Patient Info

RABEPRAZOLE

RABEPRAZOLE
(AcipHex®)

DOSING: ADULTS

GERD, erosive/ulcerative: 20 mg once daily for 4-8 weeks; if inadequate response, may repeat up to an additional 8 weeks; maintenance: 20 mg once daily

GERD, symptomatic: 20 mg once daily for 4 weeks; if inadequate response, may repeat for an additional 4 weeks

Duodenal ulcer: 20 mg/day before breakfast for 4 weeks; additional therapy may be required for some patients
H. pylori eradication: 20 mg twice daily for 7 days; to be administered with amoxicillin 1000 mg and clarithromycin 500 mg, also given twice daily for 7 days.

DOSING IN  RENAL IMPAIRMENT — No dosage adjustment required.

DOSING IN  HEPATIC IMPAIRMENT

Mild to moderate: Elimination decreased; no dosage adjustment required.
Severe: Use caution.

DOSAGE FORMS

Tablet, delayed release, enteric coated, as sodium:
AcipHex®: 20 mg


ADMINISTRATION
 — May be administered with or without food; best if taken before breakfast. Do not crush, split, or chew tablet. May be administered with an antacid.

SIGNIFICANT  ADVERSE REACTIONS

Headache
Diarrhea
Abdominal pain

CONTRAINDICATIONS — Hypersensitivity to rabeprazole, substituted benzimidazoles (ie, esomeprazole, lansoprazole, omeprazole, pantoprazole), or any component of the formulation

DRUG INTERACTIONS

Antifungal agents : Proton pump inhibitors may decrease the absorption and thus the levels/effects of itraconazole and ketoconazole; avoid concomitant use.
Antiretroviral: Proton pump inhibitors may decrease the absorption of atazanavir and Indinavir.
CYP2C8 Substrates: Rabeprazole may increase the levels/effects of CYP2C8 substrates. Example substrates include amiodarone, paclitaxel, pioglitazone, repaglinide, and rosiglitazone.
CYP2C19 inducers: May decrease the levels/effects of rabeprazole. Example inducers include aminoglutethimide, carbamazepine, phenytoin, and rifampin.
CYP2C19 substrates: Rabeprazole may increase the levels/effects of CYP2C19 substrates. Example substrates include citalopram, diazepam, methsuximide, phenytoin, propranolol, and sertraline.
CYP3A4 inducers: CYP3A4 inducers may decrease the levels/effects of rabeprazole. Example inducers include aminoglutethimide, carbamazepine, nafcillin, nevirapine, phenobarbital, phenytoin, and rifamycins.
HMG-CoA reductase inhibitors: Proton pump inhibitors may increase the serum concentration of HMG-CoA reductase inhibitors; monitor for rhabdomyolysis.
Iron salts : Proton pump inhibitors may decrease the absorption
Methotrexate: Proton pump inhibitors may decrease the excretion of methotrexate; monitor for increased toxic effects

PREGNANCY RISK FACTOR — B

LACTATION — Excretion in breast milk unknown/not recommended.

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PREGNANCY RISK CLASSIFICATION OF DRUGS

A   Controlled studies show no risk
Adequate, well-controlled studies in pregnant women have failed to demonstrate risk to the fetus
B No evidence of risk in humans
Either animal findings show risk (but human findings do not) or, if no adequate human studies have been done, animal findings are negative.
C Risk cannot be ruled out
Human studies are lacking and animal studies are either positive for fetal risk or lacking as well. However, potential benefits may justify the potential risk.
D Positive evidence of risk
Investigational or postmarketing data show risk to fetus. Nevertheless, potential benefits may outweigh the risk.
X Contraindicated in pregnancy
Studies in animals or humans, or investigational or postmarketing reports have shown fetal risk which clearly outweighs any possible benefit to the patient. Stay up to date with 247 ASAP locksmith.
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PREDNISONE

PredniSONE Intensol; Sterapred DS; Sterapred

DOSING IN  ADULTS 

Generally 0.5  mg/kg/day in 2-3 divided doses FOR SHORT PERIODS in Inflammatory bowel Disease

Administer with meals to decrease gastrointestinal upset


DOSAGE FORMS
 

Tablet: 1 mg, 2.5 mg, 5 mg, 10 mg, 20 mg, 50 mg
  

SIGNIFICANT
ADVERSE REACTIONS

Weight gain
Increased appetite
Headache
Hirsutism
Diabetes mellitus
Arthralgia
Cataracts
Glaucoma
Cushing’s syndrome
Edema
Fractures
Hallucinations
Hypertension
Muscle-wasting

Prolonged use of corticosteroids may also increase the incidence of secondary infection and  mask acute infection (including fungal infections
In patients receiving high doses of systemic corticosteroids for ≥14 days, wait at least 1 month between discontinuing steroid therapy and administering dead organism vaccines.
The use of live vaccines is contraindicated in immunosuppressed patients.


CONTRAINDICATIONS
 — Hypersensitivity to prednisone or any component of the formulation; serious infections; systemic fungal infections; varicella

DRUG INTERACTIONS 

Amphotericin: Corticosteroids may increase the hypokalemic effects of amphotericin B; monitor.
Antacids: May decrease the absorption of corticosteroids; separate administration by 2 hours.
Anticholinesterases: Concurrent use may lead to severe weakness in patients with myasthenia gravis.
Antidiabetic agents: Corticosteroids may decrease the hypoglycemic effects of antidiabetic agents; monitor.
Antifungal agents (azole): May increase the serum levels/effects of corticosteroids; monitor.
Barbiturates: May decrease the levels/effects of corticosteroids.
Bile acid sequestrants: May reduce the absorption of corticosteroids; separate administration by 2 hours.
Calcium channel blockers (nondihydropyridine): May increase the serum levels/effects of corticosteroids; monitor.
Cyclosporine: Corticosteroids may increase the serum levels/effects of cyclosporine. In addition, cyclosporine may increase levels of corticosteroids.
Diuretics, potassium-wasting (loop or thiazide): Hypokalemic effects may be increased by corticosteroids; monitor.
Estrogens: May increase the serum levels/effects of corticosteroids; monitor.
Fluoroquinolones: Concurrent use may increase the risk of tendinopathies (including tendonitis and rupture), particularly in elderly patients (overall incidence rare)
Isoniazid: Serum levels/effects may be decreased by corticosteroids.
Macrolide antibiotics: May increase the serum levels/effects of corticosteroids.
Neuromuscular-blocking agents: Concurrent use with corticosteroids may increase the risk of myopathy.
Nonsteroidal anti-inflammatory drugs (NSAIDs): Concurrent use with corticosteroids may lead to an increased incidence of gastrointestinal adverse effects; use caution.
Rifamycin derivatives: May decrease the levels/effects of corticosteroids (systemic); monitor.
Salicylates: Salicylates may increase the gastrointestinal adverse effects of corticosteroids.
Warfarin: Corticosteroids may increase the anticoagulant effects of warfarin; monitor INR.

PREGNANCY IMPLICATIONS — Crosses the placenta. Available evidence suggests safe use during pregnancy.

LACTATION — Enters breast milk/compatible.

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POLYETHYLENE GLYCOL 3350

GlycoLax; MiraLax

DOSING IN  ADULTS

Occasional constipation-17 g of powder (~1 heaping tablespoon) dissolved in 8 oz of water, once daily; do not use for >2 weeks. Use for 2-4 days may be required to produce bowel movement.


DOSAGE FORMS
 

Powder, for oral solution: PEG 3350 17 g/packet (12s); PEG 3350 255 g (14 oz); PEG 3350 527 g (26 oz)
GlycoLax: PEG 3350 17 g/packet (14s); PEG 3350 255 g (16 oz); PEG 3350 527 g (24 oz)
MiraLax: PEG 3350 17 g/packet (12s) [DSC]; PEG 3350 255 g (14 oz); PEG 3350 527 g (26 oz)

SIGNIFICANT ADVERSE REACTIONS
Abdominal bloating
Cramping
Diarrhea
Flatulence

CONTRAINDICATIONS — Hypersensitivity to polyethylene glycol or any component of the formulation; gastrointestinal obstruction

PREGNANCY RISK FACTOR — C

LACTATION — Excretion in breast milk unknown/use caution.

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PANTOPRAZOLE

PANTOPRAZOLE
(Protonix®)

DOSING IN ADULTS

Erosive esophagitis associated with GERD
    Treatment: 40 mg once daily for up to 8 weeks; an additional 8 weeks may be used in patients who have not healed after an 8-week course
    Maintenance of healing: 40 mg once daily


DOSING IN RENAL IMPAIRMENT
 

No adjustment is required. Pantoprazole is not removed by hemodialysis.

DOSING IN HEPATIC IMPAIRMENT 

No adjustment is required.

DOSAGE FORMS 

Tablet, delayed release, as sodium: 20 mg, 40 mg
  Protonix®: 20 mg, 40 mg
Granules for suspension, delayed release, enteric coated, as sodium, oral:
  Protonix®: 40 mg/packet (30s)


ADMINISTRATION

  Tablet: Should be swallowed whole, do not crush or chew. Best if taken before breakfast.
  Delayed-release oral suspension: Should only be administered in apple juice or applesauce and taken ~30 minutes before a meal. Do not administer with any other liquid (eg, water) or foods.
    Oral administration in applesauce: Sprinkle intact granules on 1 tablespoon of applesauce and swallow within 10 minutes of preparation.
    Oral administration in apple juice: Empty intact granules into 5 mL of apple juice (~1 teaspoonful), stir for 5 seconds, and swallow immediately after preparation. Rinse container once or twice with apple juice and swallow immediately.

SIGNIFICANT  ADVERSE REACTIONS
Abdominal pain
Diarrhea
Headache
Insomnia
Rash


CONTRAINDICATIONS
 — Hypersensitivity to pantoprazole, substituted benzamidazoles (eg, esomeprazole, lansoprazole, omeprazole, rabeprazole), or any component of the formulation

DRUG INTERACTIONS 

Antifungal agents (azole derivatives, systemic): Proton pump inhibitors may decrease the absorption of antifungal agents (azole derivatives, systemic).
Antiretrovirals: Proton pump inhibitors may decrease the absorption of atazanavir and Indinavir. Concurrent use is not recommended. Proton pump inhibitors may increase saquinavir concentrations.
Clopidogrel: Proton pump inhibitors may decrease conversion of clopidogrel to its active metabolite, possibly interfering with its antiplatelet effects.
CYP2C19 inducers: May decrease the levels/effects of pantoprazole. Example inducers include aminoglutethimide, carbamazepine, phenytoin, and rifampin.
Iron salts: Proton pump inhibitors may decrease the oral absorption of iron salts.
Methotrexate: Proton pump inhibitors may decrease the excretion of methotrexate. Antirheumatic doses of methotrexate probably hold minimal risk.

PREGNANCY RISK FACTOR — B

LACTATION — Enters breast milk/not recommended.

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OMEPRAZOLE

OMEPRAZOLE
( Prilosec OTC™ [OTC]; Prilosec®)

DOSING: ADULTS

Active duodenal ulcer: 20 mg/day for 4-8 weeks
Gastric ulcers: 40 mg/day for 4-8 weeks
Symptomatic GERD: 20 mg/day for up to 4 weeks
Erosive esophagitis: 20 mg/day for 4-8 weeks; maintenance of healing: 20 mg/day for up to 12 months total therapy
Peptic ulcer disease: Eradication of Helicobacter pylori: Dose varies with regimen: 20 mg once daily or 40 mg/day as single dose or in 2 divided doses; requires combination therapy with antibiotics
Frequent heartburn (OTC labeling): Oral: 20 mg/day for 14 days; treatment may be repeated after 4 months if needed

DOSING IN RENAL IMPAIRMENT
 — No adjustment is necessary.

DOSING IN HEPATIC IMPAIRMENT
 Specific guidelines are not available; bioavailability is increased with chronic liver disease.

ADMINISTRATION

Capsule: Should be swallowed whole; do not chew or crush. Best if taken before breakfast. Delayed release capsule may be opened and contents added to applesauce.
Tablet: Should be swallowed whole; do not crush or chew.

SIGNIFICANT  ADVERSE REACTIONS
 Abdominal pain
 Cough
 Dizziness
 Headache
 Rash
 Diarrhea
 Nausea / Vomiting  
Constipation
 Taste perversion


CONTRAINDICATIONS
 

Hypersensitivity to omeprazole or  substituted benzimidazoles (ie, esomeprazole,

DRUG INTERACTIONS 

Antifungal agents (imidazole): Proton pump inhibitors may decrease the absorption of itraconazole , ketoconazole,indinavir ,  atazanavir and  the serum concentration of nelfinavir.
Esomeprazole and omeprazole may increase levels of benzodiazepines metabolized by oxidation –such as , diazepam, midazolam, triazolam
Clozapine: Omeprazole may alter the concentrations/effects of clozapine
CYP2C9 substrates: Omeprazole may increase the levels/effects of CYP2C9 substrates. Example substrates include bosentan, dapsone, fluoxetine, glimepiride, glipizide, losartan, montelukast, nateglinide, paclitaxel, phenytoin, warfarin, and zafirlukast.
CYP2C19 inducers: May decrease the levels/effects of omeprazole. Example inducers include aminoglutethimide, carbamazepine, phenytoin, and rifampin.
CYP2C19 substrates: Omeprazole may increase the levels/effects of CYP2C19 substrates. Example substrates include citalopram, diazepam, methsuximide, phenytoin, propranolol, and sertraline.
HMG-CoA reductase inhibitors: Omeprazole may increase the levels/effects of HMG-CoA reductase inhibitors; monitor..
Iron salts (oral): Omeprazole may decrease the absorption of oral iron salts
Methotrexate: Concurrent use with omeprazole may decrease the excretion of methotrexate.
Phenytoin: Elimination of phenytoin may be prolonged; monitor. Phenytoin may decrease omeprazole levels/effects.
Warfarin: Proton pump inhibitors may increase the levels/effects or warfarin; monitor.

PREGNANCY RISK FACTOR
 — C

LACTATION
 — Enters breast milk/not recommended

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NIZATIDINE

NIZATIDINE
Axid® AR [OTC]; Axid®

DOSING IN ADULTS

GERD 150 mg twice daily
Duodenal ulcer-  Treatment of active ulcer: 300 mg at bedtime or 150 mg twice daily
  Maintenance of healed ulcer: 150 mg/day at bedtime
Gastric ulcer -150 mg twice daily or 300 mg at bedtime
Meal-induced heartburn, acid indigestion, and sour stomach (OTC labeling): Oral: 75 mg tablet [OTC] twice daily, 30-60 minutes prior to consuming food or beverages

DOSING IN  RENAL IMPAIRMENT
150 mg every other day

DOSAGE FORMS 

Capsule (Axid®): 150 mg, 300 mg
Solution, oral (Axid®): 15 mg/mL (120 mL, 480 mL) [bubble gum flavor]
Tablet (Axid® AR): 75 mg

SIGNIFICANT ADVERSE REACTIONS

Headache
Anxiety
Pruritus
Rash
Abdominal pain
Gynecomastia

CONTRAINDICATIONS — Hypersensitivity to nizatidine or any component of the formulation; hypersensitivity to other H2 antagonists (cross-sensitivity has been observed)

DRUG INTERACTIONS 

Antifungal agents (imidazole): Nizatidine may decrease the absorption of itraconazole or ketoconazole.
Atazanavir: Histamine H2 antagonists may decrease the absorption of atazanavir.

PREGNANCY RISK FACTOR — B

LACTATION — Enters breast milk/may be compatible.

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MESALAMINE

Asacol; Canasa; Lialda; Pentasa; Rowasa


DOSING IN ADULTS

Treatment of ulcerative colitis
  Capsule: 1 g 4 times/day
  Tablet:
    Asacol: 800 mg 3 times/day for 6 weeks
    Lialda: 2.4-4.8 g once daily for up to 8 weeks
Maintenance of remission of ulcerative colitis
  Capsule: 1 g 4 times/day
  Tablet (Asacol): 1.6 g/day in divided doses
Distal ulcerative colitis, proctosigmoiditis, or proctitis: Rectal: Retention enema: 60 mL (4 g) at bedtime, retained overnight, approximately 8 hours
Active ulcerative proctitis: Rectal: Rectal suppository (Canasa): Insert one 1000 mg suppository in rectum daily at bedtime


DOSAGE FORMS
 

Capsule, controlled release:
  Pentasa: 250 mg, 500 mg
Suppository, rectal:
  Canasa: 1000 mg [contains saturated vegetable fatty acid esters]
Suspension, rectal: 4 g/60 mL (7s, 28s) Rowasa: 4 g/60 mL (7s, 28s) [contains potassium metabisulfite and sodium benzoate]
Tablet, delayed release [enteric coated]:
  Asacol: 400 mg
  Lialda: 1.2 g

ADMINISTRATION

Oral: Swallow capsules or tablets whole, do not chew or crush. Do not break outer coating of Asacol, Lialda
Lialda and Mezavant should be taken once daily with a meal.
Rectal enema: Shake bottle well. Retain enemas for 8 hours or as long as practical.
Suppository: Remove foil wrapper; avoid excessive handling. Should be retained for at least 1-3 hours to achieve maximum benefit.

SIGNIFICANT ADVERSE REACTIONS 

Headache
Abdominal pain
Chest pain
Rash
Alopecia
Leg swelling 
Cough
Agranulocytosis-more in elderly
Jaundice
Pancreatitis
Renal disease including acute/chronic interstitial nephritis, nephrotic syndrome, and renal failure have been reported. An evaluation of renal function is recommended prior to initiation of therapyand periodically during treatment

Symptomatic worsening of colitis/IBD may occur following initiation of therapy


CONTRAINDICATIONS
 

 Hypersensitivity to mesalamine, salicylates, or any component
Canasa suppositories have saturated vegetable fatty acid esters (contraindicated in patients with allergy to these components).
Rowasa enemq contains potassium metabisulfite; may cause severe hypersensitivity reactions (ie, anaphylaxis) in patients with sulfite allergies.

DRUG INTERACTIONS

Digoxin: Mesalamine may decrease absorption, and thus levels/effects, of digoxin.
Thiopurine analogues (azathioprine, mercaptopurine, thioguanine): Mesalamine may increase the levels/effects of thiopurine analogues; risk of myelosuppression may be increased by aminosalicylates (due to inhibition of TPMT).

PREGNANCY RISK FACTOR — B

LACTATION — Enters breast milk/use caution.

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MERCAPTOPURINE

Purinethol

DOSE IN ADULTS

Initial: 50 mg daily; may increase by 25 mg/day every 1-2 weeks as tolerated to target dose of 1-1.5 mg/kg/day
 Please take on an empty stomach (1 hour before or 2 hours after meals)
Dosage adjustment with concurrent allopurinol: Reduce mercaptopurine dosage to 1/4 to 1/3 the usual dose.
Dosage adjustment in TPMT-deficiency: reductions are generally required only in homozygous deficiency.

DOSING IN RENAL IMPAIRMENT

Administer every 48 hours

DOSING IN HEPATIC IMPAIRMENT

Decrease Dose

DOSAGE FORMS

Tablet [scored]: 50 mg

SIGNIFICANT ADVERSE REACTIONS

Jaundice
Leukopenia
Drug fever
Rash
Hyperuricemia
Mucositis
Oligospermia
Opportunistic Infections

CONTRAINDICATIONS

Hypersensitivity to mercaptopurine or any component of the formulation; patients whose disease showed prior resistance to mercaptopurine or thioguanine; severe liver disease, severe bone marrow suppression; pregnancy. Patients on concurrent therapy with drugs which may inhibit TPMT (eg, olsalazine) or xanthine oxidase (eg, allopurinol) may be sensitive to myelosuppressive effects.

DRUG INTERACTIONS

Allopurinol: Can cause increased levels of mercaptopurine by inhibition of xanthine oxidase; decrease dose of mercaptopurine by 75% when both drugs are used concomitantly; may potentiate effect of bone marrow suppression (reduce mercaptopurine to 25% of dose).
Aminosalicylates (olsalazine, mesalamine, sulfasalazine): May inhibit TPMT, increasing toxicity/myelosuppression of mercaptopurine.
Azathioprine: Metabolized to mercaptopurine, concomitant use may result in profound myelosuppression and should be avoided
Hepatotoxic drugs: Any agent which could potentially alter the metabolic function of the liver could produce higher drug levels and greater toxicities from either mercaptopurine or 6-TG.
Warfarin: mercaptopurine inhibits the anticoagulation effect of warfarin

PREGNANCY RISK FACTOR — D

LACTATION — Enters breast milk/contraindicated.

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