By Shamim Tejani PharmD, Cynthia A. Sanoski BS PharmD FCCP BCPS
Davis's Pocket medical Drug Reference is a short source for the main standard medicines in medical perform. The monographs are designed to focus on pertinent details; particularly, each one monograph features a drug's widely used identify, model identify, therapeuticindication, pharmacologic type, being pregnant classification, contraindications, antagonistic drug reactions, drug interactions, dose, availability, and tracking parameters.
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Amitriptyline (Elavil) Uses: Depression; Class: tricyclic antidepressants; Preg: C; CIs: Hypersensitivity, Concurrent use with MAOIs, Post-MI, May risk of suicidal thoughts/behaviors esp. , phenothiazines, quinidine, cimetidine, and class Ic antiarrhythmics) may levels, risk of hypertensive crises, seizures, or death with MAOIs CAPITALS indicates life-threatening; underlines indicate most frequent A → → → → (discontinue for ≥2 wk), risk of toxicity with SSRIs (discontinue fluoxetine for ≥5 wk), risk of arrhythmias with other drugs that prolong QT interval, CNS depression with other CNS depressants including alcohol, antihistamines, opioids, and sedative/hypnotics, risk of anticholinergic effects with other anticholinergic agents; Dose: PO: Adults: 75 mg/day in divided doses; may be up to 300 mg/day or 50–100 mg at bedtime, may by 25–50 mg/day up to 300 mg at bedtime; PO: Geri and Adolescents: 10 mg tid and 20 mg/day at bedtime or 25 mg at bedtime initially, slowly to 100 mg/day as a single bedtime dose or in divided doses; Availability (G): Tabs: 10, 25, 50, 75, 100, 150 mg; Monitor: BP, HR, ECG, mental status, suicidal thoughts/behaviors; Notes: May take 4–6 wk to see effect.
ER (for 6–12 yr): 10 mg daily; by 5–10 mg/day at weekly intervals (max: 30 mg/day). 5, 15, 20, 30 mg; ER caps: 5, 10, 15, 20, 25, 30 mg; Monitor: BP, HR, ECG, mental status, ht/wt; Notes: Schedule II controlled substance. For IR tabs, give first dose upon awakening, and then subsequent doses at 4–6 hr intervals. Take last dose ≥6 hr before bedtime to minimize insomnia. If switching from IR to ER, give same total daily dose once daily. All children should have CV assessment prior to initiation. Potential for dependence/abuse with long-term use.
Meningitis—150–250 mg/ kg/day divided q 3–4 hr (max: 12 g/day); IM: IV: Peds: <40 kg 100–150 mg/ kg/day divided q 6 hr (max: 4 g/day). IE prophylaxis—50 mg/kg (not to exceed 2 g) 30–60 min before procedure. Meningitis—200–400 mg/kg/ day divided q 6 hr (max: 12 g/day); PO: IM: IV: Adults and Peds: dose if CrCl ≤50 ml/min; Availability (G): Caps: 250, 500 mg; Oral susp: 125 mg/5 ml, 250 mg/5 ml; Inject: 125, 250, 500 mg, 1, 2, 10 g; Monitor: HR, BP, temp, sputum, U/A, CBC, LFTs, BUN/SCr; Notes: Give on empty stomach ≥1 hr before or 2 hr after meals with full → → → → A → CAPITALS indicates life-threatening; underlines indicate most frequent anastrazole 17 glass of water.