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Capstone Top 200 ONU

Top 200 Drugs

GenericBrandClassUsual Adult Dose (Max Dose)ContraindicationsRenal/Hepatic
Acetaminophen 300mg /Codeine 30mg Tylenol #3 Narcotic analgesic 30-60mg codeine q4-6h (4g APAP/day) Signifcant respiratory depression, severe asthma, hypercapnia, paralytic ileus Hepatic
Acyclovir Zovirax Antiviral Shingles; PO: 800mg 5 times/day for 7-10 days , IV: 10 mg/kg/dose or 500 mg/m2/dose q8h for 7 days Renal
Albuterol Inhaler Proventil, Ventolin, ProAir HFA Beta2 agonist 2 puffs q4-6h prn
Alendronate Fosamax Bisphosphonate Prophylaxis: 5mg daily or 35mg weekly Treatment: 10mg daily or 70mgweekly Hypocalcemia, inability to sit or stand upright for 30 minutes, delayed esophageal emptying, risk for aspiration (oral soln)
Allopurinol Zyloprim Xanthine oxidase inhibitor 200-600 mg/day in divided doses (800mg/day) Renal
Alprazolam Xanax Benzodiazepine Anxiety: 0.25-0.5 mg TID (4 mg/day) Narrow angle glaucoma, use with ketoconazole/itraconazole, pregnancy
Amiodarone Cordarone, Pacerone Class III antiarrhythmic PO: 200-1600mg/day in 1-2 divided doses IV:150-300 mg infused over 10 minutes Severe sinus node dysfunction, 2nd/3rd degree heart block or bradycardia causing syncope (except in patient's with functional pacemaker), cardiogenic shock Hepatic
Amitriptyline Elavil TCA Oral: 50-150 mg/day single dose at bedtime or in divided doses; dose may be gradually increased up to 300 mg/day MAOI use within 14 days, acute recovery s/p MI, concurrent cisapride use
Amlodipine Norvasc CCB 2.5-10mg daily Hepatic
Amoxicillin Amoxil, Trimox Penicillin antibiotic 250-500mg q8h or 500-875mg q12h
Amoxicillin/PAmoxicillin/ Potassium Clavulanate Augmentin Penicillin antibiotic 250-500mg TID or 875mg BID History of cholestatic jaundice or hepatic dysfunction with past use, CrCl <30 mL/min, hemodialysis patients Renal
Ampicllin/Sulbactam Unasyn Pencillin antibiotic IM, IV: 1-2 g ampicillin (1.5-3 g Unasyn®) q6h
Anastrazole Arimidex Antineoplastic agent/Aromatase inhibitor 1mg daily Pregnancy or women who may become pregnant
Aripiprazole Abilify Atypical antipsychotic PO: 10-15mg daily (30mg/day)
Atenolol Tenormin Beta-blocker 25-100mg daily Sinus bradycardia, sinus node dysfunction, heart block greater than 1st degree (except in patients with functional pacemaker), cardiogenic shock, uncompensated heart failure, pulmonary edema, pregnancy Renal
Atomoxetine Strattera Norepinephrine reuptake inhibitor 40-80mg daily (100mg/day) Narrow angle glaucoma, MAOI use or use within 14 days Hepatic
Atorvastatin Lipitor HMG Co-A reductase inhibitor 10-80mg daily Acute liver disease, unexplained persistent serum transaminases elevation, pregnancy, breast-feeding
Azithromycin Zithromax Macrolide antibiotic Illness dependent; PO; CAP/SSTI/pertussis: 500mg on day 1 followed by 250mg daily x 4 days, Gonococcal infection: 1 g as a single dose; IV: CAP/PID: 500 mg daily
Benazepril Lotensin ACE-I 20-40mg daily History of angioedema Renal
Benazepril/Amlodipine Lotrel Combination antihypertensive (ACE-I and CCB) See individual agents See individual agents See individual agents
Bupropion XL Wellbutrin XL Antidepressant, Dopamine reuptake inhibitor Depression: 150mg daily (450mg/day) for HCl salt Seizure disorder, history of anorexia/bulimia, MAOI use within 14 days, patients undergoing abrupt d/c of ethanol/sedatives Hepatic and Renal
Buprenex Subutex Opioid for withdrawal Opioid dependence: 12-16mg/day
Buprenorphine/Naloxone Suboxone Opioid for withdrawal 4-24 mg daily (32 mg/day) Hepatic
Candesartan Atacand ARB 4-32mg daily Severe hepatic impairment, cholestasis, pregnancy, breast-feeding Hepatic
Carisoprodol Soma Skeletal muscle relaxant 250-350 mg TID/HS Acute intermittent porphyia
Carvedilol Coreg, Coreg CR Beta blocker Immediate release: 3.125-50mg BID Extended release: 10-80mg once daily Decomponsated cardiac failure requiring IV inotropic therapy, bronchial asthma, 2nd or 3rd degree heart block or sick sinus syndrome (SSS) (except in patient's with functional pacemaker), cardiogenic shock, severe hepatic impairment
Cefazolin Ancef 1st generation cephalosporin IV: 250mg-2g q6-12h (12 gm/day) Renal
Cefdinir Omnicef 3rd generation cephalosporin 300mg BID x10d
Cefepime Maxipime 4th generation cephalsporin IV: 1-2gm q8-12h Renal
Cefixime Suprax 3rd generation cephalosporin PO: 400mg/day divided q12-24 h Renal
Cefotaxime Claforan 3rd generation cephalosporin IM, IV: 1-2 g q8-12h Renal
Cefoxitin Mefoxin 2nd generation cephalosporin IM, IV: 1-2 g q6-8h Renal
Ceftazidime Fortaz 3rd generation cephalosporin IM, IV: 500mg - 2 g q8-12h Renal
Ceftriaxone Rocephin 3rd generation cephalosporin IM, IV: 1-2 g q12-24h Hyperbilirubinemic neonates, concurrent use with IV calcium containing solutions in neonates
Cefuroxime Ceftin, Zinacef 2nd generation cephalosporin PO: 250-500mg BID IM, IV: 750mg-1.5g q8h Renal
Celecoxib Celebrex COX2 selective NSAID 200mg BID Perioperative pain in CABG
Cephalexin Keflex 1st generation cephalosporin 250-1000mg q6h (4g/day)
Ciprofloxacin Cipro Fluoroquinolone antibiotic PO: 250-500mg BID IV: 200-400 mg q12h Concurrent use of tizanidine
Citalopram Celexa SSRI Depression: 20-40 mg daily (40mg/day, 20 mg/day with CYP2C19 poor metabolizer, use of moderate or strong CYP2C19 inhibitors, patients 60 years old or older) MAOI use or use within 14 days, concurrent use with pimozide Hepatic
Clarithromycin Biaxin Macrolide antibiotic 250-500mg BID Use with ergot derviatives, pimozide, cisapride
Clindamycin Cleocin Lincosamide antibiotic PO: 150-450mg q6-8h (1.8 g/day) IM, IV: 1.2-2.7 g/day in 2-4 divided doses (4.8 g/day) Previous pseudomembranous colitis, regional enteritis, UC (topical/vaginal) Hepatic
Clonazepam Klonopin BZD Panic disorder: 0.25-2 mg BID (Max 4mg/day) Significant liver diease, narrow angle glaucoma, pregnancy
Clonidine Catapres Alpha2 adrenergic agonist PO: 0.05-0.4mg BID Transdermal Patch: 0.1-0.3mg once weekly (2.4mg/day)
Clopidogrel Plavix Antiplatelet agent Recent MI or stroke/PAD: 75mg daily Active pathological bleeding
Conjugated Estrogens Premarin Estrogen derivative 0.3-1.25mg daily Un-dxed abnormal vag bleed, hx of or current thrombophlebitis/VTE, active/recent arterial thromboembolic dz, breast carcinoma (except in select patients txed for metastatic disease), estrogen dependent tumor, hepatic dysfunction, pregnancy Hepatic
Cyclobenzaprine Flexeril Skeletal muscle relaxant 5-10mg TID MAOI use or use with 14 days, hyperthyroidism, CHF, arrhythmias, heart block, acute recovery s/p MI
Cyclosporine, opthalmic Restasis Immunosuppressant agent 1 drop in both eyes q12h Active ocular infections
Dextroamphetamine/Amphetamine Adderall XR Stimulant 20 mg daily (60 mg daily) Advanced arteriosclerosis, symptomatic CVD, moderate-severe HTN, hyperthyroidism, glaucoma, agitated states, history of drug abuse, MAOI use or use within 14 days
Diazepam Valium Benzodiazepine Anxiety; PO, IM, IV: 2-10mg BID-QID PRN Myasthenia gravis, severe respiratory insufficiency, severe hepatic insufficiency, sleep apnea, acute narrow angle glaucoma, use <6 months of age (PO) Hepatic and Renal
Diclofenac Voltaren, Flector (patch) NSAID PO: 50mg TID Patch: apply 1 patch twice daily to most painful area (sprain, strains, contusions) Hypersenstivity to bovine protein (capsule), perioperative pain in CABG Renal
Digoxin Lanoxin, Digitek Cardiac glycoside, class IV antiarrhythmic PO: 0.125-0.5mg daily Ventricular fibrillation Renal
Diltiazem Cardizem CD, Cartia XT, Dilt-CD (extended release capsules) CCB HTN; PO: 180-420mg daily (480 mg/day) Afib; IV continuous infusion: 10 mg/hr; may increase up to 15 mg/hr PRN SSS/2nd or 3rd deg. heart block(exc in pts with fxnal pacemaker), sev hypotension, acute MI(PO), acute pulmon congestn (PO), cardiogenic shock(IV), ventr tachyIV), w/in hours of IV beta-blocker admin(IV), AFib/Aflutter asso. w/ accessory bypass tract(IV)
Donepezil Aricept Acetylcholinesterase inhibitor 5-10mg QHS
Doxycycline Vibramycin Tetracycline antibiotic 100-200 mg/day in 1-2 divided doses
Duloxetine Cymbalta SNRI Depression: 40-60mg daily (120mg/day) MAOI use and use within 14 days, do not start MAOI for 5 days after stopping duloxetine, narrow angle glaucoma Hepatic and Renal
Enalapril Vasotec ACE-I PO: 2.5-40mg daily; IV(enalaprilat): 1.25mg/dose over 5 minutes q6h up to 5mg/dose History of angioedema
Enoxaparin Lovenox Low molecular weight heparin Prophylaxis: 30 mg BID or 40 mg daily subcutaneously Treatment: 1mg/kg BID or 1.5mg/kg daily subcutaneously Thrombocytopenia with positive test for antiplatelet antibodies with enoxaparin use, hypersenstivity to pork products, active major bleeding Renal
Escitalopram Lexapro SSRI Depression: 10-20 mg daily (20 mg/day) Use with pimozide, MAOI use or use within 14 days Hepatic
Esomeprazole Nexium PPI PO, IV: 20-40mg daily
Eszopiclone Lunesta Hypnotic non-BZD 2mg QHS (3mg)
Ezetimibe Zetia Antilipidemic agent 10mg daily Use with HMG-CoA reductase inhibitors in patients with active hepatic disease, unexplained persistent serum transaminases elevation, pregnancy, breast-feeding
Famotidine Pepcid H2 antagonist PO: 20-40mg daily-BID IV: 20mg q12h Renal
Fenofibrate Tricor Fibric acid antilipidemic 48-145mg daily (145 mg/day) Hepatic dysfunction, severe renal dysfunction, pre-exsisting gallbladder disease, breast-feeding (Fenoglide) Renal
Fexofenadine Allegra Antihistamine 60mg BID or 180mg daily Renal
Fluconazole Diflucan Antifungal PO, IV: 200-800mg daily; for yeast infection: 150mg x1 dose Use with cisapride and terfenadine Renal
Fluoxetine Prozac SSRI Depression: 20-40 daily (80 mg/day) Use with MAOI, pimozide, thioridazine (should stop MAOI 14 days before starting, do not start MAOI or thioridazine for 5 weeks after stopping) Hepatic
Fluticasone Flovent HFA, Flonase Inhaled corticosteroid Oral Inhalant: 88-220mcg BID(max 440 mcg BID) Intranasal: 2 sprays in each nostril once daily Primary treatment of status asthmaticus or acute bronchospasm, use with treatment site infection, skin atrophy, or treating rosacea/perioral dermatitis (topical)
Fluticasone and salmeterol Advair Diskus Inhalted corticosteroid and B2 agonist 1 puff BID of any dose(Fluticasone 500 mcg BID) Status asthmaticus, acute episodes of asthma/COPD, hypersenstivity to milk protein (Advair Diskus)
Folic Acid Folic Acid Water soluble vitamin 1mg daily
Furosemide Lasix Loop diuretic CHF; PO: initial 20-80 mg/dose, IV bolus: 20-40 mg over 1-2 minutes Anuria
Gabapentin Neurontin Anticonvulsant Anticonvulsant: 300-800mg TID(3600 mg) Renal
Gemfibrozil Lopid Fibric acid 600mg BID 30min before breakfast and dinner Hepatic dysfunction, severe renal dysfunction, pre-exsisting gallbladder disease, primary biliary cirrhosis, concurrent use with repaglinide
Gentamicin Gentamicin Aminoglycoside antibiotic Depend on condition; IV, IM: 1-2.5 mg/kg/dose q8-12h or 4-7 mg/kg/dose once daily Renal
Glimepiride Amaryl Sulfonylurea 1-4mg daily with breakfast(8 mg/day) DKA Renal
Glipizide, Glipizide ER Glucotrol, Glucotrol XL Sulfonylurea Initial: 5mg daily(IR: 40 mg/day, ER: 20 mg/day) Type I DM, DKA Hepatic and Renal
Glyburide Diabeta, Micronase Sulfonylurea 1.25-20 daily(20 mg/day) Type I DM, DKA, concurrent use with bosentan Renal
Heparin Heparin Anticoagulant Thromboembolism prophylaxis: 5000 units q8-12 subcutaneously Treatment of thromboembolism: 80 units/kg BID IV push followed by continuous infusion of 18 units/kg/hour Severe thrombocytopenia, uncontrolled active bleeding except due to DIC, inability to obtained blood coagulation testing (treatment doses)
Hydrochlorothiazide Hydrodiuril Thiazide diuretic Edema: 25-100mg daily HTN: 12.5-50mg daily(max 200 mg/day) Anuria, renal decompensation, pregnancy Renal
Hydrocodone/Acetaminophen Vicodin; Norco (contains 325mg APAP); Lortab (contains 500mg APAP) Narcotic analgesic 1-2 tabs q4-6h prn(APAP: 4 mg/day) CNS depression, severe respiratory depression Hepatic
Hydromorphone Diladud Narcotic analgesic Opiate naïve; IV: 0.2-1 mg q2-3h PRN Severe or acute asthma, severe respiratory depression without ventilatory support, severe CNS depression Hepatic and Renal
Ibandronate Boniva Bisphosphonate PO: 150mg once monthly IV: 3mg every 3 months Hypocalcemia, inability to sit or stand upright for 60 minutes, delayed esophageal emptying Renal
Ibuprofen Motrin, Advil NSAID Rx: 400-800mg TID-QID (3200 mg/day), OTC: 200-400 mg q4-6h (1200 mg/day) Perioperative pain in CABG
Imipenem/Cilastatin Primaxin Carbapenem antibiotic IV: 250-1000mg q6-8h (4g/day)IM: 500-750 mg q12h (1500 mg/day) Severe shock or heart block (IM formulation with lidocaine) Hepatic and Renal
Insulin Aspart NovoLog Insulin Use during hypoglycemia
Insulin Detemir Levemir Insulin
Insulin Glargine Lantus Insulin
Insulin Glulisine Apidra Insulin Use during hypoglycemia
Insulin Lispro Humalog Insulin Use during hypoglycemia
Ipratropium Atrovent Anticholinergic 2 inhalations QID(12 inhalations/day)
Ipratropium and albuterol Combivent Bronchodilator (anticholinergic and B2 agonist) 2 inhalations QID(12 inhalations/day)
Irbesartan Avapro ARB 150-300 daily
Irbesartan/HCTZ Avalide Combination antihypertensive (ARB and thiazide diuretic) Initial dose: 150/12.5mg (max 300/25mg) See individual agents See individual agents
Isosorbide Mononitrate Imdur Nitrate, vasodilator 30-60mg QAM(240 mg/day) Concurrent use with PDE-5 inhibitors, angle closure glaucoma, head trauma or cerebral hemorrhage, severe anemia
Ketoralac Toradol NSAID IV: 30 mg as a single dose or 30 mg q6h (120 mg) Actve/hx PUD, recnt/hx GI bled/perfratn, pts w/ adv renl dz or risk renl failre, proph. befre majr surgry, suspct/confrm cerebrvasclr bled, hemrrhgc diathesis, incmplte hemstasis, highriskbled, concrrnt ASA/NSAID, periop pain CABG, labr/delivry, breastfed Renal
Lamotrigine Lamictal Anticonvulsant 225-375 mg/day in 2 divided doses Hepatic and Renal
Lansoprazole Prevacid PPI 15-30mg daily
Latanoprost Xalatan Antiglaucoma 1 drop daily in the affected eye(s)
Levetiracetam Keppra Anticonvulsant Initial dose; PO: immediate release: 500mg BID, extended release: 1000mg daily, IV: 500 mg BID Renal
Levofloxacin Levaquin Fluoroquinolone antibiotic PO, IV: 250-750mg daily Renal
Levothyroxine Synthroid, Levoxyl, Levothroid Thyroid product PO: 1 tablet daily 30 min before breakfast (dosage will vary), IV: 50% of oral dose Acute MI, thyrotoxicosis of any etiology, uncorrected adrenal insufficiency
Lisdexamfetamine Vyvanse Stimulant 30 mg daily (70 mg/day) Advanced arteriosclerosis, symptomatic CVD, moderate-severe HTN, hyperthyroidism, glaucoma, agitated states, history of drug abuse, MAOI use or use within 14 days
Lisinopril Zestril, Prinivil ACE-I HTN: 10-40mg daily, CHF: 20-40mg daily History of angioedema Renal
Lisinopril/Hydrochlorothiazide Prinzide, Zestoretic ACE-I/Thiazide diuretic Lisinopril; HTN: 10-40mg daily, CHF: 20-40mg daily; HCTZ; Edema: 25-100mg daily HTN: 12.5-50mg daily (max 200 mg/day) See individual agents See individual agents
Lorazepam Ativan Benzodiazepine Anxiety; PO: 2-6mg in divided doses (10 mg/day) Acute narrow angle glaucome, sleep apnea (parenteral), severe respiratory insufficiency (except with mechanical ventilation)
Losartan Cozaar ARB 25-100mg daily(100 mg/day)
Losartan/HCTZ Hyzaar Combination antihypertensive (ARB and thiazide diuretic) 1 tablet daily See individual agents See individual agents
Lovastatin Mevacor, Altoprev HMG Co-A reductase inhibitor 20 mg daily (IR: 80 mg/day) Active liver diease, unexplained persitent serum transaminase elevation,concurrent use of strong CYP3A4 inhibitors, pregnancy, breast-feeding Renal
Meclizine Antivert Antihistamine 25-100mg/day in divided doses
Meloxicam Mobic NSAID 7.5-15mg daily(15 mg/day) Perioperative pain in CABG
Memantine Namenda NMDA Rc antagonist Initial: 5mg daily, then titrate up to 20mg daily Renal
Meropenem Merrem antibiotics- carbapenem 1.5-6 g/day divided q8h(6g/day) Hepatic and Renal
Metformin, Metformin ER Glucophage, Glucophage XR Biguanide IR: 500-1000mg BID with meals (2250 mg/day), XR: 500-1000 mg daily with the evening meal (2000 mg/day) Do not use if sCr >1.5mg/dL in males or >1.4mg/dL in females, acute or chronic metabolic acidosis, abnormal creatinine clearance Hepatic and Renal
Methotrexate Rheumatrex DMARD, antifolate Arthritis; PO: 7.5mg weekly(Arthritis: 20 mg/week) Breast-feeding; in patients with RA or psoriasis: pregnancy, alcoholism, alcoholic liver disease or chronic liver disease, pre-exsisting blood dyscrasias, immunodeficiency syndrome Hepatic and Renal
Methylphenidate Concerta CNS stimulant 18-54mg QAM(6-12 years: 2 mg/kg/day or 54 mg/day, 13-17 years: 72 mg/day) Marked anxiety, tension, agitation, glaucoma, MAOI use or use within 14 days, family history or diagnosis of Tourette's syndrome
Methylprednisolone Medrol Corticosteroid Allergic conditions; PO: Tapered dose using 4mg tablets Systemic fungal infection, administration of live virus vaccines, formulations with benzyl alcohol in infants, IM use in TTP
Metoclopramide Reglan Prokinetic, antiemetic PO: 10-15mg/dose QID IV: 10-20mg over 1-2 minutes GI obstruction, perforation, or hemorrhage, pheochromocytoma, history of seizures or concurrent use of other agents likely to increase extrapyramidial symptoms Renal
Metolazone Zaroxolyn Thiazide-like diuretic 2.5-20mg daily Anuria, hepatic coma, pregnancy
Metoprolol Succinate Toprol XL Beta blocker HTN: 25-100mg daily(400 mg/day) Severe bradycardia, 2nd or 3rd degree heart block or SSS (except in patients with functional pacemaker), cardiogenic shock, decompensated heart failure,
Metoprolol Tartrate Lopressor Beta blocker 25-100mg BID(450 mg/day) MI: sevre sins brady, sig 1st deg heart blck, 2nd or 3rd deg heart blck, SBP <100, moderte-sevre CHF. HTN/angina: sinus brady, 2nd/3rd degree heart blck/SSS(excpt pts w/ fxnal pacemaker), cardiogenic shock, sevre PAD, pheochromocytoma(with alpha blockade)
Metronidazole Flagy Miscellaneous antibiotic Depends upon use, Anaerobic infections; PO, IV: 500 mg q6-8h (max 4 grams/day) Pregnancy (1st trimester) Hepatic and Renal
Midazolam Versed Benzodiazepine Depends on use; Pre-op sedation; IV: 0.02-0.04 mg/kg Narrow angle glaucoma, concurrent use with potent inhibitors of CYP3A4, pregnancy
Minocycline Minocin, Dynacin Tetracycline antibiotic 100mg BID(400 mg/day) Renal
Mirtazapine Remeron Antidepressant, Alpha2 antagonist 15-45mg daily MAOI use within 14 days Renal
Montelukast Singulair Leukotriene receptor antagonist 10mg daily
Morphine Duramorph Narcotic analgesic Opiate naïve; IV: 2.5-5 mg q3-4h Severe or acute asthma, severe respiratory depression without ventilatory support, known or suspected paralytic ileus, during labor if premature birth is anticipated, general CNS depression Renal
Moxifloxacin Avelox Fluoroquinolone antibiotic PO, IV: 400mg daily
Nabumetone Relafen NSAID 1000mg/day in 1-2 divided doses(max 2000 mg/day) Perioperative pain in CABG Renal
Naproxen Naprosyn NSAID 250-500mg BID(1250 mg/day) Perioperative pain in CABG
Niacin Niaspan Antilipidemic, water soluble vitamin 500-1000mg QHS(2 g/day) Active hepatic disease, significant or unexplained persistnet serum transaminase elevation, active peptic ulcer, arterial hemorrhage
Nifedipine ER Procardia XL CCB 30-60mg daily(120-180 mg/day) Use with strong CYP3A4 inducers, cardiogenic shock Hepatic
Nitrofurantoin Macrodantin, Macrobid Miscellaneous antibiotic Macrodantin: 50-100mg q6h(400 mg/day) Macrobid: 100mg BID Significant renal impairment, use <1 month of age, pregnancy at term or during labor or delivery, history of cholestatic jaudice or hepatic impairment with previous therapy Renal
Nitroglycerin Nitroquick, Nitro-Dur, Nitro-stat Vasodilator PO: 2.5-9mg BID to QID IV: 5mcg/min-400mcg/min Patch: 0.2-0.4mg/hr Oint: 1/2" q6h Sublingual: 0.2-0.6mg q5min Translingual: 1-2 sprays q3-5min(3 doses/15 min) Concurrent use with PDE-5 inhibitors, increased ICP, severe anemia
Nortriptyline Pamelor TCA Depression: 25mg TID-QID(150mg/day) MAOI use within 14 days, use during recovery s/p MI Hepatic
Olanzapine Zyprexa Atypical antipsychotic 5-20mg daily(30mg/day)
Olmesartan Benicar ARB 20-40mg daily
Olmesartan/hydrochlorothiazide Benicar HCT ARB/Thiazide diuretic Olmesartan: 20-40mg daily HCTZ:Edema: 25-100mg daily HTN: 12.5-50mg daily (200 mg/day) See individual agents See individual agents
Omega-3-acid ethyl esters Lovaza Miscellaneous antilipemic agent 4g/day
Omeprazole Prilosec PPI 20-40mg daily
Ondansetron Zofran Antiemetic IV: 8-16 mg/day Concomitant use of apomorphine Hepatic
Oseltamivir Tamiflu Antiviral 75 mg daily- 75 mg BID Renal
Oxcarbazepine Trileptal Anticonvulsant Initial: 300mg BID; titrate based on prior therapy Renal
Oxycodone OxyContin Narcotic analgesic 10-40mg BID(Use caution >160mg BID) Significant respiratory depression, hypercarbia, severe asthma, paralytic ileus Hepatic
Oxycodone/APAP Endocet, Percocet, Tylox Narcotic analgesic Oxycodone: 5-30mg q4-6h prn(APAP: 4g/day) Severe respiratory depression, pregnancy Hepatic
Pantoprazole Protonix PPI PO, IV: 40mg daily(240mg daily)
Paroxetine, Paroxetine CR Paxil, Paxil CR SSRI Depression; IR: 20mg daily (50 mg/day), CR: 25 mg daily(62.5 mg/day)(max 60mg/day) MAOI use with or within 14 days, use with thioridazine or pimozide or reversible MAOI inhibitors (linezolid, methylene blue) Hepatic and Renal
Penicillin VK Veetids Penicillin antibiotic Children: 25-50mg/kg/day Adults:125-500mg q6-8h(3g per day in children <12 years old) Renal
Phenytoin Dilantin Anticonvulsant Anticonvulsant; PO: usual maintenance dose: 300-600mg/day Pregnancy Hepatic
Pioglitazone Actos Thiazolidinedione 15-45mg daily(45mg/day) Class III/IV heart failure Hepatic
Piperacillin/Tazobactam Zosyn Penicillin antibiotic IV: 3.375 gm q6h or 4.5gm q6-8h (18 gm/day) Renal
Polyethylene glycol MiraLax, GlycoLax Osmotic laxative 17g daily
Potassium Chloride K-Dur, Klor-Con, Micro K Electrolyte supplement 40-80mEq/day(400mEq/day) Hyperkalemia, delay/arrest in GI passage (solid PO formulation)
Pravastatin Pravachol HMG-CoA reductase inhibitor 10-80mg daily(80mg/day) Active liver diease, unexplained persitent serum transaminase elevation, pregnancy, breast-feeding Hepatic and Renal
Prednisone Deltasone Corticosteroid Depends on condition: 5-60 mg daily Systemic fungal infection, administration of live virus vaccines with immunosuppressive doses Hepatic
Pregabalin Lyrica Anticonvulsant; Analgesic variable Renal
Promethazine Phenergan Antihistamine, antiemetic PO, IV: 12.5-25 mg q4-6h PRN Coma, treatment of lower respiratory tract symptoms, use <2 years of age
Propofol Diprivan general anesthetic variable Hypersenstivity to eggs, soybeans, soy products
Propranolol Inderal Beta blocker PO: 40-320mg/day IV: 1-3mg bolus(640mg/day) Uncompensated CHF (except if due to tachyarrhythmias treated with propranolol), cardiogenic shock, severe bradycardia, heart block greater than 1st degree (except in patients with function pacemaker), severe asthma or COPD Hepatic
Quetiapine Seroquel Atypical anti-psychotic 150-400mg BID(800mg/day)
Quinapril Accupril ACE-I 10-40mg daily History of angioedema Renal
Rabeprazole Aciphex PPI 20mg daily
Raloxifene Evista SERM 60mg daily History of or current VTE, pregnancy or women who could become pregnant, breast-feeding
Ramelteon Rozerem Hypnotic, non-BDZ 8 mg PO within 30 minutes of bedtime Concurrent use with fluvoxamine, history of angioedema with previous therapy
Ramipril Altace ACE-I 2.5-5mg daily(20mg/day) History of angioedema Hepatic and Renal
Ranitidine Zantac H2 antagonist PO: 150mg BID IV: 50mg q6-8h(600mg/day) Renal
Risedronate Actonel Bisphosphonate 5mg daily or 35mg weekly Hypocalcemia, inability to sit or stand for 30 minute, delayed esophageal emptying Renal
Risperidone Risperdal Atypical antipsychotic 1-4mg BID(16mg/day) Hepatic and Renal
Ropinirole Requip Dopamine agoinst Parkinsons: 0.25mg-1mg TID Restless leg syndrome: 0.25mg-4mg QHS" Reduced clearance in the elderly
Rosuvastatin Crestor HMG-CoA reductase inhibitor 5-40mg daily(40mg/day) Active liver diease, unexplained persistent serum transaminase elevation, pregnancy, breast-feeding Renal
Sertraline Zoloft SSRI Depression: 50-100 mg/day (200 mg /day) MAOI use within 14 days, use with pimozide, use of oral concentrate with disulfiram Hepatic
Sildenafil Viagra, Revatio PDE-5 inhibitor ED: 25-100mg 1 hr prior to sexual activity Pulmonary HTN: 20mg TID (4-6hr apart) Concurrent use of organic nitrates, concurrent use with protease inhibitor regimen when used for pulmonary HTN Hepatic and Renal
Simvastatin Zocor HMG-CoA reductase inhibitor 5-40mg QHS (80mg/day if on this dose >12 months without myopathy and use of any dose-limiting or contraindicated interacting medication, also avoid in Chinese patients on niacin 1g/day or higher, otherwise 40 mg daily) Active liver disease, unexplained persistent serum transaminases elevation, concurrent use of CYP3A4 inhibitors, cyclosporine, danazol, or gemfibrozil, pregnancy, breast-feeding
Simvastatin/Ezetimibe Vytorin HMG-CoA reductase inhibitor/antilipidemic agent Simvastatin: 10-40 mg QHS (see simvastatin) Ezetimibe:10mg QD See individual agents See individual agents
Sitagliptin Januvia DPP IV inhibitor 100mg daily Renal
Spironolactone Aldactone K+ sparing diuretic 25-200mg daily depending upon use Anuria, acute renal insufficiency, hyperkalemia Renal
Sulfamethoxazole 800mg / Trimethoprim 160mg Bactrim DS, Septra DS Sulfonamide antibiotic 1-2 tabs daily-BID Megablastic anemia due to folate deficiency, use <2 months of age, marked hepatic damage or severe renal disease, pregnancy (at term), breast-feeding Renal
Sumatriptan Imitrex Seratonin Rc agonist PO: 25-100mg as a single dose. May repeat dose in 2 hours. (200mg/day) Pts w/ IHD or sgns of IHD, cerbrovsclr syndrms, PVD, uncontrolled HTN, use w/in 24hr ergotamine derviatives, use w/in 24hr 5-HT1 agonist, MAOI use w/ or w/in 14d, mngment of hemiplegic or basilar migraine, svre hepatic impairment (PO, nasal, injectable) Hepatic
Tadalafil Cialis Phosphodiesterase-5 enzyme inhibitor ED: 10 mg at least 30 minutes prior to sexual activity Concurrent use with organic nitrates Hepatic and Renal
Tamsulosin Flomax Alpha1 antogonist 0.4-0.8mg daily ½ hour after the same meal each day
Temazepam Restoril Benzodiazepine 15-30mg QHS Narrow angle glaucoma, pregnancy
Terazosin Hytrin Alpha1 antagonist 1-20mg daily(20mg/day)
Tiotropium Spiriva Anticholinergic agent 1 capsule daily (18 mcg) Renal
Tobramycin Tobramycin Aminoglycoside antibiotic Depend on condition: IV, IM: 1-2.5 mg/kg/dose q8-12h or 4-7 mg/kg/dose once daily Pregnancy Renal
Tolterodine Detrol LA Anticholinergic, overactive bladder 2-4mg daily Urinary retention, gastric retention, uncontrolled narrow angle glaucoma Hepatic and Renal
Topiramate Topamax Anticonvulsant 25-200mg BID(1600mg/day) Hepatic and Renal
Torsemide Demadex Loop diuretic CHF; PO: 10-20 mg daily (200 mg), IV: 10-20 mg initial dose (100-200 mg single dose) Anuria
Tramadol Ultram Analgesic 50-100mg q4-6h(400mg/day) Opioid dependent patients, acute intoxication with alcohol, hypnotics, centrally acting analgesics, opioids, or psychotropic drugs Hepatic and Renal
Tramadol/APAP Ultracet Analgesic 2 tabs q4-6h prn(APAP: 4g/day) See tramadol Hepatic and Renal
Trazodone Deseryl Serotonin Reuptake Inhibitor/Antagonist Insomnia: 25 mg-200 mg qHS
Triamterene/HCTZ Maxzide, Dyazide K+ sparing diuretic/ thiazide diuretic 37.5/25mg daily-BID(300mg triamterene/200mg HCTZ) Anuria, acute renal insufficiency, chronic renal insufficiency, patients on other potassium sparing diuretics, potassium substitutes, or supplements, hyperkalemia Renal
Valacyclovir Valtrex Antiviral agent 500-1000mg BID Renal
Valproic acid Depakote Anticonvulsant Seizures: 10-15 mg/kg/day (60 mg/kg/day) Hepatic disease or impairment, urea cycle disorders Hepatic and Renal
Valsartan Diovan ARB 80-160mg daily(320mg/day) Hepatic
Vancomycin Vancocin Antibiotic, misc. IV: 2-3 g/day in divided doses Q 6-12 hrs PO: 500-1000 mg/day in divided doses Q 6 hours(3 g/day) Renal
Varenicline Chantix Smoking cessation aid Days 1-3: 0.5 mg dailyDays 4-7: 0.5 mg twice daily Maintenance (week 2-12): 1 mg twice daily Renal
Venlafaxine Effexor XR SNRI Depression: 37.5-75mg daily with food(225mg/day) MAOI use within 14 days or initiation of MAOI within 7 days of stopping venlafaxine Hepatic and Renal
Verapamil SR Calan SR CCB and class IV anti-arrhythmic PO: 120-360mg/day in 1-2 divided doses IV: 2.5-5mg over 2 minutes Sevre L ventricular dysfxn, hypotension, cardiogenic shck, SSS or 2nd or 3rd degree heart blck (except in pts w/ a fxnal pacemaker), Afib/ A flttr w/ accessaory bypass tract, ventricular tachy (IV), concurrent use with IV beta-blockers (IV)
Vitamin D2 Drisdol Vitamin D analog Osteoporosis prevention: 800-1000 units/day Hypercalcemia, malabsorption syndrome, hypervitaminosis D or abnormal senstivity to toxic effects of vitamin D
Warfarin Coumadin Anticoagulant 2-10mg daily Hemrrhage tndncy,recnt/pot. srgry eye/CNS,majr regnl lumbr blck ansthsia/srgry reslt in lrge,opn srfces,bld dyscraias,svre uncntrl HTN,pericrditis/pericrdial effusion, bactrl endocrdtis,noncmplnt/unsuprvsd pt,eclampsia/pre-eclsmpsia,thrtn abortion,prego
Ziprasidone Geodon Atypical antipsychotic 20-40mg BID with food. (80-100mg BID depending on indication) History or current prolonged QT, congential long QT syndrome, recent MI, uncompensated CHF, concurrent use with other QT-prolonging agents
Zolpidem Ambien, Ambien CR Hypnotic, non-BZD Ambien: 5-10mg qHS(10mg/day) Ambien CR: 6.25-12.5mg qHS Hepatic
Created by: c_salvino



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