IBANDRONATE (BONIVA, GENERIC)
USES: *Treat osteoporosis in postmenopausal women.*
ACTIONS: Bisphosphonate, ↓ osteoclast-mediated bone resorption.
DOSE: 2.5 mg PO daily or 150 mg 1 × mo on same day (do not lie down for 60 min after); 3 mg IV over 15–30 s q3mo; w/ low risk for fracture, consider D/C after 3–5 yr.
W/P: [C, ?/−] Do not use w/ CrCl <30 mL/min; w/ inability to stand/sit upright for 60 min (PO); anaphylaxis reported; tissue damage with inappropropriate IV administration.
CI: Hypocalcemia, component hypersensitivity.
DISP: Tabs 2.5, 150 mg, Inj IV 3 mg/3 mL.
SE: Osteonecrosis of the jaw (ONJ) (avoid extensive dental procedures) N/diarrhea, headache, dizziness, asthenia, HTN, infection, dysphagia, esophagitis, esophageal/gastric ulcer, musculoskelet al pain.
NOTES: Take 1st thing in a.m. w/ water (6–8 oz) >60 min before 1st food/beverage & any meds w/ multivalent cations; give adequate Ca2+ & vit D supls; possible association between bisphosphonates & severe muscle/bone/joint pain; may ↑ atypical subtrochanteric femur fractures.
IBUPROFEN, ORAL (ADVIL, MOTRIN, MOTRIN IB, RUFEN, OTHERS, GENERIC) [OTC]
WARNING: May ↑ risk of CV events & GI bleeding.
USES: *Arthritis, pain, fever.*
ACTIONS: NSAID.
DOSE:
Adults: 200–800 mg PO BID–QID (max. 2.4 g/d).
Peds: 30–40 mg/kg/d in 3–4 ÷ doses (max. 40 mg/kg/d); w/ food.
W/P: [C (D ≥30 wk gestation), +] May interfere w/ ASAs anti-plt effect if given <8 hr before ASA.
CI: 3rd-tri PREGNANCY, severe hepatic impairment, allergy, use w/ other NSAIDs, upper GI bleeding, ulcers.
DISP: Tabs 100, 200, 400, 600, 800 mg; chew tabs 50, 100 mg; caps 200 mg; susp 50 mg/1.25 mL, 100 mg/2.5 mL, 100 mg/5 mL, 40 mg/mL (Motrin IB & Advil OTC 200 mg are the OTC forms).
SE: Dizziness, peptic ulcer, plt inhibition, worsening of renal insufficiency.
IBUPROFEN, PARENTERAL (CALDOLOR)
WARNING: May ↑ risk of CV events & GI bleeding.
USES: *Mild–mod pain, as adjunct to opioids, ↓ fever.*
ACTIONS: NSAID.
DOSE: Pain: 400–800 mg IV over 30 min q6h PRN; Fever: 400 mg IV over 30 min, the 400 mg q4–6h or 100–200 mg q4–6h PRN.
W/P: [C <30 wk, D after 30 wk, ?/−] May ↓ ACE effects; avoid w/ ASA, and <17 yr.
CI: Hypersensitivity NSAIDs; asthma, urticaria, or allergic reactions w/ NSAIDs, periop CABG.
DISP: Vials 400 mg/4 mL, 800 mg/8 mL.
SE: N/V, headache, flatulence, hemorrhage, dizziness.
NOTES: Keep well hydrated; use lowest dose/shortest duration possible.
IFOSFAMIDE (IFEX, GENERIC)
WARNING: Administer only under supervision by an MD experienced in chemotherapy; hemorrhagic cystitis, myelosupp; confusion, coma possible.
USES: *Testis cancer, 3rd line with other agents.*
ACTIONS: Alkylating agent.
DOSE: (Per protocol) 1.2 g/m2/d for 5-day bolus or cont Inf; 2.4 g/m2/d for 3 days; w/ mesna uroprotection; ↓ in renal/hepatic impairment.
W/P: [D, M] ↑ Effect w/ phenobarbital, carbamazepine, phenytoin; St. John’s wort may ↓ levels.
CI: ↓ BM function, PREGNANCY.
DISP: Inj 1, 3 g.
SE: Hemorrhagic cystitis, nephrotoxic, N/V, mild–mod leukopenia, lethargy & confusion, alopecia, ↑ LFT.
NOTES: Administer w/ mesna to prevent hemorrhagic cystitis; WBC nadir 10–14 days; recovery 21–28 days.
IMIPENEM/CILASTATIN (PRIMAXIN, GENERIC)
USES: *Serious infections: Lower respiratory, UTI, intra-abdominal, gyn, sepsis, bone and joint, skin and skin structure, endocarditis, polymicrobial infections* d/t susceptible bacteria.
ACTIONS: Bactericidal; ↓ cell wall synth. Spectrum: gram(+) (S. aureus, group A & B streptococci), gram(−) (not Legionella), anaerobes.
DOSE:
Adults: 250–1,000 mg (imipenem) IV q6–8h, 500–750 mg IM.
Peds: 60–100 mg/kg/24 h IV ÷ q6h; ↓ if CrCl is <70 mL/min.
W/P: [C, +/−] Probenecid ↑ tox.
CI: Peds pts w/ CNS infection (↑ seizure risk) & <30 kg w/ renal impairment.
DISP: Inj (imipenem/cilastatin) 250/250, 500/500 mg.
SE: Seizures if drug accumulates, GI upset, thrombocytopenia.
IMIPRAMINE (TOFRANIL, GENERIC)
WARNING: Close observation for suicidal thinking or unusual changes in behavior.
USES: *Depression, enuresis in children >6 yo.*
ACTIONS: Tricyclic antidepressant; ↑ CNS synaptic serotonin or norepinephrine.
DOSE:
Adults: Hospitalized: Initial 100 mg/24 h PO in ÷ doses; ↑ over several wk 300 mg/d max. Outpatient: Maint 50–150 mg PO hs, 300 mg/24 h max.
Peds: Antidepressant: 1.5–5 mg/kg/24 h ÷ daily–QID. Enuresis: >6 yr: 10–25 mg PO qhs; ↑ by 10–25 mg at 1–2-wk intervals (max. 50 mg for 6–12 yr, 75 mg for >12 yr); Treat for 2–3 mo, then taper.
W/P: [D, ?/−].
CI: Use w/ MAOIs, narrow-angle glaucoma, recovery from AMI, pregnancy, CHF, angina, CV disease, arrhythmias.
DISP: Tabs 10, 25, 50 mg; caps 75, 100, 125, 150 mg.
SE: CV Sxs, dizziness, xerostomia, discolored urine.
NOTES: Less sedation than amitriptyline; retrograde ejaculation 25 mg TID × 2 wk.
IMIQUIMOD CREAM (ALDARA, ZYCLARA, GENERIC)
USES: *Anogenital warts, HPV, condylomata acuminata (Aldara, Zyclara); actinic keratosis (Zyclara); basal cell carcinoma (Aldara)* penile CIS.
ACTIONS: Inducer of interferon-α, enhances cell-mediated cytolytic activity.
DOSE:
Adults/Peds: >12 yr: Warts: 1 × day up to 8 wk (Zyclara); apply 3×/wk, leave on 6–10 h & wash off w/ soap & water, continue 16 wk max. (Aldara); Actinic keratosis: apply daily two 2 × wk cycle separate by 2 wk; Basal cell:Apply 5 d/wk × 6 wk, dose based on lesion size (see label).
W/P: [B, ?] Topical only, not intravaginal or intra-anal.
CI: Component sensitivity.
DISP: 2.5% packet, 3.75% packet or pump (Zyclara); single-dose packets 5% (250-mg cream Aldara).
SE: Local skin reactions, flu-like syndrome.
NOTES: Not a cure; may weaken condoms/Vag diaphragms, wash hands before & after use; efficacy was not demonstrated for molluscum contagiosum in children 2–12 yr; typical penile regimen described: apply 12 hr every 48 hr for 28 days.
INDIGO CARMINE, INJECTION [INDIGOTINDISULFONATE] (GENERIC)
USES: *Localization of ureteral orifices during cystoscopy,* identification of urinary tract injury intraoperatively.
ACTIONS: Excreted and appears in urine as blue color usually within 10 min of injection.
DOSE: 5 mL IV (preferred) or IM.
W/P: [C, ?].
CI: Allergy to compound.
DISP: 5 mg vials for injection; do not dilute or inject with other solutions.
SE: Mild pressor, rare idiosyncratic reaction.
NOTES: May transiently alter pulse oximeter; originally used as a renal function test. Label is not officially approved by the FDA.
INDOMETHACIN (INDOCIN, TIVORBEX, GENERIC)
WARNING: May ↑ risk of CV events & GI bleeding; not for post-CABG pain
USES: *Arthritis (gouty, osteo, rheumatoid); ankylosing spondylitis; close ductus arteriosus; * *Tivorbex: acute pain*
ACTIONS: ↓ Prostaglandins.
DOSE:
Adults: 25–50 mg PO BID–TID, max. 200 mg/d. Infants: 0.2–0.25 mg/kg/dose IV; may repeat in 12–24 hr max 3 doses; w/ food.
W/P: [C, +].
CI: ASA/NSAID sensitivity, peptic ulcer/active GI bleed, precipitation of asthma/ urticaria/rhinitis by NSAIDs/ASA, premature neonates w/ NEC, ↓ renal Fxn, active bleeding, thrombocytopenia, 3rd tri PRG.
DISP: Inj 1 mg/vial; caps 25, 50 mg; susp 25 mg/5 mL; Tivorbex: 20, 40 mg caps.
SE: GI bleeding or upset, dizziness, edema.
NOTES: Monitor renal Fxn.
INTERFERON ALFA-2B (INTRON-A)
WARNING: Can cause or aggravate fatal or life-threatening neuropsychiatric autoimmune, ischemic, and infectious disorders. Monitor closely (systemic).
USES: *Hairy cell leukemia, Kaposi sarcoma, melanoma, CML, chronic hep B & C, follicular NHL, condylomata acuminate,* RCC, superficial bladder cancer.
ACTIONS: Antiproliferative; modulates host immune response; ↓ viral replication in infected cells.
DOSE: Per protocols.
Adults: Per protocols. Condyloma: 1 MU/lesion (max. 5 lesions) 3×/wk (on alternate days) for 3 wk. Bladder CIS: High dose (50–100 MU) intravesically weekly; different regimens described; typically 6 wk. Bladder carcinoma, superficial BCG refractory: Used in combination with intravesical BCG (either standard or reduced dose BCG) with 50–100 MU interferon-α 2b for 6 wk; maintenance regimens described.
CI: Benzyl alcohol sensitivity, decompensated liver disease, autoimmune hep immunosuppressed, pregnancy, CrCl <50 mL/ min in combo w/ ribavirin.
DISP: Inj forms: powder 10/18/50 MIU; soln 6/10 MIU/mL (see also polyethylene glycol [PEG]-interferon).
SE: Flu-like Sxs, fatigue, anorexia, neurotox at high doses; up to 40% neutralizing Ab w/ Treat; not FDA approved for intravesical use; with systemic therapy follow baseline CXR and ECG; CBC w/ diff/platelets (baseline and routinely), LFTs, creatinine, electrolytes, triglycerides, thyroid function.
IRBESARTAN (AVAPRO)
WARNING: D/C immediately if pregnancy detected.
USES: *HTN, diabetic nephropathy*, CHF.
ACTIONS: Angiotensin II receptor antagonist.
DOSE: 150 mg/d PO, may ↑ to 300 mg/d.
W/P: [C (1st tri; D 2nd/3rd tri), ?/−].
CI: Component sensitivity; w/ aliskiren in diabetics
DISP: Tabs 75, 150, 300 mg
SE: Fatigue, ↓ BP, ↑ K
ISONIAZID (INH)
WARNING: Severe & sometimes fatal hep may occur usually w/in 1st 3 mo of Tx, although may develop after mo of Tx.
USES: *Treat & prophylaxis of TB.*
ACTIONS: Bactericidal; interferes w/ mycolic acid synth, disrupts cell wall.
DOSE:
Adults: Active TB: 5 mg/kg/24 h PO or IM (usually 300 mg/d) or DOT: 15 mg/kg (max. 900 mg) 3×/wk. Prophylaxis: 300 mg/d PO for 6–12 mo or 900 mg 2×/wk.
Peds: Active TB: 10–15 mg/kg/d daily PO or IM 300 mg/d max. Prophylaxis: 10 mg/kg/24 h PO; ↓ in hepatic/renal dysfunction.
W/P: [C, +] Liver disease, dialysis; avoid EtOH.
CI: Acute liver disease, Hx INH hep.
DISP: Tabs 100, 300 mg; syrup 50 mg/5 mL; Inj 100 mg/ mL.
SE: Hep, peripheral neuropathy, GI upset, anorexia, dizziness, skin reaction.
NOTES: Use w/ 2–3 other drugs for active TB, based on INH resistance patterns when TB acquired & sensitivity results; prophylaxis usually w/ INH alone. IM rarely used. ↓ Peripheral neuropathy w/ pyridoxine 50–100 mg/d. See CDC guidelines (http://www.cdc.gov/tb/) for current TB recommendations.
ITRACONAZOLE (ONMEL, SPORANOX, GENERIC)
WARNING: CI w/ cisapride, pimozide, quinidine, dofetilide, or levacetylmethadol. Serious CV events (eg, ↑ QT, torsades de pointes, VT, cardiac arrest, and/or sudden death) reported w/ these meds and other CYP3A4 inhibitor. Do not use for onychomycosis w/ ventricular dysfunction. Negative inotropic effects have been observed following IV administration D/C/reassess use if S/Sxs of HF occur during Tx.
USES: *Fungal infections (aspergillosis, blastomycosis, histoplasmosis, candidiasis, onychomycosis).*
ACTIONS: Azole antifungal, ↓ ergosterol synth.
DOSE: Dose based on indication. 200 mg PO daily–TID (caps w/ meals or cola/grapefruit juice); PO soln on empty stomach; avoid antacids.
W/P: [C, −] Numerous interactions.
CI: See “Warning"; pregnancy or considering pregnancy; ventricular dysfunction CHF.
DISP: Caps 100 mg; soln 10 mg/mL.
SE: N/V, rash, hepatotoxic, ↓ K+, CHF, ↑ BP, neuropathy.
NOTES: Soln & caps not interchangeable; useful in pts who cannot take amphotericin B; follow LFTs.