TACROLIMUS, EXTENDED RELEASE (ASTAGRAF XL)
WARNING: Only physicians experienced in immunosuppression should prescribe. ↑ Risk of malignancy; use in liver transplant not rec due to ↑mortality in female patients.
USES: *Px kidney transplant rejection w/ MMF and steroids, w/ or w/o basiliximab induction.*
ACTIONS: Calcineurin inhib/immunosuppressant.
DOSE: w/ basiliximab induct: 0.15 mg/kg/d (target level day 1–60: 5–17 ng/mL; Mo 3–12: 4–12 ng/mL w/o induct: Preop 0.1 mg/kg/d; postop 0.2 mg/kg/d (target level: Day 1–60: 6–20 ng/mL; Mo 3–12: 6–14 ng/mL; take daily q a.m; empty stomach; do not take w/ alcohol or grapefruit juice; take whole.
W/P: [C, −] not interchangeable w/ immediate release; follow glucose, Cr, K+, can ↑ BP, can ↑ QT interval; do not use w/ sirolimus, CYP3A inhib/inducers; avoid live vaccines, monitor for red cell aplasia w/ Cyclosporine; avoid topical if <2 yr; Neuro & nephrotox, ↑ risk opportunistic Infxns; avoid grapefruit juice.
CI: Component allergy, castor oil allergy w/ IV form.
Disp: ER Caps 0.5, 1, 5 mg.
SE: N, D, constipation, edema, tremor, anemia.
NOTES: Monitor levels; African Americans may need ↑ dose; see tacrolimus immediate release.
TACROLIMUS, IMMEDIATE RELEASE (PROGRAF, GENERIC)
WARNING: ↑ Risk of infection and lymphoma. Only physicians experienced in immunosuppression should prescribe.
USES: *Prevent organ rejection (kidney/liver/heart).*
ACTIONS: Calcineurin inhibitor/immunosuppressant.
DOSE:
Adults: IV: 0.03–0.05 mg/kg/d in kidney and liver, 0.01 mg/kg/d in heart IV Inf.
Peds: IV: 0.03–0.05 mg/kg/d as cont Inf. PO: 0.15–0.2 mg/kg/d PO ÷ q12h.
Adults & Peds: Eczema: Take on empty stomach; ↓ w/ hepatic/renal impairment.
W/P: [C, −] w/ Cyclosporine; avoid topical if <2 yr; Neuro & nephrotoxic, ↑ risk opportunistic infections; avoid grapefruit juice.
CI: Component allergy, castor oil allergy w/ IV form.
DISP: Caps 0.5, 1, 5 mg; Inj 5 mg/mL.
SE: HTN, edema, headache, insomnia, fever, pruritus, ↑/↓ K+, hyperglycemia, GI upset, anemia, leukocytosis, tremors, paresthesias, pleural effusion, seizures, lymphoma, PRES, BK nephropathy, PML.
NOTES: Monitor levels; Trough: 5–12 ng/mL based on indication and time since transplant.
TADALAFIL (CIALIS)
USES: *Erectile dysfunction, BPH, alone or together.*
ACTIONS: PDE5 inhibitor, ↑ cyclic guanosine monophosphate (cGMP) & NO levels; relaxes smooth muscles, dilates cavernosal arteries; 15–120 min, duration 24–36 hr.
DOSE:
Adults: PRN: 10 mg PO before sexual activity (5–20 mg max. based on response) 1 dose/24 h. Daily dosing: 2.5 mg qd, may ↑ to 5 mg qd, BPH; 5 mg PO qd; w/o regard to meals; BPH therapy initiated with tadalafil and finasteride, tadalafil dose is 5 mg/d for up to 26 wk; ↓ w/ renal/hepatic insufficiency; 5 mg not more than once in every 72 hr w/ CrCl <30 mL/min/ESRD on dialysis.
W/P: [B, −] w/ α-Blockers (except tamsulosin); use w/ CYP3A4 inhibitor 2.5 mg/daily dose or 5 mg PRN dose; CrCl <0 mL/min, hemodialysis/severe hepatic impairment, do not use daily dosing.
CI: Nitrates.
DISP: Tabs 2.5, 5, 10, 20 mg.
SE: Headache, flushing, dyspepsia, back/limb pain, myalgia, nasal congestion, urticaria, SJS, dermatitis, visual field defect, nonarteritic anterior ischemic optic neuropathy (NIAON), sudden ↓/loss of hearing, tinnitus.
NOTES: Longest acting of class (36 hr); daily dosing may ↑ drug interactions; excessive EtOH may ↑ orthostasis; transient global amnesia reports; not recommended in combo with α-blocker for BPH.
TAMSULOSIN (FLOMAX, GENERIC)
USES: *BPH,* medical expulsive therapy for ureteral stones.
ACTIONS: Antagonist of prostatic α1-receptors.
DOSE: 0.4 mg/d, may ↑ to 0.8 mg PO daily.
W/P: [B, ?] Floppy iris syndrome w/ cataract surgery.
DISP: Caps 0.4 mg.
SE: Headache, dizziness, syncope, somnolence, ↓ libido, GI upset, retrograde ejaculation, rhinitis, rash, angioedema, intraoperative floppy iris syndrome.
NOTES: Not for use as antihypertensive; do not open/crush/chew; approved for use w/ dutasteride for BPH; also available a combination (Jalyn); for patients with a ureteral stone <10 mm and well-controlled symptoms, a period of observation along with medical expulsive therapy should be considered with α1-blockers, the preferred agent.
TEMSIROLIMUS (TORISEL)
USES: *Advanced RCC.*
ACTIONS: Multikinase inhibitor, ↓mTOR (mammalian target of rapamycin), ↓ hypoxic-induced factors, ↓ VEGF.
DOSE: 25 mg IV 30–60 min 1×/wk. Hold w/ ANC <1,000 cells/μL, plt <75,000 cells/μL, or NCI grade 3 tox. Resume when tox grade 2 or less, restart w/ dose ↓ 5 mg/wk not <15 mg/wk. w/ CYP3A4 inhibitor: ↓ 12.5 mg/wk. w/ CYP3A4 inducers ↑ 50 mg/wk.
W/P: [D, −] Avoid live vaccines, ↓ wound healing, avoid periop.
CI: Bili >1.5 × ULN.
DISP: Inj 25 mg/mL w/ 250 mL diluent.
SE: Rash, asthenia, mucositis, N, bowel perforation, angioedema, impaired wound healing; interstitial lung disease anorexia, edema, ↑ lipids, ↑ glucose, ↑ triglycerides, ↑ LFTs, ↑ Cr, ↓ WBC, ↓ HCT, ↓ plt, ↓ PO4.
NOTES: Premedicate w/ antihistamine; check lipids, CBC, plt, Cr, glucose; w/ sunitinib dose-limiting tox likely; females use w/ contraception.
TERAZOSIN (HYTRIN, GENERIC)
USES: *BPH, HTN.*
ACTIONS: α1-Blocker (blood vessel & bladder neck/prostate).
DOSE: Initial, 1 mg PO hs; ↑ 20 mg/d max.; may ↓ w/ diuretic or other BP medicine.
W/P: [C, ?] w/ β-Blocker, calcium channel blocker, ACE inhibitor; use w/ phosphodiesterase-5 (PDE5) inhibitor (eg, sildenafil) can cause ↓ BP, intra-op floppy iris syndrome w/ cataract surgery.
CI: Component sensitivity.
DISP: Tabs 1, 2, 5, 10 mg; caps 1, 2, 5, 10 mg angina.
SE: Angina, ↓ BP, & syncope following 1st dose or w/ PDE5 inhibitor; dizziness, weakness, nasal congestion, peripheral edema, palpitations, GI upset.
NOTES: Caution w/ 1st dose syncope; if for HTN, combine w/ thiazide diuretic.
TERBINAFINE (LAMISIL, LAMISIL AT, GENERIC [OTC])
USES: *Onychomycosis, athlete’s foot, jock itch, ringworm*, cutaneous candidiasis, pityriasis versicolor.
ACTIONS: ↓ Squalene epoxidase resulting in fungal death.
DOSE: PO: 250 mg/d PO for 6–12 wk. Topical: Apply to area tinea pedis BID, tinea cruris & corporis daily–BID, tinea versicolor soln BID; ↓ PO in renal/hepatic impairment.
W/P: [B, −] PO ↑ effects of drug metabolism by CYP2D6, w/ liver/renal impairment.
CI: CrCl <50 mL/min, WBC <1,000/mm3, severe liver disease.
DISP: Tabs 250 mg; oral granules 125 mg/pkt, 187.5 mg/ pkt Lamisil AT [OTC] cream, gel, soln 1%.
SE: Headache, DIV/N dizziness, rash, pruritus, alopecia, GI upset, taste perversion, neutropenia, retinal damage, SJS, ↑ LFTs.
NOTES: Effect may take months d/t need for new nail growth; topical not for nails; do not use occlusive dressings; PO follow CBC/LFTs.
TERCONAZOLE (TERAZOL 3, TERAZOL 7, GENERIC)
USES: *Vag fungal infections.*
ACTIONS: Topical triazole antifungal.
DOSE: 1 applicator-full or 1 supp intravag hs × 3–7 days.
W/P: [C, ?].
CI: Component allergy.
DISP: Vag cream (Terszol 7) 0.4, (Terszol 3), 0.8%, (Terszol 3) Vag supp 80 mg.
SE: Vulvar/Vag burning.
NOTES: Insert high into vagina.
TERIPARATIDE (FORTEO)
WARNING: ↑ Osteosarcoma risk in animals, therefore only use in patients for whom the potential benefits outweigh risks.
USES: *Severe/refractory osteoporosis.*
ACTIONS: PTH (recombinant).
DOSE: 20 μg SQ daily in thigh or abdomen.
W/P: [C, ?/−].
CI: w/ Paget disease, prior radiation, bone metastases, hypercalcemia, caution in urolithiasis.
DISP: 3-mL prefilled device (discard after 28 days).
SE: Orthostatic ↓ BP on administration, N/diarrhea, hypercalcemia; leg cramps.
NOTES: 2 yr max. use; osteosarcoma in animals.
TESTOSTERONE, IMPLANT (TESTOPEL) [C-III]
USES: *Male hypogonadism (congenital/acquired).*
ACTIONS: Testosterone replacement.
DOSE: 150–450 mg (2–6 pellets) SQ implant q3–6mo (implant two 75-mg pellets for each 25 mg testosterone required weekly; eg, for 75 mg/wk, implant 450 mg or 6 pellets.
W/P: [X, −] May cause polycythemia, worsening of BPH Sx, prostate cancer, edema may worsen CHF; may ↓ blood glucose and insulin requirements; venous thrombosis risk.
CI: PCa, male breast CA, PRG women.
DISP: 75 mg/implant (3.2 mm × 9 mm).
SE: Pain/inflammation at site, gynecomastia, excessive erections, oligospermia, hirsutism, male pattern baldness, acne, retention of sodium and electrolytes, suppression of clotting factors, polycythemia, N, jaundice, ↑ LFT/cholesterol, polycythemia, rare hepatocellular neoplasms and peliosis hepatitis, ↑/↓ libido, sleep apnea, ↑ PSA.
NOTES: Check levels and adjust PRN (300–1,000 ng/dL testosterone range); follow periodic LFT and CBC; typical site upper outer posterior gluteal region using sterile technique, local anesthesia, 4 mm stab wound and provided 16G insertion trocar.
TESTOSTERONE, NASAL GEL (NATESTO) [C-III]
WARNING: Virilization reported in children exposed to topical testosterone products. Children to avoid contact w/ unwashed or unclothed application sites.
USES: *Adult male hypogonadism (congenital/ acquired).*
ACTIONS: Testosterone replacement.
DOSE: 2 pumps each nostril (11 mg testosterone) in each nostril TID (total 33 mg/day); blow nose before use; avoid blowing for 1 hr after.
W/P: [X, −] Avoid with nasal pathology; monitor BPH Sx and for DVT; may cause azoospermia, edema, sleep apnea; not rec if <18 yr; venous thrombosis risk.
CI: Prostate cancer, male breast cancer, women.
DISP: metered-dose pump; 1 pump = 5.5 mg of testosterone.
SE: ↑ PSA, headache, rhinorrhea, epistaxis, nasal discomfort, nasopharyngitis, bronchitis, URI, sinusitis, nasal scab. 1 pump = 5.5 mg of testosterone.
NOTES: Previously known as CompleoTRT; may minimize exposure of testosterone to women or children; check testosterone, PSA, Hgb, LFTs, and lipids periodically.
TESTOSTERONE, TOPICAL (ANDROGEL 1%, ANDROGEL 1.62% ANDRODERM, AXIRON, FORTESTA, STRIANT, TESTIM, VOGELXO) [C-III]
WARNING: Virilization reported in children exposed to topical testosterone products. Children to avoid contact w/ unwashed or unclothed application sites.
USES: *Male hypogonadism (congenital/acquired).*
ACTIONS: Testosterone replacement; ↑ lean body mass, libido.
DOSE: All daily applications: AndroGel 1%: 50 mg (4 pumps); AndroGel 1.62%: 40.5 mg (2 pumps); apply to clean skin on upper body only. Androderm: Two 2.5-mg or one 5-mg patch daily. Axiron: 60 mg (1 pump = 30 mg each axilla) q a.m. Fortesta: 40 mg (4 pumps) on clean, dry thighs; adjust form 1–7 pumps based on blood test 2 hr after (days 14 and 35). Striant: 30-mg buccal tabs BID. Testim: One 5-g gel tube. Vogelxo: 50 mg (1 tube or packet or 4 pump actuations) daily at same time.
W/P: [X, −] May cause polycythemia, worsening of BPH Sx.
CI: PCa, male breast CA, women, venous thrombosis risk.
DISP: AndroGel 1%: 12.5 mg/pump; AndroGel 1.62%: 20.25 mg/pump; Androderm: 2.5-, 5-mg patches; Axiron: Metered-dose pump 30 mg/pump; Fortesta: Metered-dose gel pump 10 mg/pump; Striant:30-mg buccal tab; Vogelxo:50 mg tube or packet, 12.5 mg/pump.
SE: Site reactions, acne, edema, Wt gain, gynecomastia, HTN, ↑ sleep apnea, prostate enlargement, ↑ PSA.
NOTES: PO agents (methyltestosterone & oxandrolone) associated w/ hepatic tumors; transdermal/mucosal/implant forms preferred; wash hands immediately after topical applications AndroGel forms not equivalent; check T levels and adjust PRN (300–1,000 ng/dL testosterone range).
TESTOSTERONE UNDECANOATE, INJECTABLE (AVEED)
WARNING: Pulmonary oil microembolism (POME) reactions (urge to cough, dyspnea, throat tightening, chest pain, dizziness, syncope) and episodes of anaphylaxis, including life-threatening reactions, have been reported after the administration; observe patients for 30 min after dosing.
USES: *Male hypogonadism (congenital/acquired).*
ACTIONS: Testosterone replacement; ↑ lean body mass, libido.
DOSE: 3 mL (750 mg) IM (gluteal) initially, at 4 wk, every 10 wk thereafter; observe for 30 min for POME or anaphylaxis.
W/P: [X, −] May worsen BPH Sx, azoospermia possible, edema with pre-existing cardiac/renal/hepatic Dz, sleep apnea with other risk factors, monitor PSA, hgb/Hct, lipids periodically; may reduce insulin requirements, monitor INR if on warfarin; w/ steroids may ↑ fluid retention; venous thrombosis risk.
CI: PCa, male breast cancer, women, component sensitivity.
DISP: 3-mL (750 mg) in castor oil and benzyl benzoate.
SE: Acne, injection site pain, ↑ PSA and estradiol, hypogonadism, fatigue, irritability, ↑ hemoglobin, insomnia, mood swings.
NOTES: Available only through a restricted program (Aveed REMS); other IM forms not commonly used; testosterone enanthate (Delatestryl; Generic) & testosterone cypionate (Depo-Testosterone) dosed q14–28d w/ variable serum levels.
TETRACYCLINE (GENERIC)
USES: *Broad-spectrum antibiotic.*
ACTIONS: Bacteriostatic; ↓ protein synth. Spectrum: gram(+): Staphylococcus, Streptococcus. gram(−): H. pylori. Atypicals: Chlamydia, Rickettsia, & Mycoplasma.
DOSE:
Adults: 250–500 mg PO BID–QID.
Peds: >8 yr: 25–50 mg/kg/24 h PO q6–12h; ↓ w/ renal/hepatic impairment, w/o food preferred.
W/P: [D, −].
CI: PREGNANCY, children <8 yr.
DISP: Caps 100, 250, 500 mg; tabs 250, 500 mg; PO susp 250 mg/5 mL.
SE: Photosensitivity, GI upset, renal failure, pseudotumor cerebri, hepatic impairment.
NOTES: Can stain tooth enamel & depress bone formation in children; do not administer w/ antacids or milk products.
TICAGRELOR (BRILINTA)
WARNING: ↑ Bleeding risk; can be fatal; daily aspirin >100 mg may ↓ effectiveness; do not start w/ active bleeding, Hx intracranial bleed, planned CABG; if hypotensive and recent procedure, suspect bleeding; manage any bleed w/o D/C of ticagrelor.
USES: *↓ CV death and heart attack in ACS.*
ACTIONS: Oral antiplatelet; reversibly binding ADP receptor antagonist inhibitor.
DOSE: Initial 180 mg PO w/ ASA 325 mg, then 90 mg BID w/ ASA 75–100 mg/d.
W/P: [C, −] w/ Mod hepatic impairment; w/ strong CYP3A inhibitor or CYP3A inducers.
CI: Hx intracranial bleed, active pathologic bleeding, severe hepatic impairment.
DISP: Tabs 90 mg.
SE: Bleeding, SOB.
NOTES: REMS; D/C 5 days preop.
TICARCILLIN/POTASSIUM CLAVULANATE (TIMENTIN)
USES: *Infections of the skin, bone, resp & urinary tract, abdominal, sepsis.*
ACTIONS: Carboxy-PCN; bactericidal; ↓ cell wall synth; clavulanic acid blocks β-lactamase. Spectrum: Good gram(+), not MRSA; good gram(−) & anaerobes.
DOSE:
Adults: 3.1 g IV q4–6h max. 24 g ticarcillin component/d.
Peds: Ä 60 kg: (if ≥60 kg, adult dose). 200–300 mg/kg/d IV ÷ q4–6h; ↓ in renal failure.
W/P: [B, +/−] PCN sensitivity.
DISP: Inj ticarcillin/clavulanate acid 3.1/0.1-g vial.
SE: Hemolytic anemia, false(+) proteinuria.
NOTES: Often used in combo w/ aminoglycosides; penetrates CNS w/ meningeal irritation.
TINIDAZOLE (TINDAMAX)
WARNING: Carcinogenicity has been seen in mice and rats treated chronically with metronidazole, another nitroimidazole agent.
USES: *Trichomoniasis, giardiasis and amebiasis: in patients aged 3 and older; bacterial vaginosis: in nonpregnant adult.*
ACTIONS: Nitroimidazole antimicrobial.
DOSE:
Adults: Trichomoniasis, Giardiasis: 2 g PO w/ food × 1. For trichomoniasis treat sexual partners; Bacterial vaginosis: Nonpregnant, adult women: 2 g daily for 2 days w/ food, or 1 g once daily for 5 days w/ food.
Peds: >3 yr: Giardiasis: 50 mg/kg (up to 2 g) × 1 w/ food; Amebiasis 50 mg/kg/d (up to 2 g per day) × 3 days w/ food; Amebic liver abscess same up to 5 days.
W/P: [C, OK 3 days after D/C] Seizures/nephropathy reported; vaginal candidiasis.
CI: Component allergy; 1st tri pregnancy, breast-feeding.
DISP: Tabs 250, 500 mg.
SE: Met allic/bitter taste, nausea, anorexia dyspepsia, weakness/fatigue, headache, dizziness.
TIOCONAZOLE (GENERIC [OTC])
USES: *Vaginal fungal infections.*
ACTIONS: Topical antifungal.
DOSE: 1 applicator-full intravag hs (single dose).
W/P: [C, ?].
CI: Component allergy.
DISP: Vag oint 6.5%.
SE: Local burning, itching, soreness, polyuria.
NOTES: Insert high into vagina; may damage condom or diaphragm.
TIOPRONIN (THIOLA)
USES: *Prevent cystine urolithiasis in patients with severe homozygous cystinuria with urinary cystine >500 mg/d, who are resistant to conservative measures (high fluid intake, alkali and diet modification), or have adverse reactions to D-penicillamine.*
ACTIONS: Combines with cystine to increase solubility (α-mercaptopropionylglycine).
DOSE:
Adults & Peds: >9 yr: Encourage conservative hydration therapy with 3 L fluid/d (>2 L urine output) before initiating therapy. 800 mg/d initially (peds 15/mg/kg/d) divided TID, 1 hr ac or 2 hr pc; titrate based on urinary cysteine levels; typical adult dose 1,000 mg/d.
W/P: [D, −].
CI: Pregnancy, prior history of agranulocytosis or thrombocytopenia on Thiola.
DISP: Tablets 100 mg.
SE: Fever, rash, arthralgia, lymphadenopathy, hypogeusia, wrinkling and friable skin.
NOTES: Maintain urine pH 6.5–7.0 (potassium alkali supplements over sodium alkali due to reduced hypercalciuria risks); check urinary cysteine after 1 mo and then every 3 mo to adjust dose. Better tolerated than D-penicillamine.
TOBRAMYCIN (NEBCIN)
USES: *Serious gram(−) infections.*
ACTIONS: Aminoglycoside; ↓ protein synth. Spectrum: gram(−) bacteria (including Pseudomonas).
DOSE:
Adults: Conventional dosing: 1–2.5 mg/kg/dose IV q8–12h. Once-daily dosing: 5–7 mg/kg/dose q24h.
Peds: 2.5 mg/kg/dose IV q8h; ↓ w/ renal insufficiency.
W/P: [D, −].
CI: PREGNANCY; aminoglycoside sensitivity.
DISP: Inj 10, 40 mg/mL.
SE: Nephro/ototox.
NOTES: Follow CrCl & levels. Levels: Peak: 30 min after Inf; Trough: <0.5 hr before next dose; Therapeutic Conventional: Peak: 5–10 μg/mL, Trough: <2 μg/mL.
TOLTERODINE (DETROL, DETROL LA, GENERIC)
USES: *Overactive bladder with symptoms of urge urinary incontinence, urgency, and frequency.*
ACTIONS: Anticholinergic; muscarinic receptor antagonist.
DOSE: Detrol: 1–2 mg PO BID; Detrol LA: 2–4 mg/d.
W/P: [C, −] w/ CYP2D6 & 3A3/4 inhibitor; w/ QT prolongation.
CI: Urinary retention, gastric retention, or uncontrolled narrow-angle glaucoma.
DISP: Tabs 1, 2 mg; Detrol LA tabs 2, 4 mg.
SE: Xerostomia, blurred vision, headache, constipation.
NOTES: LA form may see “intact” ghost pill in stool.
TRAMADOL (RYBIX ODT, RYZOLT ER, ULTRAM, ULTRAM ER, GENERIC) (C-IV)
USES: *Mod–severe pain.*
ACTIONS: Centrally acting synthetic opioid analgesic.
DOSE:
Adults: 50–100 mg PO q4–6h PRN, start 25 mg PO q a.m., ↑ q3d to 25 mg PO QID; ↑ 50 mg q3d, 400 mg/d max. (300 mg if >75 yr); ER 100–300 mg PO daily; Rybix ODT individualize ↑ 50 mg/d q3d to 200 mg/d or 50 mg QID; after titration 50–100 mg q4–6 PRN, 400 mg/d max.
Peds: (ER form not rec) 1–2 mg/kg q4–6h (max. dose 100 mg); ↓ w/ renal insufficiency.
W/P: [C, −] Suicide risk in addiction prone, w/ tranquilizers or antidepressants; ↑ seizures risk w/ MAOI; serotonin syndrome.
CI: Opioid dependency; w/ MAOIs; sensitivity to opioids, acute alcohol intoxication, hypnotics, centrally acting analgesics, or w/ psychotropic drugs.
DISP: Tabs 50 mg; ER 100, 200, 300 mg; Rybix ODT 50 mg.
SE: Dizziness, headache, somnolence, GI upset, resp depression, anaphylaxis.
NOTES: ↓ Seizure threshold; tolerance/dependence may develop; abuse potential d/t μ-opioid agonist activity; Avoid EtOH; do not cut, chew ODT tabs.
TRAMADOL/ACETAMINOPHEN (ULTRACET) (C-IV)
USES: *Short-term Treat acute pain (<5 days).*
ACTIONS: Centrally acting opioid analgesic w/ acetaminophen.
DOSE: 2 tabs PO q4–6h PRN; 8 tabs/d max. Elderly/renal impairment: Lowest possible dose; 2 tabs q12h max. if CrCl <30 mL/min.
W/P: [C, −] Seizures, hepatic/renal impairment, suicide risk in addiction prone, w/ tranquilizers or antidepressants.
CI: Acute intoxication, w/ ethanol, hypnotics, central-acting analgesics or psychotropic drugs, hepatic dysfunction.
DISP: Tab 37.5 mg tramadol/325 mg acetaminophen.
SE: SSRIs, TCAs, opioids, MAOIs ↑ risk of seizures; dizziness, somnolence, tremor, headache, N/V/diarrhea, constipation, xerostomia, liver tox, rash, pruritus, ↑ sweating, physical dependence.
NOTES: Avoid EtOH; abuse potential μ-opioid agonist activity (tramadol); see acetaminophen note.
TRIAMCINOLONE/NYSTATIN (GENERIC)
USES: *Cutaneous candidiasis.*
ACTIONS: Antifungal & anti-inflammatory.
DOSE: Apply lightly to area BID; max. 25 mg/d.
W/P: [C, ?].
CI: Varicella; systemic fungal infections.
DISP: Cream & oint: Triamcinolone 1 mg/g and 100,000 U nystatin/g.
SE: Local irritation, hypertrichosis, pigmentation changes.
NOTES: For short-term use (<7 days). See also nystatin.
TRIAMTERENE (DYRENIUM)
WARNING: Hyperkalemia can occur.
USES: *Edema associated w/ CHF, cirrhosis.*
ACTIONS: K+-sparing diuretic.
DOSE:
Adults: 100–300 mg/24 h PO ÷ daily–BID.
Peds: HTN: 2–4 mg/kg/d in 1–2 ÷ doses; ↓ w/ renal/hepatic impairment.
W/P: [C (Expert opinion), ?].
CI: ↑ K+, renal impairment; caution w/ other K+-sparing diuretics.
DISP: Caps 50, 100 mg.
SE: ↓ K+, ↓ BP, bradycardia, cough, headache.
NOTES: Do not use in hypercalciuria due to triamterene stone risk.
TRIETHYLENETHIOPHOS-PHORAMIDE (THIOTEPA)
USES: *Breast, ovarian cancers, lymphomas (infrequently used) preparative regimens for allogeneic & ABMT w/ high doses, intravesical for bladder cancer, intracavitary effusion control.*
ACTIONS: Polyfunctional alkylating agent.
DOSE: Per protocol typical 0.3–0.4 mg/kg IV q1–4 wk. Effusions: Intracavitary 0.6–0.8 mg/kg; 60 mg into the bladder & retained 2 hr q1–4wk; 900–125 mg/m2 in ABMT regimens (highest dose w/o ABMT is 180 mg/m2); ↓ in renal failure.
W/P: [D, −] w/ BM suppression, renal and hepatic impairment.
CI: Component allergy.
DISP: Inj 15 mg/vial.
SE: ↓ BM, N/V, dizziness, headache, allergy, paresthesias, alopecia.
NOTES: Intravesical use in bladder cancer infrequent today; due to critical US shortage in 2013 TEPADINA, a European product, was allowed to be distributed in the US.
TRIMETHOPRIM (PRIMSOL, GENERIC)
USES: *UTI d/t susceptible gram(+) & gram(−) organisms; Treat PCP w/ dapsone* suppression of UTI.
ACTIONS: ↓ Dihydrofolate reductase. Spectrum: Many gram(+) & (–) except Bacteroides, Branhamella, Brucella, Chlamydia, Clostridium, Mycobacterium, Mycoplasma, Nocardia, Neisseria, Pseudomonas, & Treponema.
DOSE:
Adults: 100 mg PO BID or 200 mg PO daily; PCP 15 mg/kg ÷ in 3 days w/ dapsone.
Peds: ≥2 mo: 4–6 mg/kg/d in 2 ÷ doses; otitis media (≥6 mo): 10 mg/kg/d in 2 ÷ doses × 10 days; For prophylaxis: 2 mg/kg/day.
W/P: [C, +]. ↓ w/ renal failure.
CI: Megaloblastic anemia d/t folate deficiency.
DISP: Tabs 100 mg; (Primsol) PO soln 50 mg/5 mL.
SE: Rash, pruritus, megaloblastic anemia, hepatic impairment, blood dyscrasias.
NOTES: Take w/ plenty of H2O.
TRIMETHOPRIM (TMP)/SULFAMETHOXAZOLE (SMX) [CO-TRIMOXAZOLE, TMP-SMX] (BACTRIM, BACTRIM DS, SEPTRA DS, GENERIC)
USES: *UTI Treat & prophylaxis, otitis media, sinusitis, bronchitis, prevent PCP pneumonia (w/ CD4 count <200 cells/mm3).*
ACTIONS: SMX ↓ synth of dihydrofolic acid, TMP ↓ dihydrofolate reductase to impair protein synth. Spectrum: Includes Shigella, PCP, & Nocardia infections, Mycoplasma, Enterobacter sp, Staphylococcus, Streptococcus, & more.
DOSE: All doses based on TMP.
Adults: 1 DS tab PO BID or 8–20 mg/kg/24 h IV in 1–2 ÷ doses. PCP: 15–20 mg/kg/d IV or PO (TMP) in 4 ÷ doses. Nocardia: 10–15 mg/kg/d IV or PO (TMP) in 4 ÷ doses. PCP prophylaxis: 1 reg tab daily or DS tab 3 × wk. UTI prophylaxis: 1 PO BID.
Peds: 8–10 mg/kg/24 h PO ÷ in 2 doses or 3–4 doses IV; do not use in <2 mo.
W/P: [C (D if near term), -]. ↓ in renal failure; maintain hydration.
CI: Sulfonamide sensitivity, porphyria, megaloblastic anemia w/ folate deficiency, PRF, breast-feeding Inf <2 mo, sig hepatic impairment.
DISP: Regular tabs 80 mg TMP/400 mg SMX; DS tabs 160 mg TMP/800 mg SMX; PO susp 40 mg TMP/200 mg SMX/5 mL; Inj 80 mg TMP/400 mg SMX/5 mL.
SE: Allergic skin reactions, photosensitivity, GI upset, SJS, blood dyscrasias, hep.
NOTES: Synergistic combo, interacts w/ warfarin.
TRIPTORELIN (TRELSTAR 3.75, TRELSTAR 11.25, TRELSTAR 22.5)
USES: *Advanced prostate cancer.*
ACTIONS: LHRH analog; ↓ GNRH w/ cont dosing; transient ↑ in LH, FSH, testosterone, & estradiol 7–10 days after 1st dose; w/ chronic use (usually 2–4 wk), sustained ↓ LH & FSH w/ ↓ testicular & ovarian steroidogenesis similar to surgical castration.
DOSE: 3.75 mg IM q4wk; or 11.25 mg IM q12wk or 22.5 mg q24wk.
W/P: [X, N/A].
CI: Pregnancy, component hypersensitivity.
DISP: Inj Depot 3.75 mg; 11.25 mg; 22.5 mg.
SE: Dizziness, emotional lability, fatigue, headache, insomnia, HTN, diarrhea, vomiting, erectile dysfunction, retention, UTI, pruritus, anemia, Inj site pain, musculoskelet al pain, osteoporosis, allergic reactions.
NOTES: Check periodic testosterone levels & PSA.
TROSPIUM (SANCTURA, SANCTURA XR, GENERIC)
USES: *OAB w/ Sx of urge incontinence, urgency, frequency.*
ACTIONS: Muscarinic antagonist, ↓ bladder smooth muscle tone.
DOSE: 20 mg tab PO BID; 60 mg ER caps PO daily a.m., 1 hr ac or on empty stomach. ↓ w/ CrCl <30 mL/min and elderly.
W/P: [C, +/−] w/ EtOH use, in hot environments, ulcerative colitis, myasthenia gravis, renal/hepatic impairment.
CI: Urinary/gastric retention, narrow-angle glaucoma.
DISP: Tab 20 mg; caps ER 60 mg.
SE: Dry mouth, constipation, headache, rash.