: Hormonal
Warnings: Must follow weight control, proper exercise, and hygiene; avoid infection
Precautions: During first 6 w, patient should be evaluated weekly; frequent tests of hepatic function
Occasional Side Effects: Edema
Rare Side Effects: Photosensitivity reactions
Contraindications: Major surgery, severe trauma, severe infections
Disease States: Hepatic porphyria; kidney, liver or thyroid problems; Addison's disease; pituitary insufficiency
Nutrition: Dietary regulation important
Other Drugs: Alcohol, anticoagulants, thiazide diuretics, salicylates, sulfonamides, miconazole, fluconazole, barbiturates
Administrative Notes: Hospitalization possibly needed to change patient from higher dosages of insulin to chlorpropamide
Chlorprothixene
Trade Name(s): Tarasan
Chemically Related To: Tricyclic antidepressants
Pregnancy Category: C
Medical Category: Antipsychotic
Accepted Indications: Psychotic disorders
Mechanism of Action: Blocks dopamine receptors in brain
Absorption/Distribution: Partially absorbed
Half life: 2–{endash}4 h
IM: 30 min; 12 h duration
Metabolism: Hepatic
Elimination: Renal
Adult Dosage: Usual dose 25–{endash}50 mg 3 or 4 times/d up to 600 mg/d
Elderly Dosage: Decrease dose
Child Dosage: 6–{endash}12 y: up to 40 mg/d
Dosage Forms: Tablets: 10 mg, 25 mg, 50 mg, and 100 mg; injection: 12.5 mg/mL
By System: CNS
Warnings: May cause drowsiness; avoid alcohol
Precautions: Regular visits to physician recommended; avoid antacids
Frequent Side Effects: Akathisia, tardive dyskinesia, constipation, dry mouth, nasal congestion
Occasional Side Effects: Anticholinergic effect, skin discoloration, decreased sexual ability, hypotension
Rare Side Effects: Agranulocytosis, heat stroke, liver dysfunction, neuroleptic malignant syndrome
Contraindications: Blood dyscrasias, bone marrow depression, circulatory collapse, CNS depression, coma
Overdosage: Convulsions, difficulty in breathing, dizziness, hypotension, coma
Antidotal Therapy: May include gastric lavage or emesis, activated charcoal slurry, saline cathartics, IV phenytoin, maintenance of respiratory function
Disease States: Alcoholism, heart disease, liver and respiratory problems, convulsions, urinary retention
Other Drugs: CNS depressants, amphetamines, epinephrine, levodopa, quinidine, MAO inhibitors, antihistamines
Lab Tests: EKG readings (prolongs QT interval), urine bilirubin, immunologic urine pregnancy, serum uric acid concentration
Administrative Notes: Avoid skin contact with liquid form of this medication; stains skin
Chlorthalidone
Trade Name(s): Hygroton, Thalitone
Chemically Related To: Thiazides
Pregnancy Category: B
Medical Category: Diuretic, antihypertensive, antidiuretic (diabetes insipidus), antiurolithic
Accepted Indications: Edema, hypertension, diabetes insipidus, renal calculi (prophylaxis)
Mechanism of Action: Inhibits sodium reabsorption
Absorption/Distribution: Rapid absorption
Half life: 35–{endash}50 h
Elimination: Renal
Adult Dosage: 25–{endash}100 mg once daily
Elderly Dosage: Caution required
Child Dosage: 2 mg/kg once daily 3 d/w
Infant Dosage: Caution in jaundiced infants, increased risk of hyperbilirubinemia from USPD
Dosage Forms: Tablets: 25 mg, 50 mg, and 100 mg
By System: Cardiovascular
Warnings: May cause photosensitivity; do not take other medications without physician's advice
Precautions: Continue medicine even if symptoms disappear
Frequent Side Effects: Electrolyte imbalance (hypokalemia, hyponatremia)
Occasional Side Effects: Anorexia, diarrhea, photosensitivity, GI upset
Rare Side Effects: Agranulocytosis, allergic reactions, gout, liver problems, thrombocytopenia, hyperglycemia
Contraindications: History of gout or lupus erythematosus
Antidotal Therapy: May include emesis/gastric lavage, supportive treatment, monitoring of serum electrolytes and kidney function
Disease States: Diabetes mellitus, gout, anuria, hypercalcemia, pancreatitis, lupus erythematosus, jaundice
Nutrition: Sodium restriction
Other Drugs: Digitalis glycosides, cholestyramine, anticoagulants, lithium, neuromuscular blocking agents
Lab Tests: Bilirubin, glucose (blood and urine), uric acid, urinary calcium concentrations, protein-bound iodine, phentolamine, tyramine
Chlorthalidone/Clonidine Hydrochloride
Trade Name(s): Clonidine HCL with chlorthalidone, Clorodone, Combipres
Pregnancy Category: C
Medical Category: Antihypertensive
Accepted Indications: Hypertension
Adult Dosage: Must be titrated individually
Dosage Forms: Tablets: 15 mg/0.1 mg, 15 mg/0.2 mg, 15 mg/0.3 mg
Chlorthalidone/Reserpine
Trade Name(s): Demi-Regroton, Regroton
Pregnancy Category: C
Medical Category: Antihypertensive
Accepted Indications: Hypertension
Adult Dosage: Must be titrated individually
Dosage Forms: Tablets: 25 mg/0.125 mg and 50 mg/0.25 mg
Chlorzoxazone
Trade Name(s): Paraflex, Parafon Forte DSC
Medical Category: Skeletal muscle relaxant
Accepted Indications: Skeletal muscle spasm
Mechanism of Action: Depresses polysynaptic reflexes in CNS
Absorption/Distribution: Rapid, complete absorption
Half life: 1–{endash}2 h
Metabolism: Hepatic
Elimination: Renal
Research Notes: Onset of action, 1 h; duration of action, 3–{endash}4 h
Adult Dosage: 250–{endash}750 mg t.i.d. or q.i.d.
Elderly Dosage: Use with caution
Child Dosage: 20 mg/kg in 3–{endash}4 divided doses
Infant Dosage: Same as child dose
Dosage Forms: Tablets: 250 mg and 500 mg
By System: CNS, subcortical nuclei
Warnings: May cause drowsiness; avoid alcohol
Precautions: May color urine orange
Frequent Side Effects: Dizziness, drowsiness
Occasional Side Effects: Headache
Rare Side Effects: GI bleeding, anemia, yellowing of skin
Antidotal Therapy: May include emesis/gastric lavage, oxygen, plasma volume expanders
Disease States: Allergies, CNS depression, liver and kidney problems
Other Drugs: CNS depressants
Administrative Notes: May be crushed and mixed with food
Cholestyramine
Trade Name(s): Cholybar, Questran
Chemically Related To: Polymer resin; anion-exchange resin
Pregnancy Category: C
Medical Category: Antihyperlipidemic, antipruritic, antidiarrheal, antidote, antihyperoxaluric
Accepted Indications: Hyperlipidemia, pruritus or diarrhea caused by bile acids, hyperoxaluria, digitalis glycoside overdose
Absorption/Distribution: Not absorbed from GI tract
Metabolism: Absorbs bile acids in the intestine
Elimination: Fecal
Research Notes: Onset of action 24–{endash}48 h and blood lipid level may continue to fall for 1 y
Adult Dosage: Up to 32 g/d
Elderly Dosage: Over 60 y: more GI side effects
Child Dosage: 6–{endash}12 y: oral 80 mg/kg t.i.d.; under 6 y: not established
Dosage Forms: Chewable bars: 4 g; for oral suspension: 5 g and 9 g
By System: Local, intestine only
Precautions: Mix oral suspension with fluid before taking
Frequent Side Effects: Constipation
Occasional Side Effects: Belching, bloating, diarrhea, dizziness, headache
Rare Side Effects: Gallstones, GI bleeding, peptic ulcer, malabsorption syndrome
Disease States: Bleeding disorders, gallstones, constipation, peptic ulcer, kidney problems, hypothyroidism, hemorrhoids
Other Drugs: Anticoagulants, diuretics, tetracyclines, folic acid, thyroid hormones, fat-soluble vitamins
Lab Tests: Prothrombin time; potassium, sodium, phosphorus, and calcium concentrations; alkaline phosphatase; Schilling test; fat-soluble vitamins
Administrative Notes: Variations in color normal and do not indicate change in strength of product. Proper diet required
Choline Bitartrate
Chemically Related To: Vitamin B
Pregnancy Category: B
Medical Category: GI drugs; vitamins/minerals
Accepted Indications: Possibly effective–{endash}tardive dyskinesia, Huntington's chorea, Tourette's syndrome, Freidreich's ataxia, presenile dementia, fatty liver, cirrhosis
Mechanism of Action: Enhances cholinergic effects of acetylcholine
Research Notes: Fish, peanuts, beef liver, eggs and wheat germ are rich in choline
Adult Dosage: 650 mg–{endash}2 g/d or as directed
Dosage Forms: Tablets: 250 mg
Choline Salicylate
Trade Name(s): Arthropan
Chemically Related To: Acetylsalicylic acid
Pregnancy Category: Avoid use during pregnancy
Medical Category: Analgesic, anti-inflammatory, antipyretic, antirheumatic
Accepted Indications: Pain, fever, arthritis, inflammation, osteoarthritis, rheumatic fever
Mechanism of Action: Inhibits activity of cyclo-oxygenase
Absorption/Distribution: Rapid and complete
Half life: Dose dependent
Metabolism: GI tract, liver, blood
Elimination: Renal
Adult Dosage: 870–{endash}1338 mg q.i.d. as needed
Elderly Dosage: Lower dose may be required
Child Dosage: Varies by age
Infant Dosage: Must be individualized
Dosage Forms: Oral solution: 870 mg/5 mL
Frequent Side Effects: GI irritation
Occasional Side Effects: Anemia, allergic dermatitis, anaphylaxis, GI ulceration, troubled breathing
Contraindications: Bleeding ulcers, hemophilia
Overdosage: Ringing, buzzing in ears, confusion, fast or deep breathing
Antidotal Therapy: May include emesis, activated charcoal
Disease States: Gout, peptic ulcer, gastritis, hemorrhagic states, renal insufficiency
Other Drugs: Anticoagulants, insulin, verapamil, vancomycin, acetaminophen, NSAIDs, heparin, thrombolytic agents, antidiabetic agents, cefamandole, cefotetan, plicamycin, cefoperazone, moxalactam disodium, valproic acid, sulfinpyrazone, ketoconazole, tetracyclines, probenecid, methotrexate, urinary alkalizers
Lab Tests: Gerhardt test, thyroid imaging
Choline Salicylate/Magnesium Salicylate
Trade Name(s): Trilisate, Tricosal
Chemically Related To: Salicylates
Pregnancy Category: C
Medical Category: Analgesic, anti-inflammatory, antipyretic, antirheumatic
Accepted Indications: Rheumatoid arthritis, acute pain in shoulder, pain, fever, inflammation, osteoarthritis, rheumatic fever
Mechanism of Action: Inhibits prostaglandin synthesis
Absorption/Distribution: Rapid and complete absorption
Half life: 2–{endash}3 h
Metabolism: GI tract, liver, blood
Elimination: Renal
Research Notes: Often called choline and magnesium salicylate in drug monographs
Adult Dosage: 2–{endash}3 g/d in 2–{endash}3 doses
Elderly Dosage: Lower doses recommended
Child Dosage: More than 37 kg: 2.2 g/d in 2 divided doses
Infant Dosage: Up to 37 kg: 50 mg/kg/d in 2 doses
Dosage Forms: Oral solution 293 mg/362 mg; tablets: 293 mg/362 mg, 440 mg/544 mg, and 587 mg/725 mg
By System: CNS
Warnings: Do not take tetracyclines within 1–{endash}2 h of this drug
Precautions: Use caution if surgery required
Frequent Side Effects: GI irritation
Occasional Side Effects: Anemia, GI ulceration
Rare Side Effects: Allergic dermatitis, shortness of breath, angioedema
Contraindications: Bleeding ulcers, hemorrhage, hemophilia, advanced kidney problems
Overdosage: CNS disturbances, alteration in electrolytes, respiratory and metabolic acidosis, hyperthermia, dehydration
Antidotal Therapy: May include emesis/gastric lavage, activated charcoal, monitoring of electrolytes, alkaline diuresis, Vitamin K if necessary
Disease States: Gastritis, peptic ulcer, renal function impairment, gout, hypertension, anemia
Other Drugs: Vancomycin, probenecid, methotrexate, zidovudine, anticoagulants, NSAIDs, urinary alkalizers
Lab Tests: Liver function, prothrombin time, serum cholesterol concentrations, copper sulfate, urine glucose, vanillylmandelic acid
Administrative Notes: Each 500-mg tablet same as 650 mg of aspirin in salicylate content
Ciclopirox Olamine
Trade Name(s): Loprox
Chemically Related To: Imidazoles
Pregnancy Category: B
Medical Category: Topical antifungal
Accepted Indications: Cutaneous candidiasis, tinea corporis, tinea cruris, tinea pedis, tinea versicolor, and onychomycosis
Mechanism of Action: Fungicidal; interferes with synthesis of protein, DNA, and RNA
Absorption/Distribution: Rapid, incomplete absorption
Half life: 1.7 h
Elimination: Renal
Research Notes: Penetrates into hair, sebaceous glands, dermis
Adult Dosage: To skin b.i.d., morning and night
Elderly Dosage: Same as adult dose
Child Dosage: Over 10 y: same as adult dose
Dosage Forms: Cream: 1%; lotion: 1%
By System: Dermal
Warnings: Avoid eyes; do not apply occlusive dressings
Rare Side Effects: Local irritation
Administrative Notes: Shake lotion well
Cilastatin Sodium
Trade Name(s): Not available as a single agent
Pregnancy Category: C
Medical Category: Beta-lactamase inhibitor
Mechanism of Action: Inhibits renal dipeptidase dehydropeptidase; blocks renal metabolism of imipenem and increases its urinary recovery
Absorption/Distribution: 75% absorption; moderate protein binding
Half life: 1 h (normal renal function), 13.3–{endash}17.1 h (impaired renal function)
IM: 1 h
Cilastatin Sodium/Imipenem
Trade Name(s): Primaxin I.M, Primaxin I.V.
Pregnancy Category: C
Medical Category: Antibacterial
Accepted Indications: Bone and joint infections, bacterial endocarditis, intra-abdominal infections, pelvic infections, bacterial pneumonia, bacterial septicemia, skin and soft tissue infections, bacterial urinary tract infections
Adult Dosage: Varies by type and severity of infection and degree of renal function
Elderly Dosage: May require lower dosage
Child Dosage: Weight <40>
Dosage Forms: For injection: 250 mg/250 mg and 500 mg/500 mg; for suspension: 500 mg/500 mg and 750 mg/750 mg
Cimetidine
Trade Name(s): Tagamet
Chemically Related To: Antihistamine (H2-receptor antagonist)
Pregnancy Category: B
Medical Category: Histamine H2-receptor antagonist, antiulcer agent, gastric acid secretion inhibitor, urticaria therapy agent
Accepted Indications: Duodenal ulcer, gastric ulcer, gastric hypersecretory conditions, Zollinger-Ellison syndrome, systemic mastocytosis, upper GI bleeding, acute urticaria
Unaccepted Indications: Minor digestive complaints
Mechanism of Action: Inhibits gastric acid secretion through inhibition of histamine
Absorption/Distribution: Rapid absorption; distributed in CSF
Half life: 2 h
Metabolism: Hepatic
Elimination: Renal
Research Notes: Duration of action: nocturnal 6–{endash}8 h; basal 4–{endash}5 h
Adult Dosage: Up to 2.4 g/d. Usual treatment of peptic ulcer: 800 mg/d
Elderly Dosage: Same as adult dose
Child Dosage: For gastric ulcer, 20–{endash}40 mg/kg/d in 4 doses
Infant Dosage: Consider risk-benefit ratio
Dosage Forms: Tablets: 200 mg, 300 mg, 400 mg, and 800 mg; oral solution: 300 mg/5 mL; injection: 300 mg/2 mL and 300 mg/50 mL
By System: GI
Warnings: Avoid alcohol
Precautions: Discontinue smoking
Occasional Side Effects: Diarrhea, dizziness, drowsiness
Rare Side Effects: Agranulocytosis, bradycardia, confusion, fever, gynecomastia, myopathy
Antidotal Therapy: No specific antidote; may include emesis/gastric lavage, IV diazepam, atropine, lidocaine
Disease States: Cirrhosis, liver and kidney problems
Nutrition: Foods that cause GI irritation
Other Drugs: Opioid analgesics, antiarrhythmics, antacids, bone marrow depressants, ketoconazole, alcohol, anticoagulants, tricyclic antidepressants, xanthines, antiepileptics, theophylline
Lab Tests: Gastric acid secretion, skin tests with allergen extracts, prolactin, parathyroid hormone, creatinine
Cinoxacin
Trade Name(s): Cinobac
Chemically Related To: Quinolones
Pregnancy Category: C
Medical Category: Systemic antibacterial
Accepted Indications: Urinary tract infections
Unaccepted Indications: Infections caused by Pseudomonas species, Enterococcus faecalis, staphylococci
Mechanism of Action: Bactericidal; inhibits DNA replication
Absorption/Distribution: Rapidly and completely absorbed; moderate to high protein binding
Half life: 1.5–{endash}2 h
Metabolism: Hepatic
Elimination: Renal
Research Notes: With kidney problems half-life possibly exceeds 10 h
Adult Dosage: 250 mg q.i.d. or 500 mg b.i.d. for 7–{endash}14 d
Elderly Dosage: Kidney problems necessitate lower dose
Child Dosage: Not recommended
Infant Dosage: Not recommended
Dosage Forms: Capsules: 250 mg and 500 mg
Occasional Side Effects: GI problems
Rare Side Effects: Dizziness, headache
Disease States: Kidney problems, rash, hypersensitivity
Lab Tests: BUN, serum creatinine, alanine aminotransferase, alkaline phosphatase
Ciprofloxacin Hydrochloride
Trade Name(s): Cipro
Chemically Related To: Oxyquinolines
Pregnancy Category: C
Medical Category: Antibacterial
Accepted Indications: Bone, skin and soft tissue, and urinary tract infections; gram-negative bacterial pneumonia; bacterial diarrhea
Unaccepted Indications: Infections caused by Pseudomonas cepacia and Pseudomonas maltophilia
Mechanism of Action: Inhibits DNA gyrase; promotes bacterial double-stranded DNA breakage
Absorption/Distribution: Well absorbed; distributed in all body tissues
Half life:
Peak activity: 1–{endash}2 h
IV: Immediate
Metabolism: Hepatic
Elimination: Renal, fecal
Research Notes: Moderately effective against streptococci
Adult Dosage: Tablets 250–{endash}750 mg b.i.d.; IV 200–{endash}400 mg b.i.d.
Elderly Dosage: Dosage reduction may be required
Child Dosage: Not recommended
Infant Dosage: Not recommended
Dosage Forms: Tablets: 250 mg, 500 mg, and 750 mg; injection: 200 mg/20 mL and 400 mg/40 ml; for injection: 200 mg/100 mL and 400 mg/200 mL
Frequent Side Effects: GI distress, slight nausea and vomiting, dizziness, headache, drowsiness
Occasional Side Effects: Cramps, diarrhea
Rare Side Effects: CNS stimulation, hypersensitivity, interstitial nephritis, phlebitis, hepatitis, tendinitis
Contraindications: Allergy to fluoroquinolones or other quinolone derivatives
Disease States: CNS disorders, renal impairment, alcoholism
Other Drugs: Antacids, sucralfate, theophylline, warfarin, NSAIDs, cyclosporine
Lab Tests: BUN, bilirubin, creatinine concentrations
Administrative Notes: Take on empty stomach
Cisplatin
Trade Name(s): Platinol
Chemically Related To: Unique compound
Pregnancy Category: D
Medical Category: Antineoplastic
Accepted Indications: Carcinomas, neuroblastomas, germ cell tumors, osteosarcomas
Mechanism of Action: Interferes with DNA and RNA, leading to cancer cell death
Absorption/Distribution: Does not cross blood–{endash}brain barrier
Half life: Alpha phase, 25–{endash}49 min; beta phase, 58–{endash}73 h
Metabolism: Nonenzymatic conversion
Elimination: Renal
Research Notes: Cell cycle nonspecific
Adult Dosage: Varies by patient and indication. Dose range 20–{endash}100 mg/m2
Elderly Dosage: Dosage reduction may be required
Dosage Forms: Injection 1 mg/mL; for injection 10 mg, 50 mg, and 100 mg
By System: Rapidly growing tissue
Warnings: Avoid immunizations; ototoxic effects may be more severe in children
Precautions: Continue medication even if GI distress occurs
Frequent Side Effects: Leukopenia, thrombocytopenia, nephrotoxicity, nausea, vomiting
Occasional Side Effects: Anaphylactic reaction, neurotoxicity, loss of appetite
Rare Side Effects: Cerebral blindness, dizziness, confusion, optic neuritis
Disease States: Bone marrow depression, chickenpox, gout, infection, kidney or liver problems, hearing difficulties
Other Drugs: Nephrotoxic or ototoxic medications, live virus vaccines, probenecid, bone marrow depressants
Lab Tests: BUN, serum uric acid, Coombs' test, creatinine clearance, serum phosphate and potassium concentrations
Administrative Notes: Need ample fluid intake
Clarithromycin
Trade Name(s): Biaxin
Chemically Related To: Erythromycin
Pregnancy Category: C
Medical Category: Systemic antibacterial
Accepted Indications: Bronchitis (bacterial), pharyngitis (streptococcal), pneumonia (caused by Mycoplasma and Streptococcus), sinusitis, skin and soft tissue infections, legionnaires' disease
Mechanism of Action: Inhibits protein synthesis
Absorption/Distribution: Well absorbed; widely distributed
Half life: 3–{endash}4 h
Metabolism: Hepatic
Elimination: Renal
Research Notes: Detected in human breast milk
Adult Dosage: 250–{endash}500 mg b.i.d. for 7–{endash}14 d
Elderly Dosage: In renal deficiency, decrease dose
Dosage Forms: Tablets: 250 mg and 500 mg
Occasional Side Effects: Abnormal taste, GI distress, headache
Disease States: Kidney problems
Other Drugs: Carbamazepine, theophylline, zidovudine, terfenadine, rifabutin, astemizole, midazolam
Lab Tests: BUN, alanine aminotransferase, aspartate aminotransferase
Clavulanate Potassium
Trade Name(s): Not available as a single agent
Chemically Related To: Penicillins
Medical Category: Beta-lactamase inhibitor
Mechanism of Action: Inactivates beta-lactamase enzymes
Half life: 1 h (normal renal function), 3 h (impaired renal function)
Research Notes: Used in combination with amoxicillin and ticarcillin disodium; has little antibacterial activity when used alone
Clavulanate Potassium/Ticarcillin Disodium
Trade Name(s): Timentin
Pregnancy Category: B
Medical Category: Systemic antibacterial
Accepted Indications: Bacterial pneumonia, bacterial septicemia, bone and joint infections, intra-abdominal infections, pelvic infections, skin and soft tissue infections, urinary tract infections
Adult Dosage: Antibacterial: up to 60 kg; IV infusion, 1.1–{endash}1.7 mg/33.3–{endash}50 mg/kg q4h or 1.7–{endash}2.5 mg/50–{endash}75 mg/kg q.i.d.; 60 kg and over: IV infusion, 100 mg/3 g q4–{endash}6h; surgical prophylaxis: IV infusion, 100 mg/3 g 0.5–{endash}1 h before surgery, then 3.1 g q4h for a total of 3 doses
Elderly Dosage: Lower dosage may be required
Child Dosage: 1 m–{endash}12 y: IV infusion, 1.7 mg/50 mg/kg q4–{endash}6h; over 12 y: same as adult dose
Infant Dosage: Under 1 m: not established; 1 m–{endash}12 y: IV infusion, 1.7 mg/50 mg/kg q4–{endash}6h
Dosage Forms: Sterile injection: 3.1 g (100 mg/3 g) and 31 g (1 g/30 g)
Clemastine Fumarate
Trade Name(s): Contac 12 Hour Allergy, Tavist, Tavist-1
Chemically Related To: Ethanolamine
Pregnancy Category: C
Medical Category: Antihistamine (H1-receptor blocker)
Accepted Indications: Rhinitis, allergic conjunctivitis, pruritus, urticaria, angioedema, transfusion reactions, sneezing, rhinorrhea, anaphylactic reaction
Mechanism of Action: Competes with histamine for H1 receptor site
Absorption/Distribution: Well absorbed
Metabolism: Hepatic, some renal
Elimination: Renal
Research Notes: Duration of action 12 h
Adult Dosage: 1.34 mg b.i.d. or 2.68 mg once daily to t.i.d., up to 8.04 mg/d
Elderly Dosage: More chance of dizziness, sedation, confusion, and hypotension
Child Dosage: Under to 6 y: dosage not established; 6–{endash}12 y: 670 m{mu}g–{endash}1.34 mg b.i.d.
Infant Dosage: Not recommended in premature or newborn infants
Dosage Forms: Syrup: 0.67 mg/5 mL; tablets: 1.34 mg and 2.68 mg
Warnings: Avoid alcohol, drowsiness
Precautions: Possible dry mouth, so use sugarless gum or candy; drug could mask ototoxic effects of salicylates
Frequent Side Effects: Drowsiness, thick mucus
Occasional Side Effects: Blood dyscrasias, cardiac arrhythmias
Rare Side Effects: Blurred vision, confusion, dizziness, appetite loss, buzzing in ears
Contraindications: Liver problems
Overdosage: Anticholinergic effects, cardiac arrhythmias, drowsiness, hallucinations, convulsions, low blood pressure
Antidotal Therapy: No specific antidote; may include emesis/gastric lavage, saline cathartics, vasopressors, oxygen, and IV fluids
Disease States: Glaucoma, urinary retention, bladder neck obstruction
Nutrition: Take with food or water
Other Drugs: Alcohol, anticholinergics, MAO inhibitors, ototoxic medications, photosensitizing medications, erythromycin
Lab Tests: Skin tests using allergen extracts
Administrative Notes: Store tablets in a tight light-resistant container
Clemastine Fumarate/Phenylpropanolamine Hydrochloride
Trade Name(s): Tavist-D
Pregnancy Category: C
Medical Category: Antihistamine, decongestant
Accepted Indications: Allergies, colds
Adult Dosage: 1 tablet b.i.d.
Child Dosage: Consult physician
Dosage Forms: Tablets: 1.34 mg/75 mg
Clidinium Bromide
Trade Name(s): Quarzan
Chemically Related To: Atropine
Pregnancy Category: C
Medical Category: Anticholinergic
Accepted Indications: Peptic ulcer
Mechanism of Action: Acetylcholine blocker
Absorption/Distribution: Irregular absorption; little distribution past blood-brain barrier
Metabolism: Hepatic
Elimination: Renal/fecal
Research Notes: Onset of action, 1 h; duration of action, up to 3 h
Adult Dosage: 2.5–{endash}5 mg 3–{endash}4 times/d with meals and at bedtime
Elderly Dosage: 2.5 mg t.i.d.
Child Dosage: Not established
Dosage Forms: Capsules: 2.5 mg and 5 mg
By System: Parasympathetic
Warnings: Blurred vision; photosensitivity
Precautions: Overheating may result in heat stroke; possible dizziness
Frequent Side Effects: Constipation, decreased sweating, dry mouth
Occasional Side Effects: Decreased flow of breast milk, difficulty with urination
Rare Side Effects: Bloated feeling, headache, memory loss, tiredness
Overdosage: Blurred vision, clumsiness, confusion, difficulty in breathing, dizziness, tachycardia, fever, hallucinations, convulsions
Antidotal Therapy: May include emesis or gastric lavage, slurry of activated charcoal, slow IV physostigmine, short-acting barbiturates, infusion of norepinephrine, oxygen
Disease States: Brain damage in children, cardiac disease, glaucoma, myasthenia gravis, tachycardia, ulcerative colitis
Other Drugs: Narcotics, ketoconazole, haloperidol, anticholinergics, antimyasthenics, urinary alkalizers
Lab Tests: Gastric acid secretion
Administrative Notes: Store in a tight, light-proof container
Clindamycin
Trade Name(s): Cleocin, Cleocin T, Clinda-Derm
Chemically Related To: Macrolide antibiotics
Pregnancy Category: Problems have not been documented
Medical Category: Antibacterial, antiprotozoal, antiacne agent, anti-infective
Accepted Indications: Bone, joint, pelvic, intra-abdominal, or skin and soft tissue infections; pneumonia; septicemia; acne vulgaris; bacterial vaginosis
Unaccepted Indications: Meningitis, deep cystic lesions; infections caused by Trichomonas vaginalis, Chlamydia trachomatis, Neisseria gonorrhoeae, and Candida albicans; herpes simplex
Mechanism of Action: Binds to 50S ribosome subunits and prevents peptide bond formation
Absorption/Distribution:
Half life: 2.4–{endash}3 h (
Peak activity: 16 h (vaginal)
IV: 1 h
Metabolism: Hepatic
Elimination: Renal
Adult Dosage: Varies by indication and form
Elderly Dosage: Varies by indication and form
Child Dosage: Varies by indication and form
Infant Dosage: Varies by indication and form
Dosage Forms: Capsules: 75 mg, 150 mg, and 300 mg; for oral solution: 75 mg/5 mL; injection: 300 mg/2 mL, 600 mg/4 mL, and 900 mg/6 mL; gel: 1%; topical solution: 1%; topical suspension: 1%; vaginal cream: 2%
Frequent Side Effects: Pseudomembranous colitis, nausea and vomiting, itching of rectal and genital areas, dryness or peeling of skin
Occasional Side Effects: Stomach cramps, diarrhea, fever, sore throat, hypersensitivity, thromocytopenia, burning sensation in skin
Rare Side Effects: Rash
Disease States: GI disease, hepatic or renal function impairment, colitis
Other Drugs: Antidiarrheals, hydrocarbon inhalation anesthetics, chloramphenicol, erythromycins, neuromuscular blocking agents, abrasive soaps, acne preparations with peeling agents, alcohol–{endash}containing preparations, isotretinoin
Lab Tests: Alanine transaminase
Clioquinol
Trade Name(s): Vioform
Chemically Related To: Quinoles
Pregnancy Category: C
Medical Category: Antibacterial (topical), antifungal (topical)
Accepted Indications: Tinea pedis, skin and nail fungal infections, dermal ulcer, tinea capitis
Unaccepted Indications: Diaper rash
Mechanism of Action: Fungistatic, bacteriostatic
Absorption/Distribution: Topical absorption; rapid, 2%–{endash}40%
Research Notes: Broad spectrum; also has minor irritant property
Adult Dosage: Topical b.i.d. or t.i.d.
Elderly Dosage: Same as adult dose
Child Dosage: Same as adult dose
Infant Dosage: Under 2 y: not recommended
Dosage Forms: Cream: 3%; ointment: 3%
By System: Dermal
Precautions: Could stain fabric, skin, nails
Rare Side Effects: Itching, rash, redness
Disease States: Sensitivity to iodine preparations
Other Drugs: Systemic corticosteroids
Lab Tests: Thyroid function, ferric chloride tests for phenylketonuria
Administrative Notes: Incompatible with oxidizing agents
Clioquinol/Hydrocortisone
Trade Name(s): Ala-Quin, Albaform HC, Corque, Iodochlor, Pedi-Cort Vioform HC
Pregnancy Category: C
Medical Category: Topical antifungal, antibacterial
Accepted Indications: Dermatitis, eczema, folliculitis, intertrigo, pruritus, minor bacterial skin infections
Adult Dosage: Topical to the skin t.i.d. or q.i.d.
Child Dosage: Up to 2 y: not recommended; 2 y and over: same as adult dosage
Dosage Forms: Cream 1%/0.5%, 1%/1%, and 3%/1%; lotion 3%/1%; ointment 3%/0.5% and 3%/1%
Clobetasol Propionate
Trade Name(s): Temovate
Chemically Related To: Corticosteroids
Pregnancy Category: C
Medical Category: Topical adrenocorticoid, steroidal anti-inflammatory
Accepted Indications: Skin disorders, alopecia areata, keloids, myxedema, lichen planus, psoriasis, sunburn, sarcoidosis
Unaccepted Indications: Acne, routine gingivitis, rosacea, perioral dermatitis
Mechanism of Action: Forms complexes with cytoplasmic receptors
Absorption/Distribution: Absorbed across the stratum corneum
Metabolism: Skin; if absorbed, hepatic
Elimination: Renal
Research Notes: High-potency adrenocorticoid
Adult Dosage: Apply to skin b.i.d. or t.i.d.
Elderly Dosage: Problems with pre-existing skin atrophy
Child Dosage: Up to 12 y: not recommended
Infant Dosage: Not recommended
Dosage Forms: Cream: 0.05%; ointment: 0.05%; solution: 0.05%
By System: Dermal
Warnings: For external use only; do not use in or around eyes
Precautions: Do not use tight diapers or plastic pants if diaper area is affected
Occasional Side Effects: Contact dermatitis, numbness in fingers, secondary skin infection, skin atrophy, purpura, itching, rash
Rare Side Effects: Acne, Cushing's syndrome, hypopigmentation, loss of hair, secondary glaucoma, hypertension
Antidotal Therapy: No specific antidote; may include dilution with fluids
Disease States: Infection at treatment site, skin atrophy
Lab Tests: Glucose, eosinophil count; hypothalmic-pituitary-adrenal axis function; adrenal function
Clocortolone Pivalate
Trade Name(s): Cloderm
Chemically Related To: Corticosteroids
Pregnancy Category: C
Medical Category: Topical corticosteroid, topical steroidal anti-inflammatory
Accepted Indications: Skin disorders
Unaccepted Indications: Perioral dermatitis, acne
Metabolism: Skin, hepatic
Adult Dosage: Topical to the skin, t.i.d.
Elderly Dosage: Use with caution
Child Dosage: Not established
Infant Dosage: Not established
Dosage Forms: Cream: 0.1%
Occasional Side Effects: Folliculitis, skin atrophy, contact dermatitis, numbness in fingers, purpura
Rare Side Effects: Secondary skin infection, burning or dryness of skin
Antidotal Therapy: May include dilution with fluids
Disease States: Skin atrophy, diabetes, infection at treatment site, glaucoma, tuberculosis
Lab Tests: Glucose, eosinophil count
Clofazimine
Trade Name(s): Lamprene
Pregnancy Category: C
Medical Category: Antibacterial (antimycobacterial)
Accepted Indications: Leprosy (secondary agent), atypical mycobacterial infection
Unaccepted Indications: Other leprosy-associated inflammatory reactions
Mechanism of Action: Bactericidal, inhibits mycobacterial growth, binds to DNA
Half life: 10 d after single dose
Metabolism: Hepatic
Elimination: Renal, fecal/biliary, sweat
Research Notes: 3 metabolites identified, with 2 conjugated
Adult Dosage: 50–{endash}100 mg once daily up to 300 mg/d with meals or milk
Elderly Dosage: Same as adult dose
Child Dosage: Not established
Infant Dosage: Not established
Dosage Forms: Capsules: 50 mg and 100 mg
Warnings: May discolor skin and body fluids
Precautions: Avoid sun/sun lamp
Frequent Side Effects: Unusual color of bowel movements and urine, GI upset, rash, itching
Occasional Side Effects: Burning sensation or itching of the eyes, photosensitivity
Rare Side Effects: GI bleeding, hepatitis, jaundice, mental depression
Antidotal Therapy: May include emesis or gastric lavage, supportive treatment
Disease States: Liver and GI problems
Lab Tests: Erythrocyte sedimentation rate; blood glucose; serum potassium, bilirubin, albumin
Administrative Notes: Doses of more than 100 mg must be given with close supervision
Clofibrate
Trade Name(s): Atromid-S
Pregnancy Category: C
Medical Category: Antihyperlipidemic
Accepted Indications: Hyperlipidemia
Unaccepted Indications: Platelet adhesion
Mechanism of Action: Involves inhibition of biosynthesis of cholesterol, decreases LDLs
Half life: 6–{endash}25 h
Metabolism: Hepatic and GI
Elimination: Renal
Research Notes: Long-term use of clofibrate may increase the risk of death from noncardiovascular causes
Adult Dosage: 1.5–{endash}2 g/d in 2–{endash}4 divided doses
Elderly Dosage: Renal function impairment may necessitate change in dosage
Dosage Forms: Capsules: 500 mg
By System: Hepatic
Precautions: If results of hepatic function tests rise significantly, withdraw drug
Frequent Side Effects: Diarrhea, nausea
Occasional Side Effects: Decreased sexual ability, flulike syndrome, headache, stomach pain, gas, stomatitis
Rare Side Effects: Anemia, leukopenia, cardiac arrhythmias, gallstones, renal toxicity
Contraindications: Primary biliary cirrhosis
Overdosage: Chest pain, arrhythmia, shortness of breath, severe stomach pain with nausea and vomiting
Antidotal Therapy: May include supportive measures
Disease States: Cardiovascular disease, gallstones, hepatic and function impairment, hypothyroidism, peptic ulcer
Other Drugs: Rifampin, probenecid, oral contraceptives, oral antidiabetic agents, anticoagulants
Lab Tests: Fibrinogen, amylase, aspartate aminotransferase
Administrative Notes: If response is inadequate after 3 m of treatment, withdraw drug
Clomiphene Citrate
Trade Name(s): Clomid, Milophene, Serophene
Chemically Related To: Estrogen
Pregnancy Category: X
Medical Category: Infertility therapy adjunct; diagnostic ovarian function
Accepted Indications: Infertility
Mechanism of Action: Increases secretion of LH and FSH with ovarian stimulation and LH surge, resulting in development of corpus luteum
Half life: 5–{endash}7 d
Metabolism: Hepatic
Elimination: Biliary
Research Notes: Asociated with an incidence of multiple pregnancies and possible premature deliveries
Adult Dosage: 25–{endash}50 mg/d up to 250 mg/d to induce ovulation
Dosage Forms: Tablets: 50 mg
By System: Reproductive
Precautions: Caution when driving or doing jobs requiring alertness; possible visual disturbances, dizziness, or lightheadedness
Frequent Side Effects: Ovarian enlargement or cyst formation, uterine fibroid enlargement, premenstrual syndrome, hot flashes
Occasional Side Effects: Persistence of visual images, blurred vision, double vision, photophobia
Rare Side Effects: Breast discomfort, dizziness, headache, mental depression
Contraindications: Hepatic function impairment, mental depression, ovarian cyst, thrombophlebitis
Disease States: Abnormal vaginal bleeding, endometriosis, fibroid tumors of uterus, polycystic ovary syndrome
Lab Tests: Transcortin, sex hormone–{endash}binding globulin
Administrative Notes: Hypoestrogenic patients require pretreatment with estrogen for ovum implant
Clomipramine Hydrochloride
Trade Name(s): Anafranil
Chemically Related To: Imipramine
Pregnancy Category: C
Medical Category: Antidepressant, anti–{endash}obsessive-compulsive, antipanic agent, antineuralgic, anticataplectic, antibulimic
Accepted Indications: Mental depression, obsessive-compulsive disorder, panic disorder, neurogenic pain, vascular headache (prophylaxis), narcolepsy, bulimia
Mechanism of Action: Inhibits reuptake of norepinephrine and/or serotonin
Absorption/Distribution: High protein binding; rapidly absorbed
Half life: 21–{endash}31 h
Metabolism: Hepatic
Elimination: Renal
Research Notes: Onset of action 2–{endash}3 w
Adult Dosage: 25 mg t.i.d. up to 250 mg/d
Elderly Dosage: 20–{endash}30 mg/d
Child Dosage: Under 10 y: not established; over 10 y: 20–{endash}30 mg/d up to 100 mg
Dosage Forms: Capsules: 25 mg, 50 mg, and 75 mg
By System: CNS, subcortical nuclei
Warnings: May cause drowsiness; avoid alcohol
Precautions: Use sugarless gum or candy for dry mouth; avoid unprotected exposure to sun, sun lamps, and tanning booths
Frequent Side Effects: Dizziness, dry mouth, drowsiness, increased appetite
Occasional Side Effects: Anticholinergic effects, arrhythmia, hypotension, nervousness, parkinsonism
Rare Side Effects: Agranulocytosis, anxiety, tinnitus, testicular swelling, alopecia
Contraindications: Acute recovery period after myocardial infarction
Overdosage: Convulsions, confusion, drowsiness, arrhythmia, fever, hallucinations, vomiting
Antidotal Therapy: May include symptomatic treatment: emesis or gastric lavage; activated charcoal; maintain respiration; lidocaine; digitalize if needed
Disease States: Asthma; blood, convulsive, or bipolar disorders; hyperthyroidism; glaucoma
Other Drugs: Sympathomimetics, MAO inhibitors, estrogens, anticonvulsants, CNS depressants, phenothiazines
Lab Tests: Blood glucose concentrations, metyrapone, EKG changes
Administrative Notes: Strengths of products may not match pediatric and geriatric needs
Clonazepam
Trade Name(s): Klonopin
Chemically Related To: Benzodiazepines
Scheduled Class: IV
Abuse Potential: Mild
Medical Category: Anticonvulsant
Accepted Indications: Epilepsy, absence or myoclonic seizures
Mechanism of Action: Enhances action of GABA
Absorption/Distribution: Well absorbed from GI tract; high protein binding
Half life: 18–{endash}50 h
Metabolism: Hepatic
Elimination: Renal, fecal
Research Notes: Drug reaches steady state in 5–{endash}14 d
Adult Dosage: 0.5 mg t.i.d. up to 20 mg/d
Elderly Dosage: Over 70 y: decrease dose
Child Dosage: Under 10 y: 0.01–{endash}0.03 mg/d up to 0.05 mg/kg/d in 2–{endash}3 divided doses
Infant Dosage: There is a possibility of prolonged CNS depression in newborns
Dosage Forms: Tablets: 0.5 mg, 1 mg, and 2 mg
By System: CNS
Warnings: Abrupt withdrawal may cause seizures; tolerance may develop; possibility of prolonged CNS depression in newborns
Precautions: During withdrawal of drug, give another anticonvulsant
Frequent Side Effects: Drowsiness, behavior problems
Occasional Side Effects: GI disturbances, headache, muscle spasm, tachycardia, changes in sexual desire
Rare Side Effects: Seizures, confusion, tingling or burning sensation, hallucinations
Overdosage: CNS depression
Antidotal Therapy: May include supportive measures, including gastric lavage and IV fluids, flumazenil
Disease States: Myasthenia gravis, pulmonary disease, glaucoma
Other Drugs: Alcohol and other CNS depressants
Lab Tests: Metyrapone, sodium iodide I 123 and sodium iodide I 131
Administrative Notes: Maintenance dose based on each individual's response
Clorazepate Dipotassium
Trade Name(s): Gen-XENE, Tranxene-SD, Tranxene T-Tab
Scheduled Class: IV
Abuse Potential: Minor
Pregnancy Category: C
Medical Category: Antianxiety agent, sedative-hypnotic, anticonvulsant
Accepted Indications: Anxiety, alcohol withdrawal, insomnia, convulsions
Mechanism of Action: Depresses limbic and subcortical areas of brain, suppresses speed of seizure activity
Absorption/Distribution: High protein binding; rapidly absorbed
Half life: 30–{endash}100 h
Metabolism: Hepatic
Elimination: Renal
Research Notes: Steady-state plasma concentration in 5 d–{endash}2 w
Adult Dosage: Antianxiety agent: 7.5–{endash}15 mg b.i.d. to q.i.d.; alcohol withdrawal: 30 mg initially, followed by 15 mg b.i.d. to q.i.d. the first day, 15 mg 3–{endash}6 times/d on second day, 7.5–{endash}15 mg t.i.d. the third day, 7.5 mg b.i.d. to q.i.d. the fourth day, thereafter 3.75 mg b.i.d. to q.i.d.; anticonvulsant: initially up to 7.5 mg t.i.d., the dosage increased by no more than 7.5 mg/w, not to exceed 90 mg/d
Elderly Dosage: Antianxiety agent: 3.75–{endash}15 mg/d, dosage increased as needed
Child Dosage: Anticonvulsant: up to 9y: safety and efficacy not established; 9–{endash}12 y: up to 7.5 mg b.i.d. dosage increased up to 60 mg/d; 12 y and over: same as adult dosage
Dosage Forms: Capsules: 3.75 mg, 7.5 mg, and 15 mg; tablets: 3.75 mg, 7.5 mg, 11.25 mg, 15mg, and 22.5 mg
By System: CNS, subcortical nuclei
Warnings: May cause drowsiness; avoid alcohol
Occasional Side Effects: Stomach cramps, confusion, increased sweating, nausea and vomiting, trembling, palpitations, drowsiness
Rare Side Effects: Convulsions, delirium, hallucinations
Overdosage: Confusion, decreased reflexes, bradycardia, severe weakness, shortness of breath
Antidotal Therapy: May include emesis or gastric lavage; activated charcoal; monitor respiration and blood pressure; IV fluids and vasopressors, flumazenil
Disease States: Glaucoma, shock, convulsions, liver or kidney failure, psychosis, sleep apnea, myasthenia gravis
Other Drugs: CNS depressants, tricyclic antidepressants, erythromycin, estrogen–{endash}containing contraceptives, zidovudine, levodopa, scopolamine
Lab Tests: Metyrapone, sodium iodide I 123 and sodium iodide I 131
Clotrimazole
Trade Name(s): Lotrimin, Mycelex
Chemically Related To: Ketoconazole
Pregnancy Category: B
Medical Category: Antifungal
Accepted Indications: Candidiasis, tinea corporis, tinea cruris, tinea pedis, tinea versicolor
Unaccepted Indications: Vulvovaginitis caused by bacterial pathogens
Mechanism of Action: Inhibits biosynthesis of ergosterol, damaging the fungal cell wall membrane and altering its permeability.
Absorption/Distribution: Oral: poor, even when swallowed; topical: dermal penetration; minimal systemic absorption
Metabolism: Hepatic
Elimination: Fecal
Research Notes: May affect the performance of some contraceptive devices
Adult Dosage: Topically b.i.d.
Elderly Dosage: Same as adult dose
Child Dosage: Same as adult dose
Infant Dosage: Same as adult dose
Dosage Forms: Cream, lotion, solution
By System: Immunologic
Warnings: Continue medicine for full course of treatment
Precautions: GI problems; may lead to skin sensitization
Occasional Side Effects: Vaginal burning, itching, discharge, abdominal or stomach cramps, headache
Disease States: Bacterial infections
Administrative Notes: Continue for full time of treatment
Cloxacillin Sodium
Trade Name(s): Cloxapen, Tegopen
Chemically Related To: Penicillin
Pregnancy Category: B
Medical Category: Antibacterial
Accepted Indications: Pneumonia (staphylococcal), sinusitis, skin and soft tissue infection, biliary tract infection, bacterial endocarditis
Unaccepted Indications: Meningitis
Mechanism of Action: Inhibits cell wall synthesis
Absorption/Distribution: 50% absorbed; high protein binding
Half life: 0.5–{endash}1.1 h
Metabolism: Hepatic
Elimination: Renal
Research Notes: Penicillinase-resistant
Adult Dosage: 250–{endash}500 mg q.i.d. up to 6 g/d
Elderly Dosage: May require a lower dosage
Child Dosage: Up to 20 kg: 6.25–{endash}12.5 mg/kg q.i.d.; over 20 kg: same as adult dose
Infant Dosage: Same as child dose
Dosage Forms: Capsules: 250 mg and 500 mg; oral solution: 125 mg/5mL
By System: Systemic
Warnings: Take for full time of treatment
Precautions: Possible need for alternative contraceptives
Frequent Side Effects: GI upset, candidiasis
Rare Side Effects: Allergic or serum sickness reaction, convulsions, pseudomembranous colitis
Contraindications: Allergy to penicillins, penicillamine
Overdosage: Severe diarrhea, nausea and vomiting
Antidotal Therapy: No specific antidote; may include supportive treatment, possible hemodialysis
Disease States: History of bleeding disorders, GI problems, infectious mononucleosis, and liver problems
Other Drugs: NSAIDs, thrombolytic agents, estrogen contraceptives, probenecid, hepatotoxic medications
Lab Tests: Bleeding time, urine glucose and protein, Coombs' test, hyperkalemia, serum uric acid and bilirubin
Administrative Notes: Take on an empty stomach
Clozapine
Trade Name(s): Clozaril, Leponex
Chemically Related To: Tricyclic antidepressants
Pregnancy Category: B
Medical Category: Antipsychotic
Accepted Indications: Schizophrenia
Mechanism of Action: Interferes with binding of dopamine
Absorption/Distribution: Rapid and nearly complete absorption; rapid distribution
Half life: 8 h
Metabolism: Hepatic
Elimination: Renal/fecal
Research Notes: Duration of action 4-12 h
Adult Dosage: Initially, 25 mg once daily or b.i.d., working up to 300–{endash}450 mg/d; maximum of 900 mg/d
Elderly Dosage: Confusion and excitement may occur more often
Child Dosage: Safety not established
Dosage Forms: Tablets: 25 mg and 100 mg
By System: CNS, subcortical nuclei
Warnings: May cause drowsiness; avoid alcohol
Precautions: Caution when getting up
Frequent Side Effects: Tachycardia, fever, orthostatic hypotension
Occasional Side Effects: Agitation, akathisia, confusion, blurred vision, hypertension, fainting
Rare Side Effects: Blood dyscrasias, eosinophilia, insomnia, depression, convulsions, neuroleptic malignant syndrome
Contraindications: Severe CNS depression, blood dyscrasias, bone marrow depression
Antidotal Therapy: No specific antidote; may include emesis, gastric lavage, or activated charcoal; maintain airway
Disease States: Heart problems, GI disorders, glaucoma, liver or kidney problems, prostatic hypertrophy
Other Drugs: CNS depressants, bone marrow depressants, lithium, digoxin, anticholinergics
Lab Tests: Negative blood test result for agranulocytosis before refills authorized
Administrative Notes: Dosage individualized by titration, requires close monitoring
Coal Tar
Trade Name(s): Aquatar, Denorex Extra Strength Medicated Shampoo, Estar, Zetar Emulsion
Chemically Related To: Unique compound
Pregnancy Category: C
Medical Category: Keratolytic, antipsoriatic, antiseborrheic
Accepted Indications: Dandruff, seborrheic or atopic dermatitis, eczema, psoriasis
Mechanism of Action: Suppresses hyperplastic skin in proliferative disorders; vasoconstrictor activity
Absorption/Distribution: Dermal
Research Notes: Induces photosensitivity
Adult Dosage: Topical to the skin or scalp
Dosage Forms: Cleansing bar, cream, gel, lotion, ointment, shampoo, solution, suspension
By System: Dermal
Warnings: Temporarily discolors blond, bleached, or tinted hair; stains skin and clothing
Precautions: Protect treated area from direct sunlight for 72 h after application of medication; do not apply to infected or oozing areas of skin
Frequent Side Effects: Stinging at application site
Rare Side Effects: Irritant contact dermatitis
Disease States: Acute inflammation, open wounds, skin infection
Other Drugs: Photosensitizing medications, such as diuretics
Administrative Notes: When used in conjunction with UV light or sunlight, exposure to light may be undertaken 2–{endash}72 h after coal tar is applied
Cocaine Hydrochloride
Trade Name(s): Generic only
Chemically Related To: Atropine
Scheduled Class: II
Abuse Potential: High
Pregnancy Category: C
Medical Category: Anesthetic, vasoconstrictor (mucosal, local)
Accepted Indications: Local pain
Unaccepted Indications: CNS stimulation
Mechanism of Action: Decreases the neuronal membrane's permeability to sodium ions; indirect acting sympathomimetic
Absorption/Distribution: Readily absorbed from all mucous membranes
Half life: 1–{endash}1.5 h
Peak activity: Mucosal 5 m
Metabolism: Hydrolyzed by plasma and hepatic cholinesterases
Elimination: Renal
Research Notes: Onset of action 1 min; duration of action 30 min–{endash}1 h, depending on concentration
Adult Dosage: 400 mg prescribing limit; lowest effctive dosage recommended
Elderly Dosage: Reduction in dosage recommended; more likely to have cerebrovascular disease
Child Dosage: Under 6 y: not recommended; 6 y and older: individualized
Dosage Forms: Crystals/flakes; tablets for topical solution: 135 mg; topical solution: 4% and 10 %; viscous topical solution: 4% and 10%
By System: Mucous membranes
Warnings: Tolerance to the anesthetic effects with repeated application
Frequent Side Effects: Loss of smell and/or taste, rebound nasal congestion, chronic rhinitis
Rare Side Effects: Cardiovascular collapse
Overdosage: Cardiac/cardiovascular effects, chills and fever, excitement and rapid breathing, unusually large pupils
Antidotal Therapy: May include use of supportive measures
Disease States: Cardiovascular disease, convulsions, hypertension, thyrotoxicosis, local infection, Tourette's syndrome, severe traumatized mucosa
Other Drugs: Amphetamines, appetite suppressants, beta-blockers, MAO inhibitors, sympathomimetics, thyroid hormones, nitrates, methyldopa, levodopa, antihypertensives, inhalational anesthetics
Lab Tests: Blood pressure, body temperature, heart rate, blood glucose concentration
Codeine Phosphate
Trade Name(s): Generic only
Chemically Related To: Morphine
Scheduled Class: II
Abuse Potential: Moderate
Pregnancy Category: C
Medical Category: Analgesic, antitussive, antidiarrheal
Accepted Indications: Mild to moderate pain, cough, diarrhea
Mechanism of Action: Exerts agonist activity at mu receptor in CNS to control pain
Absorption/Distribution: All body tissues
Half life: 2.5–{endash}4 h
IM: 30–{endash}60 min
Metabolism: Hepatic
Elimination: Renal
Research Notes: 120 mg IM or 200 mg
Adult Dosage: Analgesic: oral and injection 15–{endash}60 mg q3h–{endash}q.i.d; Antidiarrheal: oral 30 mg up to q.i.d; Antitussive: oral 10–{endash}20 mg q4h–{endash}q.i.d
Child Dosage: Analgesic: oral and injection 500 m{mu}g/kg q4h–{endash}q.i.d.; Anitdiarrheal: 500 m{mu}g/kg up to q.i.d.; Anititussive: up to 2 y not recommended, 2–{endash}5 y 1mg/kg/d q.i.d.
Infant Dosage: Newborn, not established
Dosage Forms: Oral solution 15 mg/5 mL, tablets 30 and 60 mg, injection 30 and 60 mg/mL
By System: CNS subcortical nuclei at mu receptor
Warnings: Avoid alcoholic beverages and other CNS depressants
Precautions: Do not drive or operate machinery
Frequent Side Effects: Constipation, drowsiness
Occasional Side Effects: CNS stimulation, confusion, arrhythmia, decreased urination, blurred vision, dry mouth, headache
Rare Side Effects: Convulsions, hallucinations, mental depression, muscle rigidity, trembling, biliary spasm, GI irritation, nervousness, nightmares
Contraindications: Acute respiratory depression, diarrhea associated with colitis
Overdosage: Severe drowsiness, hypotension, nervousness, bradycardia, slow or troubled breathing
Antidotal Therapy: May include naloxone 400 m{mu}g–{endash}2 mg
Disease States: Acute asthma, cardiac arrhythmias, convulsions, gallstones, head injury
Other Drugs: CNS depressants, anticholinergics, antihypertensives, antiperistaltics, antidiarrheals, MAO inhibitors, naloxone, naltrexone, neuromuscular blocking agents, zidovudine, rifampin
Lab Tests: Serum alkaline phosphatase, bilirubin, plasma lipase activity
Administrative Notes: Codeine more likely than most other opioids to cause constipation but has a lower dependence liability
Codeine Phosphate/Ephedrine Hydrochloride/Guaifenesin
Trade Name(s): Broncholate CS Syrup
Scheduled Class: V
Abuse Potential: Low
Pregnancy Category: C
Medical Category: Bronchodilator, expectorant
Accepted Indications: Cough
Dosage Forms: Syrup: 10 mg/6.25 mg/100 mg/5 mL
Codeine Phosphate/Guaifenesin
Trade Name(s): Baytussin A.C., Glydeine, Guaituss AC, Halotussin-DAC, Medi-Tuss with Codeine, Mytussin AC, Nortussin w/Codeine, Robitussin AC, Tolu-Sed
Scheduled Class: V
Abuse Potential: Low
Pregnancy Category: C
Medical Category: Antitussive, mucolytic
Accepted Indications: Coughs and colds
Adult Dosage: Syrup: 5–{endash}10 mL q4h; tablets: 1q4h
Child Dosage: 2–{endash}6 y: syrup, 2.5 mL; 6–{endash}12 y: syrup, 5 mL q4–{endash}6h
Dosage Forms: Syrup: 10 mg/100 mg/5 mL; tablets 10 mg/300 mg; oral solution: 10 mg/100 mg
Codeine Phosphate/Guaifenesin/Phenylpropanolamine
Trade Name(s): Chemdal, Codegest, Endal, Naldecon-CX, Novagest, Triaminic Expectorant with Codeine
Scheduled Class: V
Abuse Potential: Low
Pregnancy Category: C
Medical Category: Antitussive, decongestant, mucolytic
Accepted Indications: Coughs and colds
Adult Dosage: 5–{endash}10 mL t.i.d. or q.i.d.
Child Dosage: 2–{endash}6 y: 1.25–{endash}2.5 mL; 6–{endash}12 y: 2.5–{endash}5 mL every 4–{endash}6 h
Dosage Forms: Oral solution: 10 mg/100 mg/12.5 mg
Codeine Phosphate/Guaifenesin/Pseudoephedrine Hydrochloride
Trade Name(s): Alamine, Benylin with Codeine, Deconsal Pediatric Syrup, Deproist with Codeine, Dihistine, Guiatuss DAC, Guiatussin DAC, Mytussin DAC, Novagest with Codeine, Novahistine, Nucochem, Nucochem Pediatric, Nucofed, Nucofed Pediatric, Nucotuss, Nucotuss Pediatric, Phenhist, Robafen DAC, Robitussin-DAC, Ryna-CX, Tussar SF, Tussar-2
Scheduled Class: V
Abuse Potential: Low
Pregnancy Category: C
Medical Category: Antitussive, mucolytic, decongestant
Accepted Indications: Cough and cold
Adult Dosage: 10 mL q4h
Child Dosage: 2–{endash}6 y: 1.25–{endash}2.5 mL; 6–{endash}12 y: 2.5–{endash}5 mL q4–{endash}6h
Dosage Forms: Syrup 10 mg/100 mg/30 mg
Codeine Phosphate/Iodinated Glycerol
Trade Name(s): Io Tuss, Iophen-C, Tussi-Organidin
Scheduled Class: V
Abuse Potential: Low
Pregnancy Category: C
Medical Category: Antitussive
Accepted Indications: Cough
Adult Dosage: 5–{endash}10 mL every 4 h
Child Dosage: 2–{endash}6 y: 1.25–{endash}2.5 mL; 6–{endash}12 y: 2.5–{endash}5 mL t.i.d. or q.i.d.
Dosage Forms: Oral solution: 10 mg/30 mg
Codeine Phosphate/Phenylephrine Hydrochloride/Promethazine Hydrochloride
Trade Name(s): M-Phen, Para-Hist, Phenergan VC with Codeine, Pherazine VC with Codeine
Pregnancy Category: C
Medical Category: Antihistamine, antitussive, decongestant
Accepted Indications: Allergies, coughs, and colds
Adult Dosage: 5 mL every 4–{endash}6 h
Child Dosage: Under 6 y: 1.25–{endash}2.5 mL every 4–{endash}6 h; 6–{endash}12 y: 2.5–{endash}5 mL every 4–{endash}6 h
Dosage Forms: Syrup: 10 mg/5 mg/6.25 mg/5 mL
Codeine Phosphate/Phenylephrine Hydrochloride/Pyrilamine Maleate
Trade Name(s): Codimal PH
Scheduled Class: V
Abuse Potential: Moderate
Pregnancy Category: C
Medical Category: Antitussive, decongestant, antihistamine
Accepted Indications: Coughs and colds
Adult Dosage: 5–{endash}10 mL every 4–{endash}6 h
Dosage Forms: Syrup: 10 mg/5 mg/8.33 mg/5 mL
Codeine Phosphate/Promethazine Hydrochloride
Trade Name(s): Dectuss, Phenergan with Codeine, Pherazine with Codeine, Prothazine
Scheduled Class: V
Abuse Potential: Low
Pregnancy Category: C
Medical Category: Antihistamine, antitussive
Accepted Indications: Coughs and colds
Adult Dosage: 5 mL every 4–{endash}6 h
Child Dosage: Under 6 y: 1.25–{endash}2.5 mL every 4–{endash}6 h; 6–{endash}12 y: 2.5–{endash}5 mL every 4–{endash}6 h
Dosage Forms: Syrup: 10 mg/6.25 mg/5 mL
Codeine Phosphate/Terpin Hydrate
Trade Name(s): Prunicodeine
Scheduled Class: V
Abuse Potential: Low
Pregnancy Category: C
Medical Category: Antitussive
Accepted Indications: Cough
Dosage Forms: Elixir: 10 mg/85 mg
Colchicine
Trade Name(s): Generic only
Chemically Related To: Quinidine
Pregnancy Category: D
Medical Category: Antigout agent
Accepted Indications: Acute and chronic gouty arthritis
Mechanism of Action: Decreases leukocyte motility, phagocytosis, and lactic acid production, which decreases urate crystals and inflammation
Half life: Biphasic: 3–{endash}5 min distribution, 1 h elimination
Metabolism: Hepatic
Elimination: Biliary
Research Notes: Decreases body temperature, depresses the respiratory center, and constricts blood vessels
Adult Dosage: Tablets: prophylactic 500–{endash}600 m{mu}g 1–{endash}3 times/d; for relief of acute attack, 500 m{mu}g–{endash}1.2 mg initially and then 500–{endash}600 m{mu}g every 1–{endash}2 h or 1–{endash}1.2 mg every 2 h to a maximum of 6 mg. IV: as prophylactic, 500 m{mu}g–{endash}1 mg once daily or b.i.d.; for relief of acute attack, 2 mg initially and then 500 m{mu}g q.i.d. or 1 mg b.i.d.–{endash}q.i.d. to a maximum of 4 mg.
Elderly Dosage: Elderly patients more susceptible to cumulative toxicity
Child Dosage: Safety and efficacy not established
Infant Dosage: Safety and efficacy not established
Dosage Forms: Tablets: 500 m{mu}g and 600 m{mu}g; IV 1 mg/2 mL
By System: Immune tissues
Warnings: Large amounts of alcohol may increase the risk of GI toxicity, also may increase uric acid concentrations
Precautions: If diarrhea, nausea, vomiting, or stomach pain continues for more than 3 h after medication is discontinued, call physician
Frequent Side Effects: Diarrhea, nausea or vomiting, stomach pain
Occasional Side Effects: Loss of appetite, hair loss
Rare Side Effects: Thrombophlebitis at injection site, agranulocytosis, aplastic anemia, peripheral neuritis, rash, thrombocytopenia
Overdosage: Burning sensation in stomach, throat, or skin; convulsions; diarrhea; fever; mood or mental change; muscle weakness; pulmonary edema; respiratory depression; renal failure
Antidotal Therapy: May include administration of antidiarrheal or atropine; gastric lavage; correction of electrolyte imbalance and metabolic acidosis
Disease States: Alcoholism, blood dyscrasias, severe cardiac disorder or GI disorders, renal function impairment
Other Drugs: Alcohol, NSAIDs, antineoplastic agents, diuretics, bone marrow depressants, vitamin B12, radiation therapy
Lab Tests: Urine tests for red blood cells, platelet count
Administrative Notes: When used intermittently to relieve acute attacks, an interval of 3 d between courses of therapy is recommended to reduce the risk of cumulative toxicity
Colchicine/Probenecid
Trade Name(s):
Pregnancy Category: C
Medical Category: Antigout
Accepted Indications: Gouty arthritis
Adult Dosage: 1 tablet once daily for 1 w, followed by 1 tablet b.i.d. thereafter
Elderly Dosage: Lower dose may be required
Child Dosage: Not established
Infant Dosage: Not established
Dosage Forms: Tablets: 0.5 mg/500 mg
Colestipol Hydrochloride
Trade Name(s): Colestid
Chemically Related To: Anion-exchange resin
Pregnancy Category: C
Medical Category: Antihyperlipidemic, antipruritic (cholestasis), antidiarrheal (bile acid)
Accepted Indications: Hyperlipidemia, pruritus due to biliary obstruction
Mechanism of Action: Binds with bile acids in the intestine, preventing reabsorption and producing a complex that is excreted in the feces
Absorption/Distribution: Not absorbed from GI tract
Elimination: Fecal
Research Notes: After withdrawal, cholesterol concentrations return to baseline in about 1 m
Adult Dosage: 15–{endash}30 g daily in 2–{endash}4 divided doses
Elderly Dosage: Patients over 60 y more likely to experience GI side effects and adverse nutritional effects
Child Dosage: Not established
Infant Dosage: Not established
Dosage Forms: For oral suspension: 5 g/packet or level scoop
By System: GI tract
Warnings: Not recommended in children under 2 y because cholesterol is required for normal development
Frequent Side Effects: Constipation
Occasional Side Effects: Belching, bloating, diarrhea, dizziness, headache, nausea and vomiting, stomach pain
Rare Side Effects: Gallstones, GI bleeding, peptic ulcer
Contraindications: Primary biliary cirrhosis
Disease States: Bleeding disorders, gallstones, GI dysfunction, peptic ulcer, constipation, hemorrhoids, renal function impairment
Other Drugs: Anticoagulants, digitalis glycosides, thiazide diuretics, penicillin G, tetracyclines, fat-soluble vitamins
Lab Tests: Serum chloride, phosphorus, potassium and sodium levels; prothrombin time, alkaline phosphatase
Administrative Notes: Diet is preferred therapy; compliance with prescribed diet needed. If constipation occurs or worsens, reduce dose to prevent impaction.
Colistimethate Sodium
Trade Name(s): Coly-Mycin M
Chemically Related To: Polymyxins
Pregnancy Category: Safety not established
Medical Category: Polymyxin antibiotic
Accepted Indications: Acute or chronic infections caused by strains of gram-negative bacteria, urinary tract infections caused by Pseudomonas aeruginosa.
Unaccepted Indications: Infections caused by Proteus or Neisseria
Mechanism of Action: Bactericidal
Absorption/Distribution: Not absorbed from GI tract
Half life: 2–{endash}3 h
IM: 2–{endash}3 h
IV: 10 min
Elimination: Renal
Research Notes: Transferred across placental barrier
Adult Dosage: 2.5–{endash}5 mg/kg/d in 2–{endash}4 doses IM or IV
Elderly Dosage: Renal problems could require caution
Child Dosage: Same as adult dose
Infant Dosage: Pay close attention to renal function
Dosage Forms: Parenteral: 150 mg/vial
Precautions: Use caution in women of childbearing potential
Occasional Side Effects: Numbness, dizziness, blurred vision, slurred speech, pruritus, rash, tingling sensation in the extremities
Overdosage: Kidney problems, muscle weakness, apnea
Antidotal Therapy: May include assisted respiration, oxygen, calcium chloride injection
Disease States: Kidney problems
Other Drugs: Kanamycin, streptomycin, dihydrostreptomycin, polymyxin B sulfate, neomycin, curariform muscle relaxants, aminoglycosides, amphotericin B, capreomycin, methoxyflurane, vancomycin, cephalothin
Lab Tests: BUN, serum creatinine
Collagenase
Trade Name(s): Santyl
Chemically Related To: Enzymes
Medical Category: Skin and mucous membrane agent
Accepted Indications: Debridement of necrotic tissue in severe burns and dermal ulcers
Mechanism of Action: Hydrolyzes peptide bonds of collagen
Research Notes: Does not degrade fat, keratin, fibrin or hemoglobin; optimal activity pH 7-8
Adult Dosage: Apply topically as an ointment once daily for hospitalized patients and every other day for outpatients
Dosage Forms: Ointment: 250 units/g
By System: Dermal
Warnings: Apply with caution near the eyes
Precautions: Observe for signs of systemic bacterial infection
Side/Adverse Effects: Pain and burning at site of application or slight erythema in surrounding tissue
Antidotal Therapy: May include application of Burow's solution USP (pH 3.6–{endash}4.4)
Other Drugs: Detergents, hexachlorophene, mercury and silver antiseptics, benzalkonium chloride, nitrofurazone, tincture of iodine
Administrative Notes: Apply aluminum acetate solution to surrounding skin to terminate drug's activity
Cortisone Acetate
Trade Name(s): Cortone, Cortone Acetate
Pregnancy Category: Adequate studies have not been done
Medical Category: Corticosteroid, anti-inflammatory, immunosuppressant
Accepted Indications: Adrenocortical insufficiency, allergic disorders, dermatologic disorders, hematologic disorders, inflammation, ophthalmic disorders, respiratory disorders, rheumatic disorders
Absorption/Distribution: Rapidly absorbed
IM: 20–{endash}48 h
Metabolism: Hepatic, renal, tissue
Elimination: Renal
Research Notes: Duration of action 1.25–{endash}1.5 d
Adult Dosage: 25–{endash}300 mg/d
Elderly Dosage: Use with caution
Child Dosage: 700 m{mu}g–{endash}10 mg/kg/d in divided doses
Dosage Forms: Tablets: 5 mg, 10 mg and 25 mg. Suspension: 25 mg/mL and 50 mg/mL.
Frequent Side Effects: Nervousness, acne, increased appetite, indigestion, trouble sleeping
Occasional Side Effects: Change in skin color, allergic reaction, cataracts, diabetes mellitus, dizziness, increased sweating, osteoporosis
Rare Side Effects: Avascular necrosis of bone, Cushing's syndrome, sudden blindness, psychic disturbances, disorientation, euphoria, hallucinations, manic-depressive episodes, mental depression, anaphylaxis, flushing, pounding heartbeat, seizures, generalized allergic reaction, reaction at injection site
Contraindications: Blood clotting syndromes, infections, osteoporosis, intestinal obstruction
Disease States: Herpes simplex, systemic lupus erythematosus, tuberculosis, fungal infections, diabetes, joint arthroplasty, intra-articular fracture, periarticular infection, unstable joint, chicken pox, measles, myasthenia gravis, cardiac disease, CHF, renal function impairment, peptic ulcer, AIDS, HIV, diabetes mellitus
Other Drugs: Amphotericin B, antidiabetic agents, insulin, digitalis glycosides, diuretics, hepatic enzyme–{endash}inducing agents, potassium supplements, ritodrine, sodium–{endash}containing medications, somatrem, somatropin, live virus vaccines
Lab Tests: Glucose, cholesterol, potassium
Cromolyn Sodium
Trade Name(s): Gastrocrom, Intal, Nasalcrom
Chemically Related To: Unique compound
Pregnancy Category: B
Medical Category: Mast cell stabilizer, antiallergic
Accepted Indications: Allergy, bronchial asthma, mastocytosis
Mechanism of Action: Inhibits mast cell release of histamine and other substances that cause hypersensitivity reactions or histamine release
Absorption/Distribution: Poorly absorbed from GI tract; usually administered topically to site of action
Half life: 80 min
Elimination: Renal/biliary
Adult Dosage: Inhalation aerosol: 1.6 mg q.i.d.; capsules for inhalation: 20 mg q.i.d.; nasal solution: 5.2 mg t.i.d. or q.i.d.; systemic/oral capsules 800 mg/d 30 min before meals and at bedtime
Elderly Dosage: Hepatic and renal impairment could necessitate a decreased dose
Child Dosage: Up to 5 y, inhalation aerosol: safety and efficacy not established; 5 y and over: same as adult dose. Capsules for inhalation, up to 2 y: safety and efficacy not established; 2 y and over: same as adult dose. Nasal solution, up to 6 y: safety and efficacy not established; 6 y and over: same as adult dose. Capsules, up to 2 y: 20 mg/kg/d in 4 divided doses; 2–{endash}12 y: 400 mg/d; 30 min before meals and at bedtime
Dosage Forms: Inhalation aerosol: 0.8 mg/metered spray; capsules for inhalation: 20 mg; nasal solution: 40 mg/mL (5.2 mg/metered spray); oral capsules: 100 mg (mastocytosis only, not for inhalation)
Precautions: Check with physician if symptoms do not improve or condition worsens
Frequent Side Effects: Diarrhea, headache, increased bronchospasm, burning sensation or stinging inside of nose
Occasional Side Effects: Rash, abdominal pain, irritability, joint pain, nausea, trouble sleeping, cough, postnasal drip
Rare Side Effects: Anaphylactic reaction, angioedema, dizziness, painful urination, eosinophilic pneumonia, muscle pain or weakness, rash, hives, itching, epistaxis
Contraindications: Severe hepatic or renal function impairment
Disease States: Hepatic and renal impairment
Nutrition: Do not mix oral capsule medication with food, milk, or fruit juices
Other Drugs: Methacholine
Administrative Notes: For optimal results for mastocytosis, dissolve contents of the capsules for inhalation in warm water and take as a solution. For optimal results with inhalation capsules, must be used as instructed with special inhaler
Crotamiton
Trade Name(s): Eurax
Chemically Related To: Unique compound
Pregnancy Category: C
Medical Category: Scabicide
Accepted Indications: Scabies
Unaccepted Indications: Pruritus associated with dermatoses
Research Notes: Skin should be well dried before medication is applied
Adult Dosage: Topical to the skin
Child Dosage: Not established
Infant Dosage: Not established
Dosage Forms: Cream: 10%; lotion: 10%
By System: Dermal
Warnings: Hygienic measures needed to control reinfestation
Rare Side Effects: Allergic skin reaction
Antidotal Therapy: No specific antidote; if ingested, gastric lavage should be performed
Disease States: Acutely inflamed skin or raw oozing skin surface
Administrative Notes: Necessary for all household members to receive treatment if medication is being used for scabies
Cyanocobalamin
Trade Name(s): Crystamine, Crysti-12, Cyanoject, Cyomin, Rubesol-1000, Rubramin PC
Chemically Related To: Vitamin B12
Pregnancy Category: C
Medical Category: Nutritional supplement, antianemic, diagnostic aid
Accepted Indications: Pernicious anemia, vitamin deficiency
Unaccepted Indications: Viral hepatitis, angina, delayed growth, sterility, allergies, amblyopia, poor appetite, malnutrition, dermatologic disorders, fatigue, mental disorders, multiple sclerosis, thyrotoxicosis, trigeminal neuralgia
Mechanism of Action: Acts as coenzyme for metabolic functions
Half life: 6 d (plasma), 400 days (liver)
IM: 60 min
IV: 1 h
Metabolism: Hepatic storage
Elimination: Biliary
Adult Dosage: Tablets: 0.001 mg–{endash}0.025 mg/d; injection, initial, IM or SQ: 0.1 mg/d for 6–{endash}7 d, followed by 0.1 mg every other day for 7 doses, then 0.1 mg every 3–{endash}4 d for another 2–{endash}3 w; maintenance, IM: 0.1–{endash}0.2 mg once/m
Elderly Dosage: Same as adult dose
Child Dosage: Tablets: 1 y and over: 0.001 mg/d; injection, initial, IM or SQ: 0.03–{endash}0.05 mg/d for 2 or more w; maintenance, IM or SQ: 0.1 mg once/m
Infant Dosage: Tablets: up to 1 y: 0.0003 mg/d
Dosage Forms: Tablets: 0.025 mg, 0.05 mg, 0.1 mg, 0.25 mg, 0.5 mg, and 1 mg; injection: 0.03 mg/mL, 0.1 mg/mL, and 1 mg/mL
Warnings: Megadoses not recommended
Occasional Side Effects: Diarrhea, itching of skin
Rare Side Effects: Anaphylaxis
Contraindications: Leber's disease
Other Drugs: Excessive alcohol, antibiotics, ascorbic acid, folic acid, aminosalicylates, colchicine
Lab Tests: Folic acid concentrations, hematocrit, potassium concentrations
Administrative Notes: Need for lifelong therapy for pernicious anemia
Cyclizine Lactate
Trade Name(s): Marezine
Pregnancy Category: Problems in humans not documented
Medical Category: Antiemetic, antihistamine
Accepted Indications: Motion sickness, vomiting
Mechanism of Action: Diminishes vestibular stimulation
Adult Dosage: Tablets: 50 mg,30 min before travel, repeated q4–{endash}6h, up to 200 mg/d. Injection: IM, 50 mg q4–{endash}6h.
Elderly Dosage: Same as adult dose
Child Dosage: Tablets: 6–{endash}12 y: 25 mg, 30 min before travel; repeated t.i.d. or q.i.d. Injection: IM, 1 mg/kg t.i.d.
Infant Dosage: Tablets: 1 mg/kg t.i.d.
Dosage Forms: Tablets: 50 mg. Injection: 50 mg/mL.
Frequent Side Effects: Drowsiness
Occasional Side Effects: Constipation, blurred vision, difficult urination, dizziness, dry mouth, tachycardia, appetite loss, restlessness, nervousness, rash, trouble sleeping, GI upset
Disease States: Severe cardiac failure, glaucoma, bladder neck obstruction, prostatic hypertrophy, pyloroduodenal obstruction
Other Drugs: CNS depressants, anticholinergics, apomorphine
Administrative Notes: Avoid alcohol
Cyclobenzaprine Hydrochloride
Trade Name(s): Cycoflex, Flexeril
Chemically Related To: Tricyclic antidepressants
Pregnancy Category: B
Medical Category: Skeletal muscle relaxant
Accepted Indications: Skeletal muscle pain, sedative
Mechanism of Action: Acts at brainstem to reduce tonic somatic motor activity
Absorption/Distribution: Slowly absorbed; distributed in all body tissues
Half life: 1–{endash}3 d
Metabolism: GI and hepatic
Elimination: Renal
Research Notes: Duration of action of a single dose, 12–{endash}24 h
Adult Dosage: 5–{endash}60 mg/d
Elderly Dosage: Not listed
Child Dosage: Not established
Infant Dosage: Not established
Dosage Forms: Tablets: 10 mg
By System: Parasympathetic; CNS
Warnings: May cause drowsiness; avoid alcoholic beverages
Precautions: Caution if blurred vision, drowsiness, or dizziness occurs; possible dry mouth
Frequent Side Effects: Dry mouth, dizziness, drowsiness
Occasional Side Effects: Headache, confusion, constipation, GI irritation, tachycardia, unpleasant taste, allergy
Rare Side Effects: Problems in urination, dreaming, clumsiness, mental depression
Contraindications: Acute recovery phase of myocardial infarction, cardiac arrhythmias, CHF, heart block, hyperthyroidism
Overdosage: Cardiotoxicity; severe confusion; convulsions; hallucinations; dry, hot, flushed skin; increased or decreased body temperature; unexplained muscle stiffness; vomiting
Antidotal Therapy: May include supportive and maintenance therapy
Disease States: Glaucoma, urinary retention
Other Drugs: Antidepressants, CNS depressants, antidyskinetics, anticholinergics, guanethidine, MAO inhibitors
Administrative Notes: Recommended that therapy for acute, painful musculoskeletal conditions be discontinued after 2–{endash}3 w
Cyclopentolate Hydrochloride
Trade Name(s): Ak-Pentolate, Cyclogyl, Pentolair
Chemically Related To: Anticholinergics
Pregnancy Category: C
Medical Category: Cycloplegic, mydriatic
Accepted Indications: Cycloplegic refraction, mydriasis, posterior synechia prophylaxis, uveitis
Mechanism of Action: Anticholinergic
Peak activity: Cycloplegia, 25–{endash}75 min; mydriasis, within 1 h
Research Notes: Onset of action rapid, with a shorter duration of action than atropine
Adult Dosage: Topical to the conjunctiva, 1 drop of 0.5%–{endash}2% solution
Elderly Dosage: Increased potential for systemic side effects
Child Dosage: Same as adult dose
Infant Dosage: Topical, to the conjunctiva, 1 drop of 0.5% solution
Dosage Forms: Solution .5%, 1%, and 2%
By System: Ophthalmic
Warnings: For the eye; keep container tightly closed
Precautions:
Overdosage: With systemic absorption, ataxia, confusion, fever, hallucinations, thirst, weakness, flushing
Antidotal Therapy: May include physostigmine
Disease States: Brain damage in children, Down syndrome, spastic paralysis in children, glaucoma
Other Drugs: Antiglaucoma agents, carbachol, pilocarpine
Administrative Notes: Monitor infants for 30 min after administration
Cyclophosphamide
Trade Name(s): Cytoxan, Neosar
Chemically Related To: Nitrogen mustard
Pregnancy Category: D
Medical Category: Antineoplastic, immunosuppressant
Accepted Indications: Leukemias, lymphomas, ovarian and breast carcinoma, nephrotic syndrome, vasculitis, systemic lupus erythematosus
Mechanism of Action: Cross-links strands of DNA and RNA; inhibits protein synthesis in the cancer cell
Absorption/Distribution: Well absorbed; crosses blood-brain barrier
Half life: 3–{endash}12 h
IV: 2–{endash}3 h
Metabolism: Hepatic
Elimination: Renal
Adult Dosage: Varies by patient and indication
Elderly Dosage: Use caution
Child Dosage: Varies by patient and indication
Infant Dosage: Same as child dose
Dosage Forms: Oral solution compounding required; tablets: 25 mg and 50 mg; injection: in various strengths, lyophilized and nonlyophilized
By System: Hematopoietic
Warnings: Taken in morning to reduce risk of hemorrhagic cystitis
Frequent Side Effects: Gonadal suppression, leukopenia, darkening of skin and fingernails, nausea and vomiting, loss of hair
Occasional Side Effects: Anemia, thrombocytopenia, diarrhea, flushing of face, headache, increased sweating
Rare Side Effects: Hemorrhagic cystitis, hyperglycemia, hepatitis, stomatitis, long term risk of bladder cancer
Disease States: Bone marrow depression, chickenpox, gout, renal stones, hepatic and renal function impairment, infection
Other Drugs: Allopurinol, oral anticoagulants, blood dyscrasia–{endash}causing medications, bone marrow depressants, cocaine, other immunosuppressants, live virus vaccines
Lab Tests: Candida and mumps skin test, uric acid, tuberculin PPD skin tests
Administrative Notes: Frequently used in combination with other agents in various regimens; as a result, incidence and/or severity of side effects may be altered and possibly different dosages used
Cyclosporine
Trade Name(s): Sandimmune
Pregnancy Category: C
Medical Category: Immunosuppressant
Accepted Indications: Organ transplant rejection
Mechanism of Action: Inhibits production and release of interleukin-2
Absorption/Distribution: Incomplete from GI tract, variable
Half life: Biphasic, 10–{endash}27 h
Metabolism: Hepatic
Elimination: Biliary, fecal, renal
Adult Dosage: Capsules and solution, initial, 12–{endash}15 mg/kg/d beginning 4–{endash}12 h before surgery, continued for 1–{endash}2 w, then reduced; maintenance: 5–{endash}10 mg/kg/d, injection, IV infusion 2–{endash}6 mg/kg/d beginning 4–{endash}12 h before surgery and continued until patient can switch to oral solution
Elderly Dosage: Use with caution
Child Dosage: Same as adult dose
Dosage Forms: Capsules: 25 mg and 100 mg; oral solution: 100 mg/mL; concentrate for injection: 50 mg/mL
Frequent Side Effects: Gingival hyperplasia, hypertension, nephrotoxicity, hirsutism, tremor
Occasional Side Effects: Hepatotoxicity, infection, convulsions, acne, oily skin, headache, nausea, vomiting, leg cramps
Rare Side Effects: Hyperkalemia, pancreatitis, anaphylaxis, hemolytic-uremic syndrome, seizures
Contraindications: Chickenpox, herpes zoster, kidney and liver impairment
Antidotal Therapy: May include emesis
Disease States: Hyperkalemia, infection, malabsorption
Other Drugs: ACE inhibitors, heparin, beta blockers, androgens, cimetidine, danazol, diltiazem, erythromycin, estrogens, ketoconazole, miconazole, NSAIDs, hepatic enzyme inducers, hyperkalemia–{endash}causing medications, potassium–{endash}sparing diuretics, immunosuppressants, lovastatin, vaccines
Lab Tests: BUN, magnesium
Administrative Notes: Take exact amount of medication
Cyclothiazide
Trade Name(s): Generic only
Chemically Related To: Chlorothiazides
Pregnancy Category: C
Medical Category: Diuretic, antihypertensive, antidiuretic (diabetes insipidus), antiurolithic
Accepted Indications: Edema, hypertension, diabetes insipidus, renal calculi (prophylaxis)
Mechanism of Action: Inhibits sodium reabsorption in nephron
Absorption/Distribution: Rapid absorption
Elimination: Renal, bile
Research Notes: Onset of action 2–{endash}4 h; duration of action 18–{endash}24 h
Adult Dosage: 1–{endash}2 mg/d up to 6 mg
Elderly Dosage: May be more likely to have hypotension and electrolyte disturbances
Child Dosage: 20–{endash}40 m{mu}g/kg/d
Infant Dosage: Caution in infants with jaundice
Dosage Forms: Tablets: 2 mg
By System: Renal
Warnings: Avoid sun and sun lamps; do not take other medications
Precautions: Finish medication even if symptoms disappear
Frequent Side Effects: Electrolyte imbalance, hypokalemia
Occasional Side Effects: Anorexia, diarrhea, decreased sexual activity, photosensitivity, upset stomach
Rare Side Effects: Agranulocytosis, pancreatitis, gout, hepatic function impairment, thrombocytopenia, glucose intolerance
Antidotal Therapy: May include emesis or gastric lavage, monitor electrolyte concentration and kidney function
Disease States: Anuria, diabetes mellitus, gout, hyperuricemia, lupus erythematosus, pancreatitis, liver problems
Nutrition: Sodium restriction and weight reduction
Other Drugs: Lithium, neuromuscular blocking agents, sympathomimetics, digitalis glycosides, NSAIDs, dopamine
Lab Tests: Uric acid, urinary calcium, bilirubin, tyramine
Cyproheptadine Hydrochloride
Trade Name(s): Periactin
Chemically Related To: Piperidine antihistamines
Pregnancy Category: B
Medical Category: Antihistamine, appetite stimulant, vascular headache suppressant
Accepted Indications: Rhinitis, allergic conjunctivitis, pruritus, urticaria, angioedema, dermatographism, sneezing, rhinorrhea, loss of appetite, vascular headache
Unaccepted Indications: Cushing's disease, hypomotility
Mechanism of Action: Competitor for H1 receptor site
Absorption/Distribution: Well absorbed
Half life: 14–{endash}25 h
Peak activity: 6–{endash}9 h
Metabolism: Hepatic, renal
Elimination: Renal
Research Notes: Has an antiserotonin action
Adult Dosage: Initially 4 mg t.i.d. up to 500 m{mu}g/kg/d
Elderly Dosage: More chance of dizziness, sedation, or confusion
Child Dosage: 2–{endash}6 y: 2 mg every 8–{endash}12 h, not to exceed 12 mg/d; 6–{endash}14 y: 4 mg every 8–{endash}12 h, not to exceed 16 mg/d
Infant Dosage: Premature infants and neonates: not recommended
Dosage Forms: Syrup: 2 mg/5 mL; tablets: 4 mg
Warnings: May cause drowsiness; avoid alcohol
Precautions: Possible dry mouth; use sugarless gum or candy
Frequent Side Effects: Drowsiness, thick mucus
Occasional Side Effects: Blood dyscrasias, cardiac arrhythmias
Rare Side Effects: Blurred vision, dry mouth, increased appetite, GI problems, nightmares, urine retention
Contraindications: Liver problems
Overdosage: Anticholinergic effects, cardiac arrhythmias, drowsiness, hallucinations, convulsions, hypotension
Antidotal Therapy: No specific antidote; may include supportive treatment: emesis, gastric lavage, saline cathartics, vasopressors, or oxygen and IV fluids; do not use stimulants
Disease States: Other antihistamines, alcohol, CNS depressants
Administrative Notes: Appetite stimulant in children only
Cytarabine
Trade Name(s): Cytosar
Pregnancy Category: D
Medical Category: Antineoplastic
Accepted Indications: Leukemias, non-Hodgkin's lymphomas, Hodgkin's lymphomas, myelodysplastic syndrome
Mechanism of Action: Antimetabolite, immunosuppressant
Absorption/Distribution: Moderate amounts cross blood-brain barrier
Half life: Biphasic: 10–{endash}15 min and 1–{endash}3 h
Peak activity: 20–{endash}60 min (SQ)
Metabolism: Hepatic
Elimination: Renal
Adult Dosage: Maintenance dose: 1 mg/kg 1–{endash}2 times/w
Elderly Dosage: May require lower dose
Child Dosage: Same as adult dose
Infant Dosage: Safety and efficacy not established
Dosage Forms: Sterile injection: 100 mg, 500 mg, 1 g, and 2 g
Frequent Side Effects: Leukopenia, infection, stomatitis, thrombocytopenia, loss of appetite, nausea, vomiting
Occasional Side Effects: CNS toxicity, hyperuricemia, diarrhea, dizziness, headache, itching, freckling
Rare Side Effects: Thrombophlebitis, ARA-C syndrome (rash, bone and muscle pain, fever, weakness), GI hemorrhage, pulmonary edema, diffuse interstitial pneumonitis, urinary retention, hair loss, esophagitis, hepatotoxicity, megaloblastic anemia
Contraindications: Chickenpox, herpes zoster, infection
Disease States: Bone marrow depression, hepatic function impairment
Other Drugs: Probenecid, sulfinpyrazone, immunosuppressants, bone marrow suppressants, cyclophosphamide, live virus vaccines, methotrexate
Lab Tests: BUN, uric acid
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