Clinician's Pocket Drug Reference 2008

130 Leuprolidetra: PRG Disp: Tabs 2.5 mg SE: Anemia, N, hot flashes, arthralgia Notes: MonitorCBC, thyroid Fxn, lytes, LFT, & SCrLeucovorin (Wellcovorin) Uses: *OD of folic acid antagonist; megaloblasticanemia, augment 5-FU impaired MTX elimination* Action: Reduced folatesource; circumvents action of folate reductase inhibitors (eg, MTX) Dose:Leucovorin rescue: 10 mg/m 2 PO/IM/IV q6h; start w/in 24 h after dose or 15 mgPO/IM/IV q6h, 25 mg/dose max PO; Folate antagonist overdose (eg pemetrexed)100 mg/m 2 IM/IV x1 then 50 mg/m 2 IM/IV q6h × 8 days 100 mg/m 2 × 1;5-FU adjuvant tx, colon CA per protocol; low dose: 20 mg/m 2 /day IV x5 days w/5-FU 425 mg/m 2 /day IV x5 days, repeat q4–5wk × 6; high dose: 500 mg/m 2 IVqwk × 6, w/ 5-FU 500 mg/m 2 IV qwk x6wk, repeat after 2 wk off × 4; Megaloblasticanemia: 1 mg IM/IV daily Caution: [C, ?/–] Contra: Pernicious anemia Disp:Tabs 5, 10, 15, 25 mg; inj 50, 100, 200, 350, 500 SE: Allergic Rxn, N/V/D, fatigueNotes: Monitor Cr, methotrexate levels q24h w/ leucovorin rescue; do not use intrathecally/intraventricallyLeuprolide (Lupron, Lupron DEPOT, Lupron DEPOT-Ped,Viadur, Eligard) Uses: *Advanced prostatic cancer (all products exceptDepot-Ped), endometriosis (Lupron), uterine fibroids (Lupron), & precocious puberty(Lupron-Ped)* Action: LHRH agonist; paradoxically ↓ release of gonadotropin,resulting in ↓ pituitary gonadotropins (↓ LH); in men ↓ testosteroneDose: Adults. PCa: Lupron Depot: 7.5 mg IM q28d or 22.5 mg IM q3mo or 30 mgIM q4mo; Eligard: 7.5 mg IM/SQ q28d or 22.5 mg IM q3mo or 30 mg IM/SQq4mo; Eligard 45 mg SQ 6 mo; Viadur implant (PCa only); insert in inner upperarm w/ local anesthesia, replace q12mo. Endometriosis (Lupron DEPOT): 3.75 mgIM qmo × 6. Fibroids: 3.75 mg IM qmo × 3. Peds. CPP (Lupron-Ped): 50 mcg/kg/dSQ inj; ↑ by 10 mcg/kg/d until total down-regulation achieved. DEPOT: 25–37.5 kg: 11.25 mg IM q4wk. >37.5 kg: 15 mg IM q4wkCaution: [X, ?] w/ impending cord compression in PCa Contra: AUB, implant inwomen/peds; PRG Disp: Inj 5 mg/mL; Lupron DEPOT 3.75 (1 mo for fibroids, endometriosis);Lupron DEPOT for PCa: 7.5 mg (1 mo), 11.25 mg (3 mo), 22.5(3 mo), 30 mg (4 mo); Eligard depot for PCa: 7.5 mg (1 mo); 22.5 mg (3 mo), 30 mg(4 mo), 45 mg (6 mo); Viadur 65 mg 12-mo SQ implant, Lupron-Ped 7.5, 11.25, 15mg SE: Hot flashes, gynecomastia, N/V, alopecia, anorexia, dizziness, HA, insomnia,paresthesias, depression exacerbation, peripheral edema, & bone pain (transient“flare Rxn” at 7–14 d after the 1st dose [LH/testosterone surge before suppression])Notes: Nonsteroidal antiandrogen (eg, bicalutamide) may block flare in men w/CaPLevalbuterol (Xopenex, Xopenex HFA) Uses: *Asthma (Rx & preventionof bronchospasm)* Action: Sympathomimetic bronchodilator; R-isomerof albuterol Dose: Adult: HFA 2 puffs q4–6h, 12 puffs/day max; 0.63–1.25 mgNeb q6–8h prn; Peds > 4 yrs: HFA 2 puffs q4–6h, 12 puffs/day max Peds: 6–11>yrs: 0.31-0.63 mg neb q6–8h; Peds > 11 yrs: 0.63–1.25 mg neb q6–8h Caution:[C, ?] CAD, HTN, arrhythmias Contra: w/phenothiazines, MAOI w/in 14d