ECONAZOLE (ECOZA, SPECTAZOLE, GENERIC)
USES: *Tinea, cutaneous Candida, & tinea versicolor Infxns.*
ACTIONS: Topical antifungal.
DOSE: Apply to areas BID Candida; (daily for tinea versicolor) for 2–4 wk.
W/P: [C, ?].
CI: Component sensitivity.
DISP: Topical cream 1%; Ecoza foam 1%.
SE: Local irritation, pruritus, erythema.
NOTES: Early Sx/clinical improvement; complete course to avoid recurrence.
ENALAPRIL (ENALAPRILAT, EPANED KIT, VASOTEC)
WARNING: ACE inhib used during PRG can cause fet al injury & death.
USES: *HTN, CHF, LVD*, DN.
ACTIONS: ACE inhib.
DOSE:
Adults: 2.5–40 mg/d PO; 1.25 mg IV q6h.
Peds: 0.05–0.08 mg/kg/d PO q12–24h; ↓ w/ renal impairment.
W/P: [C (1st tri; D 2nd & 3rd tri), +] D/C immediately w/ PRG, w/ NSAIDs, K+ suppl.
CI: Bilateral RAS, angioedema.
DISP: Tabs 2.5, 5, 10, 20 mg; Enalaprilat IV 1.25 mg/mL; Epaned Kit powder for oral (1 mg/mL).
SE: ↓ BP w/ initial dose (esp w/ diuretics), ↑ K+, ↑ Cr, cough, angioedema.
NOTES: Monitor Cr; D/C diuretic for 2–3 days prior to start.
ENOXAPARIN (LOVENOX)
WARNING: Recent or anticipated epidural/spinal anesthesia, ↑ risk of spinal/epidural hematoma w/ subsequent paralysis.
USES: *Prevention & Treat of DVT; Treat PE; unstable angina & non–Q-wave MI.*
ACTIONS: LMW heparin; inhibit thrombin by complexing w/ antithrombin III.
DOSE:
Adults: Prevention: 30 mg SQ BID or 40 mg SQ q24h. DVT/PE Treat: 1 mg/kg SQ q12h or 1.5 mg/kg SQ q24h.; CrCl < 30 mL/min ↓ to 1 mg/kg SQ q day.
Peds: Prevention: 0.5 mg/kg SQ q12h. DVT/PE Treat: 1 mg/kg SQ q12h; ↓ dose w/ CrCl < 30 mL/min.
W/P: [B, ?] Not for prophylaxis in prosthetic heart valves.
CI: Active bleeding, heparin-induced thrombocytopenia Ab, heparin, pork sens.
DISP: Inj 10 mg/0.1 mL (30-, 40-, 60-, 80-, 100-, 120-, 150-mg syringes); 300-mg/mL multi-dose vial.
SE: Bleeding, hemorrhage, bruising, thrombocytopenia, fever, pain/hematoma at site, ↑ AST/ALT.
NOTES: No effect on bleeding time, plt function, PT, or aPTT; monitor plt for heparin-induced thrombocytopenia, clinical bleeding; may monitor antifactor Xa; not for IM.
ENZALUTAMIDE (XTANDI)
USES: *Metastatic castration-resistant prostate cancer w/ or w/o previous docetaxel.*
ACTIONS: Androgen receptor inhibitor.
DOSE: (men only): 160 mg daily, do not chew/open caps.
W/P: [X, −] w/ seizure risk; avoid w/ strong CYP2C8 inhibitor, strong/mod CYP3A4 or CYP2C8 induc, avoid CPY3A4, CYP2C9, CYP2C19 substrates w/ narrow therapeutic index.
CI: Pregnancy
DISP: Caps 40 mg.
SE: Headache, dizziness, insomnia, fatigue, anxiety, MS pain, muscle weakness, paresthesia, back pain, spinal cord compression, cauda equina syndrome, arthralgias, edema, URI, lower resp infection, hematuria, ↑ BP.
NOTES: If on warfarin check INR
EPHEDRINE (GENERIC)
USES: *Acute bronchospasm, bronchial asthma, nasal congestion*, ↓ BP, narcolepsy, enuresis, & myasthenia gravis.
ACTIONS: Sympathomimetic; stimulates α/β receptors; bronchodilator.
DOSE:
Adults: Congestion: 12.5–25 mg PO q4h PRN w/ expectorant; ↓ BP: 25–50 mg IV q5–10min, 150 mg/d max.
Peds: 0.2–0.3 mg/kg/dose IV q4–6h PRN.
W/P: [C, ?/−].
CI: Arrhythmias; narrow-angle glaucoma.
DISP: Caps 25 mg; Inj 50 mg/mL; nasal spray 0.25%.
SE: CNS stimulation (nervousness, anxiety, trembling), tachycardia, arrhythmia, HTN, xerostomia, dysuria.
NOTES: Protect from light; monitor BP, HR, urinary output; can cause false (+) amphetamine EMIT; take last dose 4–6 hr before hs; abuse potential, OTC sales mostly banned/restricted retrograde ejaculation 50 mg QID × 2 wk.
EPOETIN ALFA [ERYTHROPOIETIN, EPO] (EPOGEN, PROCRIT)
WARNING: ↑ Mortality, serious CV/thromboembolic events, and tumor progression. Renal failure pts experienced ↑ greater risks (death/CV events) on erythropoiesis-stimulating agents (ESAs) to target Hgb levels 11 g/dL. Maintain Hgb 10–12 g/dL. In cancer pt, ESAs ↓ survival/time to progression in some cancer when dosed Hgb ≥ 2 g/dL. Use lowest dose needed. Use only for myelosuppressive chemotherapy. D/C following chemotherapy. Preop ESA ↑ DVT. Consider DVT prophylaxis.
USES: *CRF-associated anemia, zidovudine treat in HIV-infected pts, cancer chemotherapy; ↓ transfusions associated w/ surgery.*
ACTIONS: Induces erythropoiesis.
DOSE:
Adults & Peds: 50–150 U/kg IV/SQ 3×/wk; adjust dose q4–6wk PRN. Surgery: 300 U/kg/d × 10 days before to 4 days after; ↓ dose if Hct ∼36% or Hgb, ↑ > ≅ 12 g/dL or Hgb ↑ >1 g/dL in 2-wk period; hold dose if Hgb >12 g/dL.
W/P: [C, ?/−].
CI: Uncontrolled HTN.
DISP: Inj 2,000, 3,000, 4,000, 10,000, 20,000, 40,000 U/mL.
SE: HTN, headache, fatigue, fever, tachycardia, N/V.
NOTES: Refrigerate; monitor baseline & posttreatment Hct/Hgb, BP, ferritin.
ERTAPENEM (INVANZ)
USES: *Complicated intra-abdominal, acute pelvic, & skin infections, pyelonephritis, community-acquired pneumonia.*
ACTIONS: α-carbapenem; β-lactam antibiotic, ↓ cell wall synth. Spectrum: Good gram(+/–) & anaerobic coverage, not Pseudomonas, PCN-resistant pneumococci, MRSA, Enterococcus, β-lactamase (+) H. influenzae, Mycoplasma, Chlamydia.
DOSE:
Adults: 1 g IM/IV daily; 500 mg/d in CrCl <30 mL/min.
Peds: 3 mo–12 yr: 15 mg/kg BID IM/IV, max. 1 g/d.
W/P: [B, ?/−] seizure Hx, CNS disorders, β-lactam & multiple allergies, probenecid ↓ renal clearance.
CI: Component hypersens or amide anesthetics.
DISP: Inj 1 g/vial.
SE: Headache, N/V/diarrhea, Inj site reactions, thrombocytosis, ↑ LFTs.
NOTES: Can give IM × 7 days, IV × 14 days; 137 mg Na+ (6 mEq)/g ertapenem; do not mix with dextrose infusion.
ERYTHROMYCIN (E-MYCIN, EES, ERY-TAB, ERYPED, ILOTYCIN, GENERIC)
USES: *Bacterial infections; bowel prep, acne vulgaris *; ↑ GI motility (prokinetic).
ACTIONS: Bacteriostatic; interferes w/ protein synth. Spectrum: Group A streptococci (S. pyogenes), S. pneumoniae, N. gonorrhoeae (if PCN-allergic), Legionella, M. pneumonia.
DOSE:
Adults: Base 250–500 mg PO q6–12h or ethylsuccinate 400–800 mg q6–12h; 500 mg–1 g IV q6h. Prokinetic: 250 mg PO TID 30 min ac.
Peds: 30–50 mg/kg/d PO ÷ q6–8h or 20–40 mg/kg/d IV ÷ q6h, max. 2 g/d.
W/P: [B, +] Pseudomembranous colitis risk, ↑ tox of carbamazepine, cyclosporine, digoxin, methylprednisolone, theophylline, felodipine, warfarin, simvastatin/lovastatin; ↓ sildenafil dose w/ use.
CI: Hepatic impairment, pre-existing liver disease (estolate), use w/ pimozide ergotamine dihydroergotamine.
DISP: Lactobionate (Ilotycin): Powder for Inj 500 mg, 1 g. Base: Tabs 250, 333, 500 mg; caps 250 mg. Stearate (Erythrocin): Tabs 250, 500 mg. Ethylsuccinate (EES, EryPed): Chew tabs 200 mg; tabs 400 mg; susp 200, 400 mg/5 mL.
SE: Headache, abdominal pain, N/V/diarrhea; ↑ QT, torsades de pointes, ventricular arrhythmias/tachycardias (rarely); cholestatic jaundice (estolate).
NOTES: 400 mg ethylsuccinate = 250 mg base/estolate; w/ food minimizes GI upset; lactobionate contains benzyl alcohol (caution in neonates).
ESTERIFIED ESTROGENS (MENEST)
WARNING: ↑ Risk endometrial cancer. Do not use in the prevention of CV disease or dementia; ↑ risk of MI, stroke, breast cancer, PE, DVT, in postmenopausal.
USES: *Vasomotor Sxs or vulvar/Vag atrophy w/ menopause; female hypogonadism, palliation of advanced prostate cancer.*
ACTIONS: Estrogen supl.
DOSE: Menopausal vasomotor Sx: 0.3–1.25 mg/d, cyclically 3 wk on, 1 wk off; add progestin 10–14 days w/ 28-day cycle w/ uterus intact; Vulvovaginal atrophy: Same regimen except use 0.3–1.25 mg; Hypogonadism: 2.5–7.5 mg/d PO × 20 days, off × 10 days; add progestin 10–14 days w/ 28-day cycle w/ uterus intact.
W/P: [X, −].
CI: Undiagnosed genital bleeding, breast cancer, estrogen-dependent tumors, thromboembolic disorders, thrombophlebitis, recent MI, pregnancy, severe hepatic disease.
DISP: Tabs 0.3, 0.625, 1.25, 2.5 mg.
SE: N, headache, bloating, breast enlargement/tenderness, edema, venous thromboembolism, hypertriglyceridemia, gallbladder disease.
NOTES: Use lowest dose for shortest time (see WHI data [www.whi.org]).
ESTRADIOL, GEL (DIVIGEL)
WARNING: ↑ Risk endometrial cancer. Do not use to prevent CV disease or dementia; ↑ risk MI, stroke, breast cancer, PE, and DVT in postmenopausal (50–79 yr). ↑ Dementia risk in postmenopausal (≥65 yr).
USES: *Vasomotor Sx in menopause.*
ACTIONS: Estrogen.
DOSE: 0.25 g q day on right or left upper thigh (alternate).
W/P: [X, +/−] May ↑ thyroid binding globulin (TBD) w/ thyroid disease.
CI: Alcohol, caution around flames until dry, not for Vag use.
ESTRADIOL, METERED GEL (ELESTRIN, ESTROGEL)
WARNING: ↑ Risk endometrial cancer. Do not use to prevent CV disease or dementia; ↑ risk MI, stroke, breast cancer, PE, and DVT in postmenopausal (50–79 yr). ↑ Dementia risk in postmenopausal (≥65 yr).
USES: *Postmenopausal vasomotor Sxs.*
ACTIONS: Estrogen.
DOSE: Apply 0.87–1.7 g to upper arm skin q day; add progestin × 10–14 days/28-day cycle w/ intact uterus; use lowest effective estrogen dose.
W/P: [X, ?].
CI: AUB, breast cancer, estrogen-dependent tumors, hereditary angioedema, thromboembolic disorders, recent MI, PREGNANCY, severe hepatic disease.
DISP: Gel 0.06%; metered dose/activation.
SE: Thromboembolic events, MI, stroke, ↑ BP, breast/ovarian/endometrial cancer, site reactions, Vag spotting, breast changes, abdominal bloating, cramps, headache, fluid retention.
NOTES: Wait >25 min before sunscreen; avoid concomitant use for >7 days; BP, breast exams.
ESTRADIOL, ORAL (DELESTROGEN, ESTRACE, FEMTRACE, GENERIC)
WARNING: ↑ Risk endometrial cancer. Do not use to prevent CV disease or dementia; ↑ risk MI, stroke, breast cancer, PE, and DVT in postmenopausal (50–79 yr). ↑ Dementia risk in postmenopausal (≥65 yr).
USES: *Atrophic vaginitis, menopausal vasomotor Sxs, prevent osteoporosis, ↑ low estrogen levels, palliation breast and PCa.*
ACTIONS: Estrogen.
DOSE: PO: 1–2 mg/d, adjust PRN to control Sxs. Vag cream: 2–4 g/d × 2 wk, then 1 g 1–3×/wk. Vasomotor Sx/Vag atrophy: 10–20 mg IM q4wk, D/C or taper at 3- to 6-mo intervals. Hypoestrogenism: 10–20 mg IM q4wk. PCa: 30 mg IM q12wk.
W/P: [X, −].
CI: Genital bleeding of unknown cause, breast cancer, porphyria, estrogen-dependent tumors, thromboembolic disorders, thrombophlebitis; recent MI; hepatic impairment.
DISP: Tabs 0.5, 1, 2 mg; depot Inj (Delestrogen) 10, 20, 40 mg/mL.
SE: N, headache, bloating, breast enlargement/tenderness, edema, ↑ triglycerides, venous thromboembolism, gallbladder disease.
NOTES: When estrogen used in postmenopausal w/ uterus, use w/ progestin.
ESTRADIOL, SPRAY (EVAMIST)
WARNING: ↑ Risk endometrial cancer. Do not use to prevent CV disease or dementia; ↑ risk MI, stroke, breast cancer, PE, and DVT in postmenopausal (50–79 yr). ↑ Dementia risk in postmenopausal (≥65 yr)
USES: *Vasomotor Sx in menopause.*
ACTIONS: Estrogen supl.
DOSE: 1 spray on inner surface of forearm.
W/P: [X, +/−] May ↑ PT/PTT/plt aggregation w/ thyroid disease.
CI: Undiagnosed genital bleeding, breast cancer, estrogen-dependent tumors, thromboembolic disorders, thrombophlebitis, recent MI, PREGNANCY, severe hepatic disease.
DISP: 1.53 mg/ spray (56-spray container).
SE: N, headache, bloating, breast enlargement/tenderness, edema, venous thromboembolism, ↑ BP, hypertriglyceridemia, gallbladder disease.
NOTES: Contains alcohol, caution around flames until dry; not for Vag use.
ESTRADIOL, TRANSDERMAL (ALORA, CLIMARA, ESTRADERM, VIVELLE DOT)
WARNING: ↑ Risk endometrial cancer. Do not use to prevent CV disease or dementia; ↑ risk MI, stroke, breast cancer, PE, and DVT in postmenopausal (50–79 yr). ↑ Dementia risk in postmenopausal (≥65 yr)
USES: *Severe menopausal vasomotor Sxs; female hypogonadism.*
ACTIONS: Estrogen supl.
DOSE: Start 0.0375–0.05 mg/d patch 1–2×/wk based on product (Climara 1×/wk; Alora 2×wk) adjust PRN to control Sxs; w/ intact uterus cycle 3 wk on 1 wk off or use cyclic progestin 10–14 days.
W/P: [X, −] See estradiol.
CI: Pregnancy, AUB, porphyria, breast cancer, estrogen-dependent tumors, Hx thrombophlebitis, thrombosis.
DISP: Transdermal patches (mg/24 h) 0.025, 0.0375, 0.05, 0.06, 0.075, 0.1.
SE: N, bloating, breast enlargement/tenderness, edema, headache, hypertriglyceridemia, gallbladder disease.
NOTES: Do not apply to breasts, place on trunk, rotate sites; see estradiol, oral notes.
ESTRADIOL, VAGINAL (ESTRING, FEMRING, VAGIFEM)
WARNING: ↑ Risk endometrial cancer. Do not use to prevent CV disease or dementia; ↑ risk MI, stroke, breast cancer, PE, and DVT in postmenopausal (50–79 y). ↑ Dementia risk in postmenopausal (≥ 65 y).
USES: *Postmenopausal Vag atrophy (Estring)* *vasomotor Sxs and vulvar/vag atrophy associated w/ menopause (Femring)* *atrophic vaginitis (Vagifem)*
ACTIONS: Estrogen supl.
DOSE: Estring: Insert ring into upper 3rd of Vag vault; remove and replace after 90 d; reassess 3–6 mo; Femring: Use lowest effective dose, insert vaginally, replace q3mo; Vagifem: 1 tab vaginally q day × 2 wk, then maint 1 tab 2×/ wk, D/C or taper at 3–6 mo.
W/P: [X, −] May ↑ PT/PTT/plt aggregation w/ thyroid disease, toxic shock reported.
CI: Undiagnosed genital bleeding, breast cancer, estrogen- dependent tumors, thromboembolic disorders, thrombophlebitis, recent MI, pregnancy, severe hepatic disease.
DISP: Estring ring: 0.0075 mg/24 h; Femring ring: 0.05 and 0.1 mg/d Vagifem tab (Vag): 10 μg.
SE: Headache, leukorrhea, back pain, candidiasis, vaginitis, Vag discomfort/hemorrhage, arthralgia, insomnia, abdominal pain; see estradiol, oral notes.
ESTRADIOL/LEVONORGESTREL, TRANSDERMAL (CLIMARA PRO)
WARNING: ↑ Risk endometrial cancer. Do not use to prevent CV disease or dementia; ↑ risk MI, stroke, breast cancer, PE, and DVT in postmenopausal (50–79 yr). ↑ Dementia risk in postmenopausal (≥65 yr).
USES: *Menopausal vasomotor Sx; prevent postmenopausal osteoporosis.*
ACTIONS: Estrogen & progesterone.
DOSE: 1 patch 1×/wk.
W/P: [X, −] w/ ↓ thyroid.
CI: AUB, estrogen-sensitive tumors, Hx thromboembolism, liver impairment, pregnancy, hysterectomy.
DISP: Estradiol 0.045 mg/levonorgestrel 0.015 mg/day patch.
SE: Site reaction, Vag bleed/spotting, breast changes, abdominal bloating/ cramps, headache, retention fluid, edema, ↑ BP.
NOTES: Apply in lower abdomen; for osteoporosis give Ca2+/vit D supl; follow breast exams.
ESTRADIOL/NORETHINDRONE (ACTIVELLA, FEMHRT, GENERIC)
WARNING: ↑ Risk endometrial cancer. Do not use to prevent CV disease or dementia; ↑ risk MI, stroke, breast cancer, PE, and DVT in postmenopausal (50–79 yr). ↑ Dementia risk in postmenopausal (≥65 yr).
USES: *Menopause vasomotor Sxs; vulvar and vaginal atrophy; prevent osteoporosis.*
ACTIONS: Estrogen/progestin; plant derived.
DOSE: 1 tab/d start w/ lowest dose combo.
W/P: [X, −] w/ ↓ Ca2+/thyroid.
CI: Pregnancy; Hx breast cancer; estrogen-dependent tumor; abnormal genital bleeding; Hx DVT, PE, or related disorders; recent (w/in past year) arterial thromboembolic disease (CVA, MI).
DISP: Femhrt: Tabs 2.5/0.5, 5 μg/1 mg; Activella: Tabs 1/0.5, 0.5 mg/0.1 mg.
SE: Thrombosis, dizziness, headache, libido changes, insomnia, emotional instability, breast pain.
NOTES: Use in women w/ intact uterus; caution in heavy smokers; combo also used as oral contraceptive.
ESTRAMUSTINE PHOSPHATE (EMCYT)
USES: *Palliative treatment of metastatic and/or progressive carcinoma of the prostate.*
ACTIONS: Estradiol w/ nitrogen mustard; exact mechanism unknown.
DOSE: 14 mg/kg/d in 3–4 ÷ doses; on empty stomach, no dairy products.
W/P: [NA, not used in females].
CI: Active thrombophlebitis or thromboembolic disorders.
DISP: Caps 140 mg.
SE: N/V, exacerbation of pre-existing CHF, edema, hepatic disturbances, thrombophlebitis, MI, PE, gynecomastia in 20–100%.
NOTES: Low-dose breast irradiation before may ↓ gynecomastia.
ESTROGEN, CONJUGATED (PREMARIN)
WARNING: ↑ Risk endometrial cancer. Do not use to prevent CV disease or dementia; ↑ risk MI, stroke, breast cancer, PE, and DVT in postmenopausal (50–79 yr). ↑ Dementia risk in postmenopausal (≥65 yr).
USES: *Mod–severe menopausal vasomotor Sxs; atrophic vaginitis; hypoestrogenism; palliation of advanced breast and prostate cancer; prevention osteoporosis.*
ACTIONS: Estrogen replacement.
DOSE: 0.3–1.25 mg/d PO; intravaginal cream 0.5–2 g × 21 days, then off × 7 days or 0.5 mg twice weekly.
W/P: [X, −].
CI: Severe hepatic impairment, genital bleeding of unknown cause, breast cancer, estrogen-dependent tumors, thromboembolic disorders, thrombosis, thrombophlebitis, recent MI.
DISP: Tabs 0.3, 0.45, 0.625, 0.9, 1.25 mg; Vag cream 0.625 mg/g.
SE: ↑ Risk of endometrial cancer, gallbladder disease, thromboembolism, headache, & possibly breast cancer.
NOTES: Generic products not equivalent.
ESTROGEN, CONJUGATED/MEDROXYPROGESTERONE (PREMPRO, PREMPHASE)
WARNING: ↑ Risk endometrial cancer. Do not use to prevent CV disease or dementia; ↑ risk MI, stroke, breast cancer, PE, and DVT in postmenopausal (50–79 yr). ↑ Dementia risk in postmenopausal (≥65 yr).
USES: *Mod–severe menopausal vasomotor Sxs; atrophic vaginitis; prevent postmenopausal osteoporosis.*
ACTIONS: Hormonal replacement.
DOSE: Prempro 1 tab PO daily; Premphase 1 tab PO daily.
W/P: [X, −].
CI: Severe hepatic impairment, genital bleeding of unknown cause, breast cancer, estrogen-dependent tumors, thromboembolic disorders, thrombosis, thrombophlebitis.
DISP: (As estrogen/medroxyprogesterone) Prempro: Tabs 0.3/1.5, 0.45/1.5, 0.625/2.5, 0.625/5 mg; Premphase: Tabs 0.625/0 (days 1–14) & 0.625/5 mg (days 15–28).
SE: Gallbladder disease, thromboembolism, headache, breast tenderness.
NOTES: See WHI (www.whi.org); use lowest dose/shortest time possible.
ESTROGEN, CONJUGATED SYNTHETIC (CENESTIN, ENJUVIA)
WARNING: ↑ Risk endometrial cancer. Do not use to prevent CV disease or dementia; ↑ risk MI, stroke, breast cancer, PE, and DVT in postmenopausal (50–79 yr). ↑ Dementia risk in postmenopausal (≥65 yr).
USES: *Vasomotor menopausal Sxs, vulvovaginal atrophy.*
ACTIONS: Multiple estrogen replacement.
DOSE: For all w/ intact uterus progestin × 10–14 days/28-day cycle; Vasomotor: 0.3–1.25 mg (Enjuvia) 0.625–1.25 mg (Cenestin) PO daily; Vag atrophy: 0.3 mg/d.
W/P: [X, −].
CI: See Estrogen, conjugated.
DISP: Tabs, Cenestin, 0.3, 0.45, 0.625, 0.9, 1.25 mg; Enjuvia ER 0.3, 0.45, 0.625, 0.9, 1.25 mg.
SE: ↑ Risk endometrial/breast cancer, gallbladder disease, thromboembolism.
ETHAMBUTOL (MYAMBUTOL, GENERIC)
USES: *Pulmonary TB* and other mycobacterial infections, mycobacterium avium complex (MAC).
ACTION: ↓ RNA synthesis.
DOSE:
Adults & Peds: >12 yr: 15–25 mg/kg/d PO single dose; ↓ in renal impairment, take w/ food, avoid antacids.
W/P: [C, +].
CI: Unconscious patients, optic neuritis.
DISP: Tablets 100, 400 mg.
SE: Headache, hyperuricemia, acute gout, abdominal pain, ↑ LFTs, optic neuritis (decreased visual acuity), GI upset.
ETIDRONATE DISODIUM (DIDRONEL, GENERIC)
USES: *Paget disease, heterotopic ossification.*
ACTIONS: ↓ Nl & abnormal bone resorption.
DOSE: Paget disease: 5–10 mg/kg/d PO ÷ doses (for 3–6 mo). ↑ Ca2+: 20 mg/kg/d IV × 30–90 days.
W/P: [B PO (C parenteral),?] Bisphosphonates may cause severe musculoskelet al pain.
CI: Esophageal abnormalities.
DISP: Tabs 200, 400 mg.
SE: GI intolerance (↓ by ÷ daily doses); hyperphosphatemia, hypomagnesemia, bone pain, abnormal taste, fever, convulsions, nephrotoxic.
NOTES: Take PO on empty stomach 2 hr before or 2 hr pc; not approved for osteoporosis.
ETOPOSIDE [VP-16] (ETOPOPHOS, GENERIC)
WARNING: Should be administered under the supervision of a qualified physician experienced in the use of chemotherapy. Severe myelosuppression with resulting infection or bleeding may occur.
USES: *Small cell lung cancer* testicular cancer, Hodgkin disease, & NHLs, peds ALL, & BMT in high doses.*
ACTIONS: Topoisomerase II inhibitor.
DOSE: 50 mg/m2/d IV for 3–5 days; 50 mg/m2/d PO for 21 days (PO availability = 50% of IV); 2–6 g/m2 or 25–70 mg/kg in BMT (per protocols); ↓ in renal/hepatic impairment.
W/P: [D, −].
CI: IT administration.
DISP: Caps 50 mg; Inj 20 mg/mL.
SE: N/V (emesis in 10–30%), ↓ BM, alopecia, ↓ BP w/ rapid IV, anorexia, anemia, leukopenia, ↑ risk secondary leukemias.
EVEROLIMUS (AFINITOR, AFINITOR DISPERZ)
USES: *Afinitor: Hormone receptor positive, HER2-negative breast cancer w/ exemestane after failure of letrozole or anastrozole; unresectable progressive neuroendocrine tumors of pancreatic origin (PNET); advanced renal cell carcinoma (RCC) after failure of sunitinib or sorafenib; adults with renal angiomyolipoma and tuberous sclerosis complex (TSC), not requiring immediate surgery. Afinitor and Afinitor Disperz: Pediatric and adult with tuberous sclerosis complex (TSC) who have subependymal giant cell astrocytoma (SEGA) that requires therapeutic intervention but cannot be resected.*
ACTIONS: mTOR inhibitor.
DOSE: 10 mg PO daily, ↓ to 5 mg w/ SE or hepatic impairment; avoid w/ high-fat meal.
W/P: [D, ?] Avoid w/ live vaccines; w/ CYP3A4 inhibitor.
CI: Compound/rapamycin-derivative hypersens.
DISP: Tabs 2.5, 5, 7.5, 10 mg; Disperz for suspen 2, 3, 5 mg.
SE: Noninfectious pneumonitis, ↑ infection risk, oral ulcers, asthenia, cough, fatigue, diarrhea, ↑ glucose/SCr/lipids; ↓ hemoglobin/WBC/plt.
NOTES: Follow CBC, LFT, glucose, lipids; see also everolimus (Zortress).
EVEROLIMUS (ZORTRESS)
USES: *Prevent renal and liver transplant rejection; combo w/ basiliximab w/ ↓ dose of steroids and cyclosporine.*
ACTIONS: mTOR inhibitor (mammalian rapamycin target).
DOSE: 0.75 mg PO BID, adjust to trough levels 3–8 ng/ mL.
W/P: [D, ?].
CI: Compound/rapamycin-derivative hypersens.
DISP: Tabs 0.25, 0.5, 0.75 mg.
SE: Peripheral edema, constipation, ↑ BP, N, ↓ Hct, UTI, ↑ lipids.
NOTES: Follow CBC, LFT, glucose, lipids; Trough level 3–8 ng/mL w/ cyclosporine see also everolimus (Afinitor).