Clinician's Pocket Drug Reference 2008

Orphenadrine 159Disp: 28-d cycle pills (21 active pills + 7 placebo or Fe supplement); 21-d cycle pills(21 active pills) SE: Intramenstrual bleeding, oligomenorrhea, amenorrhea, ↑ appetite/wgtgain, ↓ libido, fatigue, depression, mood swings, mastalgia, HA,melasma, ↑ vaginal discharge, acne/greasy skin, corneal edema, N Notes: Takencorrectly, 99.9% effective for contraception; no STDs prevention, use additional barriercontraceptive; long term, can ↓ risk of ectopic PRG, benign breast Dz, ovarian& uterine CA. Rx for menstrual cycle control: Start w/monophasic × 3 mo beforeswitching to another brand; w/continued bleed, change to pill w/↑estrogen; Rx forbirth control: Choose pill w/ lowest SE profile for particular pt; SEs numerous; dueto estrogenic excess or progesterone deficiency; each pill’s side effect profile can beunique (see insert); newer extended cycle combo have shorter/fewer hormone freeintervals ? ↓ PRG risk; OCP troubleshooting side effects w/suggested OCP:• Absent menstrual flow: ↑ estrogen, ↓ progestin: Brevicon, Necon 1/35, Norinyl1/35, Modicon, Necon 1/50, Norinyl 1/50, Ortho-Cyclen, Ortho-Novum 1/50,Ortho-Novum 1/35, Ovcon 35• Acne: use ↑ estrogen, ↓ androgenic: Brevicon, Cyclen, Demulen 1/50, Othro-TriCyclen, Mircette, Modicon, Necon, Ortho Evra, Yasmin• Break-through bleed:↑ estrogen, ↑ progestin, ↓ androgenic: Demulen 1/50, Desogen,Estrostep, Loestrin 1/20, Ortho-Cept, Ovcon 50, Yasmin, Zovia 1/50E• Breast tenderness or ↑ wgt: ↓ estrogen, ↓ progestin: Use ↓ estrogen pill thancurrent; Alesse, Levlite, Loestrin 1/20 Fe, Ortho Evra Yasmin• Depression:↓ progestin: Alesse, Brevicon, Levlite, Modicon, Necon, Ortho Evra,Ovcon 35, Othro-Cyclen, Ortho-TriCyclen Tri-Levlen, Triphasil, Trivora• Endometriosis: ↓ estrogen, ↑ progestin: Demulen 1/35, Loestrin 1.5/30, Loestrin1/20 Fe, LoOvral, Levlen, Levora, Nordette, Zovia 1/35; continuous w/0 placebopills or w/ 4 days of placebo pills• HA: ↓ estrogen, ↓ progestin: Alesse, Levlite, Ortho Evra• Moodiness/ or irritability: ↓ progestin: Alesse, Brevicon, Levlite, Modicon,Necon 1/35, Ortho Evra, Ortho-Cyclen, Ortho Tri-Cyclen, Ovcon 35, Tri-Levlen,Triphasil, Trivora• Severe menstrual cramping: ↑ progestin: Demulen 1/50, Desogen, Loestrin1.5/30, Mircette, Ortho-Cept ,Yasmin, Zovia 1/50E, Zovia 1/35EOrlistat (Xenical, Alli [OTC]). Uses: *Manage obesity w/ BMI 30kg/m 2 or 27 kg/m 2 w/ other risk factors; type 2 DM, dyslipidemia* Action: Reversibleinhibitor of gastric & pancreatic lipases. Dose: 120 mg PO tid w/ a fatcontainingmeal; Alli (OTC) 60 mg po tid w/fat containing meals Caution: [B, ?]May ↓ cyclosporine & warfarin dose requirements Contra: Cholestasis, malabsorptionDisp: Capsules 120 mg SE: Abd pain/discomfort, fatty stools, fecal urgencyNotes: Do not use if meal contains no fat; GI effects ↑ w/higher-fat meals;supplement w/fat-soluble vitaminsOrphenadrine (Norflex) Uses: *Muscle spasms* Action: Centralatropine-like effects cause indirect skeletal muscle relaxation, euphoria, analgesia