Carl Weiner-Drugs for Pregnant and Lactating Women 2nd-2009 Pg

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1600JohnF.KennedyBlvd.
Ste1800
Philadelphia,PA19103-2899
DRUGSFORPREGNANTANDLACTATINGWOMEN
ISBN:978-1-4160-4013-2
2009bySaunders,animprintofElsevierInc.
Allrightsreserved.
Nopartofthispublicationmaybereproducedortransmittedinanyformorbyany
Thousandsofpregnantandbreast-feedingwomentakeaprescriptionorover-the-
counterdrugeachday.Thoughforthemostpartsafe,asmallpercentageofthese
actionswillhaveunintendedadverseconsequencesforeithermotherorchild.An
additionalpercentageprovesineffective,dueinparttotheuniquephysiologyof
pregnancyorbreastfeeding.Andwhileanunnecessarydrugshouldneverbegiven
tothepregnantorbreast-feedingwoman,animportanttherapyshouldneverbe
withheldbecauseofherstatus.Healthcaregiversarenowaccustomedtoroutinely
checkingtheFDAclassificationofadrugbeforeprescribingit.Unfortunately,this
classificationsystem,thoughsimpleinconcept,isdated,rarelyrevisedasnewinfor-
mationbecomesavailable,andtoosimplistictoaccountforthephysiologyandhealth
careneedsofpregnantandbreast-feedingwomen.Fewdrugsareapprovedbythe
FDAforuseduringpregnancy,andevenoxytocinisaCategoryXagent.Theimpor-
tantinformationprovidedbythemanufacturerisoftencouchedinprotectivelegalese
ForewordtotheFirstEdition
Thestudyofmedicationuseinpregnancyisoneoftheleastdevelopedandmost
neglectedareasofclinicalpharmacologyanddrugresearch.Althoughpregnancyis
widelyregardedasaspecialpopulationduetoboththeuniquematernalphysiology
ForewordtotheSecondEdition
Thisisadreamcometrueforallofthosewhocareforpregnantandnon-pregnant
women.Thereisnothinglikethisinmedicalliterature.Inthepast,Ihavebeen
involvedinthepublicationsofseveraltextsondrugsandpregnancy.Thisnewtext
isontheleadingedgeofscienceandknowledgeforwomenanddrugs,withmorethan
Thesecondeditionturnedintoapredominantlysolojourney.Iwanttorecognizeand
thankCarol,whospentmanyeveningsandweekendsalonewhileIworkedonthe
text.Yoursupportiscentral.Thankyou.Ialsowanttoacknowledgetheimportant
contributionsofmygoodfriendDr.CatalinBuhimschi.
CarlP.Weiner
Frustratedbytheabsenceofacomprehensiveresourcethatrecognizestheuniqueness
ofmedicalneedsduringpregnancyandlactation,wecreatedDrugsforPregnantand
LactatingWomenasaneasy-to-use,readerfriendlyresourcecontainingthekey
informationrequiredbycaregiverstomakeprescribingdecisions.Toooften,we
checkonlytheFDAPregnancyCategorybeforemakingadecisiontoprescribeor
discontinueamedication.Unfortunately,fewofushavereadthesedefinitions
(TABLE1),understandtheirlimitations,andrealizetheassignedcategoryisessen-
tiallystagnant,basedpredominantlyoninformationavailablewhenthedrugwas
approvedintheUnitedStates,andonlyoccasionallyofficiallyupdatedtoreflect
advancingknowledge.Two-thirdsofalldrugssoldintheUnitedStatesareclassified
CategoryC,andlessthan1%CategoryA.Withthebenefitofaddedexperience,we
learnthatmanyCategoryXdrugsarenotabsolutelycontraindicatedduringpreg-
nancy,andseveralCategoryCorDdrugsareeitherclearhumanteratogensorhave
contraindicationforaparticulardrug,thoughtheycertainlymightbelistedinageneraldrugtext.Also
frequentlyremovedfromthelistaretypicalcorporateliabilitycommentsonpregnancythatarenot
substantiatedbyeitheranimalorhumanexperience.Thedoseadviceprovidedhasbeencheckedmulti-
pletimesbyatleast3individuals.However,theverydesignofthistextassumestheprescriberhas
Thefinalcommentsalwaysreflecttheneedtobalancerisk.Thisisapatient-specificprocessandnot
giventoabsolutes.Inmanyinstances,thereaderisinformedthereareotheralternativesforwhichthere
aremoreexperienceinpregnancyandlactation.Westronglysuggestthatwhereverpossible,thereader
seekandusethoseagents.Pregnancyisnottheoccasiontobeapioneer,ifunnecessary.Ifthereisapost-
InternationalBrandNames—
Glibose(Taiwan);Glicobase(Italy);Glucobay(Argentina,Austria,Bangladesh,
Belgium,Brazil,Bulgaria,Chile,Colombia,CostaRica,CzechRepublic,Denmark,DominicanRepublic,Ecuador,
ElSalvador,England,Germany,Greece,Guatemala,Honduras,Hungary,India,Israel,Italy,Japan,Korea,Malaysia,
.........................
HanefeldM,SchaperF,KoehlerC.CardiovascDrugsTher2008;
MercerSW,WilliamsonDH.BiochemJ1987;242:235-43.
Productinformation.Precose,BayerCorp.,1997.
Hypertension—begin400-800mgPOqd;max1200mg/d
Ventriculararrhythmia—begin200-400mg/d;typicaldose,600-
—hypersensitivity,CHF,heartblock,
hypotension,pulmonarydisease
Painand/orfever—650-1000mgPO/PRq4-6h;max4g/d
NOTE:includedinmanycombinations.
—hypersensitivitytodrugorclass
—hepaticorrenaldysfunction,chronicalcoholuse,
G6PDdeficiency,PKU
MaternalConsiderations
.....
suggestingthedosemayneedtobeadjustedinobesewomen.
providesmorerapidreliefofperinealpainafter
vaginaldelivery.Upto
ofpregnantwomeningest
Glaucoma—125-250mgPO/IVbidtoqid
Altitudesickness—250-500mgPObidbeginning48hbeforeascent
Epilepsy—375-1000mg(8-30mg/kg/d)POqdifsoleagent;begin
250mgqdifwithotheragents
Congestiveheartfailure—250-375mgPO/IVqd(forbestresults,
takeonalternatedays)
Drug-inducededema—250-375mgPO/IVqd(forbestresults,
takeonalternatedays)
Urinaryalkalinization—5mg/kgPO/IVbidortidtomaintain
alkalineurinepH
—hypersensitivitytodrugorclass,
hyponatremia,hypokalemia,depressedrespiratoryfunction,
cirrhosis,hyperchlorideacidosis,adrenocorticalinsufficiency
—hepaticand/orrenaldysfunction
MaternalConsiderations
.....
Therearenoadequatereportsorwell-controlledstudiesof
MaternalConsiderations
.....
Therearenoadequatereportsorwell-controlledstudiesof
Mucolytic—1nebulizerampuleq6-8h;alternatively2-5mlof10%
solutionor600mgin3divideddoses
—hypersensitivitytodrugorclass
—severerespiratoryfailure,asthma
MaternalConsiderations
.....
.........................
Genitalherpes,recurrent—200mgPO5
Genitalherpes,suppressive—400mgPObidforuptoayear,or
duringpregnancy,from36wonward;withHIV,400-800mgPO
/d,orIV5-10mg/kgq8h
Herpeszoster—800mgPO5
Ocularherpes—3%ointment5
Varicella,acute—800mgPOqid
—hypersensitivitytodrugorclass
—renaldysfunctionorconcurrentnephrotoxicdrug
MaternalConsiderations
.....
Treatmentisnotcurative,butratherintendedtoreducethe
durationofsymptomsandviralshedding.Thereisalongclinical
Acnevulgaris—apply(0.1%)creamorgeltotheaffectedarea
oncedailyatnight
—hypersensitivitytodrugorclass
MaternalConsiderations
.....
Systemicabsorptionof
acrosshumanskinislow,with
ParoxysmalSVTconversion—3-6mgIVover1-2sec;maydouble
to6mgandthen12mgifnoresponseafter1-2min
—hypersensitivitytodrugorclass,2ndor
3rddegreeheartblockorsicksinussyndrome
—asthma,chronicobstructivepulmonarydisease
MaternalConsiderations
.....
Anendogenouspurine-basednucleoside,IV
isthefirst
choiceforshort-termmanagementofparoxysmal
supraventriculararrhythmiaafteravagalmaneuverfails.
Co-administrationof
safelyreducesrecallofthe
unpleasanteffectsof
.Forlong-termtherapy,
blockingagentswith
selectivityarefirst-linedrugs;classIc
agentsandtheclassIIIdrug
areeffectivetherapeutic
hasbeenusedonmultipleoccasions
duringpregnancytotreatparoxysmalSVT.
Sideeffects
includearrhythmia(bradycardia,VForventricular
hasbeenadministeredsuccessfullyona
numberofoccasionsdirectlyintotheumbilicalveintoachieve
Bronchospasm—1-2puffsMDIq4-6h,max12puffs/d;or2-4mg
POtidorqid
Exercise-inducedasthma—2puffsMDI
1given15-30min
beforeexercise
NOTE:Numerousdruginteractionsareknown.Thereadershould
Asatocolytic,
hasnoadvantageoveranyother
-adrenoceptoragonist,prolongingpregnancyonaverage48h
overplacebo.
Itisineffective,likeall
-adrenoceptoragonists,whenusedfor
Osteoporosis,postmenopausaltreatment—10mgPOqd,or70mg
POonceaweektakenwithmeals
Osteoporosis,postmenopausalprevention—5mgPOqd,or35mg
POonceperweektakenwithmeals
Osteoporosis,steroid-induced—5mgPOqdtakenwithmeals
NOTE:avoidsupineposition.
—hypersensitivitytodrugorclass,
hypocalcemia,severerenaldysfunction
—upperGIdisease
MaternalConsiderations
.....
Therearenoadequatereportsorwell-controlledstudiesof
inpregnantwomen.Thereappearsonlyone
casereportofitsuseduringpregnancy;thewomandid
issuperiorto
conjugatedestrogens
(withorwithout
)forthepreventionof
bonelossinelderlywomen,thoughthecombinationis
Sideeffects
includeesophagitis,gastritis,dysphagia,esophageal
ulcer,N/V,abdominalpain,arthralgia,myalgias,backpain,
constipation,diarrhea,headache,chestpain,flu-likesyndrome,
andperipheraledema.
Anesthesia,induction—130-245mcg/kgIV(primarilywith
underlyingcardiacdiseaseundergoingaprolongedsurgical
procedure);morecommonly8-50mcg/kgatinductiontoblunt
thepressorresponsetotrachealintubation
Anesthesia,maintenance—3-15mcg/kgIVprn,or0.5-1mcg/kg/
mincontinuousinfusion
NOTE:chestwallrigidityiscommon,andneuromuscularblockers
areusuallygiventoenablemaskventilationbeforetracheal
Conscioussedation—3-8mcg/kgIV
—hypersensitivitytodrugorclass
—chestwallrigidity;N/V;bradycardia;hepatic,renal,
orpulmonarydysfunction;headinjury;bowelobstruction
MaternalConsiderations
.....
—(Aipico;Alloremed;Alloscan;Alonol;Aloral;
Aluline;Aluprin;Apurol;Isanol;Lopurin;Lysuron;Unizuric;
Uricemil;Uriconorm-E;Zyloprim;Zyroric)
InternationalBrandName—
Aceprax(Paraguay,Uruguay);Adenock(Japan);Alinol(Thailand);Allnol
(HongKong);Allo300(Germany);Allo-Basan(Switzerland);Allohexal(Australia);Allopin(Thailand);Allopur
(Norway,Switzerland);Allo-Puren(Germany);Alloril(Israel);Allorin(NewZealand);Allosig(Australia);Allozym(Japan);
Allurase(Philippines);Allurit(Italy);Alopron(PuertoRico);Alositol(Japan);Alpurase(Philippines);Alpurin(Philippines);
Alunlan(Philippines,Taiwan);Alurin(Guatemala);Aluron(Venezuela);Anoprolin(Japan);Anzief(Japan);
Goutprophylaxis—100-800mgPOqd;titratedoseuntiluricacid
Uratenephrolithiasisprophylaxis—100-800mgPOqd
Calciumoxalatecalculi—200-300mgPOqd
NOTE:renaldosing.
—hypersensitivitytodrugorclass
—renaldysfunction
MaternalConsiderations
.....
Therearenoadequatereportsorwell-controlledstudiesof
inpregnantwomen.Itisrarelyindicatedforits
traditionalindicationsinpregnantorlactatingwomen.Thereisa
singlereportofawomantreatedduringpregnancyforprimary
goutwith
.Shedeliveredahealthychildat35w.More
hasbeenusedduringpregnancyforwomen
undergoingtreatmentofacuteleukemia.Offutureinterestisits
potentialasanantioxidant.
wasusedunsuccessfully
inonetrialforthetreatmentofestablishedpreeclampsia.
Sideeffects
includeagranulocytosis,aplasticanemia,
thrombocytopenia,hepaticdysfunction,urticaria,Stevens-Johnson
syndrome,toxicepidermalnecrolysis,rash,diarrhea,pruritus,
nausea,andgoutflare.
Migraineheadache,acute—6.25-12.5mgPO
1;mayrepeat
q2h;max25mg/24h
NOTE:renalandhepaticdosing.
hypersensitivitytodrugorclass,
uncontrolledhypertension,ischemicheartdisease,coronary
spasm,basilarorhemiplegicmigraines,5-HT1agonistorergot
cerebrovasculardisease,PVD,ischemicbowel,
cardiacriskfactors,hepaticorrenaldysfunction
MaternalConsiderations
.....
Migraineisaparoxysmaldisorderwithattacksofheadache,N/V,
photo-andphonophobia,andmalaise.Thereisnopublished
experiencewith
duringpregnancy.Clinically,itis
similarto
forwhichthereisexperiencewithduring
Sideeffects
includehypertensivecrisis,MI,coronaryspasm,
ventriculararrhythmias,CVA,peripheralvascularischemia,bowel
ischemia,N/V,somnolence,headache,paresthesias,andchestor
jaworneckpainorpressure.
promotinggapjunctionalintercellularcommunicationand
proliferationofhumanskinfibroblasts.Therearenoadequate
reportsorwell-controlledstudiesinpregnantwomen.Itshould
neverbeingestedduringpregnancy.
Sideeffects
includeseveregastriccrampinganddiarrheaiftaken
Diarrheaassociatedwithirritablebowelsyndrome—1mgPObid
—hypersensitivitytodrugorclass,
MaternalConsiderations
.....
Therearenopublishedreportsof
Panicdisorder—0.5mgPOtid,upto1mgafter3-4d
—hypersensitivitytodrugorclass,
glaucoma,pregnancy,CNSdepression
—hepaticorrenaldysfunction
MaternalConsiderations
.....
israrelyindicatedduringpregnancy.Therearefew
publishedreportsof
useduringpregnancy.Abrupt
cessationoftherapyisassociatedwithadiscontinuation-emergent
syndromethatincludesneuropsychiatric,GI,dermatologic,CV,
andvisualsymptoms.
Sideeffects
includephysicaldependence,syncope,tachycardia,
seizures,respiratorydepression,coma,drowsiness,light-
headedness,drymouth,depression,headache,constipation,
diarrhea,N/V,insomnia,blurredvision,hypotension,increased
salivation,anddermatitis.
—(Actilyse;Activacin;Activase;TPA)
InternationalBrandName—
Actilyse(Austria,Bangladesh,Belgium,Brazil,Bulgaria,Colombia,Czech
Pulmonaryembolus—100mgIVover120min;initiate
therapyneartheendorimmediatelyfollowingthe
InfluenzaAtreatment—200mgPOqduntil24-48hafter
symptomsresolve
InfluenxaAprophylaxis—200mgPOqdbeginningimmediately
afterexposureandcontinuingatleast10d
Extrapyramidalreactions—100mgPOqdtotid(max300mg/d)
Parkinsonism—begin100mgPOqd,increasetobidafter1w,
max400mg/d;reduceto100mg/diftakingother
antiparkinsonismdrugs
NOTE:renaldosing.
—hypersensitivitytodrugorclass
—seizuredisorder,heartfailure,liverdisease,CV
disease,geriatricpopulation
MaternalConsiderations
.....
Thepublishedexperiencewith
duringpregnancy
consistsofisolatedcasereports.
hasalsobeenused
totreatthefatigueassociatedwithMS.Therehasbeena
progressiveincreasein
resistantinfluenzaA.
Sideeffects
ThereareseveralcasereportsofCVabnormalitiesinexposed
Myastheniagravis—begin5-25mgPOtid;max200mg/d
NOTE:individualizationisthenorm;thereisanarrowtherapeutic
—hypersensitivitytodrugorclass,atropine
—asthma,bradycardia,epilepsy,hyperthyroidism,
mechanicalGIorurinaryobstruction
MaternalConsiderations
.....
Therearenoadequatereportsorwell-controlledstudiesof
inpregnantwomen.Thepublishedexperience
consistsofsmallseriesandcasereports.
issimilar
inactionto
butlongeractingandwithalower
incidenceofGIsideeffects.
Sideeffects
includecardiacarrest,bronchospasm,cholinergic
crisis,salivation,fasciculation,headache,drowsiness,andGI
abnormalitiessuchasdiarrheaandabdominalpain.
Bacterialinfection—15mg/kg/dIM/IVdividedq8-24h;max1.5g/d
UTI—250mgIMbid
NOTE:renaldosing.
—hypersensitivitytodrugorclass
—renaldysfunction
MaternalConsiderations
.....
Therearenoadequatereportsorwell-controlledstudiesof
inpregnantwomen.Pregnancyincreasesthematernal
clearanceofaminoglycosidesingeneral.Womenwithnormal
renalfunctionshouldreceiveadoseof
thatreflectsthe
increasedclearance.
Sideeffects
includeneuromuscularblockade,renaltoxicity,
auditorytoxicity,rash,fever,headache,paresthesias,vomiting,
eosinophilia,anemia,hypotension,andarthralgia.
Hypertension—5-10mgPOqd;max20mg
CHF—5-10mgPOqd;max20mg
Lithium-inducedpolyuria—5-10mgPObid
NOTE:maybecombinedwith
—hypersensitivitytodrugorclass,
hyperkalemia,renalinsufficiency,anuria,potassium-sparing
.........................
Inhibitionofplasminogenactivator
DosagewithQualifiers
.......
Hemorrhage—typically4-5gIVorPOover1sthour,followedby
1g/hIV;max30g/d
—hypersensitivitytodrugorclass,DIC
unassociatedwithprimaryfibrinolysis,hemorrhageof
DosagewithQualifiers
.......
Cushing’sdisease—begin250mgPOqidunderhospitalized
supervision;adjustuntilthedesiredcortisollevelisreached(
2g/d
notrecommended)
—hypersensitivitytodrugorclass
—maysuppressaldosterone,leadingtohypotension
(orthostaticorpersistent)
MaternalConsiderations
.....
Therearenoadequatereportsorwell-controlledstudiesof
DosagewithQualifiers
.......
Ventriculararrhythmia,malignant—load800-1600mgPOqd
3wuntilresponse,then200-600mgPOqd;alternatively,150mg
IVbolusover10min,then1mg/minIV
6h,then0.5mg/minIV
for18h
Supraventriculararrhythmia—load800-1600mgPOqd
untilresponse,then200-600mgPOqd
Atrialfibrillation—load800-1600mgPOqd
1-3wuntilresponse,
then200-600mgPOqd;alternatively,300mgIVover1h,then
20mg/kgover24h,then600mgPOqd
1w,then400mg/d
Hypertrophiccardiomyopathy—load800-1600mgPOqd
untilresponse,then200-600mgPOqd
—hypersensitivitytodrugorclass,2ndor
3rddegreeheartblock,severeSAnodedisease,bradycardia
—hepaticdysfunction,pulmonarydisease,thyroid
MaternalConsiderations
.....
Therearenoadequatereportsorwell-controlledstudiesof
inpregnantwomen.Thepublishedexperienceis
limitedtofewerthan100pregnancies.Therearemany
alternativesto
duringpregnancy.
Sideeffects
includearrhythmias,heartfailure,AVblock,hepatic
failure,pulmonarytoxicity,N/V,fatigue,abdominalpain,
anorexia,constipation,visionabnormalities,edema,peripheral
neuropathy,tremor,ataxia,anddizziness.
...........................
PregnancyCategory:D
LactationCategory:NS
shouldbeavoidedduringpregnancyandlactation
unlessnoothermedicaloptionexists.
Therearealternativeagentsforwhichthereismoreexperience
duringpregnancyandlactation.
—(Amicen;Amilent;Amyzol;Elavil;Larozyl;
Pinsanu;Vanatrip)
InternationalBrandName—
Adepril(Italy);Amilit(Italy);Amineurin(Germany);Amiplin(Taiwan);
Amiprin(Japan);Amitrip(NewZealand);Amyline(Ireland);Amytril(Brazil);Anapsique(Mexico);Antalin(Chile);
Depression—begin50-75mg(or75-100mgifobservedinthe
hospital)POqhs,max300mgPOqhs;alternatively,20-30mgIM
Chronicpain—begin0.1mg/kg/d,titrateslowlyover2-3w;max
NOTE:maybecombinedwithchlordiazepoxideorperphenazine.
—hypersensitivitytodrugorclass,useofan
MAOIwithin14d
Chronichypertension—5-10mgPOqd
Angina(chronicstableandvariant)—5-10mgPOqd
NOTE:maybecombinedwith
anACEI,or
alipid-loweringagent.
—hypersensitivitytodrugorclass
MaternalConsiderations
.....
Therearenowell-controlledstudiesinwomenof
duringpregnancy.Othercalciumchannelantagonistsareusedas
Sedative—30-50mgPO/IM/IVbidortid
Hypnotic—65-200mgPO/IM/IVqhs(IVrate
NOTE:renalandhepaticdosing;oftencombinedwith
(50mg/50mgor100mg/100mgtabs).
—hypersensitivitytodrugorclass,hepatic
dysfunction,porphyria
—renaldysfunction,respiratorydisease
MaternalConsiderations
.....
Therearenoadequatereportsorwell-controlledstudiesof
inpregnantwomen.
Sideeffects
includerespiratorydepression,apnea,dyspnea,
hepatotoxicity,N/V,somnolence,agitation,confusion,ataxia,
nervousness,hallucinations,nightmares,constipation,CNS
depression,andinsomnia.
Depression—begin50mgPObid;max600mgqd
—hypersensitivitytodrugorclass,MAOI
usewithin14d,acuteMI
MaternalConsiderations
.....
Depressioniscommonduringandafterpregnancy,buttypically
goesunrecognized.Pregnancyisnotareason
apriori
discontinuepsychotropicdrugs.Therearenoadequatereportsor
well-controlledstudiesof
useinpregnantwomen.
Thereareonlyscatteredcasereportstodrawupon.
similarinefficacyto
Sideeffects
includeseizures,neurolepticmalignantsyndrome,
tardivedyskinesia,drowsiness,blurredvision,constipation,dry
—(Amoflux;Amoxiden;Amoxil;Amoxin;
Amoxipenil;Amoxycillin;Anemol;Apitart;Aspenil;Audumic;
Biomox;Bridopen;Excillin;Gemox;Imoxil;Jerramcil;Larotid;
Limox;Pensyn;Polymox;Protexillin;Reloxyl;Ronemox;Samosillin;
Samthongcillin;Senox;Sigmopen;Suprapen;Trilaxin;Trimox;
Twicyl;Unicillin;Virgoxillin;Wymox;Yisulon;Zamocillin)
InternationalBrandName—
Abdimox(Indonesia);Acilina(Paraguay);Acimox(Mexico);Acticillin(Thailand);
Actimoxi(Spain);Adbiotin(Colombia);Agerpen(Spain);A-Gram(France);Alfamox(Italy);Almodan(England);
Almorsan(Argentina);AmagesenSolutab(Germany);Ameclina(Mexico);Amoclen(CzechRepublic);Amodex(France);
Amo-flamisan(Spain);Amo-flamsian(Spain);Amoflux(Brazil);Amohexal(Australia);Amolin(HongKong,Japan,
Taiwan);Amonex(Korea);AmopharGE(France);Amosine(Indonesia);Amoval(Peru);Amox(Italy);Amoxa(Hong
Kong,Singapore);Amoxal(Colombia,Venezuela);Amoxapen(HongKong,Korea,Singapore);Amoxaren(Spain);
Amoxcil(China);Amoxcillin(Thailand);Amoxcin(Taiwan);Amoxi(Israel);Amoxi-basan(Germany);Amoxicilina
(Colombia,Ecuador);Amoxiclin(Peru);Amoxidal(Argentina,Uruguay);Amoxihexal(Germany);Amoxil(Australia,Brazil,
Ecuador,England,Greece,Indonesia,Ireland,Mexico,Peru);AmoxilDuo(Australia);Amoxillin(Israel,Italy,Norway);
Bacterialinfection—250-500mgPOtid,or500-750mgPObid
Gonorrhea,uncomplicated—3gPO
Chlamydiatrachomatis
—500mgPOtid
Endocarditisprophylaxis—2gPO
1,0.5-1hpriortothe
H.pylori
infection—1gPObid
10-14d(combinedwith
NOTE:adjustforCrCl:if10-30ml/min,administerq12h;if
min,administerq24h.
—hypersensitivitytodrugorclass
—CMVorEBVinfection,renaldysfunction,
cephalosporinallergy,PKU
MaternalConsiderations
.....
Similarto
ampicillin,amoxicillin
isgenerallyconsideredsafe
duringpregnancy.Itprovidesa
90%cureratefor
andisthemostcost-effectivetreatmentfollowedbyasingle1g
doseof
fornonresponders.
Sideeffects
includethrombocytopenia,agranulocytosis,
anaphylaxis,leukopenia,anemia,Stevens-Johnsonsyndrome,
seizures,hepatotoxicity,N/V,diarrhea,rash,urticaria,and
Amoxicillin-clavulanatepotassium
Amoclav;Augmentin)
InternationalBrandName—
Aclam(Indonesia);Ambilan(Peru);Amocla(Korea);AmoclaDuo(Korea);
Bacterialinfection—250-500mgPOtid,or500-875mgPObid
Gonorrhea,uncomplicated—3gPO
Chlamydiatrachomatis
—500mgPOtid
Endocarditisprophylaxis—2gPO
1,0.5-1hpriortotheprocedure
H.pylori
infection—1gPObid
10-14d(combinedwith
NOTE:adjustforCrCl:if10-30ml/min,administerq12h;if
min,administerq24h.
—hypersensitivitytodrugorclass,
Augmentin-associatedhepaticdysfunction
—CMVorEBVinfection,hepaticorrenaldysfunction,
cephalosporinallergy,PKU
MaternalConsiderations
.....
ispoorlyabsorbedduringlabor.
multidrugregimentotreatdrug-resistanttuberculosisduring
pregnancy.(See
Sideeffects
includethrombocytopenia,agranulocystosis,
anaphylaxis,leukopenia,anemia,Stevens-Johnsonsyndrome,
seizures,hepatotoxicity,N/V,diarrhea,rash,urticaria,and
ADD—2.5mgPOqam;increaseby2.5mgqwuntilsatisfactory
effect;alternatively,10mgtime-releasePOqam,or5mgPO
immediate-releaseqamuptobid
Narcolepsy—5-60mgPOqam
Obesity—5mgPOqam
—hypersensitivitytodrugorclass,moderate
toseverehypertension,hyperthyroidism,substanceabuse,
glaucoma,MAOinhibitoruse
14d,symptomaticCVdisease
—psychosis,mildhypertension,tics
MaternalConsiderations
.....
...........................
PregnancyCategory:C
LactationCategory:NS
ThisscheduleIIdrugisrarelyindicatedinreproductive-age
womenandshouldbeavoided.
Dependentwomenshouldbecounseledandenrolledin
Systemicfungalinfection—aspergillosis,3-4mg/kg/dIV,max
7.5mg/kg/d;systemiccandidiasis,3.9-6mg/kg/dIV
NOTE:alsoavailablecoupledtoliposomes(AmBisome)or
cholesteryl(Amphotec).
—hypersensitivitytodrugorclass
—renaldysfunction
MaternalConsiderations
.....
Therearenoadequatereportsorwell-controlledstudiesof
inpregnantwomen.Itremainsthedrugofchoice
AmphotericinB
–inducedhypokalemiamaypotentiate
toxicity.Serumpotassiumlevelsandcardiacfunctionshouldbe
monitoredclosely.
Imidazoles(e.g.,
.........................
Bactericidalbytheinhibitionofcellwallmucopeptidesynthesis
DosagewithQualifiers
.......
GBSprophylaxis—2gIVload,then1-2gIVq4hatleast4hprior
todelivery
Endocarditisprophylaxis—2gIV/IM
1(give30minpriorto
Endocarditistreatment—12gIVqd
Bacterialinfection—250-500mgPOq6h(max14g/d),or0.5-2g
IV/IMq6h
Bacterialmeningitis—2gIVloadingdose,then1-2gIVq4-6h
Cesareansectionprophylaxis—2gIVafterumbilicalcord
Gonorrhea—3.5gPOwith1gprobenecid
—hypersensitivitytodrugordrugclass,
pseudomembranouscolitis
—EBVandCMVinfection,penicillinorcephalosporin
allergy,renaldysfunction
MaternalConsiderations
.....
Wellabsorbedorallyexceptduringlabor,
isoneofthe
mostcommonlyusedantibioticsduringpregnancy.Inadditionto
thenotedindications,
wasusedwithoutsuccessin
Bacterialinfection—1.5-3gIV/IMq6h;max8g/d
NOTE:renaldosing.
—hypersensitivitytodrugordrugclass
—EBVandCMVinfection,penicillinorcephalosporin
allergy,renaldysfunction
MaternalConsiderations
.....
isareasonableselectionforprophylaxisin
womenundergoingcesareansection.
doesnotprolong
thelatencyintervalafterPPROMunlesspairedwith
Incomparisontononpregnantwomen,pregnancysignificantly
increasesthe
eliminationrateconstantandtotalbody
clearanceanddecreasestheserumt/2andAUC.Asaresult,the
doseduringpregnancyshouldbeincreasedandtheinterval
clearanceisreducedbypyelonephritisand
riseswithsuccessfultreatment.Thissuggeststhedosinginterval
shouldbereducedfrom6hto4hafterthefirst24hoftherapy.
Sideeffects
includevaginitis,seizures,thrombocytopenia,
agranulocytosis,leukopenia,anemia,Stevens-Johnsonsyndrome,
interstitialnephritis,toxicepidermalnecrosis,hemolyticanemia,
N/V,diarrhea,headache,confusion,eosinophilia,andrash.
evidenceofteratogenicityorIUGRdespitetheuseofdoses
higherthanthoseusedclinically.
HIV—1200mgPObidortid(takewithfood);increasedoseto
1200mgPOtidifgivenwith
—hypersensitivitytodrugorclass,and
cisapride,astemizole,
—hypersensitivitytosulfonamides,hepaticorrenal
MaternalConsiderations
.....
Therearelimitedpublishedcasereportsof
duringpregnancy.
Sideeffects
includeStevens-Johnsonsyndrome,N/V,diarrhea,
rash,hyperglycemia,hypertriglyceridemia,headache,fatigue,taste
change,perioraltingling,anddepression.
.Invariousrodents,dosesof
belowtheMRHDwereassociatedwithanincreasedabortionrate
anddeficientlongboneossification.
DosagewithQualifiers
.......
Essentialthrombocythemia—begin0.5mgPOqid;increaseas
necessarytomax10mg/d
—hypersensitivitytodrugorclass
—CVdisease,hepaticorrenaldysfunction
MaternalConsiderations
.....
Pregnantwomenwithessentialthrombocythemiahavean
increasedriskof1sttrimesterlossthatisnotpredictablebythe
Rheumatoidarthritis,moderatetosevere—100mgSCq24h;check
ANCatbaselineandq3mo
—hypersensitivitytodrugorclass,serious
infection,concurrentlivevaccine
—renaldysfunction,asthma
MaternalConsiderations
.....
Therearenopublishedreportsof
useduring
pregnancy.NativeIL-1type1receptorantagonisthasvariably
beenassociatedwithrecurrentpregnancyloss,andisincreasedin
AFandumbilicalvenousbloodobtainedfrompregnancies
complicatedbyPPROM.
Sideeffects
includethrombocytopenia,neutropenia,infection,
injectionsitereaction,sinusitis,URIsymptoms,nausea,diarrhea,
andabdominalpain.
Psoriasis—beginat0.1%topicallyandcoverfor8-24h;may
accelerateto1-3%topicallyandcoverfor5-60minandapplybid
—hypersensitivitytodrugorclass,lesionson
thefaceorgenitals
—renaldysfunction,salicylateallergy
MaternalConsiderations
.....
Psoriasisisachronicallyrecurringinflammatorydiseasethat
affectstheskin,scalp,andjoints.Pregnancymayprecipitate
pustularpsoriasis.Therearenoadequatereportsor
well-controlledstudiesof
inpregnantwomen.
Thoughitisgenerallyconsideredsafeforuseduring
pregnancy,therearefewdatatosupportaconclusioneither
Sideeffects
includeirritation,contactdermatitis,discolorationof
hairandnails,anderythema.
CongenitalfactorVIIIdeficiency—dosehighlyvariable,reflecting
weightandseverityofdeficiencyandthepresenceofinhibitors
NOTE:ingeneral,1IU/kgwillincreasecirculatingfactorVIIIby2%.
—hypersensitivitytodrugorclass
—hepaticdysfunction
MaternalConsiderations
.....
Notsurprisingly,therearenoadequatereportsorwell-controlled
studiesof
antihemophilicfactor
inpregnantwomensincethe
factorVIIIdeficiencyisX-linked.Unbalancedlyonizationor
crossoverduringmeiosiswouldaccountfortherarereportsin
womenifaccurate.Replacementisoflittleclinicaluseinwomen
withanacquiredinhibitoroffactorVIII.
Sideeffects
includeanaphylaxis,HIV,hepatitis,urticaria,
wheezing,nausea,fever,chills,andchesttightness.
ATIIIdeficiency(congenitaloracquired)—treatmentof
thromboembolism:50-100U/minIV,titratetoATIIIactivity
levels;prophylaxis:50-100U/minIV,titratetoATIIIactivitylevels
NOTE:ingeneral,1IU/kgincreasesATIIIlevelsby1-2.1%;goal
—hypersensitivitytodrugorclass
MaternalConsiderations
.....
Therearenoadequatestudiesof
antithrombinIIIconcentrate
pregnantwomen.ATIIIconsumptionduringnormalpregnancyis
increasedtothelevelassociatedwithsepsisinthenonpregnant
patient.WomenwithcongenitalATIIIdeficiencyhave
dramaticallyincreasedriskofthromboembolicdiseaseduring
maybeineffective,dependinguponthe
ATIIIlevel.Replacementiseffectiveprophylaxisandtreatmentof
acutethrombosisandmustbeperformedonanongoingbasis.
PreeclampsiaisacauseofacquiredATIIIdeficiencysecondaryto
increasedconsumption.SeveralstudiessuggestATIIIreplacement
mayimprovematernaloutcomeinwomenwithpreeclampsia.
Sideeffects
includedizziness,nausea,bittertaste,cramps,and
chesttightness.
Cardiacimagingunderstress—administeredbyacomputerized
system;useonlywithcontinuouscardiacmonitoring.Maxdose
0.8mcg/kg/min,maxtotaldose10mcg/kg.
Contraindications
—hypersensitivitytodrugorclass,IHSS,
historyofrecurrentventriculartachycardia,implantedpacemaker
MaternalConsiderations
.....
Therearenoreportsof
useduringpregnancy.
Sideeffects
includetremor,angina,arrhythmia,headache,
DVTprophylaxis—begin50anti-XaU/kgSCq12heveningbefore
—hypersensitivitytodrugorclassorpork
products,bleeding,thrombocytopenia,
—IMorIVuse,neuraxialanesthesiamaybe
contraindicateddependingondosingregimendesired.
Anesthesiologistmustknowofintendeddosingregimenbefore
MaternalConsiderations
.....
Thereisnopublishedexperiencewith
pregnancy.Thisclassofdrugsisbeingusedwithincreasing
frequencyduringpregnancyforthetreatmentofthrombophilia.
Sideeffects
includehemorrhage,injectionsitehematoma,fever,
N/V,bruising,arthralgia,andchestpain.
.........................
Thereisnopublishedexperienceinpregnancyorduringlactation.
...........................
PregnancyCategory:C
LactationCategory:U
Therearealternativeagentsforwhichthereismoreexperience
duringpregnancyandlactation.
InternationalBrandName—
Novastan(Japan,Korea)
DrugClass
..........................
Anticoagulants;Thrombininhibitors
.........................
Eitherprophylaxisortreatmentofthrombosisinwomenwith
-inducedthrombocytopenia
.........................
Unknown;directlyinhibitsthrombin
DosagewithQualifiers
.......
Heparin-inducedthrombocytopenia—2mcg/kg/minIV;adjust
dosebasedonaPTT;maximum10mcg/kg/min
Ascorbicacid
—(AscorL500;Cee-500;Cenolate;
Mega-C/APlus;VitaminC)
InternationalBrandName—
Acidylina(Italy);Agrumina(Italy);ArkovitalC(France);Asconvita(Philippines);
Ascorbin(Malaysia);Ascorcee(Philippines);Askorbin(Indonesia);C500(Israel);Cebion(Austria,Chile,Colombia,
CzechRepublic,Greece,Israel,Italy,Peru,Portugal,Spain);Cecap(HongKong);CeCe(Korea);Cecon(Philippines,
Nutritionaldeficiency—0.15-0.18mgPO/SC/IMqd
—(Aspergum;Bufferin;Easprin;Ecotrin;Empirin;
Fasprin;Genacote;Halfprin;Zorprin)
InternationalBrandName—
Fever—325-650mgPO/PRq4hprn
Analgesia—325-650mgPO/PRq4hprn
Preeclampsiaprophylaxis—81mgPOqd
Antiphospholipidsyndrome—81mgPOqdaloneifunassociated
TIA—650mgPObid
MI—325mgPOqdtopreventrecurrence
Arthritis—3.6-5.4gPOqdindivideddoses
Rheumaticfever—5-8gPOqdindivideddoses;treatfor1-2w,
thentaperover2-8w
NOTE:typicallyenteric-coatedtoassurereleaseintheuppersmall
intestine,whereabsorptionisoptimal.Maybecombinedwith
caffeineand
(withoutorwith
andsoldasFiorinal,orwith
andsoldasDarvon,or
—hypersensitivitytodrugorclass,G6PD
deficiency,bleedingdisorder
—GIlesions,renalorhepaticdysfunction,TTP,
MaternalConsiderations
.....
higher,andbytheU.S.PreventiveServicesTaskForceforwomen
whose5yriskofcoronaryheartdiseaseis3%orhigher.
Womeningestinglargequantitiesof
areatriskfor
myriadcomplications.Thoughoneprospectivecase-controlstudy
suggestedthattheantenataluseof
ibuprofen,naproxen,
butnot
DuleyL,Henderson-SmartD,KnightM,KingJ.BMJ2001;
EmpsonM,LassereM,CraigJ,ScottJ.CochraneDatabaseSyst
Rev2005;(2):CD002859.
.........................
Selectivelyantagonizesthe
DosagewithQualifiers
.......
Hypertension—50mgPOqd;increaseto100mgqdafter7d
MI—begin5mgIVover5min
2(10minapart),then50mgPO
7d,then100mgqd
Angina—50mgPOqd,max200mgqd
—hypersensitivitytodrugorclass,2ndor
3rddegreeheartblock,sinusbradycardia,cardiacinsufficiency
—renaldysfunction
MaternalConsiderations
.....
Hypertensioncomplicates5-10%ofpregnanciesandisaleading
causeofmaternalandperinataldeathandmorbidity.Severe
hypertension(systolicBP=170mmHgand/ordiastolic
BP=110mmHg)shouldbetreatedimmediately.Mild,chronic
-blockers.Suchpatientsmaybeunresponsivetotheusualdoses
usedtotreattheallergicreaction.
.........................
BriggsGG,NageotteMP.AnnPharmacother2001;35:859-61.
Hypercholesterolemia,hypertriglyceridemia,
InternationalBrandName—
Mepron(Canada);Wellvone(Australia,Austria,Denmark,England,France,
PCPpneumoniaforpatientswhocannottolerate
Malaria—1000mgPO(with400mgproguanil
NOTE:notforprophylaxis;maybecombinedwithproguanil.
—hypersensitivitytodrugorclass
MaternalConsiderations
.....
Therearenoadequatereportsorwell-controlledstudiesof
duringpregnancy.Severalstudiessuggestthe
combinationof
andproguaniliseffectivemalaria
resultsinasignificantdecreaseinaveragesteady-state
concentrations.Alternativesto
shouldbeconsideredduringthecourseofPCPtreatmentwith
anotherrifamycin,isstructurallysimilarto
andmaypossiblyhavesomeofthesamedruginteractionsas
.........................
GarnerP,GulmezogluAM.CochraneDatabaseSystRev2006;
Malariaprophylaxis—250/100mgPOqd(if
40kg);begin1-2d
Malariatreatment—1000/400mgPOqd
3d;notforsevere,
complicated,orcerebralmalaria;repeatdoseifemesis
1hfrom
NOTE:takewithfoodormilk.
hypersensitivitytodrugorclass,CrCl
30ml/minifprophylaxis
30ml/miniftreatment,N/V,diarrhea
MaternalConsiderations
.....
Thisisafixedcombinationagent.Falciparummalariahasa
higherriskofmorbidityandmortalityduringpregnancy.There
arenoadequatereportsorwell-controlledstudiesof
inpregnantwomen.Atfullterm,bothoralclearance
(Cl/F)andthetotalapparentvolumeofdistribution(V
estimatesforbothdrugswereroughly2
andplasma
thatreportedinhealthynonpregnantpatients
andthosewithacutemalaria.Proguanilbiotransformationinto
tobeincreasedduringpregnancytoensureefficacyandminimize
theriskofresistance.(Seecommentsunder
Sideeffects
includepancytopenia,thrombocytopenia,
neutropenia,phototoxicity,abdominalpain,N/V,diarrhea,
dizziness,pruritus,rash,tinnitus,mouthulcerations,and
increasedLFTs.
whichcanleadto
treatmentfailureandfacilitatedrugresistance.
.........................
BabalolaCP,IwheyeGB,OlaniyiAA.JClinPharmTher2002;
GarnerP,GulmezogluAM.CochraneDatabaseSystRev2006;
InternationalBrandName—
Acrium(Korea);Aculex(Korea);Genso(Taiwan);Mycurium(Israel);
Relatrac(Colombia,Peru);Tracrium(Argentina,Chile,CostaRica,DominicanRepublic,Ecuador,ElSalvador,
Guatemala,Honduras,Mexico,Nicaragua,Panama,Paraguay,Uruguay);Tracur(Brazil);Tracurix(Argentina)
DrugClass
..........................
Surgicalparalysis—0.4-0.5mg/kgIV;maysupplementwith
0.08-0.10mg/kgq15-25min
—hypersensitivitytodrugorclass
—hepaticorrenaldysfunction,hypotension,CV
disease,electrolyteabnormalities
MaternalConsiderations
.....
isanintermediate-durationcurarederivative
producingeffectivesurgicalparalysis.Therearenoadequate
reportsorwell-controlledstudiesof
inpregnant
women.Theclearanceandclinicaldurationof
unalteredduringpregnancy.Incontrast,theclearanceof
isincreased27%duringcesareansection,andthe
Symptomaticbradycardia—0.5-1mgIVq3-5minprn,max2mg
Organophosphatepoisoning—1-2mgIM/IVq20-30minuntil
muscarinicsymptomsresolve
Adjuncttoanesthesia—0.4mgIM/SC30-60minpreoperativelyto
DrugInteractions
................
Thesignsofatropinization(flushing,mydriasis,tachycardia,
drynessofthemouthandnose)mayoccurearlierthanexpected
whenusedwith
.........................
Diarrhea—30mlPOprn,max6
/d,alternatively1.2-1.5gafter
eachbowelmovement(refertoeachmanufacturer’sdosing
—hypersensitivitytodrugorclass,bowel
InternationalBrandName—
Aktil(Thailand);Auropan(Hungary);Crytion(Uruguay);Goldar(India);
Ridaura(Brazil,Canada,China,Japan,Korea,Taiwan);Ridauran(France);RidauraTiltab(HongKong,Malaysia)
DrugClass
..........................
Antiarthritics;Goldcompounds
.........................
Rheumatoidarthritis
.........................
DosagewithQualifiers
.......
Rheumatoidarthritis—3mgPObid;mayincreaseto9mg
stepwiseafter4-6mo
—hypersensitivitytodrugorclass,gold
toxicity,pulmonaryfibrosis,dermatitis,bonemarrowaplasia,
necrotizingenterocolitis
—hepaticorrenaldysfunction
MaternalConsiderations
.....
Thereisnopublishedexperiencewith
Sideeffects
includeseizures,nephriticsyndrome,renalfailure,
thrombocytopenia,ulcerativecolitis,aplasticanemia,
pneumonitis,pulmonaryfibrosis,diarrhea,rash,itching,nausea,
abdominalpain,conjunctivitis,hematuria,anemia,andanorexia.
DosagewithQualifiers
.......
Allergicrhinitis—1-2mgPObid
Urticaria—1-2mgPObid
—hypersensitivity,MAOIwithin14d,
Transplantrejection—begin3-5mg/kg/dPO/IVqd;maintenance
1-3mg/kg/d;transplantprotocolsvary
Crohn’sdiseaseandulcerativecolitis—begin50mgPOqd,
increasingto150-250mgPOqd;max2.5mg/kg/d
Rheumatoidarthritis—begin1mg/kgPOqd;increase0.5mg/kg/d
after6-8w;max2.5mg/kg/d
NOTE:monitorCBCweekly;renaldosingifCrCl
—hypersensitivitytodrugorclass
—pregnancy,lactation
MaternalConsiderations
.....
Bacterialinfection—500mgPOload
1,then250mgPOqd
orchancroid—1gPO
Uncomplicatedgonorrhea—2gPO
1(or1gPO
1plus
PID—500mgIVqd
2d,then250mgPOqd
Community-acquiredpneumonia—500mgIVqd
2-5d,then
500mgPOqdforatotal7-10d
—hypersensitivitytodrugorclass
—hepaticdysfunction,
MaternalConsiderations
.....
hasashortserumt/2intermpregnantwomen.
alsoimprovespulmonaryfunctioninwomenwith
cysticfibrosisandinwomenwhoarechronicallyinfectedwith
Pseudomonasaeruginosa
Sideeffects
includeangioedema,anaphylaxis,cholestaticjaundice,
Stevens-Johnsonsyndrome,pseudomembranouscolitis,diarrhea,
nausea,vaginitis,rash,anorexia,anditching.
...........................
PregnancyCategory:B
LactationCategory:S
Bacterialinfection—0.5-2gIV/IMq8-12h;max8g/d
Gonorrhea—1gIM
NOTE:renaldosing.
—hypersensitivitytodrugorclass
—renaldysfunction
MaternalConsiderations
.....
Therearenoadequatereportsorwell-controlledstudiesof
inpregnantwomen.Itisoneofmanyantibioticsof
potentialuseduringpregnancy.
isaseffectiveas
forthetreatmentofpuerperal
—(Ak-Tracin;Baci-IM;Baci-Rx;Bacticin;
Ocutricin;Spectro-Bacitracin)
InternationalBrandName—
Skinorwoundinfection—applycreamtopicallyqdtotid
NOTE:usenolongerthan1w;oftencombinedwith
polymixinB.
—hypersensitivitytodrugorclass
—myastheniagravis
MaternalConsiderations
.....
Thereisnopublishedexperienceduringpregnancy.
enhanceswoundhealinginnonpregnantsurgicalpatientsand
reducesscarringcomparedtoplacebo.
Sideeffects
includecontactdermatitis.
InternationalBrandName—
Alpha-Baclofen(NewZealand);Backen(Korea);Baclan(Korea);Baclapone
(Korea);Baclo(Australia);Baclofene(France);Baclon(Finland,Taiwan);Baclosal(Israel,Thailand);Bacofen(Korea);
Bacron(Korea);Bafen(Thailand);Baklofen(CzechRepublic,Denmark,Norway);Baropan(Korea);Bigafen(Korea);
Clofen(Australia,Malaysia);Curofen(Korea);Espast(Peru);Lebic(Germany);Lioresal(Argentina,Brazil,Canada,
Ecuador,Paraguay,Uruguay,Venezuela);Lioresyl(Chile);Liotec(Canada);Lyflex(England,Ireland);Onelaxant-R
(Philippines);Pacifen(NewZealand,Taiwan);Spinax(China,Taiwan);Stelax(Australia)
DrugClass
..........................
Musclerelaxants
.........................
ControlofthespasticitysecondarytoMSandotherspinalcord
.........................
GABABreceptorantagonist(central-actingmusclerelaxant)
DosagewithQualifiers
.......
Musclespasm—begin5mgPOtid;increaseby15mgqdq3d
basedonresponse;max80mg/d
—hypersensitivitytodrugorclass
—renaldysfunction,seizuredisorder
MaternalConsiderations
.....
Therearenoadequatereportsorwell-controlledstudiesof
inpregnantwomen.Thepublishedexperienceismostly
limitedtocasereports,mostlyofintrathecaluseinwomen
withMS.Forexample,onedocumentssuccessfulintrathecaluse
InternationalBrandName—
Benoquin(Argentina);Colazide(Austria,England);Premid(Denmark)
DrugClass
..........................
Gastrointestinals;Salicylates
.........................
Ulcerativecolitis,acute
.........................
Exactmechanismunknown(central-actingmusclerelaxant)
DosagewithQualifiers
.......
Ulcerativecolitis—2.25gPOtid;maxuse8w
—hypersensitivitytodrugorclass
—renaldysfunction,seizuredisorder,antibiotic
treatment,pyloricstenosis
MaternalConsiderations
.....
isaprodrugenzymaticallycleavedinthecolonto
producemelsalamine.Thoughconsideredsafetousebysome
clinicians,therearenoadequatereportsorwell-controlledstudies
inpregnantwomen.
Sideeffects
includeangioedema,bradycardia,bronchospasm,
Kidneytransplant—20mgIVsingledose
—hypersensitivitytodrugorclass
MaternalConsiderations
.....
Thereareonlycasereportsof
useduringpregnancy.
Sideeffects
includeconstipation,diarrhea,nausea,hyperkalemia,
hypokalemia,acne,insomnia,anginapectoris,headache,tremor,
hypertension,dysuria,UTI,edema,fever,asthenia,and
.........................
Anti-inflammatorymechanismunknown
DosagewithQualifiers
.......
Asthma—4-16inhalations/d
Rhinitis—1-2inhalationsineachnostrilqd;max336mcg/d
Nasalpolypprophylaxis—1-2inhalationsineachnostrilqd;max
—(Donnatal;Lomotil;AtropineSulfate)
InternationalBrandName—
Noneidentified.
DrugClass
..........................
Analgesics,narcotic;Parasympatholytics
.........................
Adjunctivetherapyforirritablebowelsyndrome,acute
enterocolitis,duodenalulcer,cesareansection(todecrease
Donnatal—0.0194mg/tab,5ml/elixir(23%alcohol)
Lomotil—0.025mg/tab,5ml
Atropinesulfate—0.1mg/ml
NOTE:individualizethedose;maybecombinedwitheitheropium,
ergotamine,phenobarbital,
hypersensitivitytodrugorclass
—neuropathy,glaucoma,hepaticdiseases,
hyperthyroidism,coronaryheartdiseases,chroniclungdiseases
MaternalConsiderations
.....
Therearenowell-controlledstudiesof
inpregnant
Sideeffects
includexerostomia,tastechange,blurredvision,
bradycardia,palpitations,drowsiness,headache,andanaphylaxis.
InternationalBrandName—
Benace(India);Boncordin(Argentina);Cibace(SouthAfrica);Cibacen(Austria,
Hypertension—begin10mgqd,max80mg/d
Congestiveheartfailure—begin5mgqd;lowerdoseswhenused
WaldmeierF,SchmidK.Arzneimittelforschung1989;39:62-7.
throughoutpregnancy.
Hypertension—5-20mgPOqd
Hypertension(Corzide)—1tabPOqd
—(Americaine;Anacaine;Otocain)
InternationalBrandName—
Anaesthesin(Germany);Auralyt(Mexico);Octicaina(Colombia);
Topicaine(Australia)
DrugClass
..........................
Congestiveandserousotitisandacuteswimmer’sear—supplied
aseardrops
Anesthesiaofmucousmembrane—suppliedastopicalgelorlocal
spray;max20mg
NOTE:combinedwithantipyrineforoticuses.
—hypersensitivitytodrugorclass,
perforatedtympanicmembrane
—notknown
MaternalConsiderations
.....
Therearenowell-controlledstudiesof
pregnancy.Itprovidesrelieffromperinealpainassociatedwith
episiotomy,especiallywhenassociatedwithacorticosteroid.
Somepractitionersuseitasanalternativeto
forthe
Benzoylperoxide
—(Benzac;Brevoxyl;Desquam-E;
Desquam-X10;Desquam-X5)
InternationalBrandName—
Acnevulgaris—applytoaffectedareasqdorbid
NOTE:alsopackagedwith
—hypersensitivitytodrugorclass
—notknown
MaternalConsiderations
.....
Benzoylperoxide
isforexternaluseonly.Ithasbeenused
forthetreatmentofacnesincethe1930s.Thereareno
well-controlledstudiesinpregnantwomen.
Sideeffects
includedryness,irritation,andpruritus.
—(Bensylate;Cogentin;Glycopyrrolate)
InternationalBrandName—
Akitan(Finland);Apo-Benzthropine(Canada);Bentrop(Australia);
Cogentin(Canada,England,HongKong,Ireland,Malaysia,Norway,Portugal,Sweden,Thailand)
DrugClass
..........................
Anticholinergics;Antihistamines;Antiparkinsonagents;
.........................
Adjuncttherapyforparkinsonismorforthetreatmentof
extrapyramidalreactions
.........................
AntagonizesAChandhistaminereceptors
DosagewithQualifiers
.......
Parkinsonism—begin0.5-1mgPOqd,increaseby0.5mgq5d;
max6mgPOqd
Extrapyramidalreactions—1-4mgPOqdorbid
—hypersensitivitytodrugorclass,
narrow-angleglaucoma,tardivedyskinesia,ileus
—CVdisease
MaternalConsiderations
.....
Therearenoadequatereportsorwell-controlledstudiesof
inpregnantwomen.Thepublishedexperienceis
limitedtoisolatedcasereports.
Sideeffects
includetachycardia,anticholinergicpsychosis,dry
mouth,constipation,tachycardia,sedation,N/V,flatulence,
anorexia,rash,dizziness,headache,nervousness,tinnitus,edema,
andblurredvision.
InternationalBrandName—
Bepricol(Japan);Cordium(Portugal);Cruor(Argentina);Unicordium(France)
DrugClass
..........................
Calciumchannelblockers
.........................
Chronicstableangina
.........................
Inhibitscalciuminfluxintomyocardialandvascularsmooth
DosagewithQualifiers
.......
Chronicstableangina—begin200mgPOqd;max400mgqd
—hypersensitivitytodrugorclass,cardiac
insufficiency,sicksinussyndrome,2ndor3rddegreeheart
block,hypotension,arrhythmia,prolongedQTinterval
—electrolyteabnormalities,bradycardia,recentMI,
hepaticorrenaldysfunction
MaternalConsiderations
.....
Thereisnopublishedexperiencewith
duringhuman
Sideeffects
includeventriculararrhythmia,prolongedQT
interval,CHF,agranulocytosis,interstitialpulmonarydisease,
—(VitaminA)
InternationalBrandName—
Supplementation—8000-25000IUPOqd
—malabsorptionsyndrome
MaternalConsiderations
.....
isanantioxidant,andconsumingfoodsrichin
mayhelpprotectfromfreeradicaldamage.Some

34w—12.5mgIM
2doses24hapart
Bursitis/tendinitis—1mlintothetendonsheathorjointcombined
Rheumatoidarthritisorosteoarthritis—0.5-2mlintothejoint
—hypersensitivitytodrugorclass,sepsis,
theriskforcleftlipwithorwithoutcleftpalate6-fold.IUGRand
shorteningoftheheadandmandiblearealsosuggestedas
sequelaeofchronicsteroiduseduringpregnancy,thoughitis
difficulttoseparatedrugfromdiseaseimpact.TheCollaborative
PerinatalProjectfollowedwomentreatedduringthe1sttrimester.
Whilethenumberofexposureswaslimited,noincreasein
Dermatitis—applytoaffectedareaqdorbid(0.05-0.01%cream
orointment)
NOTE:maybecombinedwith
—hypersensitivitytodrugorclass
MaternalConsiderations
.....
Theabsorptionleveloftopical
Hypertension—10-20mgPOqd;renaldisease,begin5mgPOqd
Glaucoma—1dropintheaffectedeyebid;therapyisindividualized
—hypersensitivitytodrugorclass,sinus
bradycardia,2ndor3rddegreeAVblock,CHF
MaternalConsiderations
.....
Parkinsonism—2mgPOtidorqid;max16mgqd
Extrapyramidaldisorder—2mgIM/IVq30min;max4doses/d
—hypersensitivitytodrugorclass,
narrow-angleglaucoma,bowelobstruction
—epilepsy,arrhythmia
MaternalConsiderations
.....
Therearenoadequatereportsorwell-controlledstudiesof
inpregnantwomen.
Sideeffects
includedrymouth,blurredvision,dizziness,urinary
Bismuthsubsalicylate
InternationalBrandName—
Noneidentified.
DrugClass
..........................
.........................
Diarrhea,heartburn,nausea
.........................
Diarrhea—30mlor2tabq30minto1h;max8dosesin24h
—hypersensitivitytodrugorclass
—hepaticorrenaldysfunction,oralanticoagulantor
hypoglycemicagents
MaternalConsiderations
.....
Therearenoadequatereportsorwell-controlledstudiesof
bismuthsubsalicylate
inpregnantwomen.Stooldarkening
shouldnotbeconfusedwithmelena.Thelongclinicalexperience
withthisOTCagentisreassuring.
Sideeffects
Bisoprololfumarate
—(Biconor;ConcorPlus;Lodoz;Ziak)
InternationalBrandName—
Bicor(Australia);Biso(Germany);Biso5(Taiwan);BisoABZ(Germany);Biso-BASF
Hypertension—2.5-40mgPOqd
...........................
PregnancyCategory:C
LactationCategory:U
shouldbeusedduringpregnancyandlactationonly
ifthebenefitjustifiesthepotentialperinatalrisk.
Therearealternativeagentsforwhichthereismoreexperience
duringpregnancyandlactation.
InternationalBrandName—
Bileco(Argentina);Blanoxan(Mexico);Blenamax(Australia,Thailand);Blenoxane
(Brazil,Canada,Ecuador,Egypt,Philippines,SouthAfrica);Bleo(HongKong);Bleocin(Bulgaria,CzechRepublic,Egypt,
Greece,HongKong,Hungary,India,Indonesia,Malaysia,Portugal,Taiwan,Thailand);Bleocina(Uruguay);Bleocris
(Paraguay);Bleolem(Mexico,Thailand);Bleomicina(Italy,Peru,Spain);Bleomycine(Belgium,France);Bleomycinum
(Germany);Blexit(Chile);Bloicin-S(Philippines)
DrugClass
..........................
Antibiotics;Antineoplastics
.........................
Palliativetreatmentofsquamouscellcarcinoma(neck,tongue,
cervix,vulva),lymphoma,andassociatedpleuraleffusion
.........................
InhibitionofDNA,RNA,andproteinsynthesis
DosagewithQualifiers
.......
Cancer—variesbasedontypeofneoplasm;mostregimens
recommend0.25-0.50U/kg(10-20U/m
—hypersensitivitytodrugorclass
—hepaticorrenaldysfunction
MaternalConsiderations
.....
Therearenoadequatereportsorwell-controlledstudiesin
pregnantwomen.Neutropeniaisanimportantrisk.Long-term
effectsof
onreproductivefunctionareinsufficiently
studied.Severalstudiesconcludedthatsubsequentfertilityis
clinicallyunaffectedaftertreatment.
Sideeffects
includeimpairmentofthepulmonaryfunction
(pulmonaryfibrosis),rash,urticaria,alopecia,andstomatitis.
...........................
PregnancyCategory:D
LactationCategory:U
shouldbeusedduringpregnancyandlactationonly
ifthebenefitjustifiesthepotentialperinatalrisk.
Ventriculararrhythmia—5-10mg/kgIM/IV
1;repeat1-2hprn
untilcontrol,thenq6horinfusionof1-2mg/min
Malignantventriculararrhythmia—5mg/kgIV
3;mayincrease
to10mg/kgandrepeatprn,orinfusion1-2/mg/min
—hypersensitivitytodrugorclass
—rapidinfusion,hepaticorrenaldysfunction
MaternalConsiderations
.....
Therearenoadequatereportsorwell-controlledstudiesof
—sodium,potassiumsalts
InternationalBrandName—
Noneidentified.
DrugClass
..........................
.........................
Epilepsy,seborrheicdermatitis
.........................
DosagewithQualifiers
.......
Epilepsy—loadingdose450mg/kg;maintenancedose20-40mg/kg
NOTE:dividethe450mg/kgdoseover5d(90mg/kg/d)andadditto
amaintenancedoseof20-40mg/kg(averageof30mg/kg)qd.Thus,
anewpatientwillreceive120mg/kgofpotassiumbromideeachday
Seborrheicdermatitis—homeopathicdoses
—hypersensitivitytodrugorclass
MaternalConsiderations
.....
Oralortopicalcombinationsofpotassiumandsodiumbromide
significantlyimproveseborrheicdermatitisanddandruffafter10
weeks.Therearenoadequatereportsorwell-controlledstudiesin
pregnantwomen.
Sideeffects
includesedation,ataxia,increasedurination,andrare
skindisorders.
—(Parlodel;Volbro)
InternationalBrandName—
Alpha-Bromocriptine(NewZealand);Antilactin(Korea);Apo-Bromocriptine
(NewZealand);Axialit(Argentina);Barlolin(Taiwan);Brameston(PuertoRico);Brocaden(Thailand);Bromed(Austria);
Bromergon(Denmark);Bromidine(Korea);Bromocorn(Poland);Bromocrel(Germany);Bromohexal(Australia);Bromokin
(Finland);Bromo-Kin(France);Bromopar(Denmark);Butin(Malaysia,Singapore);Cryocriptina(Mexico);Deprolac
(Taiwan);Diken(Mexico);Elkrip(Indonesia);Ergolactin(China);Kripton(Australia);Lactismine(Spain);Medocriptine
(HongKong);Parilac(Israel);Parlodel(Argentina,Australia,Canada,Colombia,Ecuador,Mexico,Paraguay,Peru,
Uruguay,Venezuela);Pravidel(Germany,Sweden);Provasyn(Philippines);Ronalin(Israel);Serocryptin(China,Greece,
HongKong,India,Israel,Italy,Malaysia,Mexico,Peru,Switzerland);Suplac(Malaysia,Thailand);Umprel(Austria);
Zolac(Malaysia)
DrugClass
..........................
Antiparkinsonagents;Dopaminergics;Ergotalkaloidsandderivatives
.........................
Parkinson’sdisease,amenorrhea,acromegaly
.........................
Dopamineagonist;stimulatorofthedopaminergicreceptors
DosagewithQualifiers
.......
Parkinson’sdisease—10-40mgPOqd
Amenorrhea—5-7.5mgPOqhs
Acromegaly—20-30mgPOqd
—hypersensitivitytodrugorclass,
uncontrolledhypertension,CAD
—hypertension,hepaticorrenaldysfunction
MaternalConsiderations
.....
Medicaltherapywith
istheinitialtreatmentof
choiceforinfertility.Whenthisistheprimaryindicationfor
Antiallergic—1-2tspPOq4-6h
Antitussive,sedation—1-2tspPOq4-6h
NOTE:combinedwith
—hypersensitivitytodrugorclass,
newborns,lactation
—asthma,hyperthyroidism,CVdisease
MaternalConsiderations
.....
isa
derivative.There
arenoadequatereportsorwell-controlledstudiesinpregnant
women.Whencombinedwith
hasbeenadvocatedaseffectivein
hospitaltreatmentofseverehyperemesis.Overdoseisassociated
withuterinecontractions.Itisinferiorto
forthe
reliefofpruritusassociatedwithintrathecal
Sideeffects
includesomnolence,drymouth,headache,dizziness,
andN/V.
Asthma—0.5-1mg/dinhalation
Rhinitis—MDI50mcg/puffinhalation
—hypersensitivitytodrugorclass,primary
treatmentofstatusasthmaticus
—infection,systemicsteroids
MaternalConsiderations
.....
Asthmacanbeaseriousproblemduringpregnancy.Inhaled
corticosteroidsshouldgenerallybeconsideredtheprophylactic
medicationofchoiceinpregnantwomenwithpersistentasthma,
unlesswellcontrolledbyeither
Althoughtherearenoadequatereportsorwell-controlledstudies
duringpregnancy,itisconsideredafirst-line
agentalongwith
Sideeffects
includeallergicreaction,stridor,eczema,purpura,
backpain,fracture,andmyalgia.
.........................
InhibitschlorideresorptionintheloopofHenle,andinthe
distalandproximalconvolutedtubule
DosagewithQualifiers
.......
Heartfailure—0.5-2mg/dPO;alternatively,0.5-1mgIM/IV
—hypersensitivitytodrugorclass,volume
.........................
Inhibitsnerveimpulsesbystabilizingneuronalmembranes
DosagewithQualifiers
.......
Conductionanesthesia—varies;recommendconsultingaspecialty
—(Buprenex;Subutex)
InternationalBrandName—
Pain—300mcgIM/IVq4-6h;max600mcg/dose
NOTE:300mcgshouldbegivenIM;largerdosesshouldbegivenIV
over2min.
hypersensitivitytodrugorclass
impairedhepaticfunction
MaternalConsiderations
.....
Thereisextensiveinformationintheaddictionmedicine
literatureconcerningtheuseofopioidsinrecoveringpregnant
buprenorphine.
Depression—100mgPOtid;maxdose150mgPOtid
Smokingcessation—150-300mgPObid;patientquitssmoking
after5-7doftreatment;2nddoseshouldnotbelaterthan6pm
andatleast8hafter1stdose
—hypersensitivitytodrugorclass,seizure
disorder,useofMAOIswithin14d,bulimia,anorexianervosa
—agitation,insomnia,psychosis,confusion,altered
Physiologicchangesresultingfromsmokingcessationitself,with
orwithout
recommended.Subsequentdoseadjustmentofeitherdrugshould
bebasedonclinicalassessment.
Inonestudy,administrationof
(30mgasa
singledose)with
(600mg/dayfor5d)decreasedthe
plasmaconcentrations(83.7%decreaseinC
;89.6%decrease
inAUC)andpharmacodynamiceffectsof
Ifthetwo
drugsaretobeusedincombination,thedosageof
mayneedadjustingtomaintainanxiolyticeffect.
OtherInhibitorsandInducersofCYP3A4:
Substancesthatinhibit
CYP3A4,suchas
Leukemia—variesbasedonthetypeofneoplasm
Myelofibrosis—2-4mgPO2-3
—hypersensitivitytodrugorclass,resistance
topriortreatment,blastcrisis,acutelymphocyticleukemia
—bonemarrowdepression,seizures
MaternalConsiderations
.....
Therearenoadequatereportsorwell-controlledstudiesin
pregnantwomen.
hasbeenusedsuccessfullytotreat
leukemiaandessentialpolycythemiaduringpregnancy.
Sideeffects
includemyelosuppression,pulmonaryfibrosis,
pericardialfibrosis,seizures,andhyperpigmentation.
Sedation—15-30mgPOtidorqid
Insomnia—50-100mgPOqhs(shortterm)
Preoperativesedation—50-100mgPO30-60minpreoperatively
MaternalConsiderations
.....
Therearenoadequatereportsorwell-controlledstudiesof
inpregnantwomen.
Sideeffects
includethrombocytopenia,Stevens-Johnson
syndrome,drowsiness,sedation,constipation,dyspnea,N/V,SOB,
andabdominalpain.
Pain—0.5-2mgIVq3-4hprnpain;begin1mgIVor2mgIM
Preoperativesedation—2mgIVbeforeinduction
Epiduralanesthesia—consultaspecialtytext
—hypersensitivitytodrugorclass,acuteMI,
coronaryinsufficiency
—hepaticorrenaldysfunction,CNSdepression,biliary
surgery,substanceabuse,impairedpulmonaryfunction,head
MaternalConsiderations
.....
Therearenoadequatereportsorwell-controlledstudiesin
pregnantwomenpriorto37w.
InternationalBrandName—
Cabaser(Australia,Israel)
DrugClass
..........................
Antiparkinsonagents;Dopaminergics;Ergotalkaloidsand
derivatives;Hormones/hormonemodifiers
.........................
Hyperprolactinemia,lactationsuppression
.........................
StimulatesD
dopaminereceptors
DosagewithQualifiers
.......
Hyperprolactinemia—begin0.25mg2
/w,thenincrease
0.25mg/wqmo;max1mg2
/w;monitorprolactinlevel
—hypersensitivitytodrugorclass,
uncontrolledhypertension
—hepaticdysfunction
MaternalConsiderations
.....
Therearenoadequatereportsorwell-controlledstudiesin
pregnantwomen.
LiuC,TyrrellJB.Pituitary2001;4:179-85.
MolitchME.JReprodMed1999;44:1121-6.
maypotentiatethevasoconstrictiveactionsof
byblockingthevasodilatingpropertyof
mayprovokevasoconstrictioninsomepatients,
predisposingtoagreaterischemicresponsetoergottherapy.
Thebloodlevelsofergotamine-containingdrugsassociated
withvasospasticreactionsarereportedtobeincreasedbythe
co-administrationofmacrolideantibiotics.
.........................
BrowneML.Epidemiology2006;17:324-31.
Headache—1-2tabs/suppositoriesPO/PRq30minprn;max
MaternalConsiderations
.....
ThereareonlyscatteredcasereportsofCafergotuseduring
pregnancy.Thiscombinationiscontraindicatedduetotheoxytocic
effectsof
ergotamine.
See
caffeine
ergotamine
individually.
Sideeffects
Vitamindeficiency—50-100mcgPOqd
Hypoparathyroidism—0.2-1mgPOqd
Osteoporosis—0.6mgPOqd
—hypersensitivitytodrugorclass,
hypercalcemia,hypervitaminosisD
—renalfailure,renalstones,hyperphosphatemia
MaternalConsiderations
.....
VitaminDsupplementationisrecommendedduringpregnancy.
isconvertedinthekidneytoanactiveformof
vitaminD,calcitriol.Therearenoadequatereportsorwell-
controlledstudiesinpregnantwomen.Veiledordark-skinned
pregnantwomenhaveanincreasedriskofvitaminDdeficiency,
whichisassociatedwithdisease.
Sideeffects
includehypercalcemia,elevatedcreatinine,polydipsia,
nausea,andconvulsion.
Osteoporosis—100IUSCorIMqodor200IUNASqd
Hypercalcemia—4IU/kgSCorIMq12h
—hypersensitivitytodrugorclass
—renalfailureorstones,hyperphosphatemia
MaternalConsiderations
.....
regulatescalciumhomeostasis.Therearenoadequate
reportsorwell-controlledstudiesinpregnantwomen.
Sideeffects
includerhinitis,backpain,epistaxis,nasalirritation,
andheadache.
Hypocalcemia—0.25-1mcgPOqd
Hypoparathyroidism—0.25-2mcg/dIV;increasethedoseevery
2-4wasneeded
Supplementationduringpregnancy—10mcg/dPO
—hypersensitivitytodrugorclass,
hypercalcemia,hypervitaminosisD
—renalfailureorstones,hyperphosphatemia
MaternalConsiderations
.....
isanactiveformofvitaminD.Therearenoadequate
reportsorwell-controlledstudiesinpregnantwomen.
VitaminD
supplementationisrecommendedduringpregnancy.
combinedwithcalciumsupplementationhelpslowersystolicBP
inolderwomen.
Sideeffects
includeN/V,anorexia,convulsion,drymouth,bone
pain,polydipsia,irritability,weightloss,increasedLFTs,and
Calciumchloride
DrugClass
..........................
Electrolytereplacements;Vitamins/minerals
.........................
Hypocalcemia,hypermagnesemia
.........................
Modulatorofcellularevents(e.g.,contraction,signaling)via
specificmembranechannels
DosagewithQualifiers
.......
Hypocalcemia—500-1000mgIVslowinfusion;donotexceed
Hypermagnesemia—500mgIVslowinfusion;followpatientfor
clinicalsignsofhypermagnesemia
—VF,hypercalcemia,digitalistoxicity,liver
—CVdefects,impairedrespiratoryfunction,acidosis
MaternalConsiderations
.....
Calciumchloride
islifesavinginwomenwithhypermagnesemia.
Itprovidesapproximately3
morecalciumthancalcium
Calciumchloride
reducestheincidenceofparturient
paresisincowsandtransientlyincreasescardiacoutputingravid
ewesduringhemorrhagichypotension.
Sideeffects
includetissuedestructionafterextravasation,and
hyperkalemia-relatedECGdisturbances.
—(foundinAbsorbineArthriticPainLotion10%;
Act-OnRubLotion1.5%;AnabalmLotion3%;Avalgesic;
AveenoAnti-ItchConc.Lotion0.3%;BanalgMusclePain
Reliever2%;BenGayChildren’sVaporizingRub5%;
Campho-PheniqueFirstAidGel10.8%)
InternationalBrandName—
Noneidentified.
DrugClass
..........................
.........................
.........................
AT-1receptorantagonist
DosagewithQualifiers
.......
Hypertension—begin16mgPOqdandincreasegradually;max
32mgqd
—hypersensitivitytodrugorclass,historyof
—renalarterystenosis,hepaticorrenaldysfunction,
hyponatremia,heartfailure
MaternalConsiderations
.....
Thepublishedexperiencefor
duringpregnancyis
limitedtoafewcasereports.Itisassumedtheeffectsof
aresimilartootherACEIclassagents.Assuch,it
shouldbeavoidedthroughoutpregnancyunlessthereisnoother
option.Thelowestdoseeffectiveshouldbeusedwhen
isrequiredforBPcontrolduringpregnancy.
Sideeffects
—(Capoten;Tenofax)
InternationalBrandName—
Ace-Bloc(Taiwan);Acenorm(Australia,Germany);Acepress(Indonesia,Italy);
Hypertension—25-50mgPOtid
CHF—12.5-50mgPOtid
DrugInteractions
................
—(Carbastat;Carboptic;Isopto;Miostat)
InternationalBrandName—
Carbamann(Germany);Glaumarin(Japan);IsoptoKarbakolin(Sweden);
KarbakolinIsopto(Denmark)
DrugClass
..........................
Glaucoma—2gtteacheyetid
NOTE:nomorethan0.5mlshouldbeadministeredforsatisfactory
—hypersensitivitytodrugorclass,acute
—cardiacfailure,asthma,hyperthyroidism,GIspasm,
parkinsonism,recentMI,hypertension
MaternalConsiderations
.....
Therearenoadequatereportsorwell-controlledstudiesofthe
effectof
inpregnantwomen.
isapotent
Seizuredisorder—400-600mgPObid(or12-25mg/kg/d);max
600mgPObid
Trigeminalneuralgia—200-400mgPObid
—hypersensitivity,MAOIsinthepast2w
—hepaticorrenalfailure,bonemarrowdepression,
historyofblooddyscrasia,cardiacdisease
MaternalConsiderations
.....
Anticonvulsantdrugsshouldnotbediscontinuedabruptlyduring
pregnancyifusedtopreventseizures,asthereisasignificant
possibilityofprecipitatingstatusepilepticus.Thereareno
adequatereportsorwell-controlledstudiesof
pregnantwomen.Itwouldseemadvisableforwomentocontinue
medicationduringpregnancyusingmonotherapyatthelowest
doserequiredtoachieveseizurecontrol.Polytherapywouldseem
bestavoidedwherepossible.
Sideeffects
includeseizures,Stevens-Johnsonsyndrome,
arrhythmias,agranulocytosis,thrombocytopenia,andhepatitis.
bemonitoredforpossibleadverseeffects,thedruggivenatthe
lowesteffectivedose,andbreastfeedingavoidedattimesofpeak
druglevels.
DrugInteractions
................
suspensionshouldnotbeusedwithotherliquid
medicinalagentsordiluents.Mixingitwitheither
solutionorliquid
causesaprecipitate.
CYP3A4inhibitorsinhibit
IqbalMM,SohhanT,MahmudSZ.JToxicolClinToxicol2001;
KaajaE,KaajaR,HiilesmaaV.Neurology2003;60:575-9.
MatalonS,SchechtmanS,GoldzweigG,OrnoyA.Reprod
Toxicol2002;16:9-17.
Adultinfection—2-4tabqd(1tab=382mgcarbenicillin)
—hypersensitivitytodrugorclass
—cephalosporinallergy,seizuredisorder,renal
MaternalConsiderations
.....
isindicatedforthetreatmentofacuteandchronic
infectionsoftheupperandlowerurinarytract.Thereareno
adequatereportsorwell-controlledstudiesinpregnantwomen.
Sideeffects
includeseizures,anaphylaxis,Stevens-Johnson
syndrome,hemolyticanemia,neutropenia,nausea,urticaria,
diarrhea,rash,andfever.
...........................
PregnancyCategory:B
LactationCategory:S
Penicillin-classdrugsaregenerallyconsideredsafeduring
InternationalBrandName—
Noneidentified.
DrugClass
..........................
Antiparkinsonagents;Dopaminergics
.........................
Parkinson’sdisease
.........................
Inhibitsperipheraldopaminedecarboxylation,crossesblood-brain
barrierandcanserveasadopamineprecursor
DosagewithQualifiers
.......
ShulmanLM,MinagarA,WeinerWJ.MovDisord2000;
Coldsymptoms—5mlPOqid
—hypersensitivitytodrugorclass,MAOI
Pregnancytermination—begin100mcgIMtestdose,then250mcg
IMq90-120min;max12mgtotalorusenolongerthan2d
Uterineatony—250mcgIM
1,mayrepeatq15-90min;max2mg
—hypersensitivitytodrugorclass;acute
PID;acuterenal,hepatic,orpulmonaryinsufficiency;
symptomaticCAD
—(Caridolin;Chinchen;Flexartal;Mus-Lax;
Neotica;Rela;Rotalin;Scutamil-C;Soma)
InternationalBrandName—
Artifar(Greece);Carisoma(England,India);Myolax(Thailand);Somadril
(Denmark,Norway,Sweden)
DrugClass
..........................
Musclerelaxants
.........................
Musclespasm
.........................
Musclespasm—350mgPOtidandhs,orqid
—hypersensitivitytodrugorclass,porphyria
—hepaticorrenaldysfunction
MaternalConsiderations
.....
Themajormetaboliteof
carisoprodol
meprobamate.
Thereare
noadequatereportsorwell-controlledstudiesinpregnantwomen.
Sideeffects
includeanaphylaxis,erythemamultiforme,
drowsiness,orthostatichypotension,vertigo,ataxia,vomiting,
tremor,rash,angioedema,andheadache.
.........................
Hypertension,glaucoma
.........................
-and
-adrenergicreceptors
DosagewithQualifiers
.......
Hypertension—2.5-10mgPOqd
Chronicopen-angleglaucomaandintraocularhypertension—1gttof
1%solutionbid
NOTE:renaldosing.
—hypersensitivitytodrugorclass,asthma,
COPD,bradycardia,AVblock,CHF
InternationalBrandName—
Cardivas(India);Carvedlol(Korea);Carvrol(Korea);Dilatrend(Austria,Colombia,
Ecuador,Germany,HongKong,Italy,Korea,Malaysia,Mexico,Norway,Peru,Philippines,Taiwan,Thailand);Dilbloc
(Indonesia);Eucardic(England,Ireland);Kredex(France);Querto(Germany);V-Bloc(Indonesia)
DrugClass
..........................
Adrenergicantagonists;Antihypertensives;
.........................
Hypertension,CHF
.........................
-andnonselective
-adrenergicreceptorantagonists
DosagewithQualifiers
.......
Hypertension—6.25-12.5mgPObid,re-evaluatein2w;max25mg
CHF—3.125-50mgPObid;max25-50mgPObid
—hypersensitivitytodrugorclass,asthma,
AVblock,bradycardia,CHF(classIV)
—hepaticorrenaldysfunction
MaternalConsiderations
.....
Therearenoadequatereportsorwell-controlledstudiesof
inpregnantwomen.Therearereportsofitsuseforthe
treatmentofperipartalcardiomyopathy.
Sideeffects
includeAVblock,bradycardia,thrombocytopenia,
suddendeath,bronchospasm,fatigue,N/V,orthostatic
hypotension,bradycardia,headache,gout,andabdominalpain.
Isolatedcasesofconductiondisturbance(rarelywith
hemodynamiccompromise)havebeenobservedwhen
isco-administeredwith
-Blockingdrugsmayenhancethebloodglucose–reducingeffect
andoralhypoglycemics.
.........................
Constipation—1-2tabPOqd
—hypersensitivitytodrugorclass,
constipation,appendicitis,acuteabdomen,mineraloil
MaternalConsiderations
.....
Therearenoadequatereportsorwell-controlledstudiesof
inpregnantwomen.
Sideeffects
includebowelobstruction,abdominalcramps,rash,
andelectrolytedisorders.
—(Ceclor;CeclorCD;Cefaclor)
InternationalBrandName—
Aclor(Australia);Alfatil(France);AlfatilLP(France);Alphexine(France);Brelox
(Philippines);Capabiotic(Indonesia);Castal(HongKong);CEC(SouthAfrica);CEC500(Germany);Ceclex(Korea);
Ceclobid(Philippines);Ceclor(Australia,Austria,Belgium,Brazil,Bulgaria,Canada,China,CostaRica,CzechRepublic,
DominicanRepublic,Ecuador,ElSalvador,Greece,Guatemala,Honduras,HongKong,Hungary,Indonesia,Israel,
Bacterialinfection—375-500mgXRPObidwithin1hofeating,
or250-500mgtid
NOTE:renaldosing.
—hypersensitivitytodrugorclass
—penicillinallergy,renaldysfunction,antibiotic-
associatedcolitis,seizuredisorder,concomitantuseof
nephrotoxicdrugs
MaternalConsiderations
.....
Becauseofitsantimicrobialspectrum,
isusedtotreat
acutebronchitis,pharyngitis,andskininfections.Ithaspoor
activityagainsttheanaerobesassociatedwithbacterialvaginosis.
Therearenoadequatereportsorwell-controlledstudiesin
pregnantwomen.However,cephalosporinsareusuallyconsidered
safeduringpregnancy.
Sideeffects
includeanaphylaxis,seizures,pseudomembranous
colitis,nephrotoxicity,leukopenia,thrombocytopenia,erythema
multiforme,exfoliativedermatitis,andcholestaticjaundice.
Bacterialinfection—500-1000mgPOqd
NOTE:renaldosing.
—hypersensitivitytodrugorclass
—penicillinallergy,renaldysfunction,antibiotic-
associatedcolitis,seizuredisorder,concomitantuseof
nephrotoxicdrugs
MaternalConsiderations
.....
Becauseofitsantimicrobialspectrum,
isusedtotreat
UTIsandpharyngitis.Therearenoadequatereportsorwell-
controlledstudiesinpregnantwomen.However,cephalosporins
areusuallyconsideredsafeduringpregnancy.
Sideeffects
includeanaphylaxis,seizures,pseudomembranous
colitis,nephrotoxicity,leukopenia,thrombocytopenia,erythema
multiforme,exfoliativedermatitis,cholestaticjaundice,diarrhea,
nausea,dyspepsia,urticaria,pruritus,andvaginalcandidiasis.
Bacterialinfection—500mg-1.0gIVq4-8h
Cesareansectionprophylaxis—1gIVatumbilicalcordclamping
—hypersensitivitytodrugorclass
—penicillinallergy,renaldysfunction,antibiotic-
associatedcolitis,seizuredisorder,concomitantuseof
nephrotoxicdrugs
MaternalConsiderations
.....
Becauseofitsantimicrobialspectrum,
isusedto
treatlowerrespiratorytractinfections,UTIs,peritonitis,and
septicemiaandforpost–cesareansectionprophylaxis.Forthe
latter,ithasnoadvantageoveranyothercephalosporin.Though
usedbysomeforthetreatmentofgroupBstreptococcus
colonization,thereisgrowingresistance.Cephalosporinsare
usuallyconsideredsafeduringpregnancy.
Sideeffects
includeanaphylaxis,seizures,pseudomembranous
colitis,nephrotoxicity,leukopenia,thrombocytopenia,erythema
multiforme,exfoliativedermatitis,andcholestaticjaundice.
Acuteinfection—25-100mg/kg/dIV/IMq8h
Cesareansectionprophylaxis—1gIVatumbilicalcordclamping
Bacterialendocarditis—1gIV/IM30minbeforeprocedure
NOTE:renaldosing.
—hypersensitivitytodrugorclass
—penicillinallergy,renaldysfunction,antibiotic-
associatedcolitis,seizuredisorder,concomitantuseof
nephrotoxicdrugs
MaternalConsiderations
.....
Becauseofitsantimicrobialspectrum,
isusedtotreat
lowerrespiratorytractinfections,GUtractinfections,skin
infections,peritonitis,septicemia,andendocarditis;forpost-
cesareansectionprophylaxis;andintrapartumforgroupB
issuperiorto
forgroupBstreptococcusprophylaxisinpatients
withanon-anaphylacticpenicillinallergy.Theprophylactic
administrationof
preoperatively,intraoperatively,or
postoperativelyreducestheincidenceofpost–cesareansection
infection.Thetimingofadministrationdoesnotsignificantly
alterefficacy.Forthisindication,ithasnoclinicaladvantageover
anyothercephalosporin,andcostisoftenthedecidingfactor.
Prophylaxisisusuallydiscontinuedwithin24hofthesurgical
procedure.Cephalosporinsareusuallyconsideredsafeduring
Sideeffects
includeseizures,pseudomembranouscolitis,
nephrotoxicity,leukopenia,thrombocytopenia,erythema
multiforme,andStevens-Johnsonsyndrome.
InternationalBrandName—
Cefzon(Japan);Omnicef(Austria,Korea,Thailand);Sefdin(India)
DrugClass
..........................
Antibiotics;Cephalosporins,1st-generation
.........................
Bacterialinfections(gram-positiveaerobes:
S.aureus,
S.epidermidis,S.pneumoniae;
gram-negativeaerobes:
E.coli,
Klebsiella,Enterobacter,P.mirabilis
.........................
Bactericidal—inhibitscellwallsynthesis
DosagewithQualifiers
.......
Acuteinfection—600mgPOqd
10d,or300mgPObid
—hypersensitivitytodrugorclass
—penicillinallergy,renaldysfunction,antibiotic-
associatedcolitis,seizuredisorder,concomitantuseof
nephrotoxicdrugs
MaternalConsiderations
.....
Therearenoadequatereportsorwell-controlledstudiesof
inpregnantwomen.Itappearseffectiveandsafeduring
pregnancyforthetreatmentofacuteinfections,buthasno
uniqueadvantageoverothercephalosporinsformostindications.
Costisoftenakeydecisionfactor.
Sideeffects
includediarrhea,vaginalmoniliasis,vaginitis,rash,
N/V,headache,abdominalpain,dyspepsia,flatulence,anorexia,
constipation,abnormalstools,asthenia,dizziness,insomnia,
leukorrhea,pruritus,andsomnolence.
InternationalBrandName—
Meiact(Indonesia)
DrugClass
..........................
Antibiotics;Cephalosporins,1st-generation
.........................
Bacterialinfections,hospital-acquiredpneumonia
.........................
Bactericidal—inhibitscellwallsynthesis
DosagewithQualifiers
.......
Acuteinfection—200-400mgPOwithfoodbid
Hospital-acquiredpneumonia—400mgPOwithfoodbid
NOTE:renaldosing.
—hypersensitivitytodrugorclass,
hypersensitivitytomilkproteins,carnitinedeficiency
—penicillinallergy,renaldysfunction,antibiotic-
associatedcolitis,concomitantuseofnephrotoxicdrugs,
MaternalConsiderations
.....
Thereisnopublishedexperiencewith
pregnancy.Cephalosporinsaregenerallyconsideredsafeduring
Sideeffects
includeseizures,N/V,diarrhea,pseudomembranous
colitis,abdominalpain,dyspepsia,flatulence,anorexia,
constipation,abnormalstools,Stevens-Johnsonsyndrome,vaginal
moniliasis,vaginitis,headache,asthenia,dizziness,insomnia,rash,
leukorrhea,pruritus,andsomnolence.
InternationalBrandName—
Axepim(France);Cefepim(Austria);Cefepitax(Brazil);Ceficad(India);Cepimax
Bacterialinfection—1-2gIV/IMq12h
UncomplicatedUTI—0.5-1gIV/IMq12h
NOTE:renaldosing.
—hypersensitivitytodrugorclass
—penicillinallergy,renaldysfunction,antibiotic-
associatedcolitis,seizuredisorder,concomitantuseof
nephrotoxicdrugs
MaternalConsiderations
.....
isusedtotreatlowerrespiratorytractinfections,GU
tractinfections,skininfections,andneutropenicpatientsbecause
ofitsantimicrobialspectrum.Limitedstudysuggestsitiseffective
...........................
PregnancyCategory:B
LactationCategory:S
Third-and4th-generationcephalosporinsaregenerallynot
recommendedforsurgicalprophylaxis.
Therearealternativeagentsforwhichthereismoreexperience
duringpregnancyandlactation.
—(NOTE:Thisdrughasbeenwithdrawnfromthe
Bacterialinfection—400mgPOqd
Gonorrhea(uncomplicated)—400mgPO
NOTE:renaldosing.
—hypersensitivitytodrugorclass
—penicillinallergy,renaldysfunction,antibiotic-
associatedcolitis,seizuredisorder,concomitantuseof
nephrotoxicdrugs
MaternalConsiderations
.....
isusedtotreatlowerrespiratorytractinfections,otitis
media,pharyngitis,acutebronchitis,acuteexacerbationof
chronicbronchitis,gonorrhea,GUtractinfections,skin
infections,andneutropenicpatientsbecauseofitsantimicrobial
isaneffectiveandsafeoralmedication
Bacterialinfection—2gmIVq6-12hfor5-14d
Perioperativeprophylaxis—1-2gIV30-90minpriortoprocedure;
mayberepeatedin8-16h
—hypersensitivitytodrugorclass
—penicillinallergy,renaldysfunction,antibiotic-
associatedcolitis,seizuredisorder,concomitantuseof
nephrotoxicdrugs
MaternalConsiderations
.....
Therearenoadequatereportsorwell-controlledstudiesinpregnant
women.
Cefmetazole
ishighlyeffectiveagainstmostcausesof
bacterialvaginosisduringpregnancy.
fever,epigastricpain,vaginitis,pleuraleffusion,dyspnea,and
Bacterialinfection—10-25mg/kg(or1g)IVq24h
Cesareansectionprophylaxis—1gIV30minpriortoprocedure
—hypersensitivitytodrugorclass
—penicillinallergy,renaldysfunction,antibiotic-
associatedcolitis,seizuredisorder,concomitantuseof
nephrotoxicdrugs
MaternalConsiderations
.....
Becauseofitsantimicrobialspectrum,
isusedtotreat
lowerrespiratorytractinfections,GUtractinfections,skin
infections,andsepticemiaandforsurgicalprophylaxis.Itappears
effectiveandsafeduringpregnancyforthetreatmentofacute
infectionsandpost–cesareansectionprophylaxis,buthasno
uniqueadvantageoverothercephalosporinsformostindications.
Costisoftenakeydecisionfactor.Cephalosporinsareusually
consideredsafeduringpregnancy.
Sideeffects
includeanaphylaxis,seizures,neutropenia,
pseudomembranouscolitis,thrombocytopenia,erythema
multiforme,exfoliativedermatitis,cholestaticjaundice,and
positiveCoombs’test.
.........................
Bactericidal—inhibitscellwallsynthesis
DosagewithQualifiers
.......
Bacterialinfection—1-2gIV/IMq12h
Cesareansectionprophylaxis—1-2gIV
NOTE:maybecombinedwithSulbactam.
—hypersensitivitytodrugorclass
—penicillinallergy,renaldysfunction,antibiotic-
associatedcolitis,seizuredisorder,concomitantuseof
nephrotoxicdrugs,alteredhepaticfunction
MaternalConsiderations
.....
Becauseofitsantimicrobialspectrum,
isusedto
treatlowerrespiratorytractinfections,GUtractinfections,skin
infections,andsepticemiaandforsurgicalprophylaxis.
appearseffectiveandsafeduringpregnancyforthe
treatmentofacuteinfections.Clearanceisonlymodestlyaffected
bypregnancy.Third-and4th-generationcephalosporins(e.g.,
cefotaxime,cefoperazone,ceftriaxone,ceftazidime,ceftizoxime
aregenerallynotrecommendedforsurgicalprophylaxis.Despite
theserecommendations,theyhavebeenacceptedbythemedical
communityforprophylaxisandaretodaycommonlymisused.
Sideeffects
includeanaphylaxis,serumsickness,
pseudomembranouscolitis,neutropenia,rash,urticaria,
thrombocytopenia,andnausea.
DrugClass
..........................
Antibiotics;Cephalosporins,2nd-generation
.........................
Bacterialinfection,surgicalprophylaxis
.........................
Bactericidal—inhibitscellwallsynthesis
DosagewithQualifiers
.......
Bacterialinfection—500mg-1gIVbid
Surgicalprophylaxis—500mg-1gIV
—hypersensitivitytodrugorclass
—penicillinallergy,renaldysfunction,antibiotic-
associatedcolitis,seizuredisorder,concomitantuseof
nephrotoxicdrugs
MaternalConsiderations
.....
Therearenoadequatereportsorwell-controlledstudiesof
inpregnantwomen.Itappearstohavenounique
advantageoverothercephalosporinsformostindications.
Cephalosporinsareusuallyconsideredsafeduringpregnancy.
Sideeffects
includeanaphylaxis,serumsickness,
pseudomembranouscolitis,diarrhea,N/V,constipation,headache,
andfever.
Bacterialinfection—1-2gIM/IVq8h
Gonorrhea—1gIM
Surgicalprophylaxis—1gIV/IM30-90minpreoperatively
NOTE:renaldosing.
—hypersensitivitytodrugorclass
—penicillinallergy,renaldysfunction,antibiotic-
associatedcolitis,seizuredisorder,concomitantuseof
nephrotoxicdrugs
MaternalConsiderations
.....
isusedtotreatlowerrespiratorytractinfections,GU
tractinfections,skininfections,andsepticemiaandforsurgical
prophylaxisbecauseofitsantimicrobialspectrum.
appearseffectiveandsafeduringpregnancyforthetreatmentof
acuteinfections.HighAFconcentrationssuggestitmaybe
advantageousforthetreatmentofchorioamnionitis.Third-and
4th-generationcephalosporins(e.g.,
cefotaxime,cefoperazone,
ceftriaxone,ceftazidime,ceftizoxime
)aregenerallynot
recommendedforsurgicalprophylaxis.Despitethese
recommendations,theyhavebeenacceptedbythemedical
communityforprophylaxisandaretodaycommonlymisused.
Sideeffects
includeanaphylaxis,serumsickness,
pseudomembranouscolitis,diarrhea,N/V,constipation,headache,
fever,neutropenia,thrombocytopenia,rash,andurticaria.
DrugInteractions
................
Nephrotoxicityhasbeenreportedfollowingco-administrationof
othercephalosporinsandaminoglycosides.
Bacterialinfection—1-3gIM/IVq12h
Preoperativeprophylaxis—1-2gIV30-60minpriortosurgery
Cesareansectionsurgicalprophylaxis—1-2gIVafterumbilical
cordclamping
NOTE:renaldosing.
—hypersensitivitytodrugorclass
—penicillinallergy,renaldysfunction,antibiotic-
associatedcolitis,seizuredisorder,concomitantuseof
nephrotoxicdrugs
MaternalConsiderations
.....
Becauseofitsantimicrobialspectrum,
describematernalhemolysisassociatedwith
.........................
Bactericidal—inhibitscellwallsynthesis
DosagewithQualifiers
.......
Bacterialinfection—1-2gIVq6-8h;alternativelyforsevere
infection,2gq4hor3gq6h
Perioperativeprophylaxis—2gIV,30-60minpreoperatively
NOTE:renaldosing.
—hypersensitivitytodrugorclass
—penicillinallergy,renaldysfunction,antibiotic-
associatedcolitis,seizuredisorder,concomitantuseof
nephrotoxicdrugs
MaternalConsiderations
.....
isusedtotreatlowerrespiratorytractinfections,GU
tractinfections,skininfections,andsepticemiaandforsurgical
prophylaxisbecauseofitsantimicrobialspectrum.Itisa
preferredagentforthetreatmentofPIDwhereinpatientand
outpatienttherapy(combinedwith
)yieldsimilar
appearseffectiveandsafeduringpregnancyfor
thetreatmentofacuteinfection,thoughtherearemorecost-
effectiveregimensforpost–cesareansectionprophylaxis.Itisnot
beneficialforelectivecesareandelivery.
Sideeffects
includeanaphylaxis,agranulocytosis,serumsickness,
pseudomembranouscolitis,neutropenia,thrombocytopenia,acute
renalfailure,andhemolyticanemia.
—(Banan;Cepodem;Vantin)
InternationalBrandName—
Banan(China,HongKong,Indonesia,Japan,Korea,Philippines,Taiwan,
Thailand);BananDrySyrup(Korea);Biocef(Austria);Cefodox(Israel,Italy);Cepodem(India);Orelox(CostaRica,
CzechRepublic,Denmark,DominicanRepublic,ElSalvador,England,France,Germany,Guatemala,Honduras,
Bacterialinfection—100-400mgPObid,max800mgqd
Surgicalprophylaxis—100mgPObid
—hypersensitivitytodrugorclass
—penicillinallergy,renaldysfunction,antibiotic-
associatedcolitis,seizuredisorder,concomitantuseof
nephrotoxicdrugs
MaternalConsiderations
.....
Thereislittlepublishedexperiencewith
pregnancy.Third-and4th-generationcephalosporinsare
generallynotrecommendedforsurgicalprophylaxis.Despite
theserecommendations,theyhavebeenacceptedbythemedical
communityforprophylaxisandarecommonlymisused.
Cephalosporinsareusuallyconsideredsafeduringpregnancy.
Sideeffects
includeanaphylaxis,seizure,diarrhea,
pseudomembranouscolitis,leukopenia,anemia,thrombocytopenia,
Stevens-Johnsonsyndrome,nausea,dyspepsia,rash,andpruritus.
Bacterialinfection—250-500mgPOqdorbid
NOTE:renaldosing.
—hypersensitivitytodrugorclass
—penicillinallergy,renaldysfunction,antibiotic-
associatedcolitis,seizuredisorder,concomitantuseof
nephrotoxicdrugs
MaternalConsiderations
.....
Thereisnopublishedexperiencewith
pregnancy.Cephalosporinsareusuallyconsideredsafeduring
Sideeffects
includeanaphylaxis,seizures,pseudomembranous
colitis,nephrotoxicity,leukopenia,thrombocytopenia,and
erythemamultiforme.
DrugInteractions
................
Nephrotoxicityhasbeenreportedfollowingadministrationof
aminoglycosideantibioticsandcephalosporinantibiotics.
doublestheAUCfor
.........................
Bacterialinfection—1gIV/IMq8-12h(2gIV/IMq8hfor
NOTE:renaldosing.
—hypersensitivitytodrugorclass
—penicillinallergy,impairedrenalfunction,antibiotic-
associatedcolitis,seizuredisorder,concomitantuseof
nephrotoxicdrugs
MaternalConsiderations
.....
therapeuticlevels.Third-and4th-generationcephalosporinsare
notgenerallyrecommendedforsurgicalprophylaxis.Despite
theserecommendations,theyhavebeenacceptedbythemedical
communityforprophylaxisandaretodaycommonlymisused.
Sideeffects
includeseizures,agranulocytosis,thrombocytopenia,
andanaphylaxis.
.........................
Bacterialinfections(gram-positiveaerobes:
S.aureus,
S.epidermidis,S.pneumoniae,S.pyogenes,Enterococcus;
gram-negativeaerobes:
E.coli,Klebsiella,Enterobacter,Citrobacter,
P.mirabilis,Pseudomonasaeruginosa,N.gonorrhoeae;
positiveanaerobes:
C.perfringens,Peptostreptococcus,Peptococcus,
Propionibacteriumacnes
.........................
Bactericidal—inhibitscellwallsynthesis
DosagewithQualifiers
.......
Bacterialinfection—400mgPOqd1-2hpc
NOTE:renaldosing.
—hypersensitivitytodrugorclass
—penicillinallergy,renaldysfunction,antibiotic-
associatedcolitis,seizuredisorder,concomitantuseof
nephrotoxicdrugs
MaternalConsiderations
.....
iseffectivetreatmentforacuteUTIduringpregnancy.
Thereislittleexperienceduringpregnancywithotherindications.
Third-and4th-generationcephalosporinsarenotgenerally
recommendedforsurgicalprophylaxis.Despitethese
recommendations,theyhavebeenacceptedbythemedical
communityforprophylaxisandaretodaycommonlymisused.
Cephalosporinsareusuallyconsideredsafeduringpregnancy.
Sideeffects
includeseizures,agranulocytosis,thrombocytopenia,
andanaphylaxis.
InternationalBrandName—
Acantex(Argentina,Chile);Cefigrand(Argentina);Cefizox(Austria,Canada,
CzechRepublic,England,India,Indonesia,Ireland,Portugal,Spain);Ceftix(Germany);Ceftizon(Argentina);
Epocelin(Finland,Hungary,Japan,Poland,Spain,Taiwan);Eposerin(Italy);Tefizox(Israel);Tergecin(Philippines);
Ultracef(Mexico)
DrugClass
..........................
Antibiotics;Cephalosporins,3rd-generation
.........................
Bacterialinfections(gram-positiveaerobes:
S.aureus,
S.epidermidis,S.pneumoniae,S.pyogenes,Enterococcus;
negativeaerobes:
E.coli,Klebsiella,Enterobacter,Citrobacter,
P.mirabilis,Pseudomonasaeruginosa,N.gonorrhoeae;
positiveanaerobes:
C.perfringens,Peptostreptococcus,Peptococcus,
Propionibacteriumacnes
.........................
Bactericidal—inhibitscellwallsynthesis
DosagewithQualifiers
.......
Bacterialinfection—1-2gIV/IMq8-12h;alternativelyforsevere
infection,3-4gIV/IMq8h
Gonorrhea—1gIM
NOTE:renaldosing.
—hypersensitivitytodrugorclass
Caution
—penicillinallergy,renaldysfunction,antibiotic-associated
colitis,seizuredisorder,concomitantuseofnephrotoxicdrugs
MaternalConsiderations
.....
appearseffectiveandsafeforthetreatmentofacute
infectionsduringpregnancy.Ithasnoeffectontheintervalto
delivery,orthedurationofpregnancyinwomentreatedfor
Gonorrhea—250mgIM
1(seeCDCSTDguidelines)
Bacterialinfection—1-2gIVqd
Preoperativeprophylaxis—1gIV
—hypersensitivitytodrugorclass
—penicillinallergy,renaldysfunction,antibiotic-
associatedcolitis,seizuredisorder,concomitantuseof
nephrotoxicdrugs
MaternalConsiderations
.....
appearseffectiveandsafeduringpregnancyforthe
treatmentofacuteinfections.
(singledosegivenIM)
isadrugofchoiceforthetreatmentofgonorrheainpregnancy.
Asingledoseisaseffectiveforpost–cesareanprophylaxisas
3dosesof
However,3rd-and
4th-generationcephalosporinsarenotgenerallyrecommendedfor
surgicalprophylaxis.Despitetheserecommendations,theyhave
beenacceptedbythemedicalcommunityforprophylaxisandare
todaycommonlymisused.Cephalosporinsareusuallyconsidered
safeduringpregnancy.
Sideeffects
includethrombocytopenia,anaphylaxis,diarrhea,
pseudomembranouscolitis,eosinophilia,andvomiting.
—(Ceftin;Kefurox;Zinacef)
InternationalBrandName—
Bacterialinfection—0.75-1.5gIM/IVq6-8h;max3.0gq8hfor
bacterialmeningitis
Surgicalprophylaxis—1.5gIV
NOTE:renaldosing.
—hypersensitivitytodrugorclass
—penicillinallergy,renaldysfunction,antibiotic-
associatedcolitis,seizuredisorder,concomitantuseof
nephrotoxicdrugs
MaternalConsiderations
.....
Therearenoadequatereportsorwell-controlledstudiesof
inpregnantwomen.Itappearstobesafeand
effectiveduringpregnancyforthetreatmentofacuteinfections,
especiallypyelonephritis.Oneinvestigatorsuggesteditwasafirst-
choiceoptionforthetreatmentofacutepyelonephritisduring
pregnancyduetoitstolerance,microbiologicactivity,and
superiorclinicaleffectcomparedto
areusuallyconsideredsafeduringpregnancy.
Sideeffects
includethrombocytopenia,anaphylaxis,
pseudomembranouscolitis,eosinophilia,diarrhea,vomiting,
interstitialnephritis,neutropenia,andelevatedhepaticenzymes.
Osteoarthritis—200mgPOqd
Rheumatoidarthritis—100-200mgPObid
Familialadenomatouspolyposis—200mgPObid;beginwith
100mgPOqd
Pain,acute—200mgPObid
—hypersensitivitytodrugorclass,
nonsteroidaldrug–inducedasthma,nonsteroidaldrug–induced
urticaria,aspirintriad,hepaticandrenalfailure
Caution
—nasalpolyps,GIbleeding,renalorhepaticdysfunction,
CHF,hypertension,dehydration,fluidretention,asthma
MaternalConsiderations
.....
istheprototypeCOX-2inhibitor.Thereareno
adequatereportsorwell-controlledstudiesinpregnantwomen.
Invitro
studiesrevealinhibitionofuterinecontractionsbyCOX-
2inhibition.Intwosmalltrials,
wasemployedasa
tocolyticagentwithmodesteffect.
(80and160mg/kg/
d)significantlyreducesfertility,prolongspregnancy,andinhibits
normalcervicalripeninginrats.Theauthorsconcludeditwas
similarto
Bacterialinfection—250mg-1gPOq6h
—hypersensitivitytodrugorclass
—penicillinallergy,renaldysfunction,antibiotic-
associatedcolitis
MaternalConsiderations
.....
—(Note:Thisdrughasbeenwithdrawnfrom
Bacterialinfection—500mg-2gmIM/IVq4-6h
Surgicalprophylaxis—1-2gIV30-60minpreoperatively
—hypersensitivitytodrugorclass
—penicillinallergy,renaldysfunction,antibiotic-
associatedcolitis,seizuredisorder,concomitantuseof
nephrotoxicdrugs
MaternalConsiderations
.....
Theeliminationt/2ofthis1st-generationcephalosporinis
reducedby
duringpregnancy.PrimarytreatmentofUTIswith
a1st-generationcephalosporinduringpregnancymaynolonger
beappropriateinsomegeographiclocalesasasignificantnumber
ofisolates(11%)areresistantto
Bacterialinfection—1-2gIV/IMq4-6h;max12gqd
—hypersensitivitytodrugorclass
—penicillinallergy,renaldysfunction,antibiotic-
associatedcolitis,seizuredisorder,concomitantuseof
nephrotoxicdrugs
MaternalConsiderations
.....
appearseffectiveandsafeforthetreatmentofacute
infectionduringpregnancy.
Sideeffects
includeanemia,thrombocytopenia,anaphylaxis,
pseudomembranouscolitis,diarrhea,nausea,andelevatedhepatic
Bacterialinfection—250-500mgPOq6h
UTI—upto1gPOq6h
—hypersensitivitytodrugorclass
—penicillinallergy,renaldysfunction,antibiotic-
associatedcolitis,seizuredisorder,concomitantuseof
nephrotoxicdrugs
MaternalConsiderations
.....
hasbeenusedforthetreatmentofUTIand
pharyngitisbecauseofitsantimicrobialspectrum.However,its
eliminationt/2isdecreasedby25%duringpregnancy,which
mightinpartexplainwhy
provedsuperiorinone
randomizedtrialforthetreatmentofUTI.
Sideeffects
includeanemia,thrombocytopenia,anaphylaxis,
pseudomembranouscolitis,diarrhea,nausea,andelevatedhepatic
Allergicrhinitis—5-10mgPOqd;max10mgqd
Urticaria—5-10mgPOqd;max10mgqd
NOTE:maybecombinedwith
—hypersensitivitytodrugorclass
—hepaticorrenaldysfunction,CNSdepressantuse
MaternalConsiderations
.....
Therearenoadequatereportsorwell-controlledstudiesof
—(Chebil;Chelobil;Chendal;Chenix;Chenocol;
Chenodex;Chino;Soluston)
InternationalBrandName—
Aylehning(Taiwan);Chebil(Portugal);Chendol(England,Malaysia,Portugal);
Cheno(Taiwan);Chenodex(France);Chenofalk(Austria,Belgium,CzechRepublic,England,Germany,HongKong,
Gallstones—250mgPObid
2w,increaseby250mg/wuntilthe
maxtoleratedorrecommendeddoseisreached(13-16mg/kg/d)
in2divideddoses
Contraindications
—hypersensitivitytodrugorclass,acute
cholecystitis,cholangitis,gallstonepancreatitis,intrahepatic
cholestasis,andprimarybiliarycirrhosisorsclerosingcholangitis
MaternalConsiderations
.....
Becauseofpotentialhepatotoxicity,poorresponseratesinsome
subgroupsof
-treatedpatients,andanincreased
cholecystectomyrateinothertreatedsubgroups,
isnot
appropriatetreatmentformanypatientswithgallstones.There
arenoadequatereportsorwell-controlledstudiesof
pregnantwomen.Maternalpregnancyoutcomemaybeimproved
inpregnanciescomplicatedbyintrahepaticcholestasisby
treatmentwithursodeoxicholicacid.
Sideeffects
includediarrhea,dyspepsia,N/V,constipation,and
isgenerallyconsideredcontraindicatedinwomen
whoareormaybecomepregnant.
shouldbeusedduringpregnancyandlactationonly
ifthebenefitjustifiesthepotentialperinatalrisk.
ChloralHydrate
—(Aquachloral;Chloralhydrat;Chloralix;
Dormel;Kloral;Noctec)
InternationalBrandName—
Alcoholwithdrawal—500mg-1gPOq6h
NOTE:alsoavailableinsuppositoryform.
—hypersensitivitytodrugorclass,cardiac
disease,hepaticfailure
—depression,drugabuse,porphyria
MaternalConsiderations
.....
Chloralhydrate
isananxiolytichypnotic.Therearenoadequate
reportsorwell-controlledstudiesinpregnantwomen.Thereisa
casereportofsuccessfulhemodialysisduringpregnancyforthe
treatmentofa
chloralhydrate
Sideeffects
includehypersensitivity,leukopenia,dependence,
respiratorydepression,hyperbilirubinemia,andangioedema.
...........................
PregnancyCategory:C
LactationCategory:NS
Chloralhydrate
shouldbeusedduringpregnancyand
lactationonlyifthebenefitjustifiesthepotentialperinatalrisk.
—(Leukeran;Linfolysin)
InternationalBrandName—
Chloraminophene(France);Leuceran(Bulgaria);Leukeran(Argentina,Brazil,
Canada,Chile,Ecuador,Mexico,Peru,Uruguay)
DrugClass
..........................
Antineoplastics,alkylatingagents
.........................
Cancer—variesbasedonthetypeofneoplasm.Mostregimens
recommend0.1-0.2mg/kg/d
—hypersensitivitytodrugorclass,resistance
todrug
—neutropenia,thrombocytopenia,seizures,fever,
hepatotoxicity,epilepsy
MaternalConsiderations
.....
isanalkylatingagentusedinchemotherapy
protocolsformanymalignantdiseases,includinggestational
trophoblasticdiseaseandovariancancer.Therearenoadequate
reportsorwell-controlledstudiesinpregnantwomen.Thereare
manycasereportsofasuccessfuloutcomeinwomentreatedwith
throughoutpregnancy.
Sideeffects
includebonemarrowsuppression,N/V,confusion,
PadmanabhanR,SamadPA.ReprodToxicol1999;13:189-201.
...........................
PregnancyCategory:D
LactationCategory:U
shouldbeusedduringpregnancyandlactation
onlyifthebenefitjustifiesthepotentialperinatalrisk.
.........................
Bacteriostatic—interfereswithproteinsynthesis
DosagewithQualifiers
.......
Bacterialinfections—50-100mg/kgIVqd;max100mg/kg/d
Ophthalmic—1-2gtts/eyeq4-6
72h,thenadjusttoresponse
isnotconsideredafirst-linetherapy.
—hypersensitivitytodrugorclass,
pregnancy,infancy,mildinfectiousprocess
—hepaticfailure,G6PDdeficiency,bonemarrow
MaternalConsiderations
.....
Therearenoadequatereportsorwell-controlledstudiesof
inpregnantwomen.Ithasbeenusedforthe
—(Benzodiapin;Chlordiazachel;
Chuichin;Kalbrium;Karmoplex;Libnum;Libritabs;Librium;
Medilium;Poxi;Reposans;Restocalm;Ripolin;Vapine;Zenecin)
InternationalBrandName—
Apo-Chlordiazepoxide(Canada);Balance(Japan);Benpine(Malaysia,Thailand);
Alcoholwithdrawal—50-100mgPO/IM/IV;max300mgqd
—hypersensitivitytodrugorclass
—alcohol,hepaticorrenalfailure
MaternalConsiderations
.....
Therearenoadequatereportsorwell-controlledstudiesof
duringpregnancy.Theavailableinformationis
breastmilkinlowconcentrationssuchthatonlyhighclinicaldoses
mightbeexpectedtoexertaneffectonthenursingnewborn.
DrugInteractions
................
Noclinicallyrelevantinteractionsidentified.
.........................
CzeizelAE,RockenbauerM,SorensenHT,OlsenJ.Neurotoxicol
Teratol2004;26:593-8.
GidalJ,AcsN,BanhidyF,CzeizelA.ToxicolIndHealth2008;
IqbalMM,SobhanT,RyalsT.PsychiatrServ2002;53:39-49.
KantoJH.Drugs1982;23:354-80.
McElhattonPR.ReprodToxicol1994;8:461-75.
...........................
PregnancyCategory:D
LactationCategory:S
shouldbeusedduringpregnancyand
lactationonlyifthebenefitjustifiesthepotentialperinatalrisk.
Benzodiazepinesshouldbeusedasmonotherapyatthelowest
effectivedosefortheshortestpossibleduration.
Highpeakconcentrationsareavoidedbydividingthedaily
dosageinto2or3doses.
—(Peridex;PerioGard;Plakicide;Savacol)
InternationalBrandName—
ABAntiseptico(Paraguay);Alcloxidine(Israel);Bactoscrub(Israel);Bactosept
Concentrate(Israel);Blend-A-Med(Germany);Bucoglobin(Uruguay);Chlorhex(Thailand);Chlorhexamed(Belgium,
Gingivitis,infectionprevention—15mlPO,swish/spitbid
—hypersensitivitytodrugorclass
MaternalConsiderations
.....
Whiletherearenoadequatereportsorwell-controlledstudiesin
pregnantwomen,
chlorhexidine
isconsideredsafeforcleansingof
thebirthcanal,andmaybeaseffectiveas
ampicillin
forthe
preventionofneonatalgroupBstreptococcus.Somestudiessuggest
itsuseduringlabormayalsodecreaseHIVtransmission.Itdoes
humanplacenta.Exposureto
duringbirthisnot
associatedwithanyincreaseinneonatalmortalityratedueto
sepsis,fever,poorfeeding,apnea,ordyspneainnewborns.
Malariaprophylaxis—500mgPOqw;begin2wbeforetraveland
continueuntil8wpostexposure(500mgphosphate=300mgbase)
Malariatreatment—begin1gPO
1,then500mgPO6-8hlater,
then500mgPOqd
Amebiasis—begin1gqd
2,then500mgPOqd
—hypersensitivitytodrugorclass,
andsuggestsitissafeduringthe1sttrimester.Noincreasein
spontaneousabortionormajorbirthdefectsisreportedinhumans.
...........................
PregnancyCategory:C
LactationCategory:S
shouldbeusedduringpregnancyandlactation
onlyifthebenefitjustifiesthepotentialperinatalrisk.
Edema—500-1000mgPOqdorbid
Hypertension—250-500mgPOqdorbid
NOTE:maybecombinedwith
Severevasomotorsymptoms—12-25mgPOqd;treatfor30d
Atrophicvaginitis—12-25mgPOqd;treatfor30d
—hypersensitivitytodrugorclass,
pregnancy,breastcarcinoma,hepaticcarcinoma,
thromboembolicdisorder,smokerover35yold
Theuseofestrogenanalogsforlactationsuppressionhasbeen
discontinuedduetopoorefficacyandtheriskofthrombosis.
DrugInteractions
................
Noclinicallysignificantinteractionsidentified.
.........................
Allergicrhinitis—4mgPOq4-6h
Anaphylaxis—5-20mgSC/IMq6-12hprn
NOTE:oftencombinedwith
hydrocodone,phenylephrine,
—hypersensitivitytodrugorclass
—GIobstruction,sedative
MaternalConsiderations
.....
Therearenoadequatereportsorwell-controlledstudiesof
chlorpheniramine
inpregnantwomen,anditssafetyduring
pregnancyisnotestablished.However,itiswidelyavailableinOTC
preparationsandhasnottodatebeenimplicatedinadverseeffects
duringpregnancy.Ingeneral,1st-generationantihistaminesare
preferredtolatergenerationsbecauseofthelongeruseexperience.
Sideeffects
includehypotension,drymouth,N/V,andconstipation.
DosagewithQualifiers
.......
Psychosis—200-800mgIMqd;dividedosetidorqid
Nausea—10-25mgPOq4-6h
Hiccups—25-50mgPOtidorqid;ifnoresponsePO,maybe
givenIM/IV
Porphyria(acute)—25-50mgIMtidorqid
—hypersensitivitytodrugorclass,sedation,
bonemarrowdepression,Parkinson’sdisease
—hepaticfailure,hypotension,glaucoma
MaternalConsiderations
.....
Therearenoadequatereportsorwell-controlledstudiesin
pregnantwomen.
seemssafeandeffectivewhen
usedfortheprecedingindicationsduringpregnancy.
Sideeffects
includeseizure,thrombocytopenia,agranulocytosis,
andneurolepticmalignantsyndrome.
...........................
PregnancyCategory:B
LactationCategory:NS
shouldbeusedduringpregnancyand
lactationonlyifthebenefitjustifiesthepotentialperinatalrisk.
immaturity,thoughtherearealternativeagentswithlessplacental
transfer.Rodentteratogenicitystudieshavenotbeenconducted.
Hypertension—25-100mgPOqd
Edema—begin30-60mgPOqd;max120mg/d
NOTE:mayalsobecombinedwith
—hypersensitivitytodrugorclass,anuria,
sensitivitytosulfonamides
—hepaticorrenaldysfunction,andbronchialasthma
MaternalConsiderations
.....
.........................
DepressesCNSactivity
DosagewithQualifiers
.......
Musclespasm—250-750mgPOtidorqid
NOTE:shouldbeprescribedinconjunctionwithothertreatment
modalities,suchasphysicaltherapy.
—hypersensitivitytodrugorclass,alcohol
—hepaticorrenalfailure
MaternalConsiderations
.....
Therearenoadequatereportsorwell-controlledstudiesin
pregnantwomen.
shouldnotbetakenifthereis
Cholerasusceptibility—0.5mlintradermalq1w
2doses,then
2doses;boosters0.3-0.5mlafter5y
—hypersensitivitytodrugorclass,anyacute
—avoidIVinjection
MaternalConsiderations
.....
Choleravaccine
isasterilesuspensionofkilled
V.cholerae.
arenoadequatereportsorwell-controlledstudiesof
inpregnantwomen.
Sideeffects
includeerythema,induration,pain,andtendernessat
thesiteofinjection;malaise,headache,andmildtomoderate
temperatureelevationsthatmaypersistfor1-2d.
Hypercholesterolemia—begin4gPO1-6
/d;maintenance4-8gin
2divideddoses
NOTE:itisrecommendedpatientstakeothermedicationsatleast
1hbeforeor4-6hafter
—hypersensitivitytodrugorclass,biliary
MaternalConsiderations
.....
isthechloridesaltofabasicanionexchange
resinthatisnotsystemicallyabsorbed,butcouldinterferewith
theuptakeoffat-solublevitamins.
isusedby
someforthetreatmentofcholestasisofpregnancy,butits
efficacyhaslongbeenquestioned.Theonlyrandomizedtrial
compareditto
ursodeoxycholicacid
.Theresultsdemonstrated
wasinferiorforthereliefofprutitusandwas
associatedwithworsepregnancyoutcomes.
Sideeffects
includesevereconstipation,flatulence,gastricpain,
anorexia,dyspepsia,headache,rash,fatigue,andweightloss.
.........................
Chelatespolyvalentcations(Fe
orAl
Yeastinfection—applycream(1%)orlotion(1%)ontothe
affectedandsurroundingskinbid
—hypersensitivitytodrugorclass
—hepaticorrenalfailure
MaternalConsiderations
.....
Therearenoadequatereportsorwell-controlledstudiesof
inpregnantwomen.Treatmentofmycoticcervical
inflammationduringpregnancyisfollowedbyasignificant
reductioninsymptomsandthenumberofactivecolonies.
Sideeffects
includeitchingatthesiteofapplication,worseningof
theconditionbeingtreated,andmildtosevereburning.
MaternalConsiderations
.....
Thepublishedexperiencewith
duringpregnancyis
limitedtoasinglecasereport.Itsusewasassociatedwithbreast
adenocarcinomainfemalerats.
Sideeffects
includeneutropenia,renalfailure,uveitis,N/V,
anorexia,andanemia.
Gastriculcer—300mgPO/IM/IVqid;max2.5g/d
GERD—400mgPOqacorqhsor800mgPObid
Zollinger-Ellisonsyndrome—300-600mgPO/IM/IVqid
NOTE:renaldosing.
—hypersensitivitytodrugorclass
MaternalConsiderations
.....
Therearenoadequatereportsorwell-controlledstudiesof
.........................
Bactericidal—inhibitsDNAsynthesis(activityofDNAgyraseand
DosagewithQualifiers
.......
UTI(prophylaxis)—250mgPOqhs
UTI(treatment)—250mgPOq6hor500mgPOq12h
NOTE:renaldosing.
—hypersensitivitytodrugorclass
—notknown
MaternalConsiderations
.....
Thereisnopublishedexperiencewith
Sideeffects
includeskinrash,urticaria,pruritus,edema,
angioedema,eosinophilia,itching,redness,swelling,dizziness,
headache,increasedsensitivityofskintosunlight,and
rodentstudiesdidnotrevealevidenceofteratogenicity,
wasassociatedwithbonedevelopmentabnormalitiesinyoung
—(Ciloxan;Cipro;Cyprobay)
InternationalBrandName—
Acire(Korea);AlconCilox(Colombia,Indonesia);Bacquinor(Indonesia);
UTI,uncomplicatedcystitis—250-750mgPObid
UTI,severe—200-400mgIVbid
Anthrax—400mgIVbid(or500mgPObid)
Gonorrhea—500mgPO
treatmentofanthrax.
hasalsobeenusedtotreat
Qfeverduringpregnancy.
Sideeffects
includeseizures,pseudomembranouscolitis,
psychosis,hypersensitivity,N/V,dizziness,rash,increased
CKlevels,arthropathy(animal),photosensitivity,pruritus,
agitation,confusion,tendonitis,arthralgia,andelevatedhepatic
.........................
AmericanAcademyofPediatrics,CommitteeonDrugs.Pediatrics
2001;108:776-89.
GERD—10-20mgPOqac15minbeforemealsandhs;max20mg
POqid
NOTE:checkserumelectrolytesandECGbeforeinitiating.
—hypersensitivity,arrhythmia,sinusnode
dysfunction,AVblock,CHF,ventriculararrhythmia,
—electrolyteimbalances,prolongsQTintervalonECG
MaternalConsiderations
.....
Therearenoadequatereportsorwell-controlledstudiesof
inpregnantwomen.Antacidsandantacid/alginicacid
combinationsorsucralfateconstitutefirst-linemedicaltherapy.
isreservedforpatientswithseveresymptoms.Rodent
studiessuggestdecreasedfertilityafterexposureto
Sideeffects
includeseverearrhythmias(torsadesdepointes),
pancytopenia,thrombocytopenia,anemia,hepaticfailure,
headache,N/V,fatigue,anddepression.
...........................
PregnancyCategory:C
LactationCategory:S
shouldbeusedduringpregnancyandlactationonly
ifthebenefitjustifiesthepotentialperinatalrisk.
Thereisconsiderablymoreexperiencewith
Surgicalparalysis—0.4-0.5mg/kgIV;maysupplementwith0.08-
0.10mg/kgq15-25min
—hypersensitivitytodrugorclass
—hepaticorrenaldysfunction,hypotension,CV
disease,electrolyteabnormalities
MaternalConsiderations
.....
isanintermediate-durationcurarederivative
producingeffectivesurgicalparalysis.Therearenoadequate
reportsorwell-controlledstudiesof
inpregnant
women.Theclearanceandclinicaldurationof
unalteredduringpregnancy.Incontrast,theclearanceof
isincreased27%duringcesareansection,andthe
ofactionof
Theaverageinfusionraterequirement
maybedecreasedbyasmuchas30-40%.
Otherdrugsthatmayenhancethenondepolarizing
neuromuscularblockadeincludecertainantibiotics(e.g.,
Cancer—Varieswiththetumor.Mostregimensrecommend
/cycleandrequire3-4cycles.
NOTE:prehydrationandmaintenanceofanadequateurinary
outputareabsoluterequirements.
—hypersensitivitytodrugorclass,
myelosuppression,pregnancy,lactation
—renalorhepaticfailure,neuropathy,hearing
impairment,myelosuppression
MaternalConsiderations
.....
Therearenoadequatereportsorwell-controlledstudiesin
pregnantwomen.Patientsshouldbeadvisedtoavoidpregnancy
duringtreatment.Thepublishedliteratureconsistsmostlyofcase
reportsandsmallseries.Goodoutcomesarepossible.
hasbeenusedduringpregnancyforwomendiscoveredtohave
Sideeffects
includenephrotoxity,ototoxicity,neuropathy,optic
neuritis,papilledema,seizures,anemia,hypokalemia,
hypoglycemia,blurredvision,paresthesia,ataxia,elevatedhepatic
enzymes,rash,urticaria,muscleweakness,andlossoftaste.
.........................
Serotoninreuptakeinhibition
DosagewithQualifiers
.......
Depression—20-60mgPOqd
—hypersensitivitytodrugorclass,MAOI
use,abruptwithdrawal
—seizuredisorder,mania,hepaticorrenaldysfunction,
suicidalideation
MaternalConsiderations
.....
Depressionisanimportantandoftenunrecognizedproblem
duringpregnancyandthepuerperium.Pregnancyisnotareason
...........................
PregnancyCategory:C
LactationCategory:S
shouldbeusedduringpregnancyandlactation
onlyifthebenefitjustifiesthepotentialperinatalrisk.
Therearealternativeagentsforwhichthereismoreexperience
duringpregnancyandlactation.
—(Biaxin;BiaxinXL;KlacidXL)
InternationalBrandName—
Abbotic(Indonesia);AbboticXL(Indonesia);Adel(Mexico);Aeroxina(Argentina);
Bactirel(Colombia);Biaxin(Canada);BiaxinHP(Germany);Biclar(Belgium);Bicrolid(Indonesia);Binoklar(Indonesia);
Carimycin(Taiwan);C-Clarin(Korea);Clacin(HongKong);Clacine(Indonesia);Clambiotic(Indonesia);Clapharma
(Indonesia);Clari(Korea);Claribid(India);Claridar(Israel);Clarimac(India);Claripen(Singapore);Clarith(Japan);
Claritrol(Colombia);Claroma(Korea);Clormicin(Colombia);Crixan(Singapore);Dicupal(Peru);Gervaken(Mexico);
Hecobac(Indonesia);Helitic(Indonesia);Klacid(Austria,China,Denmark,Germany,HongKong,Hungary,Ireland,
Bacterialinfection—250-500mgPObid
MACinfection—15mg/kgPOqd;dosedividedq12h
rats,rabbits,andmonkeys.However,therearereportsofa
modestincreaseinCVmalformationsandcleftpalateincertain
rodentstrains.
Highplacentaltransferduringthe1sttrimestermakesitan
attractiveagentforthetreatmentof
Clavulanatepotassium
—(Augmentin;Augmentin
ES-600;AugmentinXR)
InternationalBrandName—
Aclam(Indonesia);Ambilan(Peru);Amocla(Korea);AmoclaDuo(Korea);
Allergicrhinitis—1.34-2.68mgPObidortidprn
Urticaria—1.34-2.68mgPObidortidprn;max8.04mgqd
—hypersensitivitytodrugorclass,asthma,
hypersensitivity,acuteattacksofasthma,knownalcohol
MaternalConsiderations
.....
Therearenoadequatereportsorwell-controlledstudiesof
duringpregnancy.MAOIssuchas
prolongtheanticholinergic
effectsofantihistamines.(See
Sideeffects
includeseizures,anaphylaxis,sedation,drowsiness,
dizziness,agranulocytosis,drymouth,extremesleepiness,
confusion,weakness,ringingintheears,blurredvision,large
pupils,flushing,fever,shaking,insomnia,hallucinations,and
possiblyseizures.
Bacterialinfections—150-450mgPOqid
7-14d,max4.8g/d;
alternatively,300-900mgIVq6-12h
BV—1applicatorPVqhs
Acnevulgaris—apply1%geltopicallybid
NOTE:availableinoral,parenteral,topical,andvaginalgel
—hypersensitivitytodrugorclass,colitis
—hepaticorrenalfailure
MaternalConsiderations
.....
Becauseofitsantimicrobialspectrum,
isusedfor
thetreatmentofseriousinfectionscausedbyanaerobes,
InternationalBrandName—
Lepromatousleprosy—100mgPObidfor10d,then2
—hypersensitivitytodrugorclass
—abdominalpain,diarrhea,skindiscoloration,
depressionorsuicide,skindrynessandichthyosis;stainssoft
contactlenses
MaternalConsiderations
.....
—(Apoterin;Atromid-S;Cartagyl;Clofibral;
Clofibrato;Clofipront;Coles)
InternationalBrandName—
Amadol(Japan);ApoterinA(Japan);Arterioflexin(Austria);Arterol(Indonesia);
Artes(Finland);Atromidin(Belgium,Denmark,Sweden);Atromid-S(Finland,Greece,Portugal);Atromid-S500
Hypercholesterolemia—2gPOqd,individeddoses
NOTE:successisdefinedastriglyceridelevelreduced20-70%,HDL
increasedby10-25%,orLDLdecreased.
NOTE:maybecombinedwithastatin-typeagent.
—severerenalorhepaticdysfunction,
gallbladderdisease,primarybiliarycirrhosis
—significanthepaticorrenaldysfunction,
rhabdomyolysis,severehyperkalemia(withpreexistingrenal
MaternalConsiderations
.....
Therearenoadequatereportsorwell-controlledstudiesof
inpregnantwomen.
typicallyreducesserum
cholesterolamodestamountandserumtriglyceridessomewhat
more.Substantialreductionsincholesterolandtriglyceridescan
occurintypeIIIhyperlipidemia.Nostudyhasshowna
convincingreductioninfatalMI.Thereislittleinformation
ontheeffectof
Fulminantrhabdomyolysishasbeenseenasearlyas3wafter
initiationofcombinedtherapywithanotherfibrateand
butmaybeseenafterseveralmonths.Thepossible
benefitsofcombinedtherapywith
andafibrate
probablydonotoutweightherisksofseveremyopathy,
rhabdomyolysis,andacuterenalfailure.
.........................
Ovulationinduction—50mgPOqdfor5d(menstrualcycleday
5-10);max100mgPOqd
Contraindications
—hypersensitivitytodrugorclass,pregnancy,
abnormaluterinebleeding,adrenalglanddysfunction,thyroid
disease,pituitarytumor,endometrialcancer
—PCOS,hepaticfailure
MaternalConsiderations
.....
Therearenoindicationsfor
duringpregnancy.
Ovarianhyperstimulationmayoccurevenwhenusedasdirected.
Thereisanincreasedincidenceofmultiplepregnancies,including
bilateraltubalpregnancyandcoexistingtubalandintrauterine
Sideeffects
includethromboembolism,ovarianhyperstimulation
syndrome,multiplepregnancy,ovarianenlargement,N/V,hot
flashes,abdominaldistention,breasttenderness,blurredvision,
headache,andabnormaluterinebleeding.
Obsessive-compulsivedisorder—begin25mgPOqhs,then
increase75mgqhs;max250mgqhs
Depression—100-250mgPOqdin3divideddoses
—hypersensitivitytodrugorclass,MI,
glaucoma,pheochromocytoma,priorusageofMAOIs,suicidal
—hepaticorrenaldysfunction,seizuredisorder
MaternalConsiderations
.....
Therearenoadequatereportsorwell-controlledstudiesin
concentrationsofthesedrugs,potentiallyresultinginadverse
.........................
FengP,MaY,VogelGW.BrainResDevBrainRes2001;
Absenceseizures—0.5-5mgPOtid
Panicdisorder—0.5-1mgPObidortid
Periodiclegmovement—0.5-2mgPOtid
Neuralgia—2-4mgPOqd
NOTE:treatmentshouldnotbewithdrawnabruptly.
—hypersensitivitytodrugorclass
—hepaticfailure
MaternalConsiderations
.....
Therearenoadequatereportsorwell-controlledstudiesin
pregnantwomen.Incasereports,
wasunrelatedto
complicationsofpregnancy,labor,ordelivery.Several
investigatorshaveused
forseizureprophylaxisin
severepreeclampsia.
Sideeffects
includerespiratorydepression,neutropenia,hepatic
failure,ataxia,confusion,visualchanges,drowsiness,and
behavioralchanges.
ofexposedinfantsarenormalatbirthandhavenormalpostnatal
development.Mostseriesconcludenoincreaseinrisk,butallare
—(Catapres;Catapres-TTS;Duraclon)
InternationalBrandName—
Arkamin(India);Atensina(Brazil);Caprysin(Finland);Catapres(Bangladesh,
Canada,England,HongKong,Ireland,Korea,Malaysia,Pakistan,PuertoRico,SouthAfrica);Catapresan(Austria,
Hypertension—0.1-0.3mgPObid;max1.2mgPObid.Alsoused
-Blockersmayexacerbatethehypertensiveresponseseenwith
withdrawal.Cautionisalsowiseinpatientsreceiving
withagentsknowntoaffectsinusnodefunctionorAV
nodalconduction(e.g.,
calciumchannelblockers,and
mayprolongthedurationofpharmacologic
Alcoholwithdrawal—30mg
1,then30-60mg/dindivideddoses
—hypersensitivitytodrugorclass,substance
abuse,glaucoma,acuteangina,suicidalideation
MaternalConsiderations
.....
Therearenoadequatereportsorwell-controlledstudiesin
pregnantwomen.Allbenzodiazepinederivativesarelipophilic,
reachedwithin2h.Theabsorptiont/2approximates0.77hand
theeliminationt/2is1.3hinpregnantwomen.
Sideeffects
includehepaticfailure,drowsiness,headache,
hypotension,anddrymouth.
—(Canastene;Clomaz;Clomine;Fungicide;
Gyne-Lotrimin;Lotrimin;Mycelex;Mycelex-G)
InternationalBrandName—
Agisten(Israel);Apocanda(Germany);Aristen(HongKong);BabyAgisten(Israel);
Caginal(Thailand);Camazol(Korea);Canazol(Thailand);Candazole(Malaysia,Singapore);Candespor(SouthAfrica);
Candid(Malaysia,SouthAfrica);Candid-V3(Thailand);Candid-V6(Philippines);Candimon(Mexico);Candinox
(Thailand);Candizole(SouthAfrica);Canesten(Argentina,Bangladesh,Belgium,Brazil,Chile,CostaRica,Dominican
Republic,ElSalvador,France,Guatemala,Honduras,India,Israel,Japan,Nicaragua,Pakistan,Panama,Paraguay,
Peru,Poland,PuertoRico,Slovenia,Turkey,Uruguay,Venezuela);Canesten1(China,Korea);Canestene(Belgium);
Canifug(Germany);Catima(Korea);Chingazol(Thailand);Cinabel(Mexico);Clocreme(NewZealand);Cloderm
(Germany);Clogesten(Philippines);Clomacinvag(Peru);Clomaderm(SouthAfrica);Clomazen(Taiwan);Clomizol
(DominicanRepublic);Clonea(Australia);Clonitia(Indonesia);Clostrin(Japan);Clotrihexal(NewZealand);Clotrimaderm
(Canada,Israel,NewZealand);Cloxy(Philippines);Clozol(Peru);Clozole(HongKong);Cotren(Malaysia,Thailand);
Covospor(SouthAfrica);Dermasten(Mexico);Dermatin(Israel);Durafungol(Germany);Elcid(Japan);Empecid
(Argentina,Japan);Epicort(Colombia);Esporex(Peru);Factodin(Greece);Fungicip(Israel);Fungicon(Thailand);
Fungiderm(Indonesia);Fungistin(Philippines);Fungizid(NewZealand);Gino-Lotrimin(Colombia);GyneLotremin
(Indonesia,Malaysia);Gyne-Lotremin(Australia,HongKong);Gynesol(Philippines);GynoCanesten(Italy);Gyno-
Canestene(Belgium);Holfungin(Germany);Imazol(Germany);Jenamazol(Germany);Kanezin(Taiwan);Krema-Rosa
(Israel);Lotramina(Peru);Lotremin(Malaysia,Singapore);Medizol(Colombia);Micoter(Malaysia);Mycoban(South
Africa);Mycocid(India);Myco-Hermal(Israel,Singapore,Taiwan);Mycoril(Singapore,Taiwan);MycorilSpray(Hong
Kong);Mycozole(Thailand);Nalbix(Portugal);OraltenTroche(Israel);Pan-Fungex(Portugal);Panmicol(Argentina);
SastidAnti-Fungal(Singapore);Sinium(India);Taon(Japan);Taraten(Thailand);TinadermExtra(Australia);Tricloderm
(HongKong);Trimadan(Indonesia);Trimaze(SouthAfrica);Vanesten(Singapore,Thailand);Warimazol(HongKong);
XerasporV(SouthAfrica)
DrugClass
..........................
Antifungals,topical;Dermatologics
.........................
Tineapedis,cruris,versicolor,corporis;cutaneousand
vulvovaginalcandidiasis
.........................
Altersmembranepermeability
DosagewithQualifiers
.......
Yeastinfection—1%lotionbid2-4wforcutaneouscandidiasis
Vaginalcandidiasis—vaginalcreamshouldbeinsertedqhs
—hypersensitivitytodrugorclass
MaternalConsiderations
.....
Therearenoadequatereportsorwell-controlledstudiesin
pregnantwomen.Vaginalcandidiasis(moniliasisorthrush)isa
commonandfrequentlydistressinginfectionformanywomen.
Treatmentsfor7dmaybenecessaryduringpregnancyratherthan
theshortercoursesmorecommonlyusedfornonpregnant
women.Topical
appearstobemoreeffectivethan
fortreatingsymptomaticvaginalcandidiasisin
pregnancy.Onecase-controlstudyconcludedwomentreatedwith
duringpregnancyhadalowerprevalenceof
Rodentstudiesarereassuring,revealingnoevidenceof
teratogenicityorIUGRdespitetheuseofdoseshigherthanthose
usedclinically.
Bacterialinfection—250-500mgPOq6h;take1hbeforeorafter
losespotencywhenusedwith
Itshouldnotbeaddedtoblood
productsandIVlipids.
—hypersensitivitytodrugorclass
—hepaticorrenalfailure
MaternalConsiderations
.....
sodiumisabroad-spectrumantibioticeffective
againstpenicillinase-producing
andisusually
combinedwith
Therearenoadequatereportsorwell-
controlledstudiesinpregnantwomen.Beforeitswithdrawalin
theUS,
wasusedforthetreatmentofmastitis.There
isasignificantincreaseinthefreeplasmafractionof
duringpregnancy,beginninginthe2ndtrimesterandpeakingat
delivery.Asimilarlyincreasedfree-of-fraction
isfound
incordblood,whichincreasesfurtherduringthe1stpostnatal
ishighlyconcentratedinthekidneys.
Sideeffects
includeseizures,thrombocytopenia,agranulocytosis,
andrenalfailure.
Psychosis(schizophrenia)—begin12.5mgPOqdorbid,
increasingupto25-50mgin3-7d;titertosymptomsto
150-300mgPObid;max900mg/d
NOTE:checkCBCcountq2wforagranulocytosis.
—hypersensitivitytodrugorclass,
myocarditis,myeloproliferativedisorder,glaucoma,CNS
—renalorhepaticfailure,seizureandcardiacdisease,
bonemarrowsuppression
MaternalConsiderations
.....
Therearenoadequatereportsorwell-controlledstudiesin
pregnantwomen.
isarelativelynewmedicationfor
treatment-resistantschizophrenia.Thepublishedexperience
duringpregnancyislimitedtocasereports.Itiseffectivein
responsivepatientsexperiencingpositive(hallucinations,
delusions,bizarrebehavior,hostility)andnegative(withdrawal,
bluntedemotions,lackofmotivation,andinabilitytoexperience
pleasureorenjoyment)symptoms.Negativesymptomsseemto
riskofsignificantcognitivedeficits,andadoublingoftherateof
developmentaldelayduringthefirst2yoflife.
teratogenicoradverseeffectsonthedevelopingbrain.
exposedinfantsrequiremedicalattentionforCNSirritation,
cardiacanomalies,apnea,andfeedingdifficulties.Itisestimated
$500million(US)inadditionalhealthexpendituresresultfrom
thedirecthospitalcostsof
-exposedneonates.Ongoing
maternaldruguseisassociatedwithworsedevelopmental
outcomesamongagroupofdrug-exposedinfants.However,the
prevalentbeliefisthattheeffectsof
diminishwithage
andaremediatedlargelythroughpsychosocialfactors.
Painmanagement—15-60mgPO/IMqid
Antitussive—10-20mgPOq4-6h
NOTE:alsocombinedwith
MaternalConsiderations
.....
DosagewithQualifiers
.......
Gout(acute)—1-1.2mgPO
1,then0.5-0.6mgPOq1-2h;max
Gout(prophylaxis)—0.6mgPO1-4
FamilialMediterraneanfever(prophylaxis)—1-2mgPOin
divideddosesbidortid
—hypersensitivitytodrugorclass;CV
diseases;diarrhea,N/V,orstomachpain;blooddyscrasia
—hepaticorrenalfailure,impairedGIfunction
MaternalConsiderations
.....
Goutisextremelyrareinpregnancy.Therearenoadequate
reportsorwell-controlledstudiesinpregnantwomen.
isfoundinsomeherbssuchas
Ginkgobiloba.
Ithasbeenused
successfullytotreatfamilialMediterraneanfever.Amniocentesisis
typicallyrecommendedforwomenusing
-inducedmyopathyandneuropathy
appearmorecommonthanpreviouslyrecognized.Patients
receivinglong-termtherapyshouldbemonitoredcarefully.
Sideeffects
InternationalBrandName—
Noneidentified.
DrugClass
..........................
Antihyperlipidemics;Bileacidsequestrants
.........................
.........................
High-capacitybileacid–bindingmolecule
DosagewithQualifiers
.......
Hypercholesterolemia—4-6tabPOqd(1tab=625mg
NOTE:medicationshouldbetakenwithfood.
—hypersensitivitytodrugorclass
—constipation,triglycerideselevated(
dysphagia,majorGIsurgery
MaternalConsiderations
.....
Thereisnopublishedexperiencewith
pregnancy.Malabsorptionoffat-solublevitaminsmightoccur
duringuse.
Sideeffects
includenausea,bloating,belching,flatulence,and
weightloss.
.........................
Bindsbileacidsintheintestine,creatinganonabsorbable
DosagewithQualifiers
.......
Hypercholesterolemia—2-16gqd;beginat2gqdorbid,increase
in2gincrementsat1or2mointervals
Digitoxinoverdose—10gPO
1,then5gPOq6-8h
—hypersensitivitytodrugorclass
—constipation,vitaminabsorptioninterference
MaternalConsiderations
.....
Therearenoadequatereportsorwell-controlledstudiesin
pregnantwomen.
isanadjunctivetherapyforthe
reductionofelevatedserumtotalandLDL-Cinpatientswith
primaryhypercholesterolemia(elevatedLDL-C)whodonot
—(Cortisyl;Cortone)
InternationalBrandName—
Adrenalinsufficiency—25-300mgPOqd
Inflammationsuppression—25-300mgPOqd
NOTE:chronictreatmentmaycauseadrenalsuppression;usethe
lowestdoseforshortesttime.Patientswithsystemicinfectionor
surgicalstressrequiresupplementaltherapy.
—hypersensitivitytodrugorclass,CHF,
activeuntreatedinfections(however,maybeusedinpatients
undertreatmentfortuberculousmeningitis)
duringpregnancyhavenosignificantincreaseinbirth
defects.Femaleratsexposedto
inutero
prematurevaginalopening.
—(CromoglicicAcid;Cromogloz;Gastrocrom;
Inostral;Intal;NasalCrom;Opticrom)
InternationalBrandName—
AlerbulNasal(Colombia);AlerbulOftalmico(Colombia);Alerg(Germany);
Allergo-comod(Germany);Allergocrom(Korea,Taiwan);Clesin(Korea);Cromabak(HongKong,Singapore);
Cromadoses(France);Cromal-5Inhaler(SouthAfrica);Cromo-Asma(Spain);Cromogen(Israel);Cromolyn(Israel);
Crom-Ophtal(Indonesia);Cromoptic(France);Cronase(Israel);Cusicrom(Taiwan);Dadcrome(Israel);DNCGTrom
(Taiwan);Epicrom(Israel);Fintal(India);Frenal(Italy);Ifiral(India,Thailand);Lomudal(Belgium,Denmark,Finland,
Mastocytosis—200mgPOqid
Foodallergy—200mgPOqid
Inflammatoryboweldisease—200mgPOqid
Asthmaandexercise-inducedasthma(chronictreatment)—20mg
NEBqid
Allergicrhinitis—1puffpernostrilbidortid(5.2mg/spray)
Allergicconjunctivitis,vernalkeratitis—1gttOS/OD4-6
—hypersensitivitytodrugorclass
MaternalConsiderations
.....
istakendailytopreventsymptoms.Itisavailablein
anMDIoranebulizersolution.Therearenoadequatereportsor
well-controlledstudiesinpregnantwomen.Thereisanincrease
inadverseoutcomesduringpregnancyinwomenwhoseasthma
ispoorlycontrolled.Intranasalcorticosteroidsareconsidered
first-linetherapy,followedby1st-generationantihistamines.
Rodentstudiesusingparenterallyadministereddrugwerenot
associatedwithadverseeffects.
Sideeffects
includebronchospasm,anaphylaxis,throatirritation,
drythroat,bittertaste,cough,wheezing,anddizziness.
breastfeedingshouldbeencouragedforaslongaspossiblewhen
thereisafamilyhistoryofallergy.
DrugInteractions
................
Noclinicallyrelevantinteractionsfound.
.........................
VitaminB12deficiency—30mcgqd
5-10d,then100-1000mcg
SC/IMqmo;POroutecanbeusedformaintenance
Perniciousanemia—100mcgqd
6-7d,then100-1000mcg
SC/IMqmo
Recommendeddailyallowance—6mcgPOqd
—hypersensitivitytodrugorclass
—pruritus,diarrhea,urticaria
MaternalConsiderations
.....
‘‘Intrinsicfactor’’isessentialfortheadequatealimentary
absorptionof
Therecommendeddailyintakeis
deficiencyandthecompensatoryrisein
homocysteinearesignificantriskfactorsforCVdisease.Thereare
noadequatereportsorwell-controlledstudiesinpregnant
deficiencyhasbeenlinkedtoearly
pregnancyloss.
Sideeffects
includeanaphylaxis,thrombosis,pruritus,diarrhea,
andurticaria.
InternationalBrandName—
Noneidentified.
DrugClass
..........................
DosagewithQualifiers
.......
Musclespasm—10mgPOtid;max40-60mg/d
—hypersensitivitytodrugorclass,prioruse
ofMAOIsinthelast14d,hyperthyroidism,recentMI,
MaternalConsiderations
.....
DosagewithQualifiers
.......
Chemotherapy—variesdependingontumorandprotocol
Mycosisfungoides—2-3mg/kgPOqd
Rheumatoidarthritis—1.5-3mg/kgPOqd
NOTE:hydrationisessential.
—hypersensitivitytodrugorclass,bone
marrowdepression
—renalorhepaticfailure,leukopenia,
thrombocytopenia,recentradiation,recentchemotherapy
MaternalConsiderations
.....
isanalkylatingagentusedtotreatcancerof
theovary,breast,andbloodandlymphsystems.Transient
sterilityiscommonafter
andthereisarisk
ofsecondarymalignancy.Therearenoadequatereportsorwell-
controlledstudiesinpregnantwomen.Multiplecasereports
suggestitcanbeusedwithagoodpregnancyoutcome,though
thelossrateinwomenwithlupusmaybeincreasedafter1st
trimesteradministration.
Sideeffects
includeinfertility,CHF,malignancy,anaphylaxis,
leukopenia,thrombocytopenia,cardiomyopathy,alopecia,rash,
headache,N/V,dizziness,andstomatitis.
...........................
PregnancyCategory:D
LactationCategory:NS
shouldbeusedduringpregnancyand
lactationonlyifthebenefitjustifiesthepotentialperinatalrisk.
Breastfeedingshouldbeavoidedduringtherapy.
—(Cicloserina;Cyclorin;Seromycin)
InternationalBrandName—
Closina(Australia);Cyclomycin(Japan);Cyclorine(India);Cycosin(India);
Orientomycin(Japan)
DrugClass
..........................
.........................
ActivepulmonaryandextrapulmonaryTB
.........................
Interfereswiththesynthesisofthebacterialcellularwall
DosagewithQualifiers
.......
TB—250mgPOq12h
2w;continue0.5-1g/dindivideddoses
basedonbloodlevels(max1g/d)
—(Ciclosporin;Neoral;Sandimmune;SangCya)
InternationalBrandName—
Cipol(Korea);Cipol-N(Korea);Consupren(Israel,Thailand);Deximune(Israel);
Gengraf(HongKong);Implanta(China,Korea);Imusporin(Colombia,India);Sandimmun(Bangladesh,Bulgaria,
Preventionoftransplantrejection—5-10mg/kg/dPOin2divided
doses;5-6mg/kgIV4-12hbeforesurgery
Contraindications
—hypersensitivitytodrugorclass,hypertension
—hepaticorrenalfailure
MaternalConsiderations
.....
Therearenoadequatereportsorwell-controlledstudiesin
pregnantwomen.
promotesgrowthof1st
trimesterhumancytotrophoblastsbyapparentlyincreasing
theirinvasiveability.Successfulpregnancyaftersolidorgan
transplantationiscommon.Preconceptioncriteriaforthe
optimaltransplantrecipientincludegoodtransplantgraft
function,noevidenceofrejection,aminimumof1-2ypost-
transplantation,andeithernoorwell-controlledhypertension.
Forthesewomen,pregnancyisgenerallywithoutsignificant
adverseeffect.Becausepreeclampsiadevelopsin30%of
pregnantrenaltransplantpatients,especiallythosewith
Psoriasispatientsreceivingotherimmunosuppressiveagentsor
radiationtherapy(includingPUVAandUVB)shouldnotreceive
becauseofthepossibilityofexcessive
Allergicrhinitis—4mgPOtid
—hypersensitivitytodrugorclass,gastric
ulcer,glaucoma,MAOIsusedupto14dprior,bladderneck
MaternalConsiderations
.....
Therearenoadequatereportsorwell-controlledstudiesin
pregnantwomen.
isusedtopreventorrelieve
symptomsofrhinitis(inflammationofthemucousmembranesof
thenasalpassages,oftenassociatedwithhayfeverandother
seasonalallergies);skinitchingandhives;andtissueswelling
.........................
InterfereswithRNAandDNAchainelongationafter
DosagewithQualifiers
.......
Cancer—varieswithprotocol;mostrecommend100mg/m
bycontinuousIVinfusion(days1-7)or100mg/m
IVq12h
(days1-7)
AML—30mg/m2q4duntilCSFfindingsarenormal(intrathecal
—hypersensitivitytodrugorclass,
pregnancy,infertility
—renalorhepaticfailure
MaternalConsiderations
.....
Therearenoadequatereportsorwell-controlledstudiesin
pregnantwomen.Thecoexistenceofleukemiaandpregnancyis
extremelyrare.
isusedduringpregnancytoachieve
remissionoftheacuteepisodes.Itisanessentialcomponentof
thedrugregimenusedforthetreatmentofAML.Onceremission
isachieved,thedoseshouldbereadjusted.
Sideeffects
includeanemia,bruising,N/V,hairloss,leukopenia,
bonemarrowsuppression,andpancreatitis.
InternationalBrandName—
Dacarbazin(CzechRepublic);DacarbazineDBL(Malaysia);DacarbazineDome
Melanoma,Hodgkin’sdisease—numerousdosingschedules
dependondisease,response,andconcomitanttherapy:
;850mg/m
;250mg/m
5d;2-4.5mg/kg/d
arethemostfrequentregimens;intra-arterial
administrationisnolongerrecommended
—hypersensitivitytodrugorclass
—hepaticorrenaldysfunction
MaternalConsiderations
.....
Therearenoadequatereportsorwell-controlledstudiesin
pregnantwomen.Therearemanycasereportsof
duringpregnancywithagoodoutcome.
Sideeffects
includeleukopenia,alopecia,thrombocytopenia,
anorexia,N/V,hepatotoxicity,diarrhea,fever,myalgias,hepaticor
renaldysfunction,andphotosensitivity.
InternationalBrandName—
Zenapax(Argentina,Brazil,Canada,Chile,Colombia,HongKong,Israel,
Mexico,Paraguay,Peru,Philippines,Taiwan,Uruguay,Venezuela)
DrugClass
..........................
Immunosuppressants;Monoclonalantibodies
.........................
Preventionoftransplantedkidneyrejection
.........................
IL-2receptorantagonist
DosagewithQualifiers
.......
Preventionoftransplantrejection—1.0mg/kgIVq14d
5doses
InternationalBrandName—
Ac-De(Mexico,Peru);Cosmegen(Argentina,Brazil,Canada,Japan,Korea,
Paraguay,Philippines,SouthAfrica,Taiwan,Thailand);CosmegenLyovac(England,HongKong);Cosmogen(Israel);
CosmogenLyovac(HongKong,Malaysia);Dacmozen(India);Lyovac(England);Trepar(Philippines)
DrugClass
..........................
Antineoplastics,antibiotics
.........................
GTN,Wilms’tumor,uterinecarcinoma,Ewing’ssarcoma
.........................
InhibitsRNAandproteinsynthesis
DosagewithQualifiers
.......
GTN—12mcg/kgIV
Wilms’tumor—15mcg/kgIV
Rhabdomyosarcoma—15mcg/kgIV
Ewing’ssarcoma—protocolsvary;mostrecommenddoseshould
notexceed15mcg/kgor400-600mcg/m
IVqd
—hypersensitivitytodrugorclass,herpes
zoster,varicellainfection
—hepaticorrenaldysfunction(mayenhanceradiation
injurytotissues)
MaternalConsiderations
.....
isaderivativeof
Streptomycesparvulus
DVTprophylaxis—begin2500USC/IV1-2hpreoperatively,then
5-14d;increasedoseto5000USCinhigh-riskwomenor
duringpregnancy
DVTtreatment—200U/kg/dSCindivideddoses;max18,000U/
dose,overlapwithoralanticoagulation2-3d
Unstableangina—120U/kg;max10,000USCq12h
NOTE:2500USCqdisofsimilarantithromboticefficacyto5000U
ofunfractionated
—hypersensitivitytodrugorclass,active
4hpostbolusinpregnancy,comparedwith2hinthenonpregnant
state.Themeananti-Xalevelsat12,24,and36wgestationare
eachsignificantlyreduced2hpostinjection,comparedwiththe
nonpregnantstate.Thelowestdose-responsecurvewasat36w
gestation.Theinitialprophylacticdoseformostpregnantwomen
inthe1sttrimesteris5000Udaily.Anti-Xaactivityismeasured
afterinitiatingtherapy,andagainperiodically(atleasteach
trimester)toconfirmtheadequacyoftheprophylacticor
therapeuticdose.Adoseof5000USCshouldproduceananti-Xa
activityof0.20-0.40U/ml(0.4-0.7U/mlforfullanticoagulation)
3hafterinjection.WomentreatedwithLMWHsforpreventionof
thromboemboliccomplicationsareatriskofdevelopingan
epiduralorspinalhematomaafterneuraxialanesthesia.Itis
prudenttowaitatleast12haftertheremovalofanepidural
LMWHsmayhavelowerfrequenciesofthrombocytopeniaand
osteoporosiscomparedtounfractionated
—(Danocrine;Danatrol;Danogen;Danokrin;Ectopal;
InternationalBrandName—
Anargil(HongKong,Malaysia,Thailand);Azol(Australia,Malaysia,Taiwan);
Fibrocysticbreastdisease—50-200mgPObidfor2-6mo,then
adjustdose
Hereditaryangioedema—200mgPOtiduntilresponse,thenhalf
dosefor1-3mo
NOTE:beginduringmenstruation.
—hypersensitivitytodrugorclass,
undiagnosedgenitalbleeding,pregnancy,breastfeeding,
Caution
—hepatic,renalorcardiacdysfunction,epilepsy,migraine
MaternalConsiderations
.....
Therearenoindicationsduringpregnancyfor
Itshould
bediscontinuedifthepatientbecomespregnant.
isnot
aneffectivecontraceptive.Itdecreasesthematernalprogesterone
leveliftakenduringthe1sttrimester.
Sideeffects
includealterationofthelipidprofile(lowHDL),
contraceptivefailure,pseudotumorcerebri,weightgain,acneand
seborrhea,mildhirsutism,virilization,edema,hairloss,
hoarseness,menstrualirregularities,flushing,sweating,vaginal
—(Danlene;Dantralen;Dantrium;DantriumIV)
InternationalBrandName—
Anorex(Korea);Dantamacrin(Austria,Bulgaria,Switzerland);Dantrium
Chronicspasticity—begin25mgPOqd;max400mg/d
Malignanthyperthermiaprevention—4-8mg/kg/dPOq6-8h1-2d
preoperativelywithlastdose3-4hpriortosurgery;samedose
Malignanthyperthermiacrisis—1-2.5mg/kgIV
1,mayrepeat
q5minuntilpatientimproves;max10mg/kg
Neurolepticmalignantsyndrome—1mg/kgIV
1,repeatuntil
symptomsimprove;max10mg/kg
NOTE:monitorLFTs.
—hypersensitivitytodrugorclass,cirrhosis
35y,pulmonarydisease,cardiomyopathy
MaternalConsiderations
.....
Therearenoadequatereportsorwell-controlledstudiesof
inpregnantwomen,thoughithasbeenusedforboththe
preventionandtreatmentofacutemalignanthyperthermiaand
neurolepticmalignantsyndrome,whereitmaybelifesaving.
However,preventionofmalignanthypertensionisnotusually
FrickerRM,HoeraufKH,DreweJ,KressHG.Anesthesiology
1998;89:1023-5.
PCP—100mgPOqd;usuallygivenwith
Malariasuppression—100mgPOqw,givewith
Leprosyprophylaxis—100mgPOqd
Leprosytreatment—50mgPOqd
—hypersensitivitytodrugorclass
—cardiac,renalorhepaticdysfunction,G6PD
MaternalConsiderations
.....
Therearenoadequatereportsorwell-controlledstudiesof
inpregnantwomen.
aloneorincombination
Kaposi’ssarcoma—dosevarieswithprotocol;mostrecommend
AML—dosevarieswithprotocol;mostrecommend40mg/m
Acutelymphoblasticleukemia—dosevarieswithprotocol;
mostrecommend40mg/m
—hypersensitivitytodrugorclass
—hepatic,renal,orcardiacdysfunction;
MaternalConsiderations
.....
isananthracyclineantibiotic.
isan
encapsulatedformdesignedtomaximizeselectivityforsolid
tumorssuchasKaposi’ssarcoma.Thespecificmechanismby
whichthe
citrateliposomedeliversthedrugto
solidtumorsisnotknown.Itisalsocommonlyusedin
combinationwithotherdrugsforthetreatmentofbreastcancer.
Therearenoadequatereportsorwell-controlledstudiesof
inpregnantwomen.Therearemultiplereportsof
itsuseduringpregnancywithasuccessfuloutcome.
Sideeffects
includebonemarrowsuppression,hepaticand
cardiactoxicity,alopecia,N/V,diarrhea,mucositis,backpain,
flushing,chesttightness,fever,andlocaltissuenecrosisatthesite
ofdrugextravasation.
InternationalBrandName—
Desferal(Argentina,Brazil,Canada,Chile,China,HongKong,India,Indonesia,
Korea,Taiwan,Thailand,Venezuela);Desferin(Spain)
DrugClass
..........................
Antidotes;Chelators
.........................
Irontoxicity
.........................
DosagewithQualifiers
.......
Acuteironintoxication—1gIM
1,then500mgIMq4h
mayrepeat;donotexceed6g/24h
Chronicironoverload—500-1000mgIMqd,plus2000mgIV(not
toexceed15mg/kg/h)witheachtransfusedunitofPRBCs
—hypersensitivitytodrugorclass,severe
renaldiseaseoranuria
—IVrouteshouldbeusedonlyininstancesofCV
collapseorwithbloodtransfusion
MaternalConsiderations
.....
Therearenoadequatereportsorwell-controlledstudiesof
inpregnantwomen.Therearecasereportsofits
useduringpregnancyandlactationinwomenwithtransfusion-
dependenthomozygous
Sideeffects
includeoculardisturbancessuchasblurredvision,
cataracts,anddecreasedacuity,colorperception,andnight
vision;injectionsiteirritation;pruritus,tachycardia;hypotension;
shock;N/V;diarrhea;andabdominalpain.
InternationalBrandName—
Noneidentified.
DrugClass
..........................
HIV—400mgPOtid
—hypersensitivitytodrugorclass
MaternalConsiderations
.....
Therearenoadequatereportsorwell-controlledstudiesin
pregnantwomen.Because
increasestheplasma
concentrationsofseveralproteaseinhibitors,itmayalsobe
beneficialasacomponentofsalvagetherapyincombinationwith
proteaseinhibitors.
Sideeffects
includeskinrash(upto20%),angioedema,Stevens-
Johnsonsyndrome,anemia,GIbleeding,pancreatitis,
thrombocytopenia,neutropenia,pancytopenia,granulocytosis,
fatigue,N/V,diarrhea,abdominalpain,hematuria,dryskin,
Theuseof
St.John’swort
withNNRTIs,including
maysubstantiallydecreaseNNRTIconcentrationsandleadtothe
lossofvirologicresponseandtheemergenceofresistanceto
ortotheclassofNNRTIs.
UsewithdrugsthatinduceCYP3A,suchas
maydecrease
plasmaconcentrations,
reduceitstherapeuticeffect,andincreasethechanceofresistance
tothisclassofNNRTIs.Notsurprisingly,drugsthatinhibit
CYP3Amayincrease
plasmaconcentrations.
Phenytoin,phenobarbital,
mayleadtoloss
ofvirologicresponseandpossibleresistanceto
orto
theclassofNNRTIs.
Cisapride,pimozide,astemizole,
contraindicatedduetothepotentialforseriousand/or
life-threateningreactions
suchascardiacarrhythmias.
Dihydroergotamine,ergonovine,ergotamine,
Glaucoma—1-2gtt(0.125%or0.25%)intheaffectedeye
—hypersensitivitytodrugorclass,uveal
inflammation,glaucomaassociatedwithiridocyclitis
—narrowangle-closureglaucoma,bronchialasthma,
spasticGIdisturbances,pepticulcer,pronouncedbradycardia
andhypotension,recentMI,epilepsy,parkinsonism
MaternalConsiderations
.....
isacholinesteraseinhibitorwithsustainedactivity.
Itproducesmiosisandciliarymusclecontraction,andshouldbe
usedonlywhenshorteractingmioticshaveprovedinadequate.
Thereisnopublishedexperiencewith
Sideeffects
includesalivation,urinaryincontinence,diarrhea,
profusesweating,muscleweakness,respiratorydifficulties,shock,
cardiacirregularities,stinging,burning,tearing,lidmuscle
twitching,andheadache.
.........................
Bacteriostatic—inhibitsproteinsynthesis
DosagewithQualifiers
.......
Gonorrhea—600mgPO
1;followwith300mgq12h
NOTE:renaldosing.
—(Deprexan;Norpramin;Pertofrane)
InternationalBrandName—
Deprexan(Israel);Nebril(Argentina);Norpramin(Canada,Mexico);
Depression—Begin25-75mgPOqam,increasegraduallytoa
maximumof300mg/d(typical100-200mgqd)
—hypersensitivitytodrugorclass,usageof
MAOIsinthepast14d,CAD
—heartdisease,glaucoma,thyroiddisease,seizure
MaternalConsiderations
.....
Depressionisacommonlyoverlookedandundertreateddisorder
duringpregnancyandthepuerperium.Pregnancyisnotareason
apriori
todiscontinuepsychotropicdrugs.Womenwithahistory
ofdepressionareathighriskforrecurrenceduringpregnancy
andthepuerperium.TCAscontinuetobewidelyusedduring
pregnancy,butremaininadequatelystudied.
isa
indicatedinco-administrationandinswitchingfromoneclassto
theother.
Closesupervisionandcarefuladjustmentofdosagearerequired
isgivenconcomitantlywithanticholinergicor
vWD—0.3mcg/kgIV
1;alternativelyNAStoprovide300mcg
FactorVIIIdeficiency—0.3mcg/kgIV
1;alternativelyNAS
Nocturnalenuresis—10-40mcgNASqhs
—hypersensitivitytodrugorclass,CAD,
typeIIBvWD
—hyponatremia,electrolyteimbalance
MaternalConsiderations
.....
D-arginine]vasopressin)hasno
...........................
PregnancyCategory:B
LactationCategory:S
iseffectivetherapyforwomenwitheither
Adrenalinsufficiency—0.03-0.15mg/kgPO/IV/IMqd
Inflammatorystates—0.75-9mgPO/IV/IMqd
Inflammatoryocular—1-2gttq1-6h
Congenitaladrenalhyperplasia—0.03-0.15mg/kg/din2-4divided
Allergicreactions—0.75-9mgPOqd
Cerebraledema—10mgIV,then4mgIMq6h
Shock—1-6mg/kgIVq2-6hprn
PostoperativeN/V—4-5mgIV
NOTE:alsoavailableinamultitudeofpreparationsfor
dermatologicandophthalmologicuses;inhalation:1puff=100mcg;
Caution
factors,thatprenatalexposuretocorticosteroidsaddsa6-fold
increaseintheriskforcleftlipwithorwithoutcleftpalate,
IUGR,andshorteningoftheheadandmandible.Incontrast,the
CollaborativePerinatalProjectfollowedwomentreatedduring
the1sttrimester.Whilethenumberofexposureswaslimited,no
Patientsoncorticosteroidtherapymayhavediminishedresponses
totoxoidsandliveorinactivatedvaccines;routineadministration
shouldbedeferreduntilaftercorticosteroidtherapyis
.........................
—(Dexchlor;Dex-Cpm;
Mylaramine;Polaramine)
InternationalBrandName—
Dapriton(HongKong);Delamin(Taiwan);Destramin(Bulgaria);Dexferin
Allergicrhinitis—2-4mgPOq4-6h;max24mg/24h
Anaphylaxis—5-20mgSC/IMq6-12hprn;max40mg/24h
MaternalConsiderations
.....
Sedation—begin1mcg/kgIVover10min,then0.2-0.7mcg/kg/hIV
Postoperativepain—0.4mcg/kgIV
NOTE:avoidabruptwithdrawal.
—hypersensitivitytodrugorclass
—CVdisease,bradycardia,2nd/3rddegreeheartblock,
sicksinussyndrome,hypotension,transienthypertension,
ADD—begin2.5mgPObid;increaseby5-10mg/dqw,maxdose
—hypersensitivitytodrugorclass,historyof
ADHD—5mgPOqd/bid;increaseupto5mg/wprn,max40mgqd
Narcolepsy—10-60mgPOqd;begin10mgPOqdandincrease
10mg/wifnecessary
Obesity—5-30mgPOqd30minbeforebreakfast
—hypersensitivitytodrugorclass,
andNE
reuptake,inhibitingtheircentraleffects.Theycanbeusedtotreat
DosagewithQualifiers
.......
Antitussive—10-30mgPOq4h;max120mgqd(containsalcohol)
NOTE:maybecombinedwith
Hypercholesterolemia—begin1-2mgPOqd;increasetomax
—hypersensitivitytodrugorclass,cardiac
arrhythmia,tachycardia,CHF
—hepaticorrenaldysfunction
MaternalConsiderations
.....
isthedextrorotatoryisomerof
isasinglereportofitsuseduringpregnancyinthesuccessful
treatmentofthyroidhormoneresistancesyndrome(RTH).RTH
ischaracterizedbyanelevatedserumthyroxine,inappropriately
‘‘normal’’TSH,andreducedthyroidhormoneresponsiveness
associatedwithpointmutationsinthethyroidhormone
Sideeffects
includeangina,arrhythmia,MI,insomnia,
nervousness,palpitations,tremors,lossofweight,changesin
libido,andgallstones.
Pain,moderatetosevere—begin5mgIVq2-4hor10mgIM
q3-6h;maxdose10mgIVand20mgIM
—hypersensitivitytodrugorclass
—headinjury,hepaticorrenaldysfunction,sulfite
allergy,drugdependency,biliarysurgery,impairedlung
MaternalConsiderations
.....
indicationanddosing,one-time
useisunlikelyto
poseaclinicallysignificantrisktothebreastfeedingneonate.
DrugInteractions
................
Noclinicallysignificantinteractionsidentified.
.........................
KrasnaIH,RosenfeldD,SalernoP.JPediatrSurg1996;31:855-8.
Alcoholwithdrawal—5mgPOtidorqidprn
Seizuredisorder—2-10mgPObidorqid
Statusepilepticus—5-10mgIVq10-15min
Musclespasm—2-10mgPObidorqid
—hypersensitivitytodrugorclass,
glaucoma,CNSdepression,shock,coma,andbarbiturateand
alcoholuse
—renalorhepaticdysfunction,psychosis,pulmonary
MaternalConsiderations
.....
Therearenoadequatereportsorwell-controlledstudiesof
inpregnantwomen.ItisabeneficialadjuncttoIV
fluidsandvitaminsforthetreatmentof1sttrimester
waspreviouslyusedforprophylaxisand
treatmentofeclampticconvulsions,butprovedlesseffectivethan
magnesiumsulfate.
Pregnancymayunmaskapreexisting
potentialforchorea(choreagravidarum),andbenzodiazepines
mayaidchoreacontrol.
elimination,whileinducersofCYP2CI9(e.g.,
)andCYP3A4(e.g.,
carbamazepine,phenytoin,
—(Hyperstat;Proglycem)
InternationalBrandName—
Eudemine(England,Korea);Hyperstat(Canada);Proglicem(France,Israel,Italy,
Hypertension—1-3mg/kgIVq5-15min;max150mgIV
—hypersensitivitytodrugorclass,
...........................
PregnancyCategory:C
LactationCategory:U
isindicatedoutsidepregnancyfortherapid
reductionofBP.
Therearemanyotheralternatives(e.g.,
Glaucoma—100-200mgPOq12huntilresponse,thenmaintain
25-50mgPOqdtotid
—hypersensitivitytodrugorclass
MaternalConsiderations
.....
Thereisnopublishedexperiencewith
shouldbeusedcautiouslyasit
mayproducebriskdiuresisfollowedbyhypokalemia.
Sideeffects
includeconstipation,anorexia,N/V,weightloss,
urinaryfrequency,renalcolic,renalcalculi,skinrash,headache,
weakness,pruritus,leukopenia,agranulocytosis,
thrombocytopenia,nervousness,sedation,depression,confusion,
—(BerifenGel;Blesin;Cataflam;Clofen;
DiclofenacSodium;Oritaren;Silino;Voltaren)
InternationalBrandName—
Abdiflam(Indonesia);Abitren(Israel);Acuflam(Philippines);Allvoran(Germany);
Almiral(HongKong,Malaysia,Singapore,Taiwan);AlmiralGel(Singapore);AlmiralSR(HongKong,Malaysia);
Alonpin(Japan);Apo-DiclofenacEC(NewZealand);Arcanafenac(SouthAfrica);Arthrifen(Philippines);Artren
Dysmenorrhea—begin100mgPO,then50mgPOtid
Mildtomoderatepain—begin50mgPObidtotid
Rheumatoidarthritisorosteoarthritis—50mgPObidtotid;max
225mgqd
Ankylosingspondylitis—25mgPOqid
—hypersensitivitytodrugorclass,
NSAID-inducedasthma,nasalpolyps,GIbleeding,liver
—hypertension,nasalpolyps,CHF,GIbleedinghistory
MaternalConsiderations
.....
Therearenoadequatereportsorwell-controlledstudiesin
pregnantwomen.
isashort-actingNSAIDwith
Skininfection—125-500mgPOq6h1hacorpc
Osteomyelitis—250-500mgPOq6hacorpc
Mastitis—250-500mgPOq6hacorpc
NOTE:renaldosing;GIabsorptionof
isdelayedif
takenafterameal.
—hypersensitivitytodrugorclass
—cephalosporinallergy,neonates,renalorhepatic
dysfunction,andEpstein-BarrvirusorCMVinfections
MaternalConsiderations
.....
Therearenoadequatereportsorwell-controlledstudiesof
inpregnantwomen.
isapenicillinase-
—(Antispas;A-Spas;Bentyl;Bo-Cyclomine;
Coochil;Dedoxia;Diciclomina;Dicyclocot;Magesan;Medispaz-Im;
InternationalBrandName—
Babyspasmil(Argentina);Balacon(Japan);Bentyl(Brazil,Japan,Mexico,
Philippines,Taiwan);Bentylol(Canada);Clomin(SouthAfrica,Thailand);Cyclominol(India);Diclomin(Mexico);
Dicomin(Thailand);Dicymine(HongKong,Thailand);Dilomin(Philippines);Easy(Korea);Formulex(Canada);
Lomine(Canada);MagesanP(Japan);Medicyclomine(SouthAfrica);Merbentyl(England,Ireland,NewZealand,
SouthAfrica);Nomcramp(SouthAfrica);Notensyl(Israel);Panakiron(Japan);Respolimin(Japan);
Spasmotine(Philippines);Swityl(Taiwan)
DrugClass
..........................
Anticholinergics;Gastrointestinals
.........................
Irritablebowelsyndrome
.........................
DecreasesGImotilitybyinhibitingsmoothmusclecontractility
DosagewithQualifiers
.......
Irritablebowelsyndrome—20mgPOqid;max40mgPOqid
—hypersensitivitytodrugorclass,ulcerative
colitis,paralyticileus,toxicmegacolon,myastheniagravis,
refluxesophagitis,glaucoma
—CVdisease,hyperthyroidism
MaternalConsiderations
.....
Therearenoadequatereportsorwell-controlledstudiesof
inpregnantwomen.
Sideeffects
includedrowsiness,blurredvision,respiratory
distress,tachycardia,urticaria,confusion,constipation,mydriasis,
N/V,palpitations,fever,psychosis,andphotophobia.
pressuremaybehazardouswhentakenconcurrentlywithagents
suchascorticosteroids.
AnticholinergicagentsmayaffectGIabsorptionofvariousdrugs,
suchassustained-releasedigoxin,causingincreasedconcentrations.
Anticholinergicdrugsmayantagonizetheeffectsofdrugsthat
alterGImotility,suchas
HIV—200mgPOq12h
NOTE:ifweight
60kg,125mgPOq12h.
—hypersensitivitytodrugorclass,historyof
pancreatitis,neuropathy
—gout,neuropathy,renalorhepaticdysfunction,
concomitantuseofneurotoxicagents
MaternalConsiderations
.....
Therearenoadequatereportsorwell-controlledstudiesof
doesitreducetheriskofHIVtransmissionbysexualcontactor
bloodcontamination.Fatallacticacidosishasbeenreportedin
pregnantwomenwhohavereceivedacombinationof
Thelong-termeffectsof
onboth
treatedwomenandneonatesarepresentlyunknown.
Sideeffects
includepancreatitis,neuropathy,hepatotoxicity,optic
Atrophicvaginitis—1intravaginalapplication3
—hypersensitivitytodrugorclass,historyof
thromboembolicdisease,cancer(ovarian,uterine,breast),
unexplainedvaginalbleeding
—hepaticorrenaldysfunction,historyofdepression
MaternalConsiderations
.....
Obesity—25mgPOtidbeforemeals,orXRtabqd
—hypersensitivitytodrugorclass,useof
MAOIswithinthelast14d,CVdisease,glaucoma,
MaternalConsiderations
.....
Therearenoadequatereportsorwell-controlledstudiesof
Pain—begin1000mgPO
1;then500mgPOq12h
Osteoarthritis—250-500mgPOq12h
Rheumatoidarthritis—250-500mgPOq12h
—hypersensitivitytodrugorclass,asthmatic
attacks,urticaria,
-precipitatedrhinitis
—nasalpolyps,GIbleeding,hypertension,cardiac
failure,hepaticorrenaldysfunction
MaternalConsiderations
.....
otherNSAIDscancauseinthe3rdtrimesterconstrictionofthe
Heartfailure—0.2mgPOqd
4d;maintenancedosevaries
Atrialflutter—0.2-0.3mgPOqd
Atrialfibrillation—0.2-0.3mgPOqd
SVT—0.3mgPOqd
Rapiddigitalization—0.6mg,then0.4mgin4-6h,then0.2mg
q4-6huntildrugleveltherapeutic
—hypersensitivitytodrugorclass,
ventriculartachycardia,cardiacdisease,andhypersensitive
carotidsinussyndrome
—hypokalemia,hepaticandrenalfailure
MaternalConsiderations
.....
Therearenoadequatereportsorwell-controlledstudiesof
inpregnantwomen.
isacrystalline-pure
cardiacglycosideobtainedfrom
Digitalispurpurea
andhas
.........................
InhibitsNa
transmembraneATPase
DosagewithQualifiers
.......
CHF—beginwithaloadingdoseof0.75-1.25mgPO,or0.5-1mg
IV/IMfollowedbyamaintenancedoseof0.125-0.5mgPOqd
NOTE:digoxinlevelsshouldbemaintainedbetween0.8and2ng/ml.
Atrialfibrillation/flutter—0.125-0.5mgPOqd
Paroxysmalatrialtachycardia—0.125-0.5mgPOqd
Rapiddigitalization—0.4-0.6mgIV/PO,then0.1-0.3mgq6-8h
guidedbythedigoxinlevel
—hypersensitivitytodrugorclass,
ventricularfibrillation,ventriculartachycardia,AVaccessory
pathway,sicksinussyndrome
—bradycardia,AVblock,MI,cardiomyopathy,
constrictivepericarditis,renalorhepaticdysfunction
MaternalConsiderations
.....
Thereisalongclinicalexperiencewith
duringpregnancy
andthepuerperiumforthetreatmentofbenignarrhythmiasand
cardiomyopathy.AfullCVevaluationisrecommendedpriorto
itsinitiation.Potentialstimulants,suchassmoking,
alcoholshouldbeeliminated.Althoughnoantiarrhythmicdrugis
componentofbreastmilk.
DrugInteractions
................
Migraine—1mgIM/IV,mayrepeatqh
2;max2mgIV,or
3mg/attackor6mg/w;alternatively,1spray(0.5mg)NASeach
nostril,mayrepeatin15min;max4sprays/attackor8sprays/w
Clusterheadache—1mgIM/IV,mayrepeatq1h
2;max2mgIV,
or3mg/attackor6mg/w
NOTE:primepumpwith4sprays,discardunusedportionafter8h.
—hypersensitivitytodrugorclass,CAD,
uncontrolledhypertension,basilarmigraine,PVD,
cerebrovasculardisease,5-HT
agonistwithin24h,severe
hepaticorrenaldysfunction,concurrentvasoconstrictors,
sepsis,potentCYP3A4inhibitoruse
—cardiacriskfactors
MaternalConsiderations
.....
Therearenoadequatereportsorwell-controlledstudiesof
inpregnantwomen.Itpossessesoxytocic
propertiesandwasusedinseveraloldertrialstoassistwiththe
inductionoflabor.Itwasalsousedoccasionallyduring
pregnancyforthetreatmentof‘‘low’’BP.Neitherofthelast
twoareindications.
iseffectiveforthe
treatmentofmenstrualmigraine.
Sideeffects
includehypertension,peripheralorbowelischemia,
coronaryspasm,MI,chestpain,tachycardia,bradycardia,N/V,
numbnessinfingersandtoes,legweakness,anditching.
—(DHT;Hytakerol;Tachyrol)
InternationalBrandName—
A.T.10(Austria,Bulgaria,Germany,Hungary,Russia,Switzerland);
Osteoporosis—0.6mgPOqd;givewithcalciumandfluoride
Hypocalcemia—begin0.8-2.4mgPOqdforseveraldays,then0.2-
1mgPOqd
Renalosteodystrophy—0.1-0.6mgPOqd
—hypersensitivitytodrugorclass,
hypercalcemia,hypervitaminosisD
—renalstones,hyperphosphatemia,hypervitaminosisD
MaternalConsiderations
.....
Therearenoadequatereportsorwell-controlledstudiesof
(vitaminD)inpregnantwomen,thoughitis
partofmostprenatalvitaminpreparations.
arebotheffectiveforthemanagementof
hypoparathyroidismduringpregnancy.Thedoserequired
typicallyneedstobereadjustedupduringthelatterhalfof
gestation.Thedoseof
shouldbereducedduring
Sideeffects
includehypercalcemia,renaldysfunction,
hypercalciuria,convulsion,polydipsia,N/V,anorexia,anemia,
—(Cardizem;Clarute;DilacorXR;Lacerol;Tiazac)
InternationalBrandName—
Acalix(Argentina,Paraguay,Venezuela);Adizem-CD(Israel);Altiazem
Angina—begin30mgPOqid;max360mg/d
Atrialflutter/fibrillation—20mg(0.25mg/kg)IV,over2min;
ifinadequateresponse,0.35mg/kgIVover2min,thencontinue
infusionwith10(5-15)mg/hfor24h
NOTE:maybepackagedwith
—hypersensitivitytodrugorclass,AVblock,
hypotension,bradycardia,sicksinussyndrome,MI
—hepaticorrenaldysfunction
MaternalConsiderations
.....
Therearenoadequatereportsorwell-controlledstudiesof
inpregnantwomen.Clearanceisunalteredduring
rabbitpregnancy.
isusedforthetreatmentofacute
cardiacrhythmemergencies.
Invitro
invivo
.........................
Motionsickness—50-100mgPO/IM/IVq4-6h;beginatleast
30minbeforeanticipatedactivity,max400mg/d
Migraine—50-100mgPO
—hypersensitivitytodrugorclass
—neonates,seizuredisorder,glaucoma,concomitant
useofototoxicmedication
MaternalConsiderations
.....
Therearenoadequatereportsorwell-controlledstudiesof
inpregnantwomen.Itisapopularagentin
manylocalesforthereliefofN/Vduringpregnancy,thoughthe
practiceisunsupportedbyasingleclinicaltrial.Both
areconsideredtreatment
optionsforseveremigraineheadacheduringpregnancy.
iswarrantedsinceseveralinvestigatorsreportanincreasein
uterineactivityassociatedwith
Sideeffects
includedrowsiness,headache,fatigue,increase
—(Cervidil;Prepidil;ProstinE2;ProstinE2
VaginalSuppository)
InternationalBrandName—
Cervidil(Canada,NewZealand);Cerviprime(India);Cerviprost(Austria,
CzechRepublic,Denmark,Finland,Germany,Italy,Norway,Russia,Switzerland);K-PE(Japan);MinprostinE(2)
(Germany);PrandinE2(SouthAfrica);Prepidil(Austria,Belgium,Bulgaria,Canada,China,Colombia,CzechRepublic,
Cervicalripening—0.5mggelPVendocervical,mayrepeat
2;alternatively,10mginsertPVintotheposteriorfornix
—(Allerdryl50;Allergia-C;Allergina;
Amidryl;Banophen;Beldin;Belix;Ben-A-Vance;Bena-D10;Benadryl;
BenadrylSteri-Dose;Benahist;Benapon;Bendramine;Benoject;
Ben-Rex;Bydramine;Dibenil;Dimidril;Diphen;Diphenacen-50;
Diphenhist;Dytuss;Fynex;Genahist;Hydramine;Hydril;Hyrexin;
Noradryl;Norafed;Nordryl;Pharm-A-Dry;Restamin;Shodryl;
TegaDryl;Truxadryl;Tusstat;UadDryl;Wehdryl)
InternationalBrandName—
Allermin(Japan);BenadrylN(Bulgaria,CzechRepublic);Benocten(Switzerland);
BronchoD(Israel);Cathejell(Israel);Dibrondrin(Austria);Difenhydramin(Denmark);Dimiril(India);Dormutil(Germany);
Histergan(Israel,PuertoRico,SouthAfrica);Nytol(Canada,SouthAfrica);NytolQuickgels(Mexico);ratioAllerg
(Germany);Resmin(Japan);Tzoali(Mexico);UnisomSleepgels(HongKong);Vena(Japan);Venasmin(Japan)
DrugClass
..........................
.........................
Antihistamine,anaphylaxis,dystonicreactions,sedation,
insomnia,motionsickness
.........................
NonselectivecentralandperipheralH
receptorantagonist
DosagewithQualifiers
.......
Antihistaminic—25-50mgPO/IV/IMq6hprn
Anaphylaxis—1-1.25mg/kgPO/IV/IMq4-6h;max300mg/d
Dystonicreactions—25-50mgPOtidorqid;max300mg/d
Sedation—25-50mgPOqidprn
Insomnia—50mgPOqhs
Motionsickness—25-50mgPOq4-6hprn;max300mg/d
—hypersensitivitytodrugorclass,
concomitantuseofalcohol
—glaucoma,asthma,hyperthyroidism,CVdisease,
glaucoma,pepticulcer
MaternalConsiderations
.....
Therearenoadequatereportsorwell-controlledstudiesof
inpregnantwomen.Ithasalonghistoryof
DrugInteractions
................
HasadditiveeffectswithalcoholandotherCNSdepressants
Thromboembolism—150-400mgPOqd(usuallygivenin
combinationwitheither
Angina—50mgPOtid
Valvulopathy—75-100mgPOqid
—hypersensitivitytodrugorclass
MaternalConsiderations
.....
Thromboembolusisamajorcomplicationofmechanicalheart
valves.Theriskisgreatlyreducedbutnoteliminatedbyregimens
ofanticoagulationwith
ortherapeutic
alsoappearstobeeffectiveprophylaxis.
—(Dynabac;Norton)
InternationalBrandName—
Dimac(Austria);Dynabac(Chile,France,Guatemala,HongKong,Hungary,
Korea,Poland);Onzayt(Philippines);Unibac(Belgium)
DrugClass
..........................
Antibiotics;Macrolides
.........................
Bacterialinfections(gram-positiveaerobes:
S.aureus
Bacterialinfection—500mgPOqd
Contraindications
—hypersensitivitytodrugorclass,bacteremia
—renalorhepaticdysfunction
MaternalConsiderations
.....
Thereisnopublishedexperiencewith
isconvertedintheintestinetothe
microbiologicallyactive
erythromycylamine.Dirithromycin
comparableinefficacyto
forthetreatmentofskin
andsofttissueinfectionswithsignificantlylessnausea.Once-daily
dosingaidscompliance.
Sideeffects
includearrhythmias,pseudomembranouscolitis,
...........................
PregnancyCategory:C
LactationCategory:U
shouldbeusedduringpregnancyandlactation
onlyifthebenefitjustifiesthepotentialperinatalrisk.
Therearealternativeagentsforwhichthereismoreexperience
duringpregnancyandlactation.
InternationalBrandName—
Ventriculararrhythmia—load300mg
1,then150mgPOq6h;
adjustprn
—hypersensitivitytodrugorclass,
cardiogenicshock,2ndor3rdAVblock,CHF,prolongationof
theQTinterval,cardiomyopathy
—hypoglycemia,atrialtachyarrhythmias,renalor
hepaticdysfunction
MaternalConsiderations
.....
Therearenoadequatereportsorwell-controlledstudiesof
inpregnantwomen.Pregnancyaltersthe
percentageoffreedrugcirculatingintheplasma.Treatmentofa
cardiacarrhythmiawith
duringpregnancyis
complicatedbyreportedrisksofhemorrhageorhypotensionor
disopyramide
Alcoholdependence—begin500mgPOqam
1w;continue500-
125mgPOqam,taperingfromhightolowslowly
NOTE:mustabstainfromalcohol
12hbeforeadministration.
—hypersensitivitytodrugorclass,alcohol
12h,
Seizures—10-15mg/kg/dPOin1-3divideddoses,increaseby
5-10mg/kg/dqw;max60mg/kg/d;therapeutictrough=
Mania—250mgtidPO,increaseby5-10mg/kg/devery2-3d;max
60mg/kg/d;therapeutictrough=50-100mcg/ml
Migraineprophylaxis—250-500mgPObid
NOTE:takewithfood.
—hypersensitivitytodrugorclass,hepatic
dysfunctionordisease
—renaldysfunction,bonemarrowsuppression,
DrugInteractions
................
Newinteractionsarecontinuouslybeingreported.Thefollowing
isonlyapartiallist.
Drugsthataffecttheexpressionofhepaticenzymes,particularly
thosethatelevateglucuronosyltransferases,mayaltertheclearance
Forexample,
phenytoin,carbamazepine,
maydoubletheclearanceof
Patientsonmonotherapywillgenerallyhavelonger
t/2sandhigherconcentrationsthanthosereceivingpolytherapy
forantiepilepsy.Monitoringof
andconcomitantdrug
concentrationsshouldbeincreasedwheneverenzyme-inducing
drugsarestartedorwithdrawn.
proteinbindingandinhibitsthe
Cardiacdecompensation—2-10mcg/kg/minIV;max40mcg/kg/
—hypersensitivitytodrugorclass,IHSS,
—historyofrecentMI,arrhythmiaorsulfiteallergy
MaternalConsiderations
.....
Therearenoadequatereportsorwell-controlledstudiesof
inpregnantwomen.
isadirect-acting
-adrenergicionotropicagentproducingapressoreffectwithless
chronotropythanthe
-adrenergicagents,plussomedegreeof
vasodilation(e.g.,pulmonaryvascularresistance)butno
dopaminergicrenaleffects.
isrecommendedfor
ionotropicsupportofwomenwithcardiacdecompensation
duringpregnancy.Itisusedtoimproveventricularfunctionin
womenwithidiopathicdilatedcardiomyopathy.
alsoinduceamodestbutunsustainedincreaseincardiacoutput
inpatientswithidiopathicpulmonaryhypertension.The
diagnosisofperipartalcardiomyopathyislimitedtowomenwith
CHFanddecreasedLVsystolicfunctionduringthelastmonthof
pregnancyorwithin5moofdelivery.Womenwhoseventricular
functionisnormalatrestandexercisemayhavetheir
taperedandultimatelydiscontinuedafter6-12mo.
challengetestisusedtoassessventricular
functioninwomenwithahistoryofperipartalcardiomyopathy
whohaveregainednormalrestingLVsizeandperformance.
isrecommendedpriorto
whentreatmentis
necessaryforatrialfibrillation.
Sideeffects
includetachycardia,arrhythmia,phlebitis,
hypotension,N/V,headache,angina,palpitations,SOB,
hypertension,myocardialischemia,andVF.
Cancer—dosevariesperprotocol;mostregimensrecommend
—hypersensitivitytodrugorclass,
—renalorhepaticdysfunction
MaternalConsiderations
.....
Therearenoadequatereportsorwell-controlledstudiesof
Docusatecalcium
—(Colace;Ediclone;Kasof;Laxagel;
Prenate-90;Rapilax;Regulax;Surfak;Wasserlax)
InternationalBrandName—
Colace(Canada,Ireland);Cusate(Thailand);Jamylene(France);Lambanol(Italy);
Laxadine(Indonesia);Norgalax(Belgium,Israel,Russia);Regutol(Israel);Selax(Canada);Soflax(Canada);Softon
(HongKong);Tirolaxo(Spain)
DrugClass
..........................
.........................
.........................
Constipation—100mgPOqdorbid
NOTE:maybepackagedwith
—hypersensitivitytodrugorclass,fecal
impaction,mineraloiluse,acuteabdomen,colitis,GI
MaternalConsiderations
.....
Whiletherearenoadequatereportsorwell-controlledstudiesof
inpregnantwomen,thereisalongclinicalexperience
withvirtuallynoreportedcomplications.
isfrequently
usedpostpartumtoavoidconstipationinwomenwhohavehada
repairedepisiotomy.Itmayrarelypotentiatethehepatotoxicityof
otherdrugs.
Sideeffects
includebittertaste,nausea,rash,diarrhea,throat
irritation,andintestinalobstruction.
Atrialflutter/fibrillation—500mcgPOq12h;adjustdosebasedon
QTcandcreatinineclearance
NOTE:renaldosing;restrictedaccessintheUS.
—hypersensitivitytodrugorclass,QT
prolongation(
440-500msec),renalfailure,hypokalemia
—bradycardia,electrolyteabnormalities,renal
dysfunction,CYP3A4inhibitors
MaternalConsiderations
.....
Thereisnopublishedexperiencewith
presenceofmoreseverestructuralheartdisease,aknownrisk
factorforarrhythmia,inpatientson
.........................
DanielssonBR,SkoldAC,AzarbayjaniF.CurrPharmDes2001;
...........................
PregnancyCategory:C
LactationCategory:U
N/V,postoperative—typically12.5mgIV
115minbefore
surgeryends
N/V,chemotherapy—100mgPO
11hpre-chemo,or1.8mg/kg
115minpre-chemo
—hypersensitivitytodrugorclass
—hypomagnesemia,prolongedQT
MaternalConsiderations
.....
Thereisnopublishedexperiencewith
...........................
PregnancyCategory:B
LactationCategory:U
Alzheimer’sdementia—begin5mgPOqhs;increasegraduallyto
10mgPOqhsafter4-6w
hypersensitivitytodrugorclass,sicksinus
syndrome,SVT
asthma,CAD,pepticulcer
MaternalConsiderations
.....
isbelievedtoenhancecholinergicfunctionby
increasingAChconcentrationintheintactcholinergicnerves,
keepingthemfunctionallyintact.Further,
activityoftheNMDAsystemevenatlowtherapeutic
similarneuromuscularblockingagents,or
cholinergicagonistssuchas
Adjunctforshock—1-50mcg/kg/minIV;max20-50mcg/kg/min
2-5mcg/kg/min:primarilydopaminergicreceptoreffects,butmay
exhibitapressoreffect
5-10mcg/kg/min:primarily
-adrenergiceffectswithinotropyand
10mcg/kg/min:primarily
-adrenergiceffectswithperipheral
RefractoryCHF—1-3mcg/kg/minIV
—hypersensitivitytodrug,class,orsulfites;
VF;pheochromocytoma
InternationalBrandName—
Alfadil(Sweden);Alfamedin(Germany);Cadex(Israel);Cadil(Korea);Cardenalin
(Japan);Cardil(Korea);Cardoral(Israel);Cardoxan(NewZealand);Cardular(Germany);CardularPP(Germany);
CardularUro(Germany);Cardura(Argentina,Bulgaria,Chile,CzechRepublic,Ecuador,England,HongKong,Hungary,
Hypertension—1mgPOqd,increaseslowly(doserange
1-8mgqd);max16mgqd
—hypersensitivitytodrugorclass
—hepaticorrenaldysfunction
MaternalConsiderations
.....
Therearenoadequatereportsorwell-controlledstudiesof
inpregnantwomen.Itissimilarto
Sideeffects
includearrhythmias,headache,N/V,somnolence,
edema,dyspnea,asthenia,diarrhea,angina,fatigue,hypotension,
backpain,flu-likesyndrome,diarrhea,drymouth,blurredvision,
anddyspepsia.
—(Sinequan;Zonalon)
InternationalBrandName—
Anten(NewZealand);Aponal(Germany);Deptran(Australia);Doneurin
(Germany);Doxal(Finland);Expan(Colombia);Gilex(Israel);Mareen(Germany);Quitaxon(Belgium,Denmark,France,
Portugal,SouthAfrica);Sinquan(Denmark,Germany,Switzerland);ZonalonCream(Israel)
DrugClass
..........................
Antidepressants;Tricyclics
.........................
Depression—begin25-75mgPOqhs(alternatively50mgPOtid),
increasegraduallybasedonresponse;max300mgqd
Pruritus—applycream(5%cream)qidtoaffectedarea;systemic
absorptionsignificantwithwidespreadapplication
—hypersensitivitytodrugorclass,
importance,sufficienttimemustbeallowedbeforeinitiatinga
TCAinapatientbeingwithdrawnfrom
Cancer—dosevariesperprotocol;mostregimensrecommend
IVq3w
NOTE:hepaticandrenaldosing;useofacardioprotectantagent
(dexrazoxane)duringtreatmentrecommended.
notbeadministeredIMsinceseverelocaltissuenecrosismight
—hypersensitivitytodrugorclass,
hyperbilirubinemia,cardiomyopathy,CHF,myelosuppression,
Necrotizingcolitismanifestedbycecalinflammation,bloody
—(Doxy;Doxy-100;Doxychel;Doxycycline
Hyclate;Monodox;Vibramycin;Vibra-Tabs)
InternationalBrandName—
Amermycin(Thailand);Atrax(Philippines);Azudoxat(Germany);Bactidox
(Germany);Banndoclin(Indonesia);Basedillin(Japan);Bassado(Italy);Biocolyn(Philippines);Biodoxi(India);Bronmycin
Gonorrhea,uncomplicated—100mgPObid
7d;forcomplicated,
useincombinationwithanotheragentsuchas
(ifnotpregnantorbreastfeeding)
—100mgPObid
PID—100mgPObid
10-14dwithanotheragentsuchas
250mgIM
Malaria—100mgPOqdbeginning1-2dbeforedepartureand
continuingthrough4wafterexposure
Lymedisease—100mgPObid
14-21d(28difassociatedwith
Anthrax—100mgIV/POq12h;postexposure,100mgPOq12hfor
60doruntildiseaseexcluded
isthefirstchoiceforpregnantwomeninfected
withanthrax.
—hypersensitivitytodrugorclass,
pregnancy(see
N/V(post-chemo)—5mg/m
11-3hbeforefirstdoseof
chemo;max4-6
Anorexia(AIDS)—2.5mgPObid;max20mgqd
—hypersensitivitytodrugorclass
MaternalConsiderations
.....
Therearenoadequatereportsorwell-controlledstudiesof
inpregnantwomen.Severalpublicationssuggesta
N/V(perioperative)—0.625-1.25mgIM/IVq3-4hprn
—hypersensitivitytodrugorclass,
prolongedQTinterval
—historyofreactiontootherdrugscausingtardive
dyskinesia,hypotension,CNSdepression,CHF,bradycardia,
roomsfortheacutemanagementofmigraineheadachewith
successsimilarto
meperidine.Droperidol,propofol,
alizapride,
indecreasingorderofeffectivenessforthedosesusedin
thisstudy,reducedtheincidenceofpruritusinducedbytheuseof
intrathecal
morphine.
Inaddition,
droperidol
reducesN/Vafter
epidural
morphine
similarinefficacyto
Econazolenitrate
InternationalBrandName—
Amicel(Italy);Bismultin(Greece);Derma-Coryl(Israel);Dermazole(Australia,
HongKong,Singapore);Ecanol(India);Econ(Thailand);Econite(HongKong);Ecosone(HongKong);Ecostatin(Canada,
England,Ireland,NewZealand);Ecotam(Spain);Ecreme(NewZealand);Epi-Pevaryl(Germany);Fongeryl(France);
Fungazol(Korea);Gyno-Coryl(Israel);Micolak(Mexico);Micolis(Argentina,Chile,Ecuador,Paraguay,Peru,Uruguay);
Micos(Italy);Micostyl(Brazil,Mexico);Palavale(Japan);Penicomb(Greece);Pevaryl(Bahrain,Cyprus,Egypt,Germany,
Greece,HongKong,Ireland,Jordan,Malaysia,NewZealand,Philippines,Poland,Slovenia,Sudan,Turkey,Venezuela)
DrugClass
..........................
Antifungals;Dermatologics
.........................
Tineaandcutaneouscandidiasis
.........................
Animidazolederivativethatchangesfungalcellwallpermeability.
DosagewithQualifiers
.......
Tinea—applycreamtoaffectedareaqd
Cutaneouscandidiasis—applycreamtoaffectedareabid
MaternalConsiderations
.....
hasbeenusedforthetreatmentof
withsuccesssomewhatinferiorto
absorptionof
isextremelylow.Therearenoadequate
reportsorwell-controlledstudiesof
inpregnant
women.However,itwaseffective
invitro
usingsamplesobtained
frompregnantwomen.
prolongspregnancyinrats
whengivenorally.
Sideeffects
includeburning,itching,redness,andrash.
—(Enlon;Reversol;Tensilon)
InternationalBrandName—
Enlon(Canada)
DrugClass
..........................
Myastheniagravis,diagnosis—2mgIVtestdoseover15-30sec;
ifnoresponseafter1min,repeatwith8mg.Ifareaction,halt
infusionandadministeratropine0.5mgIV
Anesthesia,adjunct—reversalofnondepolarizingneuromuscular
blockade:500mcg/kgIVgiven1minafteratropine0.02mg/kgIV
—hypersensitivity,intestinalobstruction
—asthma,arrhythmia
MaternalConsiderations
.....
isashort-andrapid-actingcholinergicdrug.
Therearenoadequatereportsorwell-controlledstudiesof
inpregnantwomen.Olderliteraturesuggests
InternationalBrandName—
Efavir(India);Filginase(Argentina);Stocrin(Colombia,HongKong,Israel,
Mexico,Peru,Singapore,SouthAfrica,Taiwan,Thailand);Sustiva(Canada);Virorrever(Argentina)
DrugClass
..........................
Antivirals;Non-nucleosidereversetranscriptaseinhibitors
.........................
HIVinfection
.........................
DosagewithQualifiers
.......
HIV—600mgPOqd
—hepaticdysfunction,
MaternalConsiderations
.....
Therearenoadequatereportsorwell-controlledstudiesof
inpregnantwomen.However,thereareseveralcase
seriesofHIV-infectedwomenwhohaveconceivedwhiletaking
Itiscommonpracticetoswitchwomenon
toanotherNNRTI.Thevastmajorityofthesepregnanciesare
unintended,stressingtheimportanceofcontraceptivecounseling.
Hepatotoxicitymaybemorecommonduringpregnancy.Perhaps
themostrelevantconsiderationwheninitiatingapregnant
shouldnotbeusedassoleproteaseinhibitorin
combinationwith
increasesthe
concentration.Thecombination
resultsinahigherfrequencyofadverseclinicalaffects(e.g.,
dizziness,nausea,paresthesia)andlaboratoryabnormalities
(elevatedliverenzymes).
.........................
Migraineheadache,acute—20-40mgPO
1;mayrepeatq2h
ifrecurs;max80mg/24h
hypersensitivitytodrugorclass,
uncontrolledhypertension,cerebrovasculardisease,ischemic
heartdisease,coronaryspasm,basilarorhemiplegicmigraines,
PVD,ischemicbowel,5-HT
agonistorergotuse
CYP3A4inhibitoruse
cardiacriskfactors
MaternalConsiderations
.....
Migraineisaparoxysmaldisorderwithattacksofheadache,N/V,
photo-andphonophobia,andmalaise.Thereisnopublished
experiencewith
InternationalBrandName—
Hypertension—begin5mgPOqd(max40mgqd);alternatively
0.625-1.25mgIV,thenupto5mgIVq6h
CHF—begin2.5mgPOqd(max40mgqd)
MI—begin2.5mgPOqd(max40mgqd),quicklytitratedoseup
Nephropathy—5-20mgPOqd
NOTE:alsocombinedwitheither
hydrochlorothiazide
felodipine.
—hypersensitivity,renalarterystenosis
—renaldysfunction,hypovolemia,severeCHF,
collagenvasculardisease
MaternalConsiderations
.....
Therearenoadequatereportsorwell-controlledstudiesof
inpregnantwomen.Itisgenerallywelltolerated,and
pregnancydoesnotalterdosing.However,
shouldbe
discontinuedimmediatelywhendiscoveredduringpregnancyand
replacedwithanothersuitablehypotensiveagenttopreventor
InternationalBrandName—
Noneidentified.
DrugClass
..........................
Antiarrhythmics,classI
.........................
Ventriculararrhythmias
.........................
Stabilizesmembranechargebydepressingthephase0action
DosagewithQualifiers
.......
UTI,uncomplicated—200mgPObid
7d(avoidmeals)
UTI,complicated—400mgPObid
14d(avoidmeals)
Gonorrhea,uncomplicated—400mgPO
—pregnancy,lactation,renalorhepaticdysfunction,
InternationalBrandName—
Aerotina(Argentina);Clexane(Belgium,Bulgaria,China,CzechRepublic,
DVTprophylaxis(episodewithin12moofpregnancy,no
thrombophilia)—beginat20-40mgSCqd
DVTprophylaxis(associatedwiththrombophilia)—dependson
thethrombophiliaandmedicalhistory.Consultaspecialtytext
suchas
HighRiskPregnancy:ManagementOptions
Antiphospholipidsyndrome—beginat20-40mgSCqd
Cesareansection—atleast40mgSCqduntilpatientisactive
Treatmentofacutethrombosis—1-1.5mg/kgSCq12h
36w.Otherwise,patientsshouldbeinstructedtowithholdtheir
nextinjectiononcecontractionsbegin,or12hpriortoaplanned
inductionoflabor.
shouldbediscontinued12-24h
(dependingondailydose)beforeplacementofneuraxial
(epiduralorspinal)anesthesia.
shouldnotbe
(re)instituteduntilatleast12hafterremovalofanindwelling
InternationalBrandName—
Noneidentified.
DrugClass
..........................
Adrenergicagonists;Bronchodilators;Decongestants,nasal
.........................
Nasaldecongestant,pressorsupportafterepiduralanalgesia
.........................
CausesreleaseofepinephrineandNEfromnerveendings,
resultinginmainly
-adrenergicstimulation;alsoaweakdirect-
actingvasopressor
DosagewithQualifiers
.......
Decongestant—25-50mgPOq6h(max150mg/d)
NOTE:maybecombinedwith
theophylline,pentobarbital,
potassiumiodide.
—hypersensitivity,thyroidtoxicosis,
porphyria,CAD,hypertension,useofanMAOIwithin14d
—glaucoma,arrhythmia,hyperthyroidism
MaternalConsiderations
.....
Therearenoadequatereportsorwell-controlledstudiesof
inpregnantwomen.Whenabusedasadecongestant,
mayexacerbatethehypertensionassociatedwith
preeclampsia.Thereisalongclinicalexperiencewiththeuseof
duringlabortotreathypotensionassociatedwith
neuraxialanesthesia.Itisconsideredthevasopressorofchoice
unlesscontraindicatedbymaternalcondition(e.g.,coexisting
valvularstenosis)andisprotectiveoftheuterinecirculation,
perhapsthroughreleaseofNOintheplacentalvessels.Butwhile
interventionssuchascolloids,
ephedrine,phenylephrine,
lowerlegcompressionreducetheincidenceofhypotension,none
hasbeenshowntoeliminatetheneedtotreatmaternal
hypotensionduringspinalanesthesiaforcesareansection.
Womenwithpreeclampsiaarelesslikelytoexperience
hypotensionatthetimeofspinalanesthesia,andrequire
significantlyless
whentheydo.
Sideeffects
includearrhythmias,insomnia,nervousness,dizziness,
andtachycardia.
Severeasthma—0.1-0.5mgSCq10-15min
Anaphylaxis—0.1-0.5mgSCq10-15min(or0.1-0.25mgIVover5-
Sideeffects
includestroke,cerebralhemorrhage,arrhythmias,
hypertension,tachycardia,tremor,N/V,andheadache.
Transfusionreduction—300U/kgSC3
/wbeginning10d
AZT-relatedanemia—150U/kgSC/IV3
/wbeginningfor8w;
mayincreaseto300U/kgfor3wifpoorresponse
Renalfailure–relatedanemia—50-100U/kgIV/SC3
Chemotherapy-relatedanemia—150U/kgSC/IV3
/wbeginning
for8w;mayincreaseto300U/kgfor3wifpoorresponse
—hypertension;iron,folateorvitaminB
CHF;CAD;seizuredisorder;sicklecellanemia
MaternalConsiderations
.....
Therearenoadequatereportsorwell-controlledstudiesof
administeredironalone.Inonecasereport,itwasusedsuccessfully
totreatapregnantJehovah’sWitnesswithsicklecelldisease.
Sideeffects
includeseverehypertension,CHF,MI,stroke,DVT,
seizures,headache,arthralgia,tachycardia,fever,diarrhea,N/V,
dyspnea,dizziness,rash,andparesthesias.
Pulmonaryhypertension—2ng/kg/minIV,increase1-2ng/min
q15min;infusethroughacentralline
—hypersensitivity,CHF,pulmonaryedema
MaternalConsiderations
.....
isprostacyclin.PPHisarare,progressivecondition
aggravatedbythephysiologicchangesofpregnancy.
hasbeenusedtotreatwomenduringpregnancy
andintheimmediatepostpartumperiodwithapparentsuccess.
Thematernalmortalityraterangesfrom30%to50%.
Sideeffects
includepulmonaryedema,reboundpulmonary
tachycardia,hypotension,chestpain,diarrhea,paresthesias,and
Hypertension—600-800mgPOqd
—hypersensitivity,pregnancy
humanplacenta.Similarclassdrugsareknownteratogens.While
Hypoparathyroidism—50,000-200,000UPOqd(supplementwith
500mgelementalcalcium6
Familialhypophosphatemia—12,000-80,000UPOqd(supplement
with1-2gelementalphosphorus/d)
NOTE:1mcg=40U.
—hypersensitivity,renalosteodystrophy,
hypercalcemia,hypervitaminosisA
—renaldysfunctionorstones,CVD
MaternalConsiderations
.....
TherecommendedminimaldailyrequirementofvitaminDis
—(Ergomar;Ergostat;Medihaler-Ergotamine;
Abortorpreventmigraineheadache—1tabSLq30minprnat
firstsignofattack;max3tabsqd,or5tabsqw
DrugInteractions
................
Thepressoreffectsof
andothervasoconstrictordrugs
cancausedangeroushypertensionwhencombined.
.........................
DosagewithQualifiers
.......
Bacterialinfection—250-500mgPOq6-12h
PPROM—250mgPOqid
NOTE:maybecombinedwithasulfaagenttoimprovecoverageof
H.influenzae.
—myastheniagravis,hepaticdysfunction
MaternalConsiderations
.....
Theroutineuseofmacrolideantibioticsprolongsthelatency
intervalandreducesinfectiousmorbidityinwomenwith
DrugInteractions
................
Mayincrease
levels,causingtoxicity.
Mayincreaseserum
Mayincreasetheanticoagulanteffectsoforalagentswhenused
InternationalBrandName—
Cipralex(England,India,Ireland,Israel,Sweden);Ipran(Chile);Lexapro
(Argentina,Brazil,Colombia,HongKong,Peru,Philippines,Singapore,Thailand);Seroplex(France)
DrugClass
..........................
Antidepressants;SSRIs
.........................
Depression—begin10mgPOqd;max20mg/d;taperslowly
DrugInteractions
................
Invitro
studiesindicatedthatCYP3A4andCYP2C19arethe
Perioperativehypertension/tachycardia—begin150mcg/kg/minIV;
titrateupby50mcg/kg/minforamaxof300mcg/kg/min
SVT—begin500mcg/kg/min
1min,then50mcg/kg/min
repeatcycleifnoeffect,titratinginfusionupby50mcg/kg/min
aftereachloadingdose
—hypersensitivity,sinusbradycardia,AV
heartblock,cardiogenicshock
MaternalConsiderations
.....
isashort-acting
-blockeremployedfortherapidbut
short-term(9mint/2)controlofeitherhypertensionor
supraventriculararrhythmia.Therearenoadequatereportsor
well-controlledstudiesof
inpregnantwomen.The
publishedexperienceislimitedtocasereportsandsmallseries.
IthasbeenusedsuccessfullyforBPcontrolinwomenwith
preeclampsiaorpheochromocytomabeforeinductionofgeneral
anesthesia,andinwomenwithterbutalineoverdoseor
hypertrophicobstructivecardiomyopathy.
Sideeffects
includebronchospasm,hypotension,cardiacfailure,
dizziness,N/V,somnolence,fatigue,andphlebitis.
InternationalBrandName—
Esoprax(Colombia);Inexium(France);Nexium(Australia,England,Germany,
HongKong,Indonesia,Ireland,Israel,Korea,Malaysia,Singapore);Nexium-MUPS(Mexico);Sompraz(India)
DrugClass
..........................
Antiulcer;Gastrointestinals;Protonpumpinhibitors
.........................
GERD,erosiveesophagitis,
H.pylori
infectiontreatment
.........................
GERD—20-40mgPOqd
4-8w;max80mgqd
Erosiveesophagitis—20-40mgPOqd
4-8w;max80mgqd
H.pylori
—40mgPOqd
10dtakenwith
—hepaticdysfunction,long-termuse
MaternalConsiderations
.....
istheL-isomerof
.Thereareno
adequatereportsorwell-controlledstudiesinpregnantwomen.
iscost-effectivecomparedwith
theacutetreatmentofrefluxesophagitisandGERDwithout
esophagitis.Thesedrugsarebeingusedwithincreasing
frequencyduringpregnancy,andthereisagreatneedfor
additionalstudy.
Sideeffects
includehepaticdysfunction,diarrhea,andheadache.
Mayreducetheplasmalevelsofatazanavir.
Insomnia—1-2mgPOqhsprn
—hypersensitivity,pregnancy,depressed
respiratoryfunction,andsleepapnea
—hepaticorrenaldysfunction,suicidalideation,
historyofsubstanceabuse
MaternalConsiderations
.....
Thereisnopublishedexperiencewith
pregnancy.Otherdrugsofthisclasssuchas
consideredtoberelativelycontraindicatedduringpregnancy.
Sideeffects
includesomnolence,headache,asthenia,dizziness,
anddisorientation.
Smokershaveincreasedclearanceofbenzodiazepinescomparedto
.........................
Thereisnopublishedexperienceinpregnancyorduring
...........................
PregnancyCategory:X
LactationCategory:U
Benzodiazepinessuchas
aregenerally
contraindicatedduringpregnancy.
Therearealternativeagentsforwhichthereismoreexperience
duringpregnancyandlactation.
—(Alora;Climara;Estrace;Estraderm;Estring;
Fempatch;Vivelle)
InternationalBrandName—
Aerodiol(Australia,France,Germany,HongKong,Korea,Sweden);Bisteron
(Taiwan);Climaderm(Brazil,Colombia,Mexico);Climara(Canada,China,France,Philippines,SouthAfrica,Taiwan,
Thailand);ClimaraForte(NewZealand);ClimaraLowDose(Philippines);Delidose(France);Dermestril(China,Germany,
Israel,Italy);DermestrilSeptem(France);Divigel(Korea,Malaysia,Singapore,Thailand);Estrace(Canada);Estracomb
TTS(HongKong);Estraderm(Australia,Canada,Colombia,Denmark,Finland,Ireland,Norway,Sweden);Estraderm
MX(Argentina,Australia,Peru);EstradermTTS(Austria,Belgium,Brazil,Bulgaria,Colombia,CzechRepublic,Ecuador,
Vasomotorsymptoms—1-2mgPOqd,cycle21donand7doff,
addaprogestindays14-21ifuteruspresent
Osteoporosisprevention—0.5mgPOqd,cycle21donand7doff,
addaprogestindays14-21ifuteruspresent
Atrophicvaginitis—1-2mgPOqd,cycle21donand7doff,adda
progestindays14-21ifuteruspresent
Primaryovarianfailure—1-2mgPOqd
Breastcancerpalliation—10mgPOtid
.........................
Vasomotorsymptoms—0.3-1.25mgPOqdfor21d,andthen7d
off;addaprogestindays14-21ifuteruspresent
Osteoporosis—0.625mgPOqdfor21d,andthen7doff;adda
progestindays14-21ifuteruspresent
Primaryovarianfailure—1.25mgPOqdfor21d,andthen7doff;
addaprogestindays14-21ifuteruspresent
NOTE:maybecombinedwith
forthetreatmentofmenopausal
Estrogens,esterified
—(Amnestrogen;Estratab;Evex;
Femogen;Menest)
InternationalBrandName—
Menest(Argentina,Indonesia);Neo-Estrone(Canada)
DrugClass
..........................
Estrogens;Hormones
.........................
Hormonereplacement,vasomotorsymptomsofmenopause,
osteoporosisprevention,atrophicvaginitis,primaryovarian
failure,breastcancerpalliation
.........................
Bindtoestrogenreceptors;hasbothreceptor-andnon–receptor-
mediatedactivities
DosagewithQualifiers
.......
Vasomotorsymptoms—1.25mgPOqd,cycle21donand7doff,
addaprogestindays14-21ifuteruspresent
Osteoporosisprevention—0.3mgPOqd,cycle21donand7doff,
addaprogestindays14-21ifuteruspresent
Atrophicvaginitis—0.3-1.25mgPOqd,cycle21donand7doff,
addaprogestindays14-21ifuteruspresent
Primaryovarianfailure—1-25mgPOqd
Breastcancerpalliation—10mgPOtid
NOTE:maybecombinedwith
levelsofanti-factorXaandATIII,anddecreasedATIIIactivity;
increasedlevelsoffibrinogenandfibrinogenactivity;increased
plasminogenantigenandactivity;increasedplasmaHDLand
HDL-2subfractionconcentrations,reducedLDL-Cconcentration,
andincreasedtriglyceridelevels.
.........................
...........................
PregnancyCategory:X
LactationCategory:S
Thereisnoindicationfor
esterifiedestrogens
duringpregnancy.
Vasomotorsymptoms—0.625-5mgPOqd,cycle21donand7d
off,addaprogestindays14-21ifuteruspresent
Osteoporosisprevention—0.625mgPOqd,cycle21donand7d
off,addaprogestindays14-21ifuteruspresent
Hypogonadism—1.75-7.5mgPOqd,cycle21donand7doff,add
aprogestindays14-21ifuteruspresent
—hypersensitivity,pregnancy,undiagnosed
vaginalbleeding,thromboembolicdisease,estrogen-dependent
breastcancer
—lactation,hepaticdysfunction
MaternalConsiderations
.....
wasformerlyknownaspiperazineestronesulfate.
Therearenoindicationsfor
duringpregnancy.
Recentstudiessuggestestrogenplus
thetreatmentofmenopausalsymptomsincreasestheriskof
breastcancerandCVdisease.Ithasbeenlongknowntoincrease
mayreduceplasmaestrogen,possiblydecreasing
therapeuticeffectsand/orchangingtheuterinebleedingprofile,
andinhibitors(e.g.,
Hypertension—begin25mgPOqd;max100mg/d
Peripheraledema—25mgqd;max200mgPObid
—hypersensitivity,anuria
—renalorhepaticdysfunction
MaternalConsiderations
.....
Therearenoadequatereportsorwell-controlledstudiesof
DrugInteractions
................
Reducestherenalclearanceof
increasingtheriskof
Mayincreasetheototoxicityofaminoglycosidesandsome
cephalosporins.Theirconcurrentuseshouldbeavoided.
fromplasmaproteinandasaresultmay
necessitateareductioninthe
Mycobacterialinfections—15-25mg/kgqd,max1g/dose
Tuberculosisadjuvanttherapy—15-25mg/kgqd,max2.5g/dose;
givenaspartofmultidrugtherapy
NOTE:renaldosing.
—hypersensitivity,opticneuritis
—renaldysfunction,ophthalmologicdisorders
MaternalConsiderations
.....
Therearenoadequatereportsorwell-controlledstudiesof
Vasomotorsymptoms—1-2mgPOqd,cycle21donand7doff,
addaprogestindays14-21ifuteruspresent
Osteoporosisprevention—0.5mgPOqd,cycle21donand7doff,
addaprogestindays14-21ifuteruspresent
Atrophicvaginitis—1-2mgPOqd,cycle21donand7doff,adda
progestindays14-21ifuteruspresent
Primaryovarianfailure—1-2mgPOqd
Breastcancerpalliation—10mgPOtid
—hypersensitivity,pregnancy,undiagnosed
vaginalbleeding,thromboembolicdisease,estrogen-dependent
breastcancer
—lactation,hepaticdysfunction
MaternalConsiderations
.....
Therearenoindicationsfor
Absenceepilepsy—250mgPObid;monitorlevels,max1.5g/d
—bonemarrowdepression,hepaticorrenal
dysfunction,mixedseizures,abruptwithdrawal,porphyria
MaternalConsiderations
.....
Therearenoadequatereportsorwell-controlledstudiesof
Nerveblock—max8mg/kgatasingleinjection;upto400mg
NOTE:contains
—severeshock,heartblock,peripheralvasculardisease,
MaternalConsiderations
.....
Hypercalcemia—7.5mg/kg/dIV
3-7d,then20mg/kg/dPO
—hypersensitivity,renaldysfunction
—longbonefracture,enterocolitis,cardiacfailure
MaternalConsiderations
.....
Thereisnopublishedexperiencewith
Pain—200-400mgPOq6-8hprn,max1.2gqd
Osteoarthritis—300-500mgPObid,max1.2gqd
Rheumatoidarthritis—300-500mgPObid,max1.2gqd
—hypersensitivitytoitorotherNSAIDs
—GIbleeding,hypertension,CHF
MaternalConsiderations
.....
butnochangeinfree
clearance.Thereisno
significantdifferenceinthepharmacodynamiceffectof
administeredaloneand
administeredwith
Inductionofgeneralanesthesia—0.3mg/kgIV(range
0.2-0.6mg/kg)over30-60sec
MaternalConsiderations
.....
DowningJW,BuleyRJ,Brock-UtneJG,HoultonPC.BrJ
Anaesth1979;51:135-40.
HoultonPJ,DowningJW,BuleyRJ,Brock-UtneJG.SAfrMedJ
1978;54:773-5.
...........................
PregnancyCategory:C
LactationCategory:S
Severepsoriasis—0.75-1mg/kgin2-3divideddosesuntil
response,thenmaintenanceof0.5-0.75mg/kg/d;max1.5mg/kg
—hepaticdysfunction
MaternalConsiderations
.....
Therearenopublishedstudiesof
...........................
PregnancyCategory:X
LactationCategory:U
Adjuvanttherapyforbreastcancer—25mgPOqd
—hepaticorrenaldysfunction
MaternalConsiderations
.....
Thereisnopublishedexperiencewith
Sideeffects
includehotflashes,nausea,fatigue,increased
FactorIX
—(Alphanine;BebulinVH;Immuno;Konyne80;
Mononine;ProfilnineSD;ProplexT)
InternationalBrandName—
Bebulin(Denmark,Spain);BebulinS-Tim4(Austria);BebulinTeam4(Russia);
Bleeding—dose(IU)=kg
%desiredincreaseinfactorIX
(1.2forrecombinant,otherwise
1forconcentrate),givenslow
IVpush
Prophylaxis—20-30IU/kg1-2
/wgivenslowIVpush
Anticoagulantoverdose—dose(IU)=kg
%desiredincreasein
factorIX,givenslowIVpush
—hypersensitivitytomouseproteins,hepatic
dysfunction,DIC,hyperfibrinolyticstates
MaternalConsiderations
.....
FactorIX
isastabile,lyophilizedconcentrateeitherrecombinant
ormadefrompooledhumanplasma.Thelatterispurifiedby
immunoaffinitychromatography,whichreducestheriskofvirus
transmission.Therearenoadequatereportsorwell-controlled
studiesinpregnantwomen.Thepublishedliteratureconsistsof
caseseriesandsinglereports.
FactorIX
deficiencyistypicallyan
X-linkeddisorder,andthussymptomsoccuronlyinwomenwith
unbalancedlyonization.Postpartumhemorrhageisthemost
commoncomplication,anditoccursmoreofteninwomen
receivingfewerthan4doffactorIXreplacement.
Sideeffects
includethromboembolicdisease,viraldisease,
flushing,tingling,fever,chills,N/V,urticaria,headache,BP
changes,andinjectionsitereaction.
InternationalBrandName—
Combivent(Argentina,Austria,Belgium,Brazil,Canada,Chile,China,Colombia,
Denmark,England,France,HongKong,Indonesia,Ireland,Korea,Mexico,Paraguay,Peru,Philippines,Thailand,
Uruguay,Venezuela);Famtrex(India);Famvir(Australia,Canada,Ecuador,HongKong,Indonesia,Israel,Taiwan,
Thailand);Oravir(France);Pentavir(Argentina)
DrugClass
..........................
.........................
Treatmentofgenitalherpesandherpeszoster
.........................
InhibitsviralDNApolymerase
DosagewithQualifiers
.......
Genitalherpes(1stepisode)—250mgPOtid
Genitalherpes(recurrent)—125mgPObid
Genitalherpes(prophylaxis)—250mgPObid
Herpeszoster—500mgPOtid
NOTE:renaldosing.
—renaldysfunction
MaternalConsiderations
.....
InternationalBrandName—
Agufam(Thailand);Amfamox(Australia);Antiflam(Uruguay);Apo-Famotidine
(NewZealand);Apogastine(Israel);Asid(Brazil);Ausfam(Australia);Beilande(HongKong);Bestidine(Korea);Blocacid
(Singapore);Brolin(Spain);Cepal(Greece);Durater(DominicanRepublic,ElSalvador,Guatemala,Honduras,Mexico,
Panama);Facid(Indonesia);Fadin(Taiwan);Fadine(HongKong,Malaysia,Thailand);Fadul(Germany);Fafotin(Korea);
Famine(HongKong);Famo(Germany,Israel);FamoABZ(Germany);Famoc(Singapore);Famocid(India);Famodil(Italy);
Famodin(Bulgaria);Famogal(Colombia);Famogard(Russia);Famohexal(Australia);Famolta(HongKong);Famonerton
(Germany);Famopril(Singapore);Famopsin(HongKong,Malaysia,Thailand);Famos(Indonesia);Famosan(Bulgaria);
Famosia(Thailand);Famotal(Norway);Famotep(Portugal);Famotin(Ecuador,Singapore);Famotine(Peru);Famowal
(India);Famox(HongKong,NewZealand,Taiwan);Famoxal(Mexico);Fanox(Spain);Fararidin(Korea);Farmotex
(Mexico);Farotin(Korea);Fenox(Colombia);Ferotine(Korea);Fibonel(Chile,Ecuador);Fudone(SouthAfrica);
Fuweidin(Taiwan);Gardin(Korea);Gaster(China,Indonesia,Japan,Taiwan);Gastren(Paraguay);Gastridin(Italy);
Gastrion(Spain);Gastro(Israel);Gastroflux(Philippines);H2Bloc(Philippines);Incifam(Indonesia);Kemofam
(Indonesia);Kimodin(Taiwan);Logos(SouthAfrica);Motiax(Italy);Motidine(HongKong,Singapore);Pepcid
(Australia,Canada,England,Ireland,SouthAfrica,Sweden);Pepcidac(France);PepcidAC(Canada,NewZealand);
GERD—20-40mgPOqhsfor12w
Gastriculcer—20-40mgPOqhsfor4-6w
Zollinger-Ellisonsyndrome—20-60mgPOq6h,max160mgPOq6h
NOTE:renaldosing.
—hypersensitivity,PKU
—renaldysfunction
MaternalConsiderations
.....
Therearenoadequatereportsorwell-controlledstudiesof
inpregnantwomen.Thereareonlyrarereportsofits
useduringpregnancy.Asingledoseof
toparturientsPO3hbeforesurgeryismoreeffectiveneutralizing
lesserextentthan
Seizuredisorder—400-1200mgPOtid,max3600mg/d
NOTE:renaldosing.
—hepaticorrenaldysfunction,historyofblood
MaternalConsiderations
.....
Epilepsyisacommonneurologicdisorderaffecting1million
Americanreproductive-agewomen.Therearenoadequate
reportsorwell-controlledstudiesof
inpregnant
Chronichypertension—5mgPOqd,max20mg/d
—hepaticdysfunction,CHF
MaternalConsiderations
.....
Therearenoadequatereportsorwell-controlledstudiesof
inpregnantwomen.Thepublishedexperienceconsists
ofisolatedcasereportswhere
wasusedsuccessfullyfor
thetreatmentofseverehypertensionduringpregnancywithout
adverseeffect.Calciumchannelblockersarethemosteffective
tocolyticagents.
decreasesplacentalbloodflowand
prolongsparturitioninrabbits.
Sideeffects
includeedema,headache,flushing,dizziness,nausea,
abdominalpain,diarrhea,rhinorrhea,chestpain,palpitations,
musclecramps,andweakness.
InternationalBrandName—
Apo-Feno-Micro(HongKong,Malaysia);Aterolis(Uruguay);BisterolSR(Korea);
Climage(Greece);Controlip(CostaRica,DominicanRepublic,ElSalvador,Guatemala,Honduras,Mexico,Nicaragua,
Panama);Durafenat(Germany);DurafenatMicro(Germany);Evothyl(Indonesia);Fegenor(France);Felosma
(Indonesia);Fenobrate(Argentina);Fenofanton(Germany);FenogalLidose(Singapore);Fenox(Thailand);Fibrafen
(Philippines);Hyperchol(Indonesia);Lexemin(HongKong,Singapore,Thailand);Lipanthyl(Belgium,Bulgaria,
China,Cyprus,CzechRepublic,France,Germany,Greece,HongKong,Hungary,Indonesia,Italy,Kuwait,Malaysia,
Philippines,Poland,Russia,Switzerland,Taiwan,Thailand);Lipantil(England,Portugal);Liparison(Spain);Lipidax(Italy);
Lipidil(Brazil,Chile,Ecuador,Germany);LipidilSupra(Korea);Lipilo(China);Lipofen(Portugal);Lipolin(Taiwan);
Lipovas(Spain);Lipsin(Austria,SouthAfrica);LivesanGe(France);Nopid200(Korea);Normalip(Germany);Normolip
(Colombia);Nubrex(Philippines);Qualipantyl(HongKong);Rapidil(Korea);Redose200(Korea);Rorit(Korea);
Secalip(France);Trichol(Indonesia);Trolip(HongKong,Indonesia,Philippines);Zerlubron(Greece);Zumafib(Indonesia)
DrugClass
..........................
.........................
.........................
Unclear;interfereswithtriglyceridesynthesis
DosagewithQualifiers
.......
Hypertriglyceridemia—begin54mgPOqdwithmeals,adjusting
q4-8w;max160mgqd
Hypercholesterolemia—begin54mgPOqdwithmeals,adjusting
q4-8w;max160mgqd
Mixeddyslipidemia—begin54mgPOqdwithmeals,adjusting
q4-8w;max160mgqd
thereisariskthataninteractionwilllead
Severehypertension—0.025-0.3mcg/kg/minIV;increaseq15min
0.05-0.1mcg/kg/minuntilreachingmaxdoseof1.6mcg/kg/min
for48h
—glaucoma,acuteCVD,hypokalemia,sulfiteallergy,
asthma,hepaticdysfunction
MaternalConsiderations
.....
isanalternativefortreatmentofahypertensive
crisisifunresponsivetosodium
Thereareno
adequatereportsorwell-controlledstudiesof
pregnantwomen.Inisolatedsystems,itcausesrelaxationofthe
.........................
Osteoarthritisorrheumatoidarthritis—300-600mgPOtidorqid;
max3200mg/d
Painrelief—200mgPOq4-6hprn
NOTE:takewithmeals.
—hypersensitivitytodrugorclass,NSAID
—GIbleeding,hypertension,CHF,nasalpolyps
MaternalConsiderations
.....
NSAIDsincreaseplasma
andreducerenal
clearance.Patientsshouldbeobservedcarefullyforsignsof
Anesthesia,adjunct—2-50mcg/kgIVdependingonneeds
Preoperativeanalgesia—50-100mcgIV30-60minpriortosurgery
Laborepiduralanesthesia—approximately25mcgintrathecal;
40-50mcgepidural:usuallyfollowedbyadoseof20-30mcg/h
Laboranalgesia(IV)—begin50mcgIV,thereafter25mcg
q20-30minprn
Postoperativepainrelief—50-100mcgIVq1-2hprn
NOTE:alsoavailableinoralandtransdermalforms.
—hypersensitivitytodrugorclass
—hepatic,renal,orpulmonarydysfunction;bowel
obstruction;CNSdepressantuse;hypotension;biliarydisease;
seizuredisorder;inflammatoryboweldisease
MaternalConsiderations
.....
isashort-actingopiatewithconsiderableriskofabuse.
ofasuccessfulexternalversionisincreasedbyitsusewithspinal
blockade.Itsadditionto2.2mlof0.5%hyperbaric
with0.2mlof
0.2mgintrathecallyreducestheincidence
andseverityofintraoperativeandpostoperativeshiveringafter
spinalanesthesiaforcesareandeliverywithoutincreasingother
sideeffects.
Sideeffects
includerespiratorydepressionorarrest,dependency,
laryngospasm,bronchospasm,arrhythmias,ileus,cardiacarrest,
N/V,weakness,drymouth,confusion,sweating,euphoria,
itching,hypotension,andbradycardia.
WongCY,NgEH,NgaiSW,HoPC.HumReprod2002;
...........................
PregnancyCategory:C
LactationCategory:S
isashort-actingopiatewidelyusedduringpregnancy
foranalgesiaofmultipletypes.
Ferrousgluconate
InternationalBrandName—
Noneidentified.
DrugClass
..........................
Hematinics;Vitamins/minerals
.........................
Irondeficiencyandsupplementation
.........................
Essentialcomponentinmanyproteins,includinghemoglobin
DosagewithQualifiers
.......
Irondeficiency—2-3mg/kgelementalFePOqdindivideddoses
Ironsupplementation—15-30mgelementalFeqd
NOTE:300mg=35mgelementalFe;donottakewithin2hof
Ironmaydecreasetheabsorptionofnumerouscompounds,
cefdinir,didanosine,levodopa,mycophenolate,
Allergicrhinitis—180mgPOqd
Chronicurticaria—60mgPObid
NOTE:maybecombinedwith
—hypersensitivitytodrugorclass
—renaldysfunction
MaternalConsiderations
.....
isa3rd-generationantihistamineeffectiveforthe
symptomaticreliefofallergicrhinitis.Whileincreasinglypreferred
foritsnonsedatingproperties,therearenopublishedcontrolled
trialsorpopulationstudiesof
duringpregnancy.
Thepublishedclinicalliteratureconsistsofasinglecasereport
whereitwasusedforthetreatmentofPUPPP.
Sideeffects
includedysmenorrhea,drowsiness,nausea,flu-like
symptoms,dyspepsia,andfatigue.
DrugInteractions
................
Usewith
Severechronicneutropenia—10mcg/kgSCqd
AIDSneutropenia—1-10mcg/kgSCqd
Neutropeniapost–bonemarrowtransplantation—10mcg/kgIVqd
24haftereitherchemotherapyortransplantation
Chemotherapy-inducedneutropenia—5mcg/kgSC/IVqd
mayincreaseby5mcg/kgperchemocycle
Progenitorcelldonors—10mcg/kgSCqd
—hypersensitivitytodrugorclass,
hypersensitivityto
E.coli
—hepaticorrenaldysfunction
MaternalConsiderations
.....
Therearenoadequatereportsorwell-controlledstudiesof
inpregnantwomen.Ithasbeenusedtotreatsevere
chronicneutropeniaandchemotherapy-inducedneutropenia
duringpregnancywithoutobviousadverseeffect.Thepublished
literatureisconfinedtocasereportsandusuallycomplicatedby
Sideeffects
includeanaphylaxis;thrombocytopenia;N/V;
Bladderspasm—100-200mgPOtidorqid
—hypersensitivitytodrugorclass,intestinal
obstruction,GIbleeding,achalasia
MaternalConsiderations
.....
Thereisnopublishedexperiencewith
pregnancy.Innonpregnantwomen,
firstincreases,then
decreases,uterinecontractions.
Sideeffects
includeleukopenia,N/V,drymouth,dizziness,
blurredvision,tachycardia,palpitations,headache,drowsiness,
dysuria,urticaria,andfever.
Ventriculararrhythmia—100mgPOq12h(max400mgqd;
increasedoseby50mg/dq4d)
Atrialarrhythmia—50mgPOq12h(max400mgqd;increasedose
by50mg/dq4d)
—hypersensitivitytodrugorclass,
cardiogenicshock,severeAVblock,bi-ortrifascicularblock
—CHF,hepaticorrenaldysfunction,prolongedQT
MaternalConsiderations
.....
Therearenoadequatereportsorwell-controlledstudiesof
flecainide
inpregnantwomen.
Flecainide
hasbeenusedsuccessfully
forthetreatmentofmaternalarrhythmiasduringpregnancy.
Sideeffects
includeventriculararrhythmia,CHF,cardiacarrest,
arrhythmia,dizziness,blurredvision,dyspepsia,headache,N/V,
fatigue,weakness,constipation,andchestpain.
unlikelytoproduceaneonatalplasmalevelabove100ng/ml,
asubtherapeuticlevel.
DrugInteractions
................
A13-19%increaseinplasma
levelsoccurredat6h
postdoseduringadministrationofmultipleoraldosesof
tohealthysubjectsstabilizedonamaintenancedose
Inastudyinvolvinghealthysubjectsreceiving
concurrently,plasma
increased20%and
increased30%comparedtocontrol.Eachhad
negativeinotropiceffectsthatwereadditive.Inclinicaltrials,
patientsreceiving
-blockersand
didnotexperiencean
increasedincidenceofsideeffects.Nevertheless,thepossibilityof
additivenegativeinotropiceffectsof
-blockersand
shouldberecognized.
mayincrease2-foldormorewhen
isaddedifthe
dosageisnotreduced.
DrugsthatinhibitCYP11D6,suchas
mightincrease
concentrationsinpatientswhoareonchronic
therapy;especiallyifthesepatientsareextensive
InternationalBrandName—
Baten(Colombia,DominicanRepublic,ElSalvador,Guatemala,Honduras,
Panama);Biozole(Malaysia);Biozolene(Italy);Cancid(Indonesia);Cryptal(Indonesia);Diflu(Korea);Diflucan
(Canada,Chile,China,Colombia,Ecuador,HongKong,Indonesia,Japan,Korea,Malaysia,Mexico,Peru,Philippines,
Taiwan,Thailand);Difnazol(Korea);Flocan(Korea);Flozole(Korea);Flucand(Israel);Flucanol(Israel);Flucazol(Brazil);
Flucess(Indonesia);Flucona(Korea);Flucoral(Indonesia);Flucozal(Brazil,HongKong);Fludicon(HongKong);Fludizol
(Thailand);Flukazol(Mexico);Flukezol(Mexico);Flumax(Korea);Flunco(Thailand);Flunizol(Peru);Forcan(India);
Fukole(Malaysia);Fulkor(Philippines);Fumay(Taiwan);Funazol(Korea);Funex(Colombia);Fungata(Austria,
Germany);Funzela(Philippines);Govazol(Indonesia);Kyrin(Thailand);Medoflucon(China,Singapore);Mutum
(Argentina,Peru,Venezuela);Mycorest(Singapore);Nobzol-1(Colombia);Nobzol-2(Colombia);Oneflu(Korea);
Oxifugol(Mexico);Oxifungol(Mexico);Plunazol(Korea);Prinazole(Korea);Sixanol(Paraguay,Uruguay);
Stalene(HongKong,Singapore,Thailand);Syscan(India);Tavor(Colombia);Tinazole(Korea);Treflucan(Israel);
Triflucan(France,Israel,Turkey);Zemyc(Indonesia);Zoldicam(Mexico)
DrugClass
..........................
.........................
Candidiasis,cryptococcalmeningitis
.........................
Esophagealororopharyngealcandidiasis—200mgPO/IV
then100mgPO/IVqd
Vaginalcandidiasis—150mgPO
Cryptococcalmeningitis—400mgPO/IV
1,then200mg
PO/IVqd
—hypersensitivitytodrugorclass,useof
astemizole,cisapride,orterfenidine
—hepaticorrenaldysfunction
MaternalConsiderations
.....
Therearenoadequatereportsorwell-controlledstudiesof
inpregnantwomen.Ithasbeenusedforthe
treatmentofcoccidioidomycosisduringpregnancyand
sepsispostpartum.Thesystemicantifungaldrug
withwhichtherehasbeenthemostexperienceis
amphotericinB
Sideeffects
includehepatotoxicity,seizures,angioedema,Stevens-
Johnsonsyndrome,agranulocytosis,nausea,vomiting,headache,
rash,dizziness,diarrhea,dyspepsia,andtastechanges.
DrugInteractions
................
Clinicallysignificanthypoglycemiamayresultfromtheuseof
withoralhypoglycemicagentsincludingdeath.
InternationalBrandName—
Alcobon(England,Ireland,Israel,NewZealand,SouthAfrica);Ancotil
(Australia,Austria,Bulgaria,CzechRepublic,Denmark,England,France,HongKong,Ireland,Italy,Japan,Malaysia,
Severefungalinfection—50-150mg/kgPOqdin4divideddoses
—hypersensitivitytodrugorclass
—hepaticorrenaldysfunction,bonemarrow
MaternalConsiderations
.....
Therearenoadequatereportsorwell-controlledstudiesof
inpregnantwomen.Ithasbeenusedduring
pregnancyforthetreatmentofcryptococcalmeningitisand
pneumonia,and
septicemia.Thesystemicantifungal
drugwithwhichtherehasbeenthemostexperienceis
amphotericinB.
Sideeffects
includecardiacorrespiratoryarrest,ventricular
dysfunction,GIbleeding,renalfailure,agranulocytosis,aplastic
anemia,thrombocytopenia,N/V,chestpain,dyspepsia,rash,
itching,abdominalpain,diarrhea,ataxia,headache,paresthesias,
hallucinations,hypoglycemia,hypokalemia,anddizziness.
InternationalBrandName—
Astonin(Spain);AstoninH(Austria,CzechRepublic,Germany,Hungary);
Cortineff(Bulgaria,Poland);Floricot(India);Florinef(Canada,Chile,Denmark,England,Finland,Greece,HongKong,
Adrenalinsufficiency—0.1-0.2mgPOqd
Posturalhypotension—0.1-1mgPOqd
—hypersensitivitytodrugorclass,systemic
fungalinfection
Estrogensincreasethelevelofcorticosteroid-bindingglobulin,
thusincreasingtheboundfraction.Areductionincorticosteroid
dosagemayberequiredwhenestrogenisinitiated,andincreased
amountswhenestrogenisterminated.
.........................
Benzodiazepinesedationoroverdosereversal—0.2mgIVqmin
prn;max5dosesforreversalofsedation,3mgforoverdose
NOTE:watchforre-sedation.
—hypersensitivitytodrugorclass,mixed
overdose,TCAoverdose
—seizures,alcoholism,psychiatricillness
MaternalConsiderations
.....
Therearenoadequatereportsorwell-controlledstudiesof
inpregnantwomen.Thepublishedliteratureis
limitedtocasereportswhereitwasusedsuccessfullyforthe
treatmentofbenzodiazepineoverdoseduringpregnancy.
Sideeffects
includewithdrawalsyndrome,seizures,arrhythmias,
dizziness,N/V,sweating,blurredvision,headache,bradycardiaor
DrugInteractions
................
Cautionisnecessarywhenusing
flumazenil
inpatientswithmixed
drugoverdosagesincethetoxiceffects(e.g.,convulsionsandcardiac
dysrhythmias)oftheotherdrugs(especiallycyclicantidepressants)
mayemergewiththereversalofthebenzodiazepine.
Notrecommendedinepilepticpatientswhohavebeenreceiving
chronicbenzodiazepinetreatmentwheretheabruptsuppression
oftheprotectiveeffectofabenzodiazepineagonistcangiverise
toconvulsions.
Theeffectsofnonbenzodiazepineagonistsonthebenzodiazepine
receptors,suchaszopiclone,triazolopyridazines,andothers,are
alsoblockedby
.........................
DixonJC,SpeidelBD,DixonJJ.ActaPaediatr1998;87:225-6.
ShibataT,KubotaN,YokoyamaH.Masui1994;43:572-4.
StahlMM,SaldeenP,VingeE.BrJObstetGynaecol1993;100:185-8.
...........................
PregnancyCategory:C
LactationCategory:U
shouldbeusedduringpregnancyandlactation
onlyifthebenefitjustifiesthepotentialperinatalrisk.
—(AeroBid;Nasalide;Nasarel)
InternationalBrandName—
Bronalide(Canada);Bronilide(France);Flunase(Israel);Flunitec(Argentina,
Brazil,Peru,Uruguay);Gibiflu(Italy);Inhacort(Germany);Locasyn(Denmark);Lokilan(Norway);LokilanNasal(Finland,
Sweden);Lunibron-A(Italy);Lunis(Italy);Nasalide(France);Nasarel(India);Rhinalar(Canada);Sanergal(Slovenia);
Synaclyn(Japan);Syntaris(Austria,Bahrain,Belgium,Bulgaria,CzechRepublic,England,Germany,Hungary,Ireland,
Asthmaprophylaxis—2puffsINHbid(approx50mcg/puff)
Allergicrhinitis—2sprays/nostrilbidortid
—hypersensitivitytodrugorclass,status
asthmaticus,respiratoryinfection
MaternalConsiderations
.....
Thereisnopublishedexperiencewith
pregnancy,thoughinhaledcorticosteroidsareacornerstoneof
asthmatherapy.Theyareusedwidelyduringpregnancywithout
apparentadverseeffects.
Sideeffects
includeadrenalinsufficiency,N/V,diarrhea,
headache,sorethroat,nasalcongestion,dyspepsia,flu-like
symptoms,palpitations,abdominalpain,anorexia,peripheral
edema,dizziness,cough,eczema,andhypertension.
Steroid-responsivedermatitis—applytoaffectedareabidorqid
NOTE:0.01%or0.025%cream,ointment,orsalve.
—hypersensitivitytodrugorclass
MaternalConsiderations
.....
Thereisnopublishedexperiencewith
Sideeffects
includeadrenalinsufficiency,irritation,burning,
itching,dryness,folliculitis,hypertrichosis,acne,
hypopigmentation,skinatrophy,andstriae.
.........................
Thereisnopublishedexperienceinpregnancyorduring
...........................
PregnancyCategory:C
LactationCategory:U
shouldbeusedduringpregnancyandlactation
onlyifthebenefitjustifiesthepotentialperinatalrisk.
InternationalBrandName—
Actino-Hermal(Germany);Adrucil(Canada);Efudex(Canada);Efudix(Argentina,
Belgium,Bulgaria,CostaRica,CzechRepublic,DominicanRepublic,ElSalvador,England,France,Germany,Ghana,
Malignancy—Dependsontumorandprotocol
NOTE:availableinatopicalpreparationforthetreatmentofbasal
cellcarcinoma.
—hypersensitivitytodrugorclass,
myelosuppression,seriousinfection,recentsurgery
—hepaticorrenaldysfunction,prioruseofalkylating
agents,CAD
MaternalConsiderations
.....
Therearenoadequatereportsorwell-controlledstudiesof
inpregnantwomen.
ismostcommonly
usedduringpregnancyinthe2ndand3rdtrimestersforthe
craniofacialregionandlimbsaremostcommon.Thepattern
appearstobedirectlyrelatedtotheageatanddurationof
exposure,ratherthantothespecificdrugitself.
Depression—begin20mgPOqd(in
);increaseasneeded
afterseveralweeksto60mgqd
Premenstrualdysphoricsyndrome—20mgPOqd;max80mg/d
Obsessive-compulsivedisorder—begin20mgPOqd;increaseas
neededafterseveralweeksto80mg
Bulimia—60mgPOqd
—hypersensitivitytodrugorclass,useof
anMAOIwithin14d
—hepaticorrenaldysfunction,seizurehistory,
suicidethreat
MaternalConsiderations
.....
Depressioniscommonduringandafterpregnancy,buttypically
goesunrecognized.Pregnancyisnotareason
apriori
discontinuepsychotropicdrugs.A
resultsinrelativelylowtrough
Postpartumbreastengorgement—2.5mgPO
1shortlyafter
delivery,then5-10mgPOqd
Breastcancer,palliation—10-40mgPOqd
—hypersensitivitytodrugorclass,breast
cancer,hepaticorrenaldysfunction,pregnancy
MaternalConsiderations
.....
Thereisnopublishedexperiencewith
pregnancy.Therearenorecognizedindicationsforitsuseduring
Sideeffects
includepolycythemia,livertumors,menstrual
irregularities,hirsutism,acne,electrolyteimbalance,libido
changes,headache,deepenedvoice,anddyspepsia.
Psychosis—begin12.5-25mgIM;responsewithin12-96h,dose
NOTE:alsoavailableasfluphenazineenanthate,whichhasaneven
longerdurationofaction.
—hypersensitivitytodrugorclass,CNS
depression,bonemarrowdepression,severehypotension,
—hepaticdysfunction,seizuredisorder,myasthenia
gravis,Parkinson’sdisease,severeCVdisease
MaternalConsiderations
.....
isalong-actingparenteralantipsychotictypically
cationradicalbyhumanplacentalperoxidasemaybeone
mechanismofdevelopmentaltoxicity.
Steroid-responsivedermatitis—applytoaffectedareaqd/qid
NOTE:availableas0.025%or0.05%incream,ointment,orlotion;
maybecombinedwith
—hypersensitivitytodrugorclass
MaternalConsiderations
.....
Therearereportsof
useduringpregnancy.
Sideeffects
includeadrenalsuppression,burning,itching,
dryness,acne,hypopigmentation,hypertrichosis,andcontact
Insomnia—15-30mgPOqh
—hypersensitivitytodrugorclass,
—hepaticorpulmonarydysfunction,sleepapnea
MaternalConsiderations
.....
Therearenoadequatereportsorwell-controlledstudiesof
inpregnantwomen.Thereareotherhypnoticsonthe
DrugInteractions
................
Phenothiazines,narcotics,barbiturates,MAOIs,andother
antidepressantsmaypotentiatetheactionof
Dysmenorrhea—begin100mgPO
1,then50-100mgPObid
ortid
Osteoarthritis—50-100mgPObidortid
Analgesia(mildtomoderatepain)—begin100mgPO
1,then
50-100mgPObidortid
—hypersensitivitytodrugorclass,
ASA/NSAID-inducedasthma
—hypertension,historyofGIbleeding,CHF,nasal
MaternalConsiderations
.....
isanonselectiveCOXinhibitorwithanalgesic,
hepatotoxicity,agranulocytosis,dyspepsia,nausea,abdominal
pain,dizziness,headache,rash,urticaria,increasedLFTs,fluid
—(Cutivate;Flonase;FlonaseAq;Flovent;
Flunase;Zoflut)
InternationalBrandName—
Allegro(Israel);AtemurMite(Germany);BeconaseAllergy24Hour(Australia);
Cutivat(Denmark);Cutivate(Argentina,Austria,Belgium,Bulgaria,Colombia,CostaRica,CzechRepublic,Dominican
Republic,Ecuador,ElSalvador,England,Guatemala,Honduras,HongKong,Hungary,Indonesia,Ireland,Korea,
Asthmaprophylaxis—begin88mcgbidifonbronchodilator
alone;max880mcgbid,tapertolowesteffectivedose
NOTE:availableas44-,110-,220mcg/puff;alsoavailableforINand
topicaluse;maybecombinedwith
womenwhohaveasthma.Lessthan0.1%ofaninhaleddose
crossestherodentplacenta.
Hypercholesterolemia—begin20mgPOqh;max40mgbid
Mixeddyslipidemia—begin20mgPOqh;max40mgbid
Secondarypreventionofcardiacevents—begin20mgPOqh;max
40mgbid
NOTE:checkLFTsafter3mooruponincreasingdose.
—hypersensitivitytodrugorclass,active
hepaticdisease
—hepaticorrenaldisease,alcoholabuse
MaternalConsiderations
.....
)and
continuetobemonitoredappropriatelywhentheir
doseisincreasedto40mgbid.
Obsessive-compulsivedisorder—beginat50mgPOqh;increase
by50mgq3-4d;max300mg/d
NOTE:tapergraduallyifdiscontinued.
—hypersensitivitytodrugorclass,
concurrentorrecentuseof
astemizole,cisapride,terfenidine,
oranMAOIwithin14d
—CVdisease,suiciderisk,seizuredisorder
MaternalConsiderations
.....
Therearenoadequatereportsorwell-controlledstudiesof
inpregnantwomen.Itischemicallyunrelatedtothe
otherSSRIs.Thefewpublishedcasereportssuggestnoadverse
effectswhenusedatrecommendeddoses.
Sideeffects
includeseizures,bradycardia,hepatictoxicity,toxic
epidermalnecrosis,withdrawalsyndrome,N/V,constipation,
agitation,headache,sweating,flatulence,andpalpitations.
malformationsbutdoincreasetheriskofspontaneousabortion.
However,newbornsexposedtoSSRIantidepressantstowardthe
endofpregnancycanshowsignsofagitation,alteredmuscle
tone,andbreathing.Theseneonatalsymptomshavebeennoted
observationofthepatientisadvisediftreatmentwith
andanSSRI(e.g.,
Folicacid
Pregnancysupplementation—0.8-1mgPOqd
PreventionofrecurrentNTDs—5mgPOqdpriortoconception
Megaloblasticanemia—0.4mgPOqd
4-5d;max1mg/d
NOTE:availableinPOorparenteralforms.
—undiagnosedanemia
MaternalConsiderations
.....
SuboptimalpreconceptionfolateandvitaminB
especiallywhencombined,mayincreasetheriskofspontaneous
abortion.Womenwhobecomepregnantbeforefolaterestoration
.........................
AntonyAC.AmJClinNutr2007;85:598S-603S.
breastmilk.However,itisunlikelyapatientrequiringtreatment
willbreastfeedduringthatperiod.
DrugInteractions
................
Oraldosesof
(10-20mg/kg),viaalcoholdehydrogenase
DVTprophylaxisforhipreplacement—2.5mgSCqdfor5-10d
beginning6-8hpostsurgery
DVTprophylaxisforkneereplacement—2.5mgSCqdfor5-10d
beginning6-8hpostsurgery
DVTprophylaxisafterhipfracturesurgery—2.5mgSCqdfor5-
10dbeginning6-8hpostsurgery
NOTE:monitorrenalfunctionandCBC;avoidregionalanesthesia
within24h.
—hypersensitivitytodrugorclass,active
bleeding,weight
50kg,CrCl
30ml/min,thrombocytopenia
routinehemostaticmonitoring.Attherapeuticconcentrations
DosagewithQualifiers
.......
Asthmaprophylaxis—12mcgINHq12h
Treatmentofexercise-inducedasthma—12mcgINH15-30min
priortoexercise;mayrepeatq12hprn,max24mcg/d
COPDmaintenance—12mcgINHq12h;max24mcg/d
—hypersensitivitytodrugorclass,acute
Acyclovir-resistantHSV—40mg/kgIVgivenover1hq8hfor2-3w
Acutecystitis—3gPO
—sensitivitytodrugorclass
—hepaticdysfunction
MaternalConsiderations
.....
isanorallyactive,broad-spectrumbactericidalagent
thathastheadvantageofsingle-doseadministration.Inseveral
controlledtrialsconductedinpregnantwomen,itwassimilarin
efficacytoothercommonlyusedagents.
Sideeffects
includediarrhea,vaginitis,N/V,headache,weakness,
dizziness,anddyspepsia.
InternationalBrandName—
Acenor-M(Indonesia);BPNorm(Philippines);Dynacil(Germany);Fosinil
(Belgium);Fosinorm(Germany);Fosipres(Italy);Fositen(Portugal,Switzerland);Fositens(Austria,Spain);Fovas(India);
Fozitec(France);Monopril(Australia,Brazil,Canada,Chile,China,Colombia,CostaRica,Denmark,Ecuador,
ElSalvador,Greece,Guatemala,Honduras,HongKong,Hungary,Korea,Malaysia,Mexico,Nicaragua,Panama,
Hypertension—begin10mgPOqd;max80mg/d;lowerdose
CHF—begin10mgPOqd;max80mg/d
AcuteMI—10-20mgPOqd
Nephropathy—20mgPOqd
NOTE:renaldosing;mayalsobecombinedwith
—hypersensitivitytodrugorclass,hereditary
orACE-relatedangioedema,pregnancy
—renalarterystenosis,severeCHF,renaldysfunction,
.........................
Statusepilepticus—15-20mg
equivalents/kgIV
Seizuredisorder—load10-20mg
equivalents/kgIV/IM,
then4-6mg
equivalents/kgIV/IM
Seizureprophylaxisbeforeneurosurgery—load10-20mg
equivalents/kgIV/IM,then4-6mg
equivalents/kgIV/IM
NOTE:therapeuticlevel10-20mcg/ml.
—hypersensitivitytodrugorclass,sinus
bradycardia,2ndor3rddegreeAVblock,SAblock
—hypotension,hepaticorrenaldysfunction,CV
Themostsignificantdruginteractionsfollowingadministrationof
areexpectedtooccurwithdrugsthatinteractwith
phenytoin(see
Monitoringofplasma
concentrationsmaybehelpful
whenpossibledruginteractionsaresuspected.
.........................
Thereisnopublishedexperienceinpregnancyorduring
lactation.(See
...........................
PregnancyCategory:D
LactationCategory:NS
Functionallyequivalentto
shouldbeusedduringpregnancyandlactation
onlyifthebenefitjustifiesthepotentialperinatalrisk.
InternationalBrandName—
Allegro(Germany);Migard(England,Ireland)
DrugClass
..........................
.........................
.........................
Selective5-HT
DosagewithQualifiers
.......
Migraine—2.5mgPO
1,mayrepeatafter2h;max7.5mg/24h
—hypersensitivitytodrugorclass,CAD,
CVdisease,PVD,ischemicboweldisease,uncontrolled
hypertension,hemiplegicorbasilarmigraine,useofanergot
or5-HT
agonistwithin24h.
—cardiacriskfactors
MaternalConsiderations
.....
Thereisnopublishedexperiencewith
Sideeffects
includeacuteMI,coronaryvasospasm,arrhythmias,
subarachnoidhemorrhage,hypertensivecrisis,stroke,
bowelischemia,dizziness,fatigue,flushing,paresthesias,
drymouth,bonepain,dyspepsia,neckorjawtightness,and
chestpressure.
clinicallywarranted,appropriateobservationofthepatientis
.........................
Thereisnopublishedexperienceinpregnancyorduring
...........................
PregnancyCategory:C
LactationCategory:U
shouldbeusedduringpregnancyandlactation
onlyifthebenefitjustifiesthepotentialperinatalrisk.
InternationalBrandName—
Enterocodil(Brazil);Furapill(Ecuador);Furion(Thailand);Furoxona
(Chile,Colombia,Mexico,Peru,Venezuela);Furoxone(Philippines);Giardil(Argentina)
DrugClass
..........................
Antibiotics;Antiprotozoals;Nitrofurans
.........................
Bacterialinfection
.........................
Interfereswithenzymesystems
DosagewithQualifiers
.......
Bacterialinfection—100mgPOqid
—hypersensitivitytodrugorclass,useofan
MAOIwithin2w,alcoholuse
—G6PDdeficiency
MaternalConsiderations
.....
InternationalBrandName—
Aldic(Thailand);Anfuramaide(Taiwan);Apo-Frusemide(NewZealand);
Pulmonaryedema—beginat40mgIV
1slowly,assessresponse;
mayincreaseto80mgIVq1hprn
Peripheraledema—20-80mgPOqdtobid;max600mgqd
Hypertension—40mgPObid;max600mgqd
Hypercalcemia—80-100mgIVq1-2h,or120mgPOqd
—hypersensitivitytodrugorclass,
hypersensitivitytosulfonamides,anuria,hepaticcoma,
electrolyteimbalance
pancreatitis,jaundice,SLEexacerbation,vasculitis,erythema
multiforme,hemolyticanemia,dizziness,N/V,weakness,cramps,
hyperuricemia,hyperglycemia,tinnitus,paresthesias,and
InternationalBrandName—
Dineurin(Chile);Gabatin(Korea);Gantin(Australia);Kaptin(Colombia);
Neurontin(Austria,Belgium,Canada,CzechRepublic,England,Finland,France,Germany,Greece,HongKong,
Hungary,India,Indonesia,Ireland,Italy,Kenya,Korea,Malaysia,Norway,Philippines,Poland,Singapore,SouthAfrica,
Spain,Sweden,Switzerland,Taiwan,Thailand,Uruguay,Venezuela);Nupentin(Australia);Pendine(Australia)
DrugClass
..........................
.........................
Seizures(partial)—begin300mgPOqd
1d,thenbid
1d,then
tid;usualmaintenance1800-2400mgqd;max3600mg/d
Neuropathicpain—begin300mgPOqd
1d,thenbid
1d,then
tid;max3600mg/d
NOTE:renaldosing.
—hypersensitivitytodrugorclass
—renaldysfunction,abruptwithdrawal
MaternalConsiderations
.....
isa2nd-generationanticonvulsantusedmainlyasan
adjunct.Whilethereislittlepublishedexperienceduring
pregnancyandlactation,thelimitedstudyavailablesuggestsa
Inoneseries,theM:Pratiowas1.0(range,0.7-1.3)from2wto
3mo.Theinfantdosewasestimatedat0.2-1.3mg/kg/day,
equivalentto1.3-3.8%oftheweight-normalizeddosereceivedby
themother.Thus,thedrugisabsorbedbytheneonate.Theplasma
concentrationinthebreastfedinfantswasapproximately12%of
themother’splasmalevel,butnoadverseeffectswereobserved.
Absentalargerexperience,theinfantshouldbemonitoredfor
possibleadverseeffects,thedruggivenatthelowesteffectivedose,
andbreastfeedingavoidedattimesofpeakdruglevels.
DrugInteractions
................
appearstoincrease
absorptionby12-15%.
andAUCvaluesina
dose-dependentmanner.
mayincreasethemean
MRI—0.2ml/kgat1-2ml/sec(alternatively0.1mmol/kg)
—hypersensitivitytodrugorclass
—hemolyticanemia,renalinsufficiency
MaternalConsiderations
.....
Thereisnopublishedexperiencewith
Sideeffects
includebodydiscomfort,headache,abdominalpain,
asthenia,backpain,flushing,N/V,diarrhea,dyspepsia,dizziness,
paresthesias,rhinitis,andtastealteration.
Alzheimer’sdementia—begin4mgPObid;increaseby4mgbid
q4wtoamaxof12mgbid
NOTE:renalandhepaticdosing.
—hypersensitivitytodrugorclass
—pepticulcerdisease,cardiacconductiondefects,
seizuredisorder,asthma,COPD,hepaticorrenaldysfunction
MaternalConsiderations
.....
Thereisnopublishedexperienceinpregnancy.Inlightofthe
naturalhistoryofAlzheimer’sdisease,
isunlikelyto
berequiredduringpregnancy.
Sideeffects
includeAVblock,bradycardia,arrhythmias,seizures,
urinaryobstruction,N/V,diarrhea,anorexia,dizziness,dyspepsia,
fatigue,depression,insomnia,abdominalpain,rhinitis,tremor,
syncope,andhematuria.
higherthanthoseusedclinically.
hasthe
therapeuticpotentialtoprotectthebrainfromglutamatetoxicity.
...........................
PregnancyCategory:C
LactationCategory:S
shouldbeusedduringpregnancyandlactation
onlyifthebenefitjustifiesthepotentialperinatalrisk.
InternationalBrandName—
Bonoq(Germany);Bonoq-Uro(Germany);Gaticin(Indonesia);Gatiflo(Korea);
Starox(Chile);Tequin(Argentina,Brazil,Canada,Indonesia,Malaysia,Mexico,Philippines,Singapore,SouthAfrica,
Thailand);Zymar(Singapore,Thailand);Zyquin(India)
DrugClass
..........................
Antibiotics;Quinolones
.........................
Bacterialinfection;uncomplicatedgonorrhea
.........................
Bactericidal—inhibitsDNAgyraseandtopoisomeraseIV
DosagewithQualifiers
.......
Bacterialinfections—200-400mgPO/IV(infuseover60min)qd
Uncomplicatedgonorrhea—400mgPO
NOTE:renaldosing.
—hypersensitivitytodrugorclass,
prolongedQTinterval
—CVdisease,proarrhythmiccondition,concurrent
classIA,IIIantiarrhythmicagents
MaternalConsiderations
.....
isawell-absorbedoralquinolone.Thereisno
publishedexperiencewith
duringpregnancy.
Sideeffects
includepseudomembranouscolitis,superinfection,
vaginitis,increasedICP,seizures,tendinitis,toxicpsychosis,N/V,
diarrhea,abdominalpain,headache,dyspepsia,dizziness,light-
...........................
PregnancyCategory:C
LactationCategory:U
shouldbeusedduringpregnancyandlactation
onlyifthebenefitjustifiesthepotentialperinatalrisk.
Thereareotheragentswithmoreexperienceandahigher
Hypertriglyceridemia—600mgPObid30minac
Hypercholesterolemia—600mgPObid30minac
—hypersensitivitytodrugorclass,
gallbladderdisease,
use,hepaticdysfunction
—renaldysfunction,usewithotherstatins-classagents
MaternalConsiderations
.....
Therearenoadequatereportsorwell-controlledstudiesof
inpregnantwomen.Hyperlipidemiaisachronic
illness.Discontinuationoftherapyduringpregnancyisinmost
instancesunlikelytoalterthelong-termoutcome.Casereports
documentuncomplicateduseof
inpregnantwomen
witheitherhypertriglyceridemiaorfamilialchylomicronemiaor
complicationsthereof.
Sideeffects
includemyositis,cholelithiasis,cholestaticjaundice,
thrombocytopenia,anemia,rhabdomyolysis,acuteappendicitis,
atrialfibrillation,increasedLFTs,elevatedCPK,N/V,dyspepsia,
abdominalpain,diarrhea,andfatigue.
—(Garamycin;Genoptic;Gentacidin;Gentak;
G-Myticin;Ocu-Mycin)
InternationalBrandName—
Adelanin(Philippines);Alcomicin(Belgium,Canada,Indonesia,Israel,
SouthAfrica,Thailand);Apigent(Israel);Azupel(Paraguay);Bactiderm(Philippines);Biogaracin(India);Cidomycin
(England,Ireland,Israel,Malaysia,PuertoRico,SouthAfrica);Danigen(Indonesia);Dermogen(Malaysia);
Diakarmon(Greece,Israel,SouthAfrica);Dispagent(Uruguay);Epigent(Israel);Fermentmycin(SouthAfrica);
Garabiotic(Indonesia);Garalone(Portugal);Garamicin(Thailand);Garamicina(Brazil,Colombia,CostaRica,
DominicanRepublic,Ecuador,ElSalvador,Guatemala,Honduras,Mexico,Nicaragua,Panama);GaramicinaCream
(Colombia);GaramicinaCrema(Ecuador,Mexico);GaramicinaOftalmica(Colombia,CostaRica,DominicanRepublic,
Ecuador,ElSalvador,Guatemala,Honduras,Mexico,Nicaragua,Panama);Garamycin(Australia,Bulgaria,Canada,
Bacterialinfection—1-3mg/kg/din3divideddosestoachievea
peak5-10mcg/mlandtrough
Endocarditisprophylaxis—1.5mg/kgIV30-60minpriortothe
NOTE:renaldosing;availableforparenteral,topical,orophthalmic
—hypersensitivitytodrugorclass
—renaldysfunction,nephrotoxicagents,cochlear
implant,myastheniagravis
MaternalConsiderations
.....
N/V,rash,pruritus,weakness,tremor,musclecramps,anorexia,
edema,headache,diarrhea,dyspepsia,tinnitus,andelevated
RelapsingMS—20mgSCqd
—hypersensitivitytodrugorclass,
hypersensitivityto
MaternalConsiderations
.....
Thereisnopublishedexperiencewith
pregnancy.Asaresult,most"experts"recommenddiscontinuing
priortoconception.
Sideeffects
includeinjectionsitereactions,transientchestpain,
backpain,flu-likesymptoms,erythema,infection,asthenia,
MaternalConsiderations
.....
Therearenoadequatereportsorwell-controlledstudiesof
inpregnantwomen.Thepublishedexperienceis
limitedtocasereports.
Sideeffects
includehypoglycemia,pancytopenia,
thrombocytopenia,aplasticanemia,dizziness,asthenia,nausea,
andheadache.
—(Glucotrol;GlucotrolXL;Minidab)
InternationalBrandName—
Aldiab(Indonesia);Apamid(Thailand);Beapizide(Singapore);Decose(Taiwan);
Depizide(Thailand);Diabes(Taiwan);Diasef(HongKong,Singapore);Dibizide(Malaysia);Digrin(Korea);Dipazide
topical,orvaginalpreparationsof
isnotknown.
Thereisalsoapotentialinteractionof
withinhibitors
)andinducers(e.g.,
)ofCYP2C9.
Theeffectof
wasdemonstratedinaplacebo-
controlledcrossoverstudyofnormalvolunteers.Theincreasein
AUCafter
was56.9%.
.........................
Hypoglycemia,severe—0.5-1mgIV/IM/SC
1;mayrepeatin25min
—insulinoma,pheochromocytoma
MaternalConsiderations
.....
Therearenoadequatereportsorwell-controlledstudiesin
pregnantwomen.Thereis,however,along,reassuringclinical
experienceof
thepatientshouldbeobservedcloselyfor
hypoglycemia.Thepatientshouldbeobservedcloselyforlossof
controlafterwithdrawalofsuchdrugs.
Certaindrugstendtoproducehyperglycemiaandmayleadto
lossofcontrol.Thesedrugsincludethethiazidesandother
DosagewithQualifiers
.......
Constipation—1adultsuppositoryPRprn
—hypersensitivitytodrugorclass,anuria,
hypovolemia,pulmonaryedema
—abdominalpain,hepaticorrenaldysfunction
MaternalConsiderations
.....
Therearenoadequatereportsorwell-controlledstudiesof
inpregnantwomen.Maternalrisksarerelatedtoabuse
oftheproduct.
Sideeffects
includediarrhea,headache,nausea,andrectalirritation.
Pepticulcerdisease—1-2mgPObidortid;alternative0.1-2mg
IV/IMtidorqid
Anesthesiaadjunct—begin0.004mg/kgIM30-60minbefore
Neuromuscularblockadereversal—0.01mg/kg,max1mgIVfor
each1mg(0.07mg/kg;max5mgatatime)of
—hypersensitivitytodrugorclass,
glaucoma,GIobstruction,ileus,myastheniagravis,ulcerative
colitis,unstableCVsystem
—hepaticdysfunction
MaternalConsiderations
.....
reducesnauseaafterspinalanesthesiainpregnant
women.Italsoreducestheprevalenceofhypotensionafter
epiduralanesthesiainwomenwithnormalHRstoasimilar
degreeas
Itmayincreasetheriskofsignificant
tachycardiawhengivenwitha
insomnia,weakness,palpitations,dizziness,headache,confusion,
andabdominalpain.
Rheumatoidarthritis—begin10mgIMqw
1,25mgIMqw
then25-50mgIMforanadditional10w
—hypersensitivitytodrugorclass,
—granulocytopeniaoranemiasecondarytodrug
reaction,skinrash,hepaticorrenaldysfunction,moderateto
severehypertension,compromisedCVorcerebralcirculations
MaternalConsiderations
.....
Therearenoadequatereportsorwell-controlledstudiesof
sodiumthiomalate
inpregnantwomen.Itisimportantto
performaurinalysisbeforeeachinjectionbecauseoftheriskof
maternalrenaltoxicity.
Sideeffects
includepruritus,exfoliativedermatitis,oral
SevereN/Vofchemotherapy—10mcg/kgIVover5min,or2mg
POqd
SevereN/Vofradiationtherapy—2mgPOqdbeginningwithin
30minoftherapy
ProphylaxisforpostoperativeN/V—2-4mgIV
—hypersensitivitytodrugorclass
MaternalConsiderations
.....
N/Vafterspinalanesthesiaiscommonanddistressing.
—(Brofulin;FulvicinU/F;Fulvina;Grifulin;
GrifulvinV;Grisactin;GrisactinUltra;GriseofulvinUltramicrosize;
Gris-Peg;Microfulvin;Microgris;Sporostatin;Taidin/FulvicinP/G;
Ultragris;UltramicrosizeGriseofulvin)
InternationalBrandName—
Fulcin(Brazil,Bulgaria,Ecuador,Peru);FulcinForte(Mexico);Fungin(Thailand);
Tineacorporis—500mgPOqd
Tineacapitis—500mgPOqd
Tineacruris—500mgPOqd
Tineapedis—750-1000mgPOin2divideddoses
Tineaunguium—750-1000mgPOin2divideddoses
NOTE:micronizeddoselisted,500mg=330mgultramicronized;
avoidprolongedexposuretosunlight.
—hypersensitivitytodrugorclass,porphyria
—penicillinallergy,hepaticdysfunction
MaternalConsiderations
.....
Therearenoadequatereportsorwell-controlledstudiesin
pregnantwomen.Plasmaconcentrationsofcontraceptivesteroids
aredecreasedby
whichstimulatestheirhepatic
activityandmaynecessitateraisingthe
Mayreducetheefficacyoforalcontraceptivesandincreasethe
incidenceofbreakthroughbleeding.
Theeffectofalcoholmaybepotentiatedby
producingsucheffectsastachycardiaandflushing.
.........................
Coughsuppression—600-1200mgPOqd;max2400mg/d
Expectorant—200-400mgPOq4h;max2400mg/d
humanplacenta.Unfortunately,limitedepidemiologicstudy
providesnohelpinestimatingtheriskof
teratogenicitystudieshavenotbeenperformed.
Hypertension—begin2-4mgPObid;increaseby4-8mg/dq1-2w;
max32mgPObid
—hypersensitivitytodrugorclass
—hepaticorrenaldysfunction
MaternalConsiderations
.....
Thereisnopublishedexperiencewith
Sideeffects
includesedation,arrhythmias,AVblock,rebound
hypertension,dizziness,weakness,headache,N/V,diarrhea,
constipation,chestpain,bradycardia,edema,andrash.
...........................
PregnancyCategory:C
LactationCategory:U
shouldbeusedduringpregnancyandlactation
onlyifthebenefitjustifiesthepotentialperinatalrisk.
Therearemanyotherantihypertensiveagentsforwhichthere
isalargebodyofexperienceduringpregnancyandlactation.
Guanadrelsulfate
InternationalBrandName—
Noneidentified.
DrugClass
..........................
Adrenergicantagonists,peripheral;Antihypertensives
.........................
.........................
InhibitsNEreleasefromneuronalstoragesites
DosagewithQualifiers
.......
Hypertension—begin5mgPObid;adjustdoseweeklyuntila
maxof400mg/d
NOTE:renaldosing;tolerancemaydevelopafterchronicuse,
requiringanincreaseddose.
—hypersensitivitytodrugorclass,suspected
pheochromocytoma,recentorcurrentuseofanMAOI,CHF
—asthma,anticipatedmajorsurgery,pepticulcer
disease,renaldysfunction
MaternalConsiderations
.....
isanorallyactiveantihypertensivethatlowersboth
systolicanddiastolicpressure.Itistypicallyemployedasa
Hypertension,moderatetosevere:
Ambulatory—begin10mgPOqd,increaseq2-5dtoachieve
desiredcontrol
Hospitalized—begin25-50mgPOqd,increasingby25-50mgqd
NOTE:renaldosing;maybecombinedwith
orthiazide
Guanfacinehydrochloride
—(Entulic;Tenex)
InternationalBrandName—
Estulic(Belgium,CzechRepublic,Ecuador,France,Germany,Hungary,
Hypertension—1-3mgPOqhs
Migraineheadache—1mgPOqd
Heroinwithdrawal—0.03-1.5mgPOqd
NOTE:renaldosing.
—hypersensitivitytodrugorclass
—hepaticdysfunction,CAD,recentMI
MaternalConsiderations
.....
Therearenowell-controlledtrialsof
pregnancy.Itisnotgenerallyrecommendedforthetreatment
Haemophilusinfluenzae
HibTITER;OmniHIB;PedvaxHIB;ProHIBIT)
InternationalBrandName—
Act-HIB(Brazil,Canada,Chile,Ecuador,Korea,Paraguay,Peru,Uruguay);
HIBest(France,India);HibTITER(Austria,Belgium,Denmark,England,Germany,Ireland,Italy,NewZealand,
SouthAfrica,Switzerland);PedvaxHIB(Brazil,Canada)
DrugClass
..........................
.........................
Maternalsusceptibility
.........................
Immunizationtocapsularpolysaccharides
DosagewithQualifiers
.......
Haemophilusinfluenzae
Bsusceptibility—0.5mgIM
—hypersensitivitytodrugorclass,
hypersensitivitytodiphtheriavaccineorthimerosal,acute
febrileillness
MaternalConsiderations
.....
Haemophilusinfluenzae
conjugatevaccine
isacombinationof
capsularpolysaccharidespurifiedfromHIB;itprotectsonly
againsttheBstrain.Therearenoadequatereportsorwell-
controlledstudiesinpregnantwomen.Maternalimmunization
doesnotinterferewithsubsequentneonatalimmunization.
Haemophilusinfluenzae
conjugatevaccine
isnotcontraindicated
inwomenwithHIV.
Sideeffects
includeerythema,allergicreaction,andfever.
Dis2008;12:47-51.
NahmMH,GlezenP,EnglundJ.Vaccine2003;21:3393-7.
Halcinonidetopical
—(Dermalog;Halog;Halog-E)
InternationalBrandName—
Adcortin(Japan);Berodan(Korea);Cortilate(India);DermalogSimpleAl
(Mexico);Halciderm(CostaRica,ElSalvador,England,Guatemala,Honduras,Ireland,Italy,Nicaragua,Panama,Peru,
Switzerland);HalcidermCremaAl(CostaRica,DominicanRepublic,ElSalvador,Guatemala,Honduras,Nicaragua,
Panama);Halcimat(Germany);Halog(Austria,Brazil,Canada,Denmark,France,HongKong,India,Indonesia,
Norway,Venezuela);Volog(Israel,SouthAfrica,Turkey)
DrugClass
..........................
Corticosteroids,topical;Dermatologics
.........................
Steroid-responsivedermatitis
.........................
DosagewithQualifiers
.......
Steroid-responsivedermatitis—applytoaffectedareabidortid
NOTE:availableincream,ointment,salve,0.25%and0.1%.
—hypersensitivitytodrugorclass
MaternalConsiderations
.....
Thereisnopublishedexperiencewith
reducesscarformation.
Sideeffects
includeadrenalsuppression,burning,itching,contact
dermatitis,folliculitis,dryskin,acne,perioraldermatitis,
infection,andskinatrophy.
Steroid-responsivedermatitis—applyqdorbid;max50g/w
NOTE:availableincreamorointment.
—hypersensitivitytodrugorclass
MaternalConsiderations
.....
Thereisnopublishedexperiencewith
—(Einalon;Haldol;HaloperidolLactate;
Pacedol;Pericate;Seranase)
InternationalBrandName—
Alased(Greece);Aloperidin(Greece);Apo-Haloperidol(Canada,Malaysia);
Avant(Taiwan);Binison(Taiwan);Brotopon(Japan);Cereen(SouthAfrica);Cizoren(India);Depidol(India);Dores
(Indonesia);Dozic(England);Duraperidol(Germany);EinalonS(Japan);Govotil(Indonesia);Haldol(Austria,Belgium,
Brazil,Bulgaria,Chile,CostaRica,Denmark,DominicanRepublic,Ecuador,ElSalvador,England,France,Germany,
Psychosis—0.5-5mgPObidortid;max100mg/d;or2.5mg
IV/IMq4-8h
Acutepsychosis—0.5-50mgIV(slow,at5mg/min)
Inductionofanesthesia—typically0.5-3%(usuallyforchildren)
Maintenanceofanesthesia—typically0.5-1.5%
NOTE:consultspecialtytext.
—hypersensitivitytodrugorclass;historyof
malignanthyperthermia,halothane-inducedjaundice,or
—headinjury,hepaticdysfunction,arrhythmias,
prolongedQTinterval,increasedICP,pheochromocytoma,
myastheniagravis
MaternalConsiderations
.....
isahalogenatedinhalationalagentforwhichthereisa
longclinicalexperienceduringpregnancy.Itandrelated
—(HeparinFlush;HeparinLok-Pak;HeparinPorcine;
Hepflush;LiquaeminSodium;SodiumHeparin)
InternationalBrandName—
Beparine(India);Helberina(Mexico);Hepaflex(Finland,Norway);Hepalean
(Canada);Heparin(Austria,Bulgaria,CzechRepublic,England,Finland,Germany,Greece,Hungary,Israel,Norway,
SouthAfrica,Sweden,Switzerland);Heparina(Spain);HeparinaLeo(CostaRica,DominicanRepublic,ElSalvador,
Thromboembolicdisease(treatment)—80U/kgIV
1,then18U/
kg/hIVtoachieveanaPTT1.5-2
Thromboembolicdisease(prophylaxis)—5000USCbid1st
trimester,7500USCbid2ndtrimester,10,000USCbid3rd
Thrombophilias(prophylaxis)—dependsontypeandhistory
APLsyndrome—81mgPOqd
plus5000USCbid1st
trimester,7500USCbid2ndtrimester,10,000Ubid3rdtrimester
NOTE:mayneedtoadjustthedoseupformorbidobesity(
—hypersensitivitytodrugorclass,active
bleedingexceptDIC,vasculardamage,conductionanesthesia
—recentneuraxialanesthesia,severehypertension,
pepticulcerdisease,historyofGIbleeding,renaldysfunction
MaternalConsiderations
.....
consistsofsulfated,long-chainacidic
mucopolysaccharideswithMWsrangingfrom4000to30,000Da.
ThevariousLMWHsarederivatives.Eachisconsideredan
anticoagulantofchoiceduringpregnancy,isequallyeffective,and
hasasimilarriskprofile.Unfractionated
hasthe
principaladvantageoflowcost.Despitethelonghistoryof
clinicaluse,therearenoadequatereportsorwell-controlled
studiesinpregnantwomen.Perhapsthegreatestclinical
limitationisthedosevolumethatmustbeusedconsideringthe
relativelydiluteconcentrationsavailable.Therapeutic
heparinizationistheprophylaxisofchoiceforwomenwitha
mechanicalheartvalve.
Sideeffects
includehemorrhage,osteoporosis,thrombocytopenia,
hematoma,irritationatinjectionsite,ulceration,fever,chills,
itching,urticaria,andrhinitis.
DrugInteractions
................
Mayprolongtheone-stagePT.Waitatleast5hafterthelastIV
doseor24hafterthelastSCdosebeforebloodisdrawnforaPT
inwomenalsotaking
Aspirin,dextran,dipyridamole,hydroxychloroquine,ibuprofen,
HAVsusceptibility—1mlIM,repeat6-8molater
—hypersensitivitytodrugorclass,febrile
MaternalConsiderations
.....
HAVisapicornavirus,andthevaccineconsistsofinactivated
virus.Therearenoadequatereportsorwell-controlledstudiesin
pregnantwomen.Therearenoreportedadverseeffectsonmother
Thediseasecourseistypicallyunalteredbypregnancy,though
fulminanthepatitisisreportedinthe3rdtrimester.
Immunoglobulinisasafealternativeforshort-termprotection.
Sideeffects
includeanaphylaxis,localreaction,fever,rash,
pharyngitis,abdominalpain,arthralgia,elevatedCPK,myalgias,
lymphadenopathy,hypertonicepisode,photophobia,andvertigo.
Postexposureprophylaxis—0.06ml/kg(upto0.5ml)IMassoon
afterexposureaspossible(within24h)
MaternalConsiderations
.....
HepatitisBimmuneglobulin
ispreparedfrompooledplasma.
Womenwhomaybenefitfrominoculationincludethoseexposed
tohouseholdcontacts,aninfectedsexualpartner,andbloodfrom
infectedindividuals.
HepatitisBimmuneglobulin
iseffectivein
reducingperinataltransmissionofHBVtoneonatesbornto
HepatitisBvaccine,recombinant
RecombivaxHB)
InternationalBrandName—
Bio-Hep-B(Israel);Engerix-B(Argentina,Brazil,Canada,Chile,CostaRica,
DominicanRepublic,Ecuador,ElSalvador,Guatemala,Honduras,Mexico,Nicaragua,Panama,Paraguay,Peru,
SouthAfrica);EuvaxB(Korea);H-B-VaxII(England,Ireland,Mexico);HBvaxPRO(England,Ireland,NewZealand);
HeberbiovacHB(Mexico);HepavaxGene(Colombia);RecombivaxHB(Canada)
DrugClass
..........................
.........................
Maternalsusceptibility
.........................
Activeimmuneresponsetocapsularantigen
DosagewithQualifiers
.......
HBVsusceptibility—1mlIM;repeatatboth1moand6mo
—hypersensitivitytodrugorclass
MaternalConsiderations
.....
Recombinantvaccinesarebiotechnologicallyproduced,consisting
ofnonreplicatingantigens.
HepatitisBvaccine
appearssafeand
immunogenicduringpregnancy,andimmunizationmayhelp
InternationalBrandName—
Dermisan(Indonesia);pHisoHex(Canada)
DrugClass
..........................
Antiseptics;Dermatologics
.........................
Skinorwoundpreparation
.........................
Chemicalinactivation
DosagewithQualifiers
.......
Preoperativeskinpreparation—washaffectedarea30minpriorto
—hypersensitivitytodrugorclass
MaternalConsiderations
.....
isnotrecommendedduetonarrowspectrum
andtheriskofpercutaneousabsorption.Aphenol,itcanbe
neurotoxicathighconcentrations.Whilethewoundinfection
rateisreducedaftercleansing,andpreoperativeshowersreduce
—(Apresoline;Apresrex;Dralzine;Hyperex;
Ipolina;Naselin;Nepresol;Solezorin;Sulesorin;Supres;Zinepress)
InternationalBrandName—
Alphapress(Israel,NewZealand);Apdormin(Japan);Apresolin(Denmark,
Norway,Sweden,Turkey);Apresolina(Ecuador,Mexico,Portugal,Uruguay,Venezuela);Apresoline(Canada,
Hypertension(moderatetosevere)—begin10-50mgPOqid
2-4d,then25mgPOqid
1w;max100mgPOqid;alternatively,
5-40mgIV/IMq4-6h;forchronicuse,switchtoPOASAP
CHF—begin50-75mgPO
1,then50-150mgPOqid;max
NOTE:maybepackagedwith
—hypersensitivitytodrugorclass,CAD,
mitralvalvedisease
—renaldysfunction,CVdisease
MaternalConsiderations
.....
isoneofthemostwidelyuseddrugforthe
treatmentofacutehypertensionduringpregnancy.Womenwith
severepreeclampsiawhoseintravascularvolumeiscontractedare
atriskforhypotension.Theriskisamelioratedbythe
administrationofappropriateintravascularvolumepriorto
treatment.Itwassuggestedthattheincidenceofhypotensionis
increasedbythecontinuousinfusionof
butthat
amountingestedbythebreastfeedingneonateisclinically
DrugInteractions
................
MAOIsshouldbeusedwithcaution.
Profoundhypotensionmayoccurwhen
areinjectedconcomitantly.
Administrationwithfoodresultsinhigherplasmalevels.
.........................
Hypertension—12.5-50mgPOqd
Peripheraledema—25-200mgPOqd
NOTE:maybepackagedwith
irbesartan,lisinopril,losartan,
andmortality.
leadstopotassiumlossanda
transientreductioninintravascularvolumewhenfirstinitiated.
Thereafter,intravascularvolumerecovers.Thus,thiazidesshould
notbeinitiatedduringpregnancybutmaybecontinuedif
Whenindicated,themother’selectrolytesandhematocrit
shouldbemonitored.
Cough—5-10mgPOq6hprn
Acutepain—5-10mgPOq6hprn
NOTE:containshomatropine;mayalsobecombinedwith
ibuprofen,phenylephrine,phenylpropanolamine,
dependingonthe
Therearenoadequatereportsorwell-controlledstudiesin
pregnantwomen.Theanalgesiaproducedbycombinationwith
issuperiortothatachievedwith
Similarto
itseemsmoreeffectiveforthereliefof
uterinecrampingthanepisiotomypain.
Sideeffects
includedizziness,respiratorydepression,euphoria,
sedation,confusion,N/V,constipation,drymouth,urinary
DrugInteractions
................
Hasadditivedepressanteffectsifusedwithothernarcoticanalgesics,
.........................
DosagewithQualifiers
.......
Inflammatorydisorders—10-320mgPOqdin2-4divideddoses
Ulcerativecolitis—100mgqd
2-3w,thenqod
Statusasthmaticus—0.5-1mg/kgIM/IVq6h
Shock—0.5-2gIM/IVq2-6h
Steroid-responsivedermatitis—applycreambidtoqid
Pruritus—apply1%or2.5%creamthinlytoaffectedareatid
orqid
Adrenalinsufficiency—5-30mgPObidtoqid;max80mgPOqid
NOTE:availableinoral,parenteral,suppository,andtopical
preparations;maybecombinedwith
shouldbeusedcautiouslyinconjunctionwith
corticosteroidsinpatientssufferingfromhypoprothrombinemia.
Theeffectofcorticosteroidsonoralanticoagulationisvariable.
Coagulationindicesshouldbemonitoredtomaintainthedesired
anticoagulanteffect.
.........................
Pain(moderatetosevere)—begin1-2mgIV/IM/SCq4-6h,2-4mg
POq4-6h
Cough—1mgPOq3-4hprn
Conductionanesthesia—seespecialtytexts
NOTE:availableinparenteral,oral,andsuppositoryform.
—hypersensitivitytodrugorclass,increased
ICP,respiratorydepression
—hepaticorrenaldysfunction
MaternalConsiderations
.....
Recentstudysuggestsitandother
derivativescan
reducetotalestrogenlevelsbyinhibitingCYP19.
.........................
Hyperpigmentation—applybid;usesunscreen
—hypersensitivitytodrugorclass,
hypersensitivitytosulfites
MaternalConsiderations
.....
Therearenoadequatereportsorwell-controlledstudiesof
inpregnantwomen.Therearenoindicationsthat
requireuseduringpregnancy.Postpartum,itisoftenusedforthe
treatmentofmelasma.
Sideeffects
includecontactdermatitis,dryness,fissures,irritation,
andburning.
.........................
SLE,malariatreatmentandprophylaxis,rheumatoidarthritis
.........................
DosagewithQualifiers
.......
SLE—400mgPOqdorbid
Malariatreatment—begin800mgPObid
1,followed6-8hlater
by400mgPO,then400mgPOqd
Malariaprophylaxis—begin400mgPOqw
2wpriorto
exposure,continue4-6wafterexposure
Rheumatoidarthritis—begin400-600mgPOqd
4-12w,then
200-400mgPOqid
NOTE:takewithfoodormilk.
—hypersensitivitytodrugorclass,
porphyria,visualfieldchanges
MaternalConsiderations
.....
Therearenoadequatereportsorwell-controlledstudiesin
pregnantwomen.
reducesserumlipids,
includingcholesterol,triglycerides,andLDLs.Somerecommend
inpregnantwomenwith
connectivetissuediseases,eventhoughithaslongbeenusedfor
malarialprophylaxisduringpregnancyinmalaria-infestedareas.
Inonerandomizedtrial,
wasassociatedwith
asignificantreductioninthenumberofflareepisodesinwomen
withSLE.Thus,itmaybereasonabletocontinuethedrug
consideringtheterminaleliminationt/2maybeupto2mo,flares
...........................
PregnancyCategory:C
LactationCategory:S
shouldbeusedduringpregnancyand
lactationonlyifthebenefitjustifiesthepotentialperinatalrisk.
Theadditionalriskimposedby
pregnancyappearsmodest,andthedrugshouldnotbe
withheldwhennecessary.
—(Droxea;Hydrea)
InternationalBrandName—
Hydab(Philippines);Hydrea(Argentina,Belgium,Brazil,Canada,Chile,
Sicklecelldisease—15mg/kgPOqd,thenincrease5mg/kd/d
12w;max35mg/kg/d
Essentialthrombocythemia—15mg/kgPOqd;titratetocontrol
Polycythemiavera—500-1500mgPOqd
HIVinfection,adjuncttherapy—500mgPObid(usewithan
ResistantCML—20-30mg/kgPOqd
Solidtumors—80mg/kgPOq3d
—hypersensitivitytodrugorclass,bone
marrowdepression
—renaldysfunction,concurrentmyelosuppressiveagents
MaternalConsiderations
.....
Therearenoadequatereportsorwell-controlledstudiesof
hydroxyurea
inpregnantwomen.Publishedexperienceislimitedto
casereportsandsmallseriesofsicklecelldisease,thrombocythemia,
andleukemia.Thebeneficialeffectsof
hydroxyurea
onsicklecell
diseaseresultfromanincreaseinboththeintracellular
concentrationofHbFandthepercentageofHbF–containingRBCs,
improvingthehydrationandprolongingthelifespanoftheRBCs.
Inwomenwithessentialthrombocythemia,
hydroxyurea
reduces
thromboticeventsbutdoesnotincreasesurvival.Thepublished
clinicalexperiencesuggeststheriskof
hydroxyurea
duringhuman
pregnancymaybegreatlyoverestimated.
Sideeffects
includebonemarrowsuppression,anemia,
thrombocytopenia,leukopenia,leukemia,pulmonaryfibrosis,
dermatomyositis,stomatitis,anorexia,N/V,diarrhea,
constipation,erythema,dysuria,headache,dizziness,
hallucinations,seizures,alopecia,anddermatitis.
andimpairedlearninginrats.However,thehumanexperience
suggeststheriskofteratogenicityissomewhatoverestimated.
Pruritus—25-100mgPOq6-8hprn
N/V—25-100mgIMq4-6hprn;max600mg/d
Sedationadjunct—25-100mgIM
Insomnia—50-100mgPOqhs
NOTE:donotgiveIV.
—hypersensitivitytodrugorclass
MaternalConsiderations
.....
Therearenoadequatereportsorwell-controlledstudiesin
pregnantwomen.
remainsafirst-lineagentforthe
treatmentofpruritusandnauseaduringpregnancy.Itisoften
administeredwithnarcoticagentstoreducethefrequencyof
reducesthepruritusassociatedwith
epiduralorspinal
andmorphineanalogs.
issuperiorto
forreliefofnauseaassociatedwith
generalanesthesia.
Sideeffects
includeseizures,wheezing,dyspnea,drowsiness,dry
mouth,ataxia,headache,agitation,slurredspeech,andbitter
—(A-SpasSL;Anaspaz;Cystospaz-M;
Donnamar;Ed-Spaz;Gastrosed;Hyco;HyosolSL;Hyospaz;Levbid;
GItractspasm—0.125-0.25mgPOqac,qhs
Bladderspasm—0.15-0.3mgPOqid
NOTE:maybecombinedwith
—(Advil;Alaxan;Artril;Bloom;Brofen;Dolofen;
Emflam;Fenspan;Ibren;Ibugen;Ibuprohm;Ibu-Tab;Ifen;Motrin;
Nobafon;Paduden;Paxofen;Profen;Prontalgin;Tarein)
InternationalBrandName—
Actron(Paraguay,Uruguay);Adex200(Israel);AdexLiqui-Gels(Israel);Advil
(Brazil,Colombia,Ecuador,France,HongKong,Mexico,Poland,Venezuela);AdvilInfantil(Mexico);AdvilLiqui-Gels
(Israel);Afebril(Peru);Algofen(Italy);Allipen(Korea);Am-Fam400(India);Ampifen(Singapore);Anadvil(France);
Anbifen(Thailand);Anco(Germany);Andran(Japan);Anflagen(Japan);Antarene(France);Antiflam(SouthAfrica);
Mildtomoderatepain—400mgPOq4-6h;max3200mg/d
Fever—200-400mgPOq4-6h;max1200mg/d
Dysmenorrhea—400mgPOq4-6h;max2400mg/d
Osteoarthritisorrheumatoidarthritis—300-800mgPOtidorqid;
takewithfood,max3200mg/d
—hypersensitivitytodrugorclass,
ASA/NSAID-inducedasthma,3rdtrimesterpregnancy
—hypertension,CHF,historyofGIbleeding,nasalpolyps
MaternalConsiderations
.....
About5%ofwomenreportprenataluseofeither
nearconceptionorduringpregnancy.Inseveral
differenttrials,theadditionof
enhancedtheanalgesicefficacyof
Inothertrials,
significantlyreducedpostabortalpainandwassuperior
prospectivecase-controlstudy,prenatal
useincreasedtheriskofspontaneousabortionby80%(adjusted
hazardratio1.8[95%CI1.0-3.2]).Theassociationwasstronger
iftheinitialusewasaroundconceptionorifitlastedmorethan
aweek.ThereisepidemiologicevidencelinkingittoPPH.
Sideeffects
...........................
PregnancyCategory:B
LactationCategory:S
mayincreasetheriskofspontaneous
1sttrimesterexposureshouldbeminimizeduntilthe
Rapidconversionofrecentatrialflutter/fibrillation—0.01mg/kg
IVover10min,mayrepeatafter10minifnoresponse;max1mg/
—hypersensitivitytodrugorclass,useofa
classIorIIIantiarrhythmicwithin4h
—renalorhepaticdysfunction,prolongedQTinterval,
hypokalemia,polymorphicventriculartachycardia
MaternalConsiderations
.....
Therearenoadequatereportsorwell-controlledstudiesof
inpregnantwomen.Thepublishedexperienceislimited
tocasereportsandshortseries.Itsefficacyisapparently
uncompromisedbypregnancy.
Sideeffects
includebradycardia,sustainedventriculartachycardia,
sustainedpolymorphicventriculartachycardia,ventricular
arrhythmias,tachycardia,prolongedQTinterval,AVblock,
bradycardia,N/V,headache,andhypertension.
DrugInteractions
................
Supraventriculararrhythmiasmaymaskthecardiotoxicity
associatedwithexcess
Itisadvisabletobeparticularly
cautiousinpatientswhoseplasma
levelsareaboveor
suspectedtobeabovethetherapeuticrange.
.........................
AML—varieswithprotocols
—hypersensitivitytodrugorclass,prior
mediastinalradiation,prioruseofeither
MaternalConsiderations
.....
isananalogof
Therearenoadequate
reportsorwell-controlledstudiesinpregnantwomen.The
publishedexperienceislimitedtocasereportsandshortseries.
Itsefficacyisapparentlyuncompromisedbypregnancy.
Sideeffects
includeCHF,seizures,MI,ventriculararrhythmia,
extravasationnecrosis,myelosuppression,bleeding,enterocolitis,
abdominalpain,infection,N/V,diarrhea,alopecia,mucositis,
rash,pruritus,dyspnea,confusion,somnolence,cough,fever,and
HSVkeratitis—begin1gttq1huntilimprovement,thenq2h
duringthedayandq4hatnight
—hypersensitivitytodrugorclass
MaternalConsiderations
.....
Thereisnopublishedexperiencewith
pregnancy.Thequantityofdrugabsorbedsystemicallyis
Sideeffects
includecloudycornea,lacrimalpunctualocclusions,
blurredvision,andphotophobia.
...........................
PregnancyCategory:C
LactationCategory:U
shouldbeusedduringpregnancyandlactation
onlyifthebenefitjustifiesthepotentialperinatalrisk.
InternationalBrandName—
PelastinIV(Indonesia);Prepenem(Korea);Primaxin(Canada,England,Greece);
Tenacid(Italy);Tienam(Austria,Brazil,Chile,Colombia,Ecuador,Egypt,England,Germany,Greece,India,Indonesia,
Ireland,Israel,Japan,Mexico,Peru,Poland,Slovenia,Turkey);Tienam500(SouthAfrica);Zienam(Austria,Germany)
DrugClass
..........................
Antibiotics;Carbapenems
.........................
Seriousbacterialinfection
.........................
Bactericidalbyinhibitingcellwallsynthesis
DosagewithQualifiers
.......
Seriousbacterialinfection—250-1000mgIM/IVq12h;max50mg/
kg/dor4000mg/d
NOTE:renaldosing.
—hypersensitivitytodrugorclass
—cephalosporinallergy,renaldysfunction,seizure
MaternalConsiderations
.....
isbroad-spectrumcombinationthatachieves
excellentpelvictissuelevels.Becauseoftherelativelyhighcost,
Shouldnotbemixedwithorphysicallyaddedtootherantibiotics
ifgivenIV,thoughitmaybeifgivenIM.
Generalizedseizureshavebeenreportedinpatientswhoreceived
.........................
ChimuraT.JpnJAntibiot1994;47:1762-8.
HeikkilaA,RenkonenOV,ErkkolaR.AntimicrobAgents
Chemother1992;36:2652-5.
Depression—begin25-75mgPOqhs;max300mg/d
Chronicpain—begin0.2-0.3mg/kgPOqhs,increaseby50%
q2-3d;max300mg/d
Panicdisorder—begin25mgPOqhs
—hypersensitivitytodrugorclass,MAOI
usewithin14d,recoveryfromacuteMI
—historyofseizure,glaucoma,CAD,thyroiddisease,
hepaticdysfunction,suiciderisk
MaternalConsiderations
.....
Depressioniscommonduringandafterpregnancybutoftengoes
unrecognized.Pregnancyisnotareason
apriori
todiscontinue
psychotropicdrugs.
istheprototypeTCAandis
transporter,andpresumablycrossesthehumanplacenta.It
rapidlycrossestherodentplacentaandisdistributedthroughout
InternationalBrandName—
Noneidentified.
DrugClass
..........................
Antivirals;Dermatologics;Immunomodulators
.........................
Genitalwarts
.........................
Unknown;inducestheexpressionofmultiplecytokines
DosagewithQualifiers
.......
Genitalwarts—applyhs3
/w,washoffafter6-10h;max16w
—hypersensitivitytodrugorclass
MaternalConsiderations
.....
Thepublishedexperiencewith
duringpregnancyis
limitedtocasereports.Therearenostudiesofsystemic
Sideeffects
includeburning,hypopigmentation,pruritus,pain,
fatigue,flu-likesymptoms,headache,anddiarrhea.
Immuneglobulin
—(Biogam;Carimune;GamimuneN5%;
GamimuneN10%;GammagardS/D;Gammar-PI.V.;Immune
Globulin;IveegamEn;Panglobulin;PolygamS/D;Sandoglobulin;
Venoglobulin-S5%;Venoglobulin-S10%)
InternationalBrandName—
Allerglobuline(SouthAfrica);Aunativ(Israel);Baygam(Canada);Beriglobin
(Austria,Germany,Israel,Sweden);Beriglobina(Brazil,Ecuador,Spain);BeriglobinaP(Chile);BeriglobinP(Argentina,
Taiwan);Beriglobin-P(SouthAfrica);CitaxF(Mexico);Endobulin(CzechRepublic,England,Finland,SouthAfrica);
Endobuline(France);Flebogamma(Israel);Gamafine(India);GamastanImmuneGlobulin(Israel);GamimuneN
ITP—1g/kgIV;upto3dosesonalternatingdays
Primaryimmunedeficiencydiseases—200-400mg/kgIV
1,then
100-300mg/kgIVqmo
B-cellchroniclymphocyticleukemia—400mg/kgIVq3-4wif
hypogammaglobulinemiaand/orrecurrentbacterialinfection
NOTE:a5%solutioninitiallyshouldbeinfusedat0.5ml/kg/h;if
welltolerated,therateandconcentrationmaybegradually
increasedtoamaximumrateof4ml/kg/h,andthenthe
concentrationincreasedto10%concentrationat0.5ml/kg/huptoa
maximumof8ml/kg/h.
—hypersensitivitytodrugorclass,acute
renalfailure,chronicrenalfailure
withpolyclonalimmunoglobulindecreaseconstitutiveand
cytokine-inducedICAM-1andVCAM-1expressionon
DrugInteractions
................
Admixturesof
immuneglobulin
withotherdrugsandIV
solutionshavenotbeenevaluated.Theyshouldbeadministered
Antibodiesin
immuneglobulin
preparationsmayinterferewith
patientresponsestolivevaccines,suchasthoseformeasles,
mumps,andrubella.
.........................
—(Depermide;Lozol;Natralix)
InternationalBrandName—
Agelan(HongKong,Ireland);Damide(Italy);Dapa(Malaysia);Dapamax
(SouthAfrica,Tanzania,Uganda,Zambia,Zimbabwe);Diflerix(HongKong,Taiwan);Dixamid(Greece);Extur(Spain);
Hypertension—begin1.25mgPOqam,increaseifnoresponse
after1w;max5mg/d
CHF—begin2.5mgPOqam,increaseifnoresponseafter1w;
max5mg/d
—hypersensitivitytodrugorclass,
hypersensitivitytosulfonamides,hepaticorrenalfailure,
MaternalConsiderations
.....
Thereisnopublishedexperiencewith
...........................
PregnancyCategory:B
LactationCategory:U
shouldbeusedduringpregnancyandlactation
onlyifthebenefitjustifiesthepotentialperinatalrisk.
Therearealternativeagentsforwhichthereismoreexperience
duringpregnancyandlactation.
—(Crixivan;MK-639)
InternationalBrandName—
3TC(Argentina,Canada,CostaRica,DominicanRepublic,ElSalvador,
Guatemala,Honduras,HongKong,Indonesia,Korea,Malaysia,Mexico,NewZealand,Nicaragua,Panama,South
Africa,Uruguay);Crixivan(HongKong,Israel,Korea,Malaysia,Philippines,Singapore,SouthAfrica,Taiwan,Thailand);
Elvenavir(Argentina);Indivan(Paraguay);Indivir(India)
DrugClass
..........................
Antivirals;Proteaseinhibitors
.........................
HIVinfection
.........................
Proteaseinhibitor
DosagewithQualifiers
.......
HIVinfection—800mgPOq8h;drinkatleast1.5Lwaterqd
NOTE:reducedoseforhepaticdysfunction.
—hypersensitivitytodrugorclass;historyof
nephrolithiasis;concurrentuseof
astemizole,cisapride,
whereformulaisavailabletoreducetheriskofneonatal
DrugInteractions
................
increasesthe
plasmaconcentrationanda
dosagereductionmaybeindicated.
decreasesthe
plasmaconcentrationanda
dosageincreasemaybeindicated.
Dysmenorrhea—25mgPOtidorqid
Mildtomoderatepain—25-50mgPOtidprn
Osteoarthritisorrheumatoidarthritis—begin25mgPObidor
tid,or50mgprnqid,increaseby25-50mgq7d;max200mg/d
Tocolysis—50mgPRorPOload,then25mgPO/PRq6h
anti-inflammatoryeffect.
Reducesbasalplasmareninactivity(PRA),aswellasthose
elevationsofPRAinducedby
orbysaltorvolume
Crohn’sdisease,moderatetosevere—5mg/kgIV
Crohn’sdisease,fistulizing—5mg/kgIV
1forweeks0,2,6
Rheumatoidarthritis—begin3mg/kgIV
1forweeks0,2,6;
mayincreasedoseupto10mg/kg
—hypersensitivitytodrugorclass,
hypersensitivitytomouseproteins,activeinfection
—pregnancy,MS,chronicorrecurrentinfections,
latentTB,demyelinatingdisease
MaternalConsiderations
.....
Therearenoadequatereportsorwell-controlledstudiesof
useduringpregnancy.Thecurrentexperienceis
limitedtocasereportsandsmallseries.
Sideeffects
includesepsis,opportunisticinfections,worseningof
CHF,chestpain,serumsickness–likereaction,lupus-like
syndrome,fever,chills,myalgias,backache,arthralgias,dizziness,
N/V,dyspepsia,pruritus,rash,URI,UTI,hypertension,
hypotension,facialorhandedema,andelevatedLFTs.
infectionandneutropeniawithoutprovidinganyadditional
benefitcomparedtothesedrugsalone.
.........................
HaleTW.MedicationsandMother’sMilk,10thed.Amarillo,TX:
PharmasoftPublishing,2002:374.
Nonimmunestatus—0.5mlIM
—hypersensitivitytodrugorclass,
hypersensitivitytoeggs,pasthistoryofGuillain-Barre
syndrome,activefebrileillness
MaternalConsiderations
.....
Allpregnantwomen
12wgestationshouldbevaccinatedin
preparationforinfluenzaseason.Pregnantwomenhaveincreased
susceptibilitytoviralrespiratorydiseases,andthemostcommon
oneisinfluenza.Influenza-associatedexcessmortalityduring
pregnancywasdocumentedduringthepandemicsof1918-1919
and1957-1958.Theincreasedriskmightresultfrom(1)
increasedHR,strokevolume,andoxygenconsumption;
(2)decreasedlungcapacity;and(3)changesinimmunologic
function.Astudyduring17interpandemicinfluenzaseasons
revealedthattherelativeriskforhospitalizationfor
cardiorespiratoryconditionsduringpregnancyincreasedfrom
gestation,comparedtowomen1-6mopostpartum.Researchers
estimatethatanaverageof1-2hospitalizationscanbeprevented
forevery1000pregnantwomenvaccinated.Thus,allwomenwho
intendtobecomepregnantorarepregnantshouldreceivethe
influenzavaccine.
Vaccinationcanoccurinanytrimester.One
studyofinfluenzavaccinationof
2000pregnantwomen
SumayaCV,GibbsRS.JInfectDis1979;140:141-6.
DKA—begin0.1U/kgIVbolus,then0.1U/kg/hinfusion;decrease
infusionratewhenglucose
—hypersensitivitytodrugorclass,
—hypokalemia,renalorhepaticdysfunction
MaternalConsiderations
.....
Insulinaspart
isarapid-actinghumaninsulinanalogwhose
teratogenicitystudiesrevealedincreasedearlypregnancylosses,
thesewerelikelytheproductofseverehypoglycemia.
hypoglycemicepisodescomparedtoregularhumaninsulin.
Thoughtherearenoadequatereportsorwell-controlledstudies
inpregnantwomen,manystatethateitherthisagentor
shouldreplaceregularhumaninsulinincombinationwith
along-actinginsulinbecauseofamorephysiologicrelease
profile.Carefulmonitoringofglucoselevelscoupledwithactive
regulationoftheinsulindoseiscrucialforanoptimaloutcome.
Sideeffects
includehypoglycemia,hypokalemia,lipodystrophy,
pruritus,rash,andinjectionsitereaction.
childwithastructuralmalformation.Themagnitudeoftherisk
correlatesdirectlywiththeoveralldegreeofhyperglycemia.
Normalizationofglucosepriortoconceptionlowerstherisk
belowcontrolpopulations.Euglycemiaaftertheembryonicstage
Insulin,pork
DKA—begin0.1U/kgIVbolusofR,then0.1U/kg/hinfusion;
decreaseinfusionratewhenglucose
—hypersensitivitytodrugorclass,
hypoglycemia,IVadministration(N,L)
—hypokalemia,renalorhepaticdysfunction,thyroid
MaternalConsiderations
.....
Nativeinsulinisisolatedfromtheporcinepancreasandmodified
toproducethreeadditionalcompoundswithdifferingabsorption
structuralmalformation.Themagnitudeoftheriskcorrelates
directlywiththeoveralldegreeofhyperglycemia.Normalization
ofglucosepriortoconceptionlowerstheriskbelowcontrol
populations.Euglycemiaaftertheembryonicstagepreventsthe
Insulin,recombinanthuman
—(HumulinR,L,N,
andU)
InternationalBrandName—
Actrapid(Finland,France,Indonesia,NewZealand);ActrapidHM(France,
Germany,HongKong,Israel,Italy,Malaysia,Philippines,SouthAfrica,Taiwan,Thailand);ActrapidHuman(Indonesia,
Japan,Korea);BerlinsulinActrapidNormalU-40(Germany);BerlinsulinHBasalU-40(Germany);Biohulin(Korea);
HumanActrapid(India,Ireland);HumanNordisulin(India);Huminsulin‘‘Lilly’’Normal(Austria);HuminsulinNormal
(Germany,Switzerland);Humulin(Regular)(Greece);HumulinaRegular(Spain);HumulinC(Ecuador,Peru);Humuline
Regular(Sweden);HumulinR(Bulgaria,China,Colombia,CostaRica,CzechRepublic,DominicanRepublic,ElSalvador,
Guatemala,Honduras,HongKong,Hungary,Indonesia,Italy,Korea,Malaysia,Mexico,Nicaragua,Panama,Paraguay,
Philippines,Thailand,Venezuela);Humulin-R(Canada,Colombia,DominicanRepublic,ElSalvador,Guatemala,
Honduras,Nicaragua,Panama);HumulinRegular(Denmark,Finland,Norway,Portugal,Sweden,Taiwan);Insulina
(Spain);InsulinaActrapidHM(Spain);InsulinActrapidHM(Bulgaria);InsulinaHumulinR(Argentina);InsulinaVelosulin
DKA—begin0.1U/kgIVbolusofR,then0.1U/kg/hinfusion;
decreaseinfusionratewhenglucose
—hypersensitivitytodrugorclass,
hypoglycemia,IVadministration(N,L,U)
—hypokalemia,renalorhepaticdysfunction,thyroid
MaternalConsiderations
.....
Humanrecombinantinsulin
issynthesizedfrombacteriacontaining
thehumaninsulingene.Itisthenmodifiedtoproducethree
additionalcompoundswithdifferingabsorptionpatterns.Thereisa
largebodyofclinicalexperienceusing
humanrecombinantinsulin
duringpregnancy.Carefulmonitoringofglucoselevelscoupledwith
activeregulationoftheinsulindoseiscrucialforanoptimal
outcome.Aninsulininfusionmaybedesirableattimesduring
hospitalization.Abasalratecanbeprovidedwithregularinsulin
(100U/100ml)infusedatarate0.55-1.5U/h.
Sideeffects
includehypoglycemia,hypokalemia,lipodystrophy,
pruritus,rash,andinjectionsitereaction.
DosagewithQualifiers
.......
Interferonalfa-2a,recombinant
—(RoferonA)
InternationalBrandName—
Green-Alpha(Korea);Roceron(Norway);Roceron-A(Denmark,Finland,Poland,
Sweden);RoferonA(Austria,Belgium,Bulgaria,Canada,Hungary,Portugal,PuertoRico);Roferon-A(Argentina,
Brazil,Chile,CzechRepublic,Ecuador,England,France,Germany,Greece,HongKong,India,Indonesia,Italy,Japan,
ChronicHCVinfectionwithcompensatedliverdisease—3
millionU/dSC/IM3
/wfor52w
AIDS-associatedKaposi’ssarcoma—begin36millionU/dSC/IM
10-12w,then3
Hairycellleukemia—begin3millionU/d
16-24w,then3
—hypersensitivitytodrugorclass,
autoimmunehepatitis
—myelosuppressionormyelosuppressiveagents,
seizuredisorder,cardiacdisease,severehepaticorrenal
DrugInteractions
................
Mayreducetheclearanceof
MayreducehepaticCYPactivity.
UsewithIL-2maypotentiatetheriskofrenalfailure.
Theneurotoxic,hematotoxic,orcardiotoxiceffectsofpreviouslyor
concurrentlyadministereddrugsmaybeincreasedbyinterferons.
Interactionscouldoccurfollowingconcurrentadministrationof
centrallyactingdrugs.
.........................
Condylomaacuminatum—reconstitute10millionU/1mldiluent;
inject0.1mlSCintothebaseofthewart3
3w,mayinject
upto5wartspersession;a2ndcoursemaybegiven12wlater
ChronicHCVinfection—3millionUSC/IM3
16w;ifa
response,continuetotal18-24mo
ChronicHBVinfection—10millionUSC/IM3
AIDS-associatedKaposi’ssarcoma—30millionU/m
Hairycellleukemia—2millionU/m
SC/IM3
NOTE:maybecombinedwith
—hypersensitivitytodrugorclass,
autoimmunehepatitis
—myelosuppressionormyelosuppressiveagents,
seizuredisorder,cardiacdisease,severehepaticorrenal
infectionandessentialthrombocythemia.HIVinfectionisnota
contraindicationtoHCVinfectiontherapy.Liverdiseasecaused
bychronicHCVinfectionisthesecondleadingcauseofdeathin
someHIV-infectedpopulations.
Sideeffects
includeleukopenia,thrombocytopenia,anemia,
seizures,pulmonaryorhepatictoxicity,delirium,suicidal
ideation,arrhythmias,cardiomyopathy,MI,GIbleeding,
hypertension,peripheralneuropathy,flu-likesymptoms,rash,
anorexia,abdominalpain,diarrhea,arthralgias,drymouth,
cough,dizziness,headache,paresthesias,emotionallability,
Condylomaacuminatum—0.05ml(250,000U)SCatthebaseof
eachwart(max0.5mlpersession)2
NOTE:waitatleast3mobeforeconsideringarepeatcourse.
—hypersensitivitytodrugorclass,
hypersensitivitytoeggproteinsor
ChronicHCVinfectionwithcompensatedliverdisease—9mcgSC
Sideeffects
includedepression,suicidalideation,suicide,
hypertension,supraventriculararrhythmias,chestpain,MI,
leukopenia,granulocytopenia,thrombocytopenia,ophthalmologic
disorders,andhypothyroidism.
RelapsingMS—30mcgIMqw
—hypersensitivitytodrugorclass
—seizuredisorder,depression
MaternalConsiderations
.....
Therearenoadequatereportsorwell-controlledstudiesof
RelapsingMS—0.25mg(8millionU)SCqod
—hypersensitivitytodrugorclass
—seizuredisorder,depression
MaternalConsiderations
.....
Therearenotadequatereportsorwellcontrolledstudiesof
notedtransientlyinsomeanimals.Theseeffectsreversedafter
stoppingthedrug.Treatmentwithtwicetherecommendeddose
hadnoeffectoncycledurationorovulation.
Sideeffects
includeshock,seizures,cardiacarrest,arrhythmias,
anemia,muscleaches,asthenia,fever,chills,flu-likesymptoms,
nausea,diarrhea,dyspepsia,andinjectionsitereaction.
Chronicgranulomatousdisease—50mcg/m
(1millionIU/m
)if
bodysurfacearea
0.5m
and1.5mcg/kgifbodysurfacearea
0.5m
NOTE:expressedas1millionIU/50mcg.
Thisisequivalenttowhat
waspreviouslyexpressedasunits(1.5millionU/50mcg)
—hypersensitivitytodrugorclass,
hypersensitivityto
E.coli
—preexistingcardiacdisease,myelosuppression,seizure
MaternalConsiderations
.....
Thereisnopublishedexperiencewith
interferongamma-1b
duringpregnancy.
Sideeffects
includefever,headache,rash,chills,fatigue,diarrhea,
N/V,myalgias,arthralgias,andlocalinjectionsitereactions.
Intestinalamebiasis—650mgPOtidpc
—hypersensitivitytodrugorclass,hepatic
—thyroiddisease
MaternalConsiderations
.....
Thereisnorecentpublishedexperiencewith
Sideeffects
includeopticneuritis,opticatrophy,peripheral
neuropathy,acne,urticaria,pruritus,N/V,diarrhea,abdominal
pain,headache,thyromegaly,andfever.
Radiography,CTscanning—2-4mlIVasneeded;volumevaries
basedonthepatientvolumeofdistribution
NOTE:availableinconcentrationsof140and350mg/ml.
hypersensitivitytodrugorclass
MaternalConsiderations
.....
isanonionicragiographiccontrastmediumoflow
osmolalityusedextensivelyinclinicalradiology.Sideeffectsare
scanteveninpatientswithahistoryofiodinehypersensitivityor
adversereactionstootherradiographiccontrastagents.Thereare
noadequatereportsorwell-controlledstudiesof
pregnantwomen.
waspreviouslyusedtoevaluatethe
GFRofpregnantwomenatterm.
Sideeffects
includetransientmalaiseandvomiting.
24h.Theseagentsasagrouparepoorlyabsorbedorally(
andthehalf-lifeofinjected
approximates2h.Asaresult,
seemstobeoflittlerisktothebreastfeedingneonate.
DrugInteractions
................
Drugsthatlowertheseizurethresholdshouldbeavoided,
especiallyphenothiazinederivativesincludingthoseusedfor
antihistaminicorantinauseantproperties.
OtheragentstobeavoidedincludeMAOIs,TCAs,CNS
stimulants,psychoactivedrugsdescribedasanaleptics,major
tranquilizers,orantipsychoticdrugs.Suchmedicationsshouldbe
discontinuedatleast48hbeforemyelography,shouldnotbeused
forthecontrolofN/Vduringoraftermyelography,andshould
notberesumedforatleast24hpostprocedure.Consider
prophylacticuseofanticonvulsantsinnonelectiveproceduresin
patientsonthesedrugs.
.........................
FrennbyB,SternerG.EurRadiol2002;12:475-84.
MoonAJ,KatzbergRW,ShermanMP.JPediatr2000;136:548-9.
Emesisinduction—15-30mlPOfollowedby200-300mlwater;
repeatin30minifnoresponse
—hypersensitivitytodrugorclass,
unconsciouspatient
—ingestionofeithergasoline,kerosene,orvolatileoil
alkalioracid;morethan1hsinceingestion;
6moofage
MaternalConsiderations
.....
Thereisnopublishedexperiencewith
duringpregnancy.
Thereis,however,alongclinicalexperiencewithitsusetotreat
patientswhohaveingestedtoxicsubstances.
iscardiotoxic
ifnotvomited.
Sideeffects
includecardiotoxicity(chronicuse),diarrhea,
.........................
Nocurrentrelevantreferenceswereidentified.
...........................
PregnancyCategory:C
LactationCategory:S
isaworkhorseforthetreatmentofacuteintoxication.
shouldbeusedduringpregnancyandlactationonlyif
thebenefitjustifiesthepotentialperinatalrisk.
Ipratropiumbromide
—(Atrovent;Disne-Asmol)
InternationalBrandName—
Aerovent(Israel);Apo-Ipravent(Canada);Apovent(Israel);Aproven(Australia);
Atem(Israel,Italy);Atronase(Belgium);Atrovent(Argentina,Canada,Colombia,CostaRica,DominicanRepublic,
Ecuador,ElSalvador,Guatemala,Honduras,Mexico,Nicaragua,Panama,Paraguay,Peru,Uruguay,Venezuela);
AtroventAerosol(NewZealand);AtroventN(Malaysia,Singapore);AtroventNasal(HongKong,NewZealand);
Bronchospasm—2-3puffsINHtidorqid;alternatively500mcg
NEBq6-8h
Rhinitis—2sprays/nostrilbidortid(0.03%)
Rhinorrheaassociatedwithcold—2sprays/nostriltidorqid
NOTE:availableinbronchialandnasal(0.03%and0.06%)
—hypersensitivitytodrugorclass,
hypersensitivitytosoybeanorpeanuts
—narrow-angleglaucoma
MaternalConsiderations
.....
Thepublishedexperiencewith
duringpregnancyis
limitedtocasereports.Mildasthmaduringpregnancyis
managedwithinhaled
-agonists;therapyformoderateasthma
includesinhaled
Hypertension—begin150mgPOqd(ifalone);max300mg/d
—hypersensitivitytodrugorclass,
—renalarterystenosis,historyofACEangioedema,
Irondeficiency—DOSE(ml)=0.0442
(desiredHb
leanbodyweight(LBW)+(0.26
LBW).IV/IMtest
doserequiredpriortothefirsttherapeuticdose(0.5mloverat
MaternalConsiderations
.....
Thereisnoevidencethatironsupplementationimproves
pregnancyoutcomeintheindustrializedworld.Thatisnottrue,
however,indevelopingcountrieswherethetreatmentofiron
deficiencyanemiareducesboththeantenatalandpostnatal
maternalmorbidityandmortality.Underthesecircumstances,
irondextran
ismoreeffectivethanoraltreatmentincorrecting
anemiaandreducingtheneedfortransfusion.TheIM
administrationof3doses(250mgFe)atmonthlyintervals
appearseffectiveandwelltolerated;itmaybeusedinwomen
whocannottolerateoraliron.However,IMadministrationof
InternationalBrandName—
Enerzer(Japan);Marplan(Denmark)
DrugClass
..........................
Antidepressants;MAOinhibitors
.........................
.........................
NonselectivehydrazineMAOI
DosagewithQualifiers
.......
Depression—begin10mgPObid;increaseby10mgq2-3d
reaching40mg/dafter1w;thereafter,mayincreasebyanother
20mg/dforamaxof60mg/d
NOTE:reservedforpatientswhohavenotrespondedsatisfactorilyto
otherantidepressants.
—hypersensitivitytodrugorclass;
cerebrovascularorCVdisease;pheochromocytoma;hepaticor
renaldisease;concurrentorrecentuseofMAOIs,TCAs,SSRIs,
.........................
SatoT,YamamotoS,MoroiK.JpnJPharmacol1972;22:629-33.
...........................
PregnancyCategory:C
LactationCategory:U
shouldbeusedduringpregnancyandlactation
onlyifthebenefitjustifiesthepotentialperinatalrisk.
Therearealternativeagentsforwhichthereismoreexperience
duringpregnancyandlactation.
InternationalBrandName—
Anesthesia,induction—dosingvaries,typically1.5-3%
forsurgicalanesthesia.(Therearefewifanyindicationstoinduce
anesthesiawithgasinadults.)
Anesthesia,maintenance—dosingvaries,typically1-2.5%with
nitrousoxide,1.5-3%withoxygenonly
NOTE:allcommonlyusedmusclerelaxantsaremarkedly
potentiatedby
theeffectbeingmostprofoundwith
nondepolarizingagents;seespecialtytexts.
—hypersensitivitytodrugorclass,historyof
malignanthyperthermia
—headinjury,increasedICP,myastheniagravis,
cardiacriskfactors
MaternalConsiderations
.....
Therearenoadequatereportsorwell-controlledstudiesin
pregnantwomen.
hasbeenusedclinicallywithout
pregnancy-relatedsequelaeformanyyears.Likeotherhalogenated
TBprophylaxis—300mgPOqd
6-12mo;considertheaddition
of25-50mg
POqd
TBinfection—5mg/kgPO/IMqd
9-24mo;max300mg/d
NOTE:maybecombinedwith
withorwithout
—hypersensitivitytodrugorclass,acute
hepaticdisease
—hepaticorrenaldysfunction,alcoholingestion
MaternalConsiderations
.....
increasedbyalcoholingestion.TBisexperiencinga‘‘rebirth’’in
manycountries,anduntreatedTBinpregnancyisasignificant
Emergentarrhythmia—0.02-0.06mgIV
1,then2-20mcg/minIV
Atropine-resistantbradycardia—2-10mcg/minIVinfusion
CHBafterVSDclosure—0.02-0.06mgIV
Bronchospasmduringanesthesia—0.01-0.02mgIV
1;maybe
repeatedifnecessary
Bronchodilator—1deepinhalation;mayrepeatafter5minif
necessary;max5inhalations/d
NOTE:availableinIVandinhalerforms.
—hypersensitivitytodrugorclass,
hypersensitivitytosulfites,digitalisintoxication,angina
Anginaprophylaxis—begin5mgPOqd;spacedosesatleast5h
apart,max80mg/d;alternativelyforSR,begin20mgPObid
NOTE:checkpackageinsertofpreparationforrecommendeddose,
astherearevariations.
—hypersensitivitytodrugorclass,
hypotension,cardiogenicshock,
Isosorbidemononitrate
—(Imdur;Imtrate;Ismo;
Anginaprophylaxis—30-60mgPOqdin1ordivideddoses
dependingonthepreparation;max240mg/d
NOTE:checkpackageinsertofpreparationforrecommendeddose,
astherearevariations.
—hypersensitivitytodrugorclass,
use,hypotension
—acuteMI,hypotension,shock
MaternalConsiderations
.....
Thereareseveralcasereportsofitsuseinpregnantwomenwith
anacuteMI.
Isosorbidemononitrate
isabsorbedacrossthe
vaginalmucosa.Itwasinvestigatedasacervicalripeningagent
priorto1sttrimesterabortion.Ithasalsobeenstudiedasa
cervicalripeningagentwhereit(20or40mg)increasesthe
maternalpulserateandthematernalsystolicandpulsepressures.
InanotherRCTcomparingitto
misoprostol,misoprostol
superiorforcervicalripeningthoughbothdrugswereassociated
withahighfrequencyofsideeffects.IntwootherRCTstesting
itsabilitytopromotelabor,itwasinferiortoprostaglandinsbut
wastheindication,
isosorbidemononitrate
(40mg)increasedthe
FHRsome15bpm.Therewasnosignificanteffectonumbilical
arteryresistance.Rodentstudiesarereassuring,revealingno
evidenceofteratogenicityorIUGRdespitetheuseofdoses
higherthanthoseusedclinically.Embryotoxicityoccursin
rodentswithdoses50-100
theMRHD.
DosagewithQualifiers
.......
Acne,severecystic—begin0.5-2mg/kg/d
Keratinizationdisorders—0.5-2mg/kg/dPOindivideddosesbid;
max4mg/kg/d
NOTE:informedconsentrequired.
—hypersensitivitytodrugorclass,
hypersensitivitytoparabens,pregnancy
—psychiatricdisorder,lactation,exposuretobright
sunlight,seizuredisorder,hyperlipidemia,historyof
Systemiccorticosteroidsareknowntocauseosteoporosis.No
formalclinicalstudieshavebeenconductedtoassessifthereisan
Hypertension—begin2.5mgPObid,increasingby2.5mgPObid
q2-4wprn;max10mg/d
NOTE:availableinsustained-releaseformat.
—hypersensitivitytodrugorclass
MaternalConsiderations
.....
Therearenoadequatereportsorwell-controlledstudiesin
pregnantwomen.Calciumchannelantagonistsmaybethe
DosagewithQualifiers
.......
Fungalinfection—begin200mgPObid
3d,or200mgIVbid
4dosesforlife-threateningdisease
Onychomycosisofthefingernails—200mgPObid
7d,off
Onychomycosisofthetoenails—200mgPOqd
Candidiasis,oropharyngeal—swishfirst20mlPOqd
Candidiasis,esophageal—swishfirst10mlPOqd
2wafter
symptomsresolve,total3w
NOTE:alwaysconfirmdiagnosispriortoinitiatingtherapy;
clarithromycin,erythromycin,indinavir,
whomusttake
withoneofthesedrugsshouldbe
monitoredcloselyforsignsorsymptomsofincreasedor
prolongedpharmacologiceffectsof
possible,plasmaconcentrationsshouldbemonitored,anddosage
adjustmentsmadeafter
therapyisinitiated.
InducersofCYP3A4maydecreasetheplasmaconcentrationsof
andthusblockefficacy.Thesedrugsinclude
-receptorantagonists,
nevirapine,phenobarbital,phenytoin,
protonpumpinhibitors,
.........................
Strongyloidiasis—200mcg/kgPO
1takenwithwater
Onchocerciasis—150mcg/kgPO
1takenwithwater;
re-treatmentoftennecessary
Scabies—200mcg/kgPO
—hypersensitivitytodrugorclass
—hyperreactivitytoonchderm
MaternalConsiderations
.....
Therearenoadequatereportsorwell-controlledstudiesof
inpregnantwomen.Thefewpublishedcasesreport
nosequelae.Further,therehavebeenseveralmassexposuresof
pregnantwomenduringcommunity-basedtreatmentof
onchocerciasis.Noincreaseinadversepregnancyoutcomeswas
Sideeffects
includepruritus,fever,edema,rash,
lymphadenopathy,dizziness,chestpain,abdominaldistention,
tachycardia,abnormaleyesensation,hypotension,andelevated
humanplacenta;itdoesappeartoblockP-glycoprotein–mediated
efflux.Therehavebeenseveralmassexposuresofpregnant
womenduringcommunity-basedtreatmentofonchocerciasis.
Noincreaseinpregnancywastageormalformationswas
—(Kantrex;Klebcil)
InternationalBrandName—
Kamycine(France);Kanacin(Korea);Kanamed(Thailand);KanamicinaGen-Far
(Peru);KanamycinCapsulesMeiji(Thailand);KanamycinMeiji(HongKong,Philippines);KanamycinNovo
(SouthAfrica);KanamycinSanbe(Indonesia);Kancin(India,Malaysia,Philippines,Taiwan,Thailand);
Kanoxin(Indonesia,Thailand);Randikan(Mexico)
DrugClass
..........................
Aminoglycosides;Antibiotics
.........................
Bacterialinfection
.........................
Inhibitsproteinsynthesisbybindingthe30Sribosomalsubunit,
leadingtocelldestruction
DosagewithQualifiers
.......
Bacterialinfection—15mg/kg/dIM/IVin2-3divideddoses
NOTE:renaldosing;peak25-35mcg/ml,trough
—hypersensitivitytodrugorclass
—myastheniagravis,othernephrotoxicagents,renal
dysfunction,vestibularorcochlearimplant
MaternalConsiderations
.....
Therearenoadequatereportsorwell-controlledstudiesin
pregnantwomen.
isasecond-lineagentforthe
treatmentofTB,butisotherwisenotusedwidelyduring
pregnancyandoffersnoadvantagesoverotheraminoglycosides.
Routinemonitoringofpeakandtroughlevelsisnotrequiredin
otherwisehealthywomenwithnormalrenalfunction.
Sideeffects
includenephrotoxicity,ototoxicity,tinnitus,
enterocolitis,pseudotumorcerebri,pruritus,N/V,diarrhea,
weakness,tremor,musclecramps,anorexia,edema,vertigo,
agranulocytosis,thrombocytopenia,andelevatedBUN/Cr.
PacificiGM.IntJClinPharmacolTher2006;44:57-63.
WangZ,LiouL.AnnOtolRhinolLaryngol1994;103:983-5.
...........................
PregnancyCategory:D
LactationCategory:S
Formostindications,therearealternativeagentsforwhich
thereismoreexperienceduringpregnancyandlactation.
Inductionofanesthesia—1-1.5mgIVover1minor5-10mg/kgIM
maybeusedtodecreasesalivation.
—hypersensitivitytodrugorclass,
hypertension,elevatedICP,glaucoma,thyrotoxicosis,CHF,
—hepaticdysfunction,GERD
MaternalConsiderations
.....
DosagewithQualifiers
.......
Fungalinfection—200-400mgPOqd(upto800mgPOqdfor
esophagealcandidaorcavitaryhistoplasmosis)
NOTE:administerwithfood;sodaincreasesabsorption50-75%;
alsoavailableintopicalsolutionandcream.
—hypersensitivitytodrugorclass;
achlorhydria;fungalmeningitis;useof
astemizole,cisapride,
—hepatotoxicdrugs,hepaticdysfunction
MaternalConsiderations
.....
Therearenoadequatereportsorwell-controlledstudiesin
pregnantwomen.
potentialinteractioninvolvingusewith
Mildtomoderatepain—25-50mgPOq6-8h;max75mg/d
Fever—12.5mgPOq4-6h;max75mg/d
Dysmenorrhea—25-50mgPOq6-8h;max300mg/d
Osteoarthritisorrheumatoidarthritis—75mgPOtid,or50mg
POqid;max300mg/d
NOTE:requiresbothrenalandhepaticdosing;availableinSR
—hypersensitivitytodrugorclass,
ASA/NSAID-inducedasthma
—hypertension,CHF,historyofGIbleeding,nasal
polyps,hepaticorrenaldysfunction
MaternalConsiderations
.....
Therearenoadequatereportsorwell-controlledstudiesin
pregnantwomen.
Moderatetoseverepain—begin60mgIM/30mgIVthenrepeat
q6hasneeded,max120mgor10mgPOq4-6hprn,max40mg/d
NOTE:iftransitioningfromparenteraltoPO,begin20mgPO
followedby10mgPOq4-6hprn,max40mg/d.
NOTE:donotexceed5doftherapy;availableforophthalmologicuse.
—hypersensitivitytodrugorclass,ASA/
NSAID-inducedasthma,cerebrovascularhemorrhage,
preoperativeuse
—hypertension,CHF,historyofGIbleeding,nasal
polyps,hepaticorrenaldysfunction
MaternalConsiderations
.....
Rodentstudiesarereassuring,revealingnoevidenceof
teratogenicityorIUGR.Theperinatalmortalityrateinrodents
Hypertension—begin100mgPObid,increase100mgbidq2-3w;
max2.4g/d
Acutehypertension—ifdiastolicBP
105mmHg,administer
incrementaldosingof5-10mgIV,withacumulativedoseof
40-80mgIVover20min;max300mgIV
—hypersensitivitytodrugorclass,asthma,
CHF,AVblock,cardiogenicshock,bradycardia,hepatotoxicity,
hypertrophyarereportedafterlong-termoral
PirhonenJP,ErkkolaRU,MakinenJI,EkbladUU.BiolNeonate
1991;59:204-8.
Constipation—15-30ml(10-20g/d)POqdorbid
Hepaticencephalopathy—30-45mlPOtidorqid(20-30gtid
orqid)
—hypersensitivitytodrugorclass,
usedbysometomaintainasoftstoolafterdeliverycomplicated
byrectalextension.
Sideeffects
includeacidosis,abdominaldistention,belching,
abdominalpain,diarrhea,anorexia,N/V,electrolytedisorders,
hypernatremia,andflatulence.
—(Epivir;EpivirHBV;3TC)
InternationalBrandName—
3TC(Argentina,Canada,CostaRica,DominicanRepublic,ElSalvador,
Guatemala,Honduras,HongKong,Indonesia,Korea,Malaysia,Mexico,NewZealand,Nicaragua,Panama,
SouthAfrica,Uruguay);3TC-HBV(Indonesia);Epivir(Brazil,Ecuador,Paraguay,Peru,Singapore,Thailand,Venezuela);
epivir3TC(Chile);Heptodin(China);Heptovir(Canada);Inhavir(Colombia);Ladiwin(SouthAfrica);Lamidac(India);
Zeffix(Australia,Israel,Philippines,Singapore,Taiwan,Thailand)
DrugClass
..........................
Antivirals;Nucleosidereversetranscriptaseinhibitors
.........................
HIVinfection,HBVinfection
.........................
Reversetranscriptaseinhibitor
DosagewithQualifiers
.......
HIVinfection—150mgPObid
HBVinfection—100mgPOqd
—hypersensitivitytodrugorclass
—hepaticorrenaldysfunction,pancreatitis,long-term
therapy,obesity
MaternalConsiderations
.....
Therearenoadequatereportsorwell-controlledstudiesof
inpregnantwomen.
israpidlyabsorbed
afteroraladministration,reachingmaximalserumconcentrations
after30-90min.Tripletherapy(
zidovudine,lamivudine,
)isahighlyeffectiveregimen.However,thereare
reportsofrapiddevelopmentofgenotypicresistanceto
HIVtherapythatreducestheviralloadsignificantly
reducestheriskofmother-to-childtransmission.Hepatotoxicity,
usuallywithin5moofbeginningtherapy,isamajorconcern
duringpregnancy.ItismostseverewhenassociatedwithHBV
andHCVco-infection.Therearepresentlyonly2drugsforthe
treatmentofhepatitisBduringpregnancy—
interferonalfa-2b
Theinitialresponseto
issuperior
interferonalfa-2b.Lamivudine
isreportedlysafeinpregnant
womenwithchronicHBVinfectionduringthelastweeksof
pregnancy.However,reducedHBVparticlenumberdoesnot
necessarilytranslateintodecreasedverticaltransmission.Further,
resistantHBVstrainsdevelopinsomepatients.USfederal
governmentguidelinesrecommend
forhealthcarepersonnelexposedtobothHBVandHIV.
Sideeffects
includeacidosis,hepaticsteatosisortoxicity,
pancreatitis,neuropathy,neutropenia,thrombocytopenia,
rhabdomyolysis,andexacerbationofhepatitisB.
LeeLM,HendersonDK.DrugSaf2001;24:587-97.
Seizures—begin50mg/d,thenincreaseupto50-250mgPObid;
max500mg/d
NOTE:avoidabruptwithdrawal.
—hypersensitivitytodrugorclass,abrupt
—hepaticorrenaldysfunction,allergyto
MaternalConsiderations
.....
Mostpregnanciesareuneventfulinwomenwithepilepsy,and
mostbabiesaredeliveredhealthywithnoincreasedriskof
orwell-controlledstudiesof
duringpregnancy.
ConcernsoverteratogenicityofAEDsmustbeweighedagainstthe
DrugInteractions
................
Limitedclinicaldatasuggestthereisahigherincidenceof
dizziness,diplopia,ataxia,andblurredvisioninpatientsreceiving
thaninpatientsreceivingother
AEDswith
Limitedclinicaldatasuggestahigherincidenceofheadache,
dizziness,nausea,andsomnolencewithco-administrationof
comparedto
Theadditionof
mayincrease
concentrationsbyslightlymorethan2-fold.
Theadditionofeither
carbamazepine,phenobarbital,phenytoin,
candecrease
steady-stateconcentrations
byapproximately40%.
TheAUCandC
werereducedonaverageby
24%and20%,respectively,followingtheadditionof
(15mgqd)to
(200mgqd)inhealthymalevolunteers
(n=16)comparedtohealthymalevolunteersreceiving
alone(n=12).Thisreductionin
concentrationisnotexpectedtobeclinicallyrelevant.
Inastudyin10malevolunteers,
(600mg/dfor5d)
increasedtheapparentclearanceofasingle25mgdoseof
by2-fold(AUCdecreasedbyapproximately40%).
Aninhibitorofdihydrofolatereductase.Prescribersshouldbe
awareofthisactionwhenprescribingothermedicationsthat
MarchiNS,AzoubelR,TognolaWA.ArqNeuropsiquiatr2001;
OhmanI,VitolsS,TomsonT.Epilepsia2000;41:709-13.
SabersA,GramL.Drugs2000;60:23-33.
TennisP,EldridgeRR;InternationalLamotriginePregnancy
RegistryScientificAdvisoryCommittee.Epilepsia2002;43:1161-7.
PregnancyRegistry(1-800-336-2176).
—(Lopral;Ogastro;Prevacid;Zoton)
InternationalBrandName—
GERD—15-30mgPOqdorbid
Esophagitis—30mgPOqdorbid
Gastriculcer—30mgPOqdorbid
Duodenalulcer—15mgPOqdorbid
H.pylori
infection—30mgPObid
Stressulcer—15-30mgPO,throughfeedingtube
Ulcerprophylaxis—15-30mgPOqd
—hypersensitivitytodrugorclass
—long-termuse,hepaticdysfunction
MaternalConsiderations
.....
GERDand/orheartburnoccurin45-85%ofwomenduring
pregnancy.Theeffectofestrogenand
onlower
esophagealsphinctertoneisarecognizedfactor.Thetreatmentof
GERDconsistsofreducinggastricacidityfollowingastep-up
followedbyhistaminereceptorantagonists.
InternationalBrandName—
Louten(Colombia)
DrugClass
..........................
Ophthalmics;Prostaglandins
.........................
Elevatedintraocularpressure
.........................
Increasesaqueoushumoroutflow
DosagewithQualifiers
.......
Elevatedintraocularpressure—1gt(1.5mcg)OS/ODqd
—hypersensitivitytodrugorclass
MaternalConsiderations
.....
Thepublishedexperiencewith
duringpregnancyis
limitedtocasereports.
Sideeffects
includeepithelialkeratitis,blurredvision,eyelidskin
darkening,intraocularinflammation,irispigmentationchanges,
macularedema,burning,hyperemia,foreignbodysensation,
itching,dryeyes,tearing,photophobia,ocularpain,discharge,
rash,lidcrusting,andasthma/exacerbationofasthma.
InternationalBrandName—
Arabloc(Australia);Arava(Israel)
DrugClass
..........................
Antirheumatics;Immunomodulators
.........................
Rheumatoidarthritis
.........................
Pyrimidinesynthesisinhibitorwithantiproliferativeactivity
DosagewithQualifiers
.......
Rheumatoidarthritis—begin100mgPOqd
3d,then10-20mg
POqd
NOTE:checklevelq14d(normalabove0.02mcg/ml).
—hypersensitivitytodrugorclass,pregnancy
—immunodeficiency,blooddyscrasias,bonemarrow
suppression,infections,HBVorHCVinfection
MaternalConsiderations
.....
Thepublishedliteratureduringpregnancyislimitedtocase
reportsof1st/2ndtrimesterexposures.Basedonanimalstudy
DrugInteractions
................
activatedcharcoal
producearapidand
DosagewithQualifiers
.......
Heparin-inducedthrombocytopenia/thrombosis—begin0.4mg/kg,
then0.15mg/kg/hIV;max44mg
—hypersensitivitytodrugorclass
Caution
—bleeding;renaldysfunction;increasedriskofbleeding,
includingAVmalformations;hypertension;recentsurgery
MaternalConsiderations
.....
Heparin-inducedthrombocytopeniaisararebutpotentiallylife-
threateningreactiontoboth
andLMWH.Itisthemost
commondrug-inducedimmune-mediatedthrombocytopenia.
effectivelytreatsthethrombocytopeniabyinhibiting
thrombin.Manypatientsdevelopantibodies(40%),andthe
aPTTshouldbemonitoredduringlong-termtherapy.The
publishedexperienceduringpregnancyislimitedtoafewcase
reports,including1sttrimestertreatment.
Sideeffects
includebleeding,anemia,hematuria,intracranial
hemorrhage,fever,GIbleeding,increasedLFTs,andepistaxis.
Breastcancer—2.5mgPOqd
—hypersensitivitytodrugorclass
—renaldysfunction
MaternalConsiderations
.....
.........................
Counteractsfolateantagonists
DosagewithQualifiers
.......
Leucovorinrescue—15mgIV/IM/POq6h24hafterlast
Uterinefibroids—3.75mgIMqmo
NOTE:administerironandcheckthebonemineraldensityif
treatmentextendslongerthan3mo.
—hypersensitivitytodrugorclass,
undiagnosedvaginalbleeding
Bronchospasm—0.63-1.25mgNEBq6-8hprn
NOTE:avoidmixingwithothernebulizers.
Contraindications
—hypersensitivitytodrugorclass,MAOI
—arrhythmias,CAD,hypertension,hypokalemia
MaternalConsiderations
.....
isatleastaseffectiveasother
-adrenergicagonists
forthetreatmentorpreventionofbronchospasm.Thereisno
publishedexperiencewith
duringpregnancy.
Sideeffects
includeparadoxicalbronchospasm,angioedema,
cardiacarrest,arrhythmia,hypokalemia,palpitation,dizziness,
tremor,nervousness,headache,chestpain,anddrymouth.
DrugInteractions
................
Coloncancer—50mgPOq8h
3dbeginning7-30daftersurgery;
repeatmedicationq14d
—hypersensitivitytodrugorclass
—alcoholingestion
MaternalConsiderations
.....
isanimmunomodulatoroftenusedasadjuvant
treatmentforcoloncancer.Itisalsousedasanantirheumatic
andanthelminticdrug.Thereislimiteduseinpregnancy,mostly
asadewormingagentindevelopingcountries.Onepost-
Sideeffects
includeagranulocytosis,leukopenia,
thrombocytopenia,dermatitis,N/V,diarrhea,fatigue,fever,
rigors,arthralgia,dizziness,headache,paresthesias,somnolence,
tastechange,infection,hyperpigmentation,ataxia,tearing,
Seizuredisorder—begin500mgPOq12h,increasing1g/devery
2w;max3000mg/d
—hypersensitivitytodrugorclass
—renaldysfunction,abruptwithdrawal,depression
MaternalConsiderations
.....
readjustmentsmaybenecessaryandshouldbebasedonclinical
symptoms,andnotexclusivelyonserumdrugconcentrations.
Aspecificdrugregistryforwomenexposedto
InternationalBrandName—
Allergicconjunctivitis—1gtOS/ODqid;max2w
—hypersensitivitytodrugorclass,contact
MaternalConsiderations
.....
Thereisnopublishedexperiencewith
pregnancy.Approximately
ofchildbearing-agewomenhave
allergicrhinitis.Immunotherapy,
—(Dopar;Dopastral;Laradopa;Larodopa;L-Dopa;
Levotrifar;Medidopa;Prolopa)
InternationalBrandName—
Bidopal(India);Brocadopa(England);Ceredopa(Austria);Dopaflex(Czech
Republic,Germany,Hungary,PuertoRico);Doparkin(Finland);Doparkine(Argentina);Doparl(Japan);Dopasol(Japan);
Parkinson’sdisease—0.5-1gPOqd;max8g/d;therapyis
individualizedandchangedgradually
—hypersensitivitytodrugorclass,
glaucoma,MAOI
14d,undiagnosedskinlesion
—severerenalandhepaticdisease,CVdisease,
pulmonarydisease
MaternalConsiderations
.....
Parkinson’sdiseaseischaracterizedbyneuronaldegenerationin
thecorporanigra.Evidencesuggeststhesymptomsarerelatedto
Antiacidsmayincreasebioavailability.Give2hapart.
Multivitaminsmaydecreaseefficacy.
.........................
Bacterialinfections—250-500mgPO/IVqd
—hypersensitivitytodrugorclass,
prolongationoftheQTinterval,concomitantusageof
antiarrhythmicdrugs
—hepaticorrenaldysfunction(CrCl
seizuredisorder,dehydration,hypokalemia,sunexposure,
Sideeffects
includetendonitis,tendonrupture,N/V,vaginitis,
phototoxicity,pseudomembranouscolitis,seizures,psychosis,
ConnellW,MillerA.DrugSaf1999;21:311-23.
Pain—2mgPOq6-8h,or1-2mgIVq3-6h
shouldbeadministeredimmediatelyintheevent
ofoverdosage.
—hypersensitivitytodrugorclass,depressed
respiratoryfunction,MI,hypotension
—hepaticorrenaldysfunction,drugdependency,
seizuredisorder
MaternalConsiderations
.....
haspropertiessimilarto
butis4-6
morepotent.Thereisnopublishedexperienceduringpregnancy.
Sideeffects
includeN/V,respiratorydistress,bronchospasm,
diplopia,mooddisturbance,pruritus,flushing,rash,constipation,
biliaryspasm,anddrymouth.
Hypothyroidism—50-200mcgPOqd;usualdose75-125mcg/d
NOTE:levelsshouldbecheckedq2-4wuntilstable,thenyearly.
Myxedemacoma—300-500mcgIV
—hypersensitivitytodrugorclass,
thyrotoxicosis,adrenalinsufficiency
—hypertension,CVdisease
MaternalConsiderations
.....
Hypothyroidismaffects4-10%ofwomen.Manyofthesignsand
symptomsoftypicalhypothyroidismareanormalpartof
pregnancy.Thediagnosisofhypothyroidism(and
hyperthyroidism)shouldbealwaysconfirmedbylaboratorytests
andnotbysymptoms.
isthestandardforthe
treatmentofhypothyroidismduringpregnancy.Womenwith
isolatedhypothyroxinemiaareneitheratincreasedriskfor
adverseperinataloutcomenorhaveanincreasedprevalenceof
thyroidperoxidaseantibodies;itmaywellbebiologically
insignificant.Incontrast,upto
ofwomenwithasymptomatic
hypothyroidismdiagnosedbecauseofanelevatedTSHhave
thyroidperoxidiseantibodies.Ithasbeensuggestedthat
asymptomaticmaternalhypothyroidismisassociatedwithan
increasedprevalenceofneurodevelopmentalabnormalities,butis
womenaltersthatrisk.Asymptomatichypothyroidismismore
commoninmultiplegestation.BeawarethattheTSHofwomen
chronicallyhyper-orhypothyroidmayrespondmuchmore
slowlytoreplacementthanthefreeT
Sideeffects
80mgIV),
,hydantoins,NSAIDs(e.g.,
),andsalicylates(
2g/d)eachmay
causeprotein-bindingsitedisplacement,resultinginaninitial
transientincreaseinfreeT
.Continuedadministrationresultsin
adecreaseinserumT
andnormalfreeT
andTSH
concentrationsand,therefore,patientsareclinicallyeuthyroid.
SalicylatesinhibitbindingofT
andT
tothyroid-binding
...........................
PregnancyCategory:A
LactationCategory:S
isthestandardtreatmentofhypothyroidism
duringpregnancy.
Ventriculararrhythmia—begin1-1.5mg/kgIV;mayrepeatbolus
in5min,thenbegininfusion1-4mg/minIV;max300mg
Localanesthesia—infiltrateIM/SC;max300mg
anesthesiaareimprovedbytheadditionof
Thetopical
applicationof2%
geldecreasesperinealpaininwomen
withgenitalherpes.
isasecondoptionforthe
treatmentofventriculararrhythmiasafterfailedelectrical
Sideeffects
includetinnitus,blurredvision,light-headedness,
impairedswallowing,seizures,respiratoryarrest,arrhythmia,
heartblock,bradycardia,asthma,coma,tremor,confusion,
hypotension,hallucinations,agitation,N/V,andcardiovascular
Bacterialinfection—600-1000mgq8-12h
—hypersensitivitytodrugorclass,
pseudomembranouscolitis
—hepaticorrenaldysfunction,asthma,GIdisease
MaternalConsiderations
.....
Thereare2mainantibioticsinthelincosamidefamily:
hasbeen
associatedwithseverecolitisthatmayendfatally,itshouldbe
reservedforseriousinfectionswherelesstoxicantimicrobial
agentsareineffective.Therearenoadequatereportsorwell-
controlledstudiesof
inpregnantwomen,inwhom
iscommonlyused.
Sideeffects
includepseudomembranouscolitis,diarrhea,colitis,
vaginitis,glossitis,stomatitis,N/V,neutropenia,leukopenia,
agranulocytosis,tinnitus,thrombocytopenia,aplasticanemia,
angioneuroticedema,serumsickness,urticaria,rash,azotemia,
oliguria,andvertigo.
breastfednewbornhad100%absorption,thedailydosewould
DrugInteractions
................
Mayenhancetheactionofneuromuscularblockingagents,and
shouldthusbeusedwithcautioninpatientstakingthesedrugs.
Kaolin-pectinmixturesinhibittheabsorptionoforally
Pediculosis—apply20-30mlshampootodryhair,wait5minand
rinse;combhairandremovenits;mayrepeatin1w
—hypersensitivitytodrugorclass,inflamed
skin,seizuredisorder,pregnancy,breastfeeding
—genitaliacontact
MaternalConsiderations
.....
-hexachlorocyclohexane)isapopularOTCtreatment
forscabies.Thenumberofsuspectedadversereactionsissmall
consideringover10millionouncesof1%
aresoldyearly.
Almostallsuspectedadversedrugreactionsinvolvemisuse.There
arenoadequatereportsorwell-controlledstudiesof
pregnantwomen.However,
isstoredinfat,androdent
studiesdescribeareductioninuterinegapjunctionsynthesisand,
asaresult,incoordinationofuterinecontractions.
Sideeffects
includeseizures,neurotoxicity,dizziness,eczema,
DosagewithQualifiers
.......
Vancomycin-resistantenterococcalinfections—600mgIV/PO
Pneumonia—600mgIV/POq12h
Skininfection—400mgPOq12h
NOTE:avoidtyramine-containingfoods(keeptyraminecontent
100mg/meal);monitortheCBCcountweekly.
—hypersensitivitytodrugorclass
—hypertension,pheochromocytoma,carcinoid
syndrome,thyroiddisease,MAOIs,thrombocytopenia,
—(Cytomel;Triostat)
InternationalBrandName—
Cynomel(CostaRica,DominicanRepublic,ElSalvador,France,Guatemala,
Honduras,Mexico,Nicaragua,Panama,SouthAfrica);Cytomel25(Israel);T3(Greece);Tertroxin(SouthAfrica);
Thyronine(Japan);Trijodthyronin(Austria,Bulgaria);TrijodthyroninBCN(Germany)
DrugClass
..........................
Hormones,thyroid
.........................
Myxedemacoma
.........................
Myxedemacoma—25-50mcgIV
1;then25mcg/dPO,increase
12.5-25mcgq1-2w;usualdose25-75mcg/d
—hypersensitivitytodrugorclass,MI,
thyrotoxicosis,adrenalinsufficiency
hypoglycemicsshouldbecloselywatchedduringtheinitiationof
thyroidreplacement.
Estrogensincreaseserumthyroid-bindingglobulin,andfree
maybedecreasewhenestrogensarebegun.Ifthe
patient’sthyroidglandhassufficientfunction,thedecreasedfree
willtriggeracompensatoryincreaseinT
release.However,
patientswithoutafunctioningthyroidglandmayneedan
increaseddoseifestrogensorestrogen-containingoral
contraceptivesaregiven.
andotherTCAsmayincreasereceptorsensitivity
andenhanceantidepressantactivity;transientcardiacarrhythmias
arereported.Thyroidhormoneactivitymayalsobeenhanced.
Maypotentiatethetoxiceffectsofdigitalis.Thyroidhormone
Hypothyroidism—begin50mcgPOqd,increase25mcgevery
2-3wuntilreplacementadequate
—hypersensitivitytodrugorclass,MI,
thyrotoxicosis,adrenalinsufficiency
MaternalConsiderations
.....
—(Prinivil;Zestril)
InternationalBrandName—
Acepril(HongKong);Acerbon(Germany);Alapril(Italy);Alfaken(Mexico);
Carace(England,Ireland);Cipril(India);Coric(Germany);Dapril(China,SouthAfrica);ES(India);Fibsol(Australia);
Hypertension—10-40mgPOqd
CHF—5-20mgPOqd;max40mg/d
MI—5-10mgPOqd
—hypersensitivitytodrugorclass,history
ofangioedema,pregnancy
—renalarterystenosis,hepaticorrenaldysfunction,
hyponatremia,CHF,collagenvasculardisease
MaternalConsiderations
.....
Therearenoadequatereportsorwell-controlledstudiesof
inpregnantwomen.Ingeneral,inhibitorsoftherenin-
angiotensinsystemarecontraindicatedthroughoutpregnancy.
Thelowestdoseeffectiveshouldbeusedwhen
requiredduringpregnancyforBPcontrol.
Sideeffects
Theriskofhypotensioncanbereducedbyeitherdiscontinuing
Lithiumcarbonate-citrate
—(Calith;Eskalith;Eskalith
CR;Hypnorex;Hyponrex;Lilipin;Lilitin;Lithane;Litheum;Lithobid;
Lithocarb;Lithonate;Lithotabs;Manialit;Phasal)
InternationalBrandName—
Bipolardisorder—900-1200mg/dPO;max1800mgqd
Acutemania—600mgPOtid
Schizoaffectivedisorder—300mgPOtidorqid
Neutropenia(chemotherapy)—300-1000mgPOqd(SR:
600-900mgPObid)
NOTE:serumlithiumlevelsshouldnotexceed2.0mEq/L.
—hypersensitivitytodrugorclass,inability
tomonitor
level,pregnancy
—hepaticorrenaldysfunction,hypovolemia,thyroid
disorder,CAD
MaternalConsiderations
.....
Lithium
isusedforthetreatmentofpsychiatricdisorders.Itis
typicallyinadequatefortherapidcontrolofacutemania;
antipsychotics,
divalproex,
orsedativesarecommonlyused,withor
without
lithium
intheseinstances.Theusefulnessof
lithium
liesin
thelong-termpreventionofrecurrentmaniaandbipolardepression
andinreducingriskofsuicidalbehavior.Amongpatientstreatedfor
abipolardisorder,theriskofasuicideattemptislowerduring
treatmentwith
lithium
thanitiswith
divalproex.
Pregnancyand
especiallythepuerperiumaretimeshighriskforrecurrenceof
bipolardisease.Recommendationsduringpregnancyinclude
discontinuingtherapyforatleastthe1sttrimester,switchingtoan
agentwithalesscontroversialprofile(e.g.,tricyclics),usingsmaller
dosesof
lithium,
andavoidingsodiumrestrictionordiureticswhile
undertreatment.However,discontinuationduringpregnancyof
moodstabilizer,particularlyabruptly,carriesahighriskfornew
morbidityinwomenwithbipolardisease,especiallyforearly
depressiveanddysphoricstates.Thisriskisreducedmarkedlyby
continuedmoodstabilizertreatment.Treatmentplanningfor
pregnantwomenwithbipolardiseaseshouldconsidernotjustthe
Sideeffects
includetremor,musclefasciculations,twitching,
fastingbloodsugar)followedbyirreversiblebraindamagehas
occurredinafewpatientstreatedwith
Acausalrelationshiphasnotbeenestablished
Mayprolongtheeffectsofneuromuscularblockingagents.
Vernalkeratoconjunctivitis—1-2gttOS/ODqid
Vernalconjunctivitis—1-2gttOS/ODqid
Vernalkeratitis—1-2gttOS/ODqid
NOTE:treatmentcanlastupto3mo.
—hypersensitivitytodrugorclass
—contactlenses
MaternalConsiderations
.....
Thereisnopublishedexperiencewith
Sideeffects
includeocularitching,pruritus,blurredvision,dry
eye,tearing,discharge,hyperemia,foreignbodysensation,corneal
ulcer,eyepain,ocularedema,ocularswelling,cornealabrasion,
anteriorchambercells,keratitis,blepharitis,andallergy.
itisunlikelythematernalsystemicconcentrationwillreacha
clinicallyrelevantlevel.
Bacterialinfection—400mgPOqd
Gonorrhea—400mgPO
NOTE:drinkfluidsliberally;renaldosing.
—hypersensitivitytodrugorclass,
prolongationofQTinterval,concomitantuseof
antiarrhythmicdrugs
—hepaticorrenaldysfunction(CrCl
pain,dyspepsia,pseudomembranouscolitis,GIinflammation,
dysphagia,GIbleeding,pruritus,urticaria,eczema,dysuria,
hematuria,andanuria.
Diarrhea—begin4mgPO
1,then2mgPOaftereachloose
stool;max16mg/d
KallenB,NilssonE,OtterbladOlaussonP.ActaPediatr2008;
NikodemVC,HofmeyrGJ.EurJClinPharmacol1992;
...........................
PregnancyCategory:B
LactationCategory:S
shouldbeusedduringpregnancyandlactation
onlyifthebenefitjustifiesthepotentialperinatalrisk.Itisbest
toavoidfirsttrimesterexposure.
InternationalBrandName—
Carbac(Mexico);Karbef(Poland);Lorabid(Austria,Finland,France,Hungary,
Indonesia,Korea,Malaysia,Mexico,Philippines,SouthAfrica,Sweden,Taiwan,Thailand);Lorafem(Germany);
Bacterialinfections—200-400mgPObid
NOTE:besttakenonemptystomach.
—hypersensitivitytodrugorclass,
pseudomembranouscolitis
MaternalConsiderations
.....
isusedtotreatlowerrespiratorytractinfections,GU
tractinfections,skininfections,andsepticemia,andforsurgical
prophylaxis.Thoughcephalosporinsareusuallyconsideredsafe
duringpregnancy,thereisnopublishedexperiencewith
duringpregnancy.
Sideeffects
includepenicillinallergy,renaldysfunction,
antibiotic-associatedcolitis,andseizure.
...........................
PregnancyCategory:B
LactationCategory:S
shouldbeusedduringpregnancyandlactationonly
ifthebenefitjustifiesthepotentialperinatalrisk.
Therearealternativeantibioticsforwhichthereismore
experienceduringpregnancyandlactation.
—(Alavert;Claritin;ClaritinRediTabs)
InternationalBrandName—
Aerotina(Argentina);Alerfast(Peru);Alernitis(Indonesia);Alertadin(Peru);
Allerta(Philippines);Allertyn(HongKong,Singapore);Allohex(Indonesia);Ambrace(HongKong);Analergal(Mexico);
Anhissen(Indonesia);Anlos(Indonesia);Ardin(Singapore);Bonalerg(Guatemala);Caradine(Thailand);Carin(Malaysia);
Civeran(Spain);Clalodine(Thailand);Claratyne(NewZealand);Clarid(Thailand);Claritin(Brazil,Bulgaria,Canada,
Allergicrhinitis—10mgPOqd
Urticaria—10mgPOqd
maleoffpringofwomenwhoused
inearlypregnancy.
ThisconclusionisconfirmedbyarecentDanishstudy.Rodent
studiesarereassuring,revealingnoevidenceofteratogenicityor
IUGRdespitetheuseofdoseshigherthanthoseusedclinically.
Insomnia—2-4mgPOqhs
Statusepilepticus—4mgIV
1,mayberepeatedin10-15min;
max8mg/12h
—hypersensitivitytodrugorclass,
glaucoma,alcoholintoxication,depressivedisorder,psychosis
—hepatic,pulmonary,orrenaldysfunction;drugabuse
MaternalConsiderations
.....
Thereisagrowingappreciationthatthepurportedrisksof
duringpregnancyaresmallerthanfirstthought.
Womeninneedofthetherapyshouldnotbedenieditsolely
becauseofthepregnancy.Althoughnonpharmacologic
approachestothetreatmentofinsomniaarefirst-linetherapy,
intermediate-actingbenzodiazepinessuchas
maybeusefulinsomecircumstances.
reversesthehypothermiaassociatedwithneuraxialanesthesia
bupivacaine,morphine,
Sideeffects
includeCVcollapse,respiratorydepression,
withdrawalsyndrome,blooddyscrasias,gangrene,dependency,
sedation,dizziness,weakness,ataxia,depression,N/V,antegrade
amnesia,headache,sleepdisturbances,diplopia,nystagmus,
WhitelawAG,CummingsAJ,McFadyenIR.BrMedJ(ClinRes
Ed)1981;282:1106-8.
...........................
PregnancyCategory:D
LactationCategory:S
Benzodiazepineshistoricallyhavebeenprescribedinexcess.
Theyshouldbeavoidedwherepossibleduringpregnancy.
maybeanappropriatechoiceforwomenwitha
clearindication.
Therearealternativeagentsforwhichthereisbothmore
Hypercholesterolemia—begin20mgPOwithfood,increaseuntil
desiredeffect;max80mgPOqpm
PreventionofCVevents—10-80mgPOqpm
NOTE:monitorhepatictransaminasesatbaseline,6wafter
initiation,and1moaftereachincrease.
—hypersensitivitytodrugorclass,active
hepaticdisease,elevatedtransaminases,pregnancy,lactation
—hepaticorrenaldysfunction,alcoholism
MaternalConsiderations
.....
Therearenoadequatereportsorwell-controlledstudiesof
inpregnantwomen.Thelimitedinformationavailable
ontheeffectofHMG-CoAreductaseinhibitorsonpregnancy
suggestssimilaroutcomesasthegeneral,nonexposedpopulation.
Hypercholesterolemiaisachronicproblem.Discontinuationof
duringpregnancyisunlikelytoincreasematernal
Sideeffects
includerhabdomyolysis,hepatotoxicity,dyspepsia,
constipation,flatulence,abdominalpain,rash,asthenia,myalgias,
andelevatedCPKandLFTs.
...........................
PregnancyCategory:X
LactationCategory:U
Pendingtheavailabilityofreassuringstudies,
isnot
recommendedduringpregnancyorlactation.
Placentaltransportstudiesaredesperatelyneeded.
InternationalBrandName—
Desconex(Spain);Loxapac(Belgium,Canada,Denmark,England,France,
Psychosis—30-50mgPObid
—hypersensitivitytodrugorclass,
—CVdiseases,glaucoma,hepaticdisease
MaternalConsiderations
.....
isatranquilizerindicatedforthemanagementofthe
manifestationsofpsychoticdisorders.Galactorrheaisacommon
complication.Therearenoadequatereportsorwell-controlled
studiesof
inpregnantwomen.
Sideeffects
includedrowsiness,sedation,dizziness,faintness,
staggeringorshufflinggait,muscletwitching,weakness,insomnia,
agitation,tension,seizures,akinesia,slurredspeech,numbness,
confusionalstates,parkinsonian-likesymptoms,dystonicreaction,
tachycardia,hypotension,hypertension,orthostatichypotension,
light-headedness,syncope,agranulocytosis,thrombocytopenia,
leukopenia,drymouth,nasalcongestion,constipation,blurred
—(Diapid;Syntopressin)
InternationalBrandName—
Syntopressin(England,Ireland)
DrugClass
..........................
Magnesiumchloride
InternationalBrandName—
Noneidentified.
DrugClass
..........................
Electrolytereplacements;Vitamins/minerals
.........................
.........................
DosagewithQualifiers
.......
Hypomagnesemia—4gmixedin250mlof5%dextroseIVno
fasterthan3ml/min,doserange1-40gqd
NOTE:serummagnesiummeasurementsshouldguidereplacement;
keepcalciumgluconatereadilyavailabletocounteractpotentially
serioussignsofmagnesiumintoxication.
—hypersensitivitytodrugorclass,renal
failure,impairedmyocardialfunction
—electrolytedisturbances,renaldysfunction
MaternalConsiderations
.....
Therearenoadequatereportsorwell-controlledstudiesof
magnesiumchloride
inpregnantwomen.
Sideeffects
includeflushingandsweating.
Magnesiumcitrate
InternationalBrandName—
Noneidentified.
DrugClass
..........................
.........................
.........................
DosagewithQualifiers
.......
Constipation—120-240mlPOprn
—hypersensitivitytodrugorclass,
appendicitis,acuteabdomen,GIobstruction
—renaldysfunction,electrolytedisturbances
MaternalConsiderations
.....
Magnesiumcitrate
reducesthefrequencyofnightlegcrampsin
nonpregnantpatients.Therearenoadequatereportsorwell-
controlledstudiesof
magnesiumcitrate
inpregnantwomen.Its
useduringpregnancyincreasesserummagnesium.
Sideeffects
includeabdominalcramps,flatulence,diarrhea,
hypotension,hypermagnesemia,andrespiratorydisturbances.
Magnesiumoxide
InternationalBrandName—
Noneidentified.
DrugClass
..........................
Electrolytereplacements;Vitamins/minerals
.........................
.........................
DosagewithQualifiers
.......
Hypomagnesemia—1-2tabPObidortid
NOTE:400mgtab=241.3mgofelementalmagnesium.
—hypersensitivitytodrugorclass,renal
failure,impairedmyocardialfunction
—electrolytedisturbances,renaldysfunction
MaternalConsiderations
.....
Therearenoadequatereportsorwell-controlledstudiesof
magnesiumoxide
Magnesiumsulfate
—(TisUSol)
InternationalBrandName—
Noneidentified.
DrugClass
..........................
Anticonvulsants;Electrolytereplacements;Tocolytics
.........................
Ventriculararrhythmia,eclampsia,tocolysis,hypomagnesemia
.........................
InhibitsCa
releasefromtheintracytoplasmicstoragedeposits,
blocksCa
influxthroughglutamatechannelsorthroughthe
NMDAreceptor
DosagewithQualifiers
.......
Ventriculararrhythmia—3-20mg/mincontinuousIV
Eclampsia,preventionandtreatment—begin4gIV
1over
30min;then1g/hIVmaintenancerateforatleast24h
postpartum,orduringdiuresis
200ml/h;alternatively,10gIM
loadingdosefollowedby5gIMq4huntilatleast24hpostpartum
Tocolysis—begin6gIV
1over30min,then2-4g/hIV
Hypomagnesemia—1gIMq4-6h;alternative5gmixedin1LNS
IVover3h
NOTE:renaldosing;measureserummagnesiumevery4-6hif
2g/horoliguriaormaternalsymptomsoftoxicity;
reductioninneonatalmortalityandavoidsmaternaldrug
toxicity,itleadstoa2-foldincreaseinmaternaldeathandmore
neurologicallycompromisedneonatescomparedtoempiric
magnesium.Theclinicaldecisiontousemagnesiuminwomen
withmildpreeclampsiaforseizureprophylaxisshouldbe
hypotension,drowsiness,N/V,hypocalcemia,hyperkalemia,
flushing,blurredvision,sweating,muscleweakness,ECGchanges,
sedation,andconfusion.
Oliguriaprevention—50-100gIVover2h
Oliguriatreatment—50-100gIVover2h
Cerebraledema—100gIV
Diuresis,forced—25-100gIVover2h
NOTE:attempttomaintainurinaryoutput
—hypersensitivitytodrugorclass,anuria,
progressiverenalfailureafterinitiation,noresponsetothe
initialbolus,pulmonaryedema,severedehydration,intracranial
hemorrhage,progressiveheartfailure
—renaldysfunction
MaternalConsiderations
.....
beenusedforthetreatmentofposterior,reversible
Sideeffects
includeseizures,heartfailure,CVcollapse,pulmonary
edema,acuterenalfailure,CNSdepression,coma,fluid
imbalance,tachycardia,dehydration,electrolytedisorders,
acidosis,blurredvision,thrombophlebitis,urticaria,fever,
infusionsiteinfection,drynessofmouth,thirst,rhinitis,skin
necrosis,angina,andwaterintoxication.
Depression—25-50mgPObidortid;max225mgPOqd
—hypersensitivitytodrugorclass,MI,usage
ofMAOIswithin14d
—seizuredisorders,arrhythmias,strokes,tachycardia
MaternalConsiderations
.....
Therearenoadequatereportsorwell-controlledstudiesof
inpregnantwomen.
Sideeffects
includeseizures,neurolepticmalignantsyndrome,
constipation,drymouth,blurredvision,dizziness,orthostatic
diaphoresis,renalfailure,rash,edema,dyskinesia,diarrhea,bitter
taste,abdominalcramps,dysphagia,decreasedlibido,weakness,
fatigue,insomnia,agitation,hallucinations,nightmares,
disorientation,delusions,restlessness,hypomania,mania,
exacerbationofpsychosis,decreaseinmemory,andfeelingsof
Weightloss—1mgPOqd;dosagemaybeincreasedbymax
NOTE:takewithfoodormilk.
—hypersensitivitytodrugorclass,
arteriosclerosis,CVdisease,hypertension,hyperthyroidism,
Pinworminfection—100mgPO
Whipworminfection—100mgPObid
Hookworminfection—100mgPObid
Roundworminfection—100mgPObid
Capillariasis—200mgPObid
—hypersensitivitytodrugorclass,
pregnancy,children
MaternalConsiderations
.....
Treatmentofreproductive-agewomenisstronglyrecommended
inareasofwidespreadhookworminfectionanditsrelated
anemia.Insomeendemicareas,treatmentofallpregnantwomen
afterthe1sttrimestereffectivelyreducestheincidencesofIUGR
andperinataldeath.
Sideeffects
includeangioedema,seizures,neutropenia,abdominal
pain,N/V,diarrhea,fever,dizziness,headache,rash,pruritus,
alopecia,andconvulsions.
InternationalBrandName—
Mevasine(Japan)
DrugClass
..........................
Adrenergicantagonists;Antihypertensives;Smoking/drug
.........................
Hypertension,malignanthypertension,smokingcessation
.........................
Inhibitsnicotinic-cholinergicreceptors(ganglionblockade)
DosagewithQualifiers
.......
Hypertension—begin2.5mgPObidandincreaseby2.5mgq2d
until25mgqd
Smokingcessation—2.5mgPObid
—hypersensitivitytodrugorclass,
hypertension,historyofacuteMI,coronaryinsufficiency,
uremia,pyloricstenosis,glaucoma
—renalorCVdysfunction,fever,infection,anesthesia,
surgery,vigorousexercise,useofalcoholorotherhypertensive
MaternalConsiderations
.....
Thereisnopublishedexperiencewith
Sideeffects
includedizziness,light-headedness,fainting,
Malignancy—0.4mg/kg/course;numerousdosingschedulesexist
reflectingthedisease,patientresponse,andconcomitanttherapy
—hypersensitivitytodrugorclass,
suppurativeinflammation
MaternalConsiderations
.....
Therearenoadequatereportsorwell-controlledstudiesof
—(Ancolan;Antivert;Duramesan;En-Vert;
Meclicot;Meclizine;Meclozine;Medivert;Yonyun)
InternationalBrandName—
Bonamina(Argentina);Bonamine(Canada,Germany,Japan,Philippines,Taiwan);
Chiclida(Spain);Dramine(Spain);Navicalm(Portugal);Postadoxin(Germany);Postadoxine(Philippines);
Postafen(Denmark,Finland,Norway,Sweden);Postafene(Belgium,HongKong);Sea-Legs(NewZealand);
N/Vanddizzinessduetomotionsickness—25-50mgPOqd1h
beforetravel;repeatq24h
—hypersensitivitytodrugorclass
—GIandGUobstruction,usageofdrugwith
CNS-depressiveeffect
MaternalConsiderations
.....
effectivelyreducesN/Vassociatedwithemergency
hormonalcontraception(Yuzperegimen).Therearenoadequate
reportsorwell-controlledstudiesof
inpregnant
women.ItiscommonlyusedinseveralEuropeancountriesfor
thetreatmentof1sttrimesterN/V.
Sideeffects
includetachycardia,hallucinations,jaundice,
InternationalBrandName—
Pain—50mgPOq4-6h;max400mg/d
Dysmenorrhea—100mgPOtid;max6dusage
Osteoarthritis—50-100mgPOtidorqid
Rheumatoidarthritis—50-100mgPOtidorqid
Ankylosingspondylitis—50-100mgPOtid
Gout,acute—100mgPOtid
NOTE:takewithfoodormilk.
—hypersensitivitytodrugorclass,
NSAID-inducedasthma
—nasalpolyps,GIbleeding,hypertension,cardiac
failure,asthma
MaternalConsiderations
.....
isanonsteroidalagentwithanti-inflammatory,
DrugInteractions
................
Enhancestheeffectof
andthe
doseshouldbe
reducedtopreventexcessiveprolongationofthePTorINR.
maylower
plasmalevels,possibleby
Amenorrhea—5-10mgPOqd
5ondays16-21ofthecycleor
Dysfunctionaluterinebleeding—5-10mgPOqd
5ondays
16-21ofthecycleorqmo
Hormonereplacement—5-10mgPOqd
Contraception—150mgIMq3mo
—hypersensitivitytodrugorclass,
thromboembolicdisease,pregnancy,breastcancer,undiagnosed
thatnumerouspregnantwomenareexposedto
sincemanypregnancieswillnotbe
recognizeduntilafterthe1sttrimester.Progestationalagents
(i.e.,notnative
)suchas
werelongusedduringearlypregnancytoprevent1sttrimester
spontaneousabortion.Thewisdomofthispracticecannotbe
substantiated.Itisspeculatedthatprogestationalagentsmay
delayspontaneousabortioninwomenwithdefectiveova.While
therearenoadequatereportsorwell-controlledstudiesof
inpregnantwomen,epidemiologicstudies
arereassuringasthereisnodemonstrableincreaseinthe
prevalenceofectopicpregnancy.
isalso
Mefenamicacid
—(Coslan;Ponsfen;Ponstel)
InternationalBrandName—
Algastel(Philippines);Algifort(Philippines);Alpain(Indonesia);Aprostal
(Philippines);Atmose(Philippines);Beafemic(Malaysia);Benostan(Indonesia);Bonabol(Japan);Dolfenal(Thailand);
Dysman(England);Dyspen(Malaysia,Thailand);Ecopan(Switzerland);Eurostan(Philippines);Femen(Thailand);
Fenalac(Philippines);Fenamic(Israel);Fenamin(SouthAfrica);Fenamol(Israel);Fengic(Philippines);Hamitan
(HongKong);Hispen(Philippines);Hostan(HongKong);Johnstal(Taiwan);Kemostan(Indonesia);Lysalgo(Italy);
Manic(Thailand);Manomic(Thailand);Masafen(Thailand);MecidA(Philippines);Mefa(HongKong);Mefac(Ireland);
Mefacap(Singapore);Mefacit(Poland);Mefalqic(SouthAfrica);Mefast(Indonesia);Mefen(Malaysia);Mefic
Pain—50mgPOq4-6h;max400mg/d
Dysmenorrhea—100mgPOtid;max6dusage
Osteoarthritis—50-100mgPOtidorqid
Rheumatoidarthritis—50-100mgPOtidorqid
Ankylosingspondylitis—50-100mgPOtid
Gout,acute—100mgPOtid;alternatively500mgPO,then250mg
POq6hfornotmorethan7d
NOTE:takewithfoodormilk.
—hypersensitivitytodrugorclass,NSAID-
inducedasthma
—nasalpolyps,GIbleeding,hypertension,cardiac
failure,asthma
MaternalConsiderations
.....
Mefenamicacid
isanonsteroidalagentwithanti-inflammatory,
thoseusedclinically.Embryotoxicityisnotedinsomespecies.
InternationalBrandName—
Lariam(Canada,Chile,China,HongKong,Korea,Peru,Philippines,Taiwan,
Uruguay);Laricam(Japan);Mefliam(Israel,SouthAfrica);Mephaquin(Colombia,HongKong,Israel,Thailand);
Mephaquine(Switzerland);Mequin(Thailand);Tropicur(Argentina)
DrugClass
..........................
.........................
Malaria(prophylaxisandtreatment)
.........................
Unknown;actsasschizonticide
DosagewithQualifiers
.......
Malariaprophylaxis—250mgPOqwbeginning1wbeforeand
continuinguntil4wafterpossibleexposure
Malariatreatment—1250mgPO
1followedbytreatmentwith
NOTE:takewithfoodandwater.
—hypersensitivitytodrugorclass,
depression,psychosis,seriouslife-threateninginfections
—seizures,psychiatricdisorder,hepaticdysfunction,
cardiacconductiondiseases,cardiacarrhythmia
MaternalConsiderations
.....
Malariaremainsanimportantcauseofmaternalandperinatal
morbidityandmortalityinendemiccountries.
P.falciparum
drugresistanceincreasinglylimitstheeffectivenessof
antimalarialtherapy.
isthemosteffectiveagent
forthepreventionofchloroquine-resistantfalciparummalaria.
TheWHOfavors
prophylaxisinpregnantwomen
from16wonward.
aretheonly
antimalarialsgenerallyavailableforthetreatmentofdrug-
P.falciparum
duringpregnancy.Prospectivestudies
(25mg/kg)incombinationwith
(4mg/kg/dfor3d)ismoreeffectivethan
(10mg/kgq8h)
forthetreatmentofmultidrug-resistantfalciparummalaria
duringpregnancy.Manyoftheadverseeffectsof
reflectprimaryhepaticdamageorsymptomaticthyroid
disturbances,whichmightoccureitherindependentlyorasa
secondaryconsequenceofthehepatocellularinjury.Routine
intermittenttreatmentofwomeninendemiclocaleshasbeen
Sideeffects
includeseizures,hallucinations,ECGconduction
abnormalities,erythemamultiforme,Stevens-Johnsonsyndrome,
encephalopathy,dizziness,syncope,extrasystoles,myalgia,N/V,
fever,headache,chills,diarrhea,pruritus,asthenia,transient
emotionaldisturbances,andhairloss.
DrugInteractions
................
Usewithrelatedcompounds(e.g.,
chloroquine,quinidine,
)mayproduceECGabnormalitiesandincreasetheriskof
convulsions.Ifthesedrugsaretobeusedintheinitialtreatment
ofseveremalaria,
administrationshouldbedelayed
atleast12hafterthelastdose.
BecauseofthepotentialforfatalprolongationoftheQTc
shouldnotbegivensimultaneouslywithor
subsequentto
—(Magace;Megace;Niagestine)
InternationalBrandName—
Endace(India);Maygace(Spain);Megace(Argentina,Australia,Austria,Canada,
Breastcancer—40mgPOqid
AIDSwastingsyndrome—800mgPOqd;alternative400mg
PObid
—hypersensitivitytodrugorclass,
1sttrimesterpregnancy
Insomnia—0.3-1mgPObid;shouldbegivenat6:00and8:00
isnotregulatedbytheFDAandissoldOTC.
hypersensitivitytodrugorclass
CVdisease
MaternalConsiderations
.....
Therearenoadequatereportsorwell-controlledstudiesof
inpregnantwomen.
isanaturalhormone
DrugInteractions
................
Noclinicallyrelevantinteractionsidentified.
.........................
GoldmanBD.SciSTKE2003;2003(192):PE29.
Osteoarthritis—7.5-15mgPOqd;max15mg/d
—hypersensitivitytodrugorclass,NSAID-
inducedasthma
—nasalpolyps,GIbleeding,hypertension,cardiac
failure,asthma
MaternalConsiderations
.....
isanonsteroidalagentwithanti-inflammatory,
InternationalBrandName—
Alkeran(Brazil,Canada,Chile,China,Colombia,Ecuador,HongKong,India,
Indonesia,Japan,Korea,Mexico,Philippines,Taiwan,Thailand,Uruguay);Alkerana(Argentina)
DrugClass
..........................
Antineoplastics,alkylatingagent
.........................
Multiplemyeloma,ovariancancer
.........................
Alkylatesandcross-linksDNA
DosagewithQualifiers
.......
Multiplemyeloma—variesdependingontumorandprotocol
Ovariancancer—variesdependingontumorandprotocol
NOTE:themostcommonlyrecommendeddoseis10mg/d
Continuousmaintenancetherapywith2mg/disinstitutedwhenthe
4000cells/mlandthePLT
—hypersensitivitytodrugorclass,
hypersensitivityto
resistancetodrug
renalfailure,leukopenia,thrombocytopenia,anemia,
MaternalConsiderations
.....
isanalkylatingagent.While
Gastriculcer—25-50mgPOqid
—hypersensitivitytodrugorclass,
glaucoma,pyloroduodenalstenosis,achalasia,GIhemorrhage,
toxicmegacolon,myastheniagravis
—coronaryheartdisease,CHF,cardiacarrhythmia,
tachycardia,hypertension
MaternalConsiderations
.....
Thereisnopublishedexperiencewith
Sideeffects
includeN/V,constipation,lossoftaste,bloated
feeling,drymouth,tachycardia,palpitations,increased
oculartension,cycloplegia,blurredvision,dizziness,weakness,
drowsiness,headache,nervousness,anaphylaxis,andurticaria.
MayaffectGIabsorptionofvariousdrugs,suchasslowly
dissolvingformsof
increasedserum
concentrationsmayresult.
MayantagonizetheeffectsofdrugsthatalterGImotility,suchas
Pain—50-150mgPO/SC/IMq3-4h;IMpreferredoverSC/IV
Preoperativesedation—50-100mgSC/IM
1,30-60minbefore
whengivenfordystocia.
doesnothave
invitro
significanteffectonthespontaneouscontractionsofgravid
ChestnutDH.RegAnesth1997;22:495-9.
—(ThisdrugisnotdistributedintheUS.)
InternationalBrandName—
Mephentermin(Bulgaria);Mephentine(India);Wyamine
(CzechRepublic,Greece)
DrugClass
..........................
Adrenergicagonists;Pressors
.........................
.........................
StimulatesthereleaseofNE/epinephrine
DosagewithQualifiers
.......
Hypotensionshock—1mg/mlIVsolutioninD
W;mayalsobe
givenasastocksolutionof30mg/mlIV
Hypotensionspinalanesthesia—15mgIVpush
1;maybe
repeatedin30min;maintenanceofBPaccomplishedbya
continuousinfusionofa0.1%solutionof
W(1mg/mlsolution)
—hypersensitivitytodrugorclass,
hypotensioninducedby
—generalanesthesia,CVdiseases,hypertension,
MaternalConsiderations
.....
Seizuredisorder—beginwith50-100mgqdandincrease
50-100mgqwuntildesiredeffect;max800mg/dindivideddoses
—hypersensitivitytodrugorclass
MaternalConsiderations
.....
Seizurecontrolshouldbesoughtpriortopregnancy.
shouldbeusedonlyaftersaferanticonvulsantsare
givenanadequatetrialandfailed.Therearenoadequatereports
orwell-controlledstudiesof
inpregnantwomen.
Seizuredisorder—400-600mgPOqd
—(Amosene;Atacin;Disatral;Equanil;
Mepriam;Meproban-400;Meprospan;Miltown;Neuramate;
Oasil-Simes;Probate;Procalmadiol;Sinanin;Trancot;Tranmep)
InternationalBrandName—
Andaxin(Hungary);Ansiowas(Spain);Apo-Meprobamate(Canada);Atraxin
(Japan);Distoncur(Argentina);Epikur(Austria);Harmonin(Japan);Meprin(Argentina);Mepro(Israel);Meprodil
(Switzerland);Miltaun(Austria,Germany);Oasil(Belgium);Pertranquil(Austria,Belgium);Placidon(Argentina);
Praol(Greece);Procalmidol(Belgium);Quanil(Italy);Restenil(Sweden);Sycropaz(Argentina);Visanon(Germany)
DrugClass
..........................
.........................
LeonardBE.ArchToxicolSuppl1982;5:48-58.
Acutelymphocyticleukemia—numerousdosingschedules
dependingondisease,response,andconcomitanttherapy
AML—numerousdosingschedulesdependingondisease,
response,andconcomitanttherapy
Crohn’sdisease—75-125mgPOqd;max1.5mg/kg/d
Ulcerativecolitis—beginwith50mgPOqd;typicaldose
75-125mgPOqd;max1.5mg/kg/d
NOTE:monitorCBCqw
4thenqmoandLFTsq3moafter
inductionorduringmaintenanceofremission;discontinue
temporarilywithevidenceofanabnormallylargedecreaseinWBC
pregnancyisattempted.Awomanwhounexpectedlyconceives
whileherdiseaseisactiveshouldbetreatedaggressively,as
remissionprovidesthegreatesthopeforafavorableoutcome.
ThetreatmentofAMLtypicallyinvolvesacomplexdrugregimen
thatincludes
Multiplecasereportssuggestthe
useof
Bacterialinfections—
1gIVq8h;
1gIV
bacterialmeningitis:
2gIVq8h
NOTE:renaldosing.
—hypersensitivitytodrugorclass,penicillin
—seizuredisorder,renaldysfunction
MaternalConsiderations
.....
Therearenoadequatereportsorwell-controlledstudiesof
inpregnantwomen.Onemulticenterstudy
isaneffectiveandsafealternativeto
forthetreatmentofwomenwithacute
—(Asacol;Pentasa;Rowasa)
InternationalBrandName—
5-ASA400(Argentina,Paraguay);Asacol(Belgium,Canada,Denmark,England,
Ulcerativecolitis—1000mgPOqid
8w;alternatively,4gPRqh
Crohn’sdisease—1000mgPOqid
—hypersensitivitytodrugorclass,
hypersensitivitytosalicylates
—renalorhepaticdysfunction,pyloricstenosis,bowel
movementsuppressants
MaternalConsiderations
.....
Inflammatoryboweldiseasecanbechallenging.Womenwith
quiescentdiseasearelikelytohaveanuncomplicatedpregnancy,
whereasthosewithactivediseasearemorelikelytosuffer
spontaneousabortion,stillbirth,IUGR,andexacerbationof
disease.ThisistruerforpatientswithCrohn’sdiseasethanthose
withulcerativecolitis.Inwomenconsideringpregnancy,anactive
episodeshouldbetreatedaggressivelyandremission
accomplishedbeforepregnancyisattempted.Awomanwho
unexpectedlyconceiveswhileherdiseaseisactiveshouldbe
treatedaggressively,asremissionprovidesthegreatesthopefora
favorableoutcome.
isaby-productof5-
aminosalicylicacidboundtosulfapyridine.Mostpatientswith
adverseeffectsfrom
willtolerate
isatleastequivalentorsuperiorto
andsuperiortoplacebo,withadose-responsebenefit,ininducing
remissionofacuteinflammatoryboweldisease.Itisalso
comparableto
andsuperiortoplaceboforlong-
termmaintenanceofremission.
Sideeffects
includebloodydiarrhea,fever,headache,rash,
anaphylaxis,thrombocytopenia,leukopenia,anemia,
agranulocytosis,interstitialnephritis,pepticulcer,nephropathy,
myocarditis,hepatitis,peripheralneuropathy,Stevens-Johnson
syndrome,headache,abdominalpain,dyspepsia,N/V,flatulence,
constipation,asthenia,diarrhea,backpain,arthralgia,rhinitis,dry
mouth,elevatedLFTs,elevatedBUN/Cr,dysmenorrhea,hairloss,
andflu-likesymptoms.
Inflammatoryboweldiseaseisassociatedwithincreased
prematurityanddecreasedbirthweight(
330g,adjusted95%CI:
509to
150g,p
.001);thebirthweightisevenlowerif
orsteroidsarerequired.
Alcoholism—begin25mgPObid;max200mg/d
—hypersensitivitytodrugorclass,cardiac
arrhythmia,CNSdepression,coma,prolongedQTinterval,
arrhythmia,hypotension,glaucoma,paralyticileus,GI
obstruction,bonemarrowdepression
—renalorhepaticdysfunction,CVdisease,Parkinson’s
disease,seizuredisorder,CNSdepression
MaternalConsiderations
.....
Becauseofitsproarrhythmiceffect,
isindicatedfor
themanagementofschizophrenicpatientswhofirstfailto
respondadequatelytootherantipsychoticdrugs.Thereareno
adequatereportsorwell-controlledstudiesof
pregnantwomen.
Sideeffects
includethrombocytopenia,leukopenia,aplastic
anemia,agranulocytosis,neurolepticmalignantsyndrome,
dystonia,fever,laryngealedema,angioneuroticedema,asthma,
QTintervalprolongation,torsadesdepointes,arrhythmia,N/V,
jaundice,biliarystasis,blurredvision,rash,tachycardia,tardive
dyskinesia,phototoxicity,miosis,anorexia,andsuddendeath.
Contraception—1tabPOqd
Dysmenorrhea—1tabPOqd
Dysfunctionaluterinebleeding—1tabPOqd
Polycysticovarysyndrome—1tabPOqd
NOTE:combinedwith
Asthma—2-3puffsINHq3-4h;max12puffs/d;or0.2-0.3ml5%
solNEBq4h;or20mgPOtidorqid
IvanovS.AkushGinekol1997;36:9-10.
KastA,HermerM.JPerinatMed1993;2:97-106.
Shock—0.5-5mgIV
—hypersensitivitytodrugorclass,general
anesthesiawith
orcyclopropane
However,consideringthedoseandroute,itisunlikelythe
breastfedneonatewouldingestclinicallyrelevantamounts.
DrugInteractions
................
Usewithcautionindigitalizedpatients,asthecombinationmay
causeectopicarrhythmias.
Musclespasm—800mgPOtidorqidonanemptystomach
—hypersensitivitytodrugorclass,hemolytic
renalorhepaticdysfunction
MaternalConsiderations
.....
Thereisnopublishedexperiencewith
.........................
Thereisnopublishedexperienceinpregnancyorduringlactation.
...........................
PregnancyCategory:C
LactationCategory:U
PCOS—500mgPOtid
NOTE:renaldosing;holdforiodinatedcontraststudy.
—hypersensitivitytodrugorclass,renalor
reportsorwell-controlledstudiesof
estrogens,oralcontraceptives,
nicotinicacid,
Diagnosisofbronchialairwayhyperreactivity—5breaths(NEB);
measureFEV
atbaselineandafter5breaths
NOTE:diagnosticpurposeonly.
MaternalConsiderations
.....
Pain—2.5-10mgPOq3-4h
Opiateaddiction—15-20mgPOqd;max120mgqd
Opiateaddictionmaintenancetherapy—20-120mgPOqd
NOTE:equianalgesic:PO=2
IVdose.
—hypersensitivitytodrugorclass
—renalorhepaticdysfunction;hypothyroidism;
Addison’sdisease;acuteabdominalpain;concomitantuseof
rifampin,pentazocine,desipramine,
orMAOIs
MaternalConsiderations
.....
Itisnotassociatedwithrespiratorydepression.However,the
withdrawalismoreintenseinthe
maintenance(30-100mgqd).TheC
andAUCof
ScimecaMM,SavageSR,PortenoyR,LowinsonJ.MtSinaiJ
Med2000;67:412-22.
ADD—20-25mgPOqd
Weightloss—5-10mgPOtid;treatmentshouldnotexceedfew
Narcolepsy—5-60mg/dindivideddoses
—hypersensitivitytodrugorclass,
glaucoma,arteriosclerosis,CVdisease,severehypertension,
hyperthyroidism,agitation,drugabuse
MaternalConsiderations
.....
potentiallyharmfulsubstances(smoking,heavyalcoholintake,
andpolydrugusage).
Sideeffects
includetachycardia,palpitation,dizziness,dysphoria,
overstimulation,euphoria,insomnia,tremor,restlessness,
headache,diarrhea,constipation,drymouth,unpleasanttaste,
urticaria,decreasedlibido,stroke,cardiacarrhythmia,stomach
Pepticulcer—50-100mgPOqid;maydecreasedoseto25-50mg
formaintenancetherapy
—hypersensitivitytodrugorclass,
glaucoma,achalasia,paralyticileus,bowelobstruction,pyloric
stenosis,ulcerativecolitis,toxicmegacolon,myastheniagravis
—autonomicneuropathy,hepaticorrenaldisease,
CAD,CHF,tachyarrhythmias,hypertension,hiatalhernia,
MaternalConsiderations
.....
Thereisoneoldreportoftheuseof
DrugInteractions
................
Anticholinergicsmaydelayabsorptionofothermedication.
Glaucoma—50-100mgbidortid;maybeusedconcomitantly
withmioticandosmoticagents
—hypersensitivitytodrugorclass,
hyponatremia,hypokalemia,depressedrespiratoryfunction,
cirrhosis,hyperchlorideacidosis,adrenocorticalinsufficiency
—cirrhosis,hepaticdysfunction,pulmonary
obstruction,emphysema
MaternalConsiderations
.....
Thereisnopublishedexperiencewith
DrugInteractions
................
Steroidusemayleadtohypokalemia.
Bacterialinfections,urinary—1gPOqid
NOTE:ineffectiveforsomeinfectionswithP.vulgarisand
urea-splittingstrainsofPseudomonasaeruginosaandA.aerogenes.
—hypersensitivitytodrugorclass,renal
insufficiency,hypovolemia,sulfonamideusage
MaternalConsiderations
.....
Therearenoadequatereportsorwell-controlledstudiesof
DrugInteractions
................
Shouldnotbeadministeredwith
sulfamethizole
sinceformaldehyde
and
Bacterialinfections—1-2gIM/IVq4-6h
—hypersensitivitytodrugorclass
—renalorhepaticdysfunction
MaternalConsiderations
.....
Theroleof
DrugInteractions
................
Mayreducetheefficacyoforalcontraceptives.
mayincreasepenicillinlevels.
Hyperthyroidism—begin5-20mgPOq8h,then5-15mgPOqd
NOTE:takewithfood.
—hypersensitivitytodrugorclass,lactation
pregnancy,agranulocytosis,bonemarrowsuppression
MaternalConsiderations
.....
Severalclinicalaspectsofhyperthyroidismhavereceivedspecial
attentionintherecentpast.Hyperthyroidismassociatedwith
hyperemesisgravidarium
wasoriginallybelievedsecondaryto
fromhyperthyroidismandthedoseof
Musclespasm—1-1.5gPOqid
—hypersensitivitytodrugorclass,renal
dysfunction,seizures
MaternalConsiderations
.....
Thereisnopublishedexperienceduringpregnancy.
Anesthesia,induction/maintenance—1-2mg/kgIV,followedby
0.25-1mg/kgIVasneeded
hypersensitivitytodrugorclass,porphyria
severeCVdisease,hypotension,hepaticorrenal
MaternalConsiderations
.....
Consideringitsrapidclearance,itisunlikelyaclinically
significantamountwouldenterthebreastmilkwhenusedforthe
notedindications.
DrugInteractions
................
Ectopicpregnancy—50mg/m
1;mayberepeatedin1wif
hCGrising
Trophoblasticdisease—15-30mgPO/IMqd
5d;repeat
3-5at
1wintervals;administerwith
folicacid
1mgPOqdor
5mgqw
Rheumatoidarthritis—7.5-25mgPO/IM/SCqw;alternatively
2.5-7.5mgPOq12h3
/w;max30mg/w
Psoriasis—10-25mgPO/IM/SCqw;alternatively2.5-7.5mgPO
q12h3
/w;max30mg/w
Mycosisfungoides—5-50mgPO/IVqw;alternatively15-37.5mg
PO2
Chemotherapy—numerousdosingschedulesdependingon
disease,response,andconcomitanttherapy
NOTE:renaldosing.
—hypersensitivitytodrugorclass,alcohol
consumption,hepaticfailure,infection,pleuraleffusion,
immunodeficiencysyndrome
—renalorhepaticdysfunction,bonemarrow
depression,ulcerativecolitis,pepticulcer
MaternalConsiderations
.....
LFTs,N/V,exfoliativedermatitis,fever,dizziness,diarrhea,
pruritus,alopecia,andphotosensitivity.
Pain,acute—10-20mgIMq4-6h
Postoperativeanalgesia—2.5-7.5mgIMq4-6h
—hypersensitivitytodrugorclass;
antihypertensivemedication;MAOIs
14d;CNSdepression;
severecardiac,renal,orhepaticdysfunction;MI;hypotension
MaternalConsiderations
.....
forantacids;theseshouldbegiven1-2hbeforeorafteroral
administrationof
Hypotension—3-5mgIV;alternatively10-15mgIMbeforeorat
thetimeofspinalanesthesia
—hypersensitivitytodrugorclass,
—concomitantuseofTCAsoroxytocicagentsor
14d,heartblock,hyperthyroidism,bradycardia,
myocardialdisease,arteriosclerosis
MaternalConsiderations
.....
Neuraxialanalgesiaisfrequentlyaccompaniedbyhypotension.
Psoriasis,severe—20mgPOwithfood4hbeforeUVAlight
exposure;treatonlyonalternatedays
edema,dizziness,headache,malaise,hypopigmentation,
vesiculation,rash,herpessimplex,miliaria,urticaria,folliculitis,
GIdisturbances,cutaneoustenderness,legcramps,hypotension,
andextensionofpsoriasis.
Pepticulcer—2.5mgPOqac,qhs
—hypersensitivitytodrugorclass,ulcerative
colitis,glaucoma,GIobstruction,paralyticileus,acute
hemorrhage,toxicmegacolon,myastheniagravis
—hightemperature,hyperthyroidism,CAD,CHF,
tachyarrhythmias,tachycardia,hypertension
MaternalConsiderations
.....
Therearenoadequatereportsorwell-controlledstudiesof
Sideeffects
includetachycardia,palpitations,N/V,constipation,
decreasedsweating,urticaria,blurredvision,headaches,
nervousness,mentalconfusion,drowsiness,anddizziness.
monotherapyandthelowesteffectivequantitygivenindivided
dosestominimizethepeakscanminimizetherisks.
Chronichypertension—2.5-5mgPOqd;ifnocontrol8-12w,
adda2ndagent
Edema(peripheral)—2.5-10mgPOqd;max10mgPOqd
NOTE:maybecombinedwithreserpine.
hypersensitivity,electrolyteimbalances,
—hypersensitivitytosulfonamides
MaternalConsiderations
.....
Therearenoadequatereportsorwell-controlledstudiesof
Constipation—1tbspPOqdtotid
—hypersensitivitytodrugorclass,
appendicitis,fecalimpaction,acuteabdomen
MaternalConsiderations
.....
Therearenoadequatereportsorwell-controlledstudiesof
DrugInteractions
................
Noclinicallyrelevantinteractionsidentified.
.........................
ButtinoLTJr,GariteTJ.JReprodMed1990;35:155-8.
ElliottJP,ClewellWH,RadinTG.JReprodMed1992;37:713-6.
Hypertension—250-500mgPObid;begin250mgPObidand
adjustq2d;max3g/d;alternative250-500mgIVq6h
4,thenPO
NOTE:obtainaCBC,Coombs’test,andLFTsbeforebeginning.
—hypersensitivitytodrugorclass,acute
hepatitis,cirrhosis
usageofotherantihypertensivesorlevodopa,renal
dysfunction,MAOI
14d,positiveCoombs’test,hemolytic
MaternalConsiderations
.....
Oneto6%ofyoungwomenhavechronichypertension.
HauserGJ,AlmogS,TiroshM,SpirerZ.HelvPaediatrActa
1985;40:83-6.
DosagewithQualifiers
.......
Postpartumbleeding—
0.2mgIMq2-4h;max5doses;
0.2-0.4mgPOq6-12h;maxduration7d
—hypersensitivitytodrugorclass,
hypertension,toxemia,pregnancy
MaternalConsiderations
.....
Postpartumhemorrhageremainsaleadingcauseofmaternaldeath
andmorbidity.
thehumanplacenta.Rodentteratogenicitystudieshavenotbeen
performed.Inadvertentadministrationduringpregnancyis
...........................
PregnancyCategory:C
LactationCategory:S
Therearenoindicationsfor
ADHD—begin20mgPOqdbeforethe
meal;increase20mg
POqw;max60mgqd
Narcolepsy—begin5-10mgPObid;increase10mg/dq7d
NOTE:donotcrush/chew.
—hypersensitivitytodrugorclass,
DrugInteractions
................
Shouldbeusedcautiouslywithpressoragents(e.g.,
Inflammatorydisorders—2-60mgPOqd
Congenitaladrenalhyperplasia—2-60mgPOqd
Rheumaticdisorders,adjunctivetreatment—2-60mgPOqd
Collagenvasculardiseases—2-60mgPOqd
Allergy—2-60mgPOqd
Respiratorydiseases—2-60mgPOqd
Hematologicdisorders—2-60mgPOqd
MS(acuteexacerbations)—200mgPOqd
7d,then80mgPO
NOTE:4mg
MaternalConsiderations
.....
Mayincreasetheclearanceofchronichigh-dose
todecreasedsalicylatelevelsorincreasetheriskoftoxicitywhen
Breastcancer—50-200mgPOqd;alternatively25-100mg
buccalqd
—hypersensitivitytodrugorclass,
—renal,cardiac,andhepaticdysfunction
MaternalConsiderations
.....
...........................
PregnancyCategory:X
LactationCategory:U
Migraineheadache—begin2mgPOqd;typicaldose4-8mgPO
qd;drug-freeintervalof3-4wq6mo
Diarrhea(carcinoid)—begin2mgPOtid;typicaldose4-16mgPO
—hypersensitivitytodrugorclass,
arteriosclerosis,renalorhepaticdysfunction,hypertension,
CAD,collagendisease,valvularheartdisease
...........................
PregnancyCategory:X
LactationCategory:U
N/V—5-10mgPO/IM/IVq6-8h
N/V(chemo)—1-2mg/kgIV/POq2-4h
GERD—5-15mgPO/IV/IMqac,qhs
theriskofdystonia,patientsmaybepremedicatedwith
CHF—5-20mgPOqd
Peripheraledema—5-20mgPOqd
Hypertension—2.5-5mgPOqd
(morerapidbioavailability;seeNOTE)
Hypertension—begin0.5mgPOqd;max1mgPOqd
Sideeffects
includehyponatremia,hypokalemia,
hypomagnesemia,hypercalcemia,agranulocytosis,aplasticanemia,
neuropathy,pancreatitis,hypotension,dizziness,headache,
palpitations,fatigue,dyspepsia,N/V,constipation,anorexia,
musclecramps,rash,photosensitivity,hyperuricemia,and
Hypertension—50-200mgPObid
AcuteMI—begin5mgIVq2min
3;afterthe3rddose,begin
50mgPOq6h
48h;then100mgPObidor25-50mgPOq6h
Angina—50-200mgPObid;max400mgqd
—hypersensitivitytodrugorclass,
bronchospasticdisease,sinusbradycardia,cardiogenicshock,
AVblock1stdegreeorsevere,CHF,hypotension,depressed
respiratoryfunction
Bacterialinfections—500mgPOq6-8h
7-14d;alternative15mg/
kgIV
1followedby7.5mg/kgIVq5h;max1g/dose
Amebicabscess—500-750mgPOtid
BV—2gPO
1,alternative500mgPObid
Giardiasis—250mgPOtid
5-7d;alternative2gPOqd
C.difficile
colitis—500mgPOtid
7-14d;alternative250mgPO
Rosacea—topicalgelapplicationbid
Vaginaltrichomoniasis—2gPO
1;alternative500mgPObid
7d,1gPObid
1d(partnertreatmentiscritical)
NOTE:availablealsoingel(0.75%)orcream(0.75%).
—hypersensitivitytodrugorclass,alcohol
—hepaticdysfunction,blooddyscrasia,seizures,
MaternalConsiderations
.....
and
resultinginreducedplasmalevels;impairedclearanceof
hasalsobeenreported.
Drugsthatdecreasemicrosomalliverenzymeactivity(e.g.,
Arrhythmia(ventricular)—200mgPOq8h;alternative400mgPO,
then200mgPOq8-12h
Bacterialinfections—3-4gIV/IMq4-6h;alternative200-350mg/
kg/dIVindivideddoses;max24g/d
—hypersensitivitytodrugorclass
—bleeding,uremia,hypokalemia
MaternalConsiderations
.....
aloneorincombinationwithotherantibiotics,is
hemolyticanemia,leukopenia,pseudomembranouscolitis,pain,
phlebitis,N/V,eosinophilia,fever,elevatedLFTs,and
—(Fungoid;Monistat;Ony-Clear;Tara)
InternationalBrandName—
Acorvio(England,Ireland);Acromizol(Ecuador);Aflorix(Argentina);Albistat
(Belgium);Aloid(Mexico);Amykon(Germany);Andergin(Italy);Antifungal(Taiwan);Becarin(Malaysia);Brentan
(Denmark);Candiplas(Taiwan);Candizol(Israel);Candizoloral(Israel);Covarex(SouthAfrica);Daktar(Germany,
Norway,Sweden,Switzerland);Daktarin(Argentina,Austria,Belgium,Brazil,Bulgaria,Chile,Colombia,CostaRica,
CzechRepublic,DominicanRepublic,Ecuador,ElSalvador,England,Finland,France,Greece,Guatemala,Honduras,
Vulvovaginalcandidiasis—numerousdosingschedulesreflecting
disease,response,concomitanttherapy,andcommercialbrand
T.rubrum
(tineapedis,tineacruris,tineacorporis)—numerous
dosingschedulesreflectingdisease,response,concomitant
therapy,andcommercialbrand
Epidermophytonfloccosum,
cutaneouscandidiasis(moniliasis),
tineaversicolor—numerousdosingschedulesreflectingdisease,
response,concomitanttherapyandcommercialbrand
NOTE:availableinintravaginalsuppository/cream/softgelor
dermatologiccreamforms.
Severesystemicfungalinfections—400-1200mgIVq8h
—hypersensitivitytodrugorclass
MaternalConsiderations
.....
vaginitisisperhapsthemostcommonfemalegenital
tractinfection.Thevaginalmilieuduringpregnancypredisposes
C.albicans
overgrowth.Therearenoadequatereportsorwell-
controlledstudiesof
inpregnantwomen.Thereis
asoraltherapywith
forvulvovaginalcandidiasis.
About25-30%oftheoraldose,butlessthan0.1%ofthevaginal
dose,isabsorbed.Thoughwomenfrequentlypreferoral
isnotrecommendedduringpregnancy.
Sideeffects
includeanaphylaxis,thrombocytopenia,cardiacarrest,
vulvovaginalburning,itching,hives,rash,irritation,burning,
maceration,phlebitis,pruritus,N/V,fever,drowsiness,diarrhea,
anorexia,andflushing.
creamiseffectiveforthetreatmentofpregnant
womenwithconfirmedcandidiasis.
shouldbeusedduringpregnancyandlactation
onlyifthebenefitjustifiesthepotentialperinatalrisk.
—(Midolam;Versed)
InternationalBrandName—
Dalam(Argentina);Doricum(Venezuela);Dormicum(Argentina,Colombia,
CostaRica,DominicanRepublic,Ecuador,ElSalvador,England,France,Guatemala,Honduras,India,Ireland,Italy,
Mexico,Nicaragua,Panama,Paraguay,Poland,Slovenia,Uruguay);Dormonid(Brazil,Chile,Peru);Fortanest
(Indonesia);Fulsed(India,Malaysia,Singapore);Hypnovel(Belgium,Colombia,CostaRica,DominicanRepublic,
ElSalvador,England,France,Guatemala,Honduras,Ireland,Mexico,Nicaragua,Panama);Ipnovel(Italy);
Midacum(Korea);Midazo(Taiwan);Midazol(Israel,Thailand);Midolam(Israel);Miloz(Indonesia);Versed(France)
DrugClass
..........................
Anxiolytics;Benzodiazepines;Sedatives
.........................
.........................
BindsbenzodiazepinereceptorsandenhancesGABAeffects
DosagewithQualifiers
.......
Sedation,preoperative—5mgIM1hpreoperatively;alternatively,
0.07-0.08mg/kgIM
Surgicalsedation—0.5-1mgIVq2-3minprn;max5mg
Generalanesthesiainduction—0.3mg/kgIVover20-30sec
Mechanicalventilation,sedation—0.02-0.1mg/kg/hIVprn
—hypersensitivitytodrugorclass,
glaucoma,shock,CNSdepression
—historyofsubstanceabuse,COPD,CHF,renalor
hepaticdysfunction
MaternalConsiderations
.....
Outpatientsurgerydemandsrapidrecoverywithminimaldelay.
Theshort-actingsedationof
makesitoneofthemost
frequentlyusedbenzodiazepinesforshortsurgicalprocedures.
Itismostappropriateforthosewhoareparticularlyanxious.
Conscioussedationwith
improvespatientsatisfactionwith1sttrimestertermination
performedunderlocalanesthesia.Similarresultsareobtainedin
Sideeffects
includerespiratoryand/orcardiacarrest,withdrawal,
habituation,N/V,confusion,euphoria,involuntarymovements,
CamannW,CohenMB,OstheimerGW.Anesthesiology1986;
Hypotension(orthostatic)—10mgPOtid
Urinaryincontinence—2.5mgPObidortid
—hypersensitivitytodrugorclass,renal
dysfunction,thyrotoxicosis,pheochromocytoma
orthostatictachycardiasyndrome(POTS),araredisease
characterizedbysyncope,sinustachycardia,andorthostasisdue
toautonomicdysfunction.Rodentstudiesrevealnoeffecton
uterinecontractility
invitro
Sideeffects
includebradycardia,erythemamultiforme,pruritus,
Abortion—200-600mgPO
NOTE:pregnancy
49dfromLMP;oftencombinedwith
—hypersensitivitytodrug,class,or
prostaglandins;ectopicpregnancy;IUDinplace;
anticoagulation;corticosteroiduse;chronicadrenalfailure;
bleedingdisorder;porphyria;noaccesstoemergenthealthcare;
noncompliancewiththetreatment
MaternalConsiderations
.....
Sheepstudiesdemonstratethat
suppressesuterine/
maternalsystemicconcentrationwillreachaclinicallyrelevant
level.Rodentstudiesarereassuring,revealingnoevidenceof
teratogenicity,thoughtherewasasmallincreaseinIUGRat
dosesinmultiplesofthoseusedclinically.Placentaltransport
studiesintheratindicatelimitedtransportevenafterparenteral
CHF—load50mcg/kgIVover10min,then0.375mcg/kg/minand
titratetodesiredresponse;max0.75mcg/kg/min
NOTE:renaldosing.
—hypersensitivitytodrugorclass,aortic
valvedisease,pulmonaryvalvedisease,MI
—atrialfibrillation,atrialflutter,renaldysfunction
MaternalConsiderations
.....
isaninotropicagentfortheshort-termmanagement
ofCHF.Thepublishedexperienceduringpregnancyislimitedto
casereports,typicallyinwomenwithpulmonaryhypertension
andmyocardialdecompensation.Theresultshavebeenmixed.
Sideeffects
includeventriculararrhythmia,ventricularectopy,
headache,chestpain,hypotension,angina,hypokalemia,and
gram-positivemicroorganisms:
S.pyogenes,S.faecalis,
S.pneumoniae,S.aureus,N.gonorrhoeae,Listeriamonocytogenes,
B.anthracis,Fusobacteriumfusiforme
Bacterialinfections,acnevulgaris—50mgPOqdtotid
Gonorrhea—100mgPObid
5d;alternative100-200mg
followedby50mgPOqid
Syphilis—100mgPObid
Mycobacteriummarinum
infection—100mgPObid
—hypersensitivitytodrugorclass
—renalorhepaticdysfunction
MaternalConsiderations
.....
Therearenoadequatereportsorwell-controlledstudiesof
inpregnantwomen.Casereportsnoteitsuseforthe
treatmentofrecurrentpemphigoidgestations.Similartoother
...........................
PregnancyCategory:D
LactationCategory:U
Hypertension—40mg/dindivideddoses;max100mg
POqd
reassuring,revealingnoevidenceofteratogenicityorIUGR
despitetheuseofdoseshigherthanthoseusedclinically.
Embryotoxicitywasseenwithhighdoses.
Depression—15-45mgPOqhs;begin15mgPOqhs
—hypersensitivitytodrugorclass,MAOIs
—advancedage,renalorhepaticdysfunction,mania,
hypomania,seizures,CVdisease,consumptionofalcohol
MaternalConsiderations
.....
Depressioniscommonduringandafterpregnancy,buttypically
goesunrecognized.Pregnancyisnotareason
apriori
discontinuepsychotropicdrugs.
isoneoptionfor
patientsunresponsivetoorintolerantofSSRIs.Mostofthe
publishedexperiencewith
duringpregnancyis
limitedtosmallcaseseriesandepidemiologicsurveys.
Sideeffects
includeagranulocytosis,orthostatichypotension,
dizziness,asthenia,constipation,flu-likesymptoms,elevated
LFTs,urinaryfrequency,myalgia,andbackpain.
DosagewithQualifiers
.......
NSAID-inducedgastriculcers—100-200mcgPOqid
Constipation—600-2400mcg/dPObidtoqid
Cervicalripening—25mcgvaginallyq3-6h;waitatleast4hbefore
max50mcg/dose
Abortion—400mcgPO
1;mayrepeatq4-6h
NOTE:takewithmeals;
isoftenusedwith
for1sttrimestertermination.
—hypersensitivitytodrugorclass,
pregnancy(forGIindications)
—childbearingpotential(forGIindications),prior
induction.Morerecently,asingle25mcgoutpatientintravaginal
doseof
wasreportedtobeeffectiveindecreasingthe
intervaltodeliveryinwomenwithunfavorablecervicesatterm.
Thestudy,however,wasinadequatelypoweredtoprovidestrong
Stomachcancer—numerousdosingschedulesdependingon
disease,response,andconcomitanttherapy
Pancreaticcancer—numerousdosingschedulesdependingon
disease,response,andconcomitanttherapy
—hypersensitivitytodrugorclass,
thrombocytopenia,coagulopathy,herpeszoster,renal
MaternalConsiderations
.....
isanalkylatingagentusedasadjuncttherapyandis
notrecommendedassingle-agent,primarytherapy.Thereareno
adequatereportsorwell-controlledstudiesof
pregnantwomen.
Sideeffects
includethrombocytopenia,leukopenia,hemolytic-
uremicsyndrome,renaldysfunction,interstitialpneumonitis,
sepsis,N/V,alopecia,anorexia,diarrhea,andcardiacorrenal
AML—numerousdoseschedulesdependingondisease,response,
andconcomitanttherapy
IVover5-15minq3mo
NOTE:anevaluationofLVfunctionandaCBCshouldprecede
eachdose.
—hypersensitivitytodrugorclass,prior
exposure,CHF,myelosuppression
MaternalConsiderations
.....
Therearenoadequatereportsorwell-controlledstudiesof
inpregnantwomen.Thepublishedexperienceis
limitedtoseveralcasereports.Morerecently,
beenadvocatedasatreatmentforMS,adiseasecommonin
reproductive-agewomen.
Sideeffects
includeseizures,arrhythmia,myocardialtoxicity,
CHF,myelosuppression,renalfailure,N/V,fever,abdominalpain,
GIbleeding,alopecia,diarrhea,sepsis,stomatitis,conjunctivitis,
pneumonia,UTI,headache,cough,andfungalinfection.
revealingnoevidenceofteratogenicity,butthedosesstudiedwere
toolow.
Narcolepsy—200mgPOqam;max400mgqd
MS—200mgPOqam;max400mgqd
NOTE:hepaticdosing.
—hypersensitivitytodrugorclass,LV
—CAD,hypertension,renalorhepaticdysfunction,
historyofpsychosis,alcoholuse
MaternalConsiderations
.....
Thepublishedexperiencewith
duringpregnancyis
limitedtoacasereport.
isaninducerofCYPenzymes.
Thus,theeffectivenessoforalcontraceptivesmaybereduced
duringtherapyandfor1moafterdiscontinuation.MSisfairly
commoninreproductive-agewomen.
Sideeffects
includearrhythmia,tachycardia,chestpain,MI,
.........................
InhibitsACE
DosagewithQualifiers
.......
Hypertension—7.5-30mgPOqd
—hypersensitivitytodrugorclass,historyof
ACEIangioedema,hereditaryangioedema,idiopathic
angioedema,pregnancy
—renalarterystenosis,severecardiacfailure,collagen
vasculardisease,renaldysfunction,hypotension
MaternalConsiderations
.....
Thereisnopublishedexperiencewith
moexipril
duringpregnancy.
Sideeffects
includehypotension,posturalhypotension,syncope,
.........................
Unknown(selectivelyantagonizesdopamineD
DosagewithQualifiers
.......
Schizophrenia—begin50-75mgqddividedtidorqid;increaseto
100mgqdevery3-5d;max225mg/d
—hypersensitivitytodrugorclass,CNS
MaternalConsiderations
.....
Acuteschizophreniapresentsseveraldifficultmanagement
decisionsduringpregnancy,andacarefulrisk:benefitanalysisis
required.Therearenoadequatereportsorwell-controlledstudies
inpregnantwomen.Thepublishedexperience
consistsofisolatedcasereports.
Sideeffects
includeconstipation,extrapyramidaleffects,blurred
vision,tardivedyskinesia,neurolepticmalignantsyndrome,
leukopenia,decreasedsweating,drymouth,akinesia,tachycardia,
depression,hyperactivity,andeuphoria.
DosagewithQualifiers
.......
Allergicrhinitis—2sprays/nostrilqd;begin2wbeforetheallergy
Dermatitis—applyqd
NOTE:availableassprayandcream.
—hypersensitivitytodrugorclass
MaternalConsiderations
.....
Allergicrhinitisaffects
ofwomenofchildbearingage.Thereare
noadequatereportsorwell-controlledstudiesof
Ventriculararrhythmia—200-300mgPOq8h
—hypersensitivitytodrugorclass,
cardiogenicshock,2ndand3rddegreeAVblock
MaternalConsiderations
.....
isaphenothiazinederivativewithclassIC
antiarrhythmicproperties.Itundergoesextensivefirst-pass
—(Avinza;Kadian;MSContin;MSIR;Oramorph;
InternationalBrandName—
Actiskenan(France);Algedol(Uruguay);Anafil-L.C.(Mexico);Anafil-S.T.
(Mexico);Anamorph(Australia);Contalgin(Denmark);ContinueDR(Korea);Dolcontin(Finland,Sweden);Dolcontin
Depottab(Norway);Duralmor(Mexico);Duromorph(England,Ireland);Graten(Mexico);Kapanol(Australia);Kapanol
LP(France);LaMorph(NewZealand);LongphineSR(Korea);MCR(Israel);M.Elson(HongKong);M-Eslon(Canada,
Chile,Ecuador,Peru);Meslon(Colombia);M.I.R.(Israel);M-Long(Germany);MorcontinContinus(India);Morficontin
(Greece);Morphanton(Germany);MorphgesicSR(England,Ireland);MorphineMixtures(Australia);Moscontin
Pain—2.5-10mgIVslowlyover5-15min;alternative5-20mg
IM/SCor10-30mgPOq4h
Post–cesareansectionanalgesia—
2-5mg
NOTE:donotusesolutionifdark,discolored,orcontainsprecipitate.
—hypersensitivitytodrugorclass,
respiratorydepression,asthma,ileus
—COPD,headinjury,CNSdepression,seizure
disorder,acutepancreatitis,pseudomembranouscolitis,
hypotension,hepaticorrenaldysfunction,biliarydisease,
MaternalConsiderations
.....
isoneofthemostfrequentlyusedopioidsforpain
controlduringhumanparturition.Theeliminationt/2of
isshorterandtheplasmaclearancequickerin
parturientsthaninnonpregnantwomen.
aspartofan
epiduralorPCAregimeniscommon.Itisalsoadministered
intrathecallyaftercesareansectionforreliefofpostoperativepain
forthefirst48h.XRepidural
providessuperiorand
prolongedpostcesareananalgesiacomparedtoconventional
withnosignificantincreasesinadverseevents.
Theadditionofsmalldosetothespinalcomponentofthe
continuousspinalepiduralimprovestheeffectivenessofepidural
laboranalgesiaandreducestheneedforpainmedicationsover
24h,butresultsinasmallincreaseinnausea.Epidural
significantlyreducestheincidenceofheadacheandtheneedfora
bloodpatchafterduralpuncture.Thereisalongclinical
self-administrationofIVdosesofopioids,iswidelyavailableand
advocatedasaneffectiveanalgesicmodality.
offersagoodqualityofanalgesiawithminimalsideeffectsduring
boththeante-andpostnatalperiods.
doesnotaffect
thespontaneouscontractility
invitro
TheconcurrentuseofotherCNSdepressants,includingsedatives,
InternationalBrandName—
Avalox(Brazil,Germany,Israel);Avelon(SouthAfrica);Avelox(Colombia,
HongKong,Indonesia,Korea,Mexico,Peru,Philippines,Singapore,SouthAfrica,Thailand);Bacterol(Colombia);
Izilox(France);Megaxin(Israel);Moxif(India);Vigamox(Thailand)
DrugClass
..........................
Antibiotics;Quinolones
.........................
Bacterialinfections(aerobicgram-positive:
Enterococcusfaecalis,
S.saprophyticus,S.pneumoniae,S.pyogenes;
Enterobactercloacae,E.coli,H.influenzae,
H.parainfluenzae,Klebsiellapneumoniae,Legionellapneumophila,
Moraxellacatarrhalis,P.mirabilis,Pseudomonasaeruginosa;
Chlamydiapneumoniae,Mycoplasma
.........................
Bactericidal—inhibitsDNAsynthesis
DosagewithQualifiers
.......
Bacterialinfections—400mgPO/IVqd
—hypersensitivitytodrugorclass,ECG
modification,concomitantusageofantiarrhythmicmedication
(classIA,III),age
—advancedage,seizuredisorder,CNSdisorder,
MaternalConsiderations
.....
Thereisnopublishedexperiencewith
Sideeffects
includevaginitis,photosensitivity,
pseudomembranouscolitis,seizures,increasedICP,headache,
psychosis,N/V,diarrhea,abdominalpain,dyspepsia,dizziness,
insomnia,agitation,tendonitis,arthralgias,andincreasedLFTs.
TheconcomitantadministrationofanNSAIDswithsome
quinolonesmayincreasetherisksofCNSstimulationand
.........................
Thereisnopublishedexperienceinpregnancyorduring
...........................
PregnancyCategory:C
LactationCategory:U
shouldbeusedduringpregnancyandlactation
onlyifthebenefitjustifiesthepotentialperinatalrisk.
Therearealternativeagentsforwhichthereismoreexperience
regardinguseduringpregnancyandlactation.
Osteoarthritis—1gPOqdorbid
Rheumatoidarthritis—1gPOqdorbid
Anti-inflammatory—1gbid
7-14d;begin2g/d
1d;max2g/d
—hypersensitivitytodrugorclass,NSAID-
inducedasthma
—nasalpolyps,GIbleeding,hypertension,CHF
MaternalConsiderations
.....
Thereisnopublishedexperiencewith
InternationalBrandName—
Apo-Nadol(HongKong);Apo-Nadolol(NewZealand);Corgard(Argentina,
Belgium,Brazil,Canada,Chile,Colombia,England,France,Greece,Ireland,Italy,Kenya,Malaysia,Mexico,Nigeria,
Peru,Philippines,Poland,Russia,SouthAfrica,Spain,Switzerland,Taiwan,Tanzania,Turkey,Uganda,Uruguay,
Venezuela,Zambia);Farmagard(Indonesia);Nadic(Japan);Solgol(Austria,Germany,Spain)
DrugClass
..........................
Adrenergicantagonists;
.........................
Hypertension,angina,arrhythmia,headacheprophylaxis
.........................
-adrenergicreceptorantagonist
DosagewithQualifiers
.......
Hypertension—begin20-40mg/d;increase40-80mgqd
max240-320mg/d
Angina—begin20-40mg/d;increase40-80mgqd
3-7d;max160-
Arrhythmia—60-640mgPOqd
Headacheprophylaxis(vascular)—20-80mgPOqd;max120mg/d
—hypersensitivitytodrugorclass,sinus
bradycardia,asthma,2nd-3rddegreeAVblock
DevlinRG,DuchinKL,FleissPM.BrJClinPharmacol1981;
Bacterialinfections—500mg-2gIV/IMq4-6h;max12g/dIMor
20g/dIV
NOTE:hepaticandrenaldosing;concurrentadministrationof
increasesandprolongsserumlevels.
—hypersensitivitytodrugorclass
—cephalosporinallergy,renalorhepaticdysfunction,
MaternalConsiderations
.....
isapenicillinase-resistantpenicillineliminatedprimarily
High-doseregimens(e.g.,2gq4h)maydecreasetheeffectsof
forupto30dafterthe
hasbeendiscontinued.
ThePTshouldbemonitoredclosely.
Maycausesubtherapeutic
shouldbemonitoredwhenusedwith
.........................
Skininfections—applytoaffectedareaqd
NOTE:availableas1%creamorgel.
—hypersensitivitytodrugorclass
MaternalConsiderations
.....
Thereisnopublishedexperiencewith
Sideeffects
includeburning,dryness,erythema,anditching.
...........................
PregnancyCategory:B
LactationCategory:U
shouldbeusedduringpregnancyandlactationonly
ifthebenefitjustifiesthepotentialperinatalrisk.
InternationalBrandName—
Bufigen(Mexico);Nalbufina(Uruguay);NalcrynSP(Mexico);Nubain(Austria,
Brazil,Bulgaria,Canada,CostaRica,CzechRepublic,DominicanRepublic,Ecuador,ElSalvador,England,Germany,
Pain—10mgIV/IM/SCq3-6hprn;max20mg/doseor160mg/d
Anesthesia(adjunct)—0.25-0.5mg/kgprn;begin0.3-3mg/kgIV
—hypersensitivitytodrugorclass
—opiatedependency;renal,hepatic,orpulmonary
dysfunction;biliarysurgery;sulfiteallergy
MaternalConsiderations
.....
teratogenicityorIUGRdespitetheuseofdoseshigherthanthose
usedclinically.
H.parainfluenzae,Klebsiellapneumoniae,Legionellapneumophila,
Moraxellacatarrhalis,P.mirabilis,Pseudomonasaeruginosa;
Chlamydiapneumoniae,Mycoplasma
.........................
Bactericidal—inhibitsDNAsynthesis
DosagewithQualifiers
.......
Bacterialinfections—1gPOqid;alternatively,2gPOqdfor
chronicsuppression
—hypersensitivitytodrugorclass,seizures
—renalorhepaticdysfunction,impairedpulmonary
function,CVdisease,excessivesunlightexposure
MaternalConsiderations
.....
Asymptomaticbacteriuriaiscommonduringpregnancy.Perhaps
ofaffectedpregnantwomenwilldevelopsymptomaticdisease
(hemorrhagiccystitisorpyelonephritis).
Nalidixicacid
isone
treatmentalternativeforasymptomaticbacteriuriaofpregnancy.
Sideeffects
includevaginitis,photosensitivity,
pseudomembranouscolitis,seizures,increasedICP,headache,
psychosis,N/V,diarrhea,abdominalpain,dyspepsia,dizziness,
insomnia,agitation,tendonitis,arthralgia,andelevatedLFTs.
...........................
PregnancyCategory:C
LactationCategory:S
Nalidixicacid
shouldbeusedduringpregnancyonlyifthe
benefitjustifiesthepotentialperinatalrisk.
Itisareasonablefirst-linedrugforthetreatmentof
asymptomaticbacteriuriaduringthe2ndand3rdtrimesters.
—(Cervene;Revex)
InternationalBrandName—
Noneidentified.
DrugClass
..........................
Antidotes;Narcoticagonist-antagonists
.........................
Opiateoverdose,postoperativeopiatereversal
.........................
Opiatereceptorantagonist
DosagewithQualifiers
.......
Opiateoverdose—0.5mgIV;over70kg,doseindividually;max
Postoperativeopiatereversal—0.25mcg/kgIV;increase
0.25mcg/kgincrementsq2-5min;max1mcg/kgIV
—hypersensitivitytodrugorclass
—renalorhepaticdysfunction,opiateaddiction,
concomitantusageofcardiotoxicdrugs
MaternalConsiderations
.....
isalong-actingopioidantagonistusedforthe
treatmentofoverdose.Itwasalsousedtoprovidelong-term
relieffromsideeffectsofintrathecal
However,itfailed
inoneprospectivetrialtoreducetheincidenceofpruritusand
N/Vandthelevelofsedation,butincreasedtheneedfor
supplementalanalgesics.
Sideeffects
includearrhythmia,tachycardia,bradycardia,fever,
postoperativepain,N/V,headache,vasodilation,dizziness,
somnolence,confusion,andchills.
InternationalBrandName—
Antioplaz(Argentina);Mapin(HongKong,Malaysia);Nalone(France);Naloxon
Opiateoverdose—0.4-2mgSC/IV/IMq2-3min;ifnoresponseby
10min,thediagnosisshouldbequestioned
Postoperativeopiatereversal—0.1-0.2mgIVq2-3minprn
—hypersensitivitytodrugorclass
—opiateaddiction,renalorhepaticdysfunction,
cardiotoxicdrugs
MaternalConsiderations
.....
isapopularopioidantagonist.Pregnantheroinusers
havepoormaternalandneonataloutcome.Medicallysupervised
heroinwithdrawalisgenerallydiscouragedduringpregnancy
breastmilk.However,consideringtheindicationanddosing,
useisunlikelytoposeaclinicallysignificant
risktothebreastfeedingneonate.Endogenousopioidsinhibit
neuronsuntilparturition,and
Opiateaddiction—begin25mgPO
1,repeatin1hifno
withdrawal;alternatively100mgPOqd,then150mgPOq3d
NOTE:patientmustbeopiatefree
7-10dandpass
challengetest.
Alcoholdependence—50mgPOqd
—hypersensitivitytodrugorclass,hepatitis,
hepaticfailure,opiateuse,failed
challenge,failed
challenge,acuteopiatedependence,acuteopiate
MaternalConsiderations
.....
...........................
PregnancyCategory:C
LactationCategory:S
reducestheadversesymptomsassociatedwith
analgesia,butshortenstheduration.
shouldbeusedduringpregnancyandlactation
onlyifthebenefitjustifiesthepotentialperinatalrisk.
—(Ak-Con;Albalon;Allersol;I-Naphline;
Murine;Muro’sOpcon;Nafazair;Naphacel;Naphazole;Naphcon
Forte;Nazil;Ocu-Zoline;Opcon;Spectro-Con;Vasocon)
InternationalBrandName—
Ocularcongestion—1-2gttOS/ODq3-4h;max4doses/d
—hypersensitivitytodrugorclass,glaucoma
—(EC-Naprosyn;Ec-Naprosyn;Flexipen;Napoton;
Napren;Naprosyn;Sutony)
InternationalBrandName—
Acusprain(SouthAfrica);Aflamax(Peru);Agilxen(Colombia);Aleve(Paraguay,
Poland,Singapore,Uruguay);Alpron(Philippines);Anax(Korea);Anexopen(Greece);Antalgin(Spain);Apo-Naproxen
(Canada);Apranax(Bulgaria,France,Israel,Russia,Venezuela);Apraxin(Turkey);Apronax(Colombia,Ecuador,Peru);
Artagen(India);Artron(Mexico);Artroxen(Italy);Babel(Korea);Bipronyl(Singapore);Bonyl(Denmark);Complement
(Peru);Congex(Argentina);Crysanal(Australia);Dafloxen(Mexico);Daprox(Denmark);Deflamox(Mexico);Diferbest
Osteoarthritis—250-500mgPObid;max1500mg/d
Rheumatoidarthritis—250-500mgPObid;max1500mg/d
Dysmenorrhea—250mgPOq6-8hprn;begin500mg
1;max
Pain—250-500mgPObid;max1500mg/d
Ankylosingspondylitis—250-500mgPObid;max1500mg/d
Anti-inflammatoryeffect—250-500mgPObid;max1500mg/d
—hypersensitivitytodrugorclass,NSAID-
inducedasthma,renalorhepaticdysfunction
—GIbleeding,hypertension,CHF,nasalpolyps,
chronicalcoholicliverdisease,anemia
MaternalConsiderations
.....
NSAIDsarewidelydistributedinOTCpreparations,andtheir
useduringpregnancyisunderestimated.About5%ofwomen
reportuseofeither
nearconceptionor
duringpregnancy.Itmaybecombinedwith
forthe
treatmentofacutemigraine.Inarecentprospectivecase-control
study,prenatal
useincreasedtheriskof
spontaneousabortionby80%(adjustedhazardratio1.8[95%CI
1.0-3.2]).Theassociationwasstrongeriftheinitialusewas
aroundconceptionoriftheuselastedmorethan1w.
offersnodistinctclinicaladvantageafterthe1sttrimesterover
painonday2aftercesareandelivery,withthegreatesteffectsat
36h,whenpaintypicallypeaks.
Sideeffects
includeheadache,dyspnea,dizziness,drowsiness,
light-headedness,vertigo,skineruption,ecchymosis,sweating,
purpura,edema,palpitations,tinnitus,hearingdisturbances,
visualdisturbances,renalfailure,bronchospasm,Stevens-Johnson
syndrome,interstitialnephritis,hepatotoxicity,thrombocytopenia,
agranulocytosis,constipation,rash,increasedhepatic
mayincreasetheriskofspontaneous
Migraineheadache—1-2.5mgPO
1;mayrepeatin4hafter
1stdose;max5mg/d
—hypersensitivitytodrugorclass,
hypertension,CAD,hepaticfailure,significantrenalorhepatic
dysfunction,MAOIs
14d,ergotderivatives
—CVD,mildhepaticdysfunction
MaternalConsiderations
.....
Migraineheadachesareafrequentcomplaintduringpregnancy,
andergotcompoundsaregenerallyconsideredcontraindicated.
From55%to90%ofpregnantwomenexperiencean
improvementinheadachesymptomsduringthe2ndand3rd
trimesters.Ahigherpercentageofwomenwithmenstrual
migrainefindtheyimproveduringpregnancy.Thereareno
adequatereportsorwell-controlledstudiesof
pregnantwomen.Theclearanceof
ismodestly
reduced(22%)inwomenonoralcontraceptives;clearanceduring
pregnancyisunstudied.Smokingincreasesclearanceby1/3.
Themanufacturer,Glaxo-Wellcome,maintainsaregistryfor
Asthma,chronic—2puffsINHqid
Allergicconjunctivitis—1-2gttOS/ODbid
NOTE:2%solution;mayreducedose50%ifclinicalimprovement.
—hypersensitivitytodrugorclass,acute
asthmaattack
MaternalConsiderations
.....
Thereisnopublishedexperiencewith
iseffectivelong-termmaintenance
therapyforbronchialasthma.
Sideeffects
includebronchospasm,headache,bittertaste,cough,
pharyngitis,rhinitis,bronchitis,dyspnea,N/V,drymouth,
dyspepsia,andfatigue.
teratogenicityorIUGRdespitetheuseofdoseshigherthanthose
usedclinically.
Depression—begin100mgPObid,150-300mgPObid;max
—hypersensitivitytodrugorclass,active
hepaticdisease,MAOI
MaternalConsiderations
.....
Depressioniscommonduringandafterpregnancy,buttypically
goesunrecognized.Pregnancyisnotareason
apriori
discontinuepsychotropicdrugs.Theserotoninreuptakeinhibitors
HIVinfection—1250mgPOwithfoodbidincombinationwith
pregnancy(median0.8mcg/mlvs.1.5mcg/ml).Theelimination
t/2of
duringpregnancywas3.7h(range1.4-6.6h),
comparedwith5.2h(range3.1-10.1h)inthecontrolgroup.
Asmallerstudyledtoasimilarconclusion.Theseresultsindicate
thatwomeninthelaterstagesofpregnancymaybeexposedto
subtherapeuticconcentrationsof
ifthedosageor
frequencyisnotadjusted.Thisincreasedclearancetakessome
Inonestudy,the
F:Mconcentrationratiowas25%
Decreasesthe
concentration;monitorandadjustas
Usewith
increasesthe
concentrationbut
eitherdecreases(750mgtid)orhasnoeffect(1250mgbid)on
concentrations.Thedoseof
shouldbe
reducedbyhalfwhengivenwith
the1250mgbiddose
isthepreferred.
—(Mycifradin;Myciguent;Neo-Rx;Qrp)
InternationalBrandName—
Gemicina(Mexico);Mycifradin(England,Ireland,SouthAfrica);Neomicina
(Spain);Neomycin(Israel);NeomycineDiamant(France);Nivemycin(England)
DrugClass
..........................
Aminoglycosides;Antibiotics
.........................
Hepaticcoma,bacterialinfections(aerobicgram-negative:
Enterobactercloacae,E.coli,Klebsiella,Enterobacter)
.........................
Bactericidal—inhibitsproteinsynthesisreducingammonia
formingbacteriainthegut
DosagewithQualifiers
.......
Bacterialinfections—applytopicallyqdtotid;max1w
NOTE:availableincombinationwith
andpolymyxinB
asNeosporin.
—hypersensitivitytodrugorclass,GI
obstruction,inflammatoryandulcerativeGIdisease,severe
dermatologicdiseases
—hepaticdysfunction
MaternalConsiderations
.....
Therearenoadequatereportsorwell-controlledstudiesof
inpregnantwomen.
ispoorlyabsorbedin
thebowel,thoughrepeateddosingcanleadtoaccumulation
especiallyintheinnerear.Clearancecantakeweeks.TheCDC
recommendstheuseofaselectivebrothculturetoimprove
inhibitstheGIabsorptionofpenicillinV,oral
vitaminB
Myastheniagravistreatment—15-375mgPOqd;10mgSC/IV/IM
qd;0.5-2.5mgSC/IV/IMq2-3hprn;max375mgPOqd
Myastheniagravisdiagnosis—0.02mg/kgIM
1with
Neuromuscularreversal—0.07mg/kgIV,max5mg;giveslowIV
pushwith
DosagewithQualifiers
.......
AcuteCHF—begin2mcg/kgIVbolus,then0.01mcg/kg/minIV;
decreaseordiscontinueifhypotension;max0.03mcg/kg/min
—hypersensitivitytodrugorclass,
cardiogenicshock,systolicBP
90mmHg,cardiactamponade,
restrictivecardiomyopathy,obstructivecardiomyopathy,
constrictivepericarditis
DosagewithQualifiers
.......
Bacterialinfections—4-6.5mg/kg/IVqddividedq8-12h
—hypersensitivitytodrugorclass
MaternalConsiderations
.....
Therearenoadequatereportsorwell-controlledstudiesof
HIVinfection—200mgPOqd
14d;continuetreatmentwith
MaternalConsiderations
.....
TheincidenceofboththeAIDSsyndromeandopportunistic
infectionhasdecreaseddramaticallyoverthelastyearsbecauseof
advancesindrugregimens.Thisisarapidlychangingarea.Triple
zidovudine,lamivudine,nevirapine
)orquadrupletherapy
remainsthestandardofcareforthemanagementofHIV
infectioninadultsbecauseofitshighefficacy.
HAART(comparedmainlywith
-basedHAART),
westernAfricanorigin,andlowerbaselineviralloadare
associatedwithshortertimestoachievingviralsuppressionandis
probablyaregimenofchoice.Asingledoseof
concentrationagainstwild-typeHIV-1throughoutthe1stweekof
life.Thislimitedregimeniswell-toleratedandreducestheriskof
mother-to-childtransmissionbynearly50%inwomenandinfants
efficacyofthedrug.Physiciansneedingtotreatpatients
co-infectedwithtuberculosisandusinga
regimenmayuse
Decreasestheconcentrationof
Appropriatedosesfor
thiscombinationarenotestablished,butanincreaseinthedose
mayberequired.
Maydecreasetheconcentrationsof
amiodarone,carbamazepine,
cisapride,clonazepam,cyclophosph
amide,cyclosporine,diltiazem,
—(AcidoNicotinico;Akotin;Niaspan;Nicolar;Niconacid;
NicotinicAcid;Nikacid;Nikotime;Novo-Niacin;SloNiacin;
SpanNiacin;Vitaplex;Wampocap)
InternationalBrandName—
AcidoNicotinico(Colombia);Akotin250(Argentina);Apo-NicotinicAcid
Hypercholesterolemia—begin250mgPOqd,increase250mg
q4-7dbasedoneffect/tolerance;max6g/d
Mixeddyslipidemia—begin500mg/dPOqhs
4w,then1g/d
q4w;max2g/d
Hypertriglyceridemia—begin500mg/dPOqhs
4w,then1g/d
q4w;max2g/d
Pellagra—300-500mgPOqd;availableSC
mayreducetheflushing;LFTsatbaseline,q6-12w
1y,thenq3-6mo;donotcut/crush/chew.
—hypersensitivitytodrugorclass,bleeding,
hypotension,activeulcerdisease,severehepaticdysfunction
Hypertension—20-40mgPOtid;max40mgPOtid
Angina—begin20mgPOtid;max40mgPOtid
Acutehypertension—5mg/h,increase2.5mg/hq5-15minprn,
titratedowntoeffect
NOTE:hepaticdosing.
—hypersensitivitytodrugorclass,aortic
—renalorhepaticdysfunction,CHF,cardiac
conductiondisease
MaternalConsiderations
.....
Hypertensionduringpregnancy:
Hypertensionremainsasignificant
Calciumchannelblockersareconsideredtheagentsofchoice
fortocolysis.
Thereismoreexperiencewith
shouldprobablybeavoidedinwomen
receivingacalciumchannelblockerasatocolyticagent.
wouldbepreferred.
—(Habitrol;NicoDerm;Nicotrol;ProStep;QuitSpray;
InternationalBrandName—
Nicabate(Australia);NicabateCQClear(Australia);NicabateCQLozenges
(Australia);NicabateTTS(NewZealand);NicobateCQClear(Australia);Nicoderm(Canada);Nicolan(Denmark,
Mexico);NicolanLight(Denmark);Nicopasssanssucrementhefraicheur(France);Nicopasssanssucrereghasse
Smokingcessation—begin21mg/dtransdermalpatches
6w,then
2w,then7mg/d
2w;alternatively,14mg/d
6wif
100lb,
1/2ppd,orsignsofcardiacdisease
NOTE:availableinpatchesthatrelease7,14,or21mg/d.
—hypersensitivitytodrugorclass,
nonsmokers,recenthistoryofacuteMI,arrhythmia,angina,
SekhonHS,ProskocilBJ,ClarkJA,SpindelER.EurRespirJ
2004;23:906-15.
.........................
InhibitsCa
influxintovascularsmoothmuscleand
DosagewithQualifiers
.......
Hypertension—begin10mgPOtid,titertoeffect;max180mg/d
Angina,variant—begin10mgPOtid,titertoeffect;max180mg/d
—hypersensitivitytodrugorclass
MaternalConsiderations
.....
Hypertensionduringpregnancy:
Hypertensionremainsasignificant
VisserW,WallenburgHC.JHypertens1995;13:791-5.
Subarachnoidhemorrhage—begin60mgPOq4hwithin96hof
NOTE:hepaticdosing.
—hypersensitivitytodrugorclass
—hepaticdysfunction
MaternalConsiderations
.....
isacalciumchannelblockerwithselective
cerebrovasculareffect.
Hypertensionduringpregnancy:
Hypertensionremainsasignificant
Comparedto
magnesiumsulfate,nimodipine
increasescerebral
perfusionpressureinwomenwithseverepreeclampsia.While
oncesuggestedasanagenttopreventeclampsia,itisinferiorto
magnesiumsulfate
asprophylaxis.
Hypertension—20-40mgPOqd;max60mg/d
—hypersensitivitytodrugorclass
MaternalConsiderations
.....
UTI—100mgPObid;alternatively50-100mgPOqid
UTIsuppression—50-100mgPOqhs
NOTE:renaldosing.
—hypersensitivitytodrugorclass,CrCl
—asthma,anemia,G6PDdeficiency
MaternalConsiderations
.....
UTIiscommonduringpregnancy,andallpregnantwomen
shouldbescreened.Treatmentofasymptomaticbacteriuriaand
recurrentcystitisduringpregnancyreducestheriskof
shouldnotbeusedbecauseofthehigh
prevalenceofresistant
E.coli.
ishighlysolublein
urine.Itissafeandeffectiveforthetreatmentofasymptomatic
bacteriuriaaswellasacuteandrecurrentUTIs.Resistancerates
10%.Pyelonephritisoccursinapproximately7%ofwomen
despiteadequatetreatment.WomenwithrecurrentUTIare
candidatesforlong-termantibioticprophylaxis.Neithergravidity
—(Deponit;Glyceryl;Minitran;Mi-Trates;
Natirose;Nitrek;Nitro;Nitro-Bid;NitrocapT.D.;Nitrocine;Nitrocot;
Nitrodisc;Nitro-Dur;Nitrogard;Nitroglyn;Nitrol;Nitrolin;
Nitrolingual;Nitronal;Nitrong;Nitro-Par;Nitrorex;Nitrospan;
Nitrostat;Nitro-Time;NTS;NTG;Transderm-Nitro;Transiderm;Tridil)
InternationalBrandName—
Anglix(Mexico);Cardinit(Mexico);Coro-Nitro(Germany);Deponit(China,
Germany,Malaysia,Peru,Philippines);Deponit-5(Korea,Thailand);DeponitNT(HongKong,Israel);DeponitTTS5
(Israel);DeponitTTS10(Israel);Epinitril(France);Gilustenon(Germany);GlytrinSpray(NewZealand,Singapore);
Lenitral(France,HongKong);Lycinate(Australia);Millsrol(Japan);Minitran(Argentina,Australia,Canada,CostaRica,
ElSalvador,Greece,Guatemala,Honduras,Panama,Paraguay,Philippines,Uruguay,Venezuela);Myonit(India);
Angina,acute—0.3-0.6mgSLq5min;max3doseswithin15min
Angina,prophylaxis—0.3-0.6mgSL
1;take5-10minbefore
strenuousactivity
acuterenalfailure,anddeath.Treatmentofahypertensive
episodeduringpregnancyfurthercomplicatestheprocessbecause
Rodentteratogenicitystudiesarereassuring,butlimitedbydose
andformat.
Hypertension—begin0.25-0.3mcg/kg/minIV;max10mcg/kg/min
Heartfailure—0.3-10mcg/kg/minIV;max10mcg/kg/min
NOTE:checkserumthiocyanatelevelswithprolongedusage.
—hypersensitivitytodrugorclass,poor
cerebralorcoronaryperfusion,opticatrophy,tobacco-induced
—increasedICP
MaternalConsiderations
.....
severelypreeclampsiapatientsarerelativelyorabsolutely
hypovolemic.Inthesepatients,systemicBPmaybeextremely
sensitivetosmalldoses.Therefore,somecliniciansbegintherapy
atlowerratesofinfusion(e.g.,0.5-0.1mcg/min).
Cervicalripening:
TheNO-cGMPrelaxationpathwayispresentin
thehumanandcervixuterus.
decreasescollagen
cross-linksintheguineapigcervix.Itreducestheforcenecessary
todilatethecervixfora1sttrimestertermination.
Sideeffects
includeincreasedICP,dizziness,N/V,cyanideor
thiocyanatetoxicity,bradycardia,reflextachycardia,ileus,
diaphoresis,abdominalpain,headache,muscletwitching,
acidosis,andflushing.
CurrySC,CarltonMW,RaschkeRA.AnesthAnalg1997;
GERD—150mgPObid
Duodenalulcer,maintenance—150mgPOqhs
Duodenalulcer,active—300mgPOqhs
NOTE:renaldosing.
—hypersensitivitytodrugorclass
—renaldysfunction
MaternalConsiderations
.....
Gastroesophagealrefluxandheartburnarereportedby45-85%
ofwomenduringpregnancy.Therearenoadequatereportsor
well-controlledstudiesof
inpregnantwomen.
shouldbereservedforpatientswithseveresymptoms.
Sideeffects
includehepatitis,thrombocytopenicpurpura,
exfoliativedermatitis,rhinitis,headache,N/V,anorexia,
dyspepsia,abdominalpain,constipation,increasedLFTs,
pharyngitis,agitation,confusion,somnolence,insomnia,sinusitis,
drymouth,leukopenia,andanemia.
Contraception—1tabPOqd;takeatsametimeeveryday
Dysmenorrhea—1tabPOqd
Dysfunctionaluterinebleeding—1tabPOqd
PCOS—1tabPOqd
NOTE:availableincombinationwith
.........................
Bacterialinfections—400mgPObid
Gonorrhea—800mgPO
1;consultmostrecentCDCSTD
Gastroenteritis—400mgPObid
Traveler’sdiarrhea—400mgPObid
NOTE:renaldosing.
—hypersensitivitytodrugorclass
—renal,hepatic,orpulmonarydysfunction;CV
...........................
PregnancyCategory:C
LactationCategory:U
shouldbeusedduringpregnancyandlactation
onlyifthebenefitjustifiesthepotentialperinatalrisk.
Therearealternativeagentsforwhichthereismoreexperience
regardinguseduringpregnancyandlactation.
Contraception—1tabPOqd;takeatsametimeeveryday
Dysmenorrhea—1tabPOqd
Dysfunctionaluterinebleeding—1tabPOqd
PCOS—1tabPOqd
Emergencycontraception—either2tabsimmediately,or1tab
q12-24hforatotalof2tabs
adenoma,edema,breakthroughbleeding,alteredmenstrual
bleeding,amenorrhea,melasma,rash,anddizziness.
—(Allergron;Lisunim;Pamelor)
InternationalBrandName—
Allegron(Australia,Belgium,England,Ireland,NewZealand);Altilev(Uruguay);
Ateben(Argentina);Aventyl(Canada,England,Ireland,Malaysia,SouthAfrica);Kareon(Argentina);Martimil(Spain);
Noritren(Denmark,Finland,Italy,Japan,Norway,Sweden);Norline(Thailand);Norpress(NewZealand);Nortrilen
Depression—begin25-50mgPOqhs,tid,orqid,increaseq2-3w
untildesiredeffect;max150mg/d
—hypersensitivitytodrugorclass,recovery
fromacuteMI,MAOIs
—hepaticdysfunction,CAD,suiciderisk,thyroid
disease,glaucoma,seizurehistory
MaternalConsiderations
.....
Depressioniscommonduringandafterpregnancy,buttypically
goesunrecognized.Pregnancyisnotareason
apriori
discontinuepsychotropicdrugs.Therearenoadequatereportsor
well-controlledstudiesof
inpregnantwomen.
DrugInteractions
................
Useof
withTCAshasbeenshowntohavea
‘‘stimulating’’effectinsomedepressedpatients.
Closesupervisionandcarefuladjustmentofthedoseisrequired
whenusedwithotheranticholinergicdrugsand
Bacterialinfections—250mgPOtid;max1gq12h
shouldbeusedonlyafterotherantibioticswith
lowertoxicityhavefailed.
—hypersensitivitytodrugorclass
MaternalConsiderations
.....
Therearenoadequatereportsorwell-controlledstudiesof
inpregnantwomen.
shouldbeusedonly
afterotherantibioticswithlowertoxicityhavefailed.
Sideeffects
includeurticaria,erythematousmaculopapularrash,
scarlatiniformrash,Stevens-Johnsonsyndrome,leukopenia,
eosinophilia,hemolyticanemia,pancytopenia,agranulocytosis,
thrombocytopenia,jaundice,increasedLFTs,N/V,anddiarrhea.
Candidiasis,oral—0.5-1millionUPOtid;continuetreatmentat
least48hafterresolutionofthesymptoms
Candidiasis,cutaneous—applybidortid
—hypersensitivitytodrugorclass
MaternalConsiderations
.....
vaginitisisperhapsthemostcommonfemalegenital
tractinfection.
isanantifungalantibioticthatisboth
fungistaticandfungicidal
invitro
Streptomycesnoursei.
Thevaginalmilieuduringpregnancy
predisposesto
C.albicans
Invitro,
ishighly
effectiveagainst83%ofsensitivestrainsoftested
C.albicans.
Therearenoadequatereportsorwell-controlledstudiesof
InternationalBrandName—
Noneidentified.
DrugClass
..........................
.........................
Contactdermatitis(e.g.,poisonivy/oak)
.........................
Formsamoisturizing,colloidalsuspension
DosagewithQualifiers
.......
Contactdermatitis—applytidorqidprn;mayalsomixinbath
waterandsoak
—hypersensitivitytodrugorclass
MaternalConsiderations
.....
Thereisnopublishedexperiencewithtopical
Sideeffects
havenotbeenreported.
Carcinoidtumorsymptoms—50-100mcgSC/IVqdtotid;max
Carcinoidtumorcrisis—50mcg/hIV
8-24hacutely;250-500mcg
1,1-2hpreoperativelyforprevention
Acromegaly—50mcgSC/IVtid;max1500mcg/d
Esophagealvarices—begin25-50mcgIV
1forbleeding,then25-
—hypersensitivitytodrugorclass
InternationalBrandName—
Akilen(Indonesia);Baccidal(Korea);Bactocin(Mexico);Danoflox(Indonesia);
Effexin(Korea);Exocin(Ireland);Exocine(France);Flobacin(Italy);Flodemex(Philippines);Flotavid(Indonesia);Flovid
(HongKong,Malaysia,Philippines);Floxal(Germany);Floxil(Argentina,Mexico);Floxin(Canada);Floxstat(Colombia,
CostaRica,DominicanRepublic,Ecuador,ElSalvador,Guatemala,Honduras,Mexico,Nicaragua,Panama);Fugacin
(Korea);Inoflox(Malaysia,Philippines,Singapore);Kinflocin(Taiwan);Kinoxacin(Korea);Liflox(Indonesia);Loxinter
(Indonesia);Marfloxacin(HongKong);Medofloxine(Malaysia);Mergexin(Philippines);Novecin(Israel);Nufafloqo
(Indonesia);Obide(Korea);Occidal(Thailand);Ocuflox(Australia,Canada,Korea,Mexico);Ofcin(Malaysia,Singapore,
Bacterialinfections—200-400mgPO/IVq12h
Uncomplicatedgonorrhea—400mgPO
Bacterialconjunctivitis—1-2gttq2-4heacheye
2d,then
Cornealulcer—1-2gttq30mineacheye
2d,thenq1h
thenqid
Otitisexterna—10gttbid
NOTE:renaldosing;availableinotic,ophthalmic,andparenteral
—hypersensitivitytodrugorclass
—hepaticorrenaldysfunction,seizuredisorder,CNS
24hafter
Themeanbreastmilklevelswere2.4,1.9,
1.3,0.6,0.3,and0.05mcg/ml,respectively.Evenwith100%oral
absorption,breastfeedingmotherswhotake
willexpose
theirinfantsto
concentrationsbelowthatbeingstudied
inthepediatricpopulation.
DrugInteractions
................
...........................
PregnancyCategory:C
LactationCategory:S
shouldbeusedduringpregnancyifthebenefit
justifiesthepotentialperinatalrisk.
Thoughthefetalriskmaynotbeasgreatasoncethought,there
arealternativeagentsduringpregnancyforalmostallindications.
InternationalBrandName—
Dozic(Colombia);Oleanz(India);Zelta(Colombia);ZyprexaZydis(NewZealand)
DrugClass
..........................
.........................
Bipolardisorder,psychosis
.........................
Unknown;highaffinityfor5-HT
anddopaminereceptors
DosagewithQualifiers
.......
Bipolardisorder—begin5-10mgqd,increasing5mg/dprn;max
Psychosis—begin5-10mgqd,increasing5mg/dprn;max20mg/d
usefultreatmentforoverdose.
Carbamazepine
(200mgbid)causesanapproximately50%increase
olanzapine
clearance,likelybecause
carbamazepine
isapotent
inducerofCYP1A2activity.Higherdailydosesof
carbamazepine
maycauseanevengreaterincreasein
olanzapine
clearance.
isaninhibitorofCYP1A2anddoesdecreasethe
clearanceof
Thisresultsina54%increaseinthe
infemalenonsmokers(maybehigherin
smokers).Themeanincreasein
AUCwas52%.
Alowerdoseof
shouldbeconsidered.
.........................
.........................
SelectivelyAT-1receptorantagonist
DosagewithQualifiers
.......
Hypertension—begin20-40mgPOqdifmonotherapy,lowerif
.........................
Allergicconjunctivitis
.........................
SelectiveH
receptorantagonist,inhibitsmastcellreleaseof
DosagewithQualifiers
.......
Allergicconjunctivitis—1-2gtteacheyebid6-8hapart
—hypersensitivitytodrugorclass
MaternalConsiderations
.....
Thereisnopublishedexperiencewith
Sideeffects
includedryeyes,headache,burning,eyelidedema,
keratitis,hyperemia,rhinitis,andsinusitis.
Ulcerativecolitis—500mgPObid
—hypersensitivitytodrugorclass,
hypersensitivitytosalicylates
—renaldysfunction
MaternalConsiderations
.....
Therearenoadequatereportsorwell-controlledstudiesof
inpregnantwomen.Limitedpublishedexperience
consistspredominantlyofcasereportsandsmallseries.
Itsuggeststhat
abdominalpain,arthralgias,bloating,anorexia,itching,fatigue,
depression,anddizziness.
.........................
GERD—20-40mgPObeforeeatingqd
4-8w,then10mgPOqd;
max80mg/d
GIulcer(gastricorduodenal)—40mgPObeforeeating
Erosiveesophagitis—20-40mgPObeforeeatingqd
4-8w,max
H.pylori
treatment—20mgPObid
10difcombinedwith
NOTE:hepaticdosing.
—hypersensitivitytodrugorclass
—hepaticdysfunction,long-termuse
MaternalConsiderations
.....
Usewith
increasestheplasmalevelsof
omeprazole,clarithromycin,
and14-hydroxy-clarithromycin.
.........................
SevereN/V—
4mgIM/IV
24mgPOor32mgIV30minbeforeinitiatingchemotherapy;
post–radiationtherapy:
begin8mgPO1-2hbeforeradiation,
continueq8h
ismoreeffectivepreventingintrathecal
post–cesareansectionpruritusandnauseathanIV
Myelosuppressivechemotherapy—50mcg/kgSCqdbeginning
Obesity—120mgPOtid;takeduringmealswithfat
NOTE:separate
fromfat-solublevitaminsupplementsbyat
least2h.
—hypersensitivitytodrugorclass,
cholestasis,chronicmalabsorptionsyndrome
—historyofrenalstones
MaternalConsiderations
.....
isareversiblelipaseinhibitorforobesitymanagementthat
beensuggestedbutunproventhat
mightinterferewiththe
absorptionoforalcontraceptivesandthusdiminishtheirefficacy.
Sideeffects
includediarrhea,flatulence,steatorrhea,fecal
incontinence,andN/V.
Musclespasm—60-100mgPObid;alsoavailableforinjection
NOTE:oftencombinedwith
—hypersensitivitytodrugorclass,
glaucoma,pyloricorduodenalobstruction,myastheniagravis
—CVdisease,sulfiteallergy,arrhythmia
MaternalConsiderations
.....
Thereisnopublishedexperiencewith
Sideeffects
includedrowsiness,N/V,drymouth,aplasticanemia,
light-headedness,andheadache.
InfluenzaA/Bprophylaxis—75mgPOqd;initiateatoutbreak
InfluenzaA/Btreatment—75mgPObid
5dbeginningwithin
48hofsymptoms
NOTE:renaldosing.
—hypersensitivitytodrugorclass
—hepaticdysfunction
MaternalConsiderations
.....
Thereisnopublishedexperiencewith
pregnancy.Evidenceofevolvingviralresistanceisemerging.
Prophylaxisisnotasubstituteforvaccination(CDC
ImmunizationPracticesAdvisoryCommittee).
Sideeffects
includeN/V,bronchitis,insomnia,andvertigo.
DrugInteractions
................
Bacterialinfection—1-2gIV/IMq4-6h,or500-1000mgPOq4-6h
NOTE:renaldosing.
—hypersensitivitytodrugorclass
MaternalConsiderations
.....
exceedingthetypicalMIC,makingitsuitableforthetreatmentof
puerperalmastitis.Unfortunately,manystaphylococciarenow
resistant.Thoughitisgenerallyconsideredcompatiblewith
Osteoarthritisorrheumatoidarthritis—1200mgPOqdwithfood;
max1800mg/d
Mildtomoderatepain—1200mgPOqd
—hypersensitivitytodrugorclass,
hypersensitivitytoaspirin,aspirin/NSAID-inducedasthma
—hypertension,CHF,historyofGIbleeding,nasal
MaternalConsiderations
.....
isanNSAIDwithanti-inflammatory,analgesic,and
withdosesanalogoustothehuman.Pupsurvivalwasalso
—(Murelax;Serax;Wakezepam)
InternationalBrandName—
Adumbran(Argentina,Austria,Germany,Greece,Portugal,Spain);Alepam
(Australia,NewZealand,Taiwan);Alopam(Denmark,Finland,Norway,Sweden);Anastil(Venezuela);Anxiolit(Austria,
Alcoholwithdrawal—15-30mgPOtidorqid
—hypersensitivitytodrugorclass,psychosis
MaternalConsiderations
.....
Therearenoadequatereportsorwell-controlledstudiesin
pregnantwomen.Alcoholismisanoften-unrecognizedproblem
duringpregnancythatposesaclearhazardtomotherandchild.
inutero
arereportedinrodents.
...........................
PregnancyCategory:D
LactationCategory:S
shouldbeusedduringpregnancyandlactation
onlyifthebenefitjustifiesthepotentialperinatalrisk.
Thoughunnecessarytreatmentshouldbeavoided,appropriate
candidatesshouldnotbedeniedtherapysolelybecausethey
arepregnant.
InternationalBrandName—
Oxrate(India);Timox(Germany);Trileptal(Austria,Bulgaria,China,Colombia,
Denmark,England,Finland,France,Greece,HongKong,Indonesia,Ireland,Israel,Korea,Malaysia,Mexico,
Seizuredisorder—beginat300mgPObid,increasingby300mg/d
q3d;max2400mg/d
NOTE:renaldosing.
—hypersensitivitytodrugorclass
—renaldysfunction
MaternalConsiderations
.....
.........................
Skinfungalinfectiondueto
Epidermophytonfloccosum,T.
mentagrophytes,T.rubrum,Malasseziafurfur
.........................
Inhibitsergosterolbiosynthesis,whichiscriticalforcellular
membraneintegrity
DosagewithQualifiers
.......
Skinfungalinfection—applytoaffectedandsurroundingareabid
NOTE:availableincreamorlotion;fordermatologicuseonly.
—hypersensitivitytodrugorclass,vaginal
orophthalmologicinfections
MaternalConsiderations
.....
Thereisnopublishedexperiencewith
pregnancy.However,
1%oftheapplieddoseisabsorbed
Sideeffects
includeskinirritationanditching.
Bronchospasminotherwisehealthynonsmokingadults—7.8mg/
NOTE:0.8mg
=0.5mg
—hypersensitivitytodrugorclass,active
pepticulcerdisease,untreatedseizuredisorder
MaternalConsiderations
.....
isthecholinesaltof
Itsclearanceis
Bladderspasm—5mgPObidortid;max5mgPOqid
—hypersensitivitytodrugorclass,glaucoma,
ulcerativecolitis,GIobstructionorileus,myastheniagravis
—hepaticorrenaldysfunction
MaternalConsiderations
.....
Thereisnopublishedexperiencewith
Sideeffects
includetachycardia,vasodilation,rash,constipation,
decreasedsweating,drymouth,drowsiness,hallucinations,
restlessness,cycloplegia,andinsomnia.
Interstitialcystis—bladderinstillationswitha0.4%solutionin
Woundcare—addpowdertosaline,allowtostand2-3minbefore
applyingtogauzecompresses;usetidorqid
hypersensitivitytodrugorclass,siteof
theinfectionnotexposedtodirectcontactwiththesolution,
systemicuse
MaternalConsiderations
.....
isusedasatopicalantisepticfortreatinglocalized
infections,particularlywhenresistantorganismsarepresent.The
greatestpublishedexperienceisforthetreatmentofinterstitial
cystitis.However,ithasalsoprovedusefulforwound
bridementtopromotesecondaryhealing.Thereareno
adequatereportsorwell-controlledstudiesof
pregnantwomen.Anysystemicabsorptionislikelyminimal.
Sideeffects
includechemicalcystitis.
Moderatetoseverepain—
immediaterelease:
5-30mgPOq4hprn;
slowrelease:
10mgbid,increaseasneeded
NOTE:hepaticandrenaldosing.
Nasalcongestion—2-3sprayseachnostrilbid;max6sprays
pernostril/d
—hypersensitivitytodrugorclass,glaucoma
—preeclampsia,hypertension,hyperthyroidism,
DosagewithQualifiers
.......
Moderatetoseverepain—0.5-1.5mgSC/IMq4-6h;
0.5mgIVq4-6h
Laboranalgesia—0.5-1mgSC/IM
—hypersensitivitytodrugorclass
—pulmonary,hepatic,orrenaldysfunction;head
trauma;seizuredisorder;historyofsubstanceabuse
MaternalConsiderations
.....
wasatonetimepopularforlaboranalgesia.It
providessimilarpainreliefwithlessprurituscomparedto
whenusedwithepiduralanalgesia.
analternativeto
administeredbyPCAaftercesarean
section,butmaybeassociatedwithanincreaseinnausea.The
levelofsedationissimilar.
Sideeffects
includeabuseoraddiction,constipation,hypotension,
respiratorydepression,sedation,confusion,N/V,dizziness,
sweating,nervousness,andhallucinations.
Bacterialinfections—250-500mgPObiddependingonseverity,
or250mgIMqd
Gonorrheawhenpenicilliniscontraindicated—1.5gPO
1,then
500mgPOqidforatotalof9g
Syphiliswhenpenicilliniscontraindicated—500mgPOqid
NOTE:renaldosing;IMformulationcontains2%lidocaine.
—hypersensitivitytodrugorclass
—concomitantanticoagulantorpenicillintherapy
MaternalConsiderations
.....
Laborinduction—1-2mIU/minIV;doubleq20-30minuntil
8mIU/min,thenincreaseby1-2mIU/min;max200mIU/min
Postpartumbleeding—10-40IU/Lataratetitratedtocontrol
Lactationaid—1-2sprayspernostril2-3minbeforefeeding
orpumpingduring1stweekafterdelivery
NOTE:availableforeitherparenteraluseorasanasalspray.
—hypersensitivitytodrugorclass;nonpolar
andaugmentationoflabor.Insomegeographiclocales,anOCTis
stillusedtoassessplacentalreserveintheat-riskpregnancy.Itis
—(Onxol;Taxol)
InternationalBrandName—
Anzatax(Australia,Brazil,China,HongKong,Malaysia,Philippines,Singapore,
Taiwan,Thailand);Asotax(Argentina,Mexico);Biotax(Israel);Bristaxol(Mexico);Britaxol(Chile);Formoxol(Malaysia);
Genexol(Korea,Singapore);Ifaxol(Mexico);Intaxel(India,Thailand);Medixel(Israel);Mitotax(Malaysia);
Pacxel(Korea);Padexol(Korea);Parexel(Colombia,Ecuador,Paraguay);Paxus(Indonesia);Praxel(Chile,Mexico);
Taxocris(Uruguay);Taxol(Argentina,Canada,China,Ecuador,Germany,HongKong,Indonesia,Israel,Korea,
Malaysia,NewZealand,Philippines,SouthAfrica,Thailand);Taycovit(Peru)
DrugClass
..........................
Antineoplastics,antimitotics
.........................
cancer,andHIV-relatedKaposi’ssarcoma—dosing
regimensvary
—hypersensitivitytodrugorclass,
hypersensitivityto
castoroil
,neutropenia
—radiationtherapy,pregnancy
MaternalConsiderations
.....
isanaturalproduct.Itisusuallycombinedwith
asfirst-linetherapy.Therearedozensofwomengiven
duringpregnancy.Inone,themedianmaternalage
was36y(range:30-42y),andtheprimarysitewasovarianin
5(fourcarcinomasandonedysgerminoma)andthebreastin4.
beganduringthe2ndtrimesterin4instances,and
duringthe3rdtrimesterintheremaining5.Nomalformations
werereported,andtheoffspringseemedhealthywithamedian
follow-upof16mo(range:3-36mo).Onlyoneteamstudiedthe
inhibitors(e.g.,
indinavir,nelfinavir,ritonavir,saquinavir
whicharesubstratesand/orinhibitorsofCYP3A4,havenotbeen
evaluatedinclinicaltrials.
InaPhaseItrial,myelosuppressionwasmoreprofoundwhen
wasgivenafter
thanwiththealternate
sequence(i.e.,
Hypercalcemiasecondarytomalignancy—60-90mgIVinfused
over24h
Osteolyticlesions—90mgIVinfusedover4hqmo
—hypersensitivitytodrugorclass
—renaldysfunction
MaternalConsiderations
.....
Therearenoadequatereportsorwell-controlledstudiesof
inpregnantwomen.Thepublishedexperience
consistsofseveralcasereports.Inone,
employedinthe3rdtrimestertotreathypercalcemiasecondaryto
—(Amylase;AmylaseLipaseProtease;
Cotazym-S;Creon;Creon5;Donnazyme;Encron10;Entolase;
Enzymase16;Festalan;Ilozyme;Ku-ZymeHP;Lipase;Panase;
Pancote;Pancrease;PancreaticEnzyme;Pancreatin10;
Pancrelipase10000;PancrelipaseMt16;PancrelipaseMt-16;
Pancron10;Panokase;Promylin;Protease;Protilase;
ProtilaseMt16;Ultrase;UltraseMt;Vio-Moore;Zymase)
InternationalBrandName—
Combizym(NewZealand);CombizymCompositum(NewZealand);
Cotazym(Canada);Cotazym-65B(Canada);CotazymECS(NewZealand);Cotazym-S(Australia);
Cotazym-SForte(Australia);Creon(Canada);Krebsilasi(Italy);Pancrease(Belgium,Denmark,Finland,Israel,Italy,
Pancreaticinsufficiency—1-3tabsPOswallowedquicklywith
mealsdependingonpreparation
NOTE:donotcut,crush,orchew.
—hypersensitivitytodrugorclass,allergy
topork,acutepancreatitis
MaternalConsiderations
.....
Theenzymesin
actlocallyintheGItract,where
eithertheymaybedigested,ortheirconstituentspartially
thetreatmentofcysticfibrosis.
Sideeffects
includeN/V,diarrhea,stomatitis,oralulceration,
rash,urticaria,hyperuricemia,andperianalirritation.
.........................
Therearenocurrentrelevantreferences.
...........................
PregnancyCategory:B
LactationCategory:S
shouldbeusedduringpregnancyandlactation
ifthebenefitjustifiesthepotentialperinatalrisk.
InternationalBrandName—
Alpax(Israel);Bromurex(Colombia,Mexico);Curon-B(SouthAfrica);
Panconium(India);Pancuron(Paraguay);Pancuronio(Colombia);Pavulon(Argentina,Australia,Brazil,Canada,Chile,
France,India,Japan,Korea,SouthAfrica,Sweden,Venezuela)
DrugClass
..........................
Neuromuscularblockers,nondepolarizing
.........................
Anesthesia,paralysis
.........................
Paralysis—0.04-0.1mg/kgIV
theincidenceandintensityof
fasiculations,itmaycauserespiratorydepressioninsome
patients.Othernondepolarizingneuromuscularblockingagents
.........................
Erosiveesophagitis—40mgPOqdorbid
8w;mayrepeatcourse
followedbymaintenanceof40mg/d
Pantothenicacid
InternationalBrandName—
Noneidentified.
DrugClass
..........................
.........................
.........................
DosagewithQualifiers
.......
Supplementation—RDAnotestablished,but6mgdailyistypically
—hypersensitivitytodrugorclass
MaternalConsiderations
.....
Pantothenicacid
(a.k.a.vitaminB
)isawater-solubleBvitamin.
Therearenoadequatereportsorwell-controlledstudiesof
pantothenicacid
inpregnantwomen.Itslevelmaydecline
modestlyduringpregnancy.
Sideeffects
arenotreported.
InternationalBrandName—
Noneidentified.
DrugClass
..........................
Antidiarrheals;Narcotics
.........................
.........................
Bindsopioidreceptors
DosagewithQualifiers
.......
Diarrhea—5-10mlqdtoqidprnloosestools
—hypersensitivitytodrugorclass,
hypersensitivityto
diarrheasecondarytotoxic
InternationalBrandName—
Noneidentified.
DrugClass
..........................
Secondaryhyperparathyroidism—0.04-0.1mcg/kgIV3
/w;max
—hypersensitivitytodrugorclass,vitamin
Dtoxicity,hypercalcemia
MaternalConsiderations
.....
InternationalBrandName—
Gabbroral(Belgium,Bulgaria,Indonesia,Italy,SouthAfrica);Humagel(France);
Humatin(Austria,Bulgaria,Canada,Ecuador,Germany,Italy,Spain,Switzerland)
DrugClass
..........................
Antibiotics;Aminoglycosides;Antiprotozoals
.........................
Intestinalamebiasis,managementofhepaticcoma
.........................
Bactericidal—inhibitsproteinsynthesisbybindingthebacterial
30Sribosomalsubunit
DosagewithQualifiers
.......
Intestinalamebiasis—25-35mg/kg/dPOwithmeals
Management(adjunctive)ofhepaticcoma—4gPOtid
—hypersensitivitytodrugorclass,intestinal
—bowelulcerations
MaternalConsiderations
.....
closelyparallels
.Itispoorlyabsorbed
orally—nearly100%isrecoverablefromthestool.Thereareno
adequatereportsorwell-controlledstudiesinpregnantwomen.
Asinglecasereportdocumentsthesuccessfultreatmentof
Sideeffects
includeN/V,abdominalcramps,anddiarrhea.
Depression—begin20mgPOqam,increasingby10mg/dqw;max
OCD—begin20mgPOqam,increasingby10mg/dqw;max
Panicdisorder—begin10mgPOqam,increasingby10mg/dqw;
max60mg/d
Post-traumaticstress—begin20mgPOqam,increasingby
10mg/dqw;max60mg/d
Chronicheadache—begin10mgPOqam,increasingby
10mg/dqw;max60mg/d
lowerthanthatobservedwith
chronically.Noinitialdosageadjustmentof
ColeJA,EphrossSA,CosmatosIS,WalkerAM.
PharmacoepidemiolDrugSaf2007;16:1075-85.
Post-chemotherapyneutropenia—6mgSC
24hafter
abdominalpain,flankpain,elevatedLDHoruricacidor
alkalinephosphatase,andinjectionsitereaction.
ChronicHCVinfection—1mg/kg/wSC
NOTE:anemiaandneutropeniadosing;restrictedaccessinUS.
—hypersensitivitytodrugorclass,
autoimmunehepatitis,decompensatedhepaticdisease
Allergicconjunctivitis—1-2gtteacheyeqidformax4w
—hypersensitivitytodrugorclass
MaternalConsiderations
.....
Thereisnopublishedexperiencewith
inpregnancy.
Sideeffects
includeheadache,dryeyes,burningorotherocular
discomfort,andrespiratorysymptoms.
DrugInteractions
................
Noclinicallyrelevantinteractionsidentified.
.........................
Therearenocurrentrelevantreferences.
...........................
PregnancyCategory:C
LactationCategory:S
shouldbeusedduringpregnancyandlactationonly
ifthebenefitjustifiesthepotentialperinatalrisk.
InternationalBrandName—
ADHD—begin37.5mgPOqam,increasingby18.75mgqw;
max112.5mg/d
Narcolepsy—25-100mgPObid
NOTE:checkALTatbaselineandq2w.
—hypersensitivitytodrugorclass,hepatic
InternationalBrandName—
Hypertension—begin20mgPOqd;max80mgPOqd
NOTE:avoidabruptdiscontinuation.
—hypersensitivitytodrugorclass,
AVblock,sinusbradycardia,cardiacinsufficiency
Penciclovirtopical
InternationalBrandName—
Vectavir(CostaRica,DominicanRepublic,ElSalvador,Germany,Guatemala,
Honduras,Israel,Nicaragua,Panama,SouthAfrica)
DrugClass
..........................
Antivirals;Dermatologics
.........................
Herpeslabialis
.........................
InhibitsDNApolymerase
DosagewithQualifiers
.......
Herpeslabialis—applyq2h
—hypersensitivitytodrugorclass
—immunedeficiency
MaternalConsiderations
.....
Thereisnopublishedexperiencewith
inpregnancy.
Thereislittlesystemicabsorptionaftertopicalapplication.
Sideeffects
includeheadache,pruritus,tastechanges,and
—(Cuprimine;Depen;Mercaptyl)
InternationalBrandName—
Adaleen(Mexico);Artamin(Austria,Korea,Malaysia);Atamir(Denmark);
Wilson’sdisease—250-500mgPOtidorqid30minbeforemeals
Cystinuria—250-1000mgPOqid30minbeforemeals
Rheumatoidarthritis(unresponsivetoconventional
agents)—250mgPObidortid30minbeforemeals;requires
3-6moformaxeffect
Systemicinfection(moderatetosevere)—4millionUIM/IVq4h
oral,GI,orinhalational:
4millionUIVq4haspartof
amultidrugregimen
4millionUIVq4h
7-10d,thenswitchtoPOfor60d
Neurosyphilis—18-24millionUqdIV
NOTE:renaldosing.
NOTE:Bicillincombines
penicillinG
benzathinepenicillinG.
—hypersensitivitytodrugorclass
—renaldysfunction,cephalosporinallergy,seizure
MaternalConsiderations
.....
PenicillinG
istypicallygivenparenterallybecauseitisunstable
ingastrichydrochloricacid.BecauseitisgivenIV,highertissue
concentrationsareachievedthanwith
penicillinVK
breastmilk.Itisgenerallyconsideredcompatiblewith
DrugInteractions
................
Syphilis(primary,secondaryorearlylatent)—2.4million
UIM
1if
1yduration,qw
3if
1yduration(latelatent,
unknownduration,tertiary)
GroupAstreptococcusinfection—1.2millionUIM
NOTE:Bicillincombines
penicillinG
benzathinepenicillinG.
—hypersensitivitytodrugorclass
—renaldysfunction,cephalosporinallergy,seizure
MaternalConsiderations
.....
BenzathinepenicillinG
isslowlyabsorbedafterIMinjection
andsubsequentlyhydrolysedtobenzylpenicillin.Itisthedrug
ofchoicewhenprolongedlowconcentrationsofbenzylpenicillin
arerequired,allowingforprolongedantibioticactionover2-4w.
Therearenoadequatereportsorwell-controlledstudiesin
pregnantwomen.
BenzathinepenicillinG
remainsthedrugof
choiceforsyphilisduringpregnancy.However,itshouldbenoted
thatBicillinC-R(contains1.2millionUof
benzathinepenicillin
and1.2millionunitsof
procainepenicillinG
)isnot
recommendedfortreatingsyphilisbecauseitcontainsonlyhalf
therecommendeddoseof
benzathinepenicillinG.
errorshaveoccurred,andasaresultchangesinproduct
packagingweremade;specifically,thestatement‘‘Notforthe
TreatmentofSyphilis’’hasbeenaddedinredtexttoboththe
BicillinCRandBillinCR900/300syringelabels.Thereissome
benzathinepenicillinG
maynotpreventneurosyphilis,
buttheoverallriskappearslow.Partnernotificationismandatory
topreventthespreadofthedisease.About40%ofpatients
experienceaJarisch-Herxheimerreaction;treatedwomenshould
bewarnedofthepossibilityandmonitoredcloselyforthefirst
BenzathinepenicillinG-penicillinG
suspension(Bicillin
L-A)2.4millionUIMisinsufficientassoletherapyforgroupB
streptococcalprophylaxis.
Sideeffects
includethrombocytopenia,seizures,rash,
Stevens-Johnsonsyndrome,fever,hemolyticanemia,
neutropenia,interstitialnephritis,N/V,abdominalpain,
diarrhea,andthrombophlebitis.
Systemicinfection(moderatetosevere)—0.6-1.2millionUIMqd
Pneumococcalpneumonia—0.6-1.2millionUIMqd
Uncomplicatedgonorrhea—4.8millionUIM
130minafter1g
Neurosyphilis(alternativetoaqueouspenicillin)—2.4million
UIMqdplus
500mgPOqid,each
Contraindications
—hypersensitivitytodrugorclass,IVinjection
—renaldysfunction,cephalosporinallergy,seizure
MaternalConsiderations
.....
ProcainepenicillinG
isacombinationofbenzylpenicillinwith
teratogenicityorIUGRdespitetheuseofdoseshigherthanthose
usedclinically.
GroupAstreptococcusinfection—250-500mgPOq6-8h
Pneumococcalpneumoniaprophylaxis—250mgPObid
Rheumaticfeverprophylaxis—250mgPObid
NOTE:tobetaken1hbeforeor2haftermeals.
—hypersensitivitytodrugorclass
—renaldysfunction,cephalosporinallergy,seizure
disorder,PKU
MaternalConsiderations
.....
PenicillinVK
istheorallyactiveformofpenicillin.Itisless
activethanbenzylpenicillinandisonlyappropriatein
circumstanceswherehightissueconcentrationsarenotrequired.
Therearenoadequatereportsorwell-controlledstudiesin
pregnantwomen.However,thereisalongclinicalexperiencethat
isreassuring.
Sideeffects
includethrombocytopenia,seizures,rash,Stevens-
Johnsonsyndrome,hemolyticanemia,neutropenia,interstitial
nephritis,N/V,abdominalpain,diarrhea,pseudomembranous
colitis,andfever.
DosagewithQualifiers
.......
PCPprophylaxis—300mgNEBq4wk
PCPtreatment—4mg/kgIV/IMqd
—hypersensitivitytodrugorclass
—hepaticorrenaldysfunction,hypertension,
hypotension,leukopenia,hypoglycemia
MaternalConsiderations
.....
Therearenoadequatereportsorwell-controlledstudiesof
inpregnantwomen.WithholdingappropriatePCP
.........................
Bindsopiatereceptors,producingbothagonistandantagonist
DosagewithQualifiers
.......
Moderatetoseverepain—30mgIM/IV/SCq3-4hprn;max
Anesthesiaadjunct—20mgIV(or30mgIM)q2-4hprn
NOTE:SCinjectionsmaycauseseveretissuedamageandarebest
NOTE:maybecombinedwith
—(Carbrital;Nembutal)
InternationalBrandName—
Dormital(Uruguay);Embutal(Argentina);MedinoxMono(Germany);
Mintal(Japan);Sombutol(Finland)
DrugClass
..........................
Anticonvulsants;Anxiolytics;Barbiturates;Sedatives
.........................
Sedation,insomnia,barbituratecoma
.........................
Depressesthesensoryandmotorcortexandalterscerebellar
DosagewithQualifiers
.......
Sedation—20-40mgPObidtoqid
Insomnia—100mgPOqhsprnforshort-termtherapy
Barbituratecoma—loadwith5mg/kgover30min,then1-3mg/kg/
hIV;systemicarterialBPmustbesupported(e.g.,inotropic
—hypersensitivitytodrugorclass,decreased
respiratoryfunction,porphyria
—hepaticdysfunction,historyofsubstanceabuse,
suicidalideation
MaternalConsiderations
.....
BarbituratesproduceCNSmoodalterationrangingfrom
excitationtosedationtohypnosisanddeepcoma.Asasleepaid,
barbituratesareoflimitedvaluebeyondtheshorttermasthey
loseeffectivenessafter1-2w.Therearesuperioragentsthathave
lesseffectonthesleepcycle.Therearenoadequatereportsor
well-controlledstudiesof
inpregnantwomen.
Hypnoticdosesdonotimpairuterineactivityduringlabor.
Sideeffects
includeaddiction,respiratorydepression,
Stevens-Johnsonsyndrome,SLE,angioedema,confusion,
agitation,hyperkinesias,ataxia,CNSdepression,hallucinations,
dizziness,apnea,bradycardia,hypotension,syncope,N/V,
constipation,andheadache.
).Anticoagulantdoseadjustmentsmaybenecessary
ifbarbituratesareaddedorwithdrawn.
Interstitialcystitis—100mgPOtid1hbeforeor2haftermeals
—hypersensitivitytodrugorclass
—hepaticorsplenicdisorders
MaternalConsiderations
.....
Thereisnopublishedexperiencewith
pentosanpolysulfate
Sideeffects
includehepatotoxicity,diarrhea,N/V,headache,
dyspepsia,abdominalpain,dizziness,depression,alopecia,and
elevatedLFTs.
Hairycellleukemia—4mg/m
IVqw
—hypersensitivitytodrugorclass,
—activeinfection,renaldysfunction
MaternalConsiderations
.....
Thereisnopublishedexperiencewith
Sideeffects
includeN/V,arrhythmia,hemorrhage,leukopenia,
thrombocytopenia,fatigue,anorexia,diarrhea,headache,rash,
bronchitis,fever,chills,hematuria,andsomnolence.
Usewith
isnotrecommendedasitmaybeassociated
withanincreasedriskoffatalpulmonarytoxicity.
.........................
Claudication—400mgPOtidwithmeals
—hypersensitivitytodrugorclass,
whilebreastfeedingbecauseofitsassociation
withmammaryfibroadenomasinrodents.
DrugInteractions
................
Whileacausalrelationshipisnotestablished,therearereports
ofbleedingand/orprolongedPTinpatientstreatedwith
Parkinsonism—0.05mgqd
2dwhenusedasanadjunctwith
increaseby0.1mg/dq3d
12d,then
0.25mgq3d
12d,thenadjust;maxdose5mg/d
—hypersensitivitytodrugorclass
MaternalConsiderations
.....
iseffectiveprimarytreatmentforpituitary
macroprolactinomas.Itis10-1000
morepotentadopamine
agonistthan
Therearenoadequatereportsor
well-controlledstudiesinpregnantwomen.
Sideeffects
includeventriculararrhythmia,MI,cardiacvalve
damage,hypotension,N/V,dyskinesia,rhinitis,confusion,
dizziness,somnolence,hallucinations,diarrhea,dyspepsia,tremor,
syncope,andanemia.
Hypertension—begin4mgPOqd;max16mg/d
CHF—begin2mgPOqd
MaternalConsiderations
.....
Thereisnopublishedexperiencewith
pregnancy.Thelowestdoseeffectiveshouldbeusedwhenitis
requiredduringpregnancyforBPcontrol.
Sideeffects
Scabies—massageintoskinfromheadtotoe,allowtoremain
8-14hbeforebathing
—hypersensitivitytodrugorclass
MaternalConsiderations
.....
—(Trilifan;Trilafon)
InternationalBrandName—
APO-Perphenazine(Canada,Malaysia);Decentan(Austria,Germany,Spain);
Fentazin(England,Ireland);F-Mon(Japan);Leptopsique(Mexico);Peratsin(Finland);Pernamed(Thailand);Pernazine
(Thailand);Perphenan(Israel);Perzine-P(Thailand);Porazine(Thailand);Trilafon(Canada,Denmark,Indonesia,Italy,
Psychosis—8-16mgPObidtoqid;max64mg/d
SevereN/V—begin5mgIM/PO(avoidIV);max24mg/d
—hypersensitivitytodrugorclass,CNS
depression,blooddyscrasias,bonemarrowdepression,hepatic
disease,coma,subcorticaldamage
MaternalConsiderations
.....
iscommonlycombinedwith
andSSRIs(e.g.,
Seizures(complexpartialresistanttootherdrugs)—begin500mg
POtid
7dbeforeadjusting;usualdose2-3g/d
NOTE:measurehepatictransaminasesandobtainCBCbeforeand
periodicallyduringtherapy;thetotalnumberofeachcelltype/mm
DrugInteractions
................
ExtremecautionisessentialwhenusedwithanyotherAED
knowntocausesimilartoxiceffects.
Dysuria—100-200mgPOtidpc
NOTE:turnsurinered/orange;maybecombinedwith
humanbreastmilk.However,itisgenerallyconsidered
compatiblewithbreastfeedingbasedonlongclinicalexperience.
DrugInteractions
................
Noclinicallyrelevantinteractionsidentified.
.........................
MeyerBA,GonikB,CreasyRK.AmJPerinatol1991;8:297-9.
...........................
PregnancyCategory:B
LactationCategory:S
hasbeenusedfordecadesduringpregnancy
andlactation.
Thoughthereislittleobjectivestudy,itisgenerallyconsidered
safeforlistedindications.
Obesity—35mgPObidortid;individualizetothelowesteffective
NOTE:forshort-termuseonlycoupledtocalorierestriction;
toleranceoccurswithinweeks.
—hypersensitivitytodrugorclass,substance
abuse,advancedarteriosclerosis,symptomaticCVdisease,
moderateorseverehypertension,hyperthyroidism,glaucoma,
ingestionofotherCNSstimulants,agitation
Depression—15mgPOtid;responsemaytakeatleast4w
Bulimia—begin15mgPOtid;max30mgPOtid
NOTE:wait
4wafterstoppinganSSRIbeforeinitiating.
—hypersensitivitytodrugorclass,CHF,
hypertension,pheochromocytoma,hepaticdisease,general
anesthesiaor
usewithin10d,
MaternalConsiderations
.....
Depressioniscommonduringandafterpregnancy,buttypically
goesunrecognized.Pregnancyisnotareason
apriori
discontinuepsychotropicdrugs.
isofteneffectivein
treatingdepressioncharacterizedasatypical,nonendogenous,or
humanplacenta.Asformostpsychotropicdrugs,monotherapy
andthesmallesteffectivequantitygivenindivideddosesmay
reduceriskbyminimizingthesystemicpeaks.Rodent
teratogenicitystudieshaveapparentlynotbeenperformed.
Seizuredisorder—loadwith15-20mg/kgIV,then60mgPO
bidortid
Statusepilepticus—10-20mg/kgIV
1;mayrepeatifnecessary
Sedation—10-40mgPO/IM/IVtid
NOTE:avoidabruptwithdrawal;maybecombinedwith
orergotrate.
—hypersensitivitytodrugorclass,history
ofporphyria,hepaticorrespiratorydysfunction
—uremia,depressionorsuicidalideation
MaternalConsiderations
.....
LesstimeisspentinREMduringbarbiturate-inducedsleep
comparedtonormalsleep.Abruptcessationmaytrigger
increaseddreaming,nightmares,and/orinsomnia.Barbiturates
thatperiodicdoseadjustmentmaybenecessary.Alladjustments
shouldbeguidedbyclinicalsymptoms.Inaddition,
impactstheanumberofliverCYPs.
isnoteffectiveforthetreatmentofcholestasisof
pregnancy.Plannedpregnancyandcounselingbeforeconception
arecrucial.Itisimportanttodiscussfolicacidsupplementation,
medicationadherence,theriskofteratogenicity,andthe
importanceofprenatalcare.
Sideeffects
includerespiratorydepression,habituation,erythema
multiforme,Stevens-Johnsonsyndrome,hepatitis,angioedema,
Maydecreasetheeffectof
Pheochromocytoma—begin10mgPObid,increasingby
theseizures.Thesolepublishedestimateisthattheriskissimilar
Obesity—8mgPOtid
—hypersensitivitytodrugorclass,severe
hypertension,symptomaticcardiovasculardisease,MAOIuse
14d,glaucoma,agitatedstates,historyofsubstanceabuse
MaternalConsiderations
.....
Pheochromocytoma(preoperation)—5mgIM/IV1-2h
preoperatively;mayrepeatasnecessary
Hypertensivecrisis—5mgIV/IM
Extravasationnecrosis—5-10mg/10mlNaClinjectedinto
affectedarea
—hypersensitivitytodrugorclass,MI,CAD
—pepticulcerdisease
MaternalConsiderations
.....
isashort-acting
-antagonistwithdirect
iono-andchronotropicactions.Therearenoadequatereports
orwell-controlledstudiesinpregnantwomen.Therearea
numberofcasereportsdocumentingefficacyforthenoted
indications.Rodentstudiessuggest
reducesuterine
contractilitypostpartum,butthereisnoclinicalevidenceofsuch
activityinwomen.
Sideeffects
includeMI,stroke,hypotension,arrhythmia,
tachycardia,pepticulceration,weakness,dizziness,flushing,N/V,
diarrhea,abdominalpain,andnasalcongestion.
Shock—40-180mcg/mininfusion,or50mcgIVbolus
Nasalcongestion—2-3gttpernostrilq4h;donotexceed0.25%
formorethan3d
Hypotension,spinalorepidural—50-100mcgIVbolusfor
aggressivesupportofarterialBPatcesareandelivery
NOTE:frequentlycombinedwithalargerangeofpreparationsfor
MaternalConsiderations
.....
Allergicrhinitisaffectsabout
ofreproductive-agewomen.More
—(Kleer;Propan;Rhindecon)
InternationalBrandName—
Noneidentified.
DrugClass
..........................
Adrenergicagonists;Decongestants
.........................
Nasaldecongestant
.........................
Nasalcongestion—75mgPOq12hprn(XRtabs);alternatively,
25mgPOq4h(immediaterelease)
NOTE:previouslyincludedinarangeofOTCpreparations,the
FDAorderedremovalof
fromtheUS
OnuigboM,AlikhanM.SouthMedJ1998;91:1153-5.
TollK,GrafP.Rhinology2006;44:274-7.
WerlerMM,SheehanJE,MitchellAA.AmJEpidemiol2002;
WerlerMM,SheehanJE,MitchellAA.Epidemiology
...........................
PregnancyCategory:C
LactationCategory:U
isbeingwithdrawnfromtheUS
Seizuredisorder—loadwith400mg,300mg,and300mgPO2-4h
apart,then300-400mgPOqd(ordividedbid);alternatively,
10-20mg/kgIV
1,then4-6mg/kgIVqd
Statusepilepticus—15-20mg/kgIVq30minprn;max1500mg/d
NOTE:therapeuticlevel10-20mcg/ml;recommendcontinuousECG
duringloadandnottoexceed50mg/minIV;avoidabrupt
withdrawal;availableinoralandparenteralforms.
—hypersensitivitytodrugorclass,SAor
AVblock(IV),sinusbradycardia(IV),Adams-Stokes
syndrome(IV)
—hepaticorrenaldysfunction,hypotension,CV
andunbounddruglevelsarelessaffectedthantotal
mayimpairtheeffectof
corticosteroids,coumadin,digitoxin,doxycycline,estrogens,
oralcontraceptives,
quinidine,rifampin,
Drugsthatmaydecreaseserumlevelsinclude
DosagewithQualifiers
.......
Glaucoma,open-angle—1-2gttpereyetidorqid
Reversalofanticholinergicsyndrome—2mgIMorslowIV
Postanesthesiacare—0.5-1.0mgIMorslowIV;repeatatintervals
of10-30minasneededforresponse
NOTE:0.25%and0.5%ophthalmicsolutions.
—hypersensitivitytodrugorclass,acute
uveitis,cornealabrasion,closed-angleglaucoma,asthma,
Hypoprothrombinemia—10mgSC/IM/IV
1;mayrepeatin6-8h
basedonINR;or2.5-25mgPOqd-qw,max25mg/dose
NOTE:severereactions,includingfatalities,arereportedafterIVuse.
—hypersensitivitytodrugorclass,hereditary
—heparinanticoagulation
MaternalConsiderations
.....
Hypoprothrombinemiamayresultfromanticoagulation,
antibiotictherapy,orGIdisease,ormaybedrug-induced.
ThedrugslistedareeachvitaminKproductswithsome
pharmacologicdifferences.Therearenoadequatereportsor
well-controlledstudiesof
inpregnantwomen.
Sideeffects
includeanticoagulantresistance,hypotension,taste
changes,flushing,diaphoresis,dyspnea,edema,andinjection
sitehematomaorpain.
XerostomiasecondarytoSjo
gren’ssyndrome—5mgPOqid;
responsemaytake6w
Xerostomiasecondarytohead/neckcancer—begin5mgPOtid;
max30mg/d
NOTE:hepaticdosing.
—hypersensitivitytodrugorclass,acute
asthma,narrow-angleglaucoma,acuteiritis,severehepatic
Caution
—moderatehepaticdysfunction,asthma,COPD,chronic
bronchitis,biliarydisease,nephrolithiasis,psychiatricillness
MaternalConsiderations
.....
Thereisnopublishedexperiencewith
inpregnancy.
Sideeffects
includepulmonaryedema,visualimpairment,
impairedfertility,bradycardia,tachycardia,hypotension,
hypertension,cholecystitis,biliaryspasm,shock,sweating,chills,
N/V,flushing,rhinitis,dizziness,weakness,diarrhea,headache,
dyspepsia,edema,tremor,dysphagia,andvoicechanges.
Atopicdermatitis(mild-moderate)—forresistantcases,apply
topicallybidforupto6w
—hypersensitivitytodrugorclass,local
MaternalConsiderations
.....
Thereisnopublishedexperiencewith
inpregnancy.
Sideeffects
includeviralreactivation,lymphadenopathy,skin
burning,headache,cough,pharyngitis,skinpapilloma,erythema,
andpruritus.
Hypertension—begin5mgPObid,increaseby10mg/dq3-4w;
max60mg/d
Chronicstableangina—15-40mgPOqd
NOTE:hepaticdosing.
—hypersensitivitytodrugorclass,asthma,
severebradycardia,2ndor3rddegreeAVblock,CHF,severe
COPD,cardiogenicshock
—pasthistoryofCHF,abruptwithdrawal,major
preeclamptichypertensionwhen
aloneisinadequate.
Womenwithpreeclampsiatreatedwith
reportedlyhave
InternationalBrandName—
Actos(Argentina,Brazil,Canada,Chile,Colombia,HongKong,Indonesia,
Korea,Peru,Philippines,SouthAfrica,Thailand);Cereluc(Argentina);Glita(India);Glitase(India);
Pioglit(India,Paraguay);Piomed(Uruguay);Zactos(Mexico)
DrugClass
..........................
InternationalBrandName—
Acopex(Korea);Avocin(Italy);Cypercil(Philippines);Ivacin(Denmark,Sweden);
Bacterialinfections(
intra-abdominal,orsepsis)—
3-4gIV/IMq4-6h
Post-gynecologicorpost-cesareanprophylaxis—2gIV30min
preoperativelyoratumbilicalcordclamping,thenq4-6h
Gonorrhea,uncomplicated—1g
PO30minbefore
2gIM
NOTE:renaldosing;maybecombinedwiththe
(Tazosyn;Zosyn).
—hypersensitivitytodrugorclass
—cephalosporinallergy,uremia,hypokalemia,seizure
disorder,nephrotoxicagents,renaldysfunction,sodium
MaternalConsiderations
.....
iswidelydistributed,includingtherapeuticlevelsin
bone,heart,bile,andCSFduringinflammation.Itisbeststudied
duringpregnancyforthetreatmentofgonorrhea,PPROM,and
cesareansectionprophylaxis.
DrugInteractions
................
Mixingwithanaminoglycoside
invitro
producessubstantial
inactivationoftheaminoglycoside.
Mayprolongtheneuromuscularblockadeof
cautionisindicated.Duetotheirsimilarmechanismofaction,it
ispossibletheneuromuscularblockadeproducedbyanyofthe
nondepolarizingmusclerelaxantscouldbeprolongedby
beforeIM
producesabouta30%
increaseinthe
peakserumlevels.
Bacterialinfections(
intra-abdominal,or
sepsis)—3.375gIVq6h
Community-acquiredpneumonia—3.375gIVq6h
NOTE:renaldosing.
—hypersensitivitytodrugorclass
—cephalosporinallergy,uremia,hypokalemia,seizure
disorder,nephrotoxicagents,renaldysfunction,sodium
MaternalConsiderations
.....
isa
-lactamaseinhibitorwithnosignificant
antibacterialactivity;itsadditionexpandstheantibacterial
spectrumof
piperacillin.Piperacillin-tazobactam
isactive
againstmoststrainsofthefollowing
-lactamase–producingmicroorganisms:MSSA,
E.coli
(notampicillin-resistant),andthe
B.fragilis
Ascariasis—3.5gPObeforebreakfastqd
Enterobiasis—65mg/kgbeforebreakfastqd
7d;max2.5g/d
—hypersensitivitytodrugorclass,renal
dysfunction,convulsivedisorders
—hepaticdysfunction,malnutrition,anemia
MaternalConsiderations
.....
Therearenoadequatereportsorwell-controlledstudiesof
inpregnantwomen.Thelongclinicalexperienceis
reassuring.Paralysisoftheparasiteismediatedbyitsagonist
effectsupontheinhibitoryGABAreceptor.Itsselectivityfor
helminthsisderivedfromthefactthatvertebratesuseGABA
onlyintheCNSandthehelminths’GABAreceptorisadifferent
Sideeffects
includeN/V,abdominalcramps,diarrhea,urticaria,
erythemamultiforme,purpura,fever,arthralgia,headache,
vertigo,ataxia,tremors,choreiformmovement,muscular
weakness,hyporeflexia,paresthesia,blurredvision,convulsions,
EEGabnormalities,andmemorydeficit.
.........................
Bronchospasm—1-2puffs(200mcg/puff)INHq4-6h;max
NOTE:currentlyunavailableintheUS.
—hypersensitivitytodrugorclass
—(Brexicam;Feldene;Feline)
InternationalBrandName—
Antiflog(Italy);Apo-Piroxicam(Canada,NewZealand);Arpyrox(Indonesia);
Artrilase(DominicanRepublic);Atidem(Peru);Baxo(Japan);Benoxicam(Indonesia);Brexic(India);Brexicam
(CostaRica,DominicanRepublic,ElSalvador,Guatemala,Honduras,Nicaragua,Panama);Brexin(Israel,Taiwan);
Brexodin(Mexico);Camrox(Korea);Candyl-D(NewZealand);Capxidin(Singapore);CitokenT(Mexico);Dacam
(Finland);Desinflam(Peru);Dixonal(Mexico);Doblexan(Spain);Dolonex(India);Exipan(Israel);Facicam(Mexico);
Felcicam(Korea);Felden(Austria,Denmark,Finland,Germany,Norway,Sweden,Switzerland);FeldeneGel(South
Africa,Thailand);Felrox(Thailand);Felxicam(HongKong,Malaysia);FlamicGel(Thailand);Flaxine(Philippines);
Flexirox(France);Floglugen(Taiwan);Flogosan(Mexico);Focus(Taiwan);Fulden(Korea);Hotemin(HongKong,
Malaysia);Indene(Indonesia);Infeld(Indonesia);Inflamene(Brazil,Indonesia);Konshien(Taiwan);Kydoflam
(Colombia);Larapam(England);Macroxam(Philippines);Mobilis(Australia);Movon-20(India);MovonGel(India);
Moxicam(Thailand);Novopirocam(Canada);Nu-Pirox(Canada);Osteral(Mexico);Parixam(Philippines);
Piraldene(Peru);Piram(Thailand);Piram-D(NewZealand);Pirax(Thailand);Pirkam(Denmark);Pirocutan(Germany);
PirocutanGel(Germany);Pirohexal-D(Australia);Pirom(Denmark);Pirox(India);Piroxan(Mexico);Piroxedol
(Colombia);Piroxim(Colombia,Israel,SouthAfrica);Piroxton(Korea);Pixicam(SouthAfrica);Posidene(Thailand);
Priorheum(Germany);Proxalyoc(France);Pyrocaps(SouthAfrica);Pyroxy(Thailand);Raxicam(Philippines);Rexicam
(Indonesia);Rheugesic(SouthAfrica);Rosic(Indonesia);Rosiden(Korea);RosidenGel(Korea);Rosig(Australia);
Rosig-D(Australia);Roxicam(Israel,SouthAfrica);Roxium(Thailand);Ruvamed(Greece);Scandene(Indonesia);
Sefdene(HongKong);Sinalgico(Argentina);Sofden(Indonesia);Sotilen(HongKong,Israel,SouthAfrica,Taiwan,
Thailand);Stopen(Colombia);Tropidene(Indonesia);Unicam(Israel);Vidapirocam(HongKong);Xicalom(Indonesia);
Xicam(Thailand);Xycam(SouthAfrica);Zitumex(Greece);Zunden(Italy)
DrugClass
..........................
Analgesics,non-narcotic;NSAIDs;Oxicams
.........................
Osteoarthritisandrheumatoidarthritis,mildtomoderatepain,
.........................
Inhibitsprostaglandinbiosynthesis
DosagewithQualifiers
.......
Osteoarthritisandrheumatoidarthritis—20-40mgPOqdwith
Mildtomoderatepain—20mgPOqd
Dysmenorrhea—begin40mgqd
2d,then20mgPOqd
—hypersensitivitytodrugorclass,
aspirin-orNSAID-inducedasthma
—GIbleeding,nasalpolyps,hypertension,CHF
MaternalConsiderations
.....
isanorallyabsorbedoxicamwithanti-inflammatory,
Hypercalcemiaandhypercalciuria—25mcg/kgIVqdgivenover4-
6hfor3-4d
—hypersensitivitytodrugorclass,
thrombocytopenia,bleedingdisorder,herpeszoster,recent
varicella,pregnancy
MaternalConsiderations
.....
Thereisnopublishedexperiencewith
inpregnancy.
Itismostcommonlyusedforthetreatmentoftesticularcancer.
Sideeffects
includehypocalcemia,hypophosphatemia,leukopenia,
thrombocytopenia,bleeding,renalorhepaticdysfunction,N/V,
anorexia,diarrhea,stomatitis,somnolence,phlebitis,rash,
andflushing.
susceptibility—0.5mlIM
NOTE:avoidIVorintradermaladministration.
—hypersensitivitytoanycomponentof
thevaccine,Hodgkin’sdiseasetreatedwitheither
immunosuppressiveorradiotherapy
MaternalConsiderations
.....
Pneumococcalinfectionisaleadingcauseofdeathandamajor
causeofpneumonia,meningitis,andotitismedia.
isamixtureofhighlypurifiedcapsularpolysaccharides
fromthe23clinicallyrelevantpneumococcaltypesaccounting
foratleast90%ofpneumococcalbloodisolates.Theantibody
inducedbythevaccinemaypersistforaslongas5years.
SusceptiblepatientsatincreasedriskincludeHIV-infectedwomen.
Sideeffects
includelocalinjectionsitesoreness,erythemaand
swelling,rash,urticaria,arthritis,arthralgia,serumsickness,
adenitis,andfever.
Genitalorperianalwarts—applytopicallybid
3d;repeatweekly
forupto4w
—hypersensitivitytodrugorclass
MaternalConsiderations
.....
isrelatedto
podophyllumresin.
Therearenoadequate
reportsorwell-controlledstudiesinpregnantwomen.Toxicity
withoveruseisreported,butsystemicabsorptionofdosesupto
1.5mlislow.
shouldnotbeusedtotreatlargelesions
duringpregnancy.Thoughaneffectiveagent,thereareother
therapies,suchaslaserandcryotherapy,thatposefewerrisks.
Sideeffects
includeburningandinflammation.
Condylomataacuminata—applyqwforupto3w
MaternalConsiderations
.....
Podophyllumresin
isamixtureofresinsfromthemandrake
(PodophyllumpeltatumLinne
aperennialplantofthenorthern
andmiddleUS.ItismadeexclusivelyfromAmerican
podophyllin,whichhasalowerlevelofpodophyllotoxinthan
theIndianresin.Therearenoadequatereportsorwell-controlled
studiesinpregnantwomen.Thoughsystemicabsorptionofdoses
upto1.5mlislow,toxicityisreportedwithoveruse.Thus,
podophyllumresin
shouldnotbeusedduringpregnancyfor
largelesions.Thoughaneffectiveagent,thereareothertherapies,
suchaslaserandcryotherapy,thatposefewerrisks.
Sideeffects
includeparesthesia,polyneuritis,paralyticileus,
pyrexia,leukopenia,thrombocytopenia,coma,anddeath.
Poliovirussusceptibility,adult—1vialIMinthedeltoid;repeat1-
2molaterandagainin6-12mo
—hypersensitivitytodrugorclass;
hypersensitivityto
neomycin,streptomycin,
andpolymyxinB;
acutefebrileillness
MaternalConsiderations
.....
Inactivatedpoliovirusvaccine
isasterilesuspensionofthreetypes
.........................
Activeimmunization
DosagewithQualifiers
.......
Poliovirus1-3susceptibilityinadults—0.5mlPOrepeated8w
later,witha3rddose6-12moafterthe2nd
—hypersensitivitytodrugorclass;
hypersensitivityto
neomycin,streptomycin,
andpolymyxinB;
immunedeficiencystatesoralteredimmunityduetodisease
ortherapy;acutefebrileillness
MaternalConsiderations
.....
Oralpoliovirusvaccine
isalive,trivalentmixtureofthreetypes
ofattenuatedpoliovirusesgrowninmonkeykidneycellculture.
Oralpoliovirusvaccine
simulatesnaturalinfection,inducing
activemucosalandsystemicimmunitywithoutproducing
symptomsofdisease.Routineprimarypoliovirusvaccinationof
adults(
18y)livingintheUSisnotrecommended.Adultswho
areatincreasedriskofexposureandwhohavenotbeen
adequatelyimmunizedshouldreceivepoliovirusvaccination.This
groupincludestravelerstoregionswherepoliomyelitisisendemic
orepidemic,healthcareworkersinclosecontactwithpatients
Constipation—17gPOqdforupto2w
—hypersensitivitytodrugorclass,bowel
MaternalConsiderations
.....
Thereislittleifanysystemicabsorptionof
DosagewithQualifiers
.......
Ophthalmicinfection—1gteacheyeq3h
7d;max6doses/d
—hypersensitivitytodrugorclass
MaternalConsiderations
.....
Therearenoadequatereportsorwell-controlledstudiesof
Hypertension—1tabPObidortid,beginningintheevening
—hypersensitivitytodrugorclass,anuria,
hypersensitivitytosulfonamides
MaternalConsiderations
.....
Therearenoadequatereportsorwell-controlledstudiesof
inpregnantwomen.(See
Sideeffects
include1st-dosehypotensionand/orsyncope,
orthostatichypotension,dizziness,headache,somnolence,
weakness,palpitations,nausea,paresthesias,tinnitus,abdominal
pain,arthralgia,myalgia,andpruritus.
Hypokalemiatreatment—400mEqPOqdifK
10-20mEq/hPOifECGchanges
Hypokalemiaprophylaxis—begin20mEqPOqd,adjustasneeded
—hypersensitivitytodrugorclass,untreated
Addison’sdisease,hyperkalemia,renalfailure
—renaldysfunction,CVdisease
MaternalConsiderations
.....
Therearenoadequatereportsorwell-controlledstudiesof
potassiumchloride
inpregnantwomen.Themostcommoncause
ofhypokalemiaduringpregnancyistheadministrationof
Sideeffects
includearrhythmia,dyspepsia,N/V,diarrhea,rash,
andbleeding.
Thyrotoxicosis—50-250mgPOtid
Preoperativethyroidectomy—50-250mgPOtidbeginning10-14d
beforesurgery
Expectorant—50-250mgPOtid;max500mg/dose
Radiationexposure—130mg/difexpectedexposure
continueuntilriskofexposurehaspassed
—hypersensitivitytodrugorclass,
Organophosphatepoisoning—1-2gIVover15-30min;mayrepeat
in1hifclinicallyindicated
Anticholinesteraseoverdose—1-2gIVover15-30min
—hypersensitivitytodrugorclass
—myastheniagravis,renaldysfunction
MaternalConsiderations
.....
Therearenoadequatereportsorwell-controlledstudiesof
inpregnantwomen.Thepublishedexperienceis
limitedtocasereports.
Sideeffects
includetransientneuromuscularblockade,
laryngospasm,musclerigidity,blurredvision,diplopia,dizziness,
headache,N/V,hypertension,tachycardia,maculopapularrash,
andelevatedLFTs.
However,consideringtheindicationanddosing,one-time
useisunlikelytoposeaclinicallysignificantrisk
tothebreastfeedingneonate.
DrugInteractions
................
Signsofatropinization(flushing,mydriasis,tachycardia,dryness
ofthemouthandnose)mayoccurearlierthanmightbeexpected
whenusedwith
Thisisespeciallytrueifthetotaldose
islargeandtheadministrationof
.........................
BaileyB.AnnEmergMed1997;29:299.
...........................
PregnancyCategory:C
LactationCategory:U
shouldbeusedduringpregnancyandlactation
onlyifthebenefitjustifiesthepotentialperinatalrisk.
—(Mirapex;Sifrol)
InternationalBrandName—
Pexola(Colombia);Sifrol(Israel)
DrugClass
..........................
Antiparkinsonagents;Dopaminergics
.........................
.........................
Nonergotdopaminereceptoragonist
DosagewithQualifiers
.......
RestlessLegSyndrome—begin0.125mgqhsPO;increaseq4-7d
withamaxdoseof0.75mg
Parkinsonism—begin0.125mgPOtid;increaseby0.25mg/d
NOTE:renaldosing.
—hypersensitivitytodrugorclass
—renaldysfunction
MaternalConsiderations
.....
clearanceis30%lowerinwomenthanmen;most
ofthisdifferencereflectsbodyweight.Thepublishedexperience
duringpregnancyislimitedtotwocasereports.
Sideeffects
includehallucinations,orthostatichypotension,
dyskinesia,asthenia,dizziness,insomnia,somnolence,peripheral
edema,drymouth,headache,anorexia,andvisualabnormalities.
byabout20%.Inonestudy,
Hypercholesterolemia—begin40mg/d;max80mg/d
NOTE:renalandhepaticdosing;monitorhepatictransaminasesat
baselineandeitherq3moorpriortoincreasingdose.
—hypersensitivitytodrugorclass,active
liverdisease
—alcoholabuse,hepaticorrenaldysfunction
MaternalConsiderations
.....
lowerslipidsintwoways.First,itmodestlyreduces
theintracellularpoolofcholesterolbythereversibleinhibitionof
HMG-CoAreductase,increasingthenumberofLDLreceptorson
cellsurfacesandenhancingreceptor-mediatedcatabolismand
clearanceofcirculatingLDL.Second,
inhibitsLDL
productionbyinhibitinghepaticsynthesisofVLDL,theLDL
precursor.Therearenoadequatereportsorwell-controlled
studiesinpregnantwomen.Atherosclerosisisachronicprocess;
discontinuationof
duringpregnancyshouldhave
littleimpactonlong-termmaternaloutcome.
Sideeffects
includerhabdomyolysis,hepatotoxicity,cholelithiasis,
dyspepsia,abdominalpain,flatulence,constipation,rash,myalgia,
asthenia,andelevatedCPKorLFTs.
InternationalBrandName—
Biltricide(Australia,Canada,France,Germany,HongKong,Japan,
Schistosomiasis—20mg/kgPOq4-6h
Tapeworms—5-25mg/kgPO
Liverflukes—25mg/kgPOq4-6h
—hypersensitivitytodrugorclass,ocular
schistosomiasisorcysticercosis
—hepaticdysfunction
MaternalConsiderations
.....
Schistosomiasisaffectsapproximately40millionwomenof
MonteroR,OstroskyP.MutatRes1997;387:123-39.
Hypertension—begin1mgPObid;usualdose3-20mg/d
—hypersensitivitytodrugorclass
—hepaticorrenaldysfunction
MaternalConsiderations
.....
Unlikemanyotherantihypertensivedrugs,theeffectof
iscloselyrelatedtoitsplasmaconcentration.TheT
increasedanditseliminationt/2prolongedduringpregnancy.
isasecondaryagentforthetreatmentofpreeclamptic
hypertension.Whileaseffectiveas
theassociated
.........................
Steroid-responsivedermatitis—applybid
—hypersensitivitytodrugorclass
—avoidprolongeduseonface,groin,axilla,or
skincreases
MaternalConsiderations
.....
(0.1%)doesnotsuppresstheHPA-axisifusedat
30g/dfor1w.Therearenopublishedstudiesinpregnantwomen.
Sideeffects
includepruritus,skinatrophy,andacne.
—(Adnisolone;Cortalone;Delta-Cortef;
Orapred;Prelone;Ultracortenol)
InternationalBrandName—
Adelcort(Greece);Aprednislon(Austria);Capsoid(SouthAfrica);Compresolon
(Taiwan);DacortinH(Spain);Decaprednil(Germany);DecortinH(Bulgaria);Deltacortril(Belgium,England,Germany,
Ireland,RepublicofYemen,Syria,UnitedArabEmirates);Deltastab(England,Ireland);Dermosolon(Germany);
Dhasolone(Malaysia);Di-Adreson-F(HongKong,Hungary,Thailand);Hefasolon(Germany);HostacortinH(Korea);
Inflammatorydisorders—5-60mg/dPO/IV/IM,maygivein
divideddoses
RelapsingMS—begin200mgPOqd
1w,then80mgPO
Asthma(acute)—begin120-180mg/dPO/IV/IMin3-4divided
doses,then60-80mg/dPO/IV/IMforsevereexacerbations
Asthma(persistentsevere)—7.5-80mgPOqdorqod,taperslowly
Adrenalinsufficiency—4-5mg/m
POqd
Onestudyof
placentaltransfernotedthesame
F:Mof0.10.
isoftenusedassalvagetherapyforthe
Mayincreasebloodglucoseconcentration,necessitatingadose
adjustmentofhypoglycemicagents.
.........................
Inflammatorydisorders(e.g.,Crohn’sdisease)—5-60mgPOqd
RelapsingMS—begin200mgPOqd
1w,then80mgPOqod
pneumonia—begin40mgPObid
5d,then40mg
5d,then20mgqd
Adrenalinsufficiency—4-5mg/m
POqd
—hypersensitivitytodrugorclass,systemic
fungalinfection
MaternalConsiderations
.....
Therearenoadequatereportsorwell-controlledstudiesof
inpregnantwomen.Crohn’sdiseaseandother
chronicinflammatorydiseasesoftenaffectreproductive-age
women.TheavailabledatashowthatwomenwithCrohn’s
diseasecanexpecttoconceivesuccessfully,carrytoterm,and
deliverahealthybaby.Controlofdiseaseactivitybefore
conceptionandduringpregnancyiscriticaltooptimizeboth
Mayincreasetheclearanceofchronichigh-dose
todecreasedserumsalicylatelevelsoranincreasedriskof
salicylatetoxicitywhenthecorticosteroidiswithdrawn.
shouldbeusedcautiouslyinconjunctionwithcorticosteroidsin
patientssufferingfromhypoprothrombinemia.
Theeffectonoralanticoagulantsisvariable.Therearereportsof
enhancedaswellasdiminishedeffectsofanticoagulantswhen
givenconcurrentlywithcorticosteroids.Thus,coagulationindices
shouldbemonitoredclosely.
.........................
Dentalnerveblock—1-2mlinfiltratedintheanatomicallycorrect
zone;max600mg/24h
doublevision,vomiting,twitching,tremors,convulsions,
unconsciousness,respiratorydepressionorarrest,vasovagal
reaction,andsensationsofheat,cold,ornumbness.
Malaria—1tab(15mg)POqd
PCP—1-2tabs(15-30mg)POqdincombinationwith
—hypersensitivitytodrugorclass,bone
marrowsuppression,rheumatoidarthritis,SLE,recent
quinacrineuse
—G6PDdeficiency,favism
MaternalConsiderations
.....
Therearenoadequatereportsorwell-controlledstudiesin
pregnantwomen.
ismainlyusedtotreat
P.vivax
P.ovale
malaria.Oncetheparasitehasbeen
eliminatedfromthebloodstream,theremaininghypnozoites
mustberemovedfromtheliverbyadministeringa14dcourse
(theso-calledradicalcure).
consideredbysometobecontraindicatedinpregnancysincethe
.........................
DosagewithQualifiers
.......
Seizuredisorder—begin100-125mgPOqhs
3d,then
100-125mgPObid
3d,then250mgPOtidorqid;max2g/d
Essentialtremor—begin12.5-25mgPOqhs,increase12.5-25mg/d
qw;max750mg/d
NOTE:renaldosing.
—hypersensitivitytodrugorclass,porphyria
MaternalConsiderations
.....
Adjuncttopenicillintherapy—500mgPOqid
Gout—begin250mgPObid
7d;max2-3g/d
—hypersensitivitytodrugorclass,CrCl
50ml/h,uratestones,acutegout
—hypersensitivitytosulfadrugs,pepticulcerdisease,
renaldysfunction
MaternalConsiderations
.....
isusedduringpregnancywithapenicillinalmost
exclusivelyforthetreatmentofSTDs.
Sideeffects
includehemolyticanemia,aplasticanemia,hepatic
necrosis,headache,dizziness,anorexia,N/V,soregums,nephrotic
syndrome,renalcolic,dermatitis,pruritus,flushing,fever,and
exacerbationofgout.
Hyperlipidemia—500mgPObid
NOTE:donotbeginifQTintervalexceedsrate-dependent
guideline;anyhypomagnesemia,hypokalemia,orseverebradycardia
shouldberesolvedbeforeinitiating.
—hypersensitivitytodrugorclass,recent
orprogressivemyocardialdamage,prolongedQTinterval
syndrome,ventriculararrhythmia
MaternalConsiderations
.....
—(Biocoryl;Procanbid;ProcanSR;Promine;
Pronestyl;Ritmocam)
InternationalBrandName—
Amisalin(Taiwan);Biocoryl(Spain);Cardiorytmin(Finland);Gima(Indonesia);
Atrialorventriculararrhythmia—100mgIVover5min,repeatup
to500mgthenwait
10minbeforerestartinginfusion;
alternatively,15-17mg/kgIVover30-60minuntileitherQRS
widens50%orabnormalityresolves,then1-6mg/minIV;
max1.5gload,9g/dmaintenance
NOTE:renaldosing;therapeuticlevels=4-10mcg/ml,or10-30mcg/
+NAPA.
—hypersensitivitytodrugorclass,
2ndor3rddegreeAVblock,myastheniagravis,SLE,torsades
depointes
—bonemarrowdepression,CHF,renaldysfunction
MaternalConsiderations
.....
Therearenoadequatereportsorwell-controlledstudiesin
pregnantwomen.
iswelltolerated,andisa
first-lineagentforthetreatmentofacute,undiagnosed,
wide-complextachycardia.Itmaybeusedaloneorin
combinationwith
AllclassIAagentsshouldbe
administeredinthehospitalundercontinuouscardiac
monitoringduetothepotentialriskofventriculararrhythmia.
Electricalcardioversionisnecessaryinallpatientswhoare
hemodynamicallyunstablewithlife-threateningventricular
tachyarrhythmias.Inhemodynamicallystablepatients,initial
therapywithajmaline,
isindicated.
Sideeffects
includeasystole,VF,seizures,lupus-likesyndrome,
hemolyticanemia,neutropenia,thrombocytopenia,
agranulocytosis,hypotension,bradycardia,flushing,urticaria,
pruritus,angioedema,rash,fever,N/V,bittertaste,hallucinations,
confusion,depression,diarrhea,dizziness,andelevatedLFTs.
Anticholinergicdrugsmayproduceadditiveantivagaleffectson
AVnodalconduction,althoughthisisnotaswell-documented
asitisforquinidine.
Mayrequirelessneuromuscularblockingagentssuchas
dueto
effectsonreducingACh
.........................
BaileyDN.AnnClinLabSci1999;29:209-12.
DumesicDA,SilvermanNH,TobiasS,GolbusMS.NEnglJMed
1982;307:1128-31.
ItoS,MageeL,SmallhornJ.ClinPerinatol1994;21:543-72.
JoglarJA,PageRL.DrugSaf1999;20:85-94.
Localandregionalanesthesia—dosevaries;max10mg/kg
theindicationanddosing,one-time
useisunlikelyto
poseaclinicallysignificantrisktothebreastfeedingneonate.
DrugInteractions
................
Lymphomas,brainandlungcancers—dosingprotocolsvary
—hypersensitivitytodrugorclass,bone
marrowdepression
—hepaticorrenaldysfunction
MaternalConsiderations
.....
Therearenoadequatereportsorwell-controlledstudiesin
pregnantwomen.
isusuallycombinedwithother
DrugInteractions
................
Noclinicallyrelevantinteractionsidentified.
.........................
AvilesA,NeriN.ClinLymphoma2001;2:173-7.
N/V—5-10mgPO/IMtidorqid,or25mgPRbid,or5-10mgIV
over2min;max40mg/d
Psychosis—5-10mgPOtidorqid;max150mg/d
—hypersensitivitytodrugorclass,CNS
depression,adrenergicblockade,phenothiazineblooddyscrasia
—glaucoma,epilepsy,CVdisease,bonemarrow
MaternalConsiderations
.....
ismostoftenusedfortheshort-timetreatment
ofN/Vandvertigo.Therearenoadequatereportsorwell-
controlledstudiesinpregnantwomen.IntheUK,
isavailableOTCasBuccastemMinbuccal
formforthetreatmentofmigraine.Inthisindicationitblocks
thechemoreceptortriggerzoneinthebrainthatisresponsiblefor
causingsevereN/V.ItsOTCuseisrestrictedtoamaximumof
2dbecauseofthepotentiallyseveresideeffectsof
Longclinicalexperienceindicatesefficacyfor
thetreatmentofhyperemesiswhencombinedwithhydrationand
(10mgIV)issuperiorto
(10mgIV)forthereliefofacutemigraineheadache.However,
theoralcombinationof
dyskinesia,neurolepticmalignantsyndrome,hepatotoxicity,
leukopenia,drowsiness,amenorrhea,blurredvision,rash,orthostatic
hypotension,jaundice,drymouth,constipation,photosensitivity,
anxiety,oculogyriccrisis,andextrapyramidaleffects.
Parkinson’sdisease—2.5mgPOtid;increaseslowlyto5mgPOtid
—hypersensitivitytodrugorclass,
angle-closureglaucoma
MaternalConsiderations
.....
Thereisnopublishedexperiencewith
inpregnancy.
Sideeffects
includedrynessofthemouth,mydriasis,blurringof
vision,giddiness,light-headedness,andGIdisturbancessuchas
N/V,epigastricdistress,andconstipation.
...........................
PregnancyCategory:C
LactationCategory:U
shouldbeusedduringpregnancyandlactation
onlyifthebenefitjustifiesthepotentialperinatalrisk.
—(Crinone;Gesterol50;Lutolin-S;
Amenorrhea—400mgPOqd
Secondaryamenorrhea—1applicator4%PVqod
Hormonereplacement—200mgPOgiveneachdaywithestrogen
Infertility,progesteronedeficiency—1applicator8%PVqd;
continuethrough10-12wofpregnancy
Infertility,ovarianfailure—1applicator8%PVbid
conclusion.However,inasecondaryanalysis,theseinvestigators
didfindasignificantreductionintheincidenceofidiopathic
—(Liranol;Prazine;Primazine;Protactyl;
Prozine-50;Savamine;Sparine;Talofen)
InternationalBrandName—
Noneidentified.
DrugClass
..........................
Antipsychotics;Phenothiazines
.........................
Psychoticdisorders
.........................
DosagewithQualifiers
.......
Psychoticdisorders—begin50-150mgIM;upto300mgadditional
maybegivenafter30mintoachievedesiredeffect;thereafter,10-
200mgPOq4-6h
NOTE:doseandroutedictatedbyseverityofthecondition;
IMpreferred.
—hypersensitivitytodrugorclass,
drug-inducedCNSdepression,intra-arterialinjection,bone
marrowsuppression
—atherosclerosis,severehypotension,abruptcessation
MaternalConsiderations
.....
isaprototypephenothiazineusedwithvariable
successforthetreatmentofdepressiveneurosis,alcohol
...........................
PregnancyCategory:C
LactationCategory:U
shouldbeusedduringpregnancyandlactation
onlyifthebenefitjustifiesthepotentialperinatalrisk.
N/V—12.5-25mgPO/PR/IMq4-6hprn
Motionsickness—25mgPObid
Sedation—25-50mgPO/PR/IMq4-6hprn
Allergicrhinitis—12.5-25mgPOq6h,or25mgPOqhs
NOTE:maybecombinedwith
—hypersensitivitytodrugorclass,
narrow-angleglaucoma
—seizuredisorder,asthma,hepaticdysfunction,bone
marrowsuppression
MaternalConsiderations
.....
developmentinonestudy.Transportacrossthemouseplacenta
islimited.Rodentstudiesarereassuring,revealingnoevidenceof
teratogenicityorIUGRdespitetheuseofdoseshigherthanthose
usedclinically.Arecentepidemiologicalstudyfoundnoadverse
outcomesafteranattemptedsuicidewith
—(Arythmol;Norfenon;Normorytmin;
Rythmol;Rytmonorm)
InternationalBrandName—
Arythmol(England,Ireland);Jutanorm(Germany);Nistaken(Mexico);Norfenon
(Mexico);Normorytmin(Argentina);Profex(Israel);Pronon(Japan);Ritmocor(Chile);Ritmonorm(Brazil,Paraguay);
Rythmex(Israel);Rythmol(Canada,France,SouthAfrica);Rytmocard(Philippines);Rytmogenat(Germany);
Rytmonorm(Belgium,Bulgaria,China,Colombia,CostaRica,CzechRepublic,Denmark,DominicanRepublic,
ElSalvador,Finland,Germany,Greece,Guatemala,Honduras,HongKong,Hungary,Indonesia,Italy,Jordan,Korea,
Ventriculararrhythmia—150mgPOq8h;mayincreaseover3-4d
toamaxof900mg/d
—hypersensitivitytodrugorclass,CHF,
bradycardia,SAorAVconductiondefects,severehypotension,
bronchospasm,electrolyteimbalances
MaternalConsiderations
.....
Therearenoadequatereportsorwell-controlledstudiesof
inpregnantwomen.Thepublishedexperienceis
confinedtocasereports.
Sideeffects
includeCHF,ventriculararrhythmia,N/V,dizziness,
constipation,tastechange,dyspnea,fatigue,headache,blurred
vision,palpitations,rash,angina,drymouth,andsyncope.
Similarobservationshavebeenreportedwith
Pepticulcer—begin15mgPOqac,30mgqhs;max60mgPOqid
—hypersensitivitytodrugorclass,bowel
obstruction,myastheniagravis,angle-closureglaucoma,
bleeding,refluxesophagitis
—CAD,ulcerativecolitis
MaternalConsiderations
.....
Thereisnopublishedexperiencewith
propantheline
inpregnancy.
Sideeffects
includedrymouth,blurredvision,confusion,
palpitations,headache,orthostatichypotension,insomnia,
somnolence,tachycardia,mydriasis,cycloplegia,constipation,
nausea,bloating,urticaria,anhidrosis,andrespiratorydistress.
Anesthesiainduction—dosevarieswidelydependingonpatient
health;typically2-2.5mg/kgIVadministeredas40mgq10secuntil
desiredeffect
Anesthesiamaintenance—dosevarieswidelydependingonpatient
health;typically0.1-0.4mg/kg/minIVdependingonuseofINH
Sedationforventilatedpatients—begin5mcg/kg/minIV,
thenincreaseby5-10mcg/kg/minq5-10minuntildesiredeffect
—hypersensitivitytodrugorclass,allergyto
eithersoybean,egglecithin,orglycerol
Mildtomoderatepain—65mgPOq4hprn;max390mg/d
NOTE:oftencombinedwithoneofseveralanalgesicand
antihistaminiccompounds.
—hypersensitivitytodrugorclass
—historyofsubstanceabuse,depression,suicidal
ideation,hepaticorrenaldysfunction
MaternalConsiderations
.....
isanarcotic,anditscombinationwithotherCNS
depressantssuchasalcoholhasanadditiveeffect.Thereareno
adequatereportsorwell-controlledstudiesinpregnantwomen.
combinationsoffernoclinicaladvantageover
NSAIDsforthetreatmentofepisiotomypain.
Sideeffects
includerespiratorydepression,dependency,
somnolence,dizziness,hallucinations,dysphoria,constipation,
hepaticdysfunction,andpainfulmyopathy.
thatdrug.Suchoccurrenceshavebeenreportedwith
antidepressants,anticonvulsants,and
-likedrugs.Several
neurologicsigns,includingcoma,haveoccurredwithconcurrent
useof
.........................
BloomfieldSS,BardenTP,MitchellJ.ClinPharmacolTher1980;
GoldenNL,KingKC,SokolRJ.ClinPediatr1982;21:752-4.
Hypertension—begin40mgPObid,increasingq3-7d;max
Migraineheadacheprophylaxis—begin20mgPOqd;increase
graduallyto40-60mgPOqid
SVT—begin1-3mgIVat1mg/min;mayrepeat2minlater;if
control,then10-30mgPOtidorqidbeginning4hlater
Angina—80-120mgPObid;mayincreaseq7-10d
—hypersensitivitytodrugorclass,asthma,
CHF,cardiogenicshock,2ndor3rddegreeheartblock,severe
sinusbradycardia
(2mgIV)tonulliparaswhorequire
augmentationfordysfunctionallaborreducesthelikelihoodofa
cesareandeliverybyalmost
.Thestudiesof
asan
oralhypotensivearesmall.Itappearsaseffectiveas
NSAIDsblunttheantihypertensiveeffect.
Mayincreasetheconcentrationof
MonitorthePT
Aluminumhydroxide
gelgreatlyreducesintestinalabsorption.
Hyperthyroidism(Graves’disease)—begin100-125mgPOtid;
200-300mgPOqidifthyroidstorm
NOTE:renaldosing.
—hypersensitivitytodrugorclass
—pregnancy,renaldysfunction,concurrenthepatotoxic
oragranulocytosisagents,bonemarrowsuppression
MaternalConsiderations
.....
Hyperthyroidismoccursinapproximately1inevery1000-2000
historicallywastheagentofchoice
forthetreatmentofGraves’diseaseduringpregnancybecauseit
adequatereportsorwell-controlledstudiesinpregnantwomen.
InternationalBrandName—
Noneidentified.
DrugClass
..........................
Antidotes,bleedingdisorders
.........................
Heparinreversal
.........................
Bindsheparin
DosagewithQualifiers
.......
Heparinreversal—1-1.5mgIVper100U
estimatedto
remaininthebody:if0-30minfromlastdose,give1-1.5mg/
100U;if30-60min,give0.5-0.75mg/100U;if
2h,give
NOTE:monitorBP,ECG,andaPTTduringreversal.
—hypersensitivitytodrugorclass
—fishallergyorpriorexposuretovariousprotamine
MaternalConsiderations
.....
Therearenoadequatereportsorwell-controlledstudiesof
inpregnantwomen.Casereportsnoteacute
hypotension,bradycardia,andanaphylacticreactions.
doesnotreverseanticoagulationsecondarytotheLMWHs.
Sideeffects
includeanaphylaxis,bronchospasm,fatigue,
angioedema,circulatorycollapse(duetosuddenpulmonary
hypertension,rightventricularthenbiventricularfailurefollowed
bycirculatorycollapse),bradycardia,bleeding,paradoxical
hemorrhage,leukopenia,thrombocytopenia,dyspnea,flushing,
urticaria,andN/V.
—(Concordin;Triptil;Vivactil)
InternationalBrandName—
Noneidentified.
DrugClass
..........................
Antidepressants;Tricyclics
.........................
.........................
Unknown;inhibitsNEandserotoninreuptake
DosagewithQualifiers
.......
Depression—5-10mgPOtidorqid;max60mg/d
—hypersensitivitytodrugorclass,SSRIuse
—hyperthyroidism,epilepsy,CAD
MaternalConsiderations
.....
Therearenopublishedreportsof
useinpregnancy.
Sideeffects
includeMI,AVblock,arrhythmia,stroke,seizures,
.........................
Nasaldecongestion—30-60mgPOq4-6hprn;max240mg/d
NOTE:availableinasustained-releaseform,andincombination
witheithertheantihistaminetriprolidine(Actifed)or
—hypersensitivitytodrugorclass,MAOI
14d,narrow-angleglaucoma,severehypertension,severe
consideranotherdecongestant.Inthissamestudy,neonatal
ingestionwasquantifiedastheproductofaveragesteady-state
drugconcentrationinmilk,withanestimatedmilkproduction
rateof0.15L/kg/d,andexpressedrelativetothematernal
weight-adjusteddose.Assumingmaternaldoseof60mg
POqid,theestimatedinfantdosewas
5%oftheweight-adjustedmaternaldose.
DrugInteractions
................
EffectsareincreasedbyMAOIsand
Mayreducetheantihypertensiveeffectsof
Constipation—1-2tspPOdissolvedinwaterorjuiceqdtotid
—hypersensitivitytodrugorclass,suspected
appendicitis,intestinalobstruction
MaternalConsiderations
.....
Therearenoadequatereportsorwell-controlledstudiesin
pregnantwomen.
isnotabsorbedsystemically.
Sideeffects
includeesophagealobstruction,bowelobstruction,
constipation,diarrhea,abdominalcramps,bronchospasm,rhinitis,
andconjunctivitis.
Pinworm—11mg/kgPOqd
1d;maytakewithmilkorjuice,
treatallfamilymembers
Roundworm—11mg/kgPOqd
1d;maytakewithmilkorjuice
Hookworm—11mg/kgPOqd
3d;maytakewithmilkorjuice
Whipworm—11mg/kgPOqd
1d;maytakewithmilkorjuice
—hypersensitivitytodrugorclass
—hepaticdysfunction,malnutrition
MaternalConsiderations
.....
Therearenopublishedreportsof
pyrantelpamoate
usein
Sideeffects
includeanorexia,N/V,abdominalcramps,diarrhea,
dizziness,drowsiness,insomnia,tenesmus,rash,weakness,and
elevatedhepatictransaminases.
InternationalBrandName—
TB,adjuvant—15-30mg/kgPOqdgivenaspartofamultidrug
regimen;max3g/d
—hypersensitivitytodrugorclass,severe
hepaticdysfunction
InternationalBrandName—
Kalymin(Germany)
DrugClass
..........................
Myastheniagravis—begin60mgPOq8h,individualizingto
responseandsideeffects;max1500mg/d
—hypersensitivitytodrugorclass,
mechanicalGIobstruction
—asthma,pepticulcerdisease,arrhythmia,
bradycardia,seizures,renaldysfunction
MaternalConsiderations
.....
Therearenoadequatereportsorwell-controlledstudiesof
inpregnantwomen.Thepublishedliterature
consistsofsmallseriesandcasereports.
Sideeffects
includebronchospasm,bradycardia,hypertension,
cholinergiccrisis,paralysis,AVblock,arrhythmia,cardiacor
respiratoryarrest,N/V,diarrhea,dyspepsia,abdominalpain,
Morningsickness—10mgPObidortid
Pyridoxinedeficiency—10-20mgPO/IM/IVqd
3w,then
2-5mg/dPO
Pyridoxinesupplementation—2-5mgPOqd
—40-500mgPOqd
Isoniazidadjunct—25-50mgPOqdtopreventassociated
NOTE:availableinsomeareascombinedwithdoxylamine(Diclectin)
forthetreatmentofN/Vduringpregnancy;antagonizes
levodopa.
—hypersensitivitytodrugorclass,
MaternalConsiderations
.....
isacoenzymeforseveralaminoaciddecarboxylases
andtransaminases.ItreducesN/Vofpregnancy,butdoesnot
reducethesideeffectsassociatedwithoralcontraceptiveuse.
Recentstudysuggeststhepreemptiveuseof
earlyin
gestationdecreasestheprevalenceofsevereN/Vinat-risk
women.Italsoappearseffectiveinreducingpostoperativenausea
afterlaparoscopy.
isusedincombinationwith
antituberculosistherapytoreducetheriskofneuropathy.There
isnotenoughevidencetoconfirmclinicalbenefitsofroutine
supplementationduringpregnancyotherthanonetrialsuggesting
protectionagainstdentaldecay.
Sideeffects
includenumbness,unsteadygait,andparesthesias.
Malariatreatment—50mgPOqd
2wincombinationwith
usein
-resistantareas
Malariaprophylaxis—25mgPOqw
10wafterexposure;usein
-resistantareas
Toxoplasmosis—begin50-75mgPOqd
1-3w,then25-50mgPO
4-5wincombinationwithsulfadoxineandfolinicacid
ToxoplasmosiswithHIV—begin200mgPO
1,then50-100mg
POqd
4-8w,thenmaintenance
Isosporiasis—50-75mgPOqd
NOTE:maybecombinedwithsulfadoxine(Fansidar).
—hypersensitivitytodrugorclass,folate
—hepaticorrenaldysfunction,G6PDdeficiency
MaternalConsiderations
.....
Severeanemiaisacauseofmaternalmorbidityinendemicareas,
andtreatmentleadstoresolution.HIVinfectionduring
pregnancyisassociatedwithanincreasedriskofmalaria.
ofpregnantwomen(incombinationwithsulfadoxine)in
malaria-endemicareasiscost-effective,reducingtheriskof
prematurityandIUGRsecondarytoplacentalmalaria.Inrodents,
Psychosis—begin25mgPObid,increaseby25-50mg/dose
q1-2d;max800mg/d
NOTE:hepaticdosing.
—hypersensitivitytodrugorclass
—hepaticdysfunction,cardiacdisease,CVD,seizures,
hypotension,hypovolemia
MaternalConsiderations
.....
(500mgbid)increasedthemeanplasma
concentrationof
Hypertension—begin10mgPOqd,adjustforeffectq2wmoving
tobidifnecessary;max80mg/d
CHF—begin5mgPOqd,adjustweeklyforeffect,movingtobid;
max40mg/d
NOTE:renaldosing.
Contraindications
—hypersensitivitytodrugorclass,angioedema
—renaldysfunction,renalarterystenosis,collagen
vasculardisease,hyponatremia,hypovolemia
MaternalConsiderations
.....
Therearenoadequatereportsorwell-controlledstudiesof
inpregnantwomen.Ingeneral,ACEIsshouldbe
avoidedduringpregnancy.Thelowesteffectivedoseshouldbe
usedwhen
isrequiredforBPcontrolduringpregnancy.
Sideeffects
includeangioedema,hypotension,renalfailure,
cough,dizziness,fatigue,N/V,URIsymptoms,myalgia,
arthralgia,hyperkalemia,neutropenia,agranulocytosis,and
elevatedBUN/Cr.
andotherACEIsshouldbeavoidedduring
pregnancyifpossible.
Whenmother’sdiseaserequirestreatmentwith
thelowestdosesshouldbeusedfollowedbyclosemonitoring
Atrialfibrillation—324-648mgPOq8-12h(gluconate),200-300mg
POq4-6h(sulfate);adjusttotherapeuticlevelof2-6mcg/ml
Ventriculararrhythmia—324-648mgPOq8-12h(gluconate),200-
300mgPOq4-6h(sulfate);adjusttotherapeuticlevelof
SVT—324-648mgPOq8-12h(gluconate),200-300mgPOq4-6h
(sulfate);adjusttotherapeuticlevelof2-6mcg/ml
Life-threateningmalaria—15mg/kgsulfate(or24mg/kggluconate)
in250ml0.9NSover4h,then7.5mg/kgsulfate(or12mg/kg
gluconate)8haftertheloadgivenover4hq8h
—hypersensitivitytodrugorclass,
Malaria—650mgPOq8h
NOTE:usewithotherantimalarialagents.
—hypersensitivitytodrug,class,or
G6PDdeficiency,opticneuritis,
tinnitus,thrombocytopenicpurpura,hypoglycemia,
myastheniagravis
MaternalConsiderations
.....
Malariaisamajorcauseofmaternal/perinatalmorbidityand
deathinregionsoftheworld.Treatmentdramaticallyreduces
thoserisks.
isusedextensivelyindevelopingcountries
InternationalBrandName—
GERD—20mgPOqdorbid
4-8w;mayrepeatforanadditional
8wifneeded
Erosiveesophagitis—20mgPOqdorbid
4-8w;mayrepeatfor
anadditional8wifneeded
Duodenalulcer—20mgPOqdorbid
4w;mayrepeatforan
additional4wifneeded
.........................
Thereisnopublishedexperienceinpregnancyorduringlactation.
...........................
PregnancyCategory:B
LactationCategory:U
shouldbeusedduringpregnancyandlactation
onlyifthebenefitjustifiesthepotentialperinatalrisk.
Protonpumpinhibitorsareagentsofchoiceforthetreatment
ofGERDinnonpregnantpatients.
Rabiesexposure—20IU/kg(0.133ml/kg)concurrentwiththe
1stvaccinedose;iffeasible,upto
thedoseshouldbe
thoroughlyinfiltratedintheareaofthewoundandtherest
IMinthegluteus
NOTE:mayalsobegivenuptoday7after1stvaccinedose;never
giveinthesamesyringeorsiteasvaccine.
—noneknown
—hypersensitivitytodrugorclass,asthma
MaternalConsiderations
.....
Over50%oftherabiescasesamongAmericansresultfrom
exposuretodogsoutsidetheUS.Preventioniskey.Rabiesis
almostuniversallyfatalonceitoccurs.
Rabiesimmuneglobulin
ispreparedfromtheplasmaofdonorshyperimmunizedwith
rabiesvaccine.
Theproductisstandardizedtoanaverage
potencyof150IU/ml.
Rabiesvaccine
rabiesimmune
shouldbegiventoallsuspectedofrabiesexposure
unlesspreviouslyimmunizedwith
rabiesvaccine
andwith
confirmedadequateantirabiestiters.Ithasbeenusedsuccessfully
withoutcomplicationduringpregnancy.Thereportedadverse
reactionrateissimilarinpregnantandnonpregnantwomen.
Sideeffects
includeinjectionsitereactionandmildfever.
DrugInteractions
................
Repeateddosesof
rabiesimmuneglobulin
shouldnotbe
administeredoncevaccinetreatmenthasbeeninitiatedasthis
couldpreventthefullexpressionofactiveimmunityexpected
fromtherabiesvaccine.
Otherantibodiesinthe
rabiesimmuneglobulin
preparationmay
interferewiththeresponsetolivevaccinessuchasmeasles,mumps,
polio,orrubella.Immunizationwithlivevaccinesshouldnotbe
givenwithin3moafter
rabiesimmuneglobulin
administration.
.........................
ChabalaS,WilliamsM,AmentaR,OgnjanAF.AmJMed1991;
Rabiesexposure,boosterimmunization—1mlIMondays
0,7,21,and28afterexposure
Rabiesexposure,immunization—1mlIMbooster
NOTE:forIMuseonly.
—noneknown
—hypersensitivitytobovinegelatin,chickenprotein,
Thereportedadversereactionrateissimilarinpregnantand
nonpregnantwomen.
Sideeffects
includeanaphylaxis,paralysis,andmuscularsclerosis.
InternationalBrandName—
Bonmax(India);Celvista(Thailand);Evista(HongKong,Indonesia,Israel,
Postmenopausalosteoporosis—60mgPOqd
NOTE:takewithvitaminD(400Uqd)andcalcium.
—hypersensitivitytodrugorclass,
pregnancy,DVT,HRTorOCPuse
MaternalConsiderations
.....
Thedeclineinestrogenafteroophorectomyandmenopause
enhancesboneresorptionandacceleratesboneloss.Osteoporosis
isunderdiagnosedandundertreated.SERMsareanewfamilyof
drugsforthemanagementofestrogen-relatedpathology.
decreasesresorptionofboneandreducesbiochemical
markersofboneturnovertothepremenopausalrange.
Hypertension—begin2.5mgPOqd;max20mgPOqd
Post-MICHF—begin2.5mgPObid
7d,then5mgPObid
CVriskreduction—begin2.5mgPOqd
7d,then10mgPOqd;
indicatedforpatients
55ywitheitherCAD,CVA,orPVDor
Duodenalorgastriculcer—150mgPObid
Erosiveesophagitis—150mgPOqid
GERD—150mgPObid
Dyspepsia—75mgPOqdorbid
NOTE:renaldosing;maybecombinedwith
bismuthsubsalicylate
—hypersensitivitytodrugorclass,porphyria
—hepaticorrenaldysfunction
MaternalConsiderations
.....
PregnantwomenwithsymptomaticGERDshouldbemanaged
Induction—0.5-1mcg/kg/minIV;anesthesiainducedwhengiven
withahypnoticandamusclerelaxanttoavoidchestrigidity
Maintenance—0.05-2mcg/kg/minIV;usuallygivenalongwith
Postoperative—0.025-0.2mcg/kg/minIV
Sedation—0.025-0.2mcg/kg/minIV;usuallygivenwithsedative-
hypnotic(e.g.,
teratogenicityorIUGRdespitetheuseofdoseshigherthanthose
usedclinically.
humanplacenta.Rodentstudiesarereassuring,revealingno
evidenceofteratogenicity.However,anincreasedriskofIUGR
maybesecondarytochronicmaternalhypoglycemia.
—(Reserpaneed;Serpalan;Serpasil;Serpatabs;
Serpate;Serpivite)
InternationalBrandName—
Maviserpin(Mexico);Rauserpine(Taiwan);Rauverid(Philippines);Serpasil
(Canada,Indonesia);Serpasol(Spain)
DrugClass
..........................
Adrenergicantagonists,other;Antihypertensives
.........................
Hypertension,adjunctforpsychosis
.........................
Hypertension—begin0.5mgPOqd
1-2w,then0.1-0.25mg
POqd
Psychiatricdisorders—begin0.5mgPOqd
NOTE:discontinuewithfirstsignsofdepression.
—hypersensitivitytodrugorclass,
depression(especiallywithsuicidaltendencies),activepeptic
ulcer,activeulcerativecolitis,electroconvulsivetherapy
—historyofeitherpepticulcerorulcerativecolitis;
gallstones;renalinsufficiency;anesthesia;useof
orotherantihypertensives
MaternalConsiderations
.....
isapurecrystallinealkaloidofrauwolfia.Itisa
second-lineagentforthetreatmentofhypertension.
isalsousedforthetreatmentofcerebralvasospasm,migraines,
Raynaud’ssyndrome,refractorydepression,tardivedyskinesia,
andthyrotoxiccrisis.Thereisonlylimitedstudyduring
Sideeffects
includeN/V,diarrhea,anorexia,drynessofmouth,
.........................
AcuteMI—10UIVover2min;repeat2nddose30minlaterif
nocomplications
—hypersensitivitytodrugorclass,history
ofstrokeorrecentsurgeryortrauma,activebleeding,
intracranialmass,AVM,aneurysm,severehypertension
MaternalConsiderations
.....
...........................
PregnancyCategory:C
LactationCategory:U
Delivery�12wgestation—300mcgIMwithin72hcovers
transplacentalhemorrhageupto15mlPRBCs
Pregnancytermination(spontaneousoriatrogenic)12w—120-
150mcgIM
Antenatalprophylaxisat28worafterplacentalbleedingor
instrumentation—300mcgIM;repeatforeachbleedingepisode
72hapart
Transfusionaccident—Multiplythevolume(inml)ofRh
bloodadministeredbythehematocritofthedonorunit.This
equalsthevolumeofPRBCstransfused.Dividethevolume(in
ml)ofPRBCsby15toobtainthenumberofvialsorsyringesof
RhIgGtobeadministered.
NOTE:availableasapooledplasmaorengineeredproduct,in
‘‘indicationspecific’’doses.
—hypersensitivitytodrugorclass,Rh
—noneidentified
MaternalConsiderations
.....
Rhalloimmunizationremainsaperinatalhealthproblemevenin
countrieswithadevelopedprogramofprophylaxis.Patientor
medicalerroristhemostcommoncauseoffailedprophylaxis.
Anti-Dhumanimmunoglobulinhasbeeninclinicaluseformore
than30y.Itsassessmentisbasedmoreonexperiencethanon
well-designedcomparativetrials,butisestimatedtohavereduced
perinatalmortalitybyabout10,000cases/yintheUSalone.
CriteriaforanRh-incompatiblepregnancyrequiringtreatment
includes:motherRh
(D)-negative,notpreviouslysensitizedtothe
(D)factor;neonateRh
(D)-positiveanddirectantiglobulin
negative.Itisgenerallyrecommendedthat
(D)immune
shouldbeadministeredtoallnonsensitizedRh
afterspontaneousorinducedabortion,rupturedtubalpregnancy,
chorionicvillussampling,amniocentesis,abdominaltrauma,or
ChronicHCVinfection—400mgPOqamand600mgqpmif
75kg;600mgPObidif
NOTE:maybecombinedwith
interferonalfa-2b
Sideeffects
includehemolyticanemia,thrombocytopenia,
neutropenia,marrowsuppression,MI,suicidalideation,N/V,
InternationalBrandName—
Noneidentified.
DrugClass
..........................
.........................
Replacement,supplementation
.........................
DosagewithQualifiers
.......
Replacement—5-25mgPOqd
Supplementation—1.7mgPOqd(MDR)
—hypersensitivitytodrugorclass
MaternalConsiderations
.....
isanimportantnutrientcontainedinvirtuallyall
multivitaminsupplements.Contrarytoconventionalwisdom,the
maternalconcentrationof
riboflavin
doesnotdeclineduringnormal,
unsupplementedpregnancy.However,maternalsupplementation
doesgeneratesupraphysiologicleve
ls.Epidemiologicstudiessuggest
multivitaminsupplementationdur
ingthepregnancyofHIV-infected
womenimprovesmaternalweightgain.
Sideeffects
includebrightyellowurine.
...........................
PregnancyCategory:A
LactationCategory:S
Thematernalconcentrationof
doesnotchange
duringnormalpregnancy.
Prenatalmultivitaminsupplementssuccessfullyincreasethe
maternalconcentration.
—(Ansamycin;Mycobutin)
InternationalBrandName—
Alfacid(Germany);Ansatidine(France);Ansatipin(Finland,Spain);
Ansatipine(France);Mycobutin(Austria,Belgium,Bulgaria,Canada,England,Germany,HongKong,Hungary,
MACprevention—300mgPOqd
NOTE:renaldosing.
—hypersensitivitytodrugorclass,activeTB
—neutropenia,thrombocytopenia
MaternalConsiderations
.....
isanalternativeto
forthetreatmentof
TBinHIV-infectedwomentakingcertain
Therelateddrug
isknowntoreducetheactivityof
anumberofotherdrugs,includinganalgesics,anticoagulants,
cardiacglycosidepreparations,corticosteroids,
narcotics(including
TB—10-20mg/kgPOqdonanemptystomach(nottoexceed
Meningococcalprophylaxis(nottreatment)—600mgPObid
NOTE:maybecombinedwith
toreducethechanceofa‘chemical’hepatitis.TheCDC
recommendsthateither
streptomycin
Antacidusemayreducetheabsorptionof
Thedaily
doseof
shouldbegivenatleast1hbeforetheantacid.
andcotrimoxazolemayincreasethebloodlevelof
Thepotentialforhepatotoxicityisincreasedwhenusewitheither
Theircombineduseshouldbeavoided.
Monitorthepatientcloselyforhepatotoxicityif
beused.
.........................
BothamleyG.DrugSaf2001;24:553-65.
CentersforDiseaseControlandPrevention.JAMA1993;
TB—begin600mgPOwithfood2
2mo;then600mg
POqw
NOTE:notformonotherapy;takewithmealstoimprove
—hypersensitivitytodrugorclass
—hepaticdysfunction,nephrotoxicdruguse
MaternalConsiderations
.....
issimilarto
buthasamoreconvenient
dosingprotocol.Itmustbetakenintandemwithatleastone
otherantituberculosisdrugtowhichtheisolateissusceptible.
Therearenoadequatereportsorwell-controlledstudiesof
inpregnantwomen.Thepublishedexperienceis
limitedtoisolatedcasereports.
Sideeffects
includethrombocytopenia,neutropenia,leukopenia,
elevatedLFTs,hyperbilirubinemia,proteinuria,hematuria,
pancreatitis,pseudomembranouscolitis,interstitialnephritis,
hepatotoxicity,urinarycasts,rash,pruritus,acne,anorexia,
arthralgia,pain,andN/V.
atdosessimilartohuman,affectingbone,heart,spine,andpalate
(species-dependent).Thereisalsoevidenceofembryotoxicity.
InternationalBrandName—
Noneidentified.
DrugClass
..........................
Neurologics;Neuroprotectives
.........................
.........................
DosagewithQualifiers
.......
ALS—50mgPOq12htakenonanemptystomach
—hypersensitivitytodrugorclass
—hepaticorrenaldysfunction,hypertension,history
ofneutropenia
MaternalConsiderations
.....
ALSisthemostcommonprogressivemotorneurondisease,
InternationalBrandName—
Gabirol(Mexico);Germic(Argentina)
DrugClass
..........................
.........................
InfluenzaAtreatmentandprophylaxis
.........................
DosagewithQualifiers
.......
InfluenzaAtreatment—100mgPObid
Influenzaprophylaxis—100mgPObid
NOTE:renaldosing.
—hypersensitivitytodrugorclass
—hepaticorrenaldysfunction
MaternalConsiderations
.....
Pregnantwomensufferedahighermortalityrateduringthe
influenzapandemicsofthelastcenturyandshouldbe
vaccinatedpriortoeachinfluenzaseason.Prophylaxisisnota
substituteforvaccination,althoughitisanimportantadjunct.
is70-90%effectiveinpreventinginfluenzaA.
Whenusedforprophylaxis,antiviralagentscanpreventillness
whilepermittingsubclinicalinfectionandthegenesisof
protectiveantibodies.
reducesthedurationofthe
...........................
PregnancyCategory:C
LactationCategory:U
shouldbeusedduringpregnancyonlyifthe
benefitjustifiesthepotentialperinatalrisk.
InternationalBrandName—
Actonel(Australia,England,France,Germany,HongKong,Indonesia,
Ireland,Israel,Korea,Malaysia,Philippines,Singapore,Thailand);ActonelOnceAWeek(Israel,SouthAfrica);
Ribastamin(Argentina)
DrugClass
..........................
Postmenopausalosteoporosis—5mgPOwithwaterqd
Steroid-inducedosteoporosis—5mgPOqdwithwaterforwomen
7.5mg/dormore
InternationalBrandName—
Neripros(Indonesia);Noprenia(Indonesia);Riperidon(Korea);Rispen(Korea);
RisperdalConsta(England,Germany,HongKong,Ireland,Israel,NewZealand,Philippines,Thailand);Risperdalconsta
Psychosis—begin1mgPObid;increaseby1-2mg/dqw
NOTE:hepaticandrenaldosing;avoid
-containingproducts
suchascolasandtea.
—hypersensitivitytodrugorclass,
prolongedQTinterval
—hepaticorrenaldysfunction,seizures,cardiacor
cerebrovasculardisease,hypotension,hypovolemia,dehydration,
agentsthatprolongtheQTinterval,aspirationpneumoniarisk
MaternalConsiderations
.....
Therearenoadequatereportsorwell-controlledstudiesof
inpregnantwomen.Thepublishedexperienceis
limitedtoseveralcasereports.
Sideeffects
includeneurolepticmalignantsyndrome,menstrual
irregularities,hypotension,extrapyramidalsigns,tardive
didnotappeartobeaffected.Usewithother
knownenzymeinducers(e.g.,
phenobarbital,phenytoin,
)maycausesimilardecreases,whichcouldlowerthe
therapeuticefficacyof
Patientsshouldbemonitored
closelyduringthefirst4-8w.Ondiscontinuationof
orotherhepaticenzymeinducers,thedoseof
shouldbere-evaluated.
gestationalageatdeliverycomparedtoplacebo.Thoughthefirst
drugapprovedasatocolyticintheUS,itwaswithdrawnfrom
HIVinfection—begin300mgPObid
1d,then400mgPObid
2d,then500mgPObid
1d,then600mgPObid
NOTE:multipledruginteractions,includingantiarrhythmics,
antihistamines,ergotderivatives,GImobilityagents,neuroleptics,
andhypnotics;checkbeforeprescribing.
—hypersensitivitytodrugorclass,use
ofapotentCYP3A4inhibitor
—hepaticdysfunction
MaternalConsiderations
.....
Therearefewwell-controlledstudiesof
inpregnant
women.Publishedcohortstudiesandcasereportsdonotsuggest
anincreasedriskofanadverseoutcomeduringpregnancy.Many
commonlyuseddrugsaltertheclearanceof
Thepatient
shouldbequestionedcloselyaboutconcurrentdrugusebefore
Sideeffects
highdegreeofplasmaproteinbindingandtheirbackward
transportbyP-glycoproteinintheplacenta.Rodentstudiesare
generallyreassuring,revealingnoevidenceofteratogenicityor
IUGRdespitetheuseofdoseshigherthanthoseusedclinically.
Combinationtherapymayenhancetoxicity.Maternaltoxicity
fromhighdosesleadstoembryotoxicity.
Decreasestheconcentrationsof
divalproex,lamotrigine,
Mayincreaseconcentrationsof
bupropion,nefazodone,
andTCAs,requiringadosereductionintheantidepressant.
Mayincrease
levels,necessitatingadosereduction.
Usewith
increasestheplasmaconcentrationsof
Adverseeventsofnausea,dizziness,hypotension,and
syncopehavebeenobserved.Alowerdoseof
beconsidered.
levels,requiringadecreaseddoseof
.........................
Alzheimer’sdementia—begin1.5mgPObid;increasegraduallyby
1.5mg/doseq2wastolerated(6mgPObidmax)
NOTE:takewithfood.
hypersensitivitytodrugorclass,sick
sinussyndrome,bradycardia
asthma,CVdisease,COPD,pepticulcer
MaternalConsiderations
.....
isbelievedtoenhancecholinergicfunctionby
increasingAChconcentrationintheintactcholinergicnerves,
keepingthemfunctionallyintact.Thereisnoevidencethat
altersthecourseoftheunderlyingdisease.
Migraineheadache—5-10mgPO
1,mayrepeatin2h;
max24mg/d
NOTE:max5mg/dose,3doses/24hiftaking
—hypersensitivitytodrugorclass,CAD,MI,
uncontrolledhypertension,5-HT
24h,MAOI
ergotderivative
24h,basilarmigraine,hemiplegicmigraine
—peripheralorcerebrovasculardisease,cardiacrisk
factors,hepaticdysfunction
MaternalConsiderations
.....
Thereisnopublishedexperiencewith
pregnancy.Clearanceisslowerinnonpregnantwomencompared
tomen.
Sideeffects
includeacuteMI,arrhythmia,coronaryspasm,
palpitations,hypertensivecrisis,cerebralhemorrhage,stroke,
bowelorperipheralvascularischemia,angioedema,somnolence,
chestpain,necktightness,dizziness,paresthesias,flushing,N/V,
diarrhea,dyspnea,decreasedmentalacuity,tremor,andeuphoria.
itsuse(i.e.,replacing
)forrapid-sequence
inductionofgeneralanesthesiaforcesareandelivery.
neuromuscularblockademaybeprolongedby
magnesiumsulfate
infusionorinthepostpartumperiod
ifdosingisbasedontotalratherthanleanbodyweight.
Sideeffects
includearrhythmia,bronchospasm,hypotension,
hypertension,andinjectionsitepain.
Recurrentparalysismayoccurwheninjecting
therecoveryfromothermusclerelaxants.
Magnesiumsulfate
administeredforthemanagementof
Dysmenorrhea—50mgPOqdforamaxof5d
Rheumatoidarthritis—begin12.5mgPOqd;max25mg/d
Osteoarthritis—25mg/d;max25mg/d
Mildtomoderatepain—50mgPOqdforamaxof5d
NOTE:hepaticdosing.
—hypersensitivitytodrugorclass,
NSAID-inducedasthmaorurticaria,hepaticfailure,severe
renaldysfunction,aspirintriad
Caution
—GIbleeding,nasalpolyps,hepaticorrenaldysfunction,
CHF,hypertension,ischemicheartdisease,hypovolemia,asthma
MaternalConsiderations
.....
Sideeffects
includeGIbleedingorulcer,esophagitis,
bronchospasm,hypertension,CHF,MI,hepatotoxicity,renal
failure,renalpapillarynecrosis,anemia,blooddyscrasias,
epigastricpain,N/V,edema,dyspepsia,fatigue,anddizziness.
Healthcarepractitionersareurgedtoreportanyprenatal
exposureto
bycallingthemanufacturer’sPregnancy
Registry(1-800-986-8999).
Parkinson’sdisease—begin0.25mgPOtid;increase0.25mgPO
tid/w;max24mg/d
—hypersensitivitytodrugorclass
MaternalConsiderations
.....
Thereisnopublishedexperiencewith
Sideeffects
includesomnolence,atrialfibrillation,syncope,
hypotension,N/V,hallucinations,dizziness,fatigue,dyspepsia,
malaise,edema,chestorabdominalpain,sweating,pharyngitis,
anorexia,andvisualchanges.
.........................
Thereisnopublishedexperienceinpregnancyorduringlactation.
...........................
PregnancyCategory:C
LactationCategory:U
shouldbeusedduringpregnancyandlactationonly
ifthebenefitjustifiesthepotentialperinatalrisk.
InternationalBrandName—
Avandia(HongKong,Israel,Malaysia,Philippines,Singapore,Taiwan,Thailand);
Rezult(India);Rosi(Israel);Rossini(Israel)
DrugClass
..........................
Susceptiblewomenofchildbearingage—0.5mlSC
—hypersensitivitytodrugorclass,allergy
anyactivefebrileinfection,untreatedTB,
immunosuppressivetherapy(exceptreplacement
corticosteroids),blooddyscrasias,lymphoma,primaryor
acquiredimmunodeficiency(includingAIDS)
—donotgivewithimmunoglobulin
MaternalConsiderations
.....
rubellavirusvaccine
producesamodified,
noncommunicablerubellainfectioninsusceptiblepersons.
Vaccine-inducedimmunitypersistsforatleast10ywithout
significantdecline.Vaccinatingsusceptiblewomenconfers
individualprotectionagainstrubelladuringasubsequent
Perhapsthemostconvenienttimetovaccinateisimmediately
postpartumwhilethepatientisstillhospitalized.Inthat
instance,conceptionshouldbedelayed1mo.Unfortunately,the
opportunityisoftenmissedbecauseofphysician/hospital
oversight.Rubellasusceptibilityshouldbeconfirmedserologically
beforevaccinating.
Sideeffects
includeinjectionsitereaction,mildregional
lymphadenopathy,urticaria,rash,malaise,sorethroat,fever,
headache,N/V,diarrhea,polyneuritis,syncope,and
Asthmaprophylaxis—2puffsINHq12h
Exercise-inducedasthma—2puffsINH
COPD—2puffsINHq12h
NOTE:21mcg/sprayMDI.
—hypersensitivitytodrugorclass,acute
asthma,arrhythmia
acceptablealternativetothe
Arthritis—1000mgPOtid
—hypersensitivitytodrugorclass,
NSAID/ASA-inducedasthmahistory,flu-likesymptoms
orvaricella,pepticulcerdisease
—renaldysfunction
MaternalConsiderations
.....
isadimerofsalicylicacidandabsorbedintheintestine.
aspirin,salsalate
DrugInteractions
................
Salicylatesantagonizetheuricosuricactionofdrugsusedtotreat
andothersalicylateswillbeadditiveto
andmay
leadtosalicylatetoxicity.
DrugsandfoodsthatraiseurinepHwillincreaserenalclearance
HIVadjuncttreatment—600mgPOtid(Invirase)or1200mgtid
PO(Fortovase)within2hofeating
—hypersensitivitytodrugorclass;
astemizole,cisapride,
midazolam,terfenadine,
—hepaticdysfunction,useof
MaternalConsiderations
.....
iswell-toleratedduringpregnancyandispartof
severaltreatmentregimens.Itsclearanceisincreasedby
pregnancy,andtheusuallyrecommendeddosemaybe
significantlyincreases
concentration,andthecombinationduringpregnancymayhave
someadvantage.
Sideeffects
itenhances.Unboundconcentrationsof
arelikelyto
besubstantiallylowerinumbilicalcordthanmaternalplasma.It
decreasethe
levelwhile
increasingthe
shouldnotbegiven
asthesoleproteaseinhibitor.
Increasesthelevelsofbenzodiazepines(e.g.,
clorazepate,diazepam,flurazepam
),perhapsnecessitatinga
decreaseinthebenzodiazepinedose.
Increasesthelevelsofcalciumchannelblockers(e.g.,
diltiazem,felodipine,isradipine,nicardipine,nifedipine,
nimodipine,nisoldipine,verapamil
),perhapsnecessitatinga
decreaseinthedoseofthecalciumchannelblocker.
—(GM-CSF;Granulocyte
Macrophage-ColonyStimulatingFactor;Leukine;Prokine)
InternationalBrandName—
Leucogen(Korea)
DrugClass
..........................
Neutropeniapostbonemarrowtransplant—250mcg/m
IVqd
over2hbeginning2-4haftertransplantand
24hpost
Neutropeniapost-AMLchemotherapy—250mcg/m
IVqdover
4hbeginningday11postchemotherapy;continueuntilANC
3d,max42d
Progenitormobilization—250mcg/m
IVqdover24h
Bonemarrowtransplantfailure—250mcg/m
IVqdover
14d;mayrepeatin7d
—hypersensitivitytodrugorclass,leukemic
myeloidblastcells
10%,currentchemotherapy,current
radiationtherapy
—arrhythmia,CHF,pericardialeffusion,pleural
MaternalConsiderations
.....
isarecombinanthumangranulocyte-macrophage
colony-stimulatingfactor.Thereisnopublishedexperiencewith
duringpregnancy.
Sideeffects
includearrhythmias,anaphylaxis,pleuralor
pericardialeffusion,capillaryleaksyndrome,RDS,fever,chills,
headache,N/V,diarrhea,myalgias,asthenia,bonepain,edema,
rash,pruritus,dyspnea,flushing,hypotension,tachycardia,
andsyncope.
—(IsoptoHyoscine;MinimsHyoscine
Hydrobromide;Scopoderm;TransdermScop)
InternationalBrandName—
Kimite-patch(Korea);ScopodermDepotplast(Norway);ScopodermTTS
Motionsickness—1patchbehindtheear4hpriortoneed;may
replacein3d
Obstetricamnesiaorpreoperativesedation—0.32-0.65mgSC/IM
Intraoperativeamnesia—0.4mgIV
—hypersensitivitytodrugorclass,
narrow-angleglaucoma
—intestinalobstruction,historyofseizuresorpsychosis,
shouldbeusedwithcareinpatientstakingdrugs,
Short-terminsomnia—100mgPOqd
—hypersensitivitytodrugorclass,
respiratorydepression,porphyria
MaternalConsiderations
.....
Barbituratesaredangerousdrugs,withanarrowtherapeutic
Sideeffects
includerespiratorydepression,dependency,
—(Alzene;Carbex;Deprenyl;Eldeprine;
Eldepryl;Selgene)
InternationalBrandName—
Apo-Selegiline(NewZealand);Elegelin(Thailand);Julab(HongKong,
Thailand);Julegil(Malaysia);Jumex(Austria,China,HongKong,Hungary,Indonesia,Israel,Italy,Korea,Malaysia,
Philippines,Thailand);Jumexal(CostaRica,ElSalvador,Guatemala,Honduras,Nicaragua,Panama,Switzerland,
Taiwan);Kinline(Thailand);MAO-B(Korea);MAOtil(Germany);Movergan(Germany);Niar(Mexico);Otrasel(France);
Plurimen(Spain);Procythol(Greece);Sedicel(Colombia);Sefmex(HongKong);Selegil(Colombia,Peru);Selegos
(HongKong,Singapore);Selgene(Thailand);Selgin(India);Xilopar(Germany);Zelapar(Philippines)
DrugClass
..........................
Antiparkinsonagents
.........................
.........................
SelectiveMAO-Bantagonist
DosagewithQualifiers
.......
Parkinsonism—5mgPOqamandqnoon
NOTE:deathmayoccurifcombinedwith
—hypersensitivitytodrugorclass,opiateuse
MaternalConsiderations
.....
HasgreateraffinityforMAO-B;thisselectivityislostasits
concentrationincreases.Inadditiontotheirroleinthecatabolism
ofCNSmonoamines,MAOsarealsoimportantinthecatabolismof
exogenousaminesfoundinfoodsanddrugs.MAOintheGItract
(primarilytypeA)protectsfromexogenousamineswithvasopressor
actions,suchastyramine,whichifabsorbedintactcancausea
hypertensivecrisis(theso-calledcheesereaction).Ifalargeamount
oftyramineisabsorbed,itistakenupbyadrenergicneuronsand
causeshypertensionsecondarytoNEreleasefromneuronalstorage
sites.Whilemostfoodscontainnegligibleamountsornotyramine,
afewfoodproductsmaycontainlargeamountsthatrepresenta
potentialriskforpatientswithsignificantinhibitionofGIMAO-A.
Studiessuggest
selegiline
Tineaversicolor—apply2.5%lotionqd
7d,thenmonthly
NOTE:washhands,avoidcontactwithjewelry.
—hypersensitivitytodrugorclass,
inflamedskin
MaternalConsiderations
.....
Thereisnopublishedexperiencewith
seleniumsulfide
Constipation—2-4tabsPOqdorbid
—hypersensitivitytodrugorclass,bowel
obstruction,undiagnosedabdominalpain
MaternalConsiderations
.....
Despitealongclinicalexperience,therearenoadequate
reportsorwell-controlledstudiesof
inpregnantwomen.
isabsorbedacrosstheGItractonlytoalimited
degree.Somebelieve
isthepurgativeofchoiceduring
pregnancyandlactation.Iteffectivelyrelievespostpartum
Depression—begin50mgPOqd;max200mgPOqd
OCD—begin50mgPOqd;max200mgPOqd
Premenopausaldysphoricdisorder—begineither50mgPOqdor
cycledays15-28,mayincrease50mg/dpercycle,max150mg/d
Post-traumaticstressdisorder—begin25mgPOqd
7dbefore
increasing25-50mg/d;max200mg/d
Panicdisorder—begin25mgPOqd;max200mgPOqd
NOTE:discontinueslowly.
—hypersensitivitytodrugorclass,
—renaldysfunction
MaternalConsiderations
.....
Depressioniscommonduringandafterpregnancy,buttypically
goesunrecognized.Pregnancyisnotareason
apriori
discontinuepsychotropicdrugs.Therearenoadequatereportsor
well-controlledstudiesof
inpregnantwomen,though
thereisgrowingexperiencewithitsuseforthetreatmentof
postpartumdepression.However,
isnotrecommended
forprophylacticuse.Ingeneral,womentakingSSRIsduring
pregnancyfordepressionrequireanincreaseddosetomaintain
Sideeffects
includeserotoninwithdrawalsyndrome,withdrawal
syndrome,N/V,diarrhea,insomnia,headache,drymouth,
somnolence,dizziness,fatigue,tremor,dyspepsia,constipation,
decreasedlibido,sweating,anorexia,nervousness,agitation,
inhibitthebiochemicalactivityofCYP2D6(debrisoquin
hydroxylase),and,thus,mayincreasetheplasmaconcentrations
...........................
PregnancyCategory:C
LactationCategory:S
Depressioniscommonduringpregnancyandthepuerperium
andshouldnotbeignorediftreatmentisotherwiseindicated.
shouldbeusedduringpregnancyandlactationonly
ifthebenefitjustifiesthepotentialperinatalrisk.
Limitedstudysuggestsplacentaltransferof
islower
thanthatfor
Inductionofanesthesia—titrateinhalationtoeffect;atechnique
usedmainlyinchildren
dosing,one-time
useisunlikelytoposeaclinically
significantrisktothebreastfeedingneonate.
DrugInteractions
................
Benzodiazepinesandopioidswouldbeexpectedtodecreasethe
MACof
sevoflurane
inthesamemanneraswithotherinhalational
Obesity—begin10mgPOqd,increaseto15mgPOqdafter4w;
max15mg/d
—hypersensitivitytodrugorclass,MAOI
14d,CAD,CHF,arrhythmias,stroke,severehepaticorrenal
dysfunction,anorexianervosa
MaternalConsiderations
.....
Obesityisamajorepidemicintheindustrializedcountries.
InternationalBrandName—
Aphrodil(Israel);Edegra(India);Ejertol(Colombia);Erectol(Argentina);Erilin
(Colombia);Eroxim(Colombia);Penegra(India,SouthAfrica);Rigix(Paraguay);Ripol(Chile);Sildefil(Argentina);
Viagra(Canada,Colombia,HongKong,Indonesia,Japan,Korea,Mexico,Peru,Philippines,Singapore,Taiwan,
Thailand);Vigain(Israel);Zwagra(Israel)
DrugClass
..........................
PDEinhibitors
.........................
Erectiledysfunction
.........................
PDE5inhibitor
DosagewithQualifiers
.......
NoFDA—approvedindicationsforwomen
hypersensitivitytodrugorclass,nitrateuse
CAD,hepaticdysfunction,severerenaldisease,
MaternalConsiderations
.....
issuggestedasatreatmentforsexualarousaldisorder
inpremenopausalwomen.Itiseffectiveinpostmenopausal
womenforthetreatmentoffemalesexualarousaldisorder.
Thoughtherearenoadequatereportsorwell-controlledstudies
inpregnantwomen,itisapotentiallyattractive
agentasitincreasesthet/2ofNO,andthereareseveralreports
ofitsusetotreatpulmonaryarteryhypertensionduring
hasalsobeentestedasanagenttoincrease
Mayenhancethehypotensiveeffectofthe
Therehavebeeninfrequentreportsofsymptomaticpostural
hypotension.Thesereportsincludeddizzinessand
light-headedness,butnotsyncope.
Mayenhancethehypotensiveeffectof
.........................
2006;12:722-9.
HuangS,DeSantisER.AmJHealthSystPharm2007;64:1922-6.
Preventionofgonorrhealophthalmianeonatorum—apply
2gtt1%solutioneacheyeshortlyafterbirth
hypersensitivitytodrugorclass
MaternalConsiderations
.....
Silvernitrate
hasbeenusedfordecadestopreventneonatal
gonorrhealconjunctivitis.Unfortunately,itdoesnotprevent
chlamydialconjunctivitisandhasbeenlargelyreplacedwith
Sideeffects
includechemicalconjunctivitis.
Silversulfadiazinetopical
—(Canflame;Dermazin;
Flamazine;Flammazine;Geben;Sildimac;Silvadene;Silvazine;
Silverderma;Silverol;Silvirin;Sofargen;SSD;Thermazene)
InternationalBrandName—
Aldo-Silvederma(HongKong);Brandiazin(Germany);Burnazin(Indonesia);
Dermazin(HongKong,Indonesia);Flamazine(Canada,Denmark,England,Finland,HongKong,Ireland,Israel,
Malaysia,Norway,SouthAfrica,Taiwan,Thailand);Flammazine(Austria,Belgium,Bulgaria,France,Germany,
2ndor3rddegreeburns—applytode
bridedwoundqdtobid
NOTE:1%cream.
—hypersensitivitytodrugorclass
MaternalConsiderations
.....
Whileburninjuriestopregnantwomenarenotrare,the
literatureisindeedsparse.Therearenoadequatereportsor
well-controlledstudiesof
silversulfadiazine
inpregnantwomen.
Absorptionof
silversulfadiazine
variesdependinguponthe
percentageofbodysurfaceareaandtheextentofthetissue
Sideeffects
includeneutropenia,leukopenia,erythema
multiforme,burning,pain,pruritus,skinnecrosis,andrash.
Flatulence—80-120mgPOqid(pcandhs)prn;max480mg/d
—hypersensitivitytodrugorclass,intestinal
perforation,GIobstruction
MaternalConsiderations
.....
Hypercholesterolemia—begin20mgPOqd;max80mg/d
Hypertriglyceridemia—begin20mgPOqd;max80mg/d
Familialhypercholesterolemia—40mgPOqpm;max80mg/d
SecondarypreventionofCVevents—begin20mgPOqd
(40mgPOqdifgoal
45%reductionLDL);max80mg/d
NOTE:multipledruginteractionsalterdosing(e.g.,
otherfibrates,
—hypersensitivitytodrugorclass,active
hepaticdisease,unexplainedelevatedLFTs
Caution
—hepaticdysfunction,alcoholabuse,severerenaldisease
MaternalConsiderations
.....
.........................
Adjunct,renaltransplant—2mgPOqdcombinedwith
andcorticosteroids;alternative15mgPOinitially,
then5mgPOqd
NOTE:hepaticdosing;monitorrenalfunction;antimicrobial
gastroenteritis,gingivitis,ileus,abnormalLFTs,mouth
ulceration,oralmoniliasis,stomatitis,skincancer,andlymphoma.
HangJ,RillemaJA.BiochimBiophysActa1997;1358:209-14.
[Noauthors].NephrolDialTransplant2002;17(Suppl4):50-5.
Irondeficiencyinhemodialysedpatients—25mgIVtestdoseover
60minfollowedby100mgIVover1h
hypersensitivitytodrugorclass,non–iron
deficiencyanemia,ironoverload
MaternalConsiderations
.....
Sodiumferricgluconate
isastablemacromolecularcomplexin
sucroseinjection.Thereisnoadequatepublishedexperiencewith
sodiumferricgluconate
complexduringpregnancy.Anaphylaxis
hasbeenreportedduringpregnancy.
Sideeffects
includeanaphylaxis,irontoxicity,hypotension,
flushing,headache,N/V,diarrhea,weakness,fatigue,injectionsite
reactions,pain,fever,dyspnea,itching,andrash.
Sodiumpolystyrene
—(Kayexalate;Resonium;Sps)
InternationalBrandName—
Resinsodio(Spain);ResoniumA(Austria,England,Germany,HongKong,
Hyperkalemia—15mgmixedinwaterorsorbitolPOqdtoqid
—hypersensitivitytodrugorclass,
—severeCHF,severehypertension,marked
MaternalConsiderations
.....
Thereisnopublishedexperiencewith
sodiumpolystyrene
duringpregnancy.
Sideeffects
includehypokalemia,alkalosis,gastricirritation,
anorexia,N/V,diarrhea,constipation,intestinalobstruction,
fecalimpaction,andhypocalcemia.
Ventriculararrhythmia—begin80mgPOq12h,titratedosein
hospitalwithcontinuousmonitoringforatleast3d;max640mg
forrefractorycases
NOTE:renaldosing;monitorECG,QTinterval,andCrCl;
avoidabruptwithdrawal.
—hypersensitivitytodrugorclass,sinus
bradycardia,2ndand3rddegreeAVblock,prolongedQT
intervalsyndrome,cardiogenicshock,uncontrolledCHF,
asthma,hypokalemia,hypomagnesemia
—renaldysfunction,sicksinussyndrome,compensated
averagemilkintakeof0.15L/kg/d,itwascalculatedthataninfant
wouldhavereceivedadosesome20-23%ofthematernaldose.
Thisdosewasnotassociatedwithanybradycardia.However,
becauseoftherelativelylargeinfantexposuretothedrug,
breastfeedingshouldbeundertakenonlywhentheinfant
iscloselymonitoredandsideeffectssuchasbradycardia,
hypotension,respiratorydistress,orhypoglycemiaare
notdemonstrable.
DrugInteractions
................
ClassIaantiarrhythmicdrugs(e.g.,
disopyramide,procainamide,
)andotherclassIIIdrugs(e.g.,
)arenot
recommendedbecauseoftheirpotentialtoprolongrefractoriness.
Usewithcautioninconjunctionwithcalciumchannelblocking
drugsbecauseofpossibleadditiveeffectsonAVconductionor
ventricularfunction.Useofthesedrugsmayhaveadditiveeffects
onBP,leadingtohypotension.
InternationalBrandName—
Noneidentified.
DrugClass
..........................
Aminoglycosides;Antibiotics
.........................
.........................
Bactericidal—inhibitsproteinsynthesisbybindingthebacterial
30Sribosomalsubunit
DosagewithQualifiers
.......
Gonorrhea,uncomplicated—2gIM(gluteus)
1;increaseto4gif
resistance(2g/injection)
Gonorrhea,disseminated—2gIM(gluteus)
—hypersensitivitytodrugorclass
MaternalConsiderations
.....
isnoteffectiveforthetreatmentofsyphilis,and
mayinfactmaskordelaythesymptomsofincubatingsyphilis.
Allpatientswithgonorrheashouldbeserologicallytestedfor
syphilisatdiagnosis,andagain3molater.Therearenoadequate
reportsorwell-controlledstudiesof
inpregnant
women.Failuretoachieve‘‘microbiologiccure’’issimilarfor
commonantibioticregimens:
comparedwith
(OR2.40,95%CI0.71-8.12),
comparedwith
2.40,95%CI0.71-8.12),and
comparedwith
(OR1.22,95%CI0.16-9.04).Thus,theselectionisbasedon
sensitivitiesinthegeographiclocale,price,andtheprevalenceof
syphilis.Sexpartnersshouldbetestedandtreatedwhenpossible.
Sideeffects
includeurticaria,dizziness,nausea,chills,fever,
injectionsitepain,insomnia,anemia,andelevatedBUN
andLFTs.
—(Aldactone;Diatensec;Flumach;Osiren)
InternationalBrandName—
Adultmin(Japan);Aldospirone(Israel);Almatol(Taiwan);Berlactone(Thailand);
Diram(Japan);Flumach(France);Hypazon(Japan);Idrolattone(Italy);Merabis(Japan);Novospiroton(Canada);Osyrol
(Germany,Japan);Pirolacton(Japan);Pondactone(Thailand);Resacton(Japan);Spiractin(Australia,SouthAfrica);
Edema—25-50mgPOqdorbid
CHF—25mgPOqd
Hyperaldosteronismtest—400mgPOqd
4-28d(until
hypokalemiacorrects)
Hypertension—25-50mgPOqdorbid
NOTE:renaldosing.
—hypersensitivitytodrugorclass,anuria,
renalinsufficiency,hyperkalemia
ReducesthevascularresponsivenesstoNE.Exercisecautionwith
patientsundergoingregionalorgeneralanesthesia.
Possibleincreasedresponsivenesstonondepolarizingmuscle
relaxantsmayresult.
HIVinfection—40mgPOq12h;withholdifperipheral
neuropathydevelops
NOTE:renaldosing.
—hypersensitivitytodrugorclass,lactic
acidosis,lactation
—hepaticorrenaldysfunction,peripheralneuropathy,
neurotoxicagents,AIDS,historyofpancreatitis,bonemarrow
MaternalConsiderations
.....
Depression—300mgPOtid;max1500mg
hypersensitivitytodrugorclass,HIV
MaternalConsiderations
.....
St.John’swort
isanherbusedmedicinallyforcenturies.
Thecompositionof
St.John’swort
andhowitmightworkare
notwellunderstood.Itcontainsmultiplebioactivesubstances.
Thenaphthodianthroneshypericinandpseudohypericinand
multipleflavonoidshavegeneratedinterestaspotential
antidepressantandantiviralagents.
Invitro
studiesrevealMAO
inhibitoryactivity.Studiessuggestthat
St.John’swort
isofno
benefitintreatingmajordepressionofmoderateseverity.
ANationalInstitutesofHealthstudyrevealedthatconcomitant
administrationof
St.John’swort
plasmaconcentrations,potentiallydueto
inductionofCYP3A4by
St.John’swort.
Therearenoadequate
reportsorwell-controlledstudiesof
St.John’swort
pregnancy.Relevantquestionsremainregardingtheuseof
St.John’swort
inHIV-positivepregnantwomentreated
concomitantlywithproteaseinhibitorsandNNTRIs.
St.John’s
isbestavoidedduringpregnancy.
Sideeffects
includeearly-onsetcataract,drymouth,dizziness,
sexualdysfunction,GIsymptoms,increasedsensitivitytosunlight,
fatigue,andreductionoftheeffectivenessofseveraldrugs.
—(Kabikinase;K-Nase;Streptase;Zykinase)
InternationalBrandName—
K-Nase(Korea);Zykinase(India)
DrugClass
..........................
.........................
MI,PE/DVT,AVcannulaocclusion
.........................
Convertsplasminogentoplasmin
DosagewithQualifiers
.......
MI—1.5millionUIVover60min
PE/DVT—begin250,000UIVover30min,then100,000U/hfor
either72h(DVT)or24h(PE);beginwithin7-10dofocclusion
AVcannulaocclusion—100,000-250,000UIVover30min
—hypersensitivitytodrugorclass,recent
stroke,activeinternalbleeding,recenttrauma,intracranial
tumor,ulcerativecolitis,severehypertension,rheumatic
valvulardisease,
10dsinceadiagnosticarterialprocedure
—recentdelivery,recentGIbleeding,left-sidedheart
HenrichW,SchmiderA,HenrichM,DudenhausenJW.
JPerinatMed2001;29:155-7.
Paralysis,anesthesia,shortterm—0.6-1.5mg/kgIVover10-30sec;
max150mg
Paralysis,longterm—0.5-10mg/mincontinuousIV
flacciditycanoccurintheneonateafterrepeatedhighdoses,
orinthepresenceofatypicalmaternalplasmacholinesterase.
Rodentteratogenicitystudieshavenotbeenconducted.
Duodenalulcer—1gPOqid(treatment)orbid(maintenance)
—hypersensitivitytodrugorclass,
dysphagia,GIobstruction
—renaldysfunction
MaternalConsiderations
.....
GERDposesaspecialchallengeinpregnancy.Lifestyleand
medicationsarethefirstlinesoftherapy.Whenthese
interventionsareunsuccessful,
shouldbenext.
TherapywithH
receptorantagonistsorprotonpumpinhibitors
aregenerallyreservedforwomenwithrefractorysymptoms.
Therearenoadequatereportsorwell-controlledstudiesof
inpregnantwomen.
Sideeffects
includediarrhea,N/V,flatulence,constipation,rash,
dizziness,insomnia,andbezoarformation.
Generalanesthesia—begin2-8mcg/kgIVwhenusedwith
Epiduralduringlabor—severalregimens,including10-15mcg
plus10ml0.125%
Intrathecalduringlabor—severalregimens,including5-7.5mcg
withorwithout
—hypersensitivitytodrugorclass
—respiratorydepression,hepaticorrenaldysfunction
MaternalConsiderations
.....
isapotentopioid.Whenusedinbalancedgeneral
hasperhaps10
thepotencyof
Sulconazolenitratetopical
—(Exelderm;Sulcosyn)
InternationalBrandName—
Excerderm(Japan);Exelderm(Ecuador,England,Ireland,Korea,Portugal,
Tineapedis—applybid
Tineacruris—applyqdorbid
Tineacorporis—applyqdorbid
Tineaversicolor—applyqdorbid
NOTE:availablein1%creamorsolution.
—hypersensitivitytodrugorclass
MaternalConsiderations
.....
Thereisnopublishedexperiencewith
Sideeffects
includepruritus,burning,anderythema.
InternationalBrandName—
Noneidentified.
DrugClass
..........................
Antibiotics;Sulfonamides
.........................
.........................
Bacteriostatic—inhibitsdihydropteroatesynthesis
DosagewithQualifiers
.......
Toxoplasmosis—2-8gPOqdin3-4divideddoses
4wplus
...........................
PregnancyCategory:C
LactationCategory:S
shouldbeusedduringpregnancyandlactation
onlyifthebenefitjustifiesthepotentialperinatalrisk.
Bacterialinfection—begin2gPO
1,then1gPObid
NOTE:maybecombinedwith
Sideeffects
includeagranulocytosis,aplasticanemia,hemolytic
anemia,seizures,erythemamultiforme,hypoglycemia,exfoliative
dermatitis,rash,hepatocellularnecrosis,andvariousallergic
.........................
Ulcerativecolitis,rheumatoidarthritis,Crohn’sdisease
.........................
DosagewithQualifiers
.......
Ulcerativecolitis—begin500mgPOqdpcforseveraldaysof
improvement,then500mgPOqidpc
Rheumatoidarthritis—begin500mgPOqdpcforseveraldays,
then500mgPOqidpc
Crohn’sdisease—begin500mgPOqdpcforseveraldays,then
500mgPOqidpc
NOTE:obtainaCBCbiweeklyforthefirst3mooftreatment;
monitorrenalfunctionperiodically.
—hypersensitivitytodrugorclass,
hypersensitivitytosalicylates,hepaticorrenaldysfunction,
porphyria,intestinalorurinaryobstruction
—G6PDdeficiency
MaternalConsiderations
.....
—(Gantrisin;Gulfasin;Isoxazine;Lipo
Gantrisin;Novosoxazole;Oxazole;Sosol;Soxa;Sulfalar;Sulfazin;
Sulfazole;Sulphafurazole;Sulsoxin;Thiasin;Truxazole;Urazole)
InternationalBrandName—
Noneidentified.
DrugClass
..........................
Antibiotics;Sulfonamides
.........................
Bacterialinfection(e.g.,acute,recurrent,orchronicUTIs;
meningococcalmeningitis;otitismedia)
.........................
Bacteriostatic—inhibitsdihydropteroatesynthesis
DosagewithQualifiers
.......
Bacterialinfection—500-1000mgPOq6h
NOTE:renaldosing.
hypersensitivitytodrugorclass,porphyria
hepaticorrenaldysfunction
MaternalConsiderations
.....
Therearenoadequatereportsorwell-controlledstudiesof
inpregnantwomen.
isanalternative
whichsomefeelshouldnolongerbeusedinthe
treatmentofasymptomaticbacteriuriabecauseofhighratesof
resistance.Ithasbeenusedasanalternativeforthetreatment
ofchlamydiain
-allergicwomen.
Sideeffects
includeStevens-Johnsonsyndrome,jaundice,aplastic
anemia,agranulocytosis,leukopenia,thrombocytopenia,
pseudomembranouscolitis,stomatitis,hepatitis,vasculitis,
photosensitivity,anorexia,N/V,rash,headache,anddizziness.
...........................
PregnancyCategory:C
LactationCategory:S
shouldbeusedduringpregnancyandlactation
onlyifthebenefitjustifiesthepotentialperinatalrisk.
Alongclinicalexperienceisreassuring.
—(Antribid;Arthridex;Biflace;Clinoril;Clisundac;
Daclin;Imbaral;Lindak;Lyndak;Reumofil;Sudac)
InternationalBrandName—
Osteoarthritisorrheumatoidarthritis—150-200mgPObid;
max400mg/d
Anti-inflammatory—200mgPObid
7-14d;max400mg/d
Ankylosingspondylitis—150-200mgPObid;max400mg/d
Acutegout—150-200mgPObid;max400mg/d
—hypersensitivitytodrugorclass,NSAID-
oraspirin-inducedasthma
—CHF,GIbleeding,hypertension
MaternalConsiderations
.....
Migraineheadache—6mgSC
1,mayrepeatin1h,max12mg/d;
or25-100mgPO
1,mayrepeatafter2h,max200mg/d;or
1spraypernostril(20mg/spray)
NOTE:availableinoral,parenteral,andnasalsprayforms.
NOTE:Maybecombinedwith
—hypersensitivitytodrugorclass,
uncontrolledhypertension,CAD,basilarorhemiplegic
migraine,MAOI
—peripheralorcerebrovasculardisease,hepatic
dysfunction,5-HT
orergotderivativeagonist
24h,cardiac
riskfactors
MaternalConsiderations
.....
Therearenoadequatereportsorwell-controlledstudies
inpregnantwomen.
Sideeffects
includecoronaryvasospasm,acuteMI,ventricular
tachycardia,ventriculararrhythmia,death,hypertensivecrisis,
stroke,bowelorperipheralvascularischemia,asthenia,chest
pain,necktightness,dizziness,flushing,paresthesias,rhinitis
(spray),rash,tastechanges(spray),pruritus,urticaria,tinnitus
(spray),myalgias,palpitations,somnolence,andsweating.
—(Cognex;THA)
InternationalBrandName—
Cognex(Austria,Belgium,Chile,China,France,Germany,Peru);
Cognitiv(Argentina);Tacrinal(Brazil);Talem(Argentina)
DrugClass
..........................
Alzheimer’sdiseaseagents;Cholinesteraseinhibitors
.........................
Alzheimer’sdementia
.........................
Reversiblecholinesteraseinhibitor
DosagewithQualifiers
.......
Alzheimer’sdementia—begin10mgPOqid
4w;increaseby
10mgqidq4wbasedonresponse
—hypersensitivitytodrugorclass,
hepatotoxicity,hepaticdysfunction,cardiacconductiondefects
MaternalConsiderations
.....
presumablyelevatesAChinthecerebralcortexby
slowingthedegradationofAChreleasedbystill-intactcholinergic
neurons.Italsoappearstoreduceexcitatoryaminoacidtoxicity.
Thereisnoevidenceitalterstheunderlyingdementiaprocess.
Plasmaconcentrationsare50%higherinwomenthanmen.
Therearenoadequatereportsorwell-controlledstudiesof
inpregnantwomen.Thepublishedliteratureislimitedto
twocasereports3decadesagowhenitwasusedasageneral
—(FK506;Prograf,Protopic)
InternationalBrandName—
MustopicOint(India);Prograf(Argentina,Brazil,Canada,Chile,Colombia,
Denmark,England,France,Germany,HongKong,Ireland,Japan,Korea,Malaysia,Mexico,Paraguay,Philippines,
Singapore,SouthAfrica,Taiwan,Thailand,Uruguay);Protopic(England,France,HongKong,Ireland)
DrugClass
..........................
Immunosuppressants;Transplantationagents;Eczemaagents
.........................
Prophylaxisagainstliverorkidneytransplantrejection
.........................
InhibitsT-cellactivation
DosagewithQualifiers
.......
Transplantrejectionprophylaxis—0.1-0.2mg/kg/dPOin2
divideddoses;alternatively,0.03-0.05mg/kg/dascontinuous
IVinfusion
—hypersensitivitytodrugorclass
—hepaticorrenaldysfunction
MaternalConsiderations
.....
—(Dignotamoxi;Nolvadex;Valodex)
InternationalBrandName—
Exiphen(ElSalvador,Guatemala,Honduras,Panama);Gynatam(Philippines);
Istubol(Canada);Kessar(France,Germany,Greece,Italy,Philippines,SouthAfrica,Switzerland);Mamofen(India);
Moxafen(Korea);Noltam(England);Nolvadex-D(HongKong,Israel,Malaysia);Novofen(Taiwan,Thailand);
Breastcancer,adjuvant—10mgPObid
Breastcancer,ductal
insitu
—10mgPObid
5yaftersurgeryand
radiationtherapy
Breastcancer,prophylaxis—10mgPObid
5yforhigh-risk
womenbegunduringmensesafteranegativehCGtest
Mastalgia—10mgPOqd
Ovulationinduction—5-40mgPObid
—hypersensitivitytodrugorclass,
undiagnosedgenitalbleeding,historyofthromboembolism,
coumarinanticoagulation
fatigue,headache,visualchanges,vulvarpruritus,hairloss,
anorexia,andelevatedLFTs.
Tazarotenetopical
InternationalBrandName—
Zorac(England,France,Germany,Ireland,Israel,SouthAfrica)
DrugClass
..........................
Psoriasis—applytoaffectedareaqhs
Acnevulgaris—applytoaffectedareaqhs
NOTE:obtainpregnancytestbeforeinitiatingtherapy;availablein
cream(0.05%)andgel(0.05%,0.1%)formats.
—hypersensitivitytodrugorclass,
—avoidsun
MaternalConsiderations
.....
Thereisnopublishedexperiencewith
pregnancy.Thematernalsystemicconcentrationis
reportedlylow.
Sideeffects
includebirthdefects,pruritus,burning,erythema,
andirritation.
...........................
PregnancyCategory:C
LactationCategory:S
Irritablebowelsyndrome—6mgPO30-60minacbid
4-6w;may
—hypersensitivitytodrugorclass,severe
renaldysfunction,moderatetoseverehepaticdisease,history
ofbowelobstruction,abdominaladhesions,sphincterofOddi
dysfunction,symptomaticgallbladderdisease,diarrhea
—mildhepaticdysfunction
MaternalConsiderations
.....
Therearenopublishedreportsof
useduring
Sideeffects
includecholecystitis,headache,nausea,abdominal
pain,flatulence,diarrhea,anddizziness.
InternationalBrandName—
Micardis(Argentina,Australia,Brazil,Canada,Chile,Colombia,CostaRica,
DominicanRepublic,ElSalvador,Guatemala,Honduras,HongKong,Indonesia,Malaysia,Mexico,Nicaragua,
Panama,Paraguay,Peru,Philippines,Singapore,Thailand,Uruguay);Predxal(Mexico);Pritor(Argentina,Australia,
Korea,Mexico,Peru,Philippines,Venezuela);Pritoral(Chile);Telma-20(India)
DrugClass
..........................
.........................
.........................
AT-1antagonist
DosagewithQualifiers
.......
Hypertension—begin40mgPOqdifmonotherapy;max80mg/d
—hypersensitivitytodrugorclass,pregnancy
—historyofACEI-relatedangioedema,renalartery
stenosis,hepaticorrenaldysfunction,CHF,hyponatremia
MaternalConsiderations
.....
Theplasmaconcentrationof
is2-3
higherin
femalesthaninmales.Thereisnopublishedexperiencewith
duringpregnancy.Inhibitorsoftherenin-angiotensin
Insomnia,short-term—7.5-30mgPOqhs
—hypersensitivitytodrugorclass
—azoleantifungal
MaternalConsiderations
.....
Residualmedicationeffects(‘‘hangover’’)areessentiallyabsent
andearlymorningawakening,aparticular
problemforthegeriatricpatient,issignificantlyreduced
comparedtosimilaragents.REMsleepisunchanged.Thereare
noadequatereportsorwell-controlledstudiesof
pregnantwomen.Onecasereportsuggestedanassociationwith
DrugInteractions
................
Noclinicallyrelevantinteractionsidentified.
.........................
CooperJ,JauniauxE,GulbisB,BromleyL.ReprodBiomed
Online2001;2:165-71.
Astrocytoma,refractory—multipledosingregimensbasedon
responseandsideeffects
—hypersensitivitytodrugorclass,
hypersensitivitytoDTIC
—hepaticorrenaldysfunction
MaternalConsiderations
.....
Thereisnopublishedexperiencewith
Sideeffects
includemyelosuppression,N/V,abdominalpain,
constipation,diarrhea,headache,fever,convulsions,hemiparesis,
amnesia,insomnia,andviralinfection.
InternationalBrandName—
MI,acute—30-50mgIV
1,weightdependent;max50mg
—hypersensitivitytodrugorclass,active
internalbleeding,stroke,aneurysm,intracranial/spinalsurgery
ortrauma,bleedingdiathesis,uncontrolledhypertension
—severehepaticdisease,hypertension,recentsurgery
ortrauma,CVD,GPIIb/IIIause,endocarditis,acute
pericarditis,LVthrombus
MaternalConsiderations
.....
Thepublishedexperiencewith
duringpregnancyis
limitedtocasereportsincludingoneinthefirsttrimester.
Sideeffects
includeintracranialhemorrhage,stroke,severe
bleeding,arrhythmia,andangioedema.
InternationalBrandName—
Viread(Argentina,Canada)
DrugClass
..........................
Antivirals;NRTIs
.........................
HIVinfection
.........................
Reversetranscriptaseinhibitor
DosagewithQualifiers
.......
HIVinfection—300mgPOqdincombinationwithother
DecreasestheAUCandC
Itisrecommended
300mgbegivenwith
100mgifused
.........................
Hypertension—begin1mgPOqhs;max20mg/d
—hypersensitivitytodrugorclass
MaternalConsiderations
.....
Thereisnopublishedexperiencewith
Sideeffects
includehypotensionafterthefirstdose,dizziness,
vertigo,headache,palpitations,atrialfibrillation,
thrombocytopenia,asthenia,nasalcongestion,peripheraledema,
pain,paresthesias,polyuria,nervousness,andblurredvision.
DrugInteractions
................
meanAUC
11%following
thefirst
dose.After3wof
theAUCof
roseby24%withassociatedincreasesinC
andC
(32%)means.
meanT
decreasedfrom
1.3to0.8hafter3wof
.........................
Thereisnopublishedexperienceinpregnancyorduringlactation.
...........................
PregnancyCategory:C
LactationCategory:U
shouldbeusedduringpregnancyandlactationonly
ifthebenefitjustifiesthepotentialperinatalrisk.
Therearealternativeagentsforwhichthereismoreexperience
regardinguseduringpregnancyandlactation.
InternationalBrandName—
Binasil(Korea);Curasil(Korea);Dermafin(Malaysia);Exifine(Malaysia);
Interbi(Indonesia);Labijin(Korea);Lamifen(Philippines);Lamisil(China,HongKong,India,Indonesia,Japan,Korea,
Malaysia,Philippines,Taiwan,Thailand);LamisilDermgel(France,NewZealand);Lapiderm(Korea);Lespo(Korea);
Onychomycosis—250mgPOqd
6w(fingernails)or12w
Tinea—250mgPOqd
NOTE:checkLFTsatbaseline;CBCcountif
—hypersensitivitytodrugorclass
—hepaticorrenaldysfunction
MaternalConsiderations
.....
Thereisnopublishedexperiencewith
Sideeffects
includehepaticfailure,hepatotoxicity,Stevens-Johnson
syndrome,erythemamultiforme,toxicepidermalnecrolysis,rash,
pruritus,neutropenia,headache,diarrhea,dyspepsia,nausea,
abdominalpain,constipation,flatulence,andurticaria.
enzyme,suchasTCAs,
-blockers,SSRIs,andMAO-Binhibitors,
iftheyhaveanarrowtherapeuticrange.
Increasestheclearanceof
by15%.
,aCYPinducer,increases
clearanceby
Asthma—5mgPOq6hprn;max15mg/d;or2puffsINHq4-6h;
or0.25mgSCq15-30min
Tocolysis—0.25mgSCq30min;max1mg/4h;or2.5-10mcg/min
IV,max30mcg/min
NOTE:availableinoral,inhaler,orparenteralforms.
—hypersensitivitytodrugorclass
and
Vulvovaginalcandidiasis—1applicator4%qhs
7d,or8%
or1suppositoryPVqhs
NOTE:availableincream(0.4%,0.8%)andsuppository(80mg).
—hypersensitivitytodrugorclass
MaternalConsiderations
.....
isamemberofaseriesofimidazoleswhose
effectivenessappearssimilar.Therearenoadequatereportsor
well-controlledstudiesof
inpregnantwomen.
appearstobemoreeffectivethan
treatingsymptomaticvaginalcandidiasisinpregnancy.Treatment
periodsof7dmaybenecessaryduringpregnancyratherthanthe
shortercoursestypicallyrecommended.
Sideeffects
includeirritation,headache,andpruritus.
noevidenceofteratogenicityorIUGRuntilthedoseexceeds
vaccinationhistory—250IUdeepIM;administerindifferent
Sideeffects
includeinjectionsitesoreness,fever,angioneurotic
edema,andnephroticsyndrome.
DosagewithQualifiers
.......
Bacterialinfection—1-2gqddividedbidorqidatleast1hac
or2hpc
infection—500mgPOqidatleast1hacor2hpc
Acnevulgaris—250-500mgPOqidatleast1hacor2hpc
NOTE:renaldosing;availableinoral,ointment(3%),and
parenteralformats.
—hypersensitivitytodrugorclass,
—hepaticorrenaldysfunction
MaternalConsiderations
.....
pericarditis,toothdiscolorationinprogeny,N/V,dyspepsia,
anorexia,diarrhea,photosensitivity,stomatitis,oraland/or
vulvovaginalcandidiasis,urticaria,lightheadedness,dizziness,
ataxia,tinnitus,headache,blurredvision,neutropenia,
thrombocytopenia,andincreasedBUN.
Erythemanodosumleprosum—begin100-300mgPO
2wor
untilsymptomsimprove,thendecreaseby50mg/dq2-4w
HIVwasting—100-300mgPOqhs
Aphthousulcer—200mgPOqd
NOTE:effectivecontraceptionobligatory1mobefore,during,and
until1moaftertherapy;documentnegativehCGtest24hpriorto
—hypersensitivitytodrugorclass,
pregnancy,moderate/severeneuritis
—seizuredisorder,reproductiveage,CVdisease
MaternalConsiderations
.....
isaknownhumanteratogenandcontraindicated
...........................
PregnancyCategory:X
LactationCategory:U
isaknownandpotenthumanteratogen.
Itshouldbeavoidedduringpregnancy,andpregnancy
terminationconsideredafterinadvertentexposure.
Chronicasthma—begin300mgPOqdindivideddosesbidortid
3d,then400mg/d
3d,then600mg/diftolerated
COPD(maintenance)—begin300mgPOqdindivideddosesbid
ortid
3d,then400mg/d
3d,then600mg/diftolerated
NOTE:therapeuticlevel10-20mcg/ml;existsinmultipleformatswith
varyingreleaserates.Dosingquotedfor
—hypersensitivitytodrugorclass,
arrhythmia,seizures,pepticulcerdisease
—hepaticorrenaldysfunction,hypothyroidism
MaternalConsiderations
.....
hastwodistinctactionsontheairwaysofwomen
withreversibleairwayobstruction:bronchodilationand
nonbronchodilatorprophylacticeffects.Although1%ofpregnant
womenhaveasthma,itisoftenunderrecognizedand
suboptimallytreated.Severe,uncontrolledasthmaincreasesthe
clearancebyinhibitingCYP3A3,causinglevelstorise25-35%.
steady-stateserumlevelsdecreasebyasimilar
Alargerdoseofbenzodiazepines(e.g.,
diazepam,flurazepam,
)mayberequiredtoproducethedesiredlevelof
sedationastheyincreaseCNSconcentrationsof
receptors.Cautionisindicated
shouldthe
bediscontinued.
—(Mintezol;Tiabendazole;Triasox)
InternationalBrandName—
Noneidentified.
DrugClass
..........................
.........................
Helminthicinfection,cutaneouslarvamigrans,viscerallarva
migrans,trichinosis,dracunculosis
.........................
DosagewithQualifiers
.......
Helminthic(systemicpinworm,whipworm,roundworm,
threadworm)infection—1.5gPOq12h
2d;max3g/d
Cutaneouslarvamigrans—25mg/kgPOq12h
5-7d;max3g/d
Viscerallarvamigrans—25mg/kgPOq12h
5-7d;max3g/d
Trichinosis—25mg/kgPOq12h
5-7d;max3g/d
Dracunculosis—25-37.5mg/kgPOq12h
3d;max3g/d
YoneyamaM,OgataA,FujiiT,HiragaK.FoodChemToxicol
1984;22:731-5.
...........................
PregnancyCategory:C
LactationCategory:U
shouldbeusedduringpregnancyandlactation
onlyifthebenefitjustifiesthepotentialperinatalrisk.
Thoughprobablynotasignificanthumanteratogen,itshould
beusedonlyasasecond-lineagent.
—(Actamin;Alivio;Anacrodyne;Benerva;Beneuril;
Wernicke’sencephalopathy—100mgIV
1,then50-100mg
IM/IVqd
Beriberi—10-20mgIMtid
DrugInteractions
................
Noclinicallyrelevantinteractionsidentified.
.........................
Acutenonlymphocyticleukemia—multipledosingregimens,
typicallyaspartofamultidrugprotocol
—hypersensitivitytodrugorclass
MaternalConsiderations
.....
Therearenoadequatereportsorwell-controlledstudiesof
inpregnantwomen.Thepublishedliterature
includesonlycasereports.
Sideeffects
includebonemarrowsuppression,hyperuricemia,
N/V,anorexia,stomatitis,intestinalnecrosisandperforation,
jaundice,andhepatomegaly.
DrugInteractions
................
Inductionandmaintenanceofanesthesia—
50-100mgIV,repeatasnecessaryforshort
surgicalprocedures
IncreasedICP—1.5-3.5mg/kgIVinpatientsbeingmechanically
hyperventilated;repeatasnecessarybeforecontinuousIVinfusion
orsubstitutionwith
—hypersensitivitytodrugorclass,porphyria
Caution
—hepaticorrenaldysfunction,severeCVdisease,
hypotension,increasedICP,myastheniagravis,statusasthmaticus
MaternalConsiderations
.....
isanultra-short-actingCNSdepressantinusefor
morethan60y.Itinduceshypnosisandanesthesia,butnot
analgesia.Recoveryafterasmalldoseisrapid,withsome
Refractoryschizophrenia—begin50-100mgPOqdafterbaseline
ECGandpotassium;max800mg/d
—hypersensitivitytodrugorclass,severe
hypertension,hypotension,prolongedQTinterval,arrhythmia,
CNSdepression,coma,narrow-angleglaucoma,electrolyte
imbalance,paralyticileus,GIobstruction,bonemarrow
depression,decreasedCYP2D6levels
—hepaticdysfunction,CVdisease,CNSdepressants,
seizures,Parkinson’sdisease
MaternalConsiderations
.....
Therearenoadequatereportsorwell-controlledstudiesof
inpregnantwomen.Thepublishedliteratureis
confinedtocasereports.
Sideeffects
includeparalyticileus,neurolepticmalignant
syndrome,tardivedyskinesia,torsadesdepointes,arrhythmia,
menstrualirregularities,cholestaticjaundice,blooddyscrasias,
seizures,QTintervalprolongation,drowsiness,drymouth,
constipation,nausea,blurredvision,akathisia,tremor,weight
gain,edema,galactorrhea,agranulocytosis,andskinorocular
Schizophrenia—begin2-5mgPOtid;max60mg/d
—hypersensitivitytodrugorclass,coma,
CNSdepression,blooddyscrasias
—seizures,glaucoma,alcoholwithdrawal,CAD
MaternalConsiderations
.....
Therearenoadequatereportsorwell-controlledstudiesof
inpregnantwomen.Thepublishedliteratureconsists
ofasinglecasereport.
Sideeffects
includeneurolepticmalignantsyndrome,seizures,tardive
dyskinesia,agranulocytosis,drows
iness,restlessness,agitation,
insomnia,hypotension,blurredvision,drymouth,acutewithdrawal
syndrome,tachycardia,photosensitivity,andelevatedLFTs.
Complexpartialseizures—begin4mgPOqd,increaseprnto
56mg/dindivideddoseswithfood
NOTE:taperslowlytoavoidwithdrawalseizures.
—hypersensitivitytodrugorclass
—hepaticdysfunction,EEGspike/wave
MaternalConsiderations
.....
isa2nd-generationanticonvulsantfrequently
employedasadjuncttherapy.Itisnotanenzymeinducer,and
PopulationpKanalysesalsoindicatethat
clearanceis
60%greaterinpatientstaking
significantlydecreased
invitro
96.3%to94.8%,resultingina40%increaseinthefree
concentration.Theclinicalrelevanceofthis
invitro
findingis
ishighlyproteinbound(96%),ithasthepotential
tointeractwithotherhighlyproteinboundcompounds.Suchan
interactioncanpotentiallyleadtohigherfreefractionsofeither
Bacterialinfection—3-4gIV/IMq4-6h,or200-300mg/kgIV
dividedq4-6h;max24g/d
NOTE:renaldosing;maybecombinedwith
(Timentin)toextendbacterialcoverage.
—hypersensitivitytodrugorclass
—cephalosporinallergy,renaldysfunction,seizures,
sodiumrestriction,bleedingdisorder
MaternalConsiderations
.....
isanextended-spectrumpenicillin.Itisprimarily
indicatedforgram-negativeinfectionsandisoftencombined
withanaminoglycoside.Clavulanicacidisa
-lactamthat
inactivatesawiderangeof
-lactamaseenzymescommonly
foundinmicroorganismsresistanttopenicillinsand
cephalosporins.Thecombinationof
hasa
microbiologicspectrumsimilarto
Therearenoadequatereportsorwell-controlledstudiesof
inpregnantwomen.Likeotherantibiotics,itreduces
butitdoesaccumulateinthefetalcompartmentovertime.Rodent
studiesarereassuring,revealingnoevidenceofteratogenicityor
IUGRdespitetheuseofdoseshigherthanthoseusedclinically.
Thromboticstrokeprophylaxis—250mgPObidwithmeals
—hypersensitivitytodrugorclass,severe
hepaticdysfunction,activebleeding,blooddyscrasias
—mildtomoderatehepaticdysfunction
MaternalConsiderations
.....
potentiatestheeffectof
orotherNSAIDs
Hypertension—begin10mgPObid;max60mg/d
Angina—5-15mgPOtid
AcuteMI—10mgPObidwithin4wofMI
Migraineprophylaxis—10mgPObid
Elevatedintraocularpressure—1gttqdorbid
—hypersensitivitytodrugorclass,CHF,
bradycardia,2ndor3rddegreeheartblock,asthma,
cardiogenicshock
...........................
PregnancyCategory:C
LactationCategory:S
shouldbeusedduringpregnancyandlactationonly
ifthebenefitjustifiesthepotentialperinatalrisk.
Therearealternativeagentsforwhichthereismoreexperience
regardinguseduringpregnancyandlactation.
InternationalBrandName—
Innohep(Argentina,Belgium,Canada,Colombia,CostaRica,Denmark,
DominicanRepublic,ElSalvador,England,France,Germany,Guatemala,Honduras,HongKong,Ireland,Israel,
DVT—175anti-XaIU/kgSCqdatleast6dinhospitalized
patients;overlapwith
untiltherapeuticINR
NOTE:renaldosing.
—hypersensitivitytodrugorclass,
hypersensitivitytoporkproducts,activeorrecentbleeding,
conductionanesthesia,thrombocytopenia,historyof
heparin-inducedthrombocytopenia
—bleedingtendency,recentmajorsurgery,bacterial
teratogenicityorIUGRdespitetheuseofdoseshigherthan
thoseusedclinically.
Spasticity—4-8mgPOq8hprn;max36mg/d
NOTE:renaldosing.
NOTE:taperslowlytominimizetheriskofwithdrawaland
reboundhypertension,tachycardia,andhypertonia.
hypersensitivitytodrugorclass
renaldysfunction,oralcontraceptives
MaternalConsiderations
.....
iseffectiveforthetreatmentoftensionheadacheand
thespasticityassociatedwithMS.Sedationiscommon.Thereare
noadequatereportsorwell-controlledstudiesinpregnant
humanplacenta.Rodentstudiesarepredominantlyreassuring,
thoughthedosestestedwereonlymodestmultiplesofthe
MRHD.Theyrevealsomeevidenceofprolongedpregnancyand
Bacterialinfections—3-5mg/kg/dindivideddoses
Endocarditisprophylaxis—1.5mg/kgIV30-60minpre-procedure
Cysticfibrosis—300mgNEBq12hfollowing28don/offcycles
Ocularinfection—1-2gttOS/ODq4-6h
NOTE:peak4-12mcg/ml,trough0.5-2mcg/mlafterparenteraluse.
—hypersensitivitytodrugorclass
—myastheniagravis,vestibular/cochlearimplant,
nephrotoxicagents,renaldysfunction
MaternalConsiderations
.....
Therearenoadequatereportsorwell-controlledstudiesof
inpregnantwomen.Theclearanceof
duringpregnancyandthepuerperiumisincreased,requiring
3mg/kgormoretoobtainadequatepeakandtroughlevels.
Sideeffects
includenephrotoxicity,ototoxicity,neurotoxicity,
pseudotumorcerebri,enterocolitis,diarrhea,N/V,pruritus,rash,
weakness,tremor,musclecramps,anorexia,headache,edema,
increasedsalivation,tinnitus,vertigo,agranulocytosis,
thrombocytopenia,elevatedBUN/Cr,andmuscleweakness.
DosagewithQualifiers
.......
Ventriculararrhythmia—begin400mgPOq8h;max2g/d;
alternately,7.5-11.3mg/kgIVover15min
—hypersensitivitytodrugorclass,CHF,
2ndor3rddegreeheartblock,hepaticorrenaldysfunction
MaternalConsiderations
.....
issimilarto
Thereisnopublished
experiencewith
duringpregnancy.
Sideeffects
includeblooddyscrasias,pulmonaryfibrosis,CHF,
ventriculararrhythmia,respiratoryarrest,pulmonaryedema,
pneumonitis,dizziness,N/V,diarrhea,rash,nervousness,tremor,
confusion,anorexia,moodchanges,ataxia,blurredvision,
paresthesias,arthritis,tachycardia,andhypotension.
activityshouldbestressed,andCVriskfactorsidentifiedand
correctedifpossible.Whenthisapproachfails,oralhypoglycemic
agentsmaybeindicated.
isafirst-generation
sulfonylurea.Sulfonylureasmaybeassociatedwithanexcessof
CVdeath.Therearenoadequatereportsorwell-controlled
studiesof
inpregnantwomen.Additionalstudyis
necessary.Otheroralhypoglycemicagents(e.g.,
)are
poorlytransportedacrosstheplacenta.
Sideeffects
includehypoglycemia,nausea,epigastricfullness,
heartburn,leukopenia,agranulocytosis,thrombocytopenia,
hemolyticanemia,aplasticanemia,pancytopenia,pruritus,
erythema,urticaria,andmorbilliformormaculopapulareruptions.
—(Aglicem;Aglycid;Ansulin;Diabecid-R;
Diabetesmellitustype2—1-2gPOqdindivideddoses;max3g/d
—hypersensitivitytodrugorclass,IDDM
soletherapy,DKA
—hypersensitivitytosulfonamides
MaternalConsiderations
.....
Certaindrugs(e.g.,calciumchannel–blockingdrugs,
corticosteroids,estrogens,
isoniazid,nicotinicacid,
contraceptives,phenothiazines,
Osteoarthritis—200-600mgPOwithfoodtid;max1800mg/d
Rheumatoidarthritis—200-600mgPOwithfoodtid;max
—hypersensitivitytodrugorclass,
ASA/NSAID-inducedasthma
—nasalpolyps,GIbleeding,hypertension,CHF
MaternalConsiderations
.....
Therearenoadequatereportsorwell-controlledstudiesof
Somebonedemineralizationisseenatthehighestdoses.Other
drugsinthisclassareknowntocauseconstrictionoftheductus
inutero.
Thereisnoreasontoexpect
Overactivebladder—2mgPObid
NOTE:hepaticdosing.
—hypersensitivitytodrugorclass,
narrow-angleglaucoma,gastricobstruction
—hepaticorrenaldysfunction
MaternalConsiderations
.....
Thereisnopublishedexperiencewith
pregnancy.Thereisalsoprobablynoindicationforitsuse
duringpregnancy.
Sideeffects
includeanticholinergicpsychosis,drymouth,headache,
dyspepsia,constipation,dryeyes,dizziness,blurredvision,
somnolence,chestpain,cough,tachycardia,andperipheraledema.
embryotoxicity,IUGR,andbirthdefects,includingcleftpalate
Seizures,adjuncttherapy—25-50mgPOqd,increase25-50mg/w;
usualdose400mg/dindivideddoses
NOTE:renaldosing.
—hypersensitivitytodrugorclass,hepatic
MaternalConsiderations
.....
anticonvulsantssuchas
Thescientificsupportfor
thispracticeisweak.
Sideeffects
includenephrolithiasis,acutemyopia,secondary
angle-closureglaucoma,dizziness,somnolence,fatigue,language
problems,memorydifficulty,psychomotorslowing,nervousness,
ataxia,nystagmus,depression,diplopia,mooddisturbances,
paresthesias,tremor,weightloss,confusion,abdominalpain,
agitation,andURI.
—(Demadex;Presaril)
InternationalBrandName—
Toral(Indonesia);Torem(England,Germany,Korea,Sweden,Switzerland);
Unat(Chile,Germany,HongKong,Indonesia,Portugal,SouthAfrica,Thailand)
DrugClass
..........................
Hypertension—5mgPOqd
DiuresisforCHF—10-20mgPO/IVqd,doubleuntildesired
response;max200mg/d
Diuresisforrenalfailure—20mgPO/IVqd,doubleuntildesired
response;max200mg/d
Diuresisforhepaticfailure—5-10mgPO/IVqd,doubleuntil
desiredresponse;max40mg/d
—hypersensitivitytodrugorclass,
hypersensitivitytosulfonylureas
—hypersensitivitytosulfonamides,hepaticorrenal
MaternalConsiderations
.....
Thereisnopublishedexperiencewith
.........................
Thereisnopublishedexperienceinpregnancyorduringlactation.
...........................
PregnancyCategory:B
LactationCategory:U
shouldbeusedduringpregnancyandlactationonly
ifthebenefitjustifiesthepotentialperinatalrisk.
Therearealternativeagentsforwhichthereismoreexperience
regardinguseduringpregnancyandlactation.
—(Adamon;Ultram)
InternationalBrandName—
Adamon(Argentina,CostaRica,DominicanRepublic,ElSalvador,Guatemala,
Honduras,Nicaragua,Panama);Amanda(Thailand);Analab(Malaysia,Thailand);Analdol(Israel);Andalpha(Indonesia);
Bellatram(Indonesia);Biodalgic(France);Calmador(Argentina);Calmol(Uruguay);Contramal(Belgium,France,Hungary,
India,Italy);ContramalLP(France);Dolana(Indonesia);Dolika(Indonesia);Dolmal(Philippines);Dolotral(Philippines);
Dromadol(England);Eufindol(Chile);Exopen(Korea);Katrasic(Indonesia);KontramXLSR(Korea);Mabron(China,
Israel,Singapore,Thailand);Mosepan(Philippines);Newdorphin(Philippines);Nonalges(Indonesia);Omnidol(Colombia);
O.P.Pain(Korea);Pengesic(Malaysia,Philippines,Singapore);Penimadol(Korea);Prontofort(Mexico);Radol(Indonesia);
Rofy(Thailand);Sefmal(HongKong,Singapore);Sensitram(Brazil);Takadol(France);Tamolan(Thailand);Tandol(Korea);
Tarol(Israel);Topalgic(France);Trabar(Israel);Trabilan(Malaysia);Trabilin(CostaRica,ElSalvador,Guatemala,Honduras,
Nicaragua,Panama);Tradol(Mexico);Tradol-Puren(Germany);Tradonal(Philippines);Tralic(Mexico);Tramada(Malaysia);
Moderatetoseverepain—50-100mgPOq4-6hprn
NOTE:renalandhepaticdosing.
hypersensitivitytodrugorclass,alcohol
ordruguse
historyofsubstanceabuse,CNSdepressantuse,
respiratorydepressantuse,respiratorydepression,seizures,
headinjury,increaseICP,acuteabdomen,hepaticorrenal
MaternalConsiderations
.....
isacentrallyactinganalgesic.Therearenoadequate
reportsorwell-controlledstudiesof
inpregnant
women.Thereareafewstudiesusingitintrathecally.Asingle
studycomparing
forlaboranalgesia
Sideeffects
includedependency,seizures,angioedema,
bronchospasm,respiratorydepression,Stevens-Johnsonsyndrome,
toxicepidermalnecrolysis,orthostatichypotension,serotonin
syndrome,hallucinations,suicidalideation,dizziness,N/V,
InternationalBrandName—
Gopten(Colombia,CzechRepublic,Denmark,England,Finland,France,
Hypertension—begin1-2mgPOqd;max8mg/d
CHF—begin0.5mgPOqd;max4mg/d
NOTE:renalandhepaticdosing;maybecombinedwith
(Tarka;1tabPOqdorbid)forthetreatmentofhypertension.
—hypersensitivitytodrugorclass;history
ofACEI-induced,hereditary,oridiopathicangioedema
—severeCHF,renalarterystenosis,collagenvascular
ofBPafterinitiationoftherapywith
Thispossibilitymaybeminimizedbyeitherdiscontinuingthe
Depression—30mgPOqd,increaseby10mg/dq1-3w;
max60mg/d
NOTE:withdrawslowly.
—hypersensitivitytodrugorclass,
alcoholism,CHF,severehepaticorrenaldysfunction,
pheochromocytoma,narcoticuse,alcoholuse,ingestionof
cheeseorotherfoodswithahightyraminecontent,excessive
caffeineintake
MaternalConsiderations
.....
Depressioniscommonduringandafterpregnancy,buttypically
goesunrecognized.Pregnancyisnotareason
apriori
discontinuepsychotropicdrugs.
isbestsuited
forpatientswhohavefailedtorespondtodrugsmorecommonly
usedfordepression.Thereisnopublishedexperiencewith
duringpregnancy.ItsinhibitionofPGI
Depression—begin150mgPOwithmealsqdorindivideddoses,
andincreaseby50mgq3duntildesiredeffect;max400mg/d
—hypersensitivitytodrugorclass,recent
acuteMI
—suiciderisk,CNSdepressants,antihypertensiveuse,
electroconvulsivetherapy,arrhythmia
MaternalConsiderations
.....
Depressioniscommoninreproductive-agewomenandfrequently
overlookedorminimizedbythecareprovider.Thereisnoreason
apriori
todenyindicatedtreatmentduringpregnancy.
Thepublishedexperiencewith
duringpregnancyis
limitedbutreassuring.Inonereport,levelswerelowerinthe1st
and2ndtrimesterscomparedtothe3rd.Theeliminationt/2was
unchangedthough.
Sideeffects
includehypotension,syncope,drowsiness,bittertaste,
drymouth,N/V,headache,blurredvision,fatigue,arthralgia,
incoordination,andtremor.
Pulmonaryhypertension—begin1.25ng/kg/mincontinuousSC
infusion;increasedinincrementsnomorethan1.25ng/kg/min/w
forfirst4w,thennomorethan2.5ng/kg/min/wforremaining
durationdependingonclinicalresponse.
NOTE:hepaticdosing.
—hypersensitivitytodrugorclass
—abruptwithdrawal,hepaticorrenaldysfunction
MaternalConsiderations
.....
Significantpulmonaryhypertensionisassociatedwithahigh
maternalmortalityrateduringtheperipartum.Thereisno
publishedexperiencewith
duringpregnancy.
Sideeffects
includereboundpulmonaryhypertension,infusion
sitereaction,headache,diarrhea,nausea,rash,vasodilation,
jawpain,dizziness,edema,pruritus,andhypotension.
Acnevulgaris—applyqhs30minafterwashinganddryingskin
Acutepromyelocyticleukemia—45mg/m
/dPOgiveninevenly
remissionorafter90doftreatment;continueeffective
patientshouldbeplacedontworeliableformsofcontraception.
Pregnancytestingandcontraceptioncounselingshouldbe
repeatedmonthlythroughouttheperiodof
Adrenalinsufficiency—4-12mgPOqd
Inflammatorydisorders—4-48mgPOindivideddosesqd
Chronicasthma—2puffsINHtidorqid,rinsemouthafteruse;
max16puffsqd
Allergicrhinitis—1-2sprays/nostrilqd;max2sprays/nostrilqd;
discontinueafter3wifnoimprovement
Steroid-responsivedermatitis—applysparinglytoaffectedarea
bidtoqid
NOTE:availableinoral,topical,andinhalationalforms.
—hypersensitivitytodrugorclass,systemic
fungalinfection
Peripheraledema—100mgPObidpc
—hypersensitivitytodrugorclass,
hyperkalemia,otherpotassium-sparingagents
clefts,andurinarytractdefects.Itcrossestherodentplacenta.
Rodentstudiesarereassuring,revealingnoevidenceof
teratogenicityorIUGRdespitetheuseofdoseshigherthan
thoseusedclinically.
DosagewithQualifiers
.......
Insomnia,shortterm—0.25mgPOqhs
NOTE:hepaticdosing.
—hypersensitivitytodrugorclass
—hepaticdysfunction,CNSdepression,substance
MaternalConsiderations
.....
Therearenoadequatereportsorwell-controlledstudiesof
inpregnantwomen.Thepublishedliteratureconsists
ofscatteredcasereports.
Sideeffects
includedependency,reboundinsomnia,behavioral
—(Calmazine;Flupazine;Novoflurazine;
Stelazine;Suprazine;Tfp)
InternationalBrandName—
Eskazine(Spain);Espazine(India);Fluperin(Bulgaria);Flurazin(Taiwan);
Schizophrenia—begin1-2mgPObid;typicaldose2.5mgPObid;
max40mg/d
...........................
PregnancyCategory:C
LactationCategory:S
shouldbeusedduringpregnancyandlactation
onlyifthebenefitjustifiesthepotentialperinatalrisk.
Asformostpsychotropicdrugs,usingmonotherapyandthe
lowesteffectivequantitygivenindivideddosestominimizethe
peakscanminimizetherisks.
Therearealternativeagentsforwhichthereismoreexperience
regardinguseduringpregnancyandlactation.
N/V—300mgPOtidorqid,or200mgPR/IMtidorqid
—hypersensitivitytodrugorclass
MaternalConsiderations
.....
Therearenoadequatereportsorwell-controlledstudiesof
UTI—100mgPOq12h
UTIprophylaxis—100mgPOqhs
Traveler’sdiarrhea—200mgPObid
PCPtreatment—20mg/kg/dPOindivideddoses
NOTE:renaldosing;oftencombinedwith
islimited.Thecombinationof
Bacterialinfection—2tab(SS)or1tab(DS)PObid,or
PCPtreatment—15-20mg/kg
PCPprophylaxis—2tab(SS)or1tab(DS)POqd
Acuteotitismedia—4-5mg/kg
trimethoprim
IVq12h;max960mg/d
MaternalConsiderations
.....
Bacteriuria,withorwithoutclinicalsymptoms,iscommon
duringpregnancy.Ifleftuntreated,20-30%ofpatientsdevelop
Occasionalreportssuggestthatpatientsreceiving
PCPtreatment—45mg/m
IVqd
21dgivenwith
—hypersensitivitytodrugorclass
—bonemarrowdepression,hepaticorrenal
MaternalConsiderations
.....
BreastfeedingiscontraindicatedinHIV-infectednursingwomen
whereformulaisavailabletoreducetheriskofneonatal
DrugInteractions
................
DrugsthatalterCYPmayelicitimportantdrug-druginteractions
thatmayalter
Depression—begin50-75mgPOqd;max300mg/d
NOTE:taperslowly;donotswitchrapidlytoandfromSSRIs.
—hypersensitivitytodrugorclass,acuteMI,
—seizures,hepaticdysfunction,glaucoma
MaternalConsiderations
.....
Depressioniscommonduringandafterpregnancy,buttypically
goesunrecognized.Pregnancyisnotareason
apriori
discontinuepsychotropicdrugs.Thereisnopublishedexperience
duringpregnancy.
Sideeffects
DrugInteractions
................
.........................
NonselectiveH
DosagewithQualifiers
.......
Allergy—100mgPObidSR;alternatively,25-50mgPOq4-6h
immediaterelease
—hypersensitivitytodrugorclass,MAOI
14d,narrow-angleglaucoma,asthma,GIobstruction
—increasedintraocularpressure,hyperthyroidism,CV
disease,hypertension
MaternalConsiderations
.....
This1stgenerationantihistamineisoftenpairedillicitlywith
toproduceeuphoria.KnownasT’sandBlues,users
haveagreaterriskofadversepregnancyoutcome.Thereareno
adequatereportsorwell-controlledstudiesof
pregnantwomen.
Sideeffects
includedrowsiness,drymouth/nose/throat,thickening
.........................
Bactericidal;inhibitsDNAgyraseandtopoisomeraseIV
DosagewithQualifiers
.......
Bacterialinfection—begin200-300mgIVqd
1,thenswitchto
200mgPOqd
NOTE:hepaticdosing.
—hypersensitivitytodrugorclass
—hepaticorrenaldysfunction,seizures,CNSdisorder,
InternationalBrandName—
Noneidentified.
DrugClass
..........................
Adjuncttogeneralanesthesia—0.5mg/kgIVforabdominal
relaxationornonemergenttrachealintubation;mayrepeat
0.1mg/kgq40-60minasindicatedbyresponsetotrain-of-4
peripheralnervestimulation
Diagnosisofmyastheniagravis—0.02-0.04mg/kgIVfollowed
by2mg
—hypersensitivitytodrugorclass
—renalorhepaticdysfunction,CVdisease,
MaternalConsiderations
.....
istheactiveingredientofthecurare-producing
Chondodendrontomentosum.
Nondepolarizingrelaxantsare
longeractingthandepolarizingmusclerelaxants.Whilethereare
noadequatereportsorwell-controlledstudiesof
pregnantwomen,thereisalongclinicalexperience.
therapyprolongstheeffectof
agentssuchas
havegenerallybeen
DrugInteractions
................
Highparenteraldosesofcertainantibiotics(e.g.,aminoglycosides
gentamicin,kanamycin,neomycin,streptomycin
polymyxinB,
InternationalBrandNames—
IncreasedICP—1-1.5g/kgIVover1-3h;max120g/d
Increasedintraocularpressure—1-1.5g/kgIVover1-3h;
max120g/d
SIADH—80gIVover6h
—hypersensitivitytodrugorclass,
dehydration,hepaticfailure,intracranialhemorrhage,renal
dysfunction,lowerextremityinfusion
—CVdisease
MaternalConsiderations
.....
Therearenoadequatereportsorwell-controlledstudiesof
inpregnantwomen.Intra-amniotic
isavaluableadjunctfor
latepregnancytermination.Thereisnopublishedexperiencein
pregnantwomenfortheremaininglistedindications.
Sideeffects
includeheadache,N/V,syncope,disorientation,and
injectionsitereaction.
InternationalBrandName—
PE—begin4400IU/kgIVover10min,then4400IU/kgqh
within7d
Coronaryarterythrombosis—load
2500-10,000UIV,
then6000IU/minIVuntillysis(upto2h,average500,000IU)
DrugInteractions
................
Gallstonedissolution—8-10mg/kg/dPOindivideddoses;
monitorresponseq6mobyultrasound,andcontinuedrugfor
3moafterdissolution
Gallstoneprevention—300mgPObidforobesewomenlosing
Primarybiliarycirrhosis—13-15mg/kg/dPOindivideddoses
withfood
Primarysclerosingcholangitis—25-30mg/kg/dPOindivided
doseswithfood
Nonalcoholicsteatohepatitis—10-15mg/kg/dPOindivideddoses
withfood
—hypersensitivitytodrugorclass,
hypersensitivitytobileacids,unremittingacutecholecystitis,
acutecholangitis,biliaryobstruction,gallstonepancreatitis,
biliary-GIfistula,calcified/radiopaque/radiolucentgallstones
MaternalConsiderations
.....
(ursodeoxycholicacid)isanaturallyoccurringhuman
bileacidfoundinsmallquantities,butfoundinlargequantities
inthebileofcertainbears.Smallseriessuggestitcanbeeffective
forthetreatmentofcholestasisofpregnancy(approximately
16mg/kg).Intrahepaticcholestasisofpregnancyisadiagnosisof
exclusion.Itisassociatedwithincreasedperinatalmorbidityand
mortality.Pruritusandpostpartumhemorrhagearethemain
causesofmaternalmorbidity.Currentmanagementfocuseson
InternationalBrandName—
Rapivir(Mexico);Valcyclor(Colombia);Zelitrex(France,SouthAfrica)
DrugClass
..........................
.........................
Genitalherpes,herpeszoster
.........................
InhibitsDNApolymerase
DosagewithQualifiers
.......
Genitalherpes—
1000mgPObid
PObid
1000mgPOqd
Herpeszoster—1000mgPOtid
NOTE:renaldosing.
—hypersensitivitytodrugorclass,immune
—renaldysfunction
MaternalConsiderations
.....
Afteringestion,
valacyclovir
ismetabolizedtoandactuallyenhances
acyclovir
bioavailability.ItiseffectiveandwelltoleratedforHSV
suppressionforupto10yofcontinuo
ususe.Neonatalherpesaffects
1/15,000newborns.Thevastmajorityofinfectedinfantsarebornto
womenwithaprimaryinfectionduringpregnancy.Whilethereare
noadequatereportsorwell-controlledstudiesof
pregnantwomen,itisusedextensiv
elyforthelistedindications.If
initiatedprophylacticallyat36w,
reducesboththeriskof
recurrenceandthefrequencyofapositivecervicalcultureatdelivery
inwomenwhoexperienceeitheraprimaryinfectionoratleastone
secondaryepisodeduringpregnancy.Thereisinsufficientevidenceto
Osteoarthritis—10mgPOqd
Rheumatoidarthritis—10mgPOqd
Dysmenorrhea—20mgPObid
—hypersensitivitytodrugorclass,
hypersensitivitytoASA,NSAIDs,ASA/NSAID-inducedasthma
orurticaria,hepaticfailure,severerenaldysfunction
—CHF,hypertension,nasalpolyps,pepticulcer
disease,historyofGIbleeding,hepaticorrenaldysfunction,
concernswereraisedaboutpossibleincreasedrisksofMIandCVA.
Thereisnopublishedexperiencewith
duringpregnancy.
Itsadditionaftercesareandeliveryunderspinalanesthesiawith
intrathecal
doesnotimproveoutcome.Ithasnoeffecton
...........................
PregnancyCategory:C
LactationCategory:U
shouldbeusedduringpregnancyandlactation
onlyifthebenefitjustifiesthepotentialperinatalrisk.
Therearealternativeagentsforwhichthereismoreexperience
regardinguseduringpregnancyandlactationandcircumvent
anyconcernsofincreasedrisksofMIandCVA.
InternationalBrandName—
Valixa(Colombia)
DrugClass
..........................
.........................
—(Depacon;Epival)
InternationalBrandName—
Convulex(Germany);Depakin(Bulgaria,Turkey);Depakine(Austria,Belgium,
Seizures—10-15mg/kg/dIVindivideddosesqdtotid,increase
by5-10mg/kg/dq7dtoachievetherapeutictroughof
50-100mcg/ml;max60mg/kg/d
NOTE:switchtoPOwhenfeasible.
—hypersensitivitytodrugorclass,hepatic
diseaseordysfunction
—renaldysfunction,bonemarrowsuppression,
evaluatewomentaking
duringpregnancy.Asformost
psychotropicdrugs,monotherapyandthelowesteffective
quantitygivenindivideddosestominimizethepeakscan
especiallyalongwithotherAEDs,shouldbemonitoredforchanges
intheserumconcentrationsofbothdrugs.
Increasestheeliminationt/2of
by165%.The
doseshouldbereduced.Seriousskinreactions(such
asStevens-Johnsonsyndromeandtoxicepidermalnecrolysis)
havebeenreportedinassociationwiththiscombination.
Increasesthet/2of
by50%anddecreasedthe
plasmaclearanceby
.Thefractionof
decreasedasappropriate.
Valproicacid
—(Depakene;Myproicacid)
InternationalBrandName—
Atemperator(Ecuador);Convulex(Austria,Belgium,Bulgaria,CzechRepublic,
England,Ireland,Russia,Singapore,SouthAfrica,Switzerland,Taiwan);Depakene(Japan);Depakin(Italy);Depakine
(Russia,Taiwan,Venezuela);Epilim(Malaysia);EpilimChrono500(Malaysia);Leptilan(Portugal);Orfiril(Germany);
Valpakine(CostaRica,ElSalvador,Guatemala,Honduras);Valporal(Israel);Valprosid(Mexico)
DrugClass
..........................
Anticonvulsants;Bipolaragents;Migraineagents
.........................
Seizures,mania,migraineprophylaxis
.........................
DosagewithQualifiers
.......
Seizures—10-15mg/kg/dPOwithmealsindivideddosesqdto
tid,increaseby5-10mg/kg/dq7dtoachievetherapeutictroughof
50-100mcg/ml;max60mg/kg/d
Mania—10-15mg/kg/dPOwithmealsindivideddosesqdtotid,
increaseby5-10mg/kg/dq7dtoachievetherapeutictroughof
50-100mc/ml;max60mg/kg/d
Migraineprophylaxis—250-500mgPOwithmealsbid
—hypersensitivitytodrugorclass,hepatic
diseaseordysfunction
—renaldysfunction,bonemarrowsuppression,
Increasestheeliminationt/2of
by165%.The
doseshouldbereduced.Seriousskinreactions(such
asStevens-Johnsonsyndromeandtoxicepidermalnecrolysis)
havebeenreportedinassociationwiththiscombination.
Increasesthet/2of
by50%anddecreasedthe
plasmaclearanceby
.Thefractionof
decreasedasappropriate.
InternationalBrandName—
Nisis(France);Provas(Germany);Tareg(France)
DrugClass
..........................
.........................
.........................
SelectiveAT-1antagonist
DosagewithQualifiers
.......
Hypertension—begin80-160mgPOqdifmonotherapy;max
—hypersensitivitytodrugorclass
—CHF,historyofACEI-inducedangioedema,renal
.........................
Bacterialinfections—500mgIVq6h;peak25-40mcg/ml,trough5-
Endocarditisprophylaxis—1gslowIVover1h
NOTE:renaldosing.
—hypersensitivitytodrugorclass
—hepaticorrenaldysfunction,hearingloss,
nephrotoxicagents
MaternalConsiderations
.....
ismostcommonlyusedforthetreatmentofMRSA
infections.Therearenoadequatereportsorwell-controlled
studiesof
inpregnantwomen.Inoneseries,adverse
eventswerecommon,suggestingthatlongerinfusiontimesand
weight-adjusteddosesshouldbeused.Itisusedasasecond-line
ototoxicity,chills,fever,nausea,tinnitus,superinfection,urticaria,
rash,‘‘redman’’syndrome,andphlebitis.
DosagewithQualifiers
.......
Varicellasusceptibility—0.5mlSCandasecond0.5mlSCin4-8w
—hypersensitivitytodrugorclass;blood
dyscrasias;leukemia,lymphomas,orothermalignant
neoplasmsaffectingthebonemarroworlymphaticsystems;
immunesuppressionorcompromise(acquiredorcongenital);
febrileillness;activeTB
—acutelymphocyticleukemiainremission
MaternalConsiderations
.....
(PCR)inanyofthe217postvaccinationbreastmilkspecimens.
Noneoftheinfantswasseropositive.Samplesfrom6infants
weretestedforvaricella-zostervirusDNAbyPCR,andallwere
Varicellasusceptibilityandexposure—625UIM
—hypersensitivitytodrugorclass,severe
thrombocytopeniaifIM
—avoidintravascularinjection
MaternalConsiderations
.....
well-controlledstudiesof
varicella-zosterimmuneglobulin
pregnantwomen.Thereisnoevidencethatadministrationtoa
InternationalBrandName—
Pitressin(Australia,England,Germany,HongKong,Indonesia,Ireland,Taiwan);
Pressyn(Canada);Vasopin(India)
DrugClass
..........................
Abdominaldistention—5-10UIMq3-4hprn
Abdominalradiographs—5-15UIM/IV2hand30min
Renalbiopsy—5-15UIM/IV2hand30minpreoperatively
GIhemorrhage—0.2-0.4U/minIV
ACLS,VF/pulselessventriculartachycardia—40UIV
—hypersensitivitytodrugorclass
—CHF,CAD,severehepaticdisease,renaldysfunction,
asthma,migraine
MaternalConsiderations
.....
V1receptorsarewidelydistributedinsmoothmuscle,including
Paralysis—begin0.08-0.1mg/kgIV,then25-45minafterload,
0.01-0.015mg/kgIVq15-30minasindicatedbytrain-of-4
peripheralnervestimulation
—hypersensitivitytodrugorclass,
bronchogeniccarcinoma
—hepaticdysfunction,hypovolemia
MaternalConsiderations
.....
isanondepolarizingneuromuscularblocker.There
arenoadequatereportsorwell-controlledstudiesof
inpregnantwomen.Popularduringcesareandeliveryasan
adjuncttogeneralanesthesia,itseffectmaybeprolongedbythe
concurrentadministrationof
magnesiumsulfate
andpossibly
Sideeffects
includearrhythmia,tachycardia,bradycardia,
hypotension,bronchospasm,andflushing.
DrugInteractions
................
mayenhancetheneuromuscularblockingeffect
andprolongitsduration.If
istobeused,the
shouldbedelayeduntilthe
signsofwearingoff.
Othernondepolarizingneuromuscularblockingagents
Depression—begin37.5mgPOwithmealsbidandincrease
q4hasneeded;max375mg/d
NOTE:hepaticandrenaldosing;taperover2w.
—hypersensitivitytodrugorclass,
—hepaticorrenaldysfunction,seizures,historyof
mania,suiciderisk
MaternalConsiderations
.....
Depressioniscommonduringandafterpregnancy,buttypically
goesunrecognized.Pregnancyisnotareason
apriori
discontinuepsychotropicdrugs.Therearenoadequatereports
orwell-controlledstudiesof
inpregnantwomen.In
onewoman,theeliminationt/2declinedfrom8.7hto3.2hfrom
the1stto3rdtrimesters.Plasmalevelslikewisedeclined.
maybeeffectiveforthetreatmentofother
disorders,includingOCD,panicdisorder,eatingdisorders,
substanceabuse,headaches,hotflashes,andchronicpain
(includingneuropathicpain).
Sideeffects
includeseizures,headache,N/V,diarrhea,
Angina—80-480mgPOtid;max480mg/d
Hypertension—begin80mgPOtid;max480mg/d
Supraventriculararrhythmia—80-120mgPOtid;max480mg/d;
alternativeforparoxysmalSVT:
2.5-5mgIVpush,mayrepeatas
dictatedbyresponse
Atrialflutter/fibrillation—80-120mgPOtidorqid;max480mg/d
Migraineprophylaxis—80mgPOtid;adjustdosebasedoneffect
NOTE:renaldosing.
—hypersensitivitytodrugorclass,severe
hypotension,cardiogenicshock,severeLVdysfunction,2ndor
3rddegreeAVblock,atrialfibrillation/flutterwithbypasstract,
sicksinussyndrome
—bradycardia,CHF,hepaticorrenaldysfunction,
musculardystrophy,myastheniagravis,GERD
MaternalConsiderations
.....
Inadditiontothelistedindications,
verapamil
isusedinsome
localesforthetreatmentofbipolardisorderandfortocolysisin
womenwithpretermlabor.Therearenoadequatereportsorwell-
controlledstudiesof
verapamil
inpregnantwomen.Thereisno
randomizedorcase-controlstudyusing
verapamil
astheprimary
tocolytic,andthepracticeofcombiningitwitha
-blockerhas
beenappropriatelyabandoned.Isolatedcasereportsdescribeits
successfulusetotreatmaternalSVT.Therearealsorarereportsof
itsusetotreatpreeclamptichypertension,thoughthereisno
suggestionitoffersadvantagesoverother,morecommonlyused
antihypertensives.Clearanceisnotalteredintherabbitpregnancy.
Asymptomaticbradycardia(36bpm)withawanderingatrial
pacemakerhasbeenobservedinapatientreceivingconcomitant
-adrenergicblocker)eyedropsandoral
Maydecreaseintheclearanceof
disopyramide
shouldnotbeadministered
within48hbeforeor24hafter
administration.
Usewith
mayhaveadditivenegativeinotropiceffects
andprolongAVconduction.
Inasmallnumberofpatientswithhypertrophiccardiomyopathy
(IHSS),concomitantuseof
resultedin
significanthypotension.Untilfurtherdataareobtained,this
combinationshouldprobablybeavoidedinwomenwithIHSS.
Counteractstheeffectsof
onAVconduction.There
hasbeenareportofincreased
levelsduring
toxicityhasbeenreportedwithconcomitantuse;
...........................
PregnancyCategory:C
LactationCategory:S
shouldbeusedduringpregnancyonlyifthebenefit
justifiesthepotentialperinatalrisk.
Therearealternativeagentsforwhichthereismoreexperience
regardinguseduringpregnancyandlactation.
shouldbeavoidedinwomenreceiving
verapamil.Ampicillin
wouldbepreferredin
womenwithPPROM.
InternationalBrandName—
AdenaAungena(Mexico);Arasena-A(Japan)
DrugClass
..........................
Antivirals;Ophthalmics
.........................
HSVepithelialkeratitis,keratoconjunctivitis,encephalitis
.........................
InhibitsDNAsynthesis
DosagewithQualifiers
.......
HSVepithelialkeratitis—apply0.5inribbonOS/OD5
HSVkeratoconjunctivitis—apply0.5inribbonOS/OD5
HSVencephalitis—15mg/kg/d
10dIV
culturesof
Streptomycesantibioticus.
Thereisnopublished
experiencewith
fortheaboveindicationsduring
pregnancy.Treatmentforencephalitisshouldbediscontinued
whenthebrainbiopsyisnegativeforHSVincellculture.Many
oftheprevioususesfor
havebeensupercededby
Sideeffects
includetearing,foreignbodysensation,burning,
photophobia,andsuperficialpunctuatekeratitis.
...........................
PregnancyCategory:C
LactationCategory:S
(likely,topical),
shouldbeusedduringpregnancyandlactation
onlyifthebenefitjustifiesthepotentialperinatalrisk.
—(Velban;Velsar)
InternationalBrandName—
Blastovin(Israel,Paraguay);Cytoblastin(India);Lemblastine(Mexico);
Velban(Brazil);Velbastine(Korea);Velbe(Argentina,Australia,Canada,Chile,China,Hungary,Malaysia,
NewZealand,Peru,SouthAfrica,Spain,Turkey);Xintoprost(Argentina)
DrugClass
..........................
Antineoplastics,antimitotic
.........................
Ovarianorbreastcancer,choriocarcinoma,Hodgkin’sdisease,
lymphoma,Kaposi’ssarcoma,mycosisfungoides
.........................
Chemotherapy—dosingprotocolsvary;usuallycombinedwith
otheragents
—hypersensitivitytodrugorclass,bacterial
infection,granulocytopenia,intrathecaluse,intestinal
obstruction,paralyticileus
—bonemarrowdepression,neuropathy,
neuromusculardisease,neurotoxicagents,ototoxicagents,
pulmonarydisease,hepaticdysfunction,CYP3A4interactions
MaternalConsiderations
.....
Cautionshouldbeexercisedinpatientstakingdrugsknownto
Chemotherapy—multipleprotocols;typically1.4mg/m
,max
2mg/dose;usuallycombinedwithotheragents
—hypersensitivitytodrugorclass,acute
bacterialinfection,intestinalobstruction,paralyticileus,
demyelinatingCharcot-Marie-Toothdisease
—bonemarrowsuppression,neuromusculardisease,
neurotoxicagents,ototoxicagents,pulmonarydisease,hepatic
dysfunction,CYP3A4interactions
MaternalConsiderations
.....
isavincaalkaloid.Therearenoadequatereportsor
well-controlledstudiesof
inpregnantwomen.The
literatureconsistsofisolatedcasereportsandseriesofwomen
typicallytreatedduringpregnancyforleukemiaorlymphoma.
Sideeffects
includemyelosuppression,peripheralneuropathy,
paralyticileus,intestinalnecrosis,cranialnervepalsy,decreased
DTRs,severeneuromuscularimpairment,seizures,bronchospasm,
MI,SIADH,infertility,extravasationnecrosis,tumorlysis
syndrome,uricacidnephropathy,alopecia,N/V,anorexia,
constipation,diarrhea,fatigue,paresthesias,peripheral
neuropathy,dizziness,nystagmus,thrombophlebitis,ataxia,
BPchanges,weakness,andelectrolyteabnormalities.
Chemotherapy—multipleprotocolsaloneorincombinationwith
—hypersensitivitytodrugorclass,acute
bacterialinfection,granulocytopenia,intrathecal
administration,GIobstruction,paralyticileus
—bonemarrowdepression,neuropathy,
neuromusculardisease,neurotoxicagents,pulmonarydisease,
hepaticdysfunction,CYP3A4interactions
MaternalConsiderations
.....
isavincaalkaloid.Therearenoadequatereports
orwell-controlledstudiesof
inpregnantwomen.
Theliteratureconsistsofmultiplecasereportsofwomentreated
duringpregnancy.
Sideeffects
includemyelosuppression,peripheralneuropathy,
paralyticileus,intestinalnecrosis,radiationrecallreaction,severe
neuromuscularimpairment,interstitialpulmonarydisease,
dyspnea,MI,SIADH,infertility,extravasationnecrosis,
leukopenia,granulocytopenia,anemia,increasedLFTs,infusion
sitereactions,constipation,anorexia,alopecia,peripheral
neuropathy,diarrhea,dizziness,N/V,nystagmus,
thrombophlebitis,andthrombocytopenia.
DosagewithQualifiers
.......
Invasiveaspergillosis—begin6mg/kgIVq12h,then4mg/kgIV
q12horconverttoPO
Severefungalinfections—begin6mg/kgIVq12h,then4mg/kgIV
q12horconverttoPO
NOTE:renalandhepaticdosing.
NOTE:checkLFTsatbaselineandperiodicallyduringtreatment;
monitorvisualfieldsif
28dtreatment.
—hypersensitivitytodrugorclass;useof
astemizole,carbamazepine,cisapride,
pimozide,quinidine,rifabutin,rifampin,
galactoseintolerance
—hepaticorrenaldysfunction,hematologic
malignancy,prolongeduse
MaternalConsiderations
.....
Therearenoadequatereportsorwell-controlledstudiesof
inpregnantwomen.Thepublishedexperienceis
limitedtocasereportsofitsusepost–cesareansectionforthe
treatmentof
Sideeffects
includecholecystitis,hepatitis,fulminanthepatic
necrosis,acuterenalfailure,Stevens-Johnsonsyndrome,
photosensitivity,angioedema,blooddyscrasias,fever,N/V,rash,
chills,headache,increasedLFTs,hallucinations,visualchanges,
blurredvision,andphotophobia.
(aCYP3A4inhibitor);reducethe
doseto
thestartingdosewhenbeginning
followwithfrequentmonitoringof
bloodlevels.
levelshavebeenassociatedwith
nephrotoxicity.When
isdiscontinued,thedoseof
mayneedtobeincreased.
Increasesthe
level(CYP2C9inhibition),necessitating
frequentmonitoringof
Increasesthelevelsof
—(Coumadin;Jantoven)
InternationalBrandName—
Aldocumar(Spain);Befarin(Thailand);Circuvit(Argentina);Coumadan
(Argentina);CoumadanSodico(Argentina);Coumadin(Canada,Chile,Ecuador,Germany,Italy,Korea,Malaysia,
Paraguay,Peru,Philippines,Portugal,Singapore,Venezuela);Coumadine(France);Dagonal(Uruguay);
Farin(Thailand);Maforan(Thailand);Marevan(Belgium,Brazil,China,Denmark,England,Finland,Ireland,Norway,
Singapore);Orfarin(Malaysia,Thailand);Panwarfin(Greece);Simarc-2(Indonesia);UniWarfin(India);Waran(Sweden);
Warfar(Colombia);Warfil5(DominicanRepublic);Warfilone(Canada)
DrugClass
..........................
Anticoagulants;Thrombolytics
.........................
Anticoagulation,therapeuticandprophylactic
.........................
InhibitsvitaminK–dependentclottingfactorsynthesis(II,VII,
IX,X,proteinsCandS)
DosagewithQualifiers
.......
Chronictreatmentofthrombophilia—5-10mgPOqd;keep
Acutetherapyofthromboembolicdisease—begin2.5mg,increase
graduallyover2-4dtoachievedesiredINR
inmonotherapyusefulforwomenwithrecurrentearly
miscarriageonly.
Anticoagulationwasevaluatedin60pregnancieswitha
mechanicalheartvalveprosthesisand45withatissuevalve.
Allwomenhad
inthe2ndtrimesterand
delivery.The1sttrimesterwasdividedamong
andLMWH.Livebirthsoccurredin60%oftissuevalves
and30%ofmechanicalvalves.Likewise,spontaneousabortion
ratesdifferedwith2%inthetissuevalvesand37%inthe
mechanicalvalves.Theworstoutcomeswerewith
the1sttrimester.
Sideeffects
includehemorrhage,skinnecrosis,rash,major
hemorrhage,diarrhea,nausea,abdominalpain,hepatitis,
dermatitis,andbluetoesyndrome.
Bileacid–bindingresins,fibricacidderivatives,
HMG-CoAreductaseinhibitors.
SpecificDrugsReported:
Bromelains,danshen,dongquai
(Angelicasinensis),
garlic,and
Ginkgobiloba
aremostoftenassociatedwithan
inthe
effectsof
CoenzymeQ
(ubidecarenone)and
St.John’swort
aremost
oftenassociatedwitha
intheeffectsof
Botanicalsthatcontaincoumarinswithpotentialanticoagulant
InternationalBrandName—
Zuvair(India)
DrugClass
..........................
Antiasthmatics;Leukotrieneantagonists
.........................
Asthmaprophylaxis
.........................
LeukotrieneD4andE4receptorantagonist
DosagewithQualifiers
.......
Asthmaprophylaxis—20mgPO1hacor2hpcbid
NOTE:hepaticdosing.
—hypersensitivitytodrugorclass,acute
—hepaticdysfunction,systemiccorticosteroidtaper
MaternalConsiderations
.....
Thereisonlylimitedpublishedexperiencewith
duringpregnancy.Leukotrienereceptorantagonistsareprobably
safeduringpregnancybutshouldbelimitedtospecial
circumstances,wheretheyareviewedessentialforasthmacontrol.
Sideeffects
includeChurg-Strausssyndrome,headache,rhinitis,
N/V,diarrhea,pain,asthenia,abdominalpain,dizziness,myalgia,
fever,backpain,increasedhepatictransaminases,anddyspepsia.
Usewith
maydecreasemeanplasmalevelsof
bysome30%.Rareinstancesofpatientsexperiencing
levelswithorwithoutclinicalsignsor
symptomsof
toxicityaftertheadditionof
havebeenreported.Themechanismoftheinteractionisunknown.
increasesplasmalevelsof
zafirlukast
byapproximately45%.
.........................
AdvancedHIVinfection—0.75mgPOq8h
—hypersensitivitytodrugorclass
—hepaticorrenaldysfunction,peripheralneuropathy,
CHF,historyofpancreatitis
MaternalConsiderations
.....
Therearenoadequatereportsorwell-controlledstudiesof
inpregnantwomen.ThetreatmentofHIVduring
pregnancysignificantlyreducestheriskofmother-to-child
transmission.Tripletherapy(
lamivudine,nevirapine,
)remainsthestandardofcareformanagementof
HIVinfectioninadults.TheFDAhasapprovedonly4nucleoside
analogreversetranscriptaseinhibitors:
didanosine,stavudine,
zidovudine.Zalcitabine
isa2ndselection
shouldthepatientnotrespondto
Sideeffects
includeseizures,lacticacidosis,thrombocytopenia,
leukopenia,anemia,eosinophilia,peripheralneuropathy,hepatic
dysfunction,fatigue,N/V,abdominalpain,diarrhea,constipation,
rash,pruritus,urticaria,orallesions,depression,headache,fever,
cough,andrhinitis.
zalcitabine,
InternationalBrandName—
Hegon(Argentina);Hipnodem(Argentina);Noctiplon(Chile);Plenidon(Chile,
Peru);Prox(Uruguay);Sonata(Mexico);Starnoc(Canada);Zaplon(India)
DrugClass
..........................
Anxiolytics;Hypnotics
.........................
Short-termtreatmentofinsomnia
.........................
InteractswithGABA/benzodiazepinereceptorcomplex
DosagewithQualifiers
.......
InternationalBrandName—
Relenza(Argentina,Canada,CostaRica,DominicanRepublic,ElSalvador,
France,Germany,Guatemala,Honduras,HongKong,Korea,Mexico,Nicaragua,Panama)
DrugClass
..........................
.........................
Uncomplicatedinfluenza
.........................
Inhibitsinfluenzaneuraminidase
DosagewithQualifiers
.......
Uncomplicatedinfluenza—beginwithin48hofsymptoms,10mg
INHq2-4h
2,thenq12h
—hypersensitivitytodrugorclass,COPD,
asthma,unabletouseinhaler
MaternalConsiderations
.....
Thereisnopublishedexperiencewith
pregnancy.Pregnantwomenshouldconsidervaccinationpriorto
influenzaseason.
Sideeffects
includebronchospasm,nausea,dizziness,headache,
bronchitis,cough,nasalsymptoms,andear/nose/throatinfection.
HIVinfectionduringpregnancy—begin100mgPO5
/dafter
HIVinfectioninnonpregnantwomen—300mgPOq12h,or1mg/
kgIVq4h
—hypersensitivitytodrugorclass,severe
bonemarrowsuppression
—hepaticorrenaldysfunction
MaternalConsiderations
.....
ThetreatmentofHIVinfectionduringpregnancysignificantly
reducestheriskofmother-childtransmission.Combination
therapy(
lamivudine,nevirapine,zidovudine
)remainsthe
standardofcareformanagementofHIVinfectioninadultsdue
toitshighefficacy.ThePediatricAIDSClinicalTrialsGroup
(protocol076)documentedthat
reducedperinatalHIV-1transmissionbynearly70%.Sincethen,
multiplerandomizedstudiesconfirm
monotherapyis
extremelyeffectiveinpreventingverticaltransmissionofthe
virus.Shorterregimensreducedtheriskoftransmissionby50%
inanon-breastfeedingpopulation,andbyabout37%in
breastfeedingpopulations.When
iscombinedwith
somnolence,myalgia,malaise,dyspepsia,diaphoresis,dyspnea,
tastechanges,pigmentednails,andparesthesias.
NolanM,FowlerMG,MofensonLM.JAcquirImmuneDefic
Syndr2002;30:216-29.
Asthma—600mgPOqid;max2400mg/d
NOTE:checkLFTsbaseline,qmo
3mo,thenq3mo
—hypersensitivitytodrugorclass,acute
asthma,hepatotoxicity
—alcoholabuse,hepaticdysfunction
MaternalConsiderations
.....
Thereisnopublishedexperiencewith
duringpregnancy.
Sideeffects
includehepatotoxicity,insomnia,headache,dizziness,
nausea,dyspepsia,abdominalpain,neutropenia,andelevated
Schizophrenia—begin20mgPOwithmealsbid,adjustto
response;max160mg/d
—hypersensitivitytodrugorclass,
prolongedQTinterval,recentMI,uncompensatedCHF,
hypokalemia,hypomagnesemia,historyofarrhythmia
—hepaticdysfunction,seizures,cerebrovascular
disease,CVdisease,hypotension,hypovolemia,dehydration,
agentsthatprolongtheQTinterval,riskforaspiration
MaternalConsiderations
.....
Thereisnopublishedexperiencewith
Sideeffects
includeneurolepticmalignantsyndrome,tardive
dyskinesia,hypertension,QTintervalprolongation,syncope,
extrapyramidalsymptoms,irregularmenses,somnolence,nausea,
constipation,dyspepsia,akathisia,dizziness,respiratorydisorders,
asthenia,diarrhea,weightgain,rash,urticaria,visualdisturbances,
tachycardia,hyperglycemia,andhyperprolactinemia.
Migraineheadache—1.25-2.5mgPO
1,mayrepeatafter2hprn;
max10mg/24h;alternatively,usethesamedoseofthenasalspray
—hypersensitivitytodrugorclass,CAD,
coronaryvasospasm,historyofMI,uncontrolledhypertension,
24h,MAOI
14d,ergot
24h,basilar
migraine,hemiplegicmigraine,Wolff-Parkinson-White
syndromewithsymptoms
—cardiacriskfactors,hepaticdysfunction,severerenal
disease,PVD,CVD
MaternalConsiderations
.....
Pregnancyhasabeneficialeffectonmigrainein55-90%of
women,mainlyduringthe2ndand3rdtrimesters.Ahigher
percentageofwomenwithmenstrualmigrainecomparedto
othermigrainesimproveduringpregnancy.Thereisnopublished
experiencewith
duringpregnancy.Meanplasma
concentrationsof
areupto1.5-foldhigherin
InternationalBrandName—
Adormix(Chile);Amsic(Germany);Durnit(Argentina);Niotal(Italy);
Nitrest(India);Somit(Argentina,Paraguay,Uruguay);Somnil(Colombia);Somno(Ecuador,Peru);Stilnix(Israel);
Short-termtreatmentofinsomnia—5-10mgPOqhsprn
—hypersensitivitytodrugorclass
—depression,substanceabuse,impairedrespiratory
MaternalConsiderations
.....
Therearenoadequatereportsorwell-controlledstudiesof
inpregnantwomen.
significantlyinhibits
smoothmusclecontractility
invitro.
Sideeffects
includeataxia,hallucinations,headache,drowsiness,
.........................
Partialseizures—begin100mgPOqd,increasingq2worgreater
forcontrol;maxdose600mg/dindivideddosesifnecessary
—hypersensitivitytodrugorclass,
hypersensitivitytosulfonamides
—hepaticorrenaldysfunction,hotweather,history
ofnephrolithiasis
MaternalConsiderations
.....
arterialbloodgases
beforemeals
angiotensin-convertingenzyme
angiotensin-convertingenzymeinhibitor
adenosinetriphosphate
adenosinetriphosphatase
areaunderthetime-versus-concentrationcurve
arteriovenousmalformation
-deoxythymidine(zidovudine;azidothymidine)
Bacillus;Bacteroides
-humanchorionicgonadotropin
twiceaday
growthhormone
intracellularadhesionmolecule
intracranialpressure
intensivecareunit
fourthlumbarvertebra
low-densitylipoprotein
low-densitylipoproteincholesterol
liverfunctiontests
luteinizinghormone
lastmenstrualperiod
low-molecular-weightheparin
L:Sratio
lecithin:sphingomyelinratio
leftventricular
milli–Internationalunit(s)
non-nucleosidereversetranscriptaseinhibitor
nitricoxide
nicotinereplacementtherapy
nucleoside/nucleotidereversetranscriptaseinhibitor
normalsaline
nonsteroidanti-inflammatorydrug
nonstresstest
neuraltubedefect
nauseaandvomiting
NewYorkHeartAssociation
obsessive-compulsivedisorder
oxytocinchallengetest
righteye
25-hydroxyvitaminD
oralpoliovaccine
oddsratio
lefteye
probabilityvalue
Pasteurella;Plasmodium;Proteus
partialpressureofoxygeninarterialblood
pcaftermeals
PCApatient-controlledanalgesia
PCEApatient-controlledepiduralanalgesia
PCOSpolycysticovarysyndrome
Pneumocystisjiroveci(carinii)
patentductusarteriosus
pulmonaryembolism
everyday
everyhourofsleep
fourtimesdaily
everymonth
everynoon
everyotherday
everynight
theQ-Tintervalonanelectrocardiogram
correctedQ-Tinterval
everyweek
standarderrorofthemean
selectiveestrogenreceptormodulators
smallforgestationalage
upperrespiratoryinfection
UnitedStatesPharmacopeia
urinarytractinfection
AppendixI
ListofPregnancyRegistries
Table1:PregnancyRegistriesEnrollingPregnantWomenforSpecificMedical
Conditions(asofMay2008)
MedicalProducts
CoveredRegistryNameContactInformation
Table2:SpecificMedicalProducts(genericdrugname)
MedicalProducts
StudiedMedicalConditionRegistryNameContactInformation
Aldurazyme(laronidase)Mucopolysaccharidosis
I(MPSI)
Hurler’ssyndrome
Hurler-Scheiesyndrome
Scheie’ssyndrome
FabryRegistry
GenzymeCorporation
InNorthAmerica
Phone:+617-591-5500
InEurope:
Phone:+31-35-699-1232
InLatinAmerica:
Phone:+617-591-5500
InAsia-Pacific
Phone:+85228101613
Table2:SpecificMedicalProducts(genericdrugname)„contd
MedicalProducts
StudiedMedicalConditionRegistryNameContactInformation
Table2:SpecificMedicalProducts(genericdrugname)„contd
MedicalProducts
StudiedMedicalConditionRegistryNameContactInformation
Table2:SpecificMedicalProducts(genericdrugname)„contd
MedicalProducts
StudiedMedicalConditionRegistryNameContactInformation
InEurope:
Phone:+31-35-699-1232
InLatinAmerica:
Phone:+617-591-5500
InAsia-Pacific:
Phone:+85228101613
Table2:SpecificMedicalProducts(genericdrugname)„contd
MedicalProducts
StudiedMedicalConditionRegistryNameContactInformation
Singulair(montelukast)Asthma
**Thisisadifferentstudy
thantheoneconductedby
MotheriskSingulairin
MotheriskProgram
Phone:1-800-670-6126
Twinrix(hepatitisA
inactivated&hepatitisB
recombinantvaccine):
Exposureanytimefrom
1moprecedingLMP
throughtheendof
PreventionofhepatitisA
andhepatitisB
TwinrixPregnancy
PregnancyRegistry
AppendixII
FDAPregnancyRiskCategories
andPercentageofDrugsinEach
Controlled studies in women fail to demonstrate a risk to the
AppendixIII
TimingofDevelopmentofMajor
Pre-embryonicEmbryonic
AppendixIV
CriticalPeriodsinHuman
Main Embryonic Period (in weeks)
Period of dividing
zygote, implantation,
and bilaminar embryo
Not susceptible to
teratogenesis
Death of embryo and
spontaneous abortion common
123456789163238
ReproducedwithpermissionfromMooreKL,PersaudTVN.TheDevelopingHuman:ClinicallyOrientedEmbryology,6thed.Philadelphia:WBSaundersCompany,1998:548.
AppendixV
ExamplesofKnownorLikely
AppendixVI
InjectableHypoglycemicAgents
AppendixVII
EffectofPregnancyon
CytochromeP450Isoenzymes
EnzymeEffectofPregnancyExampleofSubstrates
CYP1A2Inhibited,especiallyinthe3rd
Drugnamesprintedinlightfacetypeindicategenericnames.Thosein
romantypeindicateUnitedStatesbrandnames.
Thosein
boldfaceitalic
typeindicateinternationalbrandnames.
,1122
,62
,1058
,1058
,487
,951–952
ABAntiseptico
,185
,1131–1132
,1131
,97
AbbocillinVK
,866
,1142
,212
,358
,358
AbboticXL
,212
,1026–1027
,1026
Abbreviations,1193-1205
,288
,42
,538–540
Abdominaldistention
vasopressin,1161–1162
Abdominalradiography
vasopressin,1161–1162
,182
,288
,967
,557–558
,557
,557
AcularPF
,557–558
AcularPF
,557
,71,208
,958
,480–482
,892–894
,857–858
,83
,344
,599
,480–482
,467
,784
,845
,24
,952
,81
,105
,590–592
,96
,1087–1088
,480–482
AlphaDerm
,480
,691
,1141
,182
,1142
,561
,55–56
,55
,44,214
,44,214
,44,214
,42
,42
,42–43
,42
,42–43
AmoxilDuo
,42
,42
,42–43
,42
,42–43
,42
AmoxiPlus
,44,214
,42
,42
Anginapectoris
nifedipine,784–788
nitroglycerin,794–797
pindolol,899–900
prophylaxisfor
isosorbidedinitrate,
isosorbidemononitrate,
propranolol,952–954
timolol,1102–1104
dalteparin,255–257
verapamil,1165–1168
,35
Angioedema,hereditary
danazol,257–258
,790
,541
,306
,306
,390
,415
,424
,435
,435
,727
,386
,444
,452
,467
,477
,487
,490
,496
,640
,505
,288
,1028
,358–360
attapulgite,73
,697
Attention-deficitdisorder
Bacterialinfection
gatifloxacin,443–444
gentamicin,446–447
kanamycin,551–552
levofloxacin,583–585
lincomycin,592–593
linezolid,593–594
lomefloxacin,605–606
loracarbef,608–609
meropenem,654–655
,86
,934
,312–313
,963
,312–313
BenadrylN
,312
BenadrylSteri-Dose
,312–313
,344
,867
,312–313
,312–313
,157
,167
benazepril,86–87
,934
,452
,1058
,626
,626–628
,312–313
,87–88
,101–102
,212
,48
,42
,124
BiocatinesD2masiva
,172–173
,157,161
,48
,55–56
,44,214
BioclavidForte
,44,214
,335
,937–938
,937
,344
,1087–1088
,1116
,666
BiodoneExtraForte
,666
BiodoneForte
,666
,335
,308–309
,308
,144
,144
,808
BiofanalMundgel
,808
,144
,522
,397
,172
,802
,499–501
,1130–1131
,446
,220
BiogesicSuspension
,474
,518
,29
,592
,201
,195–196
,42–43
,38
,784
CalciblocOD
,784
,306
calcifediol,123–124
,784
,130
,543
,142
,306–308
CardizemCD
,306
,163
,169
,169
,169
chloralhydrate,180–181
,180–181
ChloralumHydratum
,180
chlorambucil,181–182
,182
,190
,181
,182
chloramphenicol,182–184
,182
Chloramphenicol"Agepha"
,182
Chloramphenicol"Agepha"
,182
ChloramphenicolFaure,
,182
,182
ChloramphenicolPOS
ChloramphenicolPW
,182
ChloramphenicolRIT
,182
ChloramsaarN
,182
,191
ciprofloxacin,204–206
,204
,204
,204
,143
CloracefMR
,143
,182
,226
,182–184
CloramfeniOfteno
,182
CloramfeniUngena
,182
,182
,182–184
,335
,476
CloranfenicolN.T.
,182
clorazepate,226–227
,917
,212
,190
nedocromil,763–764
pemirolastophthalmic,
ofloxacin,749–750
Criticalperiodsinhuman
development,1214
,212
,503–504
,503
CroananDuoDrySyrup
44,214
,1101
Crohn’sdisease
infliximab,508–509
mercaptopurine,652–654
mesalamine,656–657
sulfasalazine,1059–1060
,240
Cromal-5Inhaler
,240
,240
,172
,240
,240
CromoglicicAcid
,240–241
,240–241
cromolyn,240–241
,240
,240
,240
,240
,1090
,609
,799
,609
,92
,48–50
,105
,130
,949
,401
fluconazole,401–402
miconazole,715–717
,759
,241–242
CrystapenV
,866
,241–242
CrysticillinAS
,865–866
,299–300
,74
,358–360
,197–198
CuivasilSpray
,590
,861
,861–862
,861
,861
,861
,490
CuracneGe
,544
1052
,44,214
,1079
,544
CurazidForte
,538
,288
,144
,169
,81
,845
,169
,169
,415
,114
dalteparin,255–257
,626–628
,216
,502
,493
,676
,257
,271
,257–258
,257
danazol,257–258
,257
DanazolJanMarie
,257
,257
,373–374
DanciminC
,60
seleniumsulfidetopical,
,452
,446
,561
,259–260
,452
,271–274
,271
,271–274
,271
,413
,605
,926
,271–274
,578
,578–579
,271–274
,892–894
,271
,878
,271
,462
,266–267
,266
,1101
,271–274
,83
,928
DecortinH
,926
,928
,450
,125
,444
isocarboxazid,536–537
maprotiline,624–625
mirtazapine,728–729
nefazodone,764–766
nortriptyline,806–807
,193
,193
,193–194
,193
,193
,283
,561
DiacorLP
,306
,607
,607
,928
,926
,663
,663
,663
DiaforminaLP
,663
,1017–1018
Diagnosticimaging
,306
,306
,306
,306
,306
diltiazem,306–308
,306
,306
DilzemCD
,306
,328
,328
DopaminAWD
,328
DopaminBraun
,328
dopamine,328–329
,328
DopamineInjection
,328
,328
DopaminGuilini
,328
DopaminLeopold
,328
DopaminNatterman
,328
,328
,298–299
,582–583
,582
,582
,582
,691
,582
,582
,582
,582–583
,691
,691
,330
,328
,328
DopminE
,328
,260
,298
,467
,717
,257
,490
,180–181
,640
,717
,883–885
,487
,870,883
,415
,717
,312
,335
,330
,330
,288
,72–73
,335
,120–121
,48
,335
,330
,330
,335
,330
,331
,330
,42
,330
,330
doxazosin,330
,144
doxepin,331–332
,335
,335
,1028
,335
,335
,335
,335
,335
,330
,332
DoxorLyo
,332
doxorubicin,332–334
,332
DoxorubicinMeiji
,332
,332
,335
,335–336
,335
,335–336
,335–336
,335
,335
doxycycline,335–336
,335
DoxycyclineHyclate
,335
,335
,335
,335
,467,814
,861
,1080
thiabendazole,1093–1094
Drafilyn"Z"
,33–35
Drafilyn"Z"
,32
,476–477
,308
DramamineInjection
,308–309
308
,308–309
,630
,308–309
,308–309
,899
,10
,42
,487
,928
,283
,414
Drenison14
,414
,108
,832
,534
,308
,24
,490
,528–529
,832
,355–356
,355
,54–55
,54
,54–55
,626–628
,958
,144
,337
,1116
,585
dronabinol,336–337
,379
,877
droperidol,337–338
,337
,889
,486–487
,144–145
,144
,144
,490
,328
,435
,252
,252
,252
,252
DTICDome
,252
,252
,252
,306
,48
Duactin5
,38
,107
DubeSpray
,590
,818
,220
,220
,421
,1087
,10
,358–360
,1094–1095
,335
,709
,1127
,421
,191
,1058
Duodenalulcer
belladonna,85–86
lansoprazole,568–569
nizatidine,799–800
rabeprazole,974–975
ranitidine,981–982
sucralfate,1053–1054
,818
(Continued)
,358
,358
,344
,226
,37
,344
,344
,344
enalapril,344–345
,344
,344
,344
,344
,344
,344
EnantonDepot
,576
,576
EnantoneDepot
,576
EnantoneLP
,576
EnantoneSR
,576
,344
,344
,344
,344
,344
,701
encainide,346
herpessimplexvirus
vidarabine,1168–1169
EncineEM
,62
,101
,182
,928
Encron10
,844–845
,638
,139
,27–28
,27
,709
,499
,499
Endocarditis,bacterial
amoxicillin,42–43
potassium,44-45
erythromycin,358–360
prophylaxisfor
ampicillin,48-50
gentamicin,446–447
tobramycin,1106–1107
,358–360
,368
,221
,1102–1104
Equi-TussDm
,279–280
,48
,327
,663
,964–965
,122–123
,122–123
,607
,484
,948–949
,948
,948
Erectiledysfunction
sildenafil,1034–1035
,1034
,993
,578–579
,303
,122,418
,122–123
ergocalciferol,355–356
ErgodrylMono
,357
,122,418
,122,418
,122,418
,105
,357–358
,303
ErgoSanol
,357
,357–358
,303
ergotamine,357–358
ErgotaminiTartras
,122,418
ErgotaminMedihaler
,357
,122,418
,303
,122,418
,283
,880–881
,358
,206
,823
,1034
,358
,358–360
,358
,358–360
,358
,358
,10
358
,907
,907–908
FeldeneGel
,907
,172
,388
,907–908
,415
,388
,388
,401
,509
,509
,413
,401
,401
,401
,401
,407
,407
,401
fluconazole,401–402
,401
,407
,401
,409
,409
flucytosine,403
,409
,413
FludecateMultidose
,413
,502
FludexSR
,502
,401
,401
fludrocortisone,404–405
,409
,1036
,509–511
FluimucilA
,401
,435
,163
,398
,386
,626–628
,812
,553–555
,553
,44,214
,401
,458
FulcinForte
,458
,907
,44,214,802
,401
,42
FullicilinaPlus
,44,214
,412–413
,409
,717
FulvicinU/F
,458–459
,458–459
,401
,401
,553–555
FunazoleTabs
,553
,715
,443
,443
gatifloxacin,443–444
,703
,201
,452
,1165
,1036
,1036
,444
Geluprane500
,444
,444
,444
,444
gemfibrozil,444–445
,769
,444
Gemitinoftalmico
,182
,444
,444
,42–43
,444
,609
,312–313
,4–6
,446
,446
,4–6
,182
,561–562
,57–58
,841
,247
,971
,484
Genitalherpes
famciclovir,385–386
valacyclovir,1145–1146
Genitalwarts
imiquimod,498
pidofilox,910–911
podophyllumresin,
,561
,186
,220
,561
Genophen-DmElixir
,446–447
,446
,658–659
,371
,244
,446
703
,71,208
,446
,446
,446
,446–447
,446
,446
,446
,446
GentaGrin
,446
,446–447
,446
,446
,446
,446
GentalynOftalmico-Otico
,446
,446
,446
,446
,446
gentamicin,446–447
,446
,446
GentamytrexOphthiole
,446
,446
,446
,446
,446
,446
,446
,446
,1102
,483
,446
,398
,226–227
,330
,135–136
,1187–1188
,1187
,446
,942
,880–881
,998
,686
,201–202
,212
GesicainJelly
,590
GesicainOintment
,590
,590
,942
GeslutinPNM
,942
,632
,632
Gestationalchoriocarcinoma
,29
,663
,306
,674
,727
,727
HairscienceAntidandruff
,715
,727
Hair-TreatForte
,727
Hairycellleukemia
interferonalfa-2a,
interferonalfa-2b,
pentostatin,872–873
,465
HalcidermCremaAl
,465
,465
halcinonidetopical,465
,1127–1128
,1127
,467–468
,467
,467
,1165
,464–465
,464
chlorpromazine,191–193
,42
,480–482
,892–894
,487
,444
,185
,476
,42
,538
,477
,480–482
,480–482
,477
,483–484
hydroxyurea,486–487
hydroxyzine,487–488
,477
,194–195
,194
Hygroton50
,194
,461–462
,480–482
,490–492
,490
,490
,490
,490–492
ibutilide,492–493
IcazLP
,546
IcazSRO
,546
,182–184
,547
,1156
,493–494
,493
,493
idarubicin,493–494
,505
,117–118
,505
,494
Idiopathicthrombocytopenic
aminocaproicacid,31–32
,335
,1131–1132
,1131
,62
idoxuridine,494–495
IdrilNsineaugentropfen
,1047
,494
,74
,494
,74
IDUOpthalmicSolution
,494
,494
IdylSR
,490
,408
,332
,524–525
,524
progesterone,942–944
,490
,96
,288
,907
Inflammatoryboweldisease
azathioprine,75–77
cromolyn,240–241
Inflammatorydisorders
cortisone,238–239
Irritablebowelsyndrome
dicyclomine,292–293
tegaserod,1072
,547
,532
,20–21
,10
Ischemicstroke.
,538
,541–542
,541
,490
,1053
,42
,306
Iski-90SR
,306
,663
,462
,462
,543
,652
,543
,543–544
,543
Ismo20
,541,543
,543
,1058
,541
,39–40
,541–542
,543
,541–542
,541
,541
isocarboxazid,536–537
,541–542
,541
,551
,551
KanamicinaGen-Far
,551
kanamycin,551–552
KanamycinCapsulesMeiji
KanamycinMeiji
,551
KanamycinNovo
,551
KanamycinSanbe
,551
,29
,551
,808
,228
,551
,551–552
,917–918
KaonCl
,917–918
,741
KapanolLP
,741
,727
Kaposi’ssarcoma
daunorubicin,261–262
interferonalfa-2a,
interferonalfa-2b,
paclitaxel,841–842
vinblastine,1169–1170
vinorelbine,1171–1172
,438
KarbakolinIsopto
,132,135
,133
,608
,778
,806
KarlorCD
,143
,184–185
,139
,139
,532
,324
,130
,1116
,866
,917
KayCiel
,917–918
,1043
,895
,917–918
,212
,249
,917–918
,551–552
cefadroxil,144–145
cefamandole,145–146
cefazolin,146–147
cefdinir,148–149
cefepime,150–151
,680
LanterbineSR
,1080
,37
,512–514
,512
,568
,1095
,568
,568
,568
,568
,568
,568
,144
,1079
,157
,568
,218
LaprenSL
,218
,344
,568
,250
,191
,582–583
,759
,907
,191
LargactilForte
,191
,186–188
,636–637
,636
,636
,42
,582–583
,42–43
,37
,37–38
,610
,553
Larvamigrans
,54–55
,759
,568
,586
,586
,582–583
,583
,583
,586–590
,306
,488–489
,489
,488–489
LevsinSL
,489
,361–362
,361
,390
,170
,133,172
,802
,427
,424
,838
,98
,184
,592
,184–185
,10
,404
,380
,607
,727–728
,727
,547
,727
,727–728
,727
,727
,610
,607
,610
,607
,607
,490
,607
,607
,607
,607
,607
loperamide,607–608
,607
,607
,607
,607
,607
,607
,607
,607
,444–445
,444
LopidO.D.
,444
,172–173
,175
,568–569
,568
,818
,924–925
,707
LopresorOros
,707
,290–291
,10
,838
,133–135
,791–793
,212
MacrobiolS.R.
,212
,791–793
,42
,907
,77
,686
,701–702
,818
,172
,942
,1175
,663
,638–639
,335
,292–293
MagesanP
,292
,288
,154
,48
,169
magnesiumchloride,616
magnesiumcitrate,617
magnesiumoxide,618
magnesiumsulfate,619–623
,691
,691
,828
,818
,691
,20
,612
,10
,167
,632–634
,818
,698
,480
,698–700
,632,698
,574
,634
,634
,634
,634
,634
,20
,634
,634
mefenamicacid,634–635
,634
,636
mefloquine,636–637
,605
,159
,159–161
,159
,159
,738
Mega-C/APlus
,60–61
,638–639
,638
,146
MegaceOS
,638
MegacilinaOral
,866
MegacillinOral
,866
,424
aminocaproicacid,31–32
,784
Megaloblasticanemia
folicacid,424–425
,191–193
,638
,638
,191
,744
638
,632
,638
megestrol,638–639
,167
,663
,149
,818
,344
,928
,62
,686
,686
,483–484
,483–484
dacarbazine,252
,483
,686
hydroquinonetopical,
,55–56
melatonin,639–640
,663
,640
,193–194
,691
MinimsPhenylephrine
,889
,801
,20
,924–925
,269
MinirinDDAVP
,269
,794–797
,794
,916–917
,725
,887
,725–727
,725
MinocinG
,725
MinocinMR
,725
MinocinPF
,725
,725
Minoclir50
,725
,725
Minocyclin50Stada
,725
minocycline,725–727
,450
,725
,725
,725
,725
,727
,1056
Minotab50
,725
,725
Minoxi5
,727
minoxidil,727–728
MinoxidilIsac
,727
MinoxidilMK
,727
,727
,727
,727
MinprostinE(2)
,310
,269
,870
,1093–1094
,727–728
,269
,306
,896
,455
,35
,1001
,678–679
,1001
,917
,313
,132
,98
,741
,818
,335
,715
,758
,446
,915
,1071–1072
,446
,920–921
,413
,64
,182
,725
,624
,186
mirtazapine,728–729
,219
,729
misoprostol,729–733
,734
,729
,1058
,116–117
,877
,908–909
,908–909
MitocortylDermageaisons
,733
,733
mitomycin,733–734
MitomycinC
,733
,733
Mitomycin-CKyowa
,733
,733
,841
,734
mitoxantrone,734–735
,734
,794–797
,204
,695
,734
,733
,467
,516–517
,932
,553
,553
503–504
,741
,737–738
,737
,640
,1110–1111
,640
,640
,640
,490
,907
,454
,163
modafinil,735–736
,1129
,735
,735
,413
,691–693
,561
,226
ModeratanDiffucap
,296
,820
,727–728
,735
,388
,409
,413
ModitenDepot
,413
,1129
,154
Motionsickness.
Seealso
dimenhydrinate,308–309
meclizine,630–631
,1053
,151
NedaxPlus
,877
,784
nedocromil,763–764
,823
,823
,764
,144
nefazodone,764–766
,220
,1090
,889
,832
,163
,752
,752
,802
,752–754
,752
,752
,752
Neisseriagonorrhoeae
infection.
See
Gonorrhea
mezlocillin,713–714
N.gonorrhoeae
azithromycin,77–79
aztreonam,79
cefixime,151–152
cefonicid,153–154
cefoperazone,154–156
cefotaxime,157–158
,777–778
,777
,538–540
,940
,610
,29
,781
NicabateCQ
,781
NicabateCQLozenges
NicabateTTS
,781
,777
,778
nicardipine,778–781
,292
,1116
,660
,476
,899
,599
Nopid200
,390
,1058
NopilForte
,1058
,1000
,409
,802
,658
,802
,823–824
,312–313
,312–313
,771
,609
,802
NorbactinEyeDrops
,802
,802
,452
,257
,1187–1188
,801
,1162–1163
,1162
,144–145
,144
,55
,133
,1187–1188
,312–313
,534–536
,801
,801
,547
,172
,802
,727
,917
,201
,107
NumobidDx
,279–280
,836–837
,438
,907
,759
NuquinHP
,483–484
,490
,344
,490
NurofenforChildren
,490
NurofenGel
,490
,62
,480–482
,480
,1141
,756
Nutritionalsupplementation.
,48
,409
,808
,55–56
,777
,759
,538–540
,538–540
O.P.Pain
,1116
,818
,828
,836–837
,758–759
,896
,176
,812
,1129
,823
,823
,446
Ophthalmicinfection
,487
benzocaine,89–90
Otitisexterna
ofloxacin,749–750
Otitismedia
PancreaticEnzyme
Pancreaticinsufficiency
pancrelipase,244-245
Pancreatin10
,844–845
pancrelipase,844–845
Pancrelipase10000
PancrelipaseMt16
PancrelipaseMt-16
,844
Pancron10
,844–845
,845
,845
pancuronium,845–846
,936–937
,228
,553
Penilente-LA
,863
,1116
,48
,866
,883
,866
,818
PhenobarbitalSodium
,883–885
phensuximide,886–887
,887–888
phentermine,887–888
phentolamine,888–889
,887–888
Phen-TussDM
,279–280
,879
,879–880
phenylephrine,889–891
,889
PhenylephrineHCl
phenytoin,892–894
phentolamine,888–889
PherazineDM
,279–280
,351–352
,475
,475
,413
,1090–1093
,33
,33
,1090
,487
,666
physostigmine,894–895
phytonadione,895–896
,109
,553
,902
,902
,48
,50
,271
,784
,899
,29
,249
,896
pilocarpine,896–897
,896
PilOfteno
,896
PilogelHS
,896
,896
PiloGrin
,896
,896–897
PilokarpinIsopto
,896
,896
,896
PilopineHS
,896–897
,896–897
,896–897
896
,1058
pimecrolimus,topical,
,898–899
pimozide,898–899
,90
,151
,180
,715
,911–912
,911–912
,911–912
PodofiliaNo.2
,911
,911
podofilox,910–911
,910
,911–912
,161
podophyllumresin,
PodowartPaint
,911
,161
,182
,949
Poisonivy/oak
oatmeal,810
,275
,275
,275
,190–191,275
,275
Polaramine(non-
,275
,64
Preoperativesedation
butalbital,117–118
meperidine,644–647
scopolamine,1022–1023
,1001
,310–311
,310
,206
,344
,494–495
,1115–1116
,546
,344
,38
,269
,206
,599
,306
,559
,559
,1161
,87
,952
,490–492
,1090
,1116
,954
propafenone,947–948
,952
,283
,193
,891–892
,948
,948
propantheline,948–949
,191
,828
,952
,310
Propionibacteriumacnes
cefonicid,153–154
cefoperazone,154–156
cefotaxime,157–158
Pulmonaryembolism
alteplase,26–27
streptokinase,1051–1052
urokinase,1142–1143
Pulmonaryhypertension
epoprostenol,353–354
treprostinil,1121–1122
,107
,206
,691
,610
,210
,182
,182
,949
,55
RecombivaxHB
,474–475
RecombivaxHB
,474
,444
Rectalinfection
ofloxacin,749–750
,794
,1087
,4–6
,480–482
,241
,37
Redose200
,390
,60
RedoxonC
,60
RedoxonForte
,60
,490
RhelafenForte
,490
,987
,987
,987–989
,987
,987
RhesumanBerna
,987
,963–964
,993
,204
rofecoxib,1010–1012
,555
RoferonA
,521–522
RoferonA
,521
,856–857
,521
Roferon-AHSAFree
,521
,172
,1102
,1116
,727–728
,727
,279–280
,386
,888
,125
,490
,241
,288
,557
,1087–1088
,210
,1028
,1028
,496
,1016
,105
,335
,220
,246
,114
,220–221
,220
,361
,210
,966–967
,966
,852
,220
,985–986
,985–986
,985
,985
,985–986
,985–986
,985–986
,932
,64
,201
sertraline,1028–1031
,1028
,1028
,373
,172
,48
,143
,260
,194–195
,335
,335
,446
,866
,172
,324
Softtissueinfection
ticarcillin,1100–1101
SoftUDerm
,1141
,609
,24
,313
,483
SolaquinForte
,483–484
SolaquinForte
,483
,590
,634
,578
,1044
,195
,233
,476
,476–477
,883–885
,748
ceftazidime,163–164
ceftibuten,164–165
ceftizoxime,166–167
ceftriaxone,167–168
cefuroxime,169–170
clindamycin,216–217
S.saprophyticus
levofloxacin,583–585
lomefloxacin,605–606
moxifloxacin,744–745
nalidixicacid,752–754
,271–274
,225
,1116
,20
,60
,568
TakepronOD
,568
,1080
terbutaline,1080–1082
terconazole,1082–1083
,1082
,1079
,1079
,1129
,151
,166
,133
,177
,1079
,553
,1105
,1105
,64
,625
,144
,703
,838
,838–839
,838
TerramycinNAugensalbe
TerramycinN
,446
,502
,596
,177
,193
,701–702
,701
Testonic"B"
,701
,701
,701–702
,1101
,1101
,1101
,1101
,1101
,1101
ticlopidine,1101–1102
,1130–1131
,1101
,216
,609
,1131–1132
,1131
,495
Tienam500
,495
,1130–1131
,382
TigenPlaster
,288
,838–839
,1130–1131
,1101
,1101
,1101
,1101
,325–326
,763–764
,763
TiladeCFCFree
,763
,306
Tilazem90
,306
,306
TildiemCR
,306
TildiemLA
,306
,1116
,1116
TramalSR
,1116
,1116
,1116
,1116
,467
,467
,643
,226
,651–652
,559–561
,559
trandolapril,1118–1119
,392
,487
,193
,35
,24
,651–652
,839
,114
,610
,487
,283–285
,697
,24
,283
,368
,1022
,794–797
,794
TransdermScop
,1022–1023
,1022
TransedermNitro
,794
,226
Transfusionreduction
,37
,957–958
,37
,226
,547
,1124–1126
,1124–1126
,1058
,1058
,979
,1120
,680
,177
,1058
,1127–1128
,1058
,802
,1046
,452
,393
,709
,678
,390
,62
,62
,557
,77
,313
,1106
,832
Trophoblasticdisease
chlorambucil,181–182
fluorouracil,408–409
dactinomycin,254–255
,1090–1093
,182
,883
,33
,759
,204
,1090–1093
,1146
dipyridamole,313–315
,176
VanafenOtologic
,182
VanafenS
,182
,37–38
,1156
,1156
,1156
,83–84
VancerilDS
,83–84
,1156
,1156
,1156–1157
,1156
VancocinaCP
,1156
VancocinCP
,1156
,1156
VancocinHCl
,1156
VancocinHClPulvules
,1156–1157
,1156
,1156
,1156
vancomycin,1156–1157
linezolid,593–594
,283
,1156–1157
,1156
,1156
,634
,228
,1156
,1172
,44,214
,335
,1034–1035
,1034
,48–50
,83
,83
,241–242
,241–242
,335
,335
,335
,335
,335–336
,335
,335
,335
,335
,335–336
,335
,335
,335
VibravenosSF
,335
V.cholerae
V.comma
minocycline,725–727
,703
,1156
,505
vonWillebranddisease
desmopressin,269–271
,60
,609
,288
VorenEmulgel
,288
voriconazole,1172–1174
,17
,288
VotalenSR
,288
,308
,815
,288
VoveranEmugel
,288
,421
,398
,172
,866
V-PenicillinKalium
,866
,44,214
,818
Vulvovaginalcandidiasis
clotrimazole,228–229
terconazole,1082–1083
,899
,1159–1161
V-ZVax
,1157
,828
,828–829
,94
,663
,926
,777–778
,335
,1175
,1175
warfarin,1175–1178
Warfil5
,1175
,1175
,228
,910
,910
,910
genitalorperianal
imiquimod,498
podofilox,910–911
podophyllumresin,
,10
,324
WastingsyndromeinAIDS
megestrol,638–639
,952
,163
,98
,308–309
,312–313
Weightloss
mazindol,625–626
,241–242
,528–529
,630–631
,846
,846
,846
,1179
,1034
,112–114
,112
ZybanLP
,112
ZybanSustainedRelease
,124
,10
,163
,1116
,1184
,1186–1187
,1051–1052
,1051
,20
,177
,20
,20–21
,20
,443
,844–845
,177
,201
,755
,24
,814–815
ZyprexaZydis
,814
,443
,177
,177
,177
,177
,20–21
,20
,177–178
,177
,163
ZytramBD
,1116
ZytramXLSR
,1116
,75
,10
,594–595
,594
,594
,594