Clinician's Pocket Drug Reference 2008

138 Megestrol Acetatemg SQ q3 mo (depo SQ). Secondary amenorrhea: 5–10 mg/d PO for 5–10 d. AUB:5–10 mg/d PO for 5–10 d beginning on the 16th or 21st d of menstrual cycle. EndometrialCA: 400–1000 mg/wk IM; ↓ in hepatic insuff Caution: [X, +] Contra:Hx thromboembolic disorders, hepatic Dz, PRG Disp: Tabs 2.5, 5, 10 mg; depotinj 150, 400 mg/mL; depo SQ inj 104 mg/10.65 mL SE: Breakthrough bleeding,spotting, altered menstrual flow, anorexia, edema, thromboembolic comps, depression,wgt gain Notes: Perform breast exam & Pap smear before contraceptive therapy;obtain PRG test if last inj > 3 moMegestrol Acetate (Megace) Uses: *Breast/endometrial CAs; appetitestimulant in cachexia (CA & HIV)* Action: Hormone; progesterone analog Dose:CA: 40–320 mg/d PO in ÷ doses. Appetite: 800 mg/d PO ÷ dose Caution: [X, –]Thromboembolism Contra: PRG Disp: Tabs 20, 40 mg; soln 40 mg/mL; alsoavailable in 125 mg/mL (Megase ES) SE: DVT; edema, menstrual bleeding; photosens,insomnia, rash, ↓ BM Notes: Do not D/C abruptlyMeloxicam (Mobic) WARNING: May ↑ risk of cardiovascular events &GI bleeding Uses: *Osteoarthritis, RA, JRA* Action: NSAID w/ ↑ COX-2 activityDose: Adult: 7.5–15 mg/d PO; Peds (>2 yr): 0.125 mg/kg/d, max 7.5 mg;↓ in renal insuff; take w/food Caution: [C, D (3rd trim) ?/–] Peptic ulcer, NSAID,or ASA sensitivity Disp: Tabs 7.5, 15 mg; susp. 7.5 mg/5 mL SE: HA, dizziness,GI upset, GI bleeding, edemaMelphalan [L-PAM] (Alkeran) WARNING: Administered under thesupervision of a qualified physician experienced in the use of chemotherapy; severeBM depression, leukemogenic, & mutagenic Uses: *Multiple myeloma,ovarian CAs,* breast & testicular CA, melanoma; allogenic & ABMT (high dose)Action: Bifunctional alkylating agent Dose: (Per protocol) 6 mg/d or 0.15–0.25mg/kg/d for 4–7 d, repeat 4–6-wk intervals, or 1-mg/kg × 1 q4–6wk; 0.15 mg/kg/dfor 5 d q6wk. High-dose high-risk multiple myeloma: Single dose 140 mg/m 2 .ABMT: 140–240 mg/m 2 IV; ↓ in renal insuff Caution: [D, ?] Contra: Allergy orresistance Disp: Tabs 2 mg; inj 50 mg SE: ↓ BM, secondary leukemia, alopecia,dermatitis, stomatitis, & pulm fibrosis; rare allergic Rxns Notes: Take PO onempty stomachMemantine (Namenda) Uses: *Moderate/severe Alzheimer Dz* Action:N-methyl-D-aspartate receptor antagonist Dose: Target 20 mg/d, start 5 mg/d,↑ 5 mg/d to 20 mg/d, wait > 1 wk before ↑ dose; use ÷ doses if > 5 mg/d Caution:[B, ?/–] Hepatic/mild–moderate renal impair Disp: Tabs 5, 10 mg, combo pak:5mg× 28 + 10 mg × 21; sol 2 mg/mL SE: Dizziness Notes: Renal clearance ↓ byalkaline urine (↓ 80% @ pH 8)Meningococcal conjugate vaccine (Menactra) Uses: *Immunizeagainst N. meningitidis (meningococcus)* Action: Active immunization;diphtheria toxoid conjugate of N. meningitidis A, C, Y, W-135 Dose: Adults 18–55 y0.5 mL IM X1 Peds: 11–18 y 0.5 mL IM X1 Caution: [C, ?/–] Contra: Allergy toclass/compound/latex; w/acute infect Disp: Inj SE: Local inj site Rxns, HA, fa-