Clinician's Pocket Drug Reference 2008

Deferasirox 75300 mg SE: ↑ glucose, cholesterol, triglycerides, central redistribution of fat(metabolic synd.), N, ↓ neutrophils and ↑ amylaseDasatinib (Sprycel) Uses: CML, Ph + ALL Action: multi tyrosine kinaseinhibitor Dose: 70 mg PO BID; adjust w/CYP3A4 inhibitors/inducers (Table 11)Caution: [D, ?/–] Contra: None Disp: Tabs 20, 50, 70 mg SE: ↓ BM, edema,fluid retention, pleural effusions, N/V/D, abd pain, bleeding, fever, ↑ QTDaunorubicin (Daunomycin, Cerubidine) WARNING: CardiacFxn should be monitored due to potential risk for cardiac tox & CHF, renal/hepaticdsfxn Uses: *Acute leukemias* Action: DNA intercalating agent; ↓ topoisomeraseII; generates oxygen free radicals Dose: 45–60 mg/m 2 /d for 3 consecutived; 25 mg/m 2 /wk (Per protocols); ↓ in renal/hepatic impair Caution: [D, ?] Contra:Component sensitivity Disp: Inj 20, 50 mg SE: ↓ BM, mucositis, N/V, alopecia,radiation recall phenomenon, hepatotox (hyperbilirubinemia), tissue necrosis w/extrav, cardiotox (1–2% CHF w/ 550 mg/m 2 cumulative dose) Notes: Prevent cardiotoxw/ dexrazoxane (when pt received > 300 mg/m of daunorubicin cum dose);for IV use only; allopurinol prior to ↓ hyperuricemiaDecitabine (Dacogen) Uses: *MDS* Action: Inhibits DNA methyltransferaseDose: 15 mg/m 2 cont inf over 3 h; repeat q 8 h × 3 days; repeat cycle q 6 wk,min 4 cycles; delay Tx and ↓ dose if inadequate hematologic recovery at 6 wk (seelabel protocol) Caution: [D, ?/–]; avoid pregnancy; males should not father a childduring or 2 months after; renal/hepatic impair Disp: Powder 50 mg/vial SE: Neutropenia,febrile neutropenia, thrombocytopenia, anemia, leukopenia, peripheraledema, petechiae, N/V/D, constipation, stomatitis, dyspepsia, cough, fever, fatigue,↑ LFTs & bili, hyperglycemia, Infxn, HA Notes: CBC and plt before each cycleand prn; may premedicate w/anti-emeticDelavirdine (Rescriptor) Uses: *HIV Infxn* Action: NonnucleosideRT inhibitor Dose: 400 mg PO tid Caution: [C, ?] CDC recommends HIV-infectedmothers not breast-feed (transmission risk); w/renal/hepatic impair Contra: Usew/ drugs dependent on CYP3A for clearance (Table 11) Disp: Tabs 100, 200 mgSE: Fat redistribution, immune reconstitution synd, HA, fatigue, rash, ↑ transaminases,N/V/D Notes: Avoid antacids; ↓ cytochrome P-450 enzymes; numerousdrug interactions; monitor LFTsDeferasirox (Exjade) Uses: *Chronic iron overload due to transfusion inpatients > 2 yrs* Action: Oral iron chelator Dose: Initial: 20 mg/kg PO/d; adjust by5–10 mg/kg q 3–6 mo based on monthly ferritin; 30 mg/kg/d max; on empty stomach30 min before food; hold dose if ferritin 1 gm in 7 oz) drink immediately; resuspend residueand swallow; do not chew, swallow whole tabs or take w/ Al-containing antacidsCaution: [B, ?/–] Disp: Tabs for oral susp 125, 250, 500 mg SE: N/V/D, abd pain,skin rash, HA, fever, cough, ↑ creatinine & LFTs, Infxn, hearing loss, dizziness,cataracts, retinal disorders, ↑ IOP, lens opacities, dizziness Notes: ARF, peripheralcytopenias possible; Cr weekly 1st month then Q month, monitor CBC; Do not