All posts in DRUGS

Azulfidine

DOSING IN  ADULTS

Ulcerative colitis
Initially 1 g 3-4 times/day, 2 g/day maintenance in divided doses; may initiate therapy with 0.5-1 g/day

Since sulfasalazine impairs folate absorption, provide1 mg/day folate supplement.

DOSING IN  RENAL IMPAIRMENT
Administer once daily.

DOSING IN  HEPATIC IMPAIRMENT Avoid use

DOSAGE FORMS 

Tablet: 500 mg
  Azulfidine®, Sulfazine: 500 mg
Tablet, delayed release, enteric coated: 500 mg

SIGNIFICANT  ADVERSE REACTIONS

Headache (33%)
Photosensitivity
Vomiting
Reversible oligospermia (33%)
Alopecia, anaphylaxis
Aplastic anemia

CONTRAINDICATIONS 

 Hypersensitivity to sulfasalazine, sulfa drugs, salicylates, or any component of the formulation  such as sulfonylureas, carbonic anhydrase inhibitors, thiazides, and loop diuretics (except ethacrynic acid).; porphyria; GI or GU obstruction; pregnancy (at term)

DRUG INTERACTIONS

Azathioprine, mercaptopurine, sulfasalazine: May increase the risk of myelosuppression (due to TPMT inhibition).
Cyclosporine concentrations may be decreased; monitor levels and renal function
Digoxin’s absorption may be decreased
Hypoglycemics: Increased effect of oral hypoglycemics (rare, but severe); monitor blood sugar
Methotrexate-induced bone marrow suppression may be increased
NSAIDs and salicylates: May increase sulfonamide concentrations
PABA (para-aminobenzoic acid – may be found in some vitamin supplements): Interferes with the antibacterial activity of sulfonamides; avoid concurrent use
Sulfinpyrazone: May increase sulfonamide concentrations
Thiazide diuretics: May increase the incidence of thrombocytopenia purpuraUricosuric agents: Actions of these agents are potentiated
Warfarin and other oral anticoagulants: Anticoagulant effect may be increased; decrease dose and monitor INR closely

PREGNANCY RISK FACTOR — B/D

LACTATION — Enters breast milk/use caution.
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Zantac 150™ [OTC]; Zantac 75® [OTC]; Zantac® EFFERdose®; Zantac®

DOSING IN  ADULTS

Prevention of heartburn: Zantac®75 [OTC]: 75 mg 30-60 minutes before eating food or drinking beverages which cause heartburn; maximum: 150 mg in 24 hours; do not use for more than 14 days
Erosive esophagitis: 150 mg 4 times/day; maintenance: 150 mg twice daily
Gastric ulcer:150 mg twice daily; maintenance: 150 mg once daily at bedtime
Duodenal ulcer: 150 mg twice daily, or 300 mg once daily after the evening meal or at bedtime; maintenance: 150 mg once daily at bedtime
Eradication of Helicobacter pylori: Oral: 150 mg twice daily; requires combination therapy

DOSING IN RENAL IMPAIRMENT  150 mg every 24 hours

DOSING IN  HEPATIC IMPAIRMENT Adjustments are not necessary

DOSAGE FORMS 

Capsule 150 mg, 300 mg
Syrup: 15 mg/mL (5 mL, 10 mL)
  Zantac®: 15 mg/mL (473 mL) [contains alcohol 7.5%; peppermint flavor]
Tablet: 75 mg [OTC], 150 mg, 300 mg
  Zantac®: 150 mg, 300 mg
  Zantac 75®: 75 mg
  Zantac 150™: 150 mg
Tablet, effervescent:
  Zantac® EFFERdose®: 25 mg [contains sodium 1.33 mEq/tablet, phenylalanine 2.81 mg/tablet, and sodium benzoate]

ADMINISTRATION

EFFERdose®: Should not be chewed, swallowed whole, or dissolved on tongue: 25 mg tablet: Dissolve in at least 5 mL (1 teaspoonful) of water; wait until completely dissolved before administering

ADVERSE REACTIONS SIGNIFICANT 

Dizziness
Headache
Mental confusion
Rash
Pancreatitis
Agranulocytosis
Hepatic failure

CONTRAINDICATIONS — Hypersensitivity to ranitidine or any component of the formulation

DRUG INTERACTIONS 

Antifungals: Ranitidine may reduce the absorption of itraconazole or ketoconazole.
Atazanavir: Histamine H2 antagonists may decrease the absorption of atazanavir.
 Cefuroxime, cefpodoxime: The absorption of some cephalosporins may be reduced by ranitidine (separate administrations times by at least 2 hours).
Warfarin: May increase or decrease prothrombin time when used concomitantly; monitor.

PREGNANCY RISK FACTOR — B

LACTATION — Enters breast milk/use caution.

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.

Omeprazole ( Prilosec )

Esomeprazole (Nexium)

Pantoprazole (Protonix)

Rabeprazole  (Aciphex)

Lansoprazole ( Prevacid)

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.

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.

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.

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
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.