MAGNESIUM HYDROXIDE (MILK OF MAGNESIA) [OTC]
USES: *Constipation*, hyperacidity, Mg2+ replacement.
ACTIONS: NS laxative.
DOSE:
Adults: Antacid: 5–15 mL (400 mg/5 mL) or 2–4 tabs (311 mg) PO PRN up to QID. Laxative: 30–60 mL (400 mg/5 mL) or 15–30 mL (800 mg/5 mL) or 8 tabs (311 mg) PO qhs or ÷ doses.
Peds: Antacid and <12 yr not OK. Laxative: <2 yr not OK. 2–5 yr: 5–15 mL (400 mg/5 mL) PO qhs or ÷ doses. 6–11 yr: 15–30 mL (400 mg/5 mL) or 7.5–15 mL (800 mg/5 mL) PO qhs or ÷ doses. 3–5 yr: 2 (311 mg) tabs PO qhs or ÷ doses. 6–11 yr: 4 (311 mg) tabs PO qhs or ÷ doses.
W/P: [B, +] w/ Neuromuscular disease or renal impairment.
CI: Component hypersens.
DISP: Chew tabs 311, 400 mg; liq 400, 800 mg/5 mL (OTC).
SE: Diarrhea, abdominal cramps.
NOTES: For occasional use in constipation, different forms may contain Al2+.
MAGNESIUM OXIDE (MAG-OX 400, OTHERS) [OTC]
USES: *Replace low Mg2+ levels.*
ACTIONS: Mg2+ supl.
DOSE: 400–800 mg/d or ÷ w/ food in full glass of H2O; ↓ w/ renal impairment.
W/P: [B, +] w/ Neuromuscular disease & renal impairment, w/ bisphosphonates, calcitriol, CCBs, neuromuscular blockers, tetracyclines, quinolones.
CI: Component hypersens.
DISP: Caps 140, 250, 500, 600 mg; tabs 400 mg (OTC).
SE: Diarrhea, N.
MAGNESIUM SULFATE (GENERIC)
USES: *Replace low Mg2+; preeclampsia, eclampsia, & premature labor, cardiac arrest, AMI arrhythmias, cerebral edema, barium poisoning, seizures, pediatric acute nephritis*; refractory ↓ K+ & ↓ Ca2+.
ACTIONS: Mg2+ supl, bowel evacuation, ↓ acetylcholine in nerve terminals, ↓ rate of sinoatrial node firing.
DOSE:
Adults: 1 g q6h IM × 4 doses & PRN 1–2 g q3–6h IV then PRN to correct deficiency.
Peds & Neonates: 25–50 mg/kg/dose IV, repeat PRN; max. 2 g single dose.
W/P: [A/C (manufacturer specific), +] w/ Neuromuscular disease; interactions see Magnesium Oxide and aminoglycosides.
CI: Heart block, myocardial damage.
DISP: Premix Inj: 10, 20, 40, 80 mg/mL; Inj 125, 500 mg/mL; oral/topical powder 227, 454, 1,810, 2,720 g.
SE: CNS depression, diarrhea, flushing, heart block, ↓ BP, vasodilation.
NOTES: Different formulation may contain Al2+, monitor Mg2+ levels.
MANNITOL, INTRAVENOUS (GENERIC)
USES: *Cerebral edema, ↑ IOP, renal impairment, poisonings.*
ACTIONS: Osmotic diuretic.
DOSE: Test dose: 0.2 g/kg/dose IV over 3–5 min; if no diuresis w/in 2 hr, D/C. Oliguria: 50–100 g IV over 90 min ↑ IOP: 0.25–2 g/kg IV over 30 min. Cerebral edema: 0.25–1.5 g/kg/dose IV q6–8h PRN, maintain serum osmolarity <300–320 mOsm/kg.
W/P: [C, ?/M] w/ CHF or vol overload, w/ nephrotoxic drugs & lithium.
CI: Anuria, dehydration, heart failure, PE intracranial bleeding.
DISP: Inj 5%, 10%, 15%, 20%, 25%.
SE: May exacerbate CHF, N/V/diarrhea, ↓ / ↑ BP, ↑ HR.
NOTES: Monitor for vol depletion.
MEGESTROL ACETATE (MEGACE, MEGACE-ES)
USES: *Anorexia, cachexia, or an unexplained significant weight loss in patients with AIDS; palliative treatment of advanced carcinoma of the breast or endometrium.*
ACTIONS: Hormone; anti-leuteinizing; progesterone analog.
DOSE: Appetite: Megace-ES 625 mg/day (5 mL or 1 teaspoon/d). Breast cancer: 160 mg/d (40 mg QID); Endometrial cancer: 40–320 mg/d divided doses.
W/P: [D (tablet)/X (suspension), −] Thromboembolism; handle w/ care.
CI: Pregnancy.
DISP: Tabs 20, 40 mg; susp 40 mg/ mL, Megace-ES 125 mg/mL.
SE: DVT, edema, menstrual bleeding, photosensitivity, N/V/diarrhea, headache, mastodynia, ↑ Ca, ↑ glucose, insomnia, rash, ↓ BM, ↑ BP, CP, palpitations.
NOTES: Do not D/C abruptly; Megace-ES not equivalent to others mg/mg.
MELPHALAN [L-PAM] (ALKERAN, GENERIC)
WARNING: Administer under the supervision of a qualified physician experienced in the use of chemotherapy; severe BM depression, leukemogenic, & mutagenic hypersens (including anaphylaxis in ∼2%).
USES: *Palliative treatment multiple myeloma and ovariant cancer*, breast & testicular cancer, melanoma; allogenic & ABMT (high dose), neuroblastoma, rhabdomyosarcoma.
ACTIONS: Alkylating agent, nitrogen mustard.
DOSE:
Adults: Multiple myeloma: 16 mg/ m2 IV q2wk × 4 doses then at 4-wk intervals after tox resolves; w/ renal impairment ↓ IV dose 50% or 6 mg PO qd × 2–3 wk, then D/C up to 4 wk, follow counts then 2 mg qd. Ovarian cancer:0.2 mg/kg qd × 5 days, repeat q4–5wk based on counts, ↓ in renal insufficiency.
W/P: [D, ?/−] w/ Cisplatin, digitalis, live vaccines extravasation, need central line.
CI: Allergy or resistance.
DISP: Tabs 2 mg; Inj 50 mg.
SE: N/V, secondary malignancy, AF, ↓ LVEF, ↓ BM, secondary leukemia, alopecia, dermatitis, stomatitis, pulm fibrosis; rare allergic reactions, thrombocytopenia.
NOTES: Take PO on empty stomach, false(+) direct Coombs test.
MEPERIDINE (DEMEROL, GENERIC) [C–II]
USES: *Mod–severe pain*, postoperative shivering, rigors from amphotericin B.
ACTIONS: Narcotic analgesic.
DOSE:
Adults: 50–150 mg PO or IV/IM/SQ q3–4h PRN.
Peds: 1–1.5 mg/kg/ dose PO or IM/SQ q3–4h PRN, up to 100 mg/dose; hepatic impairment, avoid in renal impairment, avoid use in elderly.
W/P: [C, −] risk for dependency, ↓ seizure threshold, adrenal insufficiency, head injury, ↑ ICP, hepatic impairment, not OK in sickle cell disease.
CI: w/ MAOIs.
DISP: Tabs 50, 100 mg; syrup/soln 50 mg/5 mL; Inj 25, 50, 75, 100 mg/mL.
SE: Resp/CNS depression, seizures, sedation, constipation, ↓ BP, rash N/V, biliary and urethral spasms, dyspnea.
NOTES: Analgesic effects potentiated w/ hydroxyzine; 75 mg IM = 10 mg morphine IM; not best in elderly; do not use oral for acute pain; not OK for repetitive use in ICU setting, naloxone does not reverse neurotox, used as analgesic, is not recommended, limit Tx to <48 hr.
MEROPENEM (MERREM, GENERIC)
USES: *Intra-abdominal infections, bacterial meningitis, skin infection.*
ACTIONS: Carbapenem; ↓ cell wall synth. Spectrum: Excellent gram(+) (except MRSA, methicillin-resistant S. epidermidis [MRSE] & E. faecium); excellent gram(−) including extended-spectrum β-lactamase producers; good anaerobic.
DOSE:
Adults: Abdominal infection: 1–2 g IV q8h. Skin infection: 500 mg IV q8h.
Peds: >3 mo, <50 kg: Abdominal infection: 20 mg/kg IV q8h. Skin infection: 10 mg/kg IV q8h; Peds >50 kg. Use adult dose; max. 2 g IV q8h; ↓ in renal insufficiency (see package insert).
W/P: [B, ?/M] w/ Probenecid, valproic acid.
CI: β-Lactam anaphylaxis.
DISP: Inj 1 g, 500 mg.
SE: Less seizure potential than imipenem; C. difficile enterocolitis, diarrhea, ↓ plt.
NOTES: Overuse ↑ bacterial resistance.
MESNA (MESNEX [ORAL], GENERIC [IV])
USES: *Prevent hemorrhagic cystitis d/t ifosfamide* or cyclophosphamide.
ACTIONS: Antidote, reacts w/ acrolein and other metabolites to form stable compounds (sodium 2-mercaptoethane sulfonate).
DOSE: Per protocol; dose as % of ifosfamide or cyclophosphamide dose. IV bolus: 20% (eg, 10–12 mg/kg) IV at 0, 4, & 8 hr; IV Inf: 20% prechemotherapy, 40% w/ chemotherapy for 12–24 hr; Oral: 100% ifosfamide dose given as 20% IV at hour 0 then 40% PO at hours 4 & 8; if PO dose vomited repeat or give dose IV; mix PO w/ juice.
W/P: [B; ?/−].
CI: Thiol sensitivity.
DISP: Inj 100 mg/mL; (Mesnex) tabs 400 mg.
SE: ↓ BP, ↓ plt, ↑ HR, ↑ RR allergic reactions, rash, headache, GI upset, taste perversion; false positive urinary ketones.
NOTES: Hydration helps ↓ hemorrhagic cystitis; higher dose for BMT; IV contains benzyl alcohol.
METHENAMINE HIPPURATE (HIPREX)
USES: *Suppress recurrent UTI long term; use only after infection cleared by antibiotics.*
ACTIONS: Converted to formaldehyde & ammonia in acidic urine; nonspecific bactericidal action.
DOSE:
Adults: 1 g PO BID.
Peds: 6–12 yr: 0.5–1 g PO BID PO ÷ BID; w/ food, ascorbic acid w/ hydration.
W/P: [C, +] Large doses (8 g/d for 3–4 wk) have caused bladder irritation, painful/frequent micturition, albuminuria, and gross hematuria.
CI: Renal insufficiency, severe hepatic disease, severe dehydration w/ sulfonamides (may precipitate in urine).
DISP: Tabs 1 g.
SE: Rash, GI upset, dysuria, ↑ LFTs, super infection w/ prolonged use, C. difficile-associated diarrhea.
NOTES: Not indicated in peds <6 yr. Not for pts w/ indwelling catheters as dwell time in bladder required for action.
METHENAMINE COMBINATION PRODUCTS (HYOPHEN, URIBEL, UROGESIC BLUE, OTHERS)
(Note: This labeling has not been approved by the FDA)
USES: *Relief of local symptoms, such as inflammation, hypermotility, and pain, which accompany lower UTIs and symptoms caused by diagnostic procedures.*
ACTIONS: Based on individual components: Methenamine in acid urine releases formaldehyde (antiseptic); phenyl salicylate is a mild analgesic; methylene blue/benzoic acid are mild antiseptics; hyoscyamine is parasympatholytic (belladonna alkaloid) ↓ bladder spasm; sodium phosphate monobasic is an acidifier to maintain an acid pH for the degradation of methenamine.
DOSE:
Adults & Peds: >12 yr: 1 tab PO QID w/ liberal fluid intake.
W/P: [C, ?/−] Avoid w/ sulfonamides, narrow-angle glaucoma, pyloric/duodenal obst, bladder outlet obstruction, coronary artery spasm.
CI: Component hypersens.
DISP: Tabs and capsules (see representative products below).
• HYOPHEN (methenamine, benzoic acid, phenyl salicylate, methylene blue, hyoscyamine sulfate) tablet
• PROSED (methenamine, phenyl salicylate, methylene blue, benzoic acid, hyoscyamine) tablet
• URIBEL (methenamine, sodium phosphate monobasic monohydrate, phenyl salicylate, methylene blue, hyoscyamine sulfate) capsule
• URIMAR-T, URIN D/S, UROGESIC BLUE, UTIRA-C (methenamine, sodium phosphate monobasic, phenyl salicylate, methylene blue, hyoscyamine sulfate) tablet
• USTELL (methenamine, sodium phosphate monobasic, phenyl salicylate, methylene blue, and hyoscyamine sulfate) capsule.
SE: Rash, dry mouth, flushing, ↑ pulse, dizziness, blurred vision, urine/feces discoloration (blue/light green), voiding difficulty/retention.
NOTES: Take w/ plenty of fluid, can cause crystalluria; not rec in peds ≤6 yr; Not for pts w/ indwelling catheters as dwell time in bladder required for action; see also hyoscyamine and phenazopyridine listings.
METHOTREXATE (RHEUMATREX DOSE PACK, TREXALL, GENERIC)
WARNING: Administration only by experienced physician; do not use in women of child-bearing age unless absolutely necessary (teratogenic); impaired elimination w/ impaired renal function, ascites, pleural effusion; severe ↓ BM w/ NSAIDs; hepatotox, occasionally fatal; can induce life-threatening pneumonitis; diarrhea and ulcerative stomatitis require D/C; lymphoma risk; may cause tumor lysis syndrome; can cause severe skin reaction, opportunistic infections; w/ RT can ↑ tissue necrosis risk. Preservatives make this agent unsuitable for intrathecal IT or higher-dose use.
USES: *ALL, AML, leukemic meningitis, trophoblastic tumors (choriocarcinoma, hydatidiform mole), breast, lung, head, & neck, cancers, Burkitt’s lymphoma, mycosis fungoides, osteosarcoma, Hodgkin disease & NHL, psoriasis; rheumatoid arthritis, JRA, SLE*, chronic disease.
ACTIONS: ↓ Dihydrofolate reductase-mediated prod of tetrahydrofolate, causes ↓ DNA synth.
DOSE:
Adults: Cancer: Per protocol. Rheumatoid arthritis: 7.5 mg/wk PO 1/wk or 2.5 mg q12h PO for 3 doses/wk. Psoriasis: 2.5–5 mg PO q12h × 3 d/wk or 10–25 mg PO/IM qwk. Chronic: 15–25 mg IM/SQ qwk, then 15 mg/wk.
Peds: JIA: 10 mg/m2 PO/IM qwk, then 5–14 mg/m2 × 1 or as 3 divided doses 12 hr apart; ↓ elderly, w/ renal/hepatic impairment.
W/P: [X, −] w/ Other nephro/hepatotoxic meds, multiple interactions, w/ seizure, profound ↓ BM other than cancer related.
CI: Severe renal/hepatic impairment, pregnancy/lactation.
DISP: Dose pack 2.5 mg in 8, 12, 16, 20, or 24 doses; tabs 2.5, 5, 7.5, 10, 15 mg; Inj 25 mg/mL; Inj powder 20 mg, 1 g.
SE: ↓ BM, N/V/diarrhea, anorexia, mucositis, hepatotox (transient & reversible; may progress to atrophy, necrosis, fibrosis, cirrhosis), rashes, dizziness, malaise, blurred vision, alopecia, photosensitivity, renal failure, pneumonitis; rare pulm fibrosis; chemical arachnoiditis & headache w/ IT delivery.
NOTES: Monitor CBC, LFTs, Cr, MTX levels & CXR; “high dose” >500 mg/m2 requires leucovorin rescue to ↓ tox; w/ IT, use preservative-/alcohol-free soln; systemic levels: Therapeutic: >0.01 μmole; Toxic: >10 micromole over 24 hr.
METHYLENE BLUE (UROLENE BLUE, VARIOUS)
USES: *Methemoglobinemia, vasoplegic syndrome, ifosfamide-induced encephalopathy, cyanide poisoning, dye in therapeutics/diagnosis.*
ACTIONS: Low IV dose converts methemoglobin to hemoglobin; excreted, appears in urine as green/green-blue color; MAOI activity.
DOSE: 1–2 mg/kg or 25–50 mg/m2 IV over 5–10 min, repeat q1h; direct instillation into fistulous tract.
W/P: [X, −] w/ Severe renal impairment w/ psych meds such as SSRI, SNRI, TCA (may cause serotonin syndrome), w/ G6PD deficiency.
CI: Intra spinal Inj, severe renal insufficiency.
DISP: 1, 10 mL Inj.
SE: IV use: N, abdominal, CP, sweating, fecal/urine discoloration, hemolytic anemia.
NOTES: Component of some oral medications; stains tissue blue, limits repeat use in surgical visualization.
METHYLPREDNISOLONE (DEPO-MEDROL, MEDROL, MEDROL DOSEPAK, SOLU-MEDROL, GENERIC) [SEE STEROIDS]
USES: *Steroid responsive conditions (endocrine, rheumatic, collagen, dermatologic, allergic, ophthalmic, respiratory, hematologic, neoplastic, edematous, GI, CNS, others).*
ACTIONS: Glucocorticoid.
DOSE:
See Steroids Peds: Status asthmaticus, anaphylactic shock: 2 mg/kg IV/IO/IM (max. 60 mg). Maint: 0.5 mg/kg IV q6h or 1 mg/kg q12h to 120 mg/d.
W/P: [C, ?/M] May mask Infx, cataract w/ prolonged use; avoid vaccines.
CI: Fungal Infx, component allergy.
DISP: Oral (Medrol) 4, 8, 16, 32 mg, (Medrol Dosepak) 21 4-mg tabs taken over 6 days; Inj acetate (Depo-Medrol) 20, 40, 80 mg/mL; Inj succinate (Solu-Medrol) 40, 125, 500 mg, 1, 2 g.
SE: Fluid and electrolyte disturbances, muscle weakness/loss, ulcers, impairment wound healing, others (see label).
NOTES: Taper dose to avoid adrenal insufficiency.
METOCLOPRAMIDE (METOZOLV, REGLAN, GENERIC)
WARNING: Chronic use may cause tardive dyskinesia; D/C if Sxs develop; avoid prolonged use (> 2 wk).
USES: *Diabetic gastroparesis, symptomatic GERD; chemo & postop N/V, facilitate small bowel intubation & upper GI radiologic exam*, *GERD, diabetic gastroparesis (Metozolv) stimulate gut in prolonged postop ileus.*
ACTIONS: ↑ Upper GI motility; blocks dopamine in chemoreceptor trigger zone, sensitized tissues to ACH.
DOSE:
Adults: Gastroparesis (Reglan): 10 mg PO 30 min ac & hs for 2–8 wk PRN, or same dose IM/IV for 10 days, then PO. Reflux: 10–15 mg PO 30 min ac & hs. Chemo antiemetic: 1–2 mg/kg/dose IV 30 min before chemo, then q2h × 2 doses, then q3h × 3 doses. Postop: 10–20 mg IV/IM q4–6h PRN.
Adults & Peds: >14 yr: Intestinal intubation: 10 mg IV × 1 over 1–2 min.
Peds: Reflux: 0.1–0.2 mg/kg/dose PO 30 min ac & hs. Chemo antiemetic: 1–2 mg/kg/dose IV as adults. Postop: 0.25 mg/kg IV q6–8h PRN.
Peds: Intestinal intubation:6–14 yr: 2.5–5 mg IV × 1 over 1–2 min; <6 yr: Use 0.1 mg/kg IV × 1.
W/P: [B, M] Drugs w/ extrapyramidal ADRs, MAOIs, tricyclic antidepressants, sympathomimetics.
CI: w/ EPS meds, GI bleeding, pheochromocytoma, seizure disorders, GI obst.
DISP: Tabs 5, 10 mg; syrup 5 mg/5 mL; ODT (Metozolv) 5, 10 mg; Inj 5 mg/mL.
SE: Dystonic reactions common w/ high doses (Treat w/ IV diphenhydramine), fluid retention, restlessness, diarrhea, drowsiness.
NOTES: ↓ w/ Renal impairment/elderly; check baseline Cr.
METRONIDAZOLE (FLAGYL, FLAGYL ER, METROCREAM, METROGEL, METROLOTION)
WARNING: Carcinogenic in rats.
USES: *Bone/joint, endocarditis, intra-abdominal, meningitis, & skin infections; amebiasis & amebic liver abscess; trichomoniasis in pt and partner; bacterial vaginosis; PID; giardiasis; antibiotic-associated pseudomembranous colitis (C. difficile), eradicate H. pylori w/ combo Treat, rosacea, prophylactic in postop colorectal surgery.*
ACTIONS: Interferes w/ DNA synth. Spectrum: Excellent anaerobic, C. difficile.
DOSE:
Adults: Anaerobic infections: 500 mg IV q6–8h. Trichomonas: 250 mg PO TID for 7 days or 2 g PO × 1 (Treat partner). C. difficile: 500 mg PO or IV q8h for 7–10 days (PO preferred; IV only if pt NPO), if no response, change to PO vancomycin. Vaginosis: 1 applicator intravag qd or BID × 5 days, or 500 mg PO BID × 7 days or 750 mg PO qd × 7 days. Acne rosacea/skin: Apply BID.
Peds: Anaerobic infections: PO: 15–35 mg/kg/d ÷ q8h IV: 30 mg/kg IV/d ÷ q6H, 4 g/d max. ÷ dose; Trichomonas: 15–30 mg/kg/d PO ÷ q8h × 7 days. C. difficile: 30 mg/kg/d PO ÷ q6h × 10 days, max. 2 g/d; ↓ w/ severe hepatic/renal impairment.
W/P: [B, −] Avoid EtOH, w/ warfarin, CYP3A4 substrates, ↑ Li levels.
CI: 1st tri pregnancy.
DISP: Tabs 250, 500 mg; ER tabs 750 mg; caps 375 mg; IV 500 mg/100 mL; lotion 0.75%; gel 0.75, 1%; intravag gel 0.75% (5 g/applicator 37.5 mg in 70-g tube), cream 0.75, 1%.
SE: Disulfiram-like reaction; dizziness, headache, GI upset, anorexia, urine discoloration, flushing, met allic taste.
NOTES: For trichomoniasis, Treat pt’s partner; no aerobic bacteria activity; use in combo w/ serious mixed infections; wait 24 hr after 1st dose to breast-feed or 48 hr if extended Treat, take ER on empty stomach.
MICAFUNGIN (MYCAMINE)
USES: *Candidemia, acute dissem and esophageal candidiasis, Candida peritonitis & abscesses; prophylaxis Candida infection w/ HSCT.*
ACTIONS: Echinocandin; ↓ fungal cell wall synth.
DOSE: Candidemia, acute disseminated candidiasis, Candida peritonitis & abscesses: 100 mg IV daily; Esophageal candidiasis: 150 mg IV daily; Prophylaxis of Candida infection: 50 mg IV daily over 1 hr.
W/P: [C, ?/−] w/ Sirolimus, nifedipine, itraconazole dosage adj may be necessary.
CI: Component or other echinocandin allergy.
DISP: Inj 50, 100 mg vials.
SE: N/V/diarrhea, headache, pyrexia, abdominal pain, ↓ K+, ↓ plt, histamine Sxs (rash, pruritus, facial swelling, vasodilatation), anaphylaxis, anaphylactoid reaction, hemolysis, hemolytic anemia, ↑ LFTs, hepatotox, renal impairment.
MICONAZOLE (MONISTAT 1 COMBO, MONISTAT 3, MONISTAT 7 [OTC]) (MONISTAT-DERM)
USES: *Candidal infections, dermatomycoses (tinea pedis/ tinea cruris/tinea corporis/tinea versicolor/candidiasis).*
ACTIONS: Azole antifungal, alters fungal membrane permeability.
DOSE: Intravag: 100 mg supp or 2% cream intravag qhs × 7 days or 200 mg supp or 4% cream intravag qhs × 3 days. Derm: Apply BID, a.m./p.m. Tinea versicolor: Apply qd. Treat tinea pedis and tinea corporis for 1 mo and other infections for 2 wk.
Peds: ≥12 yr: 100 mg supp or 2% cream intravag qhs × 7 days or 200 mg supp or 4% cream intravag qhs × 3 days. Not for OTC use in children <2 yr.
W/P: [C, ?] Azole sensitivity.
DISP: Monistat-Derm: (Prescription) Cream 2%; Monistat 1 combo: 2% cream w/ 1,200 mg supp, Monistat 3: Vag cream 4%, supp 200 mg; Monistat 7: cream 2%, supp 100 mg; lotion 2%; powder 2%; effervescent tab 2%, oint 2%, spray 2%; Vag supp 100, 200, 1,200 mg; Vag cream 2%, 4%; [OTC].
SE: Vag burning; on skin contact dermatitis, irritation, burning.
NOTES: May interfere w/ condom and diaphragm, do not use w/ tampons.
MICONAZOLE/ZINC OXIDE/PETROLATUM (VUSION)
USES: *Candidal diaper rash.*
ACTIONS: Combo antifungal.
DOSE:
Peds: ≥4 wk: Apply at each diaper change × 7 days.
W/P: [C, ?].
CI: None.
DISP: Miconazole/zinc oxide/petrolatum oint 0.25/15/81.35%, 50-, 90-g tube.
SE: None.
NOTES: Keep diaper dry, not for prevention.
MINERAL OIL [OTC]
USES: *Constipation, bowel irrigation, fecal impaction.*
ACTIONS: Lubricant laxative.
DOSE:
Adults: Constipation: 15–45 mL PO/d PRN. Fecal impaction or after barium: 118 mL rectally × 1.
Peds: >6 yr: Constipation: 5–25 mL PO qd. 2–12 yr: Fecal impaction: 59 mL rectally × 1.
W/P: [?, ?] w/ N/V, difficulty swallowing, bedridden pts; may ↓ absorption of vits A, D, E, K, warfarin.
CI: Colostomy/ileostomy, appendicitis, diverticulitis, ulcerative colitis.
DISP: All [OTC] liq, PO microemulsion 2.5 mL/5 mL, rectal enema 118 mL.
SE: Lipid pneumonia (aspiration of PO mineral oil), N/V, temporary anal incontinence.
NOTES: Take PO upright, do not use PO in peds <6 yr; no longer recommended as lubricant for surgical instruments (not water soluble).
MINERAL OIL/PRAMOXINE HCL/ZINC OXIDE (TUCKS OINTMENT [OTC])
USES: *Temporary relief of anorectal disorders (itching, etc.).*
ACTIONS: Topical anesthetic.
DOSE:
Adults & Peds: ≥12 yr: Cleanse, rinse, & dry, apply externally or into anal canal w/ tip 5×/d × 7 days max.
W/P: [?, ?] Do not place into rectum.
CI: None.
DISP: Oint 1% 30-g tube.
SE: Local irritation.
NOTES: D/C w/ or if rectal bleeding occurs or if condition worsens or does not improve w/in 7 days.
MINOCYCLINE (DYNACIN, MINOCIN, SOLODYN, GENERIC)
USES: *Mod–severe nonnodular acne (Solodyn), anthrax, rickettsiae, skin infection, URI, UTI, nongonococcal urethritis, amebic dysentery, asymptomatic meningococcal carrier, Mycobacterium marinum.*
ACTIONS: Tetracycline, bacteriostatic, ↓ protein synth.
DOSE:
Adults & Peds: >12 yr: Usual: 200 mg, then 100 mg q12h or 100–200 mg IV or PO, then 50 mg QID. Gonococcal urethritis, men: 100 mg q12h × 5 days. Syphilis: Usual dose × 10–15 days. Meningococcal carrier: 100 mg q12h × 5 days. M. marinum: 100 mg q12h × 6–8 wk. Uncomp urethral, endocervical, or rectal infection: 100 mg q12h × 7 days minimum.
Adults & Peds: >12 yr: Acne: (Solodyn) 1 mg/kg PO qd × 12 wk. > yr: 4 mg/kg initially then 2 mg/kg q12h w/ food to ↓ irritation, hydrate well, ↓ dose or extend interval w/ renal impairment.
W/P: [D, −] Associated w/ pseudomembranous colitis, w/ renal impairment, may ↓ OCP, or w/ warfarin may ↑ INR.
CI: Allergy, children <8 yr.
DISP: Tabs 50, 75, 100 mg; tabs ER (Solodyn) 45, 65, 90, 115, 135 mg, caps (Minocin) 50, 100 mg, susp 50 mg/mL.
SE: diarrhea, headache, fever, rash, joint pain, fatigue, dizziness, photosensitivity, hyperpigmentation, SLE syndrome, pseudotumor cerebri.
NOTES: Do not cut/crush/chew; keep away from children, tooth discoloration in <8 yr or w/ use last half of pregnancy.
MIRABEGRON (MYRBETRIQ)
USES: *Overactive bladder (OAB) with symptoms of urge urinary incontinence, urgency, and urinary frequency. *
ACTIONS: β-3 adrenergic agonist; relaxes smooth muscle.
DOSE: Start 25 mg PO daily; ↑ to 50 mg daily after 8 wk PRN; 25 mg max. daily w/ severe renal or mod hepatic impairment; swallow whole, do not cut/chew.
W/P: [C, −] w/ Severe uncontrolled HTN; urinary retention w/ bladder outlet obstruction & antimuscarinic drugs; w/ drugs metabolized by CYP2D6 (eg, thioridazine, flecainide, propafenone); do not use w/ ESRD or severe hepatic impairment; monitor serum digoxin when starting both together.
CI: None.
DISP: Tabs ER 25, 50 mg.
SE: ↑ BP, headache, UTI, nasopharyngitis, N/diarrhea, constipation, abdominal pain, dizziness, tachycardia, URI, arthralgia, fatigue.
MITOMYCIN (GENERIC)
WARNING: Administer only by physician experienced in chemotherapy; myelosuppressive; can induce HUS w/ irreversible renal failure.
USES: *Stomach, pancreas*, breast, colon cancer; squamous cell carcinoma of the anus; NSCLC, head & neck, cervical; bladder cancer (intravesically).
ACTIONS: Alkylating agent; generates oxygen-free radicals w/ DNA strand breaks.
DOSE: (Per protocol) 20 mg/m2 q6–8wk IV or 10 mg/m2 combo w/ other myelosuppressive drugs q6–8wk. Bladder cancer: 20–40 mg in 40 mL NS via a urethral catheter once/wk; immediately postop if no evidence of extravasation × 1 to reduce recurrences following TURBT; ↓ in renal/hepatic impairment.
W/P: [D, −] w/ Cr >1.7 mg/dL/ ↑ cardiac tox w/ vinca alkaloids/doxorubicin.
CI: ↓ Plt, coagulation disorders, ↑ bleeding tendency, pregnancy.
DISP: Inj 5, 20, 40 mg.
SE: ↓ BM (persists for 3–8 wk, may be cumulative; minimize w/ lifetime dose <50–60 mg/m2), N/V, anorexia, stomatitis, renal tox, microangiopathic hemolytic anemia w/ renal failure (HUS), veno-occlusive liver disease, interstitial pneumonia, alopecia, extrav reactions, contact dermatitis; CHF w/ doses >30 mg/m2.
MITOTANE (LYSODREN)
WARNING: Administer only by physician experienced in chemotherapy; discontinue temporarily immediately following shock or severe trauma since adrenal suppression is its prime action. Exogenous steroids should be administered in such circumstances.
USES: *Inoperable adrenocortical carcinoma (functioning/nonfunctioning).
ACTIONS: Adrenal cytotoxic agent, suppresses cortisol production by inhibiting 11β-hydroxylase (ortho-para-DDD).
DOSE: 2–6 g/d in divided dose TID–QID; increase as tolerated to max. tolerated dose (generally 2–18 g/d); decrease dose with side effects; administer with glucocorticoid and if needed mineralocorticoid replacement.
W/P: [C/?]; increases warfarin metabolism.
CI: Hypersensitivity to compound.
DISP: Tablets 500 mg.
SE: Adrenal insufficiency, GI distress, depression, lethargy, somnolence, dizziness, vertigo, orthostasis.
NOTES: Neuropsychiatric testing with use >2 yr; higher doses of glucocorticoid required due to metabolism; treat until there is no clinical benefit.
MITOXANTRONE (GENERIC)
WARNING: Administer only by physician experienced in chemotherapy; except for acute leukemia, do not use w/ ANC count of <1,500 cells/mm3; severe neutropenia can result in infection, follow CBC; cardiotoxic (CHF), secondary AML reported.
USES: *Combination for myelogenous, promyelocytic, monocytic, and erythroid acute leukemias, progressive relapsing MS; pain related to advanced hormone refractory prostate cancer. *
ACTIONS: Anthracenedione; DNA-intercalating agent; ↓ DNA synth by interacting w/ topoisomerase II.
DOSE: Per protocol; Cap 12–14 mg/m2 short IV infusion every 21 days with steroids (such as prednisone 10 qd or 5 mg PO BID); ↓ dose w/ hepatic impairment, leukopenia, thrombocytopenia.
W/P: [D, −] Reports of secondary AML, w/ MS ↑ CV risk, do not treat MS pt w/ low LVEF.
CI: Pregnancy, sig ↓ in LVEF.
DISP: Inj 2 mg/mL.
SE: ↓ BM, N/V, stomatitis, alopecia (infrequent), cardiotox, urine discoloration, secretions & scleras may be blue-green.
NOTES: Maintain hydration; baseline CV evaluation w/ ECG & LVEF; cardiac monitoring prior to each dose; not for intrathecal use.
MORPHINE (AVINZA XR, ASTRAMORPH/PF, DURAMORPH, INFUMORPH, MS CONTIN, KADIAN SR, ORAMORPH SR, ROXANOL) [C-II]
WARNING: Do not crush/chew SR/CR forms; swallow whole or sprinkle on applesauce. 100 and 200 mg for opioid-tolerant pt only for mod–severe pain when pain control needed for an extended period and not PRN. Be aware of misuse, abuse, diversion. No alcoholic beverages while on therapy.
USES: *Treat severe pain*, AMI, acute pulmonary edema.
ACTIONS: Narcotic analgesic; SR/CR forms for chronic use.
DOSE:
Adults: Short-term use PO: 5–30 mg q4h PRN; IV/IM: 2.5–15 mg q2–6h; Supp: 10–30 mg q4h. SR formulations 15–60 mg q8–12h (do not chew/crush); use w/ caution; can be reversed w/ 0.4–2 mg IV naloxone.
Peds: >6 mo: 0.1–0.2 mg/kg/dose IM/IV q2–4h PRN; 0.15–0.2 mg/kg PO q3–4h PRN.
W/P: [C, +/−] Severe resp depression possible; w/ head injury; chewing delayed release forms can cause severe rapid release of morphine.
CI: (Many product specific) Severe asthma, resp depression, GI obst/ileus; Oral soln: CHF d/t lung disease, head injury, arrhythmias, brain tumor, acute alcoholism, DTs, seizure disorders; MS Contin and Kadian CI include hypercarbia.
DISP: IR tabs 15, 30 mg; soln 10, 20, 100 mg/5 mL; supp 5, 10, 20, 30 mg; Inj 2, 4, 5, 8, 10, 15, 25, 50 mg/mL; MS Contin CR tabs 15, 30, 60, 100, 200 mg; Oramorph SR tabs 15, 30, 60, 100 mg; Kadian SR caps 10, 20, 30, 40, 50, 60, 70, 80, 100, 130, 150, 200 mg; Avinza XR caps 30, 60, 90, 120 mg; Duramorph/Astramorph PF: Inj 0.5, 1 mg/mL; Infumorph 10, 25 mg/mL.
SE: Narcotic SE (resp depression, sedation, constipation, N/V, pruritus, diaphoresis, urinary retention, biliary colic), granulomas w/ IT.
NOTES: May require scheduled dosing to relieve severe chronic pain.
MOXIFLOXACIN (AVELOX)
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: *Acute sinusitis & bronchitis, skin/soft-tissue/intra-abdominal infections, conjunctivitis, community-acquired pneumonia* TB, anthrax, endocarditis.
ACTIONS: 4th-gen quinolone; ↓ DNA gyrase. Spectrum: Excellent gram(+) except MRSA & E. faecium; good gram(−) except P. aeruginosa, Stenotrophomonas maltophilia, & Acinetobacter sp; good anaerobic.
DOSE: 400 mg/d PO/IV daily; avoid cation products, antacids TID.
W/P: [C, −] Quinolone sensitivity; interactions w/ Mg2+, Ca2+, Al2+, Fe2+-containing products, & class IA & III antiarrhythmic agents.
CI: Quinolone/component sensitivity.
DISP: Tabs 400 mg, ABC Pak 5 tabs, Inj.
SE: Dizziness, N, QT prolongation, seizures, photosensitivity, peripheral neuropathy risk.
MUPIROCIN (BACTROBAN, BACTROBAN NASAL)
USES: *Impetigo (oint); skin lesion infect w/ S. aureus or S. pyogenes; eradicate MRSA in nasal carriers.*
ACTIONS: ↓ Bacterial protein synth.
DOSE: Topical: Apply small amount 3×/d × 5–14 days. Nasal: Apply 1/2 single-use tube BID in nostrils × 5 days.
W/P: [B, ?/M].
CI: Do not use w/ other nasal products.
DISP: Oint 2%; cream 2%; nasal oint 2% 1-g single-use tubes.
SE: Local irritation, rash.
NOTES: Pt to contact healthcare provider if no improvement in 3–5 days.
MYCOPHENOLATE MOFETIL (CELLCEPT, GENERIC)
WARNING: ↑ Risk of infections, lymphoma, other cancers, progressive multifocal leukoencephalopathy (PML); risk of pregnancy loss and malformation; female of child-bearing potential must use contraception.
USES: *Prevent organ rejection after transplant.*
ACTIONS: Cytostatic to lymphocytes.
DOSE:
Adults: 1 g PO BID, doses differ based on transplant.
Peds: BSA 1.2–1.5 m2: 750 mg PO BID. BSA >1.5 m2: 1 g PO BID; used w/ steroids & cyclosporine or tacrolimus; ↓ in renal insufficiency or neutropenia. IV: Infuse over >2 hr. PO: Take on empty stomach, do not open caps.
W/P: [D, −].
CI: Component allergy; IV use in polysorbate 80 allergy.
DISP: Caps 250, 500 mg; susp 200 mg/mL, Inj 500 mg.
SE: N/V/diarrhea, pain, fever, headache, infection, HTN, anemia, leukopenia, edema.
NOTES: Cellcept & Myfortic are not interchangeable.