CABAZITAXEL (JEVTANA)
WARNING: Neutropenic deaths reported; check CBCs, CI w/ ANC ≤1,500 cells/mm3; severe hypersens (rash/erythema, ↓ BP, bronchospasm) may occur, D/C drug & Tx; CI w/ Hx of hypersens to cabazitaxel or others formulated w/ polysorbate 80.
USES: *Hormone refractory metastatic PCa after taxotere.*
ACTIONS: Microtubule inhibitor.
DOSE: 25 mg/m2 IV Inf (over 1 hr) q3wk w/ prednisone 10 mg PO daily; premed w/ antihistamine, corticosteroid, H2 antagonist; do not use w/ bili >ULN, AST/ALT ≥1.5 × ULN.
W/P: [D, ?/−] w/ CYP3A inhibitor/inducers.
CI: See “Warning"
DISP: 40 mg/mL Inj.
SE: ↓ WBC, ↓ Hgb, ↓ plt, sepsis, N/V/diarrhea, constipation, Abdominal/back/jt pain, dysgeusia, fatigue, hematuria, neuropathy, anorexia, cough, dyspnea, alopecia, pyrexia, hypersens reaction, renal failure.
NOTES: Monitor closely pts >65 yr.
CALCITONIN (FORTICAL, MIACALCIN)
USES: Miacalcin: *Paget disease, emergent Treat hypercalcemia, postmenopausal osteoporosis*; Fortical: *Postmenopausal osteoporosis.*
ACTIONS: Polypeptide hormone (salmon derived), inhibits osteoclasts.
DOSE: Paget disease: 100 U/d IM/SQ initial, 50 U/d or 50–100 units q1–3d maint. Hypercalcemia: 4 U/kg IM/SQ q12h; ↑ to 8 U/kg q12h, max. q6h. Osteoporosis: 100 U/q other day IM/SQ; intranasal 200 U = 1 nasal spray/d.
W/P: [C, ?].
DISP: Fortical, Miacalcin nasal spray 200 IU/activation; Inj, Miacalcin 200 U/mL (2 mL).
SE: Facial flushing, N, Inj site edema, nasal irritation, polyuria, may ↑ granular casts in urine.
NOTES: For nasal spray alternate nostrils daily; ensure adequate calcium and vit D intake; Fortical is rDNA derived from salmon.
CALCITRIOL (ROCALTROL, CALCIJEX)
USES: *Predialysis reduction of ↑ PTH levels to treat bone disease; ↑ Ca2+ on dialysis.*
ACTIONS: 1,25-Dihydroxycholecalciferol (vit D analog); ↑ Ca2+ and phosphorus absorption; ↑ bone mineralization.
DOSE:
Adults: Renal failure: 0.25 μg/d PO, ↑ 0.25 μg/d q4–8wk PRN; 0.5–4 μg 3×/wk IV, ↑ PRN. Hypoparathyroidism: 0.5–2 μg/d.
Peds: Renal failure: 15 ng/kg/d, ↑ PRN; maint 30–60 ng/kg/d. Hypoparathyroidism: <5 yr: 0.25–0.75 μg/d. >6 yr: 0.5–2 μg/d.
W/P: [C, ?] ↑ Mg2+ possible w/ antacids.
CI: ↑ Ca2+; vit D tox.
DISP: Inj 1 μg/mL (in 1 mL); caps 0.25, 0.5 μg; soln 1 μg/mL.
SE: ↑ Ca2+ possible.
NOTES: Check to keep Ca2+ WNL; use nonaluminum phosphate binders and low phosphate diet to control serum phosphate discomfort.
CALCIUM ACETATE (PHOSLO)
USES: *ESRD-associated hyperphosphatemia.*
ACTIONS: Ca2+ supl w/o aluminum to ↓ PO4 absorption.
DOSE: 2–4 tabs PO w/ meals; usual 2,001–2,668 mg PO w/ meals.
W/P: [C, +].
CI: ↑ Ca2+ renal calculi.
DISP: Gel-Cap 667 mg.
SE: Can ↑ Ca2+, hypophosphatemia, constipation.
NOTES: Monitor Ca2+.
CALCIUM CARBONATE (TUMS, ALKA-MINTS) [OTC]
USES: *Hyperacidity-associated w/ peptic ulcer disease, hiatal hernia, etc.*, calcium supplementation.
ACTIONS: Neutralizes gastric acid.
DOSE: 500 mg–2 g PO PRN, 7 g/d max.; ↓ w/ renal impairment.
W/P: [C, ?].
CI: ↑ cancer, ↓ phos, renal calculi, suspected digoxin tox.
DISP: Chew tabs 350, 420, 500, 550, 750, 850 mg; susp.
SE: ↑ Ca2+, ↓ PO 4-, constipation.
CALCIUM GLUBIONATE (CALCIONATE) [OTC]
USES: *Treat & prevent calcium deficiency.*
ACTIONS: Calcium supplement.
DOSE:
Adults: 1,000–1,200 mg/d ÷ doses.
Peds: 200–1,300 mg/d.
W/P: [C, ?].
DISP: OTC syrup 1.8 g/5 mL = elemental Ca 115 mg/5 mL.
SE: ↑ Ca2+, ↓ PO4-, constipation.
CALCIUM SALTS (CHLORIDE, GLUCONATE, GLUCEPTATE)
USES: *Calcium replacement*, VF, calcium blocker tox (calcium channel blocker),* severe ↑ hypermagnesemic tetany, hyperphosphatemia in ESRD.*
ACTIONS: calcium supl/replacement.
DOSE:
Adults: Replacement: 1–2 g/d PO. Tetany: 1 g CaCl over 10–30 min; repeat in 6 hr PRN; Hyperkalemia/hypermagnesemia/calcium channel blocker overdose: 500–1,000 mg (5–10 mL of 10% soln) IV; repeat PRN; comparable dose of 10% calcium gluconate is 15–30 mL.
Peds: Tetany: 10 mg/kg CaCl over 5–10 min; repeat in 6–8 hr or use Inf (200 mg/kg/d max.). Hyperkalemia/hypermagnesemia/calcium channel blocker overdose: Calcium chloride or gluconate 20 mg/kg (0.2 mL/kg) slow IV/IO, repeat PRN; central venous route preferred.
Adults & Peds: ↓ calcium d/t citrated blood Inf: 0.45 mEq Ca/100 mL citrated blood Inf (↓ in renal impairment).
W/P: [C, ?].
CI: ↑ Ca2+, suspected digoxin tox.
DISP: CaCl Inj 10% = 100 mg/mL = Ca 27.2 mg/mL = 10-mL amp; Ca gluconate Inj 10% = 100 mg/mL = Ca 9 mg/mL; tabs 500 mg = 45-mg Ca, 650 mg = 58.5-mg Ca, 975 mg = 87.75-mg Ca, 1 g = 90-mg Ca; Ca gluceptate Inj 220 mg/mL = 18-mg/mL Ca.
SE: ↓ HR, cardiac arrhythmias, ↑ Ca2+, constipation.
NOTES: CaCl 270 mg (13.6 mEq) elemental Ca/g & calcium gluconate 90 mg (4.5 mEq) Ca/g. RDA for Ca intake: Peds <6 mo: 200 mg/d; 6 mo–1 yr: 260 mg/d; 1–3 yr: 700 mg/d; 4–8 yr: 1,000 mg/d; 10–18 yr: 1,300 mg/d.Adults:, 000 mg/d; >50 yr: 1,200 mg/d.
CAPTOPRIL (CAPOTEN, OTHERS)
USES: *HTN, CHF, MI*, LVD, diabetic nephropathy.
ACTIONS: ACE inhibitor.
DOSE:
Adults: HTN: Initial, 25 mg PO BID–TID; ↑ to maint q1–2wk by 25 mg increments/dose (max. 450 mg/d) to effect. CHF: Initial, 6.25–12.5 mg PO TID; titrate PRN LVD: 50 mg PO TID. DN: 25 mg PO TID.
Peds: Infants: 0.15–0.3 mg/kg/dose PO ÷ 1–4 doses; Children: Initial, 0.3–0.5 mg/kg/dose PO; ↑ to 6 mg/kg/d max. in 2–4 ÷ doses; 1 hr ac; ↓ dose renal impairment.
W/P: [D, −].
CI: Hx Angioedema.
DISP: Tabs 12.5, 25, 50, 100 mg.
SE: Rash, proteinuria, cough, ↑ K+.
CARBOPLATIN (GENERIC)
WARNING: Administration only by physician experienced in cancer chemotherapy; ↓ PLT, anemia, ↑ infection; BM suppression possible; anaphylaxis and V may occur.
USES: *Ovarian*, lung, head & neck, testicular, urothelial, & brain cancer, NHL & allogeneic & ABMT in high doses.
ACTIONS: DNA cross-linker; forms DNA-platinum adducts.
DOSE: Per protocols based on target (Calvert formula: mg = AUC × [25 + calculated GFR]); adjust based on plt count, CrCl, & BSA (Egorin formula); up to 1,500 mg/m2 used in ABMT setting (per protocols).
W/P: [D, ?] severe hepatic tox.
CI: Severe BM suppression, excessive bleeding.
DISP: Inj 50-, 150-, 450-, 650-mg vial (10 mg/mL).
SE: Pain, ↓ Na+/Mg2+/Ca2+/K+, anaphylaxis, ↓ BM, N/V/diarrhea, nephrotoxic, hematuria, neurotox, ↑ LFTs.
NOTES: Physiologic dosing based on Calvert or Egorin formula allows ↑ doses w/ ↓ tox.
CASPOFUNGIN (CANCIDAS)
USES: *Invasive aspergillosis refractory/intolerant to standard Treat, candidemia & other candida Inf*, empiric Treat in febrile neutropenia w/ presumed fungal infection.
ACTIONS: Echinocandin; ↓ fungal cell wall synth; highest activity in regions of active cell growth.
DOSE: 70 mg IV load day 1, 50 mg/d IV; slow Inf over 1 hr; ↓ in hepatic impairment.
W/P: [C, ?/−] Do not use w/ cyclosporine.
CI: Allergy to any component.
DISP: Inj 50, 70 mg powder for recons.
SE: Fever, headache, N/V, thrombophlebitis at site, ↑ LFTs ↓ BP, edema, ↑ HR, rash, ↓ K, diarrhea, Inf reaction.
NOTES: Monitor during Inf; limited experience beyond 2 wk of Treat.
CEFACLOR (GENERIC)
USES: *Bacterial infections of the upper & lower resp tract, skin, bone, urinary tract.*
ACTIONS: 2nd-gen cephalosporin; ↓ cell wall synth. Spectrum: More gram(−) activity than 1st-gen cephalosporins; effective against gram(+) (Streptococcus sp, S. aureus); good gram(−) against H. influenzae, E. coli, Klebsiella, Proteus.
DOSE:
Adults: 250–500 mg PO > q8h.
Peds: 20–40 mg/kg/d PO ÷ 8–12 hr; ↓ renal impairment.
W/P: [B, M].
CI: Cephalosporin/PCN allergy.
DISP: Caps 250, 500 mg; tabs ER 500 mg; susp 125, 250, 375 mg/5 mL.
SE: N/diarrhea, rash, eosinophilia, ↑ LFTs, headache, rhinitis, vaginitis.
CEFADROXIL (GENERIC)
USES: *Infections skin, bone, upper & lower resp tract, urinary tract.*
ACTIONS: 1st-gen cephalosporin; ↓ cell wall synth. Spectrum: Good gram(+) (group A β-hemolytic Streptococcus, Staphylococcus); gram(−) (E. coli, Proteus, Klebsiella).
DOSE:
Adults: 1–2 g/d PO, 2 ÷ doses.
Peds: 30 mg/kg/d ÷ BID; ↓ in renal impairment.
W/P: [B, M].
CI: Cephalosporin/PCN allergy.
DISP: Caps 500 mg; tabs 1 g; susp, 250, 500 mg/5 mL.
SE: N/V/diarrhea, rash, eosinophilia, ↑ LFTs.
CEFAZOLIN (ANCEF, KEFZOL, GENERIC)
USES: *Infections of skin, bone, upper & lower resp tract, urinary tract.*
ACTIONS: 1st-gen cephalosporin; β-lactam ↓ cell wall synth. Spectrum: Good gram(+) bacilli & cocci (Streptococcus, Staphylococcus [except Enterococcus]); some gram(−) (E. coli, Proteus, Klebsiella).
DOSE:
Adults: 1–2 g IV q8h.
Peds: 25–100 mg/kg/d IV ÷ q6–8h; ↓ in renal impairment.
W/P: [B, M].
CI: Cephalosporin/PCN allergy.
DISP: Inj.
SE: Diarrhea, rash, eosinophilia, ↑ LFTs, Inj site pain.
NOTES: Widely used for surgical prophylaxis.
CEFDINIR (GENERIC)
USES: *Infections of the resp tract, skin, and skin structure.*
ACTIONS: 3rd-gen cephalosporin; ↓ cell wall synth. Spectrum: Many gram(+) & (−) organisms; more active than cefaclor & cephalexin against Streptococcus, Staphylococcus; some anaerobes.
DOSE:
Adults: 300 mg PO BID or 600 mg/d PO.
Peds: 7 mg/kg PO BID or 14 mg/kg/d PO; ↓ in renal impairment.
W/P: [B, M] w/ PCN-sensitive pts.
CI: Hypersensitivity to cephalosporins.
DISP: Caps 300 mg; susp 125, 250 mg/5 mL.
SE: Anaphylaxis, diarrhea, rare pseudomembranous colitis, headache.
CEFDITOREN (SPECTRACEF)
USES: *Acute exacerbations of chronic bronchitis, pharyngitis, tonsillitis; skin infections.*
ACTIONS: 3rd-gen cephalosporin; ↓ cell wall synth. Spectrum: Good gram(+) (Streptococcus & Staphylococcus); gram(−) (H. influenzae & M. catarrhalis)
DOSE:
Adults & Peds: >12 yr: Skin also pharyngitis, tonsillitis: 200 mg PO BID × 10 days. Chronic bronchitis: 400 mg PO BID × 10 days; avoid antacids w/in 2 hr; take w/ meals; ↓ in renal impairment.
W/P: [B, ?] Renal/ hepatic impairment.
CI: Cephalosporin/PCN allergy, milk protein, or carnitine deficiency.
DISP: Tabs 200, 400 mg.
SE: headache, N/V/diarrhea, colitis, nephrotoxic, hepatic dysfunction, SJS, TEN, allergic reactions.
NOTES: Causes renal excretion of carnitine; tabs contain milk protein.
CEFEPIME (MAXIPIME, GENERIC)
USES: *Comp/uncomp UTI, pneumonia, empiric febrile neutropenia, skin/soft-tissue infections, comp intra-abdominal infections.*
ACTIONS: 4th-gen cephalosporin; ↓ cell wall synth. Spectrum: gram(+) S. pneumoniae, S. aureus, gram(−) K. pneumoniae, E. coli, P. aeruginosa, & Enterobacter sp.
DOSE:
Adults: 1–2 g IV q8–12h.
Peds: 50 mg/kg q8h for febrile neutropenia; 50 mg/kg BID for skin/soft-tissue infections; ↓ in renal impairment.
W/P: [B, +]; seizure risk w/ CrCl < 60 mL/ min; adjust dose w/ renal insufficiency.
CI: Cephalosporin/PCN allergy.
DISP: Inj 500 mg, 1, 2 g.
SE: Rash, pruritus, N/V/diarrhea, fever, headache, (+) Coombs test w/o hemolysis.
NOTES: Can give IM or IV; concern over ↑ death rates not confirmed by FDA.
CEFIXIME (SUPRAX)
USES: *Resp tract, skin, bone, & urinary tract infections.*
ACTIONS: 3rd-gen cephalosporin; ↓ cell wall synth. Spectrum: S. pneumoniae, S. pyogenes, H. influenzae, & enterobacteria.
DOSE:
Adults: 400 mg PO ÷ daily–BID.
Peds: 8 mg/kg/d PO ÷ daily–BID; ↓ w/ renal impairment.
W/P: [B, ?].
CI: Cephalosporin/PCN allergy.
DISP: Tabs 400 mg, 100, 200 mg chew tab, susp 100, 200 mg/5 mL.
SE: N/V/diarrhea, flatulence, & abdominal pain.
NOTES: Check renal & hepatic function; use susp for otitis media.
CEFOTAXIME (CLAFORAN, GENERIC)
USES: *Infections of lower resp tract, skin, bone & jt, urinary tract, meningitis, sepsis, PID, GC.*
ACTIONS: 3rd-gen cephalosporin; ↓ cell wall synth. Spectrum: Most gram(−) (not Pseudomonas), some gram(+) cocci S. pneumoniae, S. aureus (penicillinase/nonpenicillinase producing), H. influenzae(including ampicillin resistant), not Enterococcus; many PCN-resistant pneumococci.
DOSE:
Adults: Uncomplicated infection: 1 g IV/IM q12h; Mod–severe infection: 1–2 g IV/IM q 8–12 h; Severe/septicemia: 2 g IV/IM q4–8h; GC urethritis, cervicitis, rectal in female: 0.5 g IM × 1; rectal GC men 1 g IM × 1;
Peds: 50–200 mg/kg/d IV ÷ q6–8h; ↓ w/ renal/hepatic impairment.
W/P: [B, +] Arrhythmia w/ rapid Inj; w/ colitis.
CI: Cephalosporin/PCN allergy.
DISP: Powder for Inj 500 mg, 1, 2, 10 g, premixed Inf 20 mg/mL, 40 mg/mL.
SE: diarrhea, rash, pruritus, colitis, eosinophilia, ↑ transaminases.
CEFOTETAN (GENERIC)
USES: *infections of the upper & lower resp tract, skin, bone, urinary tract, abdominal, & gynecologic system.*
ACTIONS: 2nd-gen cephalosporin; ↓ cell wall synth. Spectrum: Less active against gram(+) anaerobes including B. fragilis; gram(−), including E. coli, Klebsiella, & Proteus.
DOSE:
Adults: 1–3 g IV q12h.
Peds: 20–40 mg/kg/dose IV ÷ q12h (6 g/d max.) ↓ w/ renal impairment.
W/P: [B, +] May ↑ bleeding risk; w/ Hx of PCN allergies, w/ other nephrotoxic drugs.
CI: Cephalosporin/PCN allergy.
DISP: Powder for Inj 1, 2, 10 g.
SE: Diarrhea, rash, eosinophilia, ↑ transaminases, hypoprothrombinemia, & bleeding (d/t MTT side chain).
NOTES: May interfere w/ warfarin.
CEFOXITIN (GENERIC)
USES: *Infections of the upper & lower resp tract, skin, bone, urinary tract, Abdominal, & gynecologic system.*
ACTIONS: 2nd-gen cephalosporin; ↓ cell wall synth. Spectrum: Good gram(−) against enteric bacilli (ie, E. coli, Klebsiella, & Proteus); anaerobic: B. fragilis.
DOSE:
Adults: 1–2 g IV q6–8h.
Peds: 80–160 mg/kg/d ÷ q4–6h (12 g/d max.); ↓ w/ renal impairment.
W/P: [B, M].
CI: Cephalosporin/PCN allergy.
DISP: Powder for Inj 1, 2, 10 g.
SE: Diarrhea, rash, eosinophilia, ↑ transaminases.
CEFPODOXIME (GENERIC)
USES: *Treat resp, skin, & urinary tract infections.*
ACTIONS: 3rd-gen cephalosporin; ↓ cell wall synth. Spectrum: S. pneumoniae or non–β-lactamase–producing H. influenzae; acute uncomplicated N. gonorrhoeae; some uncomplicated gram(−) (E. coli, Klebsiella, Proteus)
DOSE:
Adults: 100–400 mg PO q12h.
Peds: 10 mg/kg/d PO ÷ BID; ↓ in renal impairment, w/ food.
W/P: [B, M].
CI: Cephalosporin/PCN allergy.
DISP: Tabs 100, 200 mg; susp 50, 100 mg/5 mL.
SE: Diarrhea, rash, headache, eosinophilia, ↑ transaminases.
NOTES: Drug interactions w/ agents that ↑ gastric pH.
CEFPROZIL (GENERIC)
USES: *Treat resp tract, skin, & urinary tract infections.*
ACTIONS: 2nd-gen cephalosporin; ↓ cell wall synth. Spectrum: Active against MSSA, Streptococcus, & gram(−) bacilli (E. coli, Klebsiella, P. mirabilis, H. influenzae, Moraxella).
DOSE:
Adults: 250–500 mg PO daily–BID.
Peds: 7.5–15 mg/kg/d PO ÷ BID; ↓ in renal impairment.
W/P: [B, M].
CI: Cephalosporin/PCN allergy.
DISP: Tabs 250, 500 mg; susp 125, 250 mg/5 mL.
SE: Diarrhea, dizziness, rash, eosinophilia, ↑ transaminases.
NOTES: Use higher doses for otitis & pneumonia.
CEFTAROLINE (TEFLARO)
USES: *Tx skin/skin structure infection (SSSI) & community-acquired pneumonia.*
ACTIONS: Unclassified (“5th gen”) cephalosporin; ↓ cell wall synthesis. Spectrum: gram(+) Staph aureus (MSSA/MRSA), Strep pyogenes, Strep agalactiae, Strep pneumoniae; gram(−) E. coli, K. pneumoniae, K. oxytoca, H. influenzae.
DOSE:
Adults: 600 mg IV q12h; CrCl 30–50 mL/min: 400 mg IV q12h; CrCl 15–29 mL/min: 300 mg IV q12h; CrCl < 15 mL/min: 200 mg IV q12h; Inf over 1 hr.
W/P: [B, ?/−] monitor for C. difficile-associated diarrhea.
CI: Cephalosporin sensitivity.
DISP: Inj 600 mg.
SE: Hypersens reaction, diarrhea/N, rash, constipation, ↓ K+, phlebitis, ↑ LFTs.
CEFTAZIDIME (FORTAZ, TAZICEF, GENERIC)
USES: *Treat resp tract, skin, bone, urinary tract infections, meningitis, & septicemia.*
ACTIONS: 3rd-gen cephalosporin; ↓ cell wall synth. Spectrum: P. aeruginosa sp, good gram(−) activity.
DOSE:
Adults: 500–2 g IV/IM q8–12h.
Peds: 30–50 mg/kg/dose IV q8h 6g/d max.; ↓ renal impairment.
W/P: [B, +] PCN sensitivity.
CI: Cephalosporin/PCN allergy.
DISP: Powder for Inj 500 mg, 1, 2, 6 g.
SE: Diarrhea, rash, eosinophilia, ↑ transaminases.
NOTES: Use only for proven or strongly suspected infection to ↓ development of drug resistance.
CEFTIBUTEN (CEDAX)
USES: *Treat resp tract, skin, urinary tract infections, & otitis media.*
ACTIONS: 3rd-gen cephalosporin; ↓ cell wall synth. Spectrum: H. influenzae & M. catarrhalis; weak against S. pneumonia.
DOSE:
Adults: 400 mg/d PO.
Peds: 9 mg/kg/d PO; ↓ in renal impairment; take on empty stomach (susp).
W/P: [B, +/−].
CI: Cephalosporin/PCN allergy.
DISP: Caps 400 mg; susp 90 mg/5 mL.
SE: diarrhea, rash, eosinophilia, ↑ transaminases.
CEFTRIAXONE (ROCEPHIN, GENERIC)
WARNING: Avoid in hyperbilirubinemic neonates or coinfusion w/ calcium-containing products.
USES: *Resp tract (pneumonia), skin, bone, abdominal & urinary tract infections, meningitis, septicemia, GC, PID, perioperative.*
ACTIONS: 3rd-gen cephalosporin; ↓ cell wall synth. Spectrum: Mod gram(+); excellent β-lactamase producers.
DOSE:
Adults: 1–2 g IV/IM q12–24h.
Peds: 50–100 mg/kg/d IV/IM ÷ q12–24h; decrease dose with renal insufficiency.
W/P: [B, +]. Postrenal acute renal failure (PARF) in children may require stenting.
CI: Cephalosporin allergy; hyperbilirubinemic neonates.
DISP: Powder for Inj 250 mg, 500 mg, 1, 2, 10 g; premixed 20, 40 mg/mL.
SE: Diarrhea, rash, ↑ WBC, thrombocytosis, eosinophilia, ↑ LFTs.
CEFUROXIME (CEFTIN [PO], ZINACEF [PARENTERAL], GENERIC)
USES: *Upper & lower resp tract, skin, bone, urinary tract, abdominal, gynecologic infections.*
ACTIONS: 2nd-gen cephalosporin; ↓ cell wall synth. Spectrum: Staphylococci, group B streptococci, H. influenzae, E. coli, Enterobacter, Salmonella, & Klebsiella.
DOSE:
Adults: 750 mg–1.5 g IV q8h or 250–500 mg PO BID.
Peds: 75–150 mg/kg/d IV ÷ q8h or 20–30 mg/kg/d PO ÷ BID; ↓ w/ renal impairment; take PO w/ food.
W/P: [B, +].
CI: Cephalosporin/PCN allergy.
DISP: Tabs 250, 500 mg; susp 125, 250 mg/5 mL; powder for Inj 750 mg, 1.5, 7.5 g.
SE: Diarrhea, rash, eosinophilia, ↑ LFTs.
NOTES: Cefuroxime film-coated tabs & susp not bioequivalent; do not substitute on a mg/mg basis; IV crosses blood–brain barrier.
CELECOXIB (CELEBREX)
WARNING: ↑ Risk of serious CV thrombotic events, MI, & stroke; can be fatal; ↑ risk of serious GI adverse events including bleeding, ulceration, & perforation of the stomach or intestines; can be fatal.
USES: *Osteoarthritis, rheumatoid arthritis, ankylosing spondylitis, acute pain, primary dysmenorrhea.*
ACTIONS: NSAID; ↓ COX-2 pathway.
DOSE: 100–200 mg/d or BID; ↓ w/ hepatic impairment; take w/ food/milk.
W/P: [C/D (3rd tri), ?] w/ renal impairment.
CI: Sulfonamide allergy, perioperative CABG.
DISP: Caps 50, 100, 200, 400 mg.
SE: See “Warning"; GI upset, HTN, edema, renal failure, headache.
NOTES: Watch for Sxs of GI bleed; no effect on plt/bleeding time; can affect drugs metabolized by P-450 pathway.
CEPHALEXIN (KEFLEX, GENERIC)
USES: *Skin, bone, upper/lower resp tract (streptococcal pharyngitis), otitis media, uncomp cystitis infections.*
ACTIONS: 1st-gen cephalosporin; ↓ cell wall synth. Spectrum: Streptococcus (including β-hemolytic), Staphylococcus, E. coli, Proteus, & Klebsiella.
DOSE:
Adults & Peds: >15 yr: 250–1,000 mg PO QID; Treat cystitis 7–14 days (4 g/d max.).
Peds: <15 yr: 25–100 mg/kg/d PO ÷ BID–QID; ↓ in renal impairment; w/ or w/o food.
W/P: [B, +].
CI: Cephalosporin/ PCN allergy.
DISP: Caps 250, 500 mg; susp, 125, 250 mg; susp 125, 250 mg/5 mL.
SE: Diarrhea, rash, eosinophilia, gastritis, dyspepsia, ↑ LFTs, C. difficile colitis, vaginitis.
CHLOROTHIAZIDE (DIURIL)
USES: *HTN, edema.*
ACTIONS: Thiazide diuretic; decreases urine calcium.
DOSE:
Adults: 500 mg–1 g PO daily–BID; 500–1,000 mg/d IV (for edema only).
Peds: >6 mo: 10–20 mg/kg/24 h PO ÷ BID; 4 mg/kg ÷ daily bio IV; OK w/ food.
W/P: [C, +].
CI: Sensitivity to thiazides/sulfonamides, anuria.
DISP: Tabs 250, 500 mg; susp 250 mg/5 mL; Inj 500 mg/vial.
SE: ↓ K+, Na+, dizziness, hyperglycemia, hyperuricemia, hyperlipidemia, photosensitivity.
NOTES: Do not use IM/SQ; take early in the day to avoid nocturia; use sunblock; monitor lytes.
CHLORTHALIDONE (GENERIC)
USES: *HTN, edema.*
ACTIONS: Thiazide diuretic.
DOSE:
Adults: 25–100 mg PO daily.
Peds: (Not FDA approved) 0.3–2 mg/kg/dose PO 3×/wk or 1–2 mg/kg/d PO;↓ in renal impairment; OK w/ food, milk.
W/P: [B, +].
CI: Cross-sensitivity w/ thiazides or sulfonamides; anuria.
DISP: Tabs 25, 50, 100 mg.
SE: ↓ K+, dizziness, photosensitivity, ↑ glucose, hyperuricemia, sexual dysfunction; 25–50 mg/d for idiopathic hypercalciuria.
CHOLECALCIFEROL [VITAMIN D3] (DELTA D)
USES: Dietary supl to Treat vit D deficiency.
ACTIONS: ↑ intestinal Ca2+ absorption.
DOSE: 400–1,000 IU/d PO.
W/P: [A (D doses above the RDA), +].
CI: ↑ Ca2+, hypervitaminosis, allergy.
DISP: Tabs 400, 1,000 IU.
SE: Vit D tox (renal failure, HTN, psychosis).
NOTES: 1 mg cholecalciferol = 40,000 IU vit D activity.
CIPROFLOXACIN (CIPRO, CIPRO XR)
WARNING: ↑ Risk Achilles tendon rupture and tendonitis, ↑ in pts >60 yr, on steroids or with organ transplant; avoid w/ myasthenia gravis, may ↑ muscle weakness.
USES: *Treat lower resp tract, sinuses, skin & skin structure, bone/joints, complex intra-abdominal infection (w/ metronidazole), typhoid, infectious diarrhea, uncomp GC, inhal anthrax, UTI including prostatitis; Peds only for multi resistant UTI not as first agent.*
ACTIONS: Quinolone antibiotic; ↓ DNA gyrase. Spectrum: Broad gram(+) & (–) aerobics; little Streptococcus; good Pseudomonas, E. coli, B. fragilis, P. mirabilis, K. pneumoniae, C. jejuni, or Shigella.
DOSE:
Adults: 250–750 mg PO q12h; XR 500–1,000 mg PO q24h; or 200–400 mg IV q12h; ↓ in renal impairment.
Peds: 6–10 mg/kg/day IV.
W/P: [C, ?/−] Children <18 yr due to cartilage concerns; avoid in myasthenia gravis.
CI: Component sensitivity; w/ tizanidine.
DISP: Tabs 100, 250, 500, 750 mg; tabs XR 500, 1,000 mg; susp 5 g/100 mL, 10 g/100 mL; Inj 200, 400 mg; premixed piggyback 200, 400 mg/100 mL.
SE: Restlessness, N/V/diarrhea, rash, ruptured tendons, ↑ LFTs, peripheral neuropathy risk.
NOTES: Avoid antacids; reduce/restrict caffeine intake; interactions w/ theophylline, caffeine, sucralfate, warfarin, antacids, most tendon problems in Achilles, rarely shoulder and hand.
CISPLATIN (PLATINOL, PLATINOL AQ, GENERIC)
WARNING: Anaphylactic-like reaction, ototox, cumulative renal tox; doses >100 mg/m2 q3–4wk rarely used, do not confuse w/ carboplatin.
USES: *Testicular, bladder, ovarian*, SCLC, NSCLC, breast, head & neck, & penile cancers; osteosarcoma; peds brain tumors.
ACTIONS: DNA binding; denatures double helix; intrastrand cross-linking.
DOSE: 10–20 mg/m2/d for 5 days q3wk; 50–120 mg/m2 q3–4wk (per protocols); ↓ w/ renal impairment.
W/P: [D, −] Cumulative renal tox may be severe; ↓ BM, hearing impairment, pre-existing renal insufficiency.
CI: w/ renal impairment, hearing impairment, myelosuppression, platinum-containing compound allergy.
DISP: Inj 1 mg/mL.
SE: Allergic reactions, N/V, nephrotoxic (↑ w/ administration of other nephrotoxic drugs; minimize by NS Inf & mannitol diuresis), high-frequency hearing loss in 30%, peripheral “stocking glove”-type neuropathy, cardiotox (ST-, T-wave changes), ↓ Mg2+, mild ↓ BM, hepatotox; renal impairment dose related & cumulative.
NOTES: Give taxanes before platinum derivatives; check Mg2+, lytes before & w/in 48 hr after cisplatin.
CITRIC ACID, GLUCONOLACTONE, AND MAGNESIUM CARBONATE (RENACIDIN)
USES: *Chemolysis of calculi/incrustations in the urinary tract composed of apatite (calcium carbonate-phosphate) or struvite (magnesium ammonium phosphates) in nonsurgical candidates; adjunctive therapy to dissolve residual apatite/struvite fragments postop; partial dissolution of calculi to facilitate surgical removal.*
ACTIONS: Dissolution of calculi by exchange of Mg2+ from irrigating solution for insoluble Ca2+ in calcification. Mg2+ salts are soluble in the citrate irrigating solution, dissolving calculus.
DOSE: Intermittent bladder irrigation: 30–50 mL via Foley, clamped for 30 min, repeated TID for encrustations and 4–6×/d for bladder stones; irrigation via dual nephrostomy tube (inflow/outflow) or into ureteral catheter with nephrostomy drainage; essential to keep pressure <80 cm H2O by manometer.
W/P: [C, ?] Caution w/ irrigating the renal pelvis of patients with impaired renal function. Observe for early signs/symptoms of hypermagnesemia (nausea, lethargy, confusion and hypotension). Severe hypermagnesemia may result in hyporeflexia, dyspnea, apnea, coma, cardiac arrest, and subsequent death. Monitor magnesium levels and deep tendon reflexes should be evaluated.
CI: Obstructed urinary tract, extravasation, UTI.
DISP: Solution.
SE: Hypermagnesemia, irritation, sepsis, other infections.
NOTES: Suby solution G was modified by addition of magnesium salts to create Renacidin.
CLARITHROMYCIN (BIAXIN, BIAXIN XL)
USES: *Upper/lower resp tract, skin/skin structure infections, H. pylori infections, & infections caused by nontuberculosis (atypical) Mycobacterium; prevention of MAC infections in HIV infection.*
ACTIONS: Macrolide antibiotic, ↓ protein synth. Spectrum: H. influenzae, M. catarrhalis, S. pneumoniae, M. pneumoniae, & H. pylori.
DOSE:
Adults: 250–500 mg PO BID or 1,000 mg (2 × 500 mg XL tab)/d. Mycobacterium: 500 mg PO BID.
Peds: >6 mo: 7.5 mg/kg/dose PO BID; ↓ w/ renal impairment.
W/P: [C, ?] Antibiotic-associated colitis; rare ↑ QT & ventricular arrhythmias; not rec w/ PDE5 inhibitor.
CI: Macrolide allergy; w/ Hx jaundice w/ Biaxin; w/cisapride, pimozide, astemizole, terfenadine, ergotamines; PDE5 inhibitors (sildenafil, others); w/ colchicine & renal impairment; w/ statins; w/ ↑ QT or ventricular arrhythmias.
DISP: Tabs 250, 500 mg; susp 125, 250 mg/5 mL; 500 mg XL tab.
SE: ↑ QT interval, causes met allic taste, N/diarrhea, abdominal pain, headache, rash.
NOTES: Multiple drug interactions, ↑ theophylline & carbamazepine levels; do not refrigerate susp.
CLINDAMYCIN (CLEOCIN, CLEOCIN-T, OTHERS)
WARNING: Pseudomembranous colitis may range from mild to life threatening.
USES: *aerobic & anaerobic infections; topical for severe acne & Vag infections.*
ACTIONS: Bacteriostatic; interferes w/ protein synth. Spectrum: Streptococci (eg, pneumococci), staphylococci, & gram(+) & (–) anaerobes; no activity against gram(−) aerobes.
DOSE:
Adults: PO: 150–450 mg PO q6–8h. IV: 300–600 mg IV q6h or 900 mg IV q8h. Vag cream: 1 applicator hs × 7 days. Vag supp: Insert 1 qhs × 3 days. Topical: Apply 1% gel, lotion, or soln BID.
Peds: Neonates: (Avoid use; contains benzyl alcohol) 10–15 mg/kg/24 h ÷ q8–12h. Children >1 mo: 10–30 mg/kg/24 h ÷ q6–8h, to a max. of 1.8 g/d PO or 4.8 g/d IV. Topical: Apply 1%, gel, lotion, or soln BID; ↓ in severe hepatic impairment.
W/P: [B, +] Can cause fatal colitis.
CI: Hx pseudomembranous colitis.
DISP: Caps 75, 150, 300 mg; susp 75 mg/5 mL; Inj 300 mg/2 mL; Vag cream 2%, topical soln 1%, gel 1%, lotion 1%, Vag supp 100 mg.
SE: Diarrhea may be C. difficile pseudomembranous colitis, rash, ↑ LFTs.
NOTES: D/C drug w/ diarrhea, evaluate for C. difficile.
CLOMIPHENE (CLOMID, SEROPHENE, GENERIC)
USES: *Tx ovulatory dysfunction in women desiring pregnancy.*
ACTIONS: Nonsteroidal ovulatory stimulant; estrogen antagonist, increases FSH and LH through blocking feedback inhibition on the pituitary.
DOSE: 50 mg × 5 days; if no ovulation ↑ to 100 mg × 5 days @ 30 d later; ovulation usually 5–10 days postcourse, time coitus w/ expected ovulation time.
W/P: [X, ?/−] r/o pregnancy & ovarian enlargement.
CI: Hypersensitivity, uterine bleed, pregnancy, ovarian cysts (not due to polycystic ovary syndrome), liver disease, thyroid/adrenal dysfunction.
DISP: Tabs 50 mg.
SE: Ovarian enlargement, vasomotor flushes.
NOTES: Off-label use in males to increase testosterone or for low sperm counts; >10% of men with azoospermia and hypoandrogenism have return of sperm to ejaculate after T normalizes using clomiphene.
CLONIDINE, ORAL (CATAPRES)
USES: *HTN* opioid, EtOH, & tobacco withdrawal, ADHD.
ACTIONS: Centrally α-adrenergic stimulant.
DOSE:
Adults: 0.1 mg PO BID, adjust daily by 0.1–0.2-mg increments (max. 2.4 mg/d).
Peds: 5–10 μg/kg/d ÷ q8–12h (max. 0.9 mg/d); ↓ in renal impairment.
W/P: [C, +/−] Avoid w/ β-blocker, elderly, severe CV disease, renal impairment; use w/ agents that affect sinus node may cause severe ↓ HR.
CI: Component sensitivity.
DISP: Tabs 0.1, 0.2, 0.3 mg.
SE: drowsiness, orthostatic ↓ BP, xerostomia, constipation, ↓ HR, dizziness.
NOTES: More effective for HTN if combined w/ diuretics; withdraw slowly, rebound HTN w/ abrupt D/C of doses >0.2 mg BID; (Duraclon epidural inj) used for chronic cancer pain.
CLOPIDOGREL (PLAVIX, GENERIC)
USES: *Reduce atherosclerotic events, acute coronary syndrome.*
ACTIONS: ↓ Plt aggregation.
DOSE: 75 mg/d; ACS: 300–600 mg PO loading dose, then 75 mg/d PO; full effects take several days.
W/P: [B, ?] Active bleeding; risk of bleeding from trauma & other; TTP; liver disease; other CYP2C19 (eg, fluconazole); OK w/ ranitidine, famotidine.
CI: Coagulation disorders, active/ intracranial bleeding; CABG planned w/in 5–7 days.
DISP: Tabs 75, 300 mg.
SE: ↑ Bleeding time, GI intolerance, headache, dizziness, rash, thrombocytopenia, ↓ WBC.
NOTES: Plt aggregation to baseline ∼5 days after D/C, plt transfusion to reverse acutely; clinical response highly variable.
CLOTRIMAZOLE (LOTRIMIN, MYCELEX, OTHERS) [OTC]
USES: *Candidiasis & tinea infections.*
ACTIONS: Antifungal; alters cell wall permeability. Spectrum: Oropharyngeal candidiasis, dermatophytoses, superficial mycoses, cutaneous candidiasis, & vulvovaginal candidiasis.
DOSE: PO: Prophylaxis: 1 troche dissolved in mouth TID. Treat: 1 troche dissolved in mouth 5×/d for 14 days. Vag 1% cream: 1 applicator-full hs for 7 days. 2% cream: 1 applicator-full hs for 3 days. Tabs:100 mg vaginally hs for 7 days or 200 mg (2 tabs) vaginally hs for 3 days or 500-mg tabs vaginally hs once. Topical: Apply BID 10–14 days.
W/P: [B (C if PO), ?] Not for systemic fungal infection; safety in children <3 yr not established.
CI: Component allergy.
DISP: 1% cream; soln; troche10 mg; vag cream 1%, 2%.
SE: Topical: Local irritation; PO: N/V, ↑ LFTs.
NOTES: PO prophylaxis for immunosuppressed pts.
CLOTRIMAZOLE/BETAMETHASONE (LOTRISONE)
USES: *Fungal skin infections.*
ACTIONS: Imidazole antifungal & anti-inflammatory. Spectrum: Tinea pedis, cruris, & corporis.
DOSE:
Children ≥ 17 yr, Adults: Apply & massage into area BID for 2–4 wk.
W/P: [C, ?] Varicella infection.
CI: Children <12 yr.
DISP: Cream 1/0.05% 15, 45 g; lotion 1/0.05% 30 mL.
SE: Local irritation, rash.
NOTES: Not for diaper dermatitis or under occlusive dressings.
CODEINE [C-II]
USES: *Mild–mod pain; symptomatic relief of cough.*
ACTIONS: Narcotic analgesic; ↓ cough reflex.
DOSE:
Adults: Analgesic: 15–60 mg PO or IM q4h PRN; 360 mg max./24 h. Antitussive: 10–20 mg PO q4h PRN; max. 120 mg/d.
Peds: Analgesic: 0.5–1 mg/kg/dose PO q4–6h PRN. Antitussive: 1–1.5 mg/kg/24 h PO ÷ q4h; max. 30 mg/24 h; ↓ in renal/hepatic impairment.
W/P: [C (D if prolonged use or high dose at term), +] CNS depression, Hx drug abuse, severe hepatic impairment.
CI: Component sensitivity.
DISP: Tabs 15, 30, 60 mg; soln 30 mg/5 mL; Inj 15, 30 mg/mL.
SE: Drowsiness, constipation, ↓ BP.
NOTES: Usually combined w/ acetaminophen for pain or w/ agents (eg, terpin hydrate) as an antitussive; 120 mg IM = 10 mg IM morphine.
COLLAGENASE CLOSTRIDIUM HISTOLYTICUM (XIAFLEX)
WARNING: Corporal rupture and other serious penile injuries reported. Restricted distribution though XIAFLEX REMS Program.
USES: *Adult men with Peyronie’s disease w/ a palpable plaque and curvature of at least 30 degrees; adults w/ Dupuytren’s contracture with a palpable cord.*
ACTION: Collagenase that hydrolyzes collagen.
DOSE: (Peyronie’s) 0.58 mg (0.25 mL)/injection into plaque; treatment course is max. 4 cycles (1 cycle = 2 injection procedures and 1 penile modeling procedure; see below); interval of 6 wk between cycles.
W/P: [N/A, N/A] Provider and facility must be certified by REMS program; avoid injection into other structures.
CI: Peyronie’s plaques involving the penile urethra.
DISP: 0.9 mg vial w/ 3 mL diluent.
SE: Corporal rupture, severe hematoma, mild allergic reactions (pruritus).
NOTES: For details of procedure see package insert; administer only by experienced provider; If the deformity is <15 degrees after any treatment cycle subsequent cycles should not be administered
• Prior to each treatment cycle, identify the area as follows:
– Induce an erection (eg, intracavernosal injection of 10 or 20 μg alprostadil).
– Locate the plaque at the point of max. concavity (or focal point) in the bend of the penis.
– Mark the point with a surgical marker, the target area in the plaque for the injection.
• Injection procedure:
– Use local/topical anesthetic.
– Use 1 mL syringe w/ 27G ½-inch needle to inject 0.25 mL Xiaflex transversely throughout the plaque; apply pressure/dressing as needed afterward.
– The 2nd injection of each treatment cycle is 1–3 days after the 1st injection and located 2–3 mm apart from the 1st injection site.
• Penile modeling 1–3 days after 2nd injection:
– Use local anesthetic if desired.
– Grasp plaque 1 cm proximal and distal; use target plaque as fulcrum point, using both hands to apply firm steady pressure to elongate/stretch the plaque. Goal is to create bending opposite the plaque.
– Hold pressure for 30 s and release; after 30 s rest; repeat 3 times.
– Patient should perform self-modeling with spontaneous erection and stretch flaccid penis 3×/d.
CONIVAPTAN HCL (VAPRISOL)
USES: Euvolemic & hypervolemic hyponatremia.
ACTIONS: Dual arginine vasopressin V1A/V2 receptor antagonist.
DOSE: 20 mg IV × 1 over 30 min, then 20 mg cont IV Inf over 24 hr; 20 mg/d cont IV Inf for 1–3 more days; may ↑ to 40 mg/d if Na+ not responding; 4 day max. use; use large vein, change site q24h.
W/P: [C, ?/−] Rapid ↑ Na+ (> 12 mEq/L/24 h) may cause osmotic demyelination syndrome; impaired renal/hepatic function; may ↑ digoxin levels; CYP3A4 inhibitor.
CI: Hypovolemic hyponatremia; w/ CYP3A4 inhibitor; anuria.
DISP: Inj 20 mg /100 mL.
SE: Inf site reactions, headache, N/V/diarrhea, constipation, ↓ K+, orthostatic ↓ BP, thirst, dry mouth, pyrexia, pollakiuria, polyuria, infection.
NOTES: Monitor Na+, vol and neurologic status; D/C w/ very rapid ↑ Na+; mix only w/ 5% dextrose.
CORTISONE
See Steroids Systemic and Topical Pages 968, 969
CYANOCOBALAMIN [VITAMIN B12] (NASCOBAL)
USES: *Pernicious anemia & other vit B12 deficiency states; ↑ requirements d/t pregnancy; thyrotoxicosis; liver or kidney disease* supplementation may be necessary with urinary diversion if distal terminal ileum resected.
ACTIONS: Dietary vit B12 supl.
DOSE:
Adults: 30 μg/d × 5–10 days intranasal: 500 μg once/wk for pts in remission, 100 μg IM or SQ daily for 5–10 days, then 100 μg IM 2×/wk for 1 mo, then 100 μg IM monthly.
Peds: Use 0.2 μg/kg × 2 day test dose; if OK 30–50 μg/d for 2 or more wk (total 1,000 μg) then maint: 100 μg/mo.
W/P: [A (C if dose exceeds RDA), +].
CI: Allergy to cobalt; hereditary optic nerve atrophy; Leber disease.
DISP: Tabs 50, 100, 250, 500, 1,000, 2,500, 5,000 μg; Inj 1,000 μg/mL; intranasal (Nascobal) gel 500 μg/0.1 mL.
SE: Itching, diarrhea, headache, anxiety.
NOTES: PO absorption erratic; OK for use w/ hyperalimentation.
CYCLOPHOSPHAMIDE (CYTOXAN, NEOSAR)
USES: *Hodgkin disease & NHLs; multiple myeloma; small cell lung, breast, & ovarian cancers; mycosis fungoides; neuroblastoma; retinoblastoma; acute leukemias; allogeneic & ABMT in high doses; severe rheumatologic disorders (SLE, JRA, Wegner granulomatosis) “minimal change” nephrotic syndrome in children.*
ACTIONS: Alkylating agent.
DOSE:
Adults: (Per protocol) 500–1,500 mg/m2; single dose at 2- to 4-wk intervals; 1.8 g/m2–160 mg/kg (or at 12 g/m2 in 75-kg individual) in the BMT setting (per protocols).
Peds: SLE: 500 mg–1g/m2 q mo. JRA: 10 mg/kg q2wk; ↓ w/ renal impairment.
W/P: [D, −] w/ BM suppression, hepatic insufficiency.
CI: Component sensitivity.
DISP: Tabs 25, 50 mg; Inj 200 mg, 500 mg, 1 g, 2 g.
SE: ↓ BM; hemorrhagic cystitis, SIADH, alopecia, anorexia; N/V; hepatotox; rare interstitial pneumonitis; irreversible testicular atrophy possible; cardiotox rare; 2nd malignancies (bladder, ALL), risk 3.5% at 8 yr, 10.7% at 12 yr.
NOTES: Hemorrhagic cystitis prophylaxis: cont bladder irrigation & MESNA uroprotection; encourage hydration, long-term bladder cancer screening.
CYCLOSPORINE (GENGRAF, NEORAL, SANDIMMUNE)
WARNING: ↑ Risk neoplasm, ↑ risk skin malignancies, ↑ risk HTN and nephrotoxic.
USES: *Organ rejection in kidney, liver, heart, rheumatoid arthritis; psoriasis.*
ACTIONS: Immunosuppressant; reversible inhibition of immunocompetent lymphocytes; a calcineurin.
DOSE:
Adults & Peds: PO: 15 mg/kg/12 h pretransplant; after 2 wk, taper by 5 mg/wk to 5–10 mg/kg/d. IV: If NPO, give 1/3 PO dose IV; ↓ in renal/hepatic impairment.
W/P: [C, −] Dose-related risk of nephrotoxic/hepatotox/serious fatal infections; calcium channel antagonists (eg, diltiazem, verapamil, and nicardipine) and certain antibiotics (eg, erythromycin, doxycycline, and ketoconazole) increase levels of cyclosporine and predispose to nephrotoxicity; some antibiotics (eg, nafcillin, trimethoprim–sulfamethoxazole, isoniazid, and rifampin) and certain anticonvulsants (eg, phenytoin, phenobarbital, and carbamazepine) decrease levels of cyclosporine and thereby predispose the patient to infection; drugs that enhance the nephrotoxicity w/o altering blood levels: Amphotericin B, acyclovir, and NSAIDs; live, attenuated vaccines may be less effective; may induce fatal malignancy; many drug interactions; ↑ risk of infections after D/C.
CI: Renal impairment; uncontrolled HTN; w/ lovastatin, simvastatin.
DISP: Caps 25, 100 mg; PO soln 100 mg/mL; Inj 50 mg/mL.
SE: May ↑ BUN & Cr and mimic transplant rejection; HTN; headache; hirsutism.
NOTES: Administer in glass container; Neoral & Sandimmune not interchangeable; monitor BP, Cr, CBC, LFTs, interaction w/ St. John’s wort; Levels: Trough: Just before next dose: Therapeutic: Variable 150–300 ng/mL RIA; acute cyclosporine toxicity (level > 300 ng/mL) causes vasoconstriction and renal ischemia (reversed by reducing the dosage). Chronic toxicity results in fixed vascular lesions and irreversible renal ischemia.
CYSTEAMINE (CYSTAGON, PROCYSBI DELAYED RELEASE)
USES: *Nephropathic cystinosis in children and adults.*
ACTIONS: Converts cystine into cysteine.
DOSE: New patient: ¼–⅙ of the maintenance dose; peds up to 12 yr: Maint 1.3 g/m2/d; patients >12 yrs and >110 lb: 2.0 g/d, divided 4 times (Cystagon) or BID (Procysbi); at least 2 hr after and at least 30 min before eating.
W/P: [C, +/−] Stop if skin rash develops.
DISP: Cystagon Caps 50, 150 mg; Procysbi Caps DR 25, 75 mg.
SE: Nausea, vomiting, anorexia and abdominal pain, lethargy.
NOTES: Follow WBC cystine or plasma cysteamine levels.