Clinician's Pocket Drug Reference 2008

142 Methyldopaleukemic meningitis, trophoblastic tumors (chorioepithelioma, choriocarcinoma,hydatidiform mole), breast, lung, head & neck CAs, Burkitt’s lymphoma, mycosisfungoides, osteosarcoma, Hodgkin Dz & NHL, psoriasis; RA* Action: ↓ Dihydrofolatereductase-mediated production of tetrahydrofolate Dose: CA: Per protocol.RA: 7.5 mg/wk PO 1/wk 1 or 2.5 mg q12h PO for 3 doses/wk; ↓ in renal/hepaticimpair Caution: [D, –] Contra: Severe renal/hepatic impair, PRG/lactation Disp:Dose Pack: 2.5 mg in 8, 12, 16, 20, or 24 doses; Tabs 2.510 mg; inj 25 mg/mL SE:↓ BM, N/V/D, anorexia, mucositis, hepatotox (transient & reversible; mayprogress to atrophy, necrosis, fibrosis, cirrhosis), rashes, dizziness, malaise, blurredvision, alopecia, photosens, renal failure, pneumonitis; rare pulm fibrosis; chemicalarachnoiditis & HA w/ IT delivery Notes: Monitor CBC, LFTs, Cr, MTX levels &CXR; “high dose” > 500 mg/m 2 requires leucovorin rescue to ↓ tox; w/ intrathecal,use preservative-free/alcohol-free soln; systemic levels Therapeutic: > 0.01 micromole;Toxic > 10 micromole over 24hMethyldopa (Aldomet) Uses: *HTN* Action: Centrally acting antihypertensiveDose: Adults. 250–500 mg PO bid–tid (max 2–3 g/d) or 250 mg–1 g IVq6–8h. Peds. 10 mg/kg/24 h PO in 2–3 ÷ doses (max 40 mg/kg/24 h ÷ q6–12h) or5–10 mg/kg/dose IV q6–8h to total dose of 20–40 mg/kg/24 h; ↓ in renal insuff/elderlyCaution: [B (PO), C (IV), +] Contra: Liver Dz; MAOIs Disp: Tabs 125,250, 500 mg; inj 50 mg/mL SE: Discolors urine; initial transient sedation/drowsinessfrequent, edema, hemolytic anemia, hepatic disordersMethylergonovine (Methergine) Uses: *Postpartum bleeding (uterinesubinvolution)* Action: Ergotamine derivative Dose: 0.2 mg IM after placentaldelivery, may repeat 2–4-h intervals or 0.2–0.4 mg PO q6–12h for 2–7 d Caution:[C, ?] Contra: HTN, PRG Disp: Injectable 0.2 mg/mL; tabs 0.2 mg SE: HTN,N/V Notes: Give IV over > 1 min w/BP monitoringMethylphenidate, Oral (Concerta, Ritalin, Ritalin SR, others)[CII] WARNING: w/ hx of drug or alcohol dependence; chronic use canlead to dependence or psychotic behavior; observe closely during withdrawal ofdrug Uses: *ADHD, narcolepsy* depression Action: CNS stimulant Dose:Adults. Narcolepsy: 10 mg PO 2–3 times/day, 60 mg/day max. Depression: 2.5 mgQAM; ↑ slowly, 20 mg/day max; use regular release only Peds. Based on product;Initial total daily dose of 15–20 mg; 90 mg/day max; administer once (ER/SR) toBID (regular) Caution: [C,+/–] Hx alcoholism or drug abuse; separate fromMAOIs by 14 days Disp: Tabs 5, 10, 20 mg; Tabs SR (Ritalin SR) 20 mg; ER tabs(Concerta) 18, 27, 36, 54 mg SE: CV, CNS stimulation Notes: Titrate dose; take30–45 min before meals; do not chew or crush; Concerta “ghost tablet” may appearin stool; see insert to convert to ER dose; see also transdermal methylphenidate;abuse and diversion concernsMethylphenidate, transdermal (Daytrana) [CII] WARNING: w/hx of drug or alcohol dependence; chronic use can lead to dependence or psychoticbehavior; observe closely during withdrawal of drug Uses: *ADHD in children