LACTOBACILLUS (LACTINEX GRANULES) [OTC]
USES: *Control of diarrhea*, especially after antibiotic Treat.
ACTIONS: Replaces normal intestinal flora, lactase production; Lactobacillus acidophilus and Lactobacillus helveticus.
DOSE:
Adults & Peds: >3 yr: 1 packet, 1–2 caps, or 4 tabs QD–QID
W/P: [A, +] Some products may contain whey.
CI: Milk/lactose allergy.
DISP: Tabs, caps; granules in packets (all OTC).
SE: Flatulence.
NOTES: May take granules on food.
LANTHANUM CARBONATE (FOSRENOL)
USES: *Hyperphosphatemia in end-stage renal disease.*
ACTIONS: Phosphate binder.
DOSE: 750–1,500 mg PO daily in ÷ doses, w/ or immediately after meal; titrate q2–3wk based on PO4 levels.
W/P: [C, ?/−] No data in GI disease; not for peds.
CI: Bowel obstruction, fecal impaction, ileus.
DISP: Chew tabs 500, 750, 1,000 mg.
SE: N/V, graft occlusion, headache, ↓ BP.
NOTES: Chew tabs before swallowing; separate from meds that interact w/ antacids by 2 hr.
LEUPROLIDE (ELIGARD, LUPRON, LUPRON DEPOT, LUPRON DEPOT-PED, GENERIC)
USES: *Advanced PCa (all except Depot-Ped), endometriosis (Lupron), uterine fibroids (Lupron), & precocious puberty (Lupron-Ped).*
ACTIONS: LHRH agonist; paradoxically ↓ release of GnRH w/ ↓ LH from anterior pituitary; in men ↓ testosterone, in women ↓ estrogen.
DOSE:
Adults: PCa: Lupron DEPOT: 7.5 mg IM q28d or 22.5 mg IM q3mo or 30 mg IM q4mo or 45 mg IM q6mo. Eligard: 7.5 mg SQ q28d or 22.5 mg SQ q3mo or 30 mg SQ q4mo or 45 mg SQ 6 mo. Endometriosis (Lupron DEPOT):3.75 mg IM qmo × 6 or 11.25 IM q3mo × 2. Fibroids: 3.75 mg IM qmo × 3 or 11.25 mg IM × 1.
Peds: CPP (Lupron DEPOT- Ped): 50 μg/kg/d SQ Inj; ↑ by 10 μg/kg/d until total downregulation achieved. Lupron DEPOT: <25 kg: 7.5 mg IM q4wk; >25–37.5 kg: 11.25 mg IM q4wk; >37.5 kg: 15 mg IM q4wk, ↑ by 3.75 mg q4wk until response.
W/P: [X, −] w/ Impending cord compression in PCa, ↑ QT w/ meds or pre-existing CV disease; postmarketing reports of seizures.
CI: AUB, implant in women/peds; pregnancy.
DISP: Inj 5 mg/mL; Lupron DEPOT: 3.75 mg (1 mo for fibroids, endometriosis); Lupron DEPOT for PCa: 7.5 mg (1 mo), 11.25 (3 mo), 22.5 (3 mo), 30 mg (4 mo), 45 mg (6 mo); Eligard depot for PCA: 7.5 (1 mo); 22.5 (3 mo), 30 (4 mo), 45 mg (6 mo); Lupron DEPOT-Ped: 7.5, 11.25, 15, 30 mg.
SE: Hot flashes, gynecomastia, N/V, alopecia, anorexia, dizziness, headache, insomnia, paresthesias, depression exacerbation, peripheral edema, & bone pain (transient “flare reaction” at 7–14 days after the 1st dose [LH/testosterone surge before suppression]); ↓ BMD w/ >6 mo use, bone loss possible, abnormal menses, hyperglycemia.
NOTES: Nonsteroidal antiandrogen (eg, bicalutamide) may block flare in men w/ PCa; Viadur 12 mo form unavailable to new patients.
LEVOFLOXACIN (LEVAQUIN, GENERIC)
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: *SSSI, UTI, chronic bacterial prostatitis, acute pyelo, acute bacterial sinusitis, acute bacterial exacerbation of chronic bronchitis, community-acquired pneumonia, including multidrug-resistant S. pneumoniae, nosocomial pneumonia; Treat inhalational anthrax in adults & peds ≥6 mo.*
ACTIONS: Quinolone, ↓ DNA gyrase. Spectrum: Excellent gram(+) except MRSA & E. faecium; excellent gram(−) except Stenotrophomonas maltophilia & Acinetobacter sp; poor anaerobic.
DOSE:
Adults: ≥18 yr: IV/PO: Bronchitis: 500 mg qd × 7 days. Community-acquired pneumonia: 500 mg qd × 7–14 days or 750 mg qd × days. Sinusitis: 500 mg qd × 10–14 days or 750 mg qd × days. Prostatitis:500 mg qd × 28 days. Uncomp SSSI: 500 mg qd × 7–10 days. Comp SSSI/nosocomial pneumonia: 750 mg qd × 7–14 days. Anthrax: 500 mg qd × 60 days; Uncomp UTI: 250 mg qd × 3 days. Comp UTI/acute pyelo: 250 mg qd × 10 days or 750 mg qd × 5 days. CrCl 10–19 mL/min: 500 mg then 250 mg q other day or 750 mg, then 500 mg q48h. Hemodialysis: 750 mg, then 500 mg q48h.
Peds: ≥6 mo: Anthrax >50 kg: 500 mg q24h × 60 days, <50 kg: 8 mg/kg (250 mg/dose max.) q12h for 60 days ↓ w/ renal impairment avoid antacids w/ PO; oral soln 1 hr before, 2 hr after meals; Community-acquired pneumonia: ≥6 mo–≤4 yr: 8 mg/kg/dose q12h (max. 750 mg/d), 5–16 yr: 8 mg/kg/dose once daily (750 mg/d).
W/P: [C, −] w/ Cation-containing products (eg, antacids), w/ drugs that ↑ QT interval.
CI: Quinolone sensitivity.
DISP: Tabs 250, 500, 750 mg; premixed IV 250, 500, 750 mg, Inj 25 mg/mL; Leva-Pak 750 mg × 5 days.
SE: N/D, dizziness, rash, GI upset, photosensitivity, CNS stimulant w/ IV use, C. difficile enterocolitis; rare fatal hepatox, peripheral neuropathy risk.
NOTES: Use w/ steroids ↑ tendon risk; only for anthrax in peds.
LIDOCAINE; LIDOCAINE W/ EPINEPHRINE (ANESTACON TOPICAL, XYLOCAINE, XYLOCAINE VISCOUS, XYLOCAINE MPF, OTHERS)
USES: *Local anesthetic, epidural/caudal anesthesia, regional nerve blocks, topical on mucous membranes (mouth/pharynx/urethra).*
ACTIONS: Anesthetic; stabilizes neuronal membranes; inhibits ionic fluxes required for initiation and conduction.
DOSE:
Adults: Local Inj anesthetic: 4.5 mg/kg max. total dose or 300 mg; w/ epi 7 mg/kg or total 500 mg max. dose. Oral: 15 mL viscous swish and spit or pharyngeal gargle and swallow, do not use <3-hr intervals or >8 × in 24 hr. Urethra: Jelly 5–30 mL (200–300 mg) in men, 3–5 mL female urethra; 600 mg/24 h max.
Peds: Topical: Apply max. 3 mg/kg/ dose. Local Inj anesthetic: Max. 4.5 mg/kg.
W/P: [B, +] Epi-containing soln may interact w/ tricyclic antidepressants or MAOI and cause severe ↑ BP.
CI: Do not use lidocaine w/ epi on penis, digits, ears, or nose (vasoconstriction & necrosis).
DISP: Inj local: 0.5%, 1%, 1.5%, 2%, 4%, 10%, 20%; Inj w/ epi 0.5%/1:200,000, 1%/1:100,000, 2%/1:100,000; (MPF) 1%/1:200,000, 1.5%/1:200,000, 2%/1:200,000; cream 2%, 3%, 4%; lotion 30%, jelly 2%, gel 2%, 2.5%, 4%, 5%; oint 5%; liq 2.5%; soln 2, 4%; viscous 2% topical spray 9.6%.
SE: Dizziness, paresthesias, & seizures associated w/ tox.
LIDOCAINE/PRILOCAINE (EMLA, ORAQ IX)
USES: *Topical anesthetic for intact skin or genital mucous membranes*; adjunct to phlebotomy or dermal procedures.
ACTIONS: Amide local anesthetics.
DOSE:
Adults: EMLA cream, thick layer 2–2.5 g to intact skin over 20–25 cm2 of skin surface, cover w/ occlusive dressing (eg, Tegaderm) for at least 1 hr. Anesthetic disc: 1 g/10 cm2 for at least 1 hr.
Peds: Max. dose: <3 mo or <5 kg: 1 g/10 cm2 for 1 hr. 3–12 mo & >5 kg: 2 g/20 cm2 for 4 hr. 1–6 yr & >10 kg: 10 g/100 cm2 for 4 hr. 7–12 yr & >20 kg: 20 g/200 cm2 for 4 hr.
W/P: [B, +].
CI: Methemoglobinemia use on mucous membranes, broken skin, eyes; allergy to amide-type anesthetics.
DISP: Cream 2.5% lidocaine/2.5% prilocaine; anesthetic disc (1 g); periodontal gel 2.5/2.5%.
SE: Burning, stinging, methemoglobinemia.
NOTES: Longer contact time ↑ effect.
LIDOCAINE/TETRACAINE, PATCH (SYNERA) CREAM (PLIAGLIS)
USES: *Topical anesthesia for venipuncture and dermatologic procedures (Synera); dermatologic procedures (Pliaglis).*
ACTIONS: Combo amide and ester local anesthetic.
DOSE:
Adults & Peds: Synera: Apply patch 20–30 min before procedure.
Adults: Pliaglis: Apply cream 20–60 min before procedure, volume based on site surface (see label).
W/P: [B, ?/−] Use on intact skin only; avoid eyes; not for mucous membranes; do not use w/ Hx methemoglobinemia anaphylaxis reported; caution w/ Class I antiarrhythmic drugs; remove before MRI.
CI: Component sensitivity (PABA or local anesthetics).
DISP: Synera 70 mg lidocaine/70 mg tetracaine in 50 cm2 patch; Pliaglis 70 mg lidocaine/70 mg tetracaine/g (7%/7%) cream 30, 60, 100 g tube.
SE: Erythema, blanching, and edema.
LINDANE (GENERIC)
WARNING: Only for pts intolerant/failed 1st-line Treat w/ safer agents. Seizures and deaths reported w/ repeated/prolonged use. Caution d/t increased risk of neurotox in infants, children, elderly, w/ other skin conditions, and if <50 kg. Instruct pts on proper use and inform that itching occurs after successful killing of scabies or lice.
USES: *Head lice, pubic “crab” lice, body lice, scabies.*
ACTIONS: Ectoparasiticide & ovicide.
DOSE:
Adults & Peds. Cream or lotion: Thin layer to dry skin after bathing, leave for 8–12 hr, rinse; also use on laundry. Shampoo: Apply 30 mL to dry hair, develop a lather w/ warm water for 4 min, comb out nits.
W/P: [C, −].
CI: Premature infants, uncontrolled seizure disorders, Norwegian scabies, open wounds.
DISP: Lotion 1%; shampoo 1%.
SE: Arrhythmias, seizures, local irritation, GI upset, ataxia, alopecia, N/V, aplastic anemia.
NOTES: Caution w/ overuse (may be absorbed); caution w/ hepatic in pts may repeat Treat in 7 days; try OTC 1st w/ pyrethrins (Pronto, Rid, others).
LINEZOLID (ZYVOX)
USES: *Infections caused by gram(+) bacteria (including VRE), pneumonia, skin infections.*
ACTIONS: Unique, binds ribosomal bacterial RNA; bactericidal for streptococci, bacteriostatic for enterococci & staphylococci. Spectrum: Excellent gram(+) including VRE & MRSA.
DOSE:
Adults: 600 mg IV or PO q12h.
Peds: Ä ≤11 y: 10 mg/kg IV or PO q8h (q12h in preterm neonates).
W/P: [C, ?/−].
CI: Concurrent MAOI use or w/in 2 wk, uncontrolled HTN, thyrotoxicosis, vasopressive agents, carcinoid tumor, SSRIs, tricyclics, w/ MAOI (may cause serotonin syndrome when used w/ these psych meds), avoid foods w/ tyramine & cough/cold products w/ pseudoephedrine; w/ ↓ BM.
DISP: Inj 200, 600 mg; tabs 600 mg; susp 100 mg/5 mL.
SE: Lactic acidosis, peripheral/optic neuropathy, HTN, N/diarrhea, headache, insomnia, GI upset, ↓ BM, tongue discoloration prolonged use C. diff infection.
NOTES: Check weekly CBC; not for gram(−) infection, ↑ deaths in catheter-related infections; MAOI activity.
LISINOPRIL (PRINIVIL, ZESTRIL, GENERIC)
WARNING: ACE inhibitor can cause fet al injury/death in 2nd/3rd tri; D/C w/ pregnancy.
USES: *HTN, CHF, prevent diabetic nephropathy & acute MI*
ACTIONS: ACE inhibitor.
DOSE: 5–40 mg/24 h PO daily–BID, CHF target 40 mg/d. AMI: 5 mg w/in 24 hr of MI, then 5 mg after 24 hr, 10 mg after 48 hr, then 10 mg/d; ↓ in renal insufficiency; use low dose, ↑ slowly in elderly.
W/P: [C (1st tri) D (2nd, 3rd tri), −] w/ Aortic stenosis/ cardiomyopathy.
CI: Pregnancy, ACE inhibitor sensitivity, idiopathic or hereditary angioedema.
DISP: Tabs 2.5, 5, 10, 20, 30, 40 mg.
SE: Dizziness, headache, cough, ↓ BP, angioedema, ↑ K+, ↑ Cr, rare ↓ BM.
NOTES: To prevent DN, start when urinary microalbuminuria begins; check BUN, Cr, K+, WBC.
LISINOPRIL/HYDROCHLOROTHIAZIDE (PRINZIDE, ZESTORETIC, GENERIC)
WARNING: ACE inhibitor can cause fet al injury/death in 2nd/3rd tri; D/C w/ pregnancy.
USES: *HTN.*
ACTIONS: ACE inhibitor w/ diuretic (HCTZ).
DOSE: Initial 10 mg lisinopril/12.5 mg HCTZ, titrate upward to effect; >80 mg/d lisinopril or >50 mg/day HCTZ are not recommended; ↓ in renal insufficiency; use low dose, ↑ slowly in elderly.
W/P: [C 1st tri, D after, −] w/ Aortic stenosis/cardiomyopathy, bilateral RAS.
CI: Pregnancy, ACE inhibitor, idiopathic or hereditary angioedema, sensitivity (angioedema).
DISP: Tabs (mg lisinopril/mg HCTZ) 10/12.5, 20/12.5; Zestoretic also available as 20/25.
SE: Anaphylactoid reaction (rare), dizziness, headache, cough, fatigue, ↓ BP, angioedema, ↑ / ↓ K+, ↑ Cr, rare ↓ BM/cholestatic jaundice.
NOTES: Use only when monotherapy fails; check BUN, Cr, K+, WBC.
LOSARTAN (COZAAR, HYZAAR, GENERIC)
WARNING: Can cause fet al injury and death if used in 2nd & 3rd tri. D/C Treat if pregnancy detected.
USES: *HTN, DN, HTN w/ LVH.*
ACTIONS: Angiotensin II receptor antagonist.
DOSE:
Adults: 25–50 mg PO daily–BID, max. 100 mg; ↓ in elderly/hepatic impairment.
Peds: ≥6 yr: HTN: Initial 0.7 mg/kg qd, ↑ to 50 mg/d PRN; 1.4 mg/kg/d or 100 mg/d max.
W/P: [C (1st tri, D 2nd, & 3rd tri), ?/−] w/ NSAIDs; w/ K+-sparing diuretics, supl may cause ↑ K+; w/ RAS, hepatic impairment.
CI: Pregnancy, component sensitivity.
DISP: Tabs 25, 50, 100 mg.
SE: ↓ BP in pts on diuretics; ↑ K+; GI upset, facial/angioedema, dizziness, cough, weakness, ↓ renal function.
NOTES: w/ DM risk check glucose.
LULICONAZOLE (LUZU)
USES: *Tinea pedis, tinea cruris, tinea corporis.*
ACTIONS: Azole antifungal, inhibits ergosterol synthesis.
DOSE: Tinea pedis apply 1×/d for 2 wk; tinea corporis, tinea cruris apply 1 ×/d for 1 wk.
W/P: [C, ?/-].
CI: None.
DISP: Cream, 1%; 30/60 g.
SE: Site reaction, rare.
LYMPHOCYTE IMMUNE GLOBULIN [ANTITHYMOCYTE GLOBULIN, ATG] (ATGAM)
WARNING: Should only be used by physician experienced in immunosuppressive therapy or management of solid organ and/or BMT pts. Adequate lab and supportive resources must be readily available.
USES: *Allograft rejection in renal transplant pts; aplastic anemia if not candidates for BMT*, GVHD after BMT.
ACTIONS: ↓ Circulating antigen-reactive T lymphocytes; a human, & equine product.
DOSE:
Adults: Prevent rejection: 15 mg/kg/d IV × 14 days, then q other day × 7 days for total 21 doses in 28 days; initial w/in 24 hr before/after transplant. Treat rejection: Same but use 10–15 mg/kg/d; max. 21 doses in 28 days, qd 1st 14 days. Aplastic anemia: 10–20 mg/kg/d × 8–14 days, then q other day × 7 doses for total 21 doses in 28 days.
Peds: Prevent renal allograft rejection: 5–25 mg/kg/d IV; aplastic anemia 10–20 mg/kg/day IV 8–14 days then q other day for 7 more doses.
W/P: [C, ?/−] D/C if severe unremitting thrombocytopenia, leukopenia.
CI: Hx previous reaction or reaction to other equine γ-globulin prep, ↓ plt and WBC.
DISP: Inj 50 mg/mL.
SE: D/C w/ severe ↓ plt and WBC; rash, fever, chills, ↓ BP, headache, CP, edema, N/V/diarrhea, lightheadedness.
NOTES: Test dose: 0.1 mL 1:1,000 dilution in NS, a systemic reaction precludes use; give via central line; pretreat w/ antipyretic, antihistamine, and steroids; monitor WBC, plt; plt counts usually return to nl w/o D/C Treat 4 hr Inf.