RADIUM-223 DICHLORIDE (XOFIGO)
USES: *Castration-resistant prostate cancer, symptomatic bone metastases w/o visceral metastatic disease.*
ACTIONS: α-emitting radioactivity, forms complexes in bone in area of ↑ bone turnover.
DOSE:
Adults: Men only: 50 kBq/kg, Q 4 wk × 6 doses.
W/P: [X, -] not indicated in women.
CI: Preg.
DISP: Single vial, 1,000 kBq/mL or 6,000 kBq/vial.
SE: Anemia, ↓ lymphocytes, ↓ WBC, ↓ plts, ↓ neutrophils; N/V/D, edema.
NOTES: Slow IV infusion over 1 min; follow radiation safety and pharmaceutical quality control requirements; men should use condoms during Tx & to 6 mo post-Tx and female partners should use 1 method because of potential effects of radiation on sperm; less bone marrow toxicity than β-emitters such as strontium.
RALOXIFENE (EVISTA)
WARNING: Increased risk of venous thromboembolism and death from stroke.
USES: *Prevent osteoporosis, breast cancer prevention.*
ACTIONS: Partial antagonist of estrogen, behaves like estrogen.
DOSE: 60 mg/d.
W/P: [X, −].
CI: Thromboembolism, pregnancy.
DISP: Tabs 60 mg.
SE: CP, insomnia, rash, hot flashes, GI upset, hepatic dysfunction, leg cramps.
RAMIPRIL (ALTACE, GENERIC)
WARNING: ACE inhibitor used during pregnancy can cause fet al injury & death.
USES: *HTN, CHF, DN, post-MI.*
ACTIONS: ACE inhibitor.
DOSE: 1.25–20 mg/d PO ÷ daily–BID; ↓ in renal failure.
W/P: [C-1st tri/D-2nd & 3rd, +].
CI: ACE inhibitor-induced angioedema.
DISP: Caps 1.25, 2.5, 5, 10 mg.
SE: Cough, headache, dizziness, ↓ BP, renal impairment, angioedema.
NOTES: OK in combo w/ diuretics.
RASBURICASE (ELITEK)
WARNING: Anaphylaxis possible; do not use in G6PD deficiency and hemolysis; can cause methemoglobinemia; can interfere w/ uric acid assays; collect blood samples and store on ice.
USES: *Reduce ↑ uric acid d/t tumor lysis.*
ACTIONS: Catalyzes uric acid.
DOSE:
Adult & Peds: 0.20 mg/kg IV over 30 min, daily × 5; do not bolus, redosing-based uric acid levels.
W/P: [C, ?/−] Falsely ↓ uric acid values.
CI: Anaphylaxis, screen for G6PD deficiency to avoid hemolysis, methemoglobinemia.
DISP: 1.5, 7.5 mg powder Inj.
SE: Fever, neutropenia, GI upset, headache, rash.
NOTES: Place blood test tube for uric acid level on ice to stop enzymatic reaction; removed by dialysis; doses as low as 0.05 mg/kg have been used effectively in clinical trials.
RIFAMPIN (RIFADIN, RIMACTANE, GENERIC)
USES: *TB & Treat & prophylaxis of N. meningitidis, H. influenzae, or S. aureus carriers*; adjunct w/ severe S. aureus.
ACTIONS: ↓ DNA-dependent RNA polymerase.
DOSE:
Adults: N. meningitidis & H. influenzae carrier: 600 mg/d PO for 4 d. TB: 600 mg PO or IV daily or 2×/wk w/ combo regimen.
Peds: 10–20 mg/kg/dose PO or IV daily–BID; ↓ in hepatic failure.
W/P: [C, +] w/ Fosamprenavir, multiple drug interactions.
CI: Allergy, active N. meningitidis infection, w/ saquinavir/ritonavir.
DISP: Caps 150, 300 mg; Inj 600 mg.
SE: Red-orange–colored bodily fluids, ↑ LFTs, flushing, headache.
NOTES: Never use as single agent w/ active TB.
RISEDRONATE (ACTONEL, ACTONEL W/ CALCIUM, GENERIC)
USES: *Paget disease; Treat/prevention glucocorticoid-induced/postmenopausal osteoporosis, ↑ bone mass in osteoporotic men; w/ calcium only FDA approved for female osteoporosis.*
ACTIONS: Bisphosphonate; ↓ osteoclast-mediated bone resorption.
DOSE: Paget disease: 30 mg/d PO for 2 mo. Osteoporosis Treat/prevention: 5 mg daily or 35 mg qwk or 150 mg qmo; 30 min before 1st food/drink of the day; stay upright for at least 30 min after dose.
W/P: [C, ?/−] Ca2+ supls & antacids ↓ absorption; jaw osteonecrosis, avoid dental work.
CI: Component allergy, ↓ Ca2+, esophageal abnormalities, unable to stand/sit for 30 min, CrCl <30 mL/min.
DISP: Tabs 5, 30, 35, 150 mg; Risedronate 35 mg (4 tabs)/calcium carbonate 1,250 mg (24 tabs).
SE: Back pain, headache, abdominal pain, dyspepsia, arthralgia; flu-like Sxs, hypersensitivity (rash, etc.), esophagitis, bone pain, eye inflammation.
NOTES: Monitor LFTs, Ca2+, PO3+, K+; may ↑ atypical subtrochanteric femur fractures.
RISEDRONATE, DELAYED RELEASE (ATELVIA)
USES: *Postmenopausal osteoporosis.*
ACTIONS: See Risedronate.
DOSE: One 35 mg tab 1 × wk; in a.m. following breakfast w/ 4-oz water; do not lie down for 30 min.
W/P: [C, ?/−] Ca2+ & Fe2+ supls/ antacids ↓ absorption; do not use w/ Actonel or CrCl <30 mL/min; jaw osteonecrosis reported, avoid dental work; may ↑ subtrochanteric femur fractures; severe bone/ jt pain.
CI: Component allergy, ↓ Ca2+, esophageal abnormalities, unable to stand/sit for 30 min.
DISP: DR Tabs 35 mg.
SE: Diarrhea, influenza, arthralgia, back/abdominal pain; rare hypersens, eye inflam.
NOTES: Correct ↓ Ca2+ before use; check Ca2+.
RIVAROXABAN (XARELTO)
WARNING: May ↑ risk of spinal/epidural hematoma w/ paralysis & increase risk of stroke w/ premature D/C, monitor closely.
USES: *Prevention of DVT in knee/hip replacement surgery & prevention of stroke and systemic embolism in pts w/ nonvalvular Afib.*
ACTIONS: Factor Xa inhibitor.
DOSE: 10 mg PO qd × 35 d (hip) or 12 d (knee), stroke 20 mg daily; w or w/o food.
W/P: [C, −] w/ CYP3A4 inhibitor/inducers, other anticoagulants or plt inhibitor; avoid w/ CrCl <30 mL/min or mod/severe hepatic impairment.
CI: Active bleeding; component hypersens.
DISP: Tabs 10 mg.
SE: Bleeding.
NOTES: See PI for information about timing of stopping or starting dosage in relation to other anticoagulants.