Before administering a medication, always ask the recipient if he suffers from allergy to it. If so, do not administer the drug or anything that you feel is similar to it. Use medications only if you have a reasonable understanding of what you are treating.
Many drugs are used to suppress symptoms (such as abdominal pain, nausea and vomiting, and headache) of potentially serious disorders. In these cases, do not overmedicate the victim if you need to watch for a worsening condition.
Drugs are listed here by purpose. I have listed a number of products that are available over the counter; however, many of the drugs require a prescription. This is not a comprehensive formulary, but rather, emphasizes the medications mentioned throughout the book. Always have a doctor or pharmacist explain the actions and side effects of any drug you obtain.
Doses are listed in absolute amount (generally, for adults) or in amount to be given per body weight or per age (generally, for children). For determination of weight, 1 kilogram (kg) equals 2.2 pounds (lb). The drug should be administered orally unless otherwise specified.
Because children generally require a fraction of the dose used for adults, they may need to have the drug in special tablet or liquid form. The average weights for children, according to age, are as follows:
1 year—10 kg (22 lb)
3 years—15 kg (33 lb)
6 years—20 kg (44 lb)
8 years—25 kg (55 lb)
9 ½ years—30 kg (66 lb)
11 years—35 kg (77 lb)
Exercise extreme caution and do not administer drugs to pregnant women, infants, or small children unless absolutely necessary.
Drugs have many side effects. Some of the common ones are noted. Be familiar with the drugs you carry.
Corticosteroids (“steroids”) are interchangeable to a certain degree. If you must substitute, here is a rough measure of equivalence: 20 mg prednisone equals 16 mg methylprednisolone equals 3 mg dexamethasone.
Drugs are listed in the following order:
• For relief from a severe allergic reaction (page 491)
• For relief from a mild allergic reaction (page 492)
• For relief from severe asthma (page 493)
• For relief from mild (or chronic) asthma (page 494)
• For relief of chest pain (angina) (page 495)
• For treatment of congestive heart failure (page 496)
• For treatment of seizures (epilepsy) (page 496)
• For relief from pain (page 496)
• For relief from fever (page 497)
• For relief from muscle aches or minor arthritis (page 497)
• For relief from migraine headache (page 497)
• For relief from itching (page 498)
• For relief from toothache (page 498)
• For relief from motion sickness (page 498)
• For relief from nausea and vomiting (page 499)
• For relief from diarrhea (page 499)
• For relief from constipation (page 500)
• For relief from ulcer pain (page 501)
• For relief from indigestion or gas pains (page 501)
• For relief from heartburn (reflux esophagitis) (page 502)
• For relief from nasal congestion (page 502)
• For relief from cough (page 503)
• For relief from sore throat (page 503)
• Cold formulas (page 503)
• Skin medications (page 504)
• For sleep (page 506)
• Antibiotics (page 507)
DRUGS AND PREGNANCY
In general, it is best to avoid taking any medication when pregnant to avoid the risk of fetal malformation, or illness or injury in the newly born child. A pregnant woman should be discouraged from taking over-the-counter drugs. However, women can certainly become ill during pregnancy, so it is important to know what can be administered safely and what should be absolutely avoided. Fortunately, many of the drugs that are labeled “potentially hazardous” have only been proven hazardous in laboratory animals, frequently in relative doses that far exceed their common usage in humans. Furthermore, some drugs, such as diazepam and salicylates, formerly thought to cause malformation of the developing fetus have since been proven safe when administered in normal therapeutic doses.
The following list reflects recommendations compiled from the current medical literature. Whenever possible, a pregnant woman contemplating use of a medication should seek advice in advance from her physician.
Antibiotic, Antifungal, Antiviral, Antimalarial
NO RECOGNIZED HAZARD
amoxicillin-clavulanate
penicillin
cephalosporins
erythromycin
clotrimazole
miconazole
nystatin
proguanil
ampicillin/amoxicillin
paromomycin
mefloquine (apparently safe)
terconazole
gentamicin topical eye medication
AVOID IF POSSIBLE
chloramphenicol
chloroquine (apparently safe)
ciprofloxacin
gentamicin injection
trimethoprim-sulfamethoxazole
metronidazole
nitrofurantoin
quinine
primaquine
quinacrine
acyclovir
HAZARDOUS
tetracycline/doxycycline (causes staining of teeth and altered bone development in fetus)
norfloxacin
ofloxacin
fleroxacin
Pain Medication
NO RECOGNIZED HAZARD
acetaminophen
hydrocodone
meperidine
naproxen (use with caution in later pregnancy)
oxycodone
AVOID IF POSSIBLE
codeine
aspirin (but probably safe)
ibuprofen and most other nonsteroidal antiinflammatory drugs (“NSAIDs”) during later pregnancy
HAZARDOUS
indomethacin
Vaccine
NO RECOGNIZED HAZARD
hepatitis A
hepatitis B (killed)
tetanus toxoid
diphtheria toxoid
tetanus immunoglobulin
pooled serum immunoglobulin
AVOID IF POSSIBLE
influenza (inactivated virus)
polio (oral and injection)
typhus
tuberculosis (BCG)
typhoid
cholera
yellow fever
meningococcal vaccine
pneumococcal vaccine
rabies vaccine (preexposure; must be used for postexposure)
HAZARDOUS
smallpox
measles
mumps
varicella
rubella
Antiallergy
NO RECOGNIZED HAZARD
epinephrine (use only in a critical situation)
cimetidine
dimenhydrinate
famotidine
topical corticosteroids, decongestants (e.g., oxymetazoline)
AVOID IF POSSIBLE
chlorpheniramine
epinephrine (avoid in a noncritical situation)
hydroxyzine
prednisone
HAZARDOUS
diphenhydramine (during first trimester)
brompheniramine
dimenhydrinate
cyclizine
Antinausea, Anti–Motion-Sickness, Antidiarrheal, Anticonstipation
NO RECOGNIZED HAZARD
trimethobenzamide
prochlorperazine
promethazine
ondansetron
dimenhydrinate
docusate
bisacodyl
mineral oil
meclizine
metoclopramide (apparently safe)
AVOID IF POSSIBLE
scopolamine
anticholinergic drugs
Other
NO RECOGNIZED HAZARD
antacids
caffeine
cyproheptadine
prednisone
betamethasone
dextromethorphan
casanthranol
prednisolone
kaolin-pectin
loperamide
lindane (use with caution)
omeprazole
oxymetazoline
pyrethrins with piperonyl butoxide
ranitidine
simethicone
sucralfate
AVOID IF POSSIBLE
albuterol
amantadine
beclomethasone
bismuth subsalicylate
dexamethasone
furosemide
isoproterenol
acetazolamide
triazolam
loperamide
diphenoxylate
theophylline
metaproterenol
nifedipine
HAZARDOUS
thyroid inhibitors
captopril (and all other angiotensin-converting enzyme [“ACE”] inhibitors)
chlordiazepoxide
chlorothiazide
isotretinoin
phenacetin
phenytoin
dapsone
diazepam
hydrochlorothiazide
tolbutamide
midazolam
ALLERGIC REACTION TO A DRUG
If a person develops an allergic reaction to a drug (itching, shortness of breath, swollen tongue, difficulty talking, skin rash, hives, and so on), immediately discontinue the drug and follow the instructions on page 66.
FOR RELIEF FROM A SEVERE ALLERGIC REACTION
Epinephrine (adrenaline) 1:1,000 aqueous solution. Adult dose 0.3 to 0.5 mL injected subcutaneously (see page 474). This may be repeated two times at 20-minute intervals. The pediatric dose is 0.01 mL/kg (2.2 lb) of body weight, not to exceed 0.3 mL, injected subcutaneously. Unless the situation is life threatening, do not use epinephrine if the victim is older than 45 years, has a known history of heart disease, or is a pregnant female.
Side effects: rapid heartbeat, nervousness.
Epinephrine is available in preloaded syringes in certain allergy kits, which include the Twinject (Verus Pharmaceuticals), the Ana-Kit, and the EpiPen autoinjector and EpiPen Jr. autoinjector (Dey). Instructions for use accompany the kits. The Twinject and EpiPen epinephrine products are generally easier for laypeople to use, because they require less manual dexterity to accomplish the injection. The Twinject autoinjector and Ana-Kit preloaded syringe carry enough epinephrine for a second (repeat) adult dose given by routine injection, which is necessary in one out of six episodes of severe allergic reactions.
For dosing purposes, the Twinject and EpiPen autoinjectors (0.3 mg per dose) should be used for adults and children over 66 lb (30 kg) in weight. Children 66 lb and under should be injected with the Twinject 0.15 mg or EpiPen Jr. autoinjector.
Take particular care to handle preloaded syringes properly, to avoid inadvertent injection into a finger or toe. Do not intentionally inject epinephrine into the buttocks or a vein. Epinephrine should not be exposed to heat or sun, but does not need to be kept refrigerated. If clear (liquid) epinephrine turns brown, it should be discarded.
When administering an injection, never share needles between people.
Diphenhydramine (Benadryl). Adult dose 25 to 50 mg every 4 to 6 hours; pediatric dose 1 mg/kg (2.2 lb) of body weight.
Side effects: drowsiness, paradoxical hyperactivity (children).
Albuterol (Ventolin) or metaproterenol (Alupent) metered-dose inhaler. Adult dose 2 puffs every 3 to 6 hours as needed.
Side effects: rapid heartbeat, nervousness (“jitters”).
The proper technique for using a metered-dose inhaler device is as follows:
1. Shake the inhaler vigorously for 5 seconds before each use.
2. Invert the inhaler so that the opening is downward if directed to do so. Hold the inhaler 4 cm (1.6 in) in front of an open mouth, or place a spacer on the opening, around which the lips will be sealed.
3. Exhale fully. Close your lips around the spacer, or hold it about 4 cm (1.6 in) from your mouth, or close your lips around the mouthpiece.
4. Activate the inhaler at the beginning of inspiration.
5. Inhale slowly and deeply to full lung capacity.
6. Hold your breath for 10 seconds, then exhale slowly.
7. Wait one minute before repeating all steps before the next puff. Shake the inhaler before each puff.
Prednisone. Adult dose 50 to 80 mg the first day. Each day, the dose is decreased by 10 mg. The pediatric dose is 1 mg/kg (2.2 lb) of body weight the first day, tapered every 4 days by halving the dose. Administer with food or with an antacid if possible.
For a severe skin reaction to poison ivy, oak, or sumac, see the instructions on page 234. For a severe sunburn, see the instructions on page 227.
Corticosteroids should always be taken with the understanding that a rare side effect is serious deterioration of the head (“ball” of the ball-and-socket joint) of the femur, the long bone of the thigh.
FOR RELIEF FROM A MILD ALLERGIC REACTION OR HAY FEVER
Diphenhydramine (Benadryl). Same as “For Relief from a Severe Allergic Reaction.”
Diphenhydramine (25 mg) with pseudoephedrine (60 mg) (Benadryl Decongestant). Adult dose one tablet every 8 hours.
Cetirizine hydrochloride (Zyrtec). Dose 5 to 10 mg a day; do not use in children under 6 years of age.
Fexofenadine (Allegra). Adult dose 60 mg every 12 hours. In adults, it may also be administered as 180 mg once a day. Rarely causes drowsiness. Do not use in children less than 12 years of age. This drug replaces terfenadine (Seldane), and should be used in preference to that medication. If for some reason terfenadine is used, observe the following precautions: a person with impaired liver function or who is taking ketoconazole, itraconazole, erythromycin, clarithromycin, or troleandomycin should not take terfenadine at the same time. Allegra-D: fexofenadine 60 mg with pseudoephedrine 120 mg extended-release tablet.
Loratadine (Claritin). Adult dose 10 mg every 24 hours. Rarely causes drowsiness. Do not use in children less than 12 years of age. Claritin-D: loratadine 5 mg with pseudoephedrine 120 mg. Claritin-D 24 Hour: loratidine 10 mg with pseudoephedrine 240 mg.
Prednisone. Adult dose 50 to 80 mg the first day for severe seasonal allergies that do not respond to other medications. Each day, the dose is decreased by 10 mg. The pediatric dose is 1 mg/kg (2.2 lb) of body weight the first day, tapered every 4 days by halving the dose. Administer with food or with an antacid, if possible. Corticosteroids should always be taken with the understanding that a rare side effect is serious deterioration of the head (“ball” of the ball-and-socket joint) of the femur, the long bone of the thigh.
Triprolidine with pseudoephedrine (Actifed). Adult dose 1 tablet every 8 hours; pediatric dose (6 to 12 years of age) half tablet every 8 hours.
Side effect: drowsiness.
FOR RELIEF FROM SEVERE ASTHMA/CHRONIC OBSTRUCTIVE PULMONARY DISEASE (COPD)
Many asthma/COPD medications are administered by metered-dose inhaler. The proper technique for using this device is as follows:
1. Shake the inhaler vigorously for 5 seconds before each use.
2. Invert the inhaler so that the opening is downward if directed to do so. Hold the inhaler 4 cm (1.6 in) in front of an open mouth, or place a spacer on the opening, around which the lips will be sealed.
3. Exhale fully. Close your lips around the spacer, or hold it about 4 cm (1.6 in) from your mouth, or close your lips around the mouth piece.
4. Activate the inhaler at the beginning of inspiration.
5. Inhale slowly and deeply to full lung capacity.
6. Hold your breath for 10 seconds, then exhale slowly.
7. Wait one minute before repeating all steps before the next puff. Shake the inhaler before each puff.
Epinephrine (adrenaline) 1:1,000 aqueous solution. Adult dose 0.3 to 0.5 mL injected subcutaneously (see page 474). This may be repeated two times at 20-minute intervals. The pediatric dose is 0.01 mL/kg (2.2 lb) of body weight, not to exceed 0.3 mL, injected subcutaneously. Do not use epinephrine for treatment of COPD.
The drug is available in preloaded syringes in certain allergy kits, which include the Twinject (Verus Pharmaceuticals) autoinjector, the Ana-Kit, and the EpiPen autoinjector and EpiPen Jr. autoinjector (Dey). Instructions for use accompany the kits. The EpiPen and Twinject epinephrine products are generally easier for laypeople to use, because they require less manual dexterity for injection.
For dosing purposes, the EpiPen or Twinject 0.3 mg dose autoinjector should be used for adults and children over 66 lb (30 kg) in weight. Children 66 lb and under should be injected with the EpiPen Jr. or Twinject 0.15 mg autoinjector.
Take particular care to handle preloaded syringes properly, to avoid inadvertent injection into a finger or toe. Do not intentionally inject epinephrine into the buttocks or a vein. Epinephrine should not be exposed to heat or sun, but does not need to be kept refrigerated. If clear (liquid) epinephrine turns brown, it should be discarded.
Do not use epinephrine if the victim is older than 45 years, has a known history of heart disease, or is a pregnant female unless the situation is life threatening. Do not use epinephrine for treatment of COPD.When administering an injection, never share needles between people.
Primatene Mist (inhaler) is a mixture of epinephrine and alcohol available over the counter. This preparation should not be used in substitution for injected epinephrine in cases of severe asthma.
Side effects: rapid heartbeat, nervousness.
Terbutaline (Brethine) tablets. Adult dose 2.5 to 5 mg every 6 to 8 hours.
Terbutaline (Brethaire) metered-dose inhaler. Adult dose 2 puffs every 4 to 6 hours.
Flunisolide (Aerobid) metered-dose inhaler. Adult dose as directed.
Triamcinolone acetonide (Azmacort) metered-dose inhaler. Adult dose 1 puff twice a day for treatment of chronic asthma, equivalent to 10 mg per day of oral prednisone.
Albuterol (Ventolin) or metaproterenol (Alupent) metered-dose inhaler. Adult dose 2 puffs every 4 hours as needed.
Side effects: rapid heartbeat, nervousness (“jitters”).
Ipratropium bromide metered-dose inhaler. Adult dose 2 puffs every 4 hours.
Tiotropium bromide dry-powder inhaler. Adult dose one puff a day.
Combivent (ipratropium bromide and albuterol sulfate) metered-dose inhaler. Adult dose 2 puffs four to six times a day, not to exceed 12 puffs in 24 hours.
Bitolterol (Tornalate) metered-dose inhaler. Adult dose 2 puffs every 8 hours.
Pirbuterol (Maxair) metered-dose inhaler. Adult dose 2 puffs every 4 to 6 hours.
Salmeterol xinafoate (Serevent) or formoterol fumarate dry-powder inhaler. Adult dose one puff every 12 hours. Longer-acting beta-2 agonists, such as salmeterol, have been associated with a worsening of asthma episodes with or without the use of shorter-acting beta-2 agonists, such as albuterol, so persons who take salmeterol should be watched carefully when they suffer an asthma attack.
Budesonide/formoterol fumarate dihydrate inhalation aerosol (Symbicort). Adult dose two inhalations twice daily.
Fluticasone propionate/250 micrograms plus salmeterol 50 micrograms (Advair Diskus). Adult dose 1 inhalation twice a day.
Metaproterenol (Alupent) tablets. Adult dose 20 mg every 4 to 6 hours; pediatric dose (6 to 9 years of age or less than 60 lb, or 27.2 kg, of body weight) 10 mg.
Albuterol (Ventolin) tablets. Adult dose 2 to 4 mg three to four times a day.
Cromolyn sodium (Intal) metered-dose inhaler. Adult and pediatric dose 2 puffs every 4 to 6 hours; not for use in children less than 5 years of age.
Theophylline. Adult dose 100 to 200 mg every 6 to 8 hours; pediatric dose 4 mg/kg (2.2 lb) of body weight every 6 to 8 hours.
Prednisone. Adult dose 50 to 80 mg the first day. Each day, the dose is decreased by 10 mg. The pediatric dose is 1 mg/kg (2.2 lb) of body weight the first day, tapered every 4 days by halving the dose. Administer with food or with an antacid, if possible. Corticosteroids should always be taken with the understanding that a rare side effect is serious deterioration of the head (“ball” of the ball-and-socket joint) of the femur, the long bone of the thigh.
FOR RELIEF FROM MILD ASTHMA
In addition to drugs under “For Relief from Severe Asthma”:
Ipratropium bromide (Atrovent) metered-dose inhaler. Adult dose 2 puffs every 4 to 6 hours as needed. Do not exceed 12 puffs in 24 hours. Do not use in children less than 12 years of age.
Beclomethasone dipropionate (Vanceril) metered-dose inhaler. Adult dose 2 puffs every 4 to 6 hours, not to exceed 20 puffs in 24 hours; pediatric dose (6 to 12 years of age) 1 or 2 puffs every 6 hours, not to exceed 10 puffs in 24 hours. Rinse the mouth after each use.
Zafirlukast (Accolate). Adult dose 20 mg tablet twice a day taken 1 hour before or 2 hours following meals. Do not use in children less than 12 years of age.
FOR TREATMENT OF CHEST PAIN (ANGINA)
Nitroglycerin 1/150 grain (0.4 mg) or lingual aerosol (0.4 mg metered dose per spray). Adult dose 1 tablet dissolved under the tongue, or 1 spray under the tongue, for treatment of angina. This may be repeated every 10 minutes for two additional doses.
Side effects: dizziness (low blood pressure), headache. If a person uses nitroglycerin and becomes faint, he should lie down with his legs elevated until his skin color returns to normal and he feels better (usually, in a minute or two). If chest pain or weakness persists, this may indicate a heart attack (see page 50).
Nitroglycerin patch 0.4 to 0.6 mg. Apply for 12 to 24 hours.
Isorbide mononitrate or dinitrate (short acting formulation). Adult dose 20 to 60 mg by mouth twice daily.
Isorbide mononitrate or dinitrate (sustained release formulation). Adult dose 60 to 120 mg by mouth twice daily.
Side effects: headache, dizziness, nausea, irregular heartbeat (palpitations). This drug should not be given with medications for erectile dysfunction (e.g., sildenafil citrate [Viagra]).
Metoprolol (short-acting formulation). Adult dose 50 to 150 mg by mouth twice daily.
Metoprolol (sustained-release formulation). Adult dose 100 to 300 mg once daily.
Side effects: fatigue, shortness of breath, wheezing, weakness, dizziness. Should be used with caution in persons with chronic obstructive pulmonary disease, diabetes, depression, severe peripheral vascular disease, certain abnormal heart rhythms, or erectile dysfunction.
Nifedipine (sustained-release formulation). 30 to 90 mg by mouth once daily.
Verapamil (short-acting formulation). 20 to 120 mg 2 to 3 times by mouth daily.
Verapamil (sustained-release formulation). 180 to 240 mg by mouth once or twice daily.
Diltiazem (sustained-release formulation). 120 to 480 mg by mouth once daily.
FOR TREATMENT OF CONGESTIVE HEART FAILURE
Furosemide (Lasix) diuretic (promotes urination). Adult dose 1 to 4 tablets (20 to 80 mg) each day for the fluid retention associated with heart failure. Diuretics should not be used for fluid retention not associated with heart failure (such as that from high altitude) or for weight reduction.
Digoxin (Lanoxin). Adult dose 0.125 to 0.25 mg each day.
FOR TREATMENT OF SEIZURES (EPILEPSY)
Diphenylhydantoin (Dilantin). Adult dose 300 to 400 mg per day; pediatric dose 2.5 mg/kg (2.2 lb) of body weight twice a day.
Phenobarbital. Adult dose 60 to 120 mg three times per day; pediatric dose 1 to 1.5 mg/kg (2.2 lb) of body weight three times a day.
Carbamazepine (Tegretol). Adult dose 400 to 1,200 mg a day in two to three divided doses; pediatric dose 10 to 20 mg/kg (2.2 lb) of body weight each day in two to three divided doses.
Levetiracetam (Keppra). Adult dose 500 to 1500 mg twice a day; pediatric dose 10 to 30 mg/kg (2.2 lb) of body weight twice a day.
FOR RELIEF FROM PAIN (SEE ALSO “FOR RELIEF FROM MUSCLE ACHES OR MINOR ARTHRITIS”)
Acetylsalicylic acid (aspirin). Adult dose 325 to 1,000 mg every 4 to 6 hours (maximum dose 4,000 mg per day); pediatric dose 60 mg (1 grain) per year of age (not to exceed 600 mg) every 4 to 6 hours.
Side effect: stomach irritation. Do not administer to a person with an ulcer or upset stomach. Take with food or an antacid, if possible. Enteric-coated aspirin (such as Ecotrin) helps prevent stomach irritation and should be used whenever possible. To avoid Reye syndrome (postviral encephalopathy and liver failure), do not use aspirin to control fever in a child under age 17.
Acetaminophen (Tylenol). Adult dose 500 to 1,000 mg every 4 to 6 hours (maximum dose 4,000 mg per day); pediatric dose: up to 1 year, 60 mg; 1 to 3 years, 60 to 120 mg; 3 to 6 years, 120 mg; 6 to 12 years, 240 mg.
Codeine. Adult dose 30 to 60 mg every 6 to 8 hours; pediatric dose 0.5 to 1 mg/kg (2.2 lb) of body weight.
Side effects: Codeine is a narcotic and has side effects of drowsiness and alteration of mental status. In addition, it may cause constipation.
Acetaminophen (Tylenol) 325 mg with codeine 30 mg. Adult dose 1 to 2 tablets every 4 to 6 hours.
Hydrocodone 5 mg with acetaminophen 500 mg (Vicodin). Adult dose 1 to 2 tablets every 4 to 6 hours. This is a narcotic drug and should not be taken in any situation where altered mental status will be dangerous.
Ketorolac (Toradol) 10 mg. Adult dose 1 tablet every 6 to 8 hours. This is an antiinflammatory drug that is particularly useful for persons suffering kidney stones.
FOR RELIEF FROM FEVER
Acetylsalicylic acid (aspirin). Same as “For Relief from Pain.” To avoid Reye syndrome (postviral encephalopathy and liver failure), do not use aspirin to control fever in a child under age 17.
Acetaminophen (Tylenol). Same as “For Relief from Pain.”
Ibuprofen (Motrin, Advil, Nuprin). Adult dose 400 to 600 mg every 4 to 6 hours; pediatric dose 5 to 10 mg/kg (2.2 lb) of body weight, not to exceed 400 mg.
FOR RELIEF FROM MUSCLE ACHES OR MINOR ARTHRITIS
Acetylsalicylic acid (aspirin). Same as “For Relief from Pain.”
Acetaminophen (Tylenol). Same as “For Relief from Pain.”
Nonsteroidal antiinflammatory drugs (“NSAIDs” should not be taken on an empty stomach; side effects are abdominal pain and diarrhea):
Ibuprofen (Motrin, Advil, Nuprin). Adult dose 400 to 800 mg every 6 to 8 hours.
Ketoprofen (Orudis KT, Actron). Adult dose 12.5 to 50 mg every 6 to 8 hours.
Naproxen (Naprosyn, Aleve). Adult dose 250 to 500 mg every 6 to 12 hours.
Naproxen sodium (Naprelan). Adult dose 375 or 500 mg sustained release every 24 hours.
Ketorolac (Toradol). Adult dose 10 mg every 8 to 12 hours; do not exceed 3 days’ consecutive use.
Diclofenac/misoprostol (Arthrotec). Adult dose 50 to 75 mg (based on diclofenac) every 6 to 8 hours. This drug should not be given to women who are pregnant or who may become pregnant, because misoprostol may induce a miscarriage.
Celecoxib (Celebrex). Adult dose 10 to 200 mg twice a day. This is a COX-2 antagonist drug. This drug is possibly associated with a higher incidence of heart attack in persons who use it.
Metaxalone (Skelaxin). Adult dose 800 mg 3 or 4 times a day for relief from acute painful muscle spasms.
FOR RELIEF FROM MIGRAINE HEADACHE
Sumatriptan oral tablets. Adult dose 50 to 100 mg every 2 hours, not to exceed 200 mg/24 hours.
Sumatriptan nasal spray. Adult dose 5 or 20 mg every 2 hours, not to exceed 40 mg/24 hours.
Zolmitriptan oral tablets. Adult dose 2.5 to 5 mg every 2 hours, not to exceed 10 mg/24 hours.
Zolmitriptan “melting” tablets. Adult dose 2.5 mg to dissolve under the tongue every 2 hours, not to exceed 10 mg/24 hours.
Rizatriptan oral tablets. Adult dose 5 or 10 mg every 2 hours, not to exceed 30 mg/24 hours. If propranolol is also taken, use the 5 mg dose.
Almotriptan oral tablets. Adult dose 6.25 or 12.5 mg every 2 hours, not to exceed 25 mg/24 hours.
Naratriptan oral tablets. Adult dose 1 or 2.5 mg every 4 hours, not to exceed 5 mg/24 hours.
Frovatriptan oral tablets. Adult dose 2.5 mg every 4 hours, not to exceed 5 mg/24 hours.
Eletriptan oral tablets. Adult dose 20 or 40 mg every 2 hours, not to exceed 80 mg/24 hours.
FOR RELIEF FROM ITCHING
Diphenhydramine (Benadryl). Same as “For Relief from a Mild Allergic Reaction.”
Hydroxyzine (Atarax). Adult dose 25 to 50 mg every 8 hours; pediatric dose: up to 6 years, 10 mg every 8 hours; 6 to 12 years, 10 to 25 mg every 8 hours.
FOR RELIEF FROM TOOTHACHE
Benzocaine-phenol-alcohol (Anbesol). For topical application to the gums.
Oil of cloves. For topical application to the gums.
FOR RELIEF FROM MOTION SICKNESS
Dimenhydrinate (Dramamine). Adult dose 50 mg every 4 to 6 hours; pediatric dose (8 to 12 years of age) 25 mg every 4 to 6 hours.
Side effect: drowsiness.
Meclizine (Antivert, Bonine). Adult dose 25 to 50 mg one to two times per day. Do not give this drug to children under age 12.
Side effect: drowsiness.
• Cyclizine (Marezine). Adult dose 25 mg; pediatric dose 12.5 mg for ages 9 to 12.
• Scopolamine (Transderm-Scōp Transdermal Therapeutic System). Adult dose: Apply 1 patch (1.5 mg scopolamine) on the hairless area behind the ear. A single patch is good for 3 days. Take care to wash the hands carefully after application of the patch, to avoid getting any medication in the eyes. Not approved for children under age 12.
Side effects: blurred vision, dry mouth, decreased sweating, difficulty with urination, propensity to heat illness, altered mental status. A diver who uses this preparation should be alert to the danger of heat illness while out of the water encased in a constrictive (heat-retaining) wet suit.
FOR RELIEF FROM NAUSEA AND VOMITING
Ondansetron (Zofran). Adult dose 4 or 8 mg tablet dissolved on the tongue every 8 hours; pediatric dose 0.15 mg/kg body weight of the oral dissolving tablet every 8 hours. This drug is also indicated for nausea and vomiting after surgery or associated with chemotherapy. It appears to be safe in children and in the elderly.
Prochlorperazine (Compazine). Adult dose 5 to 10 mg by mouth every 8 to 12 hours (by suppository 25 mg twice daily). Do not give this drug to children under age 12.
Side effects: neck spasms, difficulty in swallowing and talking (inability to control the tongue), restlessness, difficulty with eye movement, and muscle stiffness. These side effects may occur in combination (“dystonic reaction”). If any of these occur, discontinue use of the drug and administer diphenhydramine (Benadryl) 50 mg every 6 hours for four doses. If a child has a dystonic reaction, the dose of diphenhydramine (Benadryl) to alleviate the side effects is 1 mg/kg (2.2 lb) of body weight. Be certain that the victim is capable of purposeful swallowing.
Promethazine (Phenergan). Adult dose 25 mg every 6 to 8 hours (by suppository 12.5 to 25 mg every 12 hours); pediatric dose 0.25 to 0.5 mg/kg (2.2 lb) of body weight by mouth or per rectum (suppository).
Side effects: similar to those with prochlorperazine.
Trimethobenzamide (Tigan). Adult dose 250 mg by mouth or 200 mg by suppository every 6 to 8 hours.
Side effects: similar to those with prochlorperazine.
Cyclizine hydrochloride (Marezine). Adult dose 25 to 50 mg every 6 to 8 hours.
FOR RELIEF FROM DIARRHEA
Loperamide (Imodium or Pepto Diarrhea Control caplets). Adult dose 2 pills (2 mg each) initially, followed by 1 pill after each loose bowel movement, not to exceed 8 pills. With uncomplicated (no fever or blood in stools) watery diarrhea, this drug can be given to children age 2 years and older. The dose in children is 0.2 mg/kg (2.2 lb) of body weight every 6 hours. The liquid preparation contains 1 mg per 5 tsp (5 mL).
Diphenoxylate (Lomotil). Adult dose 2 tablets two to four times per day. Do not give this drug to children under age 18.
Bismuth subsalicylate (Pepto-Bismol). Adult dose 2 tbsp (30 mL) or 2 tablets every 30 to 60 minutes, not to exceed 8 to 10 doses; pediatric dose: 3 to 6 years, 1 tsp (5 mL) or ½ tablet; 6 to 10 years, 2 tsp (10 mL) or 1 tablet; 10 to 14 years, 4 tsp (20 mL) or 1½ tablets; may repeat dose in children every 1 hour, not to exceed four doses. This drug should not be given to people who are sensitive to aspirin-containing products, have kidney disease or gout, or who are taking anticoagulants, probenecid, or methotrexate.
Side effects: black discoloration of the tongue and bowel movements, ringing in the ears, nausea, and constipation.
Kaolin-pectin (Kaopectate). Adult dose 4 to 8 tbsp (60 to 120 mL) after each loose bowel movement; pediatric dose: 3 to 6 years, 1 to 2 tbsp (15 to 30 mL); 6 to 12 years, 2 to 4 tbsp (30 to 60 mL); older than 12 years, 4 tbsp (60 mL) after each loose bowel movement. This drug is of limited value; it does not shorten the course of diarrheal illness, and acts only to add a little consistency to stools.
FOR RELIEF FROM CONSTIPATION
Mineral oil. Adult dose 1 to 2 tbsp (15 to 30 mL); pediatric (older than 5 years) dose 1 to 2 tsp (5 to 10 mL). This drug is a mild laxative.
Docusate sodium (Colace). Adult dose 100 mg twice a day; pediatric dose 0.3 mg/kg (2.2 lb) of body weight once or twice a day. The dose should be adjusted to the response. This drug is a stool softener.
Docusate sodium (stool softener) with casanthranol (laxative) (Peri-Colace). Adult dose 1 capsule once or twice a day.
Docusate sodium (stool softener) 5 mL microenema. Adult dose 200 mg (one enema) once a day as necessary.
Docusate calcium (stool softener) (Surfak Stool Softener Gel Cap). Adult dose 240 mg once or twice a day.
Senna extract (Senokot). Two tablets a day at bedtime. This drug is a mild laxative.
Magnesium hydroxide (Phillips’ Milk of Magnesia). Adult dose 1 to 2 tbsp (15 to 30 mL) once or twice a day. This drug is a mild laxative.
Magnesium citrate (Evac-Q-Mag). Adult dose 10 to 20 tbsp (150 to 300 mL) as needed.
Lactulose syrup, USP (Duphalac). Adult dose 1 to 2 tbsp (15 to 30 mL) daily. This drug is a mild laxative.
Bisacodyl (Dulcolax). Adult dose two 5 mg tablets or one 10 mg suppository. This drug is a moderate laxative. A child age 6 to 12 years may take one 5 mg tablet.
Cascara sagrada 150 mg; aloe 100 mg (Nature’s Remedy) (laxative). Adult dose 2 tablets a day.
Psyllium mucilloid (Metamucil, Perdiem, Fiberall). Adult dose titrate up to 20 grams per day. These natural psyllium fiber products increase the bulk of the stool, and should be ingested with at least a quart (liter) of liquid.
Methylcellulose (Citrucel). Adult dose titrate up to 20 grams per day.
Polycarbophil (Fibercon, Equalactin, Konsyl). Adult dose titrate up to 20 grams per day.
Lactulose. 10 mg/15 mL of syrup. Adult dose 15 to 30 mL per day, up to 60 mL per day.
Polyethylene glycol solution (MiraLax). 17 g powder (1 heaping tbsp) dissolved in 8 oz (240 mL) water, taken once per day for up to 4 days to produce a bowel movement.
FOR RELIEF FROM ULCER PAIN
Mylanta II. Adult dose 2 tbsp (30 mL) or 2 tablets (chewed) 1 and 3 hours after meals, at bedtime, and as needed. This is a mixture of aluminum hydroxide, magnesium hydroxide, and simethicone.
Rolaids. Adult dose 1 to 2 tablets (chewed) after meals as necessary. These contain dihydroxy-aluminum sodium carbonate. Because of the relatively high sodium content, these should not be used routinely by people with congestive heart failure (see page 47).
Cimetidine (Tagamet). Adult dose 300 mg three times a day with meals and at bedtime. This H2RA (antagonist to histamine H2 receptor) drug decreases the secretion of gastric acid.
Ranitidine hydrochloride (Zantac). Adult dose 75 to 150 mg two times a day. This H2RA drug decreases the secretion of gastric acid.
Famotidine (Pepcid). Adult dose 20 mg twice a day or 40 mg at bedtime for 4 weeks to treat an active duodenal ulcer, then 20 mg at bedtime for 2 to 4 weeks for suppression therapy to diminish the secretion of gastric acid. This H2RA drug decreases the secretion of gastric acid.
Propantheline bromide (Pro-Banthine). Adult dose 7.5 to 15 mg three times a day before meals and at bedtime. This drug is used to control gastric acid secretion and to reduce bowel activity (decrease cramping).
Sucralfate (Carafate). Adult dose 1 tablet (gram) 1 hour before meals and at bedtime. This drug binds to the ulcer crater, and therefore requires the presence of acid to work properly. Thus, antacids should not be ingested within 30 minutes before or after the ingestion of sucralfate.
Omeprazole (Prilosec). Adult dose 1 capsule (20 mg) a day given 30 minutes before a meal. This PPI (proton [acid] pump inhibitor) drug diminishes gastric acid secretion.
FOR RELIEF FROM INDIGESTION OR GAS PAINS
Antacid (such as Mylanta II). Same as “For Relief from Ulcer Pain.”
Simethicone (Mylicon-80). Adult dose 1 to 2 tablets (chewed) after meals and at bedtime.
FOR RELIEF FROM HEARTBURN (REFLUX ESOPHAGITIS)
Omeprazol (Prilosec). Adult dose 10 to 20 mg once a day.
Antacid (such as Mylanta II). Same as “For Relief from Ulcer Pain.”
Ranitidine hydrochloride (Zantac). Adult dose 75 mg every 12 hours as needed. This H2RA (antagonist to histamine H2 receptor) drug decreases the secretion of gastric acid.
Cimetidine (Tagamet HB). Adult dose 200 mg (two 100 mg tablets) 30 to 60 minutes before a meal, not to exceed twice in a 24-hour period. This H2RA drug decreases the secretion of gastric acid.
Famotidine (Pepcid AC). Adult dose 10 to 20 mg as 10 mg chewable tablet or gelcap twice a day for up to 6 weeks.
Gaviscon or Gaviscon II. Adult dose 1 to 2 tablets (chewed) or 1 to 2 tbsp (15 to 30 mL) (liquid preparation) after each meal and at bedtime. This is a mixture of aluminum hydroxide, magnesium trisilicate, sodium bicarbonate, and alginic acid.
Metoclopramide hydrochloride (Reglan). Adult dose 10 mg up to four times a day, 30 minutes before meals and at bedtime.
Side effects: rarely, neck spasms, difficulty in swallowing and talking (inability to control the tongue), difficulty with eye movement, and muscle stiffness. These side effects may occur in combination (“dystonic reaction”). If any of these occur, discontinue use of the drug and administer diphenydramine (Benadryl) 50 mg every 6 hours for four doses. Be certain that the victim is capable of purposeful swallowing.
FOR RELIEF FROM NASAL CONGESTION
Pseudoephedrine (Sudafed). Adult dose 30 to 60 mg every 6 to 8 hours; pediatric dose 1 mg/kg (2.2 lb) of body weight. THE U.S. FDA RECOMMENDS THAT THIS DRUG NOT BE USED IN CHILDREN UNDER 6 YEARS OF AGE.
Phenylephrine hydrochloride 0.25% nasal spray (Neo-Synephrine ¼%). Adult dose 2 to 3 drops or sprays twice a day; pediatric dose (older than 6 years) 0.125% two drops twice a day. Do not use this drug for more than 3 consecutive days, to avoid “rebound” swelling of the nasal passages from chemical irritation and sensitization to the medicine.
Oxymetazoline hydrochloride 0.05% (Afrin). Adult dose 2 to 3 drops or sprays twice a day; pediatric dose (older than 6 years) two 0.025% (half-strength) drops twice a day. Do not use this drug for more than 3 consecutive days, to avoid “rebound” swelling of the nasal passages from chemical irritation and sensitization to the medicine.
FOR RELIEF FROM COUGH
A U.S. FOOD AND DRUG ADMINISTRATION ADVISORY PANEL IN 2007 RECOMMENDED THAT THERE IS NO EVIDENCE THAT OVER-THE-COUNTER COLD AND COUGH MEDICINES WORK IN CHILDREN AND THAT THE PRODUCTS SHOULD NOT BE GIVEN TO CHILDREN YOUNGER THAN 6 YEARS OF AGE.
Glyceryl guaiacolate (Robitussin) expectorant. Adult dose 1 tsp (5 mL) every 3 to 4 hours.
Robitussin A-C: plus codeine (cough suppressant).
Robitussin-DAC: plus codeine, pseudoephedrine (decongestant).
Robitussin-PE: plus pseudoephedrine.
Robitussin-DM: plus dextromethorphan (cough suppressant).
Codeine. Adult dose 15 to 30 mg every 4 to 6 hours. This is a potent cough suppressant.
CoTylenol Liquid Cold Formula. Adult dose 2 tbsp (30 mL) every 6 hours. Two tbsp (30 mL) contains dextromethorphan hydrobromide 30 mg (for cough), acetaminophen 650 mg (for fever, aches), chlorpheniramine maleate (antihistamine) 4 mg, and pseudoephedrine hydrochloride (decongestant) 60 mg.
Dextromethorphan hydrobromide–guaifenesin (Vicks Cough Syrup). Adult dose 2 to 3 tsp (10 to 15 mL) every 4 to 6 hours.
Dextromethorphan hydrobromide–guaifenesin–phenylpropanolamine (Naldecon cough syrup). Adult dose 1 tsp (5 mL) every 4 hours.
Buckwheat honey. Dose one to two teaspoons for children ages 2 to 18 years. It is not advised to feed honey to infants or children younger than 12 months of age because of the risk for infant botulism.
Mucinex (guaifenesin 600 mg). This drug is taken every 12 hours and works to help loosen phlegm (mucus) and thin bronchial secretions to rid the bronchial passageways of bothersome mucus and make coughs more productive.
FOR RELIEF FROM SORE THROAT
Benzocaine-hexylresorcinol (Sucrets antiseptic throat lozenges).
Benzocaine-cetylpyridinium (Cēpacol lozenges, Vicks lozenges).
COLD FORMULAS
A U.S. FOOD AND DRUG ADMINISTRATION ADVISORY PANEL IN 2007 RECOMMENDED THAT THERE IS NO EVIDENCE THAT OVER-THE-COUNTER COLD AND COUGH MEDICINES WORK IN CHILDREN AND THAT THE PRODUCTS SHOULD NOT BE GIVEN TO CHILDREN YOUNGER THAN 6 YEARS OF AGE.
Contac. Phenylpropanolamine (decongestant), chlorpheniramine (antihistamine).
Contac Severe Cold Formula. Pseudoephedrine (decongestant), chlorpheniramine, acetaminophen (for fever, aches), dextromethorphan (for cough).
Chlor-Trimeton. Chlorpheniramine.
Chlor-Trimeton Decongestant. Chlorpheniramine, pseudoephedrine.
Coricidin. Chlorpheniramine, aspirin.
Coricidin D. Phenylpropanolamine, chlorpheniramine, aspirin.
CoAdvil. Ibuprofen (for fever, aches), pseudoephedrine.
CoTylenol. See “For Relief from Cough.”
Dristan. Phenylephrine (decongestant), chlorpheniramine, aspirin, caffeine.
Dristan Time Capsule. Phenylephrine, chlorpheniramine.
TheraFlu. Acetaminophen, pseudoephedrine, chlorpheniramine.
SKIN MEDICATIONS
Antiseptic Ointments, Solutions, and Scrubs
Apply ointments thinly to the skin twice a day.
Bacitracin antiseptic ointment.
Bacitracin–polymyxin B sulfate (Polysporin) ointment.
Mupirocin (Bactroban) 2% ointment.
Mupirocin (Bactroban) calcium 2% cream.
Bacitracin–polymyxin B sulfate–neomycin (Neosporin, Triple Antibiotic, or Mycitracin) ointment.
Neomycin-gramicidin (Spectrocin) ointment.
Neomycin (Myciguent) ointment.
Retapamulin 1% (Altabax) ointment.
Povidone iodine 0.5% (Betadine First Aid) cream.
Silver sulfadiazine (Silvadene) cream. Soothing antiseptic cream for burns; apply to the skin once or twice a day. Do not use in children younger than 2 years. Avoid use on the face.
Benzalkonium chloride (Zephiran) antiseptic solution (1:750 dilution in water). May be used full strength to clean unbroken skin, but should be diluted 1:2 or 1:3 with water to swab an open wound or animal bite (to kill rabies virus).
Hexachlorophene scrub (pHisoHex). Use as a scrubbing soap on cuts, scrapes, and infected skin. Do not use on children under 1 year of age.
Povidone iodine (Betadine) antiseptic solution. Use in a 1:10 dilution with water to gently scrub cuts and scrapes.
Anti-Itch, Anti-Sting
Campho-Phenique. Topical anti-itch gel medication consisting of camphorated phenol in mineral oil.
Campho-Phenique Maximum Strength ointment or Neosporin Plus ointment or Mycitracin Plus ointment. Topical anti-itch and antiseptic medication consisting of lidocaine hydrochloride, bacitracin zinc, neomycin sulfate, and polymyxin B sulfate.
Lidocaine hydrochloride 2.5% anesthetic ointment. Use for relief from pain due to scrapes; apply to the skin and leave in place for 10 minutes before scrubbing. Do not apply if the area to be covered is greater than 5% of the total body surface area (an area approximately four to five times the size of the victim’s palm).
Benzalkonium chloride 0.13%; lidocaine hydrochloride 2.5% (Bactine solution). Very mild antiseptic-anesthetic combination available over the counter. May be used to swab animal bites if Zephiran is not available.
Calamine lotion. Apply thinly as a drying agent two to three times a day to skin affected with poison ivy, oak, or sumac.
Phenolated (1%) calamine lotion. Apply thinly as a drying agent two to three times a day to skin affected with poison ivy, oak, or sumac.
Calamine–pramoxine hydrochloride 1% (Caladryl). Apply thinly as a drying agent two to three times a day to skin affected with poison ivy, oak, or sumac.
Hydrocortisone and pramoxine (Pramosone). Topical anti-itch medication for skin rashes due to plant allergy, insect bites, or sunburn. Apply two to three times a day.
Antifungal Cream, Lotion, Pill, Spray and Powder
Apply to the skin two to three times a day for athlete’s foot or jock itch.
Tolnaftate 1% (Tinactin, Aftate).
Terbinafine 1% cream or spray (Lamisil).
Clotrimazole 1% (Lotrimin, Mycelex).
Zinc undecylenate (Desenex).
Miconazole nitrate 2% (Micatin).
Nizoral cream. Apply thinly once or twice a day to treat yeast or fungal infection.
Nizoral. 400 mg one oral dose for tinea versicolor (harmless yeast overgrowth on the skin); induce mild sweating 2 to 4 hours after dose; don’t shower for 8 hours after dose (the drug is excreted in sweat).
Spectizole cream. Apply thinly once or twice a day to treat yeast or fungal infection.
Anti-Mites
Permethrin 5% cream (Elimite). Apply to entire skin, leave on for 8 hours, and then shower for treatment of scabies; appears to be safe in pregnant women and children over 2 months of age.
Permethrin 1% creme rinse (Nix). Apply to washed and towel-dried hair, leave on for 10 minutes, and then rinse thoroughly and comb out nits for treatment of head lice.
Malathion (Ovide). Apply to dry hair, leave on without occlusion for 8 to 12 hours, and then shampoo and rinse thoroughly and comb out nits for treatment of head lice.
Crotamiton (Eurax). For topical use only. To treat scabies, take a bath or shower. Apply the medication over the whole body from the chin down. Rub in gently, paying special attention to skin folds and creases. Trim fingernails and apply the medication under the nails. Change all clothing and bed linens the next morning and wash them in the hot cycle of the washing machine. A second application of the medication should be done in 24 hours. Take a good cleaning bath or shower 48 hours after the last application. To relieve dry skin, apply a small amount of the medication to the affected area and rub it in gently until it disappears. Avoid use on open, irritated, or inflamed skin. Avoid use near the eyes, mouth, or vagina.
Topical Steroids
Hydrocortisone 1% cream, 2.5% cream (Hytone). Safe for infants, face, perianal area, skin folds.
Triamcinolone 0.1% ointment. Often mixed with Eucerin cream 1:1; moisturizer increases penetration’too potent for face, genitalia, or infants.
FOR SLEEP
Diphenhydramine (Benadryl, Sominex, Nytol). Adult dose 50 mg at bedtime.
Triazolam (Halcion). Adult dose 0.125 to 0.25 mg at bedtime. This is short-acting and may be a better choice at high altitude.
Side effects: short-term memory loss, bad dreams.
Zolpidem tartrate (Ambien). Adult dose 5 to 10 mg, or 6.25 mg or 12.5 mg extended release, at bedtime. There have been rare reports of hallucinations in people who took higher doses; elders may be prone to such a reaction.
Zaleplon (Sonata). Adult dose 10 mg at bedtime. The dose is 5 mg for elderly, debilitated, or liver-impaired adults.
Eszopiclone (Lunesta). Adult dose 1, 2, or 3 mg at bedtime.
Ramelteon (Rozerem). Adult dose 8 mg at bedtime.
Temazepam (Restoril). Adult dose 15 to 30 mg at bedtime.
Flurazepam (Dalmane). Adult dose 15 to 30 mg at bedtime.
Melatonin. The hormone melatonin is endogenously produced by humans in the pineal gland from the precursor tryptophan. Melatonin levels in the blood increase and are highest during normal hours of sleep, decreasing toward morning.
Sold over the counter, melatonin is considered a “dietary supplement,” and thus does not come under the scrutiny of the Food and Drug Administration. The science supporting its use to induce sleep, decrease wakefulness during sleep, and decrease jet lag is preliminary and suggests that it might be beneficial, without any obvious adverse effects. The doses cited range from 1 mg to 5 mg administered orally 1 to 2 hours before going to bed.
ANTIBIOTICS
Amoxicillin. Adult dose 250 to 500 mg every 8 hours; pediatric dose 10 to 15 mg/kg (2.2 lb) of body weight every 8 hours (three times a day).
Amoxicillin-clavulanate (Augmentin). Adult dose 500 to 875 mg two times a day; pediatric dose 25 to 45 mg/kg (2.2 lb) of body weight in two divided doses per day. For otitis media in children, use the higher dose.
Ampicillin. Same dose as phenoxymethyl penicillin (see below).
Azithromycin (Zithromax). Adult dose 500 mg day 1, then 250 mg per day for 4 additional days; pediatric dose 10 mg/kg (2.2 lb) of body weight day 1, then 5 mg/kg body weight for 4 additional days.
Cefadroxil (Duricef). Adult dose 500 mg to 1 g twice a day. For pharyngitis, to eradicate the group A streptococcus, an acceptable dose is 1 g once a day for 10 days. Pediatric dose: for skin infections, 30 mg/kg (2.2 lb) of body weight per day in two divided doses; for pharyngitis, administer in a single dose or two divided doses for 10 days.
Cefdinir. Adult dose 300 mg twice per day; pediatric dose 7 mg/kg (2.2 lb) of body weight twice per day.
Cefixime. Adult dose 400 mg per day; pediatric dose 8 mg/kg (2.2 lb) of body weight once per day; no refrigeration needed’discard 14 days after the dry powder is reconstituted with water.
Cefuroxime axetil. Adult dose 500 mg twice a day; pediatric dose 30 mg/kg (2.2 lb) of body weight in two divided doses a day.
Cefpodoxime (Vantin). Adult dose 200 to 400 mg twice a day for pneumonia.
Cefprozil (Cefzil). Adult dose 500 g once a day; pediatric dose 7.5 to 15 mg/kg (2.2 lb) of body weight twice per day.
Cephalexin (Keflex). Adult dose 250 mg every 4 to 6 hours or 500 mg every 12 hours; pediatric dose the same as for phenoxymethyl penicillin. Avoid use in a person with penicillin allergy, because 5% to 10% of those allergic to penicillin are also allergic to cephalosporins.
Ciprofloxacin (Cipro). Adult dose 500 mg twice a day for 3 days to treat infectious diarrhea. This drug should not be given to pregnant women or children under age 18. This drug should not be administered to someone with myasthenia gravis, because of the possibility of a prolonged myasthenic crisis.
Clarithromycin (Biaxin). Adult dose 500 mg twice a day; pediatric dose 15 mg/kg (2.2 lb) of body weight in two divided doses per day.
Clindamycin (Cleocin). Adult dose 300 mg three times a day; pediatric dose 30 mg/kg (2.2. lb) of body weight in three or four divided doses per day.
Dicloxacillin. Same dose as phenoxymethyl penicillin (below).
Doxycycline (Vibramycin). Adult dose 100 mg twice a day for treatment, or once a day for prevention, of infectious diarrhea. Do not give to pregnant women or children up to age 7 years, because this drug may cause permanent dark discoloration of the teeth. Children above age 7 years may take 2 to 4 mg/kg (2.2 lb) of body weight in two or four divided doses.
Erythromycin. Same dose as phenoxymethyl penicillin (see below). Common side effects are stomach upset and diarrhea. This drug is the first alternative to penicillin in penicillin-allergic individuals. This drug should not be taken in combination with nitroimidazole antifungal agents (ketoconazole, itraconazole, fluconazole), diltiazem, verapamil, or troleandomycin because of a potential interaction that might cause a serious abnormal heart rhythm associated with sudden death.
Fleroxacin. Adult dose 400 mg once a day for 3 days for the treatment of infectious diarrhea. This drug should not be administered to someone with myasthenia gravis, because of the possibility of a prolonged myasthenic crisis.
Levofloxacin. Adult dose 250 to 500 mg once a day. This drug should not be administered to someone with myasthenia gravis, because of the possibility of a prolonged myasthenic crisis.
Linezolid (Zyvox). Adult dose 400 to 600 mg twice a day for MRSA infection; pediatric dose 30 mg/kg (2.2 lb) of body weight in three divided doses.
Metronidazole (Flagyl). Adult dose 250 mg three times a day. Do not drink alcohol when taking this medication and for 3 days afterward; the interaction would cause severe abdominal pain, nausea, and vomiting.
Noroxin. Adult dose 400 mg every 12 hours. This drug should not be administered to someone with myasthenia gravis, because of the possibility of a prolonged myasthenic crisis.
Ofloxacin. Adult dose 300 to 400 mg every 12 hours. This drug should not be administered to someone with myasthenia gravis, because of the possibility of a prolonged myasthenic crisis.
Phenoxymethyl penicillin (Penicillin VK). Adult dose 250 to 500 mg every 4 to 6 hours; pediatric dose: 2 to 6 years, 125 mg every 6 to 8 hours; 6 to 10 years, 250 mg every 6 to 8 hours. For pharyngitis, to eradicate the group A streptococcus, an acceptable adult dose is 1 g twice a day for 10 days. Swelling of the lips, eyes, and mucous membranes occurs in about 1 per 10,000 courses of penicillin.
Rifampin (Rifadin). Adult and pediatric dose 20 mg/kg (2.2 lb) of body weight per day in two or four divided doses, not to exceed 600 mg per day.
Rifaximin. Adult dose 200 mg three times a day for traveler’s diarrhea.
Sparfloxacin (Zagam). Adult dose 400 mg day 1, then 200 mg each day. This drug should not be administered to someone with myasthenia gravis, because of the possibility of a prolonged myasthenic crisis.
Sulfisoxazole (Gantrisin). Pediatric dose 150 mg/kg (2.2 lb) of body weight in four to six divided doses a day, not to exceed 6 gm per day.
Telithromycin (Ketek). Adult dose 800 mg once a day.
Tetracycline. Adult dose 500 mg four times a day. Do not give to pregnant women or children up to age 7, because this drug may cause permanent dark discoloration of the teeth.
Tinidazol (Tiniba, Fasgyn). Adult dose 2 g in a single dose; pediatric dose 50 mg/kg (2.2 lb) of body weight in a single dose
Trimethoprim-sulfamethoxazole (Bactrim or Septra DS [double strength]). Adult dose 1 pill (80 mg trimethoprim with 400 mg sulfamethoxazole) twice a day for infectious diarrhea or bladder infection; 1 pill once a day for prevention of traveler’s diarrhea. The pediatric dose for an ear infection, MRSA infection, or severe infectious diarrhea (caused by Shigella bacteria) is 1 tsp (5 mL) of the pediatric suspension per 10 kg (22 lb) of body weight every 12 hours (twice a day), not to exceed 4 tsp (20 mL) (the adult dose) per dose. More precisely, the pediatric dose is 4 mg/kg/dose trimethoprim (TMP) with 20 mg/kg/dose sulfamethoxazole (SMX).
Trovafloxacin (Trovan). Adult dose 200 mg once a day for 10 days to treat acute sinusitis. This drug should not be administered to someone with myasthenia gravis, because of the possibility of a prolonged myasthenic crisis.