A B C D E F G H I J K L M N O P Q R S T U V W X Y Z

GENERIC NAME  
Calcitriol Calcitriol is the preferred vitamin D analog (P&T review),  for use in post parathyroidectomy patients (to prevent hypocalcemia). All other patients will be automatically converted to doxercalciferol oral or doxercalciferol injection for those who can not take oral.

·        Calcitriol has an increased incidence of hypercalcemia and hyperphosphatemia when compared to doxercalciferol and paricalcitol.  Calcitriol will remain on formulary for use to increase calcium in post parathyroidectomy patients.

·      Pharmacy will auto substitute oral Hectorol for injectable Hectorol, injectable Zemplar, and oral Zemplar at an equivalent dose in patients who can take oral medications. Hectoral injection will be auto substituted for those who can not take oral.

 

Dosage Equivalence (mcg)

Calcijex (calcitriol) Injection

Zemplar (paricalcitol) Injection

Zemplar (paricalcitol)

Oral

Hectorol (doxercalciferol) Injection

Hectorol Oral

(doxercalciferol)

0.2

0.7

1

0.3

0.5

0.4

1.4

2

0.6

1.5

0.75

2.5

4

1

2.5

1.5

5

8

2

5

2.25

7.5

10

3

7.5

3

10

14

4

10

3.75

12.5

18

5

12.5

4.5

15

20

6

15

5.25

17.5

24

7

17.5

6

20

28

8

20

Reference: K/DOQI Clinical Practice Guidelines for Bone Metabolism and Disease in Chronic Kidney Disease

1 mcg of doxercalciferol inj. is approximately equivalent to 2.5 mcg of paricalcitol inj. or 0.75 mcg calcitriol inj.

Paricalcitol oral 72% bioavailable, doxercalciferol oral 42% bioavailable

 

Calcium Chloride Injection
  • Calcium chloride injection (P&T review) will be available in the Pyxis stations in the OR, PACU, and ED, and will remain in the code carts.
  • Calcium chloride is restricted to use in emergent situations and is best infused via a central catheter due to the risk of extravasation and tissue necrosis when infused peripherally.
  • Calcium gluconate is the standard for intravenous supplementation. 

 

Dosing Information

  • Intravenous supplementation calcium is used for severe and/or acute symptomatic hypocalcemia (serum calcium < 7.5mg/dL or ionized calcium < 0.9 mmol/L) when rapid correction is needed (see chart below). 
  • Calcium gluconate or chloride have been used for patients with serum potassium above 7 milliequivalents/liter (mEq/L) and electrocardiographic (ECG) evidence of severe hyperkalemia
    • 1 g of calcium gluconate (10 ml of 10% solution) over 2 to 3 minutes with continuous ECG monitoring
    • 300 to 400 milligrams of calcium chloride (3 to 4 milliliters of 10% solution) over 2 to 5 minutes with continuous ECG monitoring.
    • If the patient is receiving digoxin calcium should be used with extreme caution. In this case 1 g of calcium gluconate in 100 ml of D5W infused over 20-30 minutes is recommended.

 

 

Condition

 

Calcium Salt

 

Intermittent Dosage

 

Continuous Infusion Dosage

Mild to moderate hypocalcemia, asymptomatic and unable to take oral calcium

Gluconate

1-2 g (4.56-9.12 mEq) in 100 ml D5W or 0.9% NaCl over 30-60min; may repeat every 6 hrs prn

NA

Severe hypocalcemia, symptomatic

Gluconate (preferred)

 

Or

 

 Chloride

3 g calcium gluconate

Or

1 g calcium chloride  (13.6 mEq) over 10 minutes; may repeat prn

NA

Severe hypocalcemia, symptomatic; refractory to intermittent bolus doses

Gluconate (preferred)

 

Or

 

Chloride

Not applicable

0.03-0.12 g per hour of elemental calcium

calcium gluconate (0.336-1.32 g per hour)

Or

 

calcium chloride (0.112-0.441 g per hour)

 

Severe hyperkalemia with  electrocardiographic evidence of severe hyperkalemia

Gluconate (preferred)

1 g of calcium gluconate (10 ml of 10% solution)  over 2-3 minutes with continuous ECG monitoring

 

If the patient is receiving digoxin calcium should be used with extreme caution. In this case 1 g of calcium gluconate in 100 ml of D5W infused over 20-30 minutes is recommended.

 

 

-      Severe hypocalcemia is defined as total serum calcium < 7.5mg/dL or ionized calcium < 0.9mmol/L

-        1g calcium chloride = 13.6 mEq calcium; 1g calcium gluconate = 4.56 mEq calcium

-        Maximum rate of injection should not exceed 0.8-1.5 mEq calcium per minute because of the potential risk for cardiac arrhythmias associated with rapid calcium infusion.

-        Since an IV bolus may only be effective for 2 hours or less, severe hypocalcemia may not be corrected with intermittent boluses.  A continuous infusion may be required.  Calcium levels should be monitored at least every 6 hours during the infusion and infusion rate adjusted to avoid recurrent symptomatic hypocalcaemia.  The underlying cause should be treated or long-term therapy started, and the IV infusion should be gradually tapered.

-        Hypocalcemia due to citrated blood transfusion can be treated by administering 1.35 mEq of calcium for each 100ml of blood transfused (1 g of calcium gluconate or 4.56 mEq per unit of blood).

-        Routine monitoring of serum calcium levels every 24-48 hours is recommended in the ICU setting.

-        The calcium should be diluted in dextrose and water or saline, because concentrated calcium solutions are irritating to veins

-     Concomitant hypomagnesemia must be corrected first in order to correct hypocalcemia.

Calcium Gluconate Injection
  • Calcium chloride is restricted to use in emergent situations and is best infused via a central catheter due to the risk of extravasation and tissue necrosis when infused peripherally
Calfactant Calfactant (Infasurf) Dosing
CAPD The follow adobe files may be found on the http://www.nephrologypharmacy.com/ web site

Dialysis of Drugs Text 2006

Peritoneal Dialysis Text 2006

Caspofungin Removed from formulary, use anidulafungin, P&T review
  • Anidulafungin (Eraxis) is formulary. Caspofungin (Cancidas) and Micafungin are non formulary and should not be stocked. Please recommend Eraxis when ever you get an order for Cancidas or Micafungin.
    • Fluconazole is the drug of choice for esophageal candidiasis and hematopoietic stem cell transplant (HSCT).  It is also the primary agent for febrile neutropenia 400-800 mg/day, candidemia 400 mg/day, and other candida infections 400 mg/day.
    • Voriconazole is the drug of choice for aspergillus.

     

Advantages of anidulafungin over other echinocandins.

  • Anidulafungin is not a substrate, inhibitor or inducer of cytochrome P450 enzymes. It has only one known drug interaction (cyclosporine), but anidulafugin’s does not require a dosage adjustment
    • Medications studied include rifampin, cyclosporine, tacrolimus, voriconazole, and amphotericin B
  • Anidulafungin has the longest half-life (26 hours) and the lowest protein binding (84%) of the echinocandins.
  • Anidulafungin is chemically degraded in the body and is not metabolized by the cytochrome P450 system
  • Anidulafungin does not require dosage adjustment for liver or renal dysfunction
  • Anidulafungin is less expensive than other echinocandins
  • Anidulafungin provides higher free levels than caspofungin and micafungin
  • Anidulafungin’s adverse effect profile appears to be better than other echinocandins
  • Antifungal spectrums of echinocandins are equivalent.
    • Anidulafungin has a broad spectrum activity against Candida (including those strains that are resistant to polyenes and azoles), non-albicans strains and Aspergillus species. Potential synergy with azoles against Aspergillus has been demonstrated in vitro. It is inactive against Cryptococcus neoformans, Trichosporon spp., Zygomycetes and Fusarium. All echinocandins are less active against C. parapsilosis
  • Anidulafugin is the only echinocandin that has been studied in a randomized control trial versus fluconazole in candidemia and other invasive candida infections (phase three clinical trial, not published)

 

 

Efficacy Analysis: Global Success (MITT)* in Patients with Candidemia and other Candida Infections**, Package Insert

Time Point

Eraxis

200 mg LD, 100 mg/day

N=127

Fluconazole

800 mg LD, 400 mg/day

 N=118

Treatment Difference %, (95% C.I)

End of IV Therapy

75.6%

60.2%

15.4% (3.9, 27) (SS)

End of IV Therapy (candidemia)

75.9% (88/116)

61.2%

(63/103)

14.7(2.5,26.9) (SS)

End of All Therapy

74%

56.8%

17.24% (2.9, 31.6) (SS)

2 Week Follow-up

64.6%

49.2%

15.4% (0.4, 30.4) (SS)

6 Week Follow-up

55.9%

44.1%

11.84% NS

Overall Study Mortality

22.8%

31.4%

NS

Mortality During Study Therapy

7.9%

14.4%

NS

Mortality Attributed to Candida

1.6%

4.2%

NS

* Patients with at least 1 dose of study drug and a positive culture for Candida species for a normally sterile site, clinical cure or improvement and documented or presumed microbiological eradication

** Patients with C. krusei (fluconazole not active), candida endocarditis, osteomyelistis, and meningitis were excluded from the study

 

Cefadroxil Autosubstitute with Cephradine or Cephalexin

Cephalexin or cephradine will be automatically substituted for cefadroxil depending on their availability and cost. The pharmacy buyer will determine which product, cephalexin or cephradine, is carried.

Cefadroxil Ordered

Cephradine or Cephalexin Substitute

500 mg q 12h

500 mg q6h

1 gm q12h

1 gm q6h

 

Commonly Recommended Adult Doses

Cephalexin

Cephradine

Usual:

250 mg-1 gm q 6H

Usual:

500mg q 6H-1g q 6H

Strep pharyngitis, skin, uncomplicated cystitis:

500mg q 12H

Uncomplicated pneumonia, skin, UTI:

500 mg q 6H

 

Severe:

500 mg q 6H

Severe:

500mg –1 g q 4h

Cefadroxil

Cephradine

UTI:

500 mg q 12H- 1g q 12H

Usual:

500mg q 6H-1g q 6H

Skin:

500 mg q 12H

Uncomplicated pneumonia, skin, UTI:

500 mg q 6H 

 

Severe:

500 mg-1g q 4H

 

 

Cefazolin Surgical Prophylaxis

Recommendations for Surgical Prophylaxis: MEC Approved

·       Use 2 gm of cefazolin (Ancef) for patients weighing greater than 100 kg.

 

Cefepime Autosubstitute with Ceftazidime

Auto-substitute ceftazidime for cefepime.  The spectrums and cost are similar including cost in renal impaired patients. 

Cefepime Ordered

Substitute Ceftazidime

0.5 gm q12h

0.5 gm q8h

1 gm q12h

1 gm q8h

2 gm q12h

2 gm q8h

2 gm q8h

2 gm q8h

 

Adult Dosage

Cefepime

Clcr (ml/min)

Cefepime Dosage

Cost per day

Ceftazidime Clcr (ml/min)

Ceftazidime Dosage

Cost    per day

> 60

0.5-2 gm q8-12h

$12.54-74.37

> 50

0.25 - 2 gm q8-12h

$7.48-44.88

30 to 60

0.5-2 gm q12-24h

$6.27-49.58

31 to 50

1 gm q8-12h

$14.96-22.44

11 to 29

0.5-2 gm q24h

$6.27-24.79

16 to 30

1-1.5 gm q24h

$7.48-14.96

< 11

0.25–1 gm q24h

$6.27-12.49

6 to 15

0.5-0.75 gm q24h

$3.74-7.48

 

 

 

<= 5

0.5-0.75 gm q48h

$1.87-3.74

Hemodialysis

0.25-1 gm q24h after dialysis

 

 

0.5 gm q48h & 1 gm after dialysis on dialysis days

 

Peritoneal dialysis

0.5-2 gm q48h

 

 

Loading dose 1 gm

Maintenance dose 0.5 gm q24h

 

 

Adult Dosage Normal Renal Function

 

 

 

Cefepime

Ceftazidime

Mild to Moderate uncomplicated or complicated UTI

0.5-1 gm q12h

0.5 gm q8-12h

Severe uncomplicated or complicated UTI

2 gm q12h

1 gm q8h

Moderate to Severe pneumonia

1-2 gm q12h

1-2 gm q8h

Moderate-Severe Skin & Skin Structure

2 gm q12h

1-2 gm q8h

Empiric Therapy for febrile neutropenia

2 gm q8h

2 gm q8h

 

Cefepime Ordered

Ceftazidime Substitute

0.5 gm q12h ($12.54/day)

0.5 gm q8h ($11.22)

1 gm q12h ($25/day)

1 gm q8h ($22.44)

2 gm q12h ($49.59/day)

2 gm q8h($44.89)

2 gm q8h ($74.38/day)

2 gm q8h ($44.89)

 

Cefoperazone Autosubstitute with Ceftazidime

Ceftazidime is automatically substituted for Cefoperazone.

 

Cefoperazone Ordered

Ceftazidime Substitution

1 gm q12h

1 gm q12h

2 gm q12h

2 gm q12h

2 gm q8h

2 gm q8h

2 gm q6h

2 gm q8h

4 gm q6h

2 gm q8h

 

Common Adult Doses

Cefoperazone

Ceftazidime

Normal:

1-2 g q 12H

Uncomplicated UTI:

500 mg q 8-12H

 

Uncomplicated pneumonia or mild skin infection:

0.5-1g q 8H

 

 

Bone /Joint:

2 g q 12H

Severe: (6-12 gm perday)

1.5-4g q 6-12H

Severe:

2g q 8H

Cefotaxime Autosubstitute with Ceftriaxone

Ceftriaxone is automatically substituted for cefotaxime except for treatment of intra-abdominal infections and neonatal infections.

 

Cefotaxime Ordered

Ceftriaxone

1 gm q12h

0.5 gm q24h

1 gm q6h

1 gm q24h

1-2 gm q8h

1 gm q24h

2 gm q4-6h

2 gm q24h

2 gm  q4h (meningitis)

2 gm q12h

 

Cefotaxime

Ceftriaxone

Uncomplicated infection:

1gm q 12H

0.5 gm q24h

Moderate-severe infection:

1-2gm q8H

Moderate-severe Infection:

1 gm q24H

Infections requiring higher doses:

2 gm q 6-8H

Severe infection:

2 gm q 24 H

Life threatening infection:

2 gm q 4H

Life threatening Infection:

2 gm q 24H

 

 

Meningitis:

2 gm q 12H

 

 

Cefotaxime Ordered

Cost $ per Day

Ceftriaxone

Cost $ per Day

1 gm q12h

$15.38

0.5 gm q24h

$12.17

1 gm q6h

$30.77

1 gm q24h

$20.81

1-2 gm q8h

$23.08-43.50

1 gm q24h

$20.81

2 gm q4-6h

$58-87

2 gm q24h

$41.36

2 gm  q4h (meningitis)

$87

2 gm q12h

$82.72

 

 

Cefotetan Autosubstitute with Cefoxitin

 

Cefoxitin Autosubstitute

Cefotan Ordered

1 qm q6h

1 gm q12h

2 gm q6h

2 gm q12h

3 gm q6h

3 gm q12h

Cefoxitin

Please review the table below for alternatives to cefoxitin/cefotetan when shortages occur (Cefoxitin Shortage: Recommended Alternatives 9/06).

 

Surgery Type

Recommend Agents for Surgical Prophylaxis

Appendectomy

Cefoxitin 1gm (<100 kg) or 2 gm (> 100 kg)

                                        Or

Cefazolin 1gm (<100 kg) or 2 gm (> 100 kg) plus Metronidazole 500 mg

 

 

 

Beta lactam allergic:

Clindamycin 600-900 mg with (gentamicin 1.5 mg/kg or levofloxacin 750 mg or aztreonam 1-2 gm)

                                        Or

Metronidazole 500 mg with (gentamicin 1.5 mg/kg or levofloxacin 750 mg)

 

 

Biliary tract (high risk only): open and laparoscopic procedures

High risk patients: > 70 years old, obstructive jaundice, acute cholecystitis, acute cholangitis, nonfunctioning gallbladder, & common duct stone

 

Cefazolin 1gm (<100 kg) or 2 gm (> 100 kg)

                                        Or

Cefoxitin 1gm (<100 kg) or 2 gm (> 100 kg)

                                        Or

Culture based selection

 

 

 

Beta lactam allergic: clindamycin 600-900 mg

 

 

Colorectal: operations that open the colon and/or rectum

A mechanical bowel preparation is recommended before surgery.

 

Oral: neomycin and erythromycin base: 1 gm of each at 19, 18, and 9 hours before surgery

 

Erythromycin Allergic: Use metronidazole 500 mg po for erythromycin

 

Parenteral:

Cefoxitin1gm (<100 kg) or 2 gm (> 100 kg)

                                        Or

Cefazolin 1gm (<100 kg) or 2 gm (> 100 kg) plus metronidazole 500 mg

                                        Or

Ampicillin/Sulbactam 3 gm

 

 

 

Beta lactam allergic:

Clindamycin 600-900 mg with (gentamicin 1.5 mg/kg or levofloxacin 750 mg or aztreonam 1-2 gm)

                                        Or

Metronidazole 500 mg with (gentamicin 1.5 mg/kg or levofloxacin 750 mg)

 

Gastroduodenal (high risk only): gastric bypass, percutaneous endoscopic gastrostomy, and esophageal

High risk: morbid obesity and when gastric acidity and gastrointestinal motility are diminished by obstruction, hemorrhage, gastric ulcer or malignancy, and use of H2-blockers or proton pump blocker

 

Cefazolin 1 gm (< 100 kg) or 2 gm (> 100 kg)

                                        Or

Cefoxitin1gm (<100 kg) or 2 gm (> 100 kg)

 

 

 

Beta lactam allergic: Clindamycin 600-900 mg

 

Cesarean section (high risk such as active labor or premature rupture of membranes)

 

Cefazolin 2 gm after cord clamped

 

 

 

Beta lactam allergic: clindamycin 600-900 mg after cord clamped

 

Vaginal or abdominal hysterectomy:

 

Cefoxitin 1gm (<100 kg) or 2 gm (> 100 kg)

                                        Or

Cefazolin 1gm (<100 kg) or 2 gm (> 100 kg)

                                        Or

Ampicillin/Sulbactam 3 gm

 

 

 

Beta lactam allergic:

Clindamycin 600-900 mg with (gentamicin 1.5 mg/kg or levofloxacin 750 mg or aztreonam 1-2 gm)

                                        Or

Metronidazole 500 mg with (gentamicin 1.5 mg/kg or levofloxacin 750 mg)

                                        Or

Clindamycin 600-900 mg monotherapy

 

Ceftriaxone Indications for 2 gm doses of ceftriaxone include: CNS infections, gonococcal endocarditis, osteomyelitis, and Lyme disease.
  • Patients with symptoms of CNS infections empirically, or evidence of CNS infections susceptible to ceftriaxone, should be given 2 gram doses of ceftriaxone at a dosing interval of every 12 hours.  Patients with gonococcal endocarditis may also require twice daily dosing.  Patients with endocarditis, febrile neutropenia, osteomyelitis, and Lyme disease should receive ceftriaxone 2 gram given daily.
  • All other indications for ceftriaxone should be treated with 1 gram daily dosing.  Pharmacists will call the physician or leave a note for the physician recommending conversion to 1 gram daily unless the patient meets one of the above indications. If pneumococcal resistance is a concern Levaquin may be added and it covers atypical pathogens.

Safety Warning for Neonates (Letter from company, PI 5/07),  ASHP clarification

Cetriaxone should not be administered concurrently with calcium-containing solutions or products in newborns because of the risk of precipitation. Calcium containing solutions or products must not be administered within 48 hours of the last administration of ceftriaxone.

Ceftizoxime Autosubstitute with Ceftriaxone

 

Ceftizoxime Ordered

Ceftriaxone Autosubstitute

500 gm q12h

1 gm q24h

1 gm 12h

1 gm q24h

1 gm q8h

1 gm q24h

2 gm q8h

1-2 gm q24h*

3-4 gm q8h

1-2 gm q24h*

 *See above for times when ceftriaxone 2 gm per day is indicated

 

Commonly Recommended Adult Doses

Ceftizoxime

Cetriaxone

Uncomplicated UTI:

500 mg q 12H

 

Other sites:

1 g q 8-12H

Moderate:

1g q 24H

Pelvic inflammatory disease:

2 g q 8H

 

Severe or refractory:

1g q 8H or 2g q 8-12H

Severe:

2g q 24H

Life threatening:

3-4g q 8H

Life threatening:

2g q 24H

Septicemia:

6-12g daily

Meningitis:

2g q 12H

 

Cefuroxime Autosubstitute with Ceftriaxone

Non formulary,  ceftriaxone is automatically substituted except for surgical prophylaxis where cefazolin is recommended.

     

Cefuroxime (Zinacef, Kefurox) Ordered

Cost $ per day

Ceftriaxone (Rocephin) Autosubstitue

Cost $ per Day

750 mg q8h

$9.42

1 gm daily

$20.81

1.5 gm q8h

$18.81

1 gm daily

$20.81

1.5 gm q6h

$25.08

2 gm daily

$41.36

 

 

 

Cephalexin

Cephalexin or cephradine will be interchanged depending on availability and cost. The pharmacy buy will determine which product is carried. 

 

Cephalexin

Cephradine

Same dose and frequency

Same dose and frequency

 

Cephalothin Autosubstitute with Cefazolin

Note cephalothin is no longer manufactured.

 

Cephalothin Ordered

Cefazolin Autosubstitution

1 gm q6h

0.5 gm q8h

1 gm q4h

1 gm q8h

2 gm q4h

2 gm q8h

 

Cetirizine Autosubstitute with Loratadine

Loratadine (Claritinâ) and Claritin D 12 hour (5 mg with 120 of pseudoephedrine) are the P&T recommended formulary non-sedating antihistamines with automatic substitution for desloratadine (Clarinexâ) fexofenadine (Allegraâ 30, 60, 180 mg), Allegra Dâ (60 mg fexofenadine with 120 mg pseudoephedrine), Allegra D 24 Hourâ (180 mg fexofenadine and 240 mg pseudoephedrine), cetirizine (Zyrtecâ), and Semprex D (8 mg acrivastine with 60 mg pseudoephedrine). They will be stocked in the following dosage forms: Claritin 10 mg, Clartin D 12 hour, and as the syrup 1 mg/ml for pediatric patients.

 P&T/MEC APPROVED 11/2000, updated 3/21/07

 

Non Formulary Medication Ordered

P&T/MEC Approved Auto Substitution

Allegra 30 mg every day, 6-11 years old with renal dysfunction

Claritin 10 mg every other day

Allegra 30 mg BID, 6-11 years old

Claritin 10 mg every day

Allegra 60 mg every day, 12 years and older with renal dysfunction

Claritin 10 mg every other day

Allegra 60 mg BID, 12 years and older

Claritin 10 mg every day

Allegra 180 mg every day, 12 years and older

Claritin 10 mg every day

Allegra D one every 12 hours, 12 years and older

Claritin D one every 12 hours

Allegra D 24H every day

Claritin D one every 12 hours

 

 

Clarinex 5 mg every other day, 12 years and older: Clcr < 30 ml/min or liver impairment

Claritin 10 mg every other day

Clarinex 5 mg every day, 12 years and older

Claritin 10 mg every day

 

 

Zyrtec 2.5 mg every day, 6 months to < 2 years

Maximum dose: 2.5 mg every 12 hours

Do not substitute for patients < 2 years

Zyrtec 2.5 mg every day, 2-5 years old

Maximum 2.5 mg every 12 hours or 5 mg once daily

Claritin 5 mg every day

Zyrtec 5 mg every day, 6-11 years old: clcr < 31 ml/min, on hemodialysis or hepatically impaired

Claritin 10 mg every other day

Zyrtec 5–10 mg every day, 6-11 years old

Claritin 10 mg every day

Zyrtec 5 mg every day, 12 years and older: clcr < 31 ml/min, on hemodialysis or hepatically impaired

Claritin 10 mg every other day

Zyrtec 5-10 mg every day, 12 years and older

Claritin 10 mg every day

*Note Claritin dosage in renal impairment, clcr < 30 ml/min, or hepatic failure: 2-5 years old 5 mg every other day, 6 years and older 10 mg every other day.

Chemotherapy P&T/MEC allow Chemotherapy, monoclonal antibodies, and IVIG orders to be rounded up or down by 5% to minimize wastage.

Physician Ordering Form

Cimetidine Autosubstitute with Famotidine

            Famotidine, the P&T preferred H2 antagonist, will be automatically substituted for ranitidine, cimetidine, nizatidine, other H2 when ordered by the IV or oral route unless the physician has checked the dispense as written block or the patient is allergic to famotidine.

Dosage Conversion:

Cimetidine                                                         Famotidine

            300 mg q6-8H                                       20 mg q12H

            300 mg q12-24H                                    20 mg q24H

            400 mg QHS                                         20 mg QHS

            400 mg BID                                           10 mg BID or 20 mg QHS

            400 mg QID                                          20 mg BID

            800 mg QHS                                         40 mg QHS

            800 mg BID                                           20 mg BID

Ranitidine

            50 mg q6-8H IV                                     20 mg q12H

            50 mg q12-24H IV                                 20 mg q24H

            150 mg QD                                           20 mg QD

            150 mg BID                                           20 mg q12h

            300 mg QHS                                         40 mg QHS

              

 

Ciprofloxacin Autosubstitute with Levofloxacin (except for osteomyelitis)

·        Do not substitute Levaquin when ciprofloxacin is used for osteomyelitis.

 

Creatinine Clearance

Ordered Ciprofloxacin

Levaquin  Auto Substitution

> 50 ml/min

 

400 mg Q8H

 (750 mg Q12H)

Please check indication. If severe complicated skin and skin structure infection, pneumonia, or intra-abdominal infections use 750 mg Q24H.

400 mg (500) Q12H

500 mg Q24H

200 mg (250) Q12H

250 mg Q24H

20-49 ml/min

 

400 mg (500) Q24H

500 mg Q24H

200 mg (250) Q24H

250 mg Q24H

< 20 ml/min

 

400 mg (500) Q24H

500 mg Q48H

200 mg (250) Q24H

250 mg Q48H

Hemodialysis

200-400 mg Q24H

500 mg x1 then 250 mg Q48H, 250 mg supplemental dose after dialysis

CAPD

200-400 mg Q24H

500 mg x1 then 250 mg q48H

( ) are oral doses of ciprofloxacin

 

Dosage Recommendations Per Package Insert

 

Ciprofloxacin Ordered

Levofloxacin Auto Substitution

Acute Bacterial Exacerbation of Chronic Bronchitis

400 mg Q12H

500mg Q24H x 5-7 days

Acute Bacterial Sinusitis

400 mg Q12H

750mg Q24H x 5 days

Bone & Joint

400 mg Q8-12H

DO NOT SUBSTITUTE

Community Acquired Pneumonia

 

750mg Q24H x 5 days

Nosocomial Pneumonia

400 mg Q8H

750 mg Q24H x 7-14 days

intra-abdominal

400 mg q12H (plus metronidazole)

750 mg Q24H (plus metronidazole)

Uncomplicated UTI

200 mg Q12H

250mg Q24H x 3 days              

Complicated UTI

400 mg Q12H

250mg Q24H x 10 days

Acute Pyelonephritis

 

250mg Q24H x 10 days

Chronic Bacterial Prostatitis

400 mg Q12H

500 mg daily x 28 days

Uncomplicated UG in Men, Endocervical and Rectal Gonorrhea in Women

 

 

Uncomplicated Skin & Skin Structure Infection

400 mg Q12H

500 mg QD 7-10 days

Complicated Skin and Skin Structure Infection

400 mg Q8H

750 mg QD 7-14 days

 

 

Cipro XR Autosubstitute with Cipro
CoLytely Use CoLytely In place of HalfLytely

Substitute 2000 ml of Colytely and 4 bisacodyl 5 mg delayed release tablets for prescriptions written for Halflytely.  2000 ml of Colytely has the same active ingredients as 2000 ml of Halflytely.  Mix 4 liters of water with Colytely and then dispense 2 liters to patient.  Throw out remainder.

 

Oral administration: Swallow all four bisacodyl delayed release tablets with water (do not chew or crush).  Wait for a bowel movement (or a maximum of 6 hours) then drink 1 glass (8 oz) of the solution every 10 minutes.  Drink all the solution.  

 

Active Ingredients:

HalfLytely®

CoLYTELY®

    polyethylene glycol 3350

210 g

420 g

    sodium bicarbonate

2.86 g

5.72 g

    sodium chloride

5.60 g

11.2 g

    potassium chloride

0.74 g

1.48 g

    bisacodyl  5 mg delayed release tablets

4

 

Volume per unit

2 L

4 L

Cost per unit

$34.10

$4.03

 

Collagenase Ointment
  • Accuzyme and Ethezyme 830 are equivalent products containing identical amounts of active ingredients. Pharmacy will stock and autosubstitute the most cost effective product which is Ethezyme 830.
  • Panafil and Ziox Ointment are equivalent products containing identical amounts of active ingredients. Pharmacy will stock and autosubstitute the most cost effective product which is Ziox.

 

 

Accuzyme Ointment

Ethezyme 830 Ointment

Panafil Ointment

Ziox Ointment

Santyl Ointment

Xenaderm

Indications

Debridement of necrotic tissue and liquefaction of slough in acute and chronic lesions such as pressure ulcers, varicose and diabetic ulcers, burns, postoperative wounds, pilonidal cyst wounds, carbuncles and miscellaneous traumatic or infected wounds.

Acute and chronic lesions such as varicose, diabetic and decubitus ulcers, burns, postoperative wounds, pilonidal cyst wounds, carbuncles and miscellaneous traumatic of infected wounds.

Debriding chronic dermal ulcers.

Promote healing and the treatment of decubitus ulcers, varicose ulcers and dehiscent wounds.

Dosing Frequency

Once or twice daily

Once or twice daily

One daily

> Twice daily

Ingredients

Papain 8.3 x 105 units/gram

100 mg Urea/ gram

Hydrophilic ointment base

Papain 8.3 x 105 units/gram

100 mg Urea/ gram

Hydrophilic ointment base

Papain 5.2 x 105 /gram,

100 mg/gram Urea,

0.5% Chlorophyllin Copper Complex

in a hydrophilic base

Collagenase 250 units/gram

White petrolatum USP

Trypsin 90 units/gram,

Balsam Peru 87 mg/gram,

Castor Oil 788 mg/gram

Action

Papain digest nonviable protein.

 

Urea denatures nonviable protein making is susceptible to enzymatic digestion and exposes sulfhydryl groups which active papain.

Papain digest nonviable protein.

 

Urea denatures nonviable protein making is susceptible to enzymatic digestion and exposes sulfhydryl groups which active papain.

 

Chlorophyllin copper complex inhibits the hemagglutinating and inflammatory properties of protein degradation products in the wound.

 

Collagenase digest collagen in necrotic tissue

Balsam Peru is a capillary bed stimulant used to increase circulation in the wound site area. Castor oil is used to improve epithelialization by preventing drying and cornification and is a protective covering.  Trypsin is a debriding agent.

Active pH range

3-7

3-12

3-7

3-12

6-8

 

Inactivate by

Heavy metals, hydrogen peroxide

Heavy metals, hydrogen peroxide

Heavy metals

 

Cost per gram

$1.27

$0.43

$2.17

$0.98

$1.60

$0.65

 
Compounding Formulas Aminophylline Oral Solution 25 mg/ml 10ml

Cholestyramine 3.5% in Aquaphor 420 g

Bethanechol Oral Suspension 5 mg/ml 30 ml

Baclofen Oral Suspension 5 mg/ml 30 ml

Clonazepam Oral Suspension 0.1 mg/ml 30 ml

Clonindine Oral Suspension 0.1 mg/ml 30 ml

Captopril Oral Suspension 0.75 mg/ml 50 ml

Diltiazem Oral Suspension 12 mg/ml 30 ml

Enalapril Oral Suspension 1 mg/ml 30 ml

Famotidine Oral Suspension 8 mg/ml 50 ml

Glycopyrrolate Oral Solution 0.2 mg/ml 20 ml

Greer's Goo (Modified) 30 g

Hydrochlorothiazide Oral Suspension 5 mg/ml 30 ml

Ibuprofen Suppository 100 mg and 400 mg

Indomethacin Suppository 25 mg and 100 mg

Ketoconazole Oral Suspension 20 mg/ml 30 ml

Ketamine Oral Solution 100 mg/ml 5 ml

Lansoprazole Oral Suspension 3 m/ml 30 ml

Metronidazole Oral Suspension 50 mg/ml 30 ml

Morphine Cream 0.15% 60 g

Morphine Oral Solution 0.4 mg/ml 10 ml

Nipple Ointment (Dr. Jack Newman's Formula) 134 g

Omeprazole Oral Suspension 2 mg/ml 30 ml

Phenylephrine Nasal Solution 0.125% 30 ml

Potassium Chloride Oral Solution 2 meq/ml 10 ml

Rifampin Oral Suspension 25 mg/ml 60 ml

Sildenafil Oral Suspension 2 mg/ml 30 ml

Sodium Chloride Oral Solution 4 meq/ml 30 ml

Spironolactone Oral Suspension 5 mg/ml 30 ml

Total Hip Solution for Irrigation 500 ml

Tripple Butt Paste  90 g

Ursodiol Oral Suspesnsion 20 mg/ml 30 ml

Vancomycin Oral Solution 50 mg/ml 40 ml

Water (Aqua) 20% in Aquaphor 60 g

 

 

 

Conivaptan Conivaptan P&T Review

·        Conivaptan is non formulary

o       Conivaptan is FDA approved for use in acute dilutional euvolemic hypotonic hyponatremia

·        3% Sodium Chloride injection it to be recommended as an alternative and may be used for the following conditions

  • severe symptomatic euvolemic hypotonic hyponatremia when serum sodium is less than 125 mEq/l
  • severe symptomatic hypervolemic hypotonic hyponatremia with loop diuretics when serum sodium is less than 125 mEq/l
  • severe symptomatic hypovolemic hypotonic hyponatremia  when serum sodium is less than 125 mEq/l

*severe symptomatic hypotonic hyponatremia : confusion, ataxia, seizures, obtundation, coma, respiratory arrest

·        Dosing Tools for 3% Sodium Chloride Injection and a hyponatremia algorithm are available for or the physicians and pharmacists.

·        Patients will meet the following criteria to receive conivaptan

o       Serum sodium less than 130 mEq/l

o       Plasma osmolality less than 290 mOsm/kg H20

o       Euvolemic hyponatremia (absence of pitting edema or ascites)

·        Conivaptan infusions should not exceed 96 hours per the package insert

·        Patients receiving conivaptan will not have any of the following exclusion criteria:

o       Clinical evidence of dehydration or volume depletion

o       Hypervolemic hypotonic hyponatremia (CHF, cirrhosis with ascites, nephrotic syndrome, acute or chronic renal failure)

o       Contraindicated in hypovolemic hypotonic hyponatremia (burns, GI fluid losses, Addison’s disease)

·        Monitoring will include the following:

o       Serum sodium every 2 hours until the patient is asymptomatic then every 4-8 hours

o       Urine and serum osmolality and electrolytes (sodium and potassium) every 4-6 hours

§        Serum sodium should not increase any faster than 12 mEq/l in 1st  24 hours and less than 20 mEq/l in 1st  48 hours for acute hyponatremia, and less than 12 mEq/l 1st 24 hours and less than 18 mEq/l 1st 48 hours for chronic hyponatremia.

o       Urine volume

o       IV site for signs of phlebitis

·        Conivaptan injection should be infused into a large vessel and the IV site should be changed every 24 hours.

Please see the Hyponatremia page for articles on hyponatremia

Corticosteroid Equivalence Chart  
Creatinine Clearance Calculator  
   
   

Home

Hit Counter