Patient Info

LUBIPROSTONE

Amitiza

DOSING IN  ADULTS
Idiopathic constipation-24 mcg twice daily ( to be taken with food)
Irritable bowel Syndrome ( in women > 18 years )-8 mcg thrice a day

DOSAGE FORMS
24 mcg, 8 mcg


SIGNIFICANT
ADVERSE REACTIONS
Headache
Nausea
Diarrhea
Edema

CONTRAINDICATIONS — Hypersensitivity to lubiprostone or any component of the formulation; known mechanical bowel obstruction

PREGNANCY RISK FACTOR — C

Women of childbearing potential should have a negative pregnancy test prior to starting therapy and should be capable of complying with effective contraception.

LACTATION — Excretion in breast milk unknown/not recommended.

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LANSOPRAZOLE

LANSOPRAZOLE
( Prevacid® SoluTab™; Prevacid®)


DOSING IN  ADULTS

Symptomatic GERD: Short-term treatment: 15 mg once daily for up to 8 weeks
Erosive esophagitis:  Short-term treatment: 30 mg once daily for up to 8 weeks; continued treatment for an additional 8 weeks may be considered for recurrence or for patients who do not heal after the first 8 weeks of therapy; maintenance therapy: 15 mg once daily
Duodenal ulcer:  Short-term treatment: 15 mg once daily for 4 weeks; maintenance therapy: 15 mg once daily
Peptic ulcer disease: Eradication of Helicobacter pylori: 30 mg once daily or 60 mg/day in 2 divided doses; requires combination therapy with antibiotics
Gastric ulcer: Short-term treatment: 30 mg once daily for up to 8 weeks
NSAID-associated gastric ulcer (healing): 30 mg once daily for 8 weeks; controlled studies did not extend past 8 weeks
NSAID-associated gastric ulcer (to reduce risk): 15 mg once daily for up to 12 weeks; controlled studies did not extend past 12 weeks

DOSING IN  RENAL IMPAIRMENT  

No adjustment is necessary.

DOSING IN  HEPATIC IMPAIRMENT  

May require a dose reduction.

DOSAGE FORMS 

Capsule, delayed release:
   Prevacid®: 15 mg, 30 mg
Granules, for oral suspension, delayed release:
   Prevacid®: 15 mg/packet (30s) [strawberry flavor], 30 mg/packet (30s) [strawberry flavor] [DSC]
Tablet, orally disintegrating:
  Prevacid® SoluTab™: 15 mg [contains phenylalanine 2.5 mg; strawberry flavor]; 30 mg [contains phenylalanine 5.1 mg; strawberry flavor]

ADMINISTRATION

Best if taken before breakfast. The intact granules should not be chewed or crushed.  Capsules may be opened and the intact granules sprinkled on 1 tablespoon of applesauce, cottage cheese, yogurt, or strained pears. The granules should then be swallowed immediately.  Capsules may be opened and emptied into ~60 mL orange juice, apple juice, or tomato juice; mix and swallow immediately. Rinse the glass with additional juice and swallow to assure complete delivery of the dose.
Delayed release oral suspension granules should be mixed with 2 tablespoonfuls (30 mL) of water; no other liquid should be used. Stir well and drink immediately

ADVERSE REACTIONS SIGNIFICANT

Headache
Diarrhea
Abdominal pain
Nausea

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

DRUG INTERACTIONS 

Antiretrovirals: Proton pump inhibitors may decrease the absorption of atazanavir and Indinavir. Concurrent use is not recommended.
Antifungal agents (imidazoles): Proton pump inhibitors may decrease the absorption of itraconazole and ketoconazole.
CYP2C19 inducers: May decrease the levels/effects of lansoprazole. Example inducers include aminoglutethimide, carbamazepine, fosphenytoin, phenytoin, and rifampin.
CYP2C19 substrates: Lansoprazole 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 lansoprazole. 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.
Iron salts (oral): Lansoprazole may decrease the absorption of oral iron salts.
Methotrexate: Proton pump inhibitors may decrease the excretion of methotrexate.

PREGNANCY RISK FACTOR  B

LACTATION — Excretion in breast milk unknown/not recommended.

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HYOSCYAMINE

Anaspaz, Levbid, Levsin/SL, Levsinex, Levsin, NuLev

DOSING IN  ADULTS
Oral or S.L.: 0.125-0.25 mg every 4 hours or as needed (before meals or food); maximum: 1.5 mg/24 hours
Oral, timed release: 0.375-0.75 mg every 12 hours; maximum: 1.5 mg/24 hours


DOSAGE FORMS

Capsule, timed release, as sulfate (Levsinex): 0.375 mg
Elixir, as sulfate: 0.125 mg/5 mL (480 mL)
Levsin: 0.125 mg/5 mL (480 mL) [contains alcohol 20%; orange flavor]
Tablet, as sulfate (Anaspaz, Levsin): 0.125 mg
Tablet, extended release, as sulfate (Levbid) 0.375 mg
Tablet, orally disintegrating, as sulfate (NuLev): 0.125 mg [contains phenylalanine 1.7 mg/tablet, mint flavor]
Tablet, sublingual, as sulfate: 0.125 mg


SIGNIFICANT ADVERSE REACTIONS

Dry mouth
Palpitation
Dizziness
Lactation suppression
Bloating
Constipation
Urinary retention
Blurred vision
Decreased Sweating

CONTRAINDICATIONS — Hypersensitivity to belladonna alkaloids or any component of the formulation; glaucoma; obstructive uropathy; myasthenia gravis; obstructive GI tract disease, paralytic ileus, unstable cardiovascular status in acute hemorrhage, myocardial ischemia

DRUG INTERACTIONS

Antacids: Antacids may decrease absorption of hyoscyamine; administer hyoscyamine before meals and give antacids after meals.
Antihistamines: Additive adverse effects may occur with some antihistamines due to cholinergic blockade.
Antimuscarinics: Additive adverse effects may occur due to cholinergic blockade.
Haloperidol: Additive adverse effects may occur due to cholinergic blockade.
Phenothiazines: Additive adverse effects may occur due to cholinergic blockade.
Tricyclic antidepressants: Additive adverse effects may occur due to cholinergic blockade.

PREGNANCY RISK FACTOR — C

LACTATION — Enters breast milk/not recommended

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FAMOTIDINE

FAMOTIDINE
Pepcid® AC [OTC]; Pepcid®

DOSING IN ADULTS
Esophagitis and accompanying symptoms due to GERD:  20 mg or 40 mg twice daily for up to 12 weeks
Duodenal ulcer: Acute therapy: 40 mg/day at bedtime for 4-8 weeks; maintenance therapy: 20 mg/day at bedtime
GERD:  20 mg twice daily for 6 weeks
Heartburn, indigestion, sour stomach: OTC labeling: 10-20 mg every 12 hours; dose may be taken 15-60 minutes before eating foods known to cause heartburn

DOSING IN  RENAL IMPAIRMENT Administer 50% of dose or increase the dosing interval to every 36-48 hours

DOSAGE FORMS 

  Pepcid® AC: 10 mg
Powder for oral suspension:
  Pepcid®: 40 mg/5 mL (50 mL) [contains sodium benzoate; cherry-banana-mint flavor]
Tablet: 10 mg [OTC], 20 mg, 40 mg
  Pepcid®: 20 mg, 40 mg


ADMINISTRATION

 May be taken with or without food.

SIGNIFICANT ADVERSE REACTIONS

Headache
Dizziness
Diarrhea
Agranulocytosis
Bronchospasm
Rash
Seizure

CONTRAINDICATIONS — Hypersensitivity to famotidine, other H2 antagonists, or any component of the formulation

DRUG INTERACTIONS

Antifungal agents (azole derivatives, systemic): Histamine H2 antagonists may decrease the absorption of azole antifungal.
Atazanavir: Histamine H2 antagonists may decrease the absorption of atazanavir.
Cefpodoxime: Histamine H2 antagonists may decrease the absorption of cefpodoxime; separate oral doses by at least 2 hours.
Cefuroxime: Histamine H2 antagonists may decrease the absorption of cefuroxime; separate oral doses by at least 2 hours.
Cyclosporine: Histamine H2 antagonists may increase the serum concentration of cyclosporine; monitor.
Iron Salts: Histamine H2 antagonists may decrease the absorption of iron salts.

PREGNANCY RISK FACTOR — B

LACTATION — Enters breast milk/not recommended.

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ESOMEPRAZOLE

ESOMEPRAZOLE
(Nexium®)


DOSING IN  ADULTS

Erosive esophagitis (healing): Initial: 20-40 mg once daily for 4-8 weeks; if incomplete healing, may continue for an additional 4-8 weeks; maintenance: 20 mg once daily
Maintenance of healing of erosive esophagitis: 20 mg once daily; clinical trials evaluated therapy for ≤6 months
Symptomatic gastroesophageal reflux: 20 mg once daily for 4 weeks; may consider an additional 4 weeks of treatment if symptoms do not resolve
Peptic ulcer disease: Eradication of Helicobacter pylori: 40 mg once daily for 10 days; requires combination therapy
Prevention of NSAID-induced gastric ulcers: 20-40 mg once daily for up to 6 months
DOSING IN  RENAL IMPAIRMENT No adjustment is necessary.
DOSING IN  HEPATIC IMPAIRMENT 
 Mild-to-moderate hepatic impairment -No dosage adjustment needed.
Severe hepatic impairment -Dose should not exceed 20 mg/day.
DOSAGE FORMS 
Capsule, delayed release, as magnesium:
  Nexium®: 20 mg, 40 mg
Granules, for oral suspension, delayed release, as magnesium:
  Nexium®: 10 mg/packet (30s); 20 mg/packet (30s); 40 mg/packet (30s)


ADMINISTRATION

  Capsule: Should be swallowed whole and taken at least 1 hour before eating (best if taken before breakfast). Capsule can be opened and contents mixed with 1 tablespoon of applesauce. Swallow immediately; mixture should not be chewed or warmed.
  Granules: Empty into container with 1 tablespoon of water and stir; leave 2-3 minutes to thicken. Stir and drink within 30 minutes. If any medicine remains after drinking, add more water, stir and drink immediately.


SIGNIFICANT
  ADVERSE REACTIONS

Abdominal pain
Headache
Hypertension
Chest pain


CONTRAINDICATIONS
 — Hypersensitivity to esomeprazole, substituted benzimidazoles (ie, lansoprazole, omeprazole, pantoprazole, rabeprazole), 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: 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 Nexium. Example inducers include aminoglutethimide, carbamazepine, phenytoin, and rifampin.
CYP2C19 substrates: 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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DICYCLOMINE

Bentyl

DOSING IN  ADULTS
 
10-20 mg 4 times/day . Administer 30-60 minutes before a meal.

DOSAGE FORMS 

Bentyl Capsule, as hydrochloride: 10 mg
Syrup, as hydrochloride: 10 mg/5 mL (480 mL)
Bentyl Tablet, as hydrochloride: 20 mg


SIGNIFICANT
  ADVERSE REACTIONS

Palpitations
Dizziness
Rash
Suppression of lactation
Xerostomia
Urinary retention
Blurred vision
Use caution in hot weather and/or exercise as Dicyclomine decreases sweating

CONTRAINDICATIONS — Hypersensitivity to dicyclomine or any component of the formulation; obstructive diseases of the gastrointestinal and urinary tract ; unstable cardiovascular status in acute hemorrhage; obstructive
uropathy; narrow-angle glaucoma; myasthenia gravis; breast-feeding; should not be used in infants <6 months of age

DRUG INTERACTIONS

Anticholinergic agents: The anticholinergic effects of dicyclomine are additive with other anticholinergic agents, including antihistamines, amantadine, opioids, phenothiazines, and tricyclic antidepressants.
Acetylcholinesterase inhibitors (central): Effects of dicyclomine may be diminished

PREGNANCY RISK FACTOR — B

LACTATION — Enters breast milk/contraindicated.

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CIMETIDINE

Gastroesophageal reflux disease: Oral: 400 mg 4 times/day or 800 mg twice daily for 12 weeks

Short-term treatment of active ulcers:
  300 mg 4 times/day or 800 mg at bedtime or 400 mg twice daily for up to 8 weeks
    
Duodenal ulcer prophylaxis: 400 mg at bedtime
Heartburn, acid indigestion, sour stomach (OTC labeling):  200 mg up to twice daily; may take 30 minutes prior to eating foods or beverages expected to cause heartburn or indigestion

DOSING IN  RENAL IMPAIRMENT –decrease by 50%

DOSING IN  HEPATIC IMPAIRMENT Safe in mild liver disease but use with caution and in reduced dosage in severe liver disease


DOSAGE FORMS
 

Tablet: 200 mg [OTC], 300 mg, 400 mg, 800 mg
  Tagamet® HB 200: 200 mg

ADMINISTRATION

Administer with meals so that the drug’s peak effect occurs at the proper time

SIGNIFICANT  ADVERSE REACTIONS

Headache
Dizziness
Gynecomastia
 
Diarrhea
Hypotension
Pancreatitis
Confusion

CONTRAINDICATIONS — Hypersensitivity to cimetidine, any component of the formulation, or other H2 antagonists

DRUG INTERACTIONS 

Amiodarone: Serum concentration of amiodarone is increased; avoid concurrent use.
Antiretrovirals: Histamine H2 antagonists may decrease the absorption of atazanavir
Benzodiazepines (except lorazepam, oxazepam, temazepam): Serum concentration of the benzodiazepine is increased; consider alternative H2 antagonist or monitor for benzodiazepine toxicity.
Beta-blockers (except atenolol, betaxolol, bisoprolol, nadolol, penbutolol): Effects of the beta-blocker may be increased
Calcium channel blockers (except amlodipine and nicardipine): Serum concentration of the CCB is increased
Carbamazepine: Plasma concentration of carbamazepine may increase transiently (1 week). Monitor for carbamazepine toxicity or use an alternative H2 antagonist.
Citalopram: Serum concentration of citalopram is increased
Clozapine: Cimetidine may increase levels/effects; consider alternative H2 antagonist
Cyclosporine: Serum concentration of cyclosporine may increase; monitor cyclosporine levels.
CYP1A2 substrates: Cimetidine may increase the levels/effects of CYP1A2 substrates. Example substrates include aminophylline ropinirole, theophylline, and trifluoperazine.
CYP2C19 substrates: Cimetidine may increase the levels/effects of CYP2C19 substrates. Example substrates include citalopram, diazepam, phenytoin, propranolol, and sertraline.
CYP2D6 substrates: Cimetidine may increase the levels/effects of CYP2D6 substrates. Example substrates include amphetamines, selected beta-blockers, fluoxetine, lidocaine, mirtazapine, nefazodone, risperidone, ritonavir, tricyclic antidepressants, and venlafaxine.
CYP2D6 prodrug substrates: Cimetidine may decrease the levels/effects of CYP2D6 prodrug substrates. Example prodrug substrates include codeine, hydrocodone, oxycodone, and tramadol.
CYP3A4 substrates: Cimetidine may increase the levels/effects of CYP3A4 substrates. Example substrates include benzodiazepines, calcium channel blockers, cyclosporine, mirtazapine, nateglinide, nefazodone, sildenafil ,tacrolimus, and venlafaxine.
Ketoconazole, fluconazole, itraconazole (especially capsule): Decreased serum concentration; avoid concurrent use with H2 antagonists.
Lidocaine: Serum concentration of lidocaine is increased; use alternative H2 antagonist.
Metformin: Serum levels/effects may be increased by cimetidine; monitor for hypoglycemia.
Phenytoin: Serum levels/effects may be increased by cimetidine; avoid concurrent use.
Procainamide: Cimetidine may increase levels/effects; monitor.
Quinolones: Renal elimination of quinolone antibiotics may be decreased.
Selective serotonin reuptake inhibitors (eg, paroxetine, citalopram): Serum concentrations may be increased by cimetidine; monitor.
Sulfonylureas: Cimetidine may increase levels/effects; monitor for hypoglycemia
Tricyclic antidepressants: Serum concentration is increased; consider alternative H2 antagonist or monitor for TCAs toxicity.
Thioridazine: Serum levels/effects may be increased by cimetidine; concurrent use contraindicated by manufacturer.
Warfarin: INR is increased; cimetidine’s effect is dose related. Use an alternative H2 antagonist if possible or monitor INR closely and adjust warfarin dose as needed.

PREGNANCY RISK FACTOR — B

LACTATION — Enters breast milk/not recommended.

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