KETOCONAZOLE, ORAL (NIZORAL, GENERIC)
WARNING: (Oral use) Risk of fatal hepatotox. Concomitant dofetilide, quinidine, pimozide, cisapride, methadone, disopyramide, dronedarone, ranolazine are CI d/t serious CV adverse events.
USES: *Systemic fungal infections (Candida, blastomycosis, histoplasmosis, etc.); refractory topical dermatophyte infection*; PCa when rapid ↓ testosterone needed or hormone refractory; Cushing’s disease medical therapy when surgery not possible.
ACTIONS: Azole, ↓ fungal cell wall synth; high dose blocks P450, to ↓ testosterone production.
DOSE: PO: 200 mg PO daily; ↑ to 400 mg PO daily for serious infection. PCa: 400 mg PO TID w/ hydrocortisone 20–40 mg divided BID; best on empty stomach.
W/P: [C, −/−] w/ Any agent that ↑ gastric pH (↓ absorption); may enhance anticoagulants; w/ EtOH (disulfiram-like reaction); numerous interactions including statins, niacin; do not use w/ clopidogrel (↓ effect).
CI: CNS fungal infections, w/ dofetilide, quinidine, pimozide, cisapride, methadone, disopyramide, dronedarone, ranolazine. Ketoconazole can cause elevated plasma concentrations of these drugs and may prolong QT intervals.
DISP: Tabs 200 mg.
SE: N, rashes, hair loss, headache, ↑ Wt gain, dizziness, disorientation, fatigue, impotence, hepatox, adrenal suppression, acquired cutaneous adherence (“sticky skin syndrome”).
NOTES: Monitor LFTs; can rapidly ↓ testosterone levels at high dose.
KETOROLAC, INJECTION (GENERIC)
WARNING: For short-term (≤5 days) Treat of mod–severe acute pain; CI w/ PUD, GI bleed, post CABG, anticipated major surgery, severe renal insufficiency, bleeding diathesis, L&D, nursing, and w/ ASA/NSAIDs. NSAIDs may cause ↑ risk of CV/thrombotic events (MI, stroke). PO CI in peds <16 yr, dose adjustments for <50 kg.
USES: *Pain.*
ACTIONS: NSAID; ↓ prostaglandins.
DOSE:
Adults: 15–30 mg IV/IM q6h; 10 mg PO QID only as continuation of IM/IV; max. IV/IM 120 mg/d, max. PO 40 mg/d; ↓ if >65 yr, elderly, w/ renal impairment, <50 kg.
Peds: 2–16 yr: 1 mg/kg IM × 1 dose; 30 mg max.; IV: 0.5 mg/kg, 15 mg max.; do not use for >5 days.
W/P: [C (D 3rd tri), −] w/ ACE inhibitor, diuretics, BP meds, warfarin.
CI: See “Warning"; as prophylactic analgesic before any major surgery.
DISP: Tabs 10 mg; Inj 15 mg/mL, 30 mg/mL.
SE: Bleeding, peptic ulcer disease, ↑ Cr & LFTs, ↑ BP, edema, dizziness, allergy.
NOTES: Volume depletion increases renal toxicity.
KETOROLAC, NASAL (SPRIX)
WARNING: For short-term (5 days) use; CI w/ PUD, GI bleed, suspected bleeding risk, postop CABG, advanced renal disease or risk of renal failure w/ vol depletion; risk CV thrombotic events (MI, stroke). Not indicated for use in children.
USES: *Short-term (<5 days) Treat pain requiring opioid level analgesia.*
ACTIONS: NSAID; ↓ prostaglandins.
DOSE: <65 yr: 31.5 mg (one 15.75-mg spray each nostril) q6–8h; max. 126 mg/d. ≥65 yr, w/ renal impairment or <50 kg: 15.75 mg (one 15.75-mg spray in only 1 nostril) q6–8h; max. 63 mg/d.
W/P: [C (D 3rd tri), −] Do not use w/ other NSAIDs; can cause severe skin reactions; do not use w/ critical bleeding risk; w/ CHF.
CI: See “Warning"; prophylactic to major surgery/L&D, w/ Hx allergy to other NSAIDs recent or Hx of GI bleed or perforation.
DISP: Nasal spray 15.75-mg ketorolac/100-μL spray (8 sprays/bottle).
SE: Nasal discomfort/rhinitis, ↑ lacrimation, throat irritation, oliguria, rash, ↓ HR, ↓ urine output, ↑ ALT/AST, ↑ BP.
NOTES: Discard open bottle after 24 hr.
KUNECATECHINS [SINECATECHINS] (VEREGEN)
USES: *External genital/perianal warts.*
ACTIONS: Unknown; green tea extract.
DOSE: Apply 0.5-cm ribbon to each wart 3×/d until all warts clear; not >16 wk.
W/P: [C, ?].
DISP: Oint 15%.
SE: Erythema, pruritus, burning, pain, erosion/ulceration, edema, induration, rash, phimosis.
NOTES: Wash hands before/after use; not necessary to wipe off prior to next use; avoid on open wounds, may weaken condoms & Vag diaphragms, use in combo is not recommended.