SARGRAMOSTIM [GM-CSF] (LEUKINE)
USES: *Myeloid recovery following BMT or chemotherapy.*
ACTIONS: Recombinant GF, activates mature granulocytes & macrophages.
DOSE:
Adults & Peds: 250 μg/m2/d IV cont until ANC >1,500 cells/m2 for 3 consecutive days.
W/P: [C, ?/−] Li, corticosteroids.
CI: >10% blasts, allergy to yeast, concurrent chemotherapy/RT.
DISP: Inj 250, 500 μg.
SE: Bone pain, fever, ↑ BP, tachycardia, flushing, GI upset, myalgia.
NOTES: Rotate Inj sites; use acetaminophen PRN for pain.
SEVELAMER CARBONATE (RENVELA)
USES: *Control of serum phosphorus in patients with chronic kidney disease (CKD) on dialysis.*
ACTIONS: Intestinal phosphate binder.
DOSE: Start 0.8 or 1.6 g PO TID w/ meals; titrate 0.8 g/meal for target PO4 3.5–5.5 mg/dL; switch g/g among sevelamer forms, titrate PRN.
W/P: [C, ?] w/ Swallow disorders, bowel problems, may ↓ absorption of vits D, E, K, ↓ ciprofloxacin & other medicine levels.
CI: Bowel obst.
DISP: Tab 800 mg, powder 0.8/2.4 g.
SE: N/V/diarrhea, dyspepsia, abdominal pain, flatulence, constipation.
NOTES: Separate other meds 1 hr before or 3 hr after.
SEVELAMER HYDROCHLORIDE (RENAGEL)
USES: *Control of serum phosphorus in patients with chronic kidney disease (CKD) on dialysis. *
ACTIONS: Binds intestinal PO4.
DOSE: Initial: PO4 >5.5 and <7.5 mg/dL: 800 mg PO TID; ≥7.5 mg/dL: 1,200–1,600 mg PO TID. Switching from sevelamer carbonate: per-g basis; titrate ↑/↓ 1 tab/meal 2-wk intervals PRN; take w/ food 2–4 caps PO TID w/ meals; adjust based on PO4; max. 4 g/dose.
W/P: [C, ?] May ↓ absorption of vits D, E, K, ↓ ciprofloxacin & other medicine levels.
CI: ↓ PO4, bowel obst.
DISP: Tab 400, 800 mg.
SE: N/V/diarrhea, dyspepsia, ↑ Ca2+.
NOTES: Do not open/chew caps; separate other meds 1 hr before or 3 hr after; 800 mg sevelamer = 667 mg Ca acetate.
SILDENAFIL (VIAGRA, REVATIO)
USES: Viagra: *erectile dysfunction*; Revatio: *Pulm artery HTN (adult only).*
ACTIONS: ↓ Phosphodiesterase type 5 (PDE5) (responsible for cGMP breakdown); ↑ cGMP activity to relax smooth muscles & ↑ flow to corpus cavernosum and pulm vasculature; possibly antiproliferative on pulm artery smooth muscle; onset 15–60 min, duration 4 hr.
DOSE: Erectile dysfunction: 25–100 mg PO 1 hr before sexual activity, max. 1/d; ↓ if >65 yr.
W/P: [B, ?] w/ CYP3A4 inhibitor, retinitis pigmentosa; hepatic/severe renal impairment; w/ sig hypo/hypertension.
CI: w/ Nitrates or if sex not advised; w/ protease inhibitor.
DISP: Tabs Viagra: 25, 50, 100 mg, tabs. Revatio: Tabs 20 mg; Inj 5–10 mg/vial.
SE: Headache; flushing; dizziness; blue haze visual change (reacts with PDE6 in retina), hearing loss, priapism.
NOTES: Cardiac events in the absence of nitrates debatable; postpone dose for 4 hr after taking α-adrenergic antagonist; transient global amnesia reports; report of ↑melanoma risk; avoid fatty food w/ dose; not for peds use.
SILODOSIN (RAPAFLO)
USES: *BPH*
ACTIONS: α-blockers of prostatic α1a.
DOSE: 8 mg/d; 4 mg/d w/ CrCl 30–50 mL/min; take w/ food.
W/P: [B, ?] Not for use in females; do not use w/ other α-blockers or glycoprotein inhibitor (ie, cyclosporine); R/O PCa before use; intraoperative floppy iris syndrome possible w/ cataract surgery.
CI: Severe hepatic/renal impairment (CrCl <30 mL/min), w/ CYP3A4 inhibitor (eg, ketoconazole, clarithromycin, itraconazole, ritonavir).
DISP: Caps 4, 8 mg.
SE: Retrograde ejaculation, dizziness, diarrhea, syncope, somnolence, orthostatic ↓ BP, nasopharyngitis, nasal congestion, intraoperative floppy iris syndrome during contract surgery.
NOTES: Not for use as antihypertensive; no effect on QT interval.
SILVER NITRATE (GENERIC)
USES: *Removal of granulation tissue & warts; prophylaxis in burns*, control hemorrhagic cystitis.
ACTIONS: Caustic antiseptic & astringent.
DOSE:
Adults & Peds: Apply to moist surface 2–3 × wk for 2–3 wk or until effect; 0.5–1% solution instilled in bladder for up to 20 min (R/O reflux before, requires anesthesia.
W/P: [C, ?].
CI: Do not use on broken skin.
DISP: Topical impregnated applicator sticks, soln 0.5, 10, 25, 50%; topical ointment 10%.
SE: May stain tissue black, usually resolves; local irritation, methemoglobinemia.
NOTES: D/C if redness or irritation develops; no longer used in US for newborn prevention of gonococcus conjunctivitis
SILVER SULFADIAZINE (SILVADENE, GENERIC)
USES: *Prevention & Treat of infection in 2nd- & 3rd-degree burns.*
ACTIONS: Bactericidal.
DOSE:
Adults & Peds: Aseptically cover the area w/ 1/16-in coating BID.
W/P: [B unless near term, ?/−].
CI: Infants <2 mo, pregnancy near term.
DISP: Cream 1%.
SE: Itching, rash, skin discoloration, blood dyscrasias, hep, allergy.
NOTES: Systemic absorption w/ extensive application.
SIPULEUCEL-T (PROVENGE)
USES: *Asymptomatic/minimally symptomatic metastatic castrate-resistant PCa.*
ACTIONS: Autologous (pt specific) cellular immunotherapy.
DOSE: 3 doses over 1 mo @ 1-wk intervals; premed w/ acetaminophen & diphenhydramine.
W/P: [N/A, N/A] Confirm identity/expir date before Inf; acute transfusion reaction possible; not tested for transmissible disease.
CI: None.
DISP: 50 MU autologous CD54+ cells activated w/ PAP GM-CSF in 250 mL LR.
SE: Chills, fatigue, fever, back pain, N, joint ache, headache.
NOTES: Pt must undergo leukapheresis, w/ shipping and autologous cell processing at manufacturing facility before each Inf. Confirm/maintain testosterone <50 ng/mL.
SIROLIMUS [RAPAMYCIN] (RAPAMUNE)
WARNING: Use only by physicians experienced in immunosuppression; immunosuppression associated w/ lymphoma,↑ infection risk; do not use in lung transplant (fatal bronchial anastomotic dehiscence); do not use in liver transplant: ↑ risk hepatic artery thrombosis, graft failure, and mortality (w/ evidence of infection).
USES: *Prevent organ rejection in new renal Tx pts.*
ACTIONS: ↓ T-lymphocyte activation and proliferation.
DOSE:
Adults: >40 kg: 6 mg PO on day 1, then 2 mg/d PO.
Peds: <40 kg & ≥13 y: 3 mg/m2 load, then 1 mg/ m2/d (in H2O/orange juice; no grapefruit juice w/ sirolimus); take 4 hr after cyclosporine; ↓ in hepatic impairment.
W/P: [C, ?/−] Impaired wound healing & angioedema; grapefruit juice, ketoconazole.
CI: Component allergy.
DISP: Soln 1 mg/mL, tab 0.5, 1, 2 mg.
SE: HTN, edema, CP, fever, headache, insomnia, acne, rash, ↑ cholesterol, GI upset, ↑/↓ K+, infections, blood dyscrasias, arthralgia, tachycardia, renal impairment, graft loss & death in liver transplant (hepatic artery thrombosis), ascites.
NOTES: Levels: Trough: 4–20 ng/mL; varies w/ assay method and indication.
SODIUM BICARBONATE [NAHCO3] (GENERIC)
USES: *Alkalinization of urine, RTA, metabolic acidosis, ↑ K+, tricyclic antidepressants OD*, alkalize bladder urine to retrieve sperm in retrograde ejaculation.
ACTIONS: Alkalinizing agent.
DOSE:
Adults: ECC 2010: Cardiac arrest w/ good ventilation, hyperkalemia, OD of TCAs, ASA, cocaine, diphenhydramine: 1 mEq/kg IV bolus; repeat 1/2 dose q10min PRN. Metabolic acidosis: 2–5 mEq/kg IV over 8 hr & PRN based on acid–base status. ↑ K+: 50 mEq IV over 5 min. Alkalinize urine: 4 g (48 mEq) PO, then 12–24 mEq q4h; adjust based on urine pH; 2 amp (100 mEq)/1 L D5W at 100–250 mL/h IV, monitor urine pH & serum bicarbonate. Chronic renal failure: 1–3 mEq/kg/d. Distal RTA: 0.5–2 mEq/kg/d in 4–5 ÷ doses.
Peds: Severe metabolic acidosis, hyperkalemia: 1 mEq/kg IV slow bolus; 4.2% conc in infants <1 mo. Chronic renal failure: See Adult dosage. Distal RTA: 2–3 mEq/kg/d PO. Proximal RTA: 5–10 mEq/kg/d; titrate based on serum bicarbonate. Urine alkalinization: 84–840 mg/kg/d (1–10 mEq/kg/d) in ÷ doses; adjust based on urine pH.
W/P: [C, ?].
CI: Alkalosis, ↑ Na+, severe pulm edema, ↓ Ca2+.
DISP: Powder, tabs; 325 mg = 3.8 mEq; 650 mg = 7.6 mEq; Inj 1 mEq/1 mL, 4.2% (5 mEq/10 mL), 7.5% (8.92 mEq/ mL), 8.4% (10 mEq/10 mL) vial or amp.
SE: Belching, edema, flatulence, ↑ Na+, metabolic alkalosis.
NOTES: 1 g neutralizes 12 mEq of acid; 50 mEq bicarbonate = 50 mEq Na; can make 3 amps in 1 L D5W = D5NS w/ 150 mEq bicarbonate.
SODIUM CITRATE/CITRIC ACID (ORACIT)
USES: *Chronic metabolic acidosis, alkalinize urine; dissolve uric acid & cysteine stones.*
ACTIONS: Urinary alkalinizer.
DOSE:
Adults: 10–30 mL in 1–3- oz H2O pc & hs.
Peds: 5–15 mL in 1–3-oz H2O pc & hs; best after meals.
W/P: [?, ?].
CI: Severe renal impairment, oliguria or azotemia, untreated Addison’s disease, adynamia episodica hereditaria, acute dehydration, heat cramp, anuria, severe myocardial damage, and hyperkalemia.
DISP: 15- or 30-mL unit dose: 16 (473 mL) or 4 fl oz.
SE: Tetany, metabolic alkalosis, ↑ K+, GI upset; avoid use of multiple 50-mL amps; can cause ↑ Na+/hyperosmolality.
NOTES: 1 mL = 1 mEq Na & 1 mEq bicarbonate.
SODIUM PHOSPHATE (OSMOPREP, VISICOL)
WARNING: Acute phosphate nephropathy reported w/ permanent renal impairment risk; w/ ↑ age, hypovolemia, bowel obstr or colitis, baseline kidney disease, w/ meds that affect renal perf/function (diuretics, ACE inhibitor, ARB, NSAIDs).
USES: *Bowel prep prior to colonoscopy in adults*, short-term constipation.
ACTIONS: Hyperosmotic laxative.
DOSE: 3 tabs PO w/ at least 8-oz clear liq q15min for 6 doses; then 2 additional tabs in 15 min, 3–5 hr prior to colonoscopy;3 tabs q15 min for 6 doses, then 2 additional tabs in 15 min.
W/P: [C, ?] Renal impairment, electrolyte disturbances.
CI: Megacolon, bowel obst.
DISP: Tabs 0.398, 1.102 g (32/bottle).
SE: ↑ QT, ↑ PO4, ↓ calcium, diarrhea, flatulence, cramps, abdominal bloating/pain.
NOTES: Acute phosphate nephropathy is associated w/ calcium-phosphate crystal deposits in the renal tubules and may result in permanent renal dysfunction. Risk factors for acute phosphate nephropathy: Age >55 yr, hypovolemia, pre-existing renal impairment, bowel obstruction, or active colitis; w/ meds that may affect renal perfusion/function (eg, diuretics, ACE inhibitors, ARBs, and possibly NSAIDs).
SODIUM POLYSTYRENE SULFONATE (KAYEXALATE, KIONEX, GENERIC)
USES: *Treat of ↑ K+*
ACTIONS: Na+/K+ ion-exchange resin.
DOSE:
Adults: 15–60 g PO or 30–50 g PR q6h based on serum K+.
Peds: 1 g/kg/dose PO or PR q6h based on serum K+.
W/P: [C, ?].
CI: Obstructive bowel disease; ↑ Na+; neonates w/ ↓ gut motility.
DISP: Powder; susp 15 g/60 mL sorbitol.
SE: ↑ Na+, ↓ K+, GI upset, fecal impaction.
NOTES: Enema acts more quickly than PO; PO most effective, onset action >2 hr.
SOLIFENACIN (VESICARE)
USES: *Overactive bladder with symptoms of urge urinary incontinence, urgency, and urinary frequency. *
ACTIONS: Muscarinic antagonist, ↓ detrusor contractions.
DOSE: 5 mg PO daily, 10 mg/d max.; ↓ w/ renal/hepatic impairment.
W/P: [C,?/−] Bladder outlet obstruction or GI obst, ulcerative colitis, myasthenia gravis, renal/hepatic impairment, QT prolongation risk.
CI: Uncontrolled narrow-angle glaucoma, urinary/gastric retention.
DISP: Tabs 5, 10 mg.
SE: Constipation, xerostomia, dyspepsia, blurred vision, drowsiness.
NOTES: CYP3A4 substrate; azole antifungals ↑ levels; recent concern over cognitive effects.
SORAFENIB (NEXAVAR)
USES: *Advanced RCC, differentiated thyroid carcinoma, unresectable hepatocellular carcinoma, advanced thyroid carcinoma refractory to radioactive iodine.
ACTIONS: Tyrosine kinase inhibitor.
DOSE:
Adults: 400 mg PO BID on empty stomach.
W/P: [D, −] w/ Irinotecan, doxorubicin, warfarin; avoid conception (male and female); avoid inducers.
CI: Hypersensitivity; combo with carboplatin and paclitaxel in squamous cell lung cancer.
DISP: Tabs 200 mg.
SE: Hand–foot syndrome; treatment emergent hypertension; bleeding, ↑ INR, cardiac infarction/ischemia; ↑ pancreatic enzymes, hypophosphatemia, lymphopenia, anemia, fatigue, alopecia, pruritus, diarrhea, GI upset, headache, neuropathy.
NOTES: Monitor BP 1st 6 wk; may require ↓ dose (daily or q other day); impaired metabolism w/ Asian descent; may effect wound healing, D/C before major surgery.
SPIRONOLACTONE (ALDACTONE, GENERIC)
WARNING: Tumorigenic in animal studies; avoid unnecessary use.
USES: *Hyperaldosteronism, HTN, class III/IV CHF, ascites from cirrhosis.*
ACTIONS: Aldosterone antagonist; K+-sparing diuretic.
DOSE:
Adults: CHF (NYHA class III–IV) 12.5–25 mg/d (w/ ACE and loop diuretic); HTN 25–50 mg/d; Ascites: 100–400 mg q a.m w/ 40–160 mg of furosemide, start w/ 100 mg/40 mg, wait at least 3 days before ↑ dose.
Peds: 1–3.3 mg/kg/24 h PO ÷ BID q12–24h, take w/ food.
W/P: [C, + (D/C w/ breast-feeding)].
CI: ↑ K+, acute renal failure, anuria.
DISP: Tabs 25, 50, 100 mg.
SE: ↑ K+ & gynecomastia, arrhythmia, sexual dysfunction, confusion, dizziness, diarrhea/N/V, abnormal menstruation.
STARCH, TOPICAL, RECTAL (TUCKS SUPPOSITORIES [OTC])
USES: *Temporary relief of anorectal disorders (itching, etc.)*.
ACTIONS: Topical protectant.
DOSE:
Adults & Peds: ≥12 y: Cleanse, rinse, and dry, insert 1 supl rectally 6×/d × 7 d max.
W/P: [?, ?]
CI: None
DISP: Supp
SE: D/C w/ or if rectal bleeding occurs or if condition worsens or does not improve w/in 7 days.
STEROIDS, SYSTEMIC (SEE TABLE AT BOTTOM OF PAGE)
The following relates only to the commonly used systemic glucocorticoids.
USES: *Endocrine disorders (adrenal insufficiency), rheumatoid disorders, collagen–vascular diseases, derm diseases, allergic states, cerebral edema*, nephritis, nephrotic syndrome, immunosuppression for transplantation, ↑ Ca2+, malignancies (breast, lymphomas), preop (pt who has been on steroids in past year, known hypoadrenalism, preop for adrenalectomy); Inj into joints/tissue.
ACTIONS: Glucocorticoid.
DOSE: Varies w/ use & institutional protocols.
• Adrenal Insufficiency, acute: Adults: Hydrocortisone: 100 mg IV; then 300 mg/d ÷ q8h for 48 hr then convert to 50 mg PO q8h × 6 doses, taper to 30–50 mg/d ÷ BID. Peds: Hydrocortisone: 1–2 mg/kg IV, then 150–250 mg/d ÷ q6h–q8h.
• Adrenal Insufficiency, chronic (physiologic replacement): May need mineralocorticoid supl such as Florinef. Adults: Hydrocortisone: 20 mg PO q a.m., 10 mg PO q p.m.; cortisone: 25–35 mg PO daily. Dexamethasone: 0.03–0.15 mg/kg/d or 0.6–0.75 mg/ m2/d ÷ q6–12h PO, IM, IV. Peds: Hydrocortisone: 8–10 mg/m2/d ÷ q8h; some may require up to 12 mg/m2/d. Hydrocortisone succinate: 0.25–0.35 mg/kg/d IM.
• Asthma, acute: Adults: Methylprednisolone 40–80 mg/d in 1–2 ÷ dose PO/IV or dexamethasone 12 mg IV q6h. Peds: Prednisolone 1–2 mg/kg/d or prednisone 1–2 mg/kg/d ÷ daily–BID for up to 5 days; methylprednisolone 12 mg/kg/d IV ÷ BID; dexamethasone 0.1–0.3 mg/kg/d ÷ q6h.
• Congenital adrenal hyperplasia: Peds: Initial hydrocortisone 10–20 mg/m2/d in 3 ÷ doses.
• Extubation/airway edema: Adults: Dexamethasone: 0.5–2 mg/kg/d IM/IV ÷ q6h (start 24 hr prior to extubation; continue × 4 more doses). Peds: Dexamethasone: 0.5–2 mg/kg/d ÷ q6h (start 24 hr before & cont for 4–6 doses after extubation).
• Immunosuppressive/anti-inflammatory: Adults & Older Peds: Hydrocortisone: 15–240 mg PO, IM, IV q12h. Methylprednisolone: 2–60 mg/d PO in 1–4 ÷ doses, taper to lowest effective dose. Methylprednisolone Na succinate:10–80 mg/d IM or 10–40 mg/d IV. Adults: Prednisone or prednisolone: 5–60 mg/d PO ÷ daily–QID. Infants & Younger Children: Hydrocortisone: 2.5–10 mg/kg/d PO ÷ q6–8h; 1–5 mg/kg/d IM/IV ÷ BID–daily.
• Nephrotic syndrome: Peds: Prednisolone or prednisone: 2 mg/kg/d PO TID–QID until urine is protein-free for 5 days, use up to 28 days; for persistent proteinuria, 4 mg/kg/ dose PO q other day max., 120 mg/d for an additional 28 days; maint 2 mg/kg/dose q other day for 28 days; taper over 4–6 wk (max. 80 mg/d).
• Septic shock (controversial): Adults: Hydrocortisone: 50 mg IV q6h; max. 300 mg/d; some suggest 200 mg/d cont Inf. Peds: Hydrocortisone: 1–2 mg/kg/d intermittent or continuous Inf; may titrate up to 50 mg/kg/d.
• Status asthmaticus: Adults & Peds: Hydrocortisone: 1–2 mg/kg/dose IV q6h for 24 hr; then ↓ by 0.5–1 mg/kg q6h.
• Rheumatic disease: Adults: Intra-articular: Hydrocortisone acetate: 25–37.5 mg large jt, 10–25 mg small jt. Methylprednisolone acetate: 20–80 mg large jt, 4–10 mg small jt. Intrabursal: Hydrocortisone acetate: 25–37.5 mg. Intraganglial: Hydrocortisone acetate: 25–37.5 mg. Tendon sheath: Hydrocortisone acetate: 5–12.5 mg.
• Perioperative steroid coverage: Hydrocortisone: 100 mg IV night before surgery, 1 hr preop, intraoperative, & 4, 8, & 12 hr postop; postop day No. 1 100 mg IV q6h; postop day No. 2 100 mg IV q8h; postop day No. 3 100 mg IV q12h; postop day No. 4 50 mg IV q12h; postop day No. 5 25 mg IV q12h; resume prior PO dosing if chronic use or D/C if only perioperative coverage required.
• Cerebral edema: Dexamethasone: 10 mg IV; then 4 mg IV q4–6h.
W/P: [C/D, ?].
CI: Active varicella infection, serious infection except TB, fungal infections.
DISP:
SE: ↑ Appetite, hyperglycemia, ↓ K+, osteoporosis, nervousness, insomnia, “steroid psychosis,” adrenal suppression.
NOTES: Hydrocortisone succinate for systemic, acetate for intra-articular; never abruptly D/C steroids, taper dose; also used for bacterial and TB meningitis.
STEROIDS, TOPICAL (SEE TABLE NEXT PAGE)
USES: *Steroid-responsive dermatoses (seborrheic/atopic dermatitis, neurodermatitis, anogenital pruritus, psoriasis).*
ACTIONS: Glucocorticoid; ↓ capillary permeability, stabilizes lysosomes to control inflammation; controls protein synthesis; ↓ migration of leukocytes, fibroblasts.
DOSE: Use lowest potency produce for shortest period for effect (see Table next page).
W/P: [C, +] Do not use occlusive dressings; high potency topical products not for rosacea, perioral dermatitis; not for use on face, groin, axillae; none for use in a diapered area.
CI: Component hypersens.
DISP: See Table on next page.
SE: Skin atrophy w/ chronic use; chronic administration or application over large area may cause adrenal suppression or hyperglycemia.
STREPTOMYCIN (GENERIC)
WARNING: Neuro/oto/renal toxicity possible; neuromuscular blockage w/ respiratory paralysis possible.
USES: *TB combo therapy, nontuberculous infections (eg, Pasteurella pestis [plague], Francisella tularensis [tularemia], others, see package insert).
ACTIONS: Aminoglycoside; ↓ protein synthesis.
DOSE:
Adults: TB: 15 mg/kg/d (up to 1 g), directly observed therapy (DOT) 2× wk 20–30 mg/kg/dose (max. 1.5 g), DOT 3 × wk 25–30 mg/kg/dose (max. 1 g).
Peds: 15 mg/kg/d; DOT 2 × wk 20–40 mg/kg/dose (max. 1 g); DOT 3 × wk 25–30 mg/kg/dose (max. 1 g);↓ w/ renal insufficiency, either IM or IV over 30–60 min.
W/P: [D, +]. CI: Pregnancy.
DISP: Injectable 400 mg/mL (1-g vial).
SE: ↑ Incidence of vestibular and auditory toxicity, ↑ neurotoxicity risk in patients w/ impaired renal function.
NOTES: Monitor levels: Peak: 20–30 μg/mL, Trough: <5 μg/mL; Toxic peak: >50, Trough: >10; IV over 30–60 min.
STRONTIUM-89 CHLORIDE (METASTRON)
USES: Bone pain in patients with osseous metastasis.
ACTIONS: Ca2+ analogue taken up by bone in areas of active osteogenesis with selective radiation of metastasis.
DOSE: 148 MBq (4 mCi) IV slowly, or 15–22 MBq/kg.
W/P: [D, −].
CI: Pregnancy.
DISP: Injectable.
SE: Platelets nadir about 12–16 wk after treatment.
NOTES: Administered by radiation oncology; caution with platelet counts <60,000 or WBC of <2,400.
SUCROFERRIC OXYHYDROXIDE (VELPHORO)
USES: *↓ phos in ESRD/CKD.*
ACTIONS: Binds phosphate.
DOSE:
Adults: Chew 500 mg TID w/ meals; may ↑ dose weekly to target phos <5.5 mg/dL; max. dose studied 3,000 mg/d.
W/P: [B, +] check Fe +2 w/ peritonitis during peritoneal dialysis, hepatic or GI disorders, post-GI surgery or Dz resulting in Fe+2 accumulation.
CI: None.
DISP: Tab 500 mg.
SE: D, discolored feces.
NOTES: DO NOT prescribe with levothyroxine or vit D; take alendronate or doxycycline 1 hr before.
SUNITINIB (SUTENT)
WARNING: Hepatotox that may be severe and/or result in fatal liver failure.
USES: *Advanced GI stromal tumor (GIST) refractory/intolerant of imatinib; advanced RCC; well-differentiated pancreatic neuroendocrine tumors unresectable, locally advanced, metastatic.*
ACTIONS: Tyrosine kinase inhibitor; VEGF inhibitor.
DOSE:
Adults: 50 mg PO daily × 4 wk, followed by 2 wk holiday = 1 cycle; ↓ to 37.5 mg w/ CYP3A4 inhibitor, to ↑ 87.5 mg or 62.5 mg/d w/ CYP3A4 inducers.
CI: None.
W/P: [D, −] Multiple interactions require dose modification (eg, St. John’s wort); TEN and SJS reported.
DISP: Caps 12.5, 25, 50 mg.
SE: ↓ WBC & plt, bleeding, ↑ BP, ↓ ejection fraction, ↑ QT interval, pancreatitis, DVT, seizures, adrenal insufficiency, N/V/diarrhea, skin discoloration, oral ulcers, taste perversion, hypothyroidism.
NOTES: Monitor left ventricular ejection fraction, ECG, CBC/plts, chemistries (K+/Mg2+/phosphate), TFT & LFTs periodically; ↓ dose in 12.5-mg increments if not tolerated.