Clinician's Pocket Drug Reference 2008

66 ClofarabineAdults. PO: 150–450 mg PO q6–8h. IV: 300–600 mg IV q6h or 900 mg IV q8h.Vaginal: 1 applicator hs for 7 d. Topical: Apply 1% gel, lotion, or soln bid. Peds.Neonates: (Avoid use; contains benzyl alcohol) 10–15 mg/kg/24 h ÷ q8–12h. Children>1 mo.: 10–30 mg/kg/24 h ÷ q6–8h, to a max of 1.8 g/d PO or 4.8 g/d IV. Topical:Apply 1%, gel, lotion, or soln bid; ↓ in severe hepatic impair Caution: [B, +]Can cause fatal colitis Contra: Hx pseudomembranous colitis Disp: Caps 75, 150,300 mg; susp 75 mg/5 mL; inj 300 mg/2 mL; vaginal cream 2%, topical sol 1%, gel1%, lotion 1%, vaginal supp 100 mg SE: D may be C. difficile pseudomembranouscolitis, rash, ↑ LFTs Notes: D/C drug w/D, evaluate for C. difficileClofarabine (Clolar) Uses: Rx relapsed/refractory ALL after at least 2 regimensin children 1–21 y Action: Antimetabolite; ↓ ribonucleotide reductase w/false nucleotide base-inhibiting DNA synth Dose: 52 mg/m 2 IV over 2 h daily × 5d (repeat q2–6wk); Per protocol Caution: [D, –] Disp: Inj 20 mg/20 mL SE:N/V/D, anemia, leukopenia, thrombocytopenia, neutropenia, Infxn, ↑ AST/ALTNotes: Monitor for tumor lysis synd & systemic inflammatory response synd(SIRS)/capillary leak synd; hydrate wellClonazepam (Klonopin) [C-IV] Uses: *Lennox-Gastaut synd, akinetic& myoclonic Szs, absence Szs, panic attacks,* restless legs synd, neuralgia,parkinsonian dysarthria, bipolar disorder Action: Benzodiazepine; anticonvulsantDose: Adults. 1.5 mg/d PO in 3 ÷ doses; ↑ by 0.5–1 mg/d q3d PRN up to 20 mg/d.Peds. 0.01–0.03 mg/kg/24 h PO ÷ tid; ↑ to 0.1–0.2 mg/kg/24 h ÷ tid; avoid abruptD/C Caution: [D, M] Elderly pts, resp Dz, CNS depression, severe hepatic impair,NAG Contra: Severe liver Dz, acute NAG Disp: Tabs 0.5, 1, 2 mg, Oral disintegratingtabs 0.125, 0.25, 0.5, 1, 2 mg SE: CNS side effects, including drowsiness,dizziness, ataxia, memory impair Notes: Can cause retrograde amnesia; a CYP3A4substrateClonidine, Oral (Catapres) Uses: *HTN*; opioid, EtOH, & tobaccowithdrawal Action: Centrally acting α-adrenergic stimulant Dose: Adults. 0.1 mgPO bid, adjust daily by 0.1- to 0.2-mg increments (max 2.4 mg/d). Peds. 5–10mcg/kg/d ÷ q8–12h (max 0.9 mg/d); ↓ in renal impair Caution: [C, +/–] Avoid w/β-blocker Contra: Component sensitivity Disp: Tabs 0.1, 0.2, 0.3 mg SE: drowsiness,orthostatic ↓ BP, xerostomia, constipation, bradycardia, dizziness Notes:More effective for HTN if combined w/ diuretics; withdraw slowly, rebound HTNw/ abrupt D/C of doses >0.2 mg bidClonidine, Transdermal (Catapres TTS) Uses: *HTN* Action:Centrally acting α-adrenergic stimulant Dose: 1 patch q7d to hairless area (upperarm/torso); titrate to effect; ↓ w/ severe renal impair; Caution: [C, +/–] Avoid w/β-blocker, withdraw slowly Contra: Component sensitivity Disp: TTS-1, TTS-2,TTS-3 (delivers 0.1, 0.2, 0.3 mg, respectively, of clonidine/d for 1 wk) SE:Drowsiness, orthostatic ↓ BP, xerostomia, constipation, bradycardia Notes: Do notD/C abruptly (rebound HTN) Doses >2 TTS-3 usually not associated w/ ↑ efficacy;steady state in 2–3 d