Clinician's Pocket Drug Reference 2008

Methotrexate 141Contra: SCr > 1.4 in females or > 1.5 in males; hypoxemic conditions (eg acuteCHF/sepsis) Disp: Tabs 500, 850, 1000 mg; XR tabs 500, 750, 1,000 mg SE:Anorexia, N/V, rash, lactic acidosis (rare, but serious)Methadone (Dolophine) [C-II] WARNING: Deaths, cardiac and respiratoryhave been reported during initiation and conversion of pain patients tomethadone treatment from treatment with other opioids Uses: *Severe pain;detox w/ maint of narcotic addiction* Action: Narcotic analgesic Dose: Adults.2.5–10 mg IM q3–8h or 5–15 mg PO q8h; titrate as needed Peds. 0.7 mg/kg/24 hPO or IM ÷ q8h; ↑ slowly to avoid resp depression; ↓ in renal impair Caution:[B/D (prolonged use/high doses at term), + (w/ doses =/> 20 mg/24 h)], severeliver Dz Disp: Tabs 5, 10, 40 mg; PO soln 5, 10 mg/5 mL; PO conc 10 mg/mL; inj10 mg/mL SE: Resp depression, sedation, constipation, urinary retention, ↑ QT interval,arrhythmias Notes: Equianalgesic w/ parenteral morphine; longer half-lifeMethenamine (Hiprex, Urex, others) Uses: *Suppress/eliminatebacteriuria associated w/ chronic/ recurrent UTI* Action: Converted to formaldehyde& ammonia in acidic urine; nonspecific bactericidal action Dose: Adults.Hippurate: 0.5–1 gm bid. Mandelate: 1 g qid PO pc & hs Peds 6–12 y. Hippurate:25–50 mg/kg/d PO ÷ bid. Mandelate: 50–75 mg/kg/d PO ÷ qid (take w/ food,ascorbic acid w/ adequate hydration) Caution: [C, +] Contra: Renal insuff, severehepatic Dz, & severe dehydration; sulfonamide allergy Disp: Methenamine hippurate(Hiprex, Urex): Tabs 1 g. Methenamine mandelate: 500 mg, 1g EC tabs SE:Rash, GI upset, dysuria, ↑ LFTsMethimazole (Tapazole) Uses: *Hyperthyroidism, thyrotoxicosis,* prepfor thyroid surgery or radiation Action: Blocks T 3 & T 4 formation Dose: Adults.Initial: 15–60 mg/d PO ÷ tid. Maint: 5–15 mg PO daily. Peds. Initial: 0.4–0.7mg/kg/24 h PO ÷ tid. Maint: 1 ⁄3– 2 ⁄3 of initial dose PO daily; w/ food Caution: [D,+/–] Contra: Breast-feeding Disp: Tabs 5, 10, 20 mg SE: GI upset, dizziness,blood dyscrasias Notes: Follow clinically & w/ TFTMethocarbamol (Robaxin) Uses: *Relief of discomfort associated w/painful musculoskeletal conditions* Action: Centrally acting skeletal muscle relaxantDose: Adults. 1.5 g PO qid for 2–3 d, then 1-g PO qid maint therapy; IVform rarely indicated. Peds. 15 mg/kg/dose IV, may repeat PRN (OK for tetanusonly), max 1.8 g/m 2 /d for 3 d Caution: Sz disorders [C, +] Contra: MyG, renalimpair Disp: Tabs 500, 750 mg; inj 100 mg/mL SE: Can discolor urine; drowsiness,GI upsetMethotrexate (Rheumatrex Dose Pack, Trexall) WARNING:Administration only by experienced physician; do not use in women of childbearingage unless absolutely necessary (teratogenic); impaired elimination w/ impairedrenal funct, ascites, pleural effusion; severe myelosuppression if used withNSAIDs; hepatotoxic; can induce lung disease; D and ulcerative stomatitis requireD/C; lymphoma risk; may cause tumor lysis synd; can cause severe skin Rxn, opportunisticinfns; with RT can ↑ risk of tissue necrosis Uses: *ALL, AML,