Clinician's Pocket Drug Reference 2008

146 MisoprostolMisoprostol (Cytotec) WARNING: Use in pregnancy can cause abortion,premature birth, or birth defects; do not use to decrease ulcer risk in women ofchildbearing age Uses: *Prevent NSAID-induced gastric ulcers*; induce labor(cervical ripening); incomplete & therapeutic abortion Action: Prostaglandin(PGE-1), w/antisecretory & mucosal protective properties; induces uterine contractionsDose: Ulcer prevention: 200 mcg PO qid w/ meals; in females, start 2nd or 3rdday of next nl menstrual period; 25–50 mcg for induction of labor (term); 400 mcgon day 3 of mifepristone for PRG termination; take w/ food Caution: [X, –] Contra:PRG, component allergy Disp: Tabs 100, 200 mcg SE: Can cause miscarriagew/ potentially dangerous bleeding; HA, GI common (D, abd pain, constipation)Mitomycin (Mutamycin) WARNING: Administer only by physician experiencedin chemotherapy; myelosuppressive; can induce hemolytic uremic syndwith irreversible renal failure Uses: *Stomach, pancreas,* breast, colon CA;squamous cell carcinoma of the anus; non-small-cell lung, head & neck, cervical;bladder CA (intravesically) Action: Alkylating agent; may generate oxygen-freeradicals w/ DNA strand breaks Dose: Per protocol; 20 mg/m 2 q6–8wk or 10 mg/m 2in combo w/ other myelosuppressive drugs; bladder CA 20–40 mg in 40 mL NSvia a urethral catheter once/wk × 8 wk, followed by monthly × 12 mo for 1 y; ↓ inrenal/hepatic impair Caution: [D, –] Contra: Thrombocytopenia, leukopenia, coagulationdisorders, SCr >1.7 mg/dL Disp: Inj 5, 20, 40 mg SE: ↓ BM, (persists3–8 wk after, may be cumulative; minimize w/lifetime dose