-
Acetaminophen 300mg /Codeine 30mg
- Tylenol #3
- Narcotic analgesic
- 30-60mg codeine q4-6h (4g APAP/day)
- Significant respiratory depression, severe asthma, hypercapnia, paralytic ileus
- Hepatic
-
Acyclovir
- Zovirax
- Antiviral
- Shingles; PO: 800mg 5 times/day for 7-10 days, IV: 10 mg/kg/dose or 500 mg/m2/dose q8h for 7 days
- Renal
-
Albuterol Inhaler
- Proventil, Ventolin, ProAir HFA
- Beta2 agonist
- 2 puffs q4-6h prn
-
Alendronate
- Fosamax
- Bisphosphonate
- Prophylaxis: 5mg daily or 35mg weekly
- Treatment: 10mg daily or 70mgweekly
- Hypocalcemia, inability to sit or stand upright for 30 minutes, delayed esophageal emptying, risk for aspiration (oral soln)
-
Allopurinol
- Zyloprim
- Xanthine oxidase inhibitor
- 200-600 mg/day in divided doses (800mg/day)
- Renal
-
Alprazolam
- Xanax
- Benzodiazepine
- Anxiety:0.25-0.5 mg TID (4 mg/day)
- Narrow angle glaucoma, use with ketoconazole/itraconazole, pregnancy
-
Amiodarone
- Cordarone, Pacerone
- Class III antiarrhythmic
- PO: 200-1600mg/day in 1-2 divided doses
- IV: 150-300 mg infused over 10 minutes
- Severe sinus node dysfunction, 2nd/3rd degree heart block or bradycardia causing syncope (except in patient's with functional pacemaker), cardiogenic shock
- Hepatic
-
Amitriptyline
- Elavil
- TCA
- Oral: 50-150 mg/day single dose at bedtime or in divided doses; dose may be gradually
- increased up to 300 mg/day
- MAOI use within 14 days, acute recovery s/p MI, concurrent cisapride use
-
Amlodipine
- Norvasc
- CCB
- 2.5-10mg daily
- Hepatic
-
Amoxicillin
- Amoxil, Trimox
- Penicillin antibiotic
- 250-500mg q8h or 500-875mg q12h
-
Amoxicillin/Potassium Clavulanate
- Augmentin
- Penicillin antibiotic
- 250-500mg TID or 875mg BID
- History of cholestatic jaundice or hepatic dysfunction with past use, CrCl <30 mL/min, hemodialysis patients
- Renal
-
Ampicllin/Sulbactam
- Unasyn
- Pencillin antibiotic
- IM, IV: 1-2 g ampicillin (1.5-3 g Unasyn®) q6h
-
Anastrazole
- Arimidex
- Antineoplastic agent/Aromatase inhibitor
- 1mg daily
- Pregnancy or women who may become pregnant
-
Aripiprazole
- Abilify
- Atypical antipsychotic
- PO: 10-15mg daily (30mg/day)
-
Atenolol
- Tenormin
- Beta-blocker
- 25-100mg daily
- Sinus bradycardia, sinus node dysfunction, heart block greater than 1st degree (except in patients with functional pacemaker), cardiogenic shock, uncompensated heart failure, pulmonary edema, pregnancy
- Renal
-
Atomoxetine
- Strattera
- Norepinephrine reuptake inhibitor
- 40-80mg daily (100mg/day)
- Narrow angle glaucoma, MAOI use or use within 14 days
- Hepatic
-
Atorvastatin
- Lipitor
- HMG Co-A reductase inhibitor
- 10-80mg daily
- Acute liver disease, unexplained persistent serum transaminases elevation, pregnancy,
- breast-feeding
-
Azithromycin
- Zithromax
- Macrolide antibiotic
- Illness dependent;
- PO; CAP/SSTI/pertussis: 500mg on day 1 followed by 250mg daily x 4 days, Gonococcal infection: 1 g as a single dose;
- IV: CAP/PID: 500 mg daily
-
Benazepril
- Lotensin
- ACE-I
- 20-40mg daily
- History of angioedema
- Renal
-
Benazepril/Amlodipine
- Lotrel
- Combination antihypertensive (ACE-I and CCB)
- See individual agents
-
Bupropion XL
- Wellbutrin XL
- Antidepressant, Dopamine reuptake inhibitor
- Depression: 150mg daily (450mg/day) for HCl salt
- Seizure disorder, history of anorexia/bulimia, MAOI use within 14 days, patients undergoing abrupt d/c of ethanol/sedatives
- Hepatic and Renal
-
Buprenex
- Subutex
- Opioid for withdrawal
- Opioid dependence: 12-16mg/day
-
Buprenorphine/Naloxone
- Suboxone
- Opioid for withdrawal
- 4-24 mg daily (32 mg/day)
-
Candesartan
- Atacand
- ARB
- 4-32mg daily
- Severe hepatic impairment, cholestasis, pregnancy, breast-feeding
- Hepatic
-
Carisoprodol
- Soma
- Skeletal muscle relaxant
- 250-350 mg TID/HS
- Acute intermittent porphyia
-
Carvedilol
- Coreg, Coreg CR
- Beta blocker
- Immediate release: 3.125-50mg BID
- Extended release: 10-80mg once daily
- Decomponsated cardiac failure requiring IV inotropic therapy, bronchial asthma, 2nd or 3rd degree heart block or sick sinus syndrome (SSS) (except in patient's with functional pacemaker), cardiogenic shock, severe hepatic impairment
-
Cefazolin
- Ancef
- 1st generation cephalosporin
- IV: 250mg-2g q6-12h (12 gm/day)
- Renal
-
Cefdinir
- Omnicef
- 3rd generation cephalosporin
- 300mg BID x10d
-
Cefepime
- Maxipime
- 4th generation cephalsporin
- IV: 1-2gm q8-12h
- Renal
-
Cefixime
- Suprax
- 3rd generation cephalosporin
- PO: 400mg/day divided q12-24 h
- Renal
-
Cefotaxime
- Claforan
- 3rd generation cephalosporin
- IM, IV: 1-2 g q8-12h
- Renal
-
Cefoxitin
- Mefoxin
- 2nd generation cephalosporin
- IM, IV: 1-2 g q6-8h
- Renal
-
Ceftazidime
- Fortaz
- 3rd generation cephalosporin
- IM, IV: 500mg - 2 g q8-12h
- Renal
-
Ceftriaxone
- Rocephin
- 3rd generation cephalosporin
- IM, IV: 1-2 g q12-24h
- Hyperbilirubinemic neonates, concurrent use with IV calcium containing solutions in neonates
-
Cefuroxime
- Ceftin, Zinacef
- 2nd generation cephalosporin
- PO: 250-500mg BID
- IM, IV: 750mg-1.5g q8h
- Renal
-
Celecoxib
- Celebrex
- COX2 selective NSAID
- 200mg BID
- Perioperative pain in CABG
-
Cephalexin
- Keflex
- 1st generation cephalosporin
- 250-1000mg q6h (4g/day)
-
Ciprofloxacin
- Cipro
- Fluoroquinolone antibiotic
- PO: 250-500mg BID
- IV: 200-400 mg q12h
- Concurrent use of tizanidine
-
Citalopram
- Celexa
- SSRI
- Depression: 20-40 mg daily (40mg/day, 20 mg/day with CYP2C19 poor metabolizer, use of moderate or strong CYP2C19 inhibitors, patients 60 years old or older)
- MAOI use or use within 14 days, concurrent use with pimozide
- Hepatic
-
Clarithromycin
- Biaxin
- Macrolide antibiotic
- 250-500mg BID
- Use with ergot derviatives, pimozide, cisapride
-
Clindamycin
- Cleocin
- Lincosamide antibiotic
- PO: 150-450mg q6-8h (1.8 g/day)
- IM, IV: 1.2-2.7 g/day in 2-4 divided doses (4.8 g/day)
- Previous pseudomembranous colitis, regional enteritis, UC (topical/vaginal)
- Hepatic
-
Clonazepam
- Klonopin
- BZD
- Panic disorder: 0.25-2 mg BID (Max 4mg/day)
- Significant liver diease, narrow angle glaucoma, pregnancy
-
Clonidine
- Catapres
- Alpha2 adrenergic agonist
- PO: 0.05-0.4mg BID
- Transdermal Patch: 0.1-0.3mg once weekly (2.4mg/day)
-
Clopidogrel
- Plavix
- Antiplatelet agent
- Recent MI or stroke/PAD: 75mg daily
- Active pathological bleeding
-
Conjugated Estrogens
- Premarin
- Estrogen derivative
- 0.3-1.25mg daily
- Undiagnosed abnormal vaginal bleeding, history of or current thrombophlebitis/VTE, active or recent arterial thromboembolic disease, breast carcinoma (except in select patients treated for metastatic disease), estrogen dependent tumor, hepatic dysfunction, pregnancy
- Hepatic
-
Cyclobenzaprine
- Flexeril
- Skeletal muscle relaxant
- 5-10mg TID
- MAOI use or use with 14 days, hyperthyroidism, CHF, arrhythmias, heart block, acute recovery s/p MI
-
Cyclosporine,opthalmic
- Restasis
- Immunosuppressant agent
- 1 drop in both eyes q12h
- Active ocular infections
-
Dextroamphetamine/Amphetamine
- Adderall XR
- Stimulant
- 20 mg daily (60mg daily)
- Advanced arteriosclerosis, symptomatic CVD, moderate-severe HTN, hyperthyroidism, glaucoma, agitated states, history of drug abuse, MAOI use or use within 14 days
-
Diazepam
- Valium
- Benzodiazepine
- Anxiety; PO, IM, IV: 2-10mg BID-QID PRN
- Myasthenia gravis, severe respiratory insufficiency, severe hepatic insufficiency, sleep apnea, acute narrow angle glaucoma, use <6 months of age (PO)
- Hepatic and Renal
-
Diclofenac
- Voltaren, Flector (patch)
- NSAID
- PO: 50mg TID
- Patch: apply 1 patch twice daily to most painful area (sprain, strains, contusions)
- Hypersenstivity to bovine protein (capsule), perioperative pain in CABG
- Renal
-
Digoxin
- Lanoxin, Digitek
- Cardiac glycoside, class IV antiarrhythmic
- PO: 0.125-0.5mg daily
- Ventricular fibrillation
- Renal
-
Diltiazem
- Cardizem CD, Cartia XT, Dilt-CD (extended release capsules)
- CCB
- HTN; PO: 180-420mg daily (480mg/day)
- Afib; IV continuous infusion: 10mg/hr; may increase up to 15 mg/hr PRN
- SSS or 2nd or 3rd degree heart block ((except in patients with functional pacemaker), severe hypotension, acute MI (PO), acute pulmonary congestion (PO), cardiogenic shock (IV), ventricular tachycardia (IV), use with or within few hours of IV beta-blocker administration (IV), AFib/A flutter associated with accessory bypass tract (IV)
-
Donepezil
- Aricept
- Acetylcholinesterase inhibitor
- 5-10mg QHS
-
Doxycycline
- Vibramycin
- Tetracycline antibiotic
- 100-200 mg/day in 1-2 divided doses
-
Duloxetine
- Cymbalta
- SNRI
- Depression: 40-60mg daily (120mg/day)
- MAOI use and use within 14 days, do not start MAOI for 5 days after stopping duloxetine, narrow angle glaucoma
- Hepatic and Renal
-
Enalapril
- Vasotec
- ACE-I
- PO: 2.5-40mg daily;
- IV(enalaprilat): 1.25mg/dose over 5 minutes q6h up to 5mg/dose
- History of angioedema
-
Enoxaparin
- Lovenox
- Low molecular weight heparin
- Prophylaxis: 30 mg BID or 40 mg daily subcutaneously
- Treatment: 1mg/kg BID or 1.5mg/kg daily subcutaneously
- Thrombocytopenia with positive test for antiplatelet antibodies with enoxaparin use, hypersenstivity to pork products, active major bleeding
- Renal
-
Escitalopram
- Lexapro
- SSRI
- Depression: 10-20 mg daily (20 mg/day)
- Use with pimozide, MAOI use or use within 14 days
- Hepatic
-
Esomeprazole
- Nexium
- PPI
- PO, IV: 20-40mg daily
-
Eszopiclone
- Lunesta
- Hypnotic, non-BZD
- 2mg QHS (3mg)
-
Ezetimibe
- Zetia
- Antilipidemic agent
- 10mg daily
- Use with HMG-CoA reductase inhibitors in patients with active hepatic disease, unexplained persistent serum transaminases elevation, pregnancy, breast-feeding
-
Famotidine
- Pepcid
- H2 antagonist
- PO: 20-40mg daily-BID
- IV: 20mg q12h
- Renal
-
Fenofibrate
- Tricor
- Fibric acid
- antilipidemic 48-145mg daily (145 mg/day)
- Hepatic dysfunction, severe renal dysfunction, pre-exsisting gallbladder disease, breast-feeding (Fenoglide)
- Renal
-
Fexofenadine
- Allegra
- Antihistamine
- 60mg BID or 180mg daily
- Renal
-
Fluconazole
- Diflucan
- Antifungal
- PO, IV: 200-800mg daily; for yeast infection: 150mg x1 dose
- Use with cisapride and terfenadine
- Renal
-
Fluoxetine
- Prozac
- SSRI
- Depression: 20-40 daily (80 mg/day)
- Use with MAOI, pimozide, thioridazine (should stop MAOI 14 days before starting, do not start MAOI or thioridazine for 5 weeks after stopping)
- Hepatic
-
Fluticasone
- Flovent HFA, Flonase
- Inhaled corticosteroid
- Oral Inhalant: 88-220mcg BID (max 440 mcg BID)
- Intranasal: 2 sprays in each nostril once daily
- Primary treatment of status asthmaticus or acute bronchospasm, use with treatment site infection, skin atrophy, or treating rosacea/perioral dermatitis
- (topical)
-
Fluticasone and salmeterol
- Advair Diskus
- Inhalted corticosteroid and B2 agonist
- 1 puff BID of any dose (Fluticasone 500 mcg BID)
- Status asthmaticus, acute episodes of asthma/COPD, hypersenstivity to milk protein
- (Advair Diskus)
-
Folic Acid
- Folic Acid
- Water soluble vitamin
- 1mg daily
-
Furosemide
- Lasix
- Loop diuretic
- CHF; PO: initial 20-80 mg/dose,
- IV bolus: 20-40 mg over 1-2 minutes
- Anuria
-
Gabapentin
- Neurontin
- Anticonvulsant
- Anticonvulsant: 300-800mg TID (3600 mg)
- Renal
-
Gemfibrozil
- Lopid
- Fibric acid
- 600mg BID 30min before breakfast and dinner
- Hepatic dysfunction, severe renal dysfunction, pre-exsisting gallbladder disease, primary biliary cirrhosis, concurrent use with repaglinide
-
Gentamicin
- Gentamicin
- Aminoglycoside antibiotic
- Depend on condition; IV, IM: 1-2.5 mg/kg/dose q8-12h or 4-7 mg/kg/dose once daily
- Renal
-
Glimepiride
- Amaryl
- Sulfonylurea
- 1-4mg daily with breakfast (8 mg/day)
- DKA
- Renal
-
Glipizide, Glipizide ER
- Glucotrol, Glucotrol XL
- Sulfonylurea
- Initial: 5mg daily (IR: 40 mg/day, ER: 20 mg/day)
- Type I DM, DKA
- Hepatic and Renal
-
Glyburide
- Diabeta, Micronase
- Sulfonylurea
- 1.25-20 daily (20 mg/day)
- Type I DM, DKA, concurrent use with bosentan
- Renal
-
Heparin
- Heparin
- Anticoagulant
- Thromboembolism prophylaxis: 5000 units q8-12 subcutaneously
- Treatment of thromboembolism: 80 units/kg BID IV push followed by continuous infusion of 18 units/kg/hour
- Severe thrombocytopenia, uncontrolled active bleeding except due to DIC, inability to obtained blood coagulation testing (treatment doses)
-
Hydrochlorothiazide
- Hydrodiuril
- Thiazide diuretic
- Edema: 25-100mg daily
- HTN: 12.5-50mg daily (max 200 mg/day)
- Anuria, renal decompensation, pregnancy
- Renal
-
Hydrocodone/Acetaminophen
- Vicodin; Norco (contains 325mg APAP); Lortab (contains 500mg APAP)
- Narcotic analgesic
- 1-2 tabs q4-6h prn (APAP: 3 g/day)
- CNS depression, severe respiratory depression
- Hepatic
-
Hydromorphone
- Diladud
- Narcotic analgesic
- Opiate naïve; IV: 0.2-1 mg q2-3h PRN
- Severe or acute asthma, severe respiratory depression without ventilatory support, severe CNS depression
- Hepatic and Renal
-
Ibandronate
- Boniva
- Bisphosphonate
- PO: 150mg once monthly
- IV: 3mg every 3 months
- Hypocalcemia, inability to sit or stand upright for 60 minutes, delayed esophageal emptying
- Renal
-
Ibuprofen
- Motrin, Advil
- NSAID
- Rx: 400-800mg TID-QID (3200 mg/day), OTC: 200-400 mg q4-6h (1200 mg/day)
- Perioperative pain in CABG
-
Imipenem/Cilastatin
- Primaxin Carbapenem
- antibiotic
- IV: 250-1000mg q6-8h (4g/day)
- IM: 500-750 mg q12h (1500 mg/day)
- Severe shock or heart block (IM formulation with lidocaine)
- Hepatic and Renal
-
Insulin Aspart
- NovoLog
- Insulin
- Use during hypoglycemia
-
-
-
Insulin Glulisine
- Apidra
- Insulin
- Use during hypoglycemia
-
Insulin Lispro
- Humalog
- Insulin
- Use during hypoglycemia
-
Ipratropium
- Atrovent
- Anticholinergic
- 2 inhalations QID (12 inhalations/day)
-
Ipratropium and albuterol
- Combivent
- Bronchodilator (anticholinergic and B2 agonist)
- 2 inhalations QID (12 inhalations/day)
-
-
Irbesartan/HCTZ
- Avalide
- Combination antihypertensive (ARB and thiazide diuretic)
- Initial dose: 150/12.5mg (max 300/25mg)
- See individual agents
- See individual agents
-
Isosorbide Mononitrate
- Imdur
- Nitrate, vasodilator
- 30-60mg QAM (240 mg/day)
- Concurrent use with PDE-5 inhibitors, angle closure glaucoma, head trauma or cerebral hemorrhage, severe anemia
-
Ketoralac
- Toradol
- NSAID
- IV: 30 mg as a single dose or 30 mg q6h (120 mg)
- Active or history of peptic ulcer disease, recent or history of GI bleeding or perforation, patients with advanced renal disease or risk of renal failure, prophylaxis before major surgery, suspected or confirmed cerebrovascular bleeding, hemorrhagic diathesis, incomplete hemostasis, high risk of bleeding, concurrent ASA or other NSAID use, perioperative pain in the setting of CABG, labor and delivery, breast-feeding
- Renal
-
Lamotrigine
- Lamictal
- Anticonvulsant
- 225-375 mg/day in 2 divided doses
-
Lansoprazole
- Prevacid
- PPI
- 15-30mg daily
-
Latanoprost
- Xalatan
- Antiglaucoma
- 1 drop daily in the affected eye(s)
-
Levetiracetam
- Keppra
- Anticonvulsant
- Initial dose; PO: immediate release: 500mg BID, extended release: 1000mg daily,
- IV: 500 mg BID
- Renal
-
Levofloxacin
- Levaquin
- Fluoroquinolone antibiotic
- PO, IV: 250-750mg daily
- Renal
-
Levothyroxine
- Synthroid, Levoxyl, Levothroid
- Thyroid product
- PO: 1 tablet daily 30 min before breakfast (dosage will vary),
- IV: 50% of oral dose
- Acute MI, thyrotoxicosis of any etiology, uncorrected adrenal insufficiency
-
Lisdexamfetamine
- Vyvanse
- Stimulant
- 30 mg daily (70 mg/day)
- Advanced arteriosclerosis, symptomatic CVD, moderate-severe HTN, hyperthyroidism, glaucoma, agitated states, history of drug abuse, MAOI use or use within 14days
-
Lisinopril
- Zestril, Prinivil
- ACE-I
- HTN: 10-40mg daily,
- CHF: 20-40mg daily
- History of angioedema
- Renal
-
Lisinopril/Hydrochlorothiazide
- Prinzide, Zestoretic
- ACE-I/Thiazide diuretic
- Lisinopril; HTN: 10-40mg daily, CHF: 20-40mg daily;
- HCTZ; Edema: 25-100mg daily HTN: 12.5-50mg daily (max 200 mg/day)
-
Lorazepam
- Ativan
- Benzodiazepine
- Anxiety; PO: 2-6mg in divided doses (10 mg/day)
- Acute narrowangle glaucome, sleep apnea (parenteral), severe respiratory insufficiency (except with mechanical ventilation)
-
Losartan
- Cozaar
- ARB
- 25-100mg daily (100 mg/day)
-
Losartan/HCTZ
- Hyzaar
- Combination antihypertensive (ARB and thiazide diuretic)
- 1 tablet daily
-
Lovastatin
- Mevacor, Altoprev
- HMG Co-A reductase inhibitor
- 20 mg daily (IR: 80 mg/day)
- Active liver diease, unexplained persitent serum transaminase elevation,concurrent use of strong CYP3A4 inhibitors, pregnancy, breast-feeding
- Renal
-
Meclizine
- Antivert
- Antihistamine
- 25-100mg/day in divided doses
-
Meloxicam
- Mobic
- NSAID
- 7.5-15mg daily (15 mg/day)
- Perioperative pain in CABG
-
Memantine
- Namenda
- NMDA Rc antagonist
- Initial: 5mg daily, then titrate up to 20mg daily
- Renal
-
Meropenem
- Merrem
- antibiotics-carbapenem
- 1.5-6 g/day divided q8h (6g/day)
- Hepatic and Renal
-
Metformin,
Metformin ER
- Glucophage, Glucophage XR
- Biguanide
- IR: 500-1000mg BID with meals (2250 mg/day), XR: 500-1000 mg daily with the evening meal (2000 mg/day)
- Do not use if sCr >1.5mg/dL in males or >1.4mg/dL in females, acute or chronic metabolic acidosis, abnormal creatinine clearance
- Hepatic and Renal
-
Methotrexate
- Rheumatrex
- DMARD, antifolate
- Arthritis; PO: 7.5mg weekly (Arthritis: 20 mg/week)
- Breast-feeding; in patients with RA or psoriasis: pregnancy, alcoholism, alcoholic liver disease or chronic liver disease, pre-exsisting blood dyscrasias, immunodeficiency syndrome
- Hepatic and Renal
-
Methylphenidate
- Concerta
- CNS stimulant
- 18-54mg QAM (6-12 years: 2 mg/kg/day or 54 mg/day, 13-17 years: 72 mg/day)
- Marked anxiety, tension, agitation, glaucoma, MAOI use or use within 14 days, family history or diagnosis of Tourette's syndrome
-
Methylprednisolone
- Medrol
- Corticosteroid
- Allergic conditions; PO: Tapered dose using 4mg tablets
- Systemic fungal infection, administration of live virus vaccines, formulations with benzyl alcohol in infants, IM use in TTP
-
Metoclopramide
- Reglan
- Prokinetic, antiemetic
- PO: 10-15mg/dose QID
- IV: 10-20mg over 1-2 minutes
- GI obstruction, perforation, or hemorrhage, pheochromocytoma, history of seizures or concurrent use of other agents likely to increase extrapyramidial symptoms
- Renal
-
Metolazone
- Zaroxolyn
- Thiazide-like diuretic
- 2.5-20mg daily
- Anuria, hepatic coma, pregnancy
-
Metoprolol
Succinate
- Toprol XL
- Beta blocker
- HTN: 25-100mg daily (400 mg/day)
- Severe bradycardia, 2nd or 3rd degree heart block or SSS (except in patients with functional pacemaker), cardiogenic shock, decompensated heart failure,
-
Metoprolol
Tartrate
- Lopressor
- Beta blocker
- 25-100mg BID (450 mg/day)
- In MI: severe sinus bradycardia, significant 1st degree heart block, 2nd or 3rd degree heart block, SBP <100 mmHg, moderate-severe CHF. In HTN or angina: sinus bradycardia, 2nd or 3rd degree heart block or SSS (except in patients with functional pacemaker), cardiogenic shock, severe PAD, pheochromocytoma (with alpha blockade)
-
Metronidazole
- Flagyl
- Miscellaneous antibiotic
- Depends upon use, Anaerobic infections; PO, IV: 500 mg q6-8h (max 4 grams/day)
- Pregnancy (1st trimester)
- Hepatic and Renal
-
Midazolam
- Versed
- Benzodiazepine
- Depends on use; Pre-op sedation; IV: 0.02-0.04 mg/kg
- Narrow angle glaucoma, concurrent use with potent inhibitors of CYP3A4, pregnancy
-
Minocycline
- Minocin, Dynacin
- Tetracycline antibiotic
- 100mg BID (400 mg/day)
- Renal
-
Mirtazapine
- Remeron
- Antidepressant, Alpha2 antagonist
- 15-45mg daily
- MAOI use within 14 days
- Renal
-
Montelukast
- Singulair
- Leukotriene receptor antagonist
- 10mg daily
-
Morphine
- Duramorph
- Narcotic analgesic
- Opiate naïve; IV: 2.5-5 mg q3-4h
- Severe or acute asthma, severe respiratory depression without ventilatory support, known or suspected paralytic ileus, during labor if premature birth is anticipated, general CNS depression
- Renal
-
Moxifloxacin
- Avelox
- Fluoroquinolone antibiotic
- PO, IV: 400mg daily
-
Nabumetone
- Relafen
- NSAID
- 1000mg/day in 1-2 divided doses (max 2000 mg/day)
- Perioperative pain in CABG
- Renal
-
Naproxen
- Naprosyn
- NSAID
- 250-500mg BID (1250 mg/day)
- Perioperative pain in CABG
-
Niacin
- Niaspan
- Antilipidemic, water soluble vitamin
- 500-1000mg QHS (2 g/day)
- Active hepatic disease, significant or unexplained persistnet serum transaminase elevation, active peptic ulcer, arterial hemorrhage
-
Nifedipine
ER
- Procardia XL
- CCB
- 30-60mg daily (120-180 mg/day)
- Use with strong CYP3A4 inducers, cardiogenic shock
- Hepatic
-
Nitrofurantoin
- Macrodantin, Macrobid
- Miscellaneous antibiotic
- Macrodantin: 50-100mg q6h (400 mg/day)
- Macrobid: 100mg BID
- Significant renal impairment, use <1 month of age, pregnancy at term or during labor or delivery, history of cholestatic jaudice or hepatic impairment with previous therapy
- Renal
-
Nitroglycerin
- Nitroquick, Nitro-Dur, Nitro-stat
- Vasodilator
- PO: 2.5-9mg BID to QID
- IV: 5mcg/min-400mcg/min
- Patch: 0.2-0.4mg/hr
- Oint: 1/2" q6h
- Sublingual: 0.2-0.6mg q5min
- Translingual: 1-2 sprays q3-5min (3 doses/15 min)
- Concurrent use with PDE-5 inhibitors, increased ICP, severe anemia
-
Nortriptyline
- Pamelor
- TCA
- Depression: 25mg TID-QID (150mg/day)
- MAOI use within 14 days, use during recovery s/p MI
- Hepatic
-
Olanzapine
- Zyprexa
- Atypical antipsychotic
- 5-20mg daily (30mg/day)
-
Olmesartan
- Benicar
- ARB
- 20-40mg daily
-
Olmesartan/hydrochlorothiazide
- Benicar HCT
- ARB/Thiazide diuretic
- Olmesartan: 20-40mg daily
- HCTZ:Edema: 25-100mg daily
- HTN: 12.5-50mg daily (200 mg/day)
-
Omega-3-acid
ethyl esters
- Lovaza
- Miscellaneous antilipemic agent
- 4g/day
-
Omeprazole
- Prilosec
- PPI
- 20-40mg daily
-
Ondansetron
- Zofran
- Antiemetic
- IV: 8-16 mg/day
- Concomitant use of apomorphine
- Hepatic
-
Oseltamivir
- Tamiflu
- Antiviral
- 75 mg daily- 75 mg BID
- Renal
-
Oxcarbazepine
- Trileptal
- Anticonvulsant
- Initial: 300mg BID; titrate based on prior therapy
- Renal
-
Oxycodone
- OxyContin
- Narcotic analgesic
- 10-40mg BID (Use caution >160mg BID)
- Significant respiratory depression, hypercarbia, severe asthma, paralytic ileus
- Hepatic
-
Oxycodone/APAP
- Endocet, Percocet, Tylox
- Narcotic analgesic
- Oxycodone: 5-30mg q4-6h prn (APAP: 4g/day)
- Severe respiratory depression, pregnancy
- Hepatic
-
Pantoprazole
- Protonix
- PPI
- PO, IV: 40mg daily (240mg daily)
-
Paroxetine,
Paroxetine CR
- Paxil, Paxil CR
- SSRI
- Depression; IR: 20mg daily (50 mg/day), CR: 25 mg daily (62.5 mg/day) (max 60mg/day)
- MAOI use with or within 14 days, use with thioridazine or pimozide or reversible MAOI inhibitors (linezolid, methylene blue)
- Hepatic and Renal
-
Penicillin
VK
- Veetids
- Penicillin antibiotic
- Children: 25-50mg/kg/day
- Adults: 125-500mg q6-8h (3g per day in children <12 years old)
- Renal
-
Phenytoin
- Dilantin
- Anticonvulsant
- Anticonvulsant; PO: usual maintenance dose: 300-600mg/day
- Pregnancy
- Hepatic
-
Pioglitazone
- Actos
- Thiazolidinedione
- 15-45mg daily (45mg/day)
- Class III/IV heart failure
- Hepatic
-
Piperacillin/Tazobactam
- Zosyn
- Penicillin antibiotic
- IV: 3.375 gm q6h or 4.5gm q6-8h (18 gm/day)
- Renal
-
Polyethylene
glycol
- MiraLax, GlycoLax
- Osmotic laxative
- 17g daily
-
Potassium
Chloride
- K-Dur, Klor-Con, Micro K
- Electrolyte supplement
- 40-80mEq/day (400mEq/day)
- Hyperkalemia, delay/arrest in GI passage (solid PO formulation)
-
Pravastatin
- Pravachol
- HMG-CoA reductase inhibitor
- 10-80mg daily (80mg/day)
- Active liver diease, unexplained persitent serum transaminase elevation, pregnancy, breast-feeding
- Hepatic and Renal
-
Prednisone
- Deltasone
- Corticosteroid
- Depends on condition: 5-60 mg daily
- Systemic fungal infection, administration of live virus vaccines with immunosuppressive doses
- Hepatic
-
Pregabalin
- Lyrica
- Anticonvulsant;Analgesic
- variable
- Renal
-
Promethazine
- Phenergan
- Antihistamine, antiemetic
- PO, IV: 12.5-25 mg q4-6h PRN
- Coma, treatment of lower respiratory tract symptoms, use <2 years of age
-
Propofol
- Diprivan
- general anesthetic
- variable
- Hypersenstivity to eggs, soybeans, soy products
-
Propranolol
- Inderal
- Beta blocker
- PO: 40-320mg/day
- IV: 1-3mg bolus (640mg/day)
- Uncompensated CHF (except if due to tachyarrhythmias treated with propranolol), cardiogenic shock, severe bradycardia, heart block greater than 1st degree (except in patients with function pacemaker), severe asthma or COPD
- Hepatic
-
Quetiapine
- Seroquel
- Atypical anti-psychotic
- 150-400mg BID (800mg/day)
-
Quinapril
- Accupril
- ACE-I
- 10-40mg daily
- History of angioedema
- Renal
-
-
Raloxifene
- Evista
- SERM
- 60mg daily
- History of or current VTE, pregnancy or women who could become pregnant, breast-feeding
-
Ramelteon
- Rozerem
- Hypnotic, non-BDZ
- 8 mg PO within 30 minutes of bedtime
- Concurrent use with fluvoxamine, history of angioedema with previous therapy
-
Ramipril
- Altace
- ACE-I
- 2.5-5mg daily (20mg/day)
- History of angioedema
- Hepatic and Renal
-
Ranitidine
- Zantac
- H2 antagonist
- PO: 150mg BID
- IV: 50mg q6-8h(600mg/day)
- Renal
-
Risedronate
- Actonel
- Bisphosphonate
- 5mg daily or 35mg weekly
- Hypocalcemia, inability to sit or stand for 30 minute, delayed esophageal emptying
- Renal
-
Risperidone
- Risperdal
- Atypical antipsychotic
- 1-4mg BID (16mg/day)
- Hepatic and Renal
-
Ropinirole
- Requip
- Dopamine agoinst
- Parkinsons: 0.25mg-1mg TID
- Restless leg syndrome: 0.25mg-4mg QHS
- Reduced clearance in the elderly
-
Rosuvastatin
- Crestor
- HMG-CoA reductase inhibitor
- 5-40mg daily (40mg/day)
- Active liver diease, unexplained persistent serum transaminase elevation, pregnancy, breast-feeding
- Renal
-
Sertraline
- Zoloft
- SSRI
- Depression: 50-100 mg/day (200 mg /day)
- MAOI use within 14 days, use with pimozide, use of oral concentrate with disulfiram
- Hepatic
-
Sildenafil
- Viagra, Revatio
- PDE-5 inhibitor
- ED: 25-100mg 1 hr prior to sexual activity
- Pulmonary HTN: 20mg TID (4-6hr apart)
- Concurrent use of organic nitrates, concurrent use with protease inhibitor regimen when used for pulmonary HTN
- Hepatic and Renal
-
Simvastatin
- Zocor
- HMG-CoA reductase inhibitor
- 5-40mg QHS (80mg/day if on this dose >12 months without myopathy and use of any dose-limiting or contraindicated interacting medication, also avoid in Chinese patients on niacin 1g/day or higher, otherwise 40 mg daily)
- Active liver disease, unexplained persistent serum transaminases elevation, concurrent use of CYP3A4 inhibitors, cyclosporine, danazol, or gemfibrozil, pregnancy,
- breast-feeding
-
Simvastatin/Ezetimibe
- Vytorin
- HMG-CoA reductase inhibitor/antilipidemic agent
- Simvastatin: 10-40 mg QHS (see simvastatin) Ezetimibe: 10mg QD
-
Sitagliptin
- Januvia
- DPP IV inhibitor
- 100mg daily
- Renal
-
Spironolactone
- Aldactone
- K+ sparing diuretic
- 25-200mg daily depending upon use
- Anuria, acute renal insufficiency, hyperkalemia
- Renal
-
Sulfamethoxazole
800mg / Trimethoprim 160mg
- Bactrim DS, Septra DS
- Sulfonamide antibiotic
- 1-2 tabs daily-BID
- Megablastic anemia due to folate deficiency, use <2 months of age, marked hepatic damage or severe renal disease, pregnancy (at term), breast-feeding
- Renal
-
Sumatriptan
- Imitrex
- Seratonin Rc agonist
- PO: 25-100mg as a single dose. May repeat dose in 2 hours. (200mg/day)
- Patients with IHD or signs of IHD, cerebrovascular syndromes, PVD, uncontrolled HTN, use within 24 hours of ergotamine derviatives, use within 24 hours of another 5-HT1 agonist, MAOI use with or within 14 days, management of hemiplegic or basilar migraine, severe hepatic impairment (PO, nasal, injectable)
- Hepatic
-
Tadalafil
- Cialis
- Phosphodiesterase-5 enzyme inhibitor
- ED: 10 mg at least 30 minutes prior to sexual activity
- Concurrent use with organic nitrates
- Hepatic and Renal
-
Tamsulosin
- Flomax
- Alpha1 antogonist
- 0.4-0.8mg daily
- ½ hour after the same meal each day
-
Temazepam
- Restoril
- Benzodiazepine
- 15-30mg QHS
- Narrow angle glaucoma, pregnancy
-
Terazosin
- Hytrin
- Alpha1 antagonist
- 1-20mg daily (20mg/day)
-
Tiotropium
- Spiriva
- Anticholinergic agent
- 1 capsule daily (18 mcg)
- Renal
-
Tobramycin
- Tobramycin
- Aminoglycoside antibiotic
- Depend on condition: IV, IM: 1-2.5 mg/kg/dose q8-12h or 4-7 mg/kg/dose once daily
- Pregnancy
- Renal
-
Tolterodine
- Detrol LA
- Anticholinergic, overactive bladder
- 2-4mg daily
- Urinary retention, gastric retention, uncontrolled narrow angle glaucoma
- Hepatic and Renal
-
Topiramate
- Topamax
- Anticonvulsant
- 25-200mg BID (1600mg/day)
- Hepatic and Renal
-
Torsemide
- Demadex
- Loop diuretic
- CHF; PO: 10-20 mg daily (200 mg), IV: 10-20 mg initial dose (100-200 mg single dose)
- Anuria
-
Tramadol
- Ultram
- Analgesic
- 50-100mg q4-6h (400mg/day)
- Opioid dependent patients, acute intoxication with alcohol, hypnotics, centrally acting analgesics, opioids, or psychotropic drugs
- Hepatic and Renal
-
Tramadol/APAP
- Ultracet
- Analgesic
- 2 tabs q4-6h prn (APAP: 4g/day)
- See tramadol
- Hepatic and Renal
-
Trazodone
- Deseryl
- Serotonin Reuptake Inhibitor/Antagonist
- Insomnia: 25 mg-200 mg qHS
-
Triamterene/HCTZ
- Maxzide, Dyazide
- K+ sparing diuretic/ thiazide diuretic
- 37.5/25mg daily-BID (300mg triamterene/200mg HCTZ)
- Anuria, acute renal insufficiency, chronic renal insufficiency, patients on other potassium sparing diuretics, potassium substitutes, or supplements, hyperkalemia
- Renal
-
Valacyclovir
- Valtrex
- Antiviral agent
- 500-1000mg BID
- Renal
-
Valproic
acid
- Depakote
- Anticonvulsant
- Seizures: 10-15 mg/kg/day (60 mg/kg/day)
- Hepatic disease or impairment, urea cycle disorders
- Hepatic and Renal
-
Valsartan
- Diovan
- ARB
- 80-160mg daily (320mg/day)
- Hepatic
-
Vancomycin
- Vancocin
- Antibiotic, misc.
- IV: 2-3 g/day in divided doses Q 6-12 hrs
- PO: 500-1000 mg/day in divided doses Q 6 hours (3 g/day)
- Renal
-
Varenicline
- Chantix
- Smoking cessation aid
- Days 1-3: 0.5 mg daily
- Days 4-7: 0.5 mg twice daily
- Maintenance (week 2-12): 1 mg twice daily
- Renal
-
Venlafaxine
- Effexor XR
- SNRI
- Depression: 37.5-75mg daily with food (225mg/day)
- MAOI use within 14 days or initiation of MAOI within 7 days of stopping venlafaxine
- Hepatic and Renal
-
Verapamil
SR
- Calan SR
- CCB and class IV anti-arrhythmic
- PO: 120-360mg/day in 1-2 divided doses
- IV: 2.5-5mg over 2 minutes
- Severe left ventricular dysfunction, hypotension, cardiogenic shock, SSS or 2nd or 3rd degree heart block (except in patient's with a functional pacemaker), Afib/ A flutter with accessaory bypass tract, ventricular tachycardia (IV), concurrent use with IV beta-blockers (IV)
-
Vitamin
D2
- Drisdol
- Vitamin D analog
- Osteoporosis
- prevention: 800-1000 units/day
- Hypercalcemia, malabsorption syndrome, hypervitaminosis D or abnormal senstivity to toxic effects of vitamin D
-
Warfarin
- Coumadin
- Anticoagulant
- 2-10mg daily
- Hemorrhagic tendencies, recent or potential surgery of the eye or CNS, major regional lumbar block anesthesia or surgery resulting in large, open surfaces, blood dyscraias, severe uncontrolled HTN, pericarditis or pericardial effusion, bacterial endocarditis, noncompliant or unsupervised patient, eclampsia/pre-eclsmpsia, threatened abortion, pregnancy
-
Ziprasidone
- Geodon
- Atypical antipsychotic
- 20-40mg BID with food. (80-100mg BID depending on indication)
- History or current prolonged QT, congential long QT syndrome, recent MI, uncompensated CHF, concurrent use with other QT-prolonging agents
-
Zolpidem
- Ambien, Ambien CR
- Hypnotic, non-BZD
- Ambien: 5-10mg qHS (10mg/day)
- Ambien CR: 6.25-12.5mg qHS
- Hepatic
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