Tigan

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Tigan

 [ti´gan]
trademark for preparations of trimethobenzamide hydrochloride, an antiemetic.

triamterene

Dyrenium, Dytac (UK)Apo-Triazo (CA), Gen-Triazolam (CA), HalcionApo-Trifluoperazine (CA), Novo-Trifluzine (CA), PMS-Trifluoperazine (CA), Terfluzine (CA)Apo-Trihex (CA), Broflex (UK), PMS-Trihexyphenidyl (CA)TiganDecapeptyl SR (UK), Gonapeptyl Depot (UK), Trelstar Depot, Trelstar LAThamRegurin (UK), Sanctura, Sanctura XR

Pharmacologic class: Potassium-sparing diuretic

Therapeutic class: Diuretic

Pregnancy risk category B

Pharmacologic class: Benzodiazepine

Therapeutic class: Sedative-hypnotic

Controlled substance schedule IV

Pregnancy risk category X

Pharmacologic class: Piperazine phenothiazine

Therapeutic class: Antipsychotic

Pregnancy risk category C

Pharmacologic class: Anticholinergic

Therapeutic class: Antidyskinetic

Pregnancy risk category C

Pharmacologic class: Anticholinergic

Therapeutic class: Antiemetic

Pregnancy risk category C

Pharmacologic class: Synthetic agonist analog of luteinizing hormone-releasing hormone (LHRH)

Therapeutic class: Antineoplastic

Pregnancy risk category X

Pharmacologic class: Protein substrate

Therapeutic class: Systemic alkalizer

Pregnancy risk category C

Pharmacologic class: Anticholinergic, antimuscarinic

Therapeutic class: Renal and genitourinary agent, antispasmodic

Pregnancy risk category C

FDA Box Warning

• Abnormal serum potassium elevation may occur, and is more likely in patients with renal impairment or diabetes and in elderly or severely ill patients. As uncorrected hyperkalemia may be fatal, monitor serum potassium levels frequently, especially when dosage is changed or patient has an illness that may influence renal function.

Action

Depresses sodium resorption and potassium excretion in renal distal tubule

Availability

Capsules: 50 mg, 100 mg

Indications and dosages

Edema

Adults: 100 mg P.O. b.i.d. Do not exceed 300 mg/day.

Dosage adjustment

• Concurrent antihypertensive drug therapy
• Elderly patients

Off-label uses
• Diabetes insipidus

Contraindications

• Hypersensitivity to drug
• Hyperkalemia
• Severe hepatic disease
• Anuria, severe renal dysfunction (except nephrosis)
• Concurrent use of other potassium-sparing diuretics or potassium supplements

Precautions

Use cautiously in:
• hepatic dysfunction, renal insufficiency, diabetes mellitus
• history of gout or renal calculi
• elderly or debilitated patients
• pregnant or breastfeeding patients
• children (safety not established).

Administration

• Give after meals.
• Know that drug may be used alone or as adjunct to thiazide or loop diuretics.
• Make sure patient stops taking potassium supplements before starting triamterene.

Adverse reactions

CNS: headache, fatigue, asthenia, dizziness

GI: nausea, vomiting, diarrhea, dry mouth

GU: azotemia, renal calculi

Hematologic: megaloblastic anemia, thrombocytopenia

Hepatic: jaundice

Metabolic: hyperglycemia, hyperkalemia, metabolic acidosis

Skin: rash, photosensitivity

Other: anaphylaxis

Interactions

Drug-drug.Amantadine: increased amantadine blood level, greater risk of toxicity

Angiotensin-converting enzyme inhibitors, cyclosporine, indomethacin, potassium-sparing diuretics, potassium supplements, other potassium-containing

preparations: increased risk of hyperkalemia

Antihypertensives, nondepolarizing muscle relaxants, other diuretics, preanesthetic and anesthetic agents: potentiated effects of these drugs

Chlorpropamide: increased risk of hyponatremia

Cimetidine: increased bioavailability and decreased renal clearance of triamterene

Indomethacin: increased risk of acute renal failure

Lithium: decreased lithium clearance, greater risk of lithium toxicity

Drug-diagnostic tests.Alkali reserves, hemoglobin, platelets: decreased values

Blood urea nitrogen (BUN), creatinine, glucose, hepatic enzymes, potassium: increased levels

Liver function tests: increased values

Quinidine blood level: interference with fluorescent measurement

Drug-food.Salt substitutes containing potassium: increased risk of hyperkalemia

Drug-herbs.Gossypol, licorice: increased risk of hypokalemia

Patient monitoring

• Monitor BUN, creatinine, and electrolyte levels. Stay alert for hyperkalemia.
• Assess CBC with white cell differential.

Patient teaching

• Advise patient to take after meals to reduce nausea.
• Instruct patient to take last daily dose in early evening to avoid nocturia.
• Teach patient to recognize and report signs and symptoms of electrolyte imbalances.
• Tell patient to avoid salt substitutes. Advise him not to use herbs without consulting prescriber.
• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs, tests, foods, and herbs mentioned above.


triazolam

Apo-Triazo (CA), Gen-Triazolam (CA), Halcion


Pharmacologic class: Benzodiazepine

Therapeutic class: Sedative-hypnotic

Controlled substance schedule IV

Pregnancy risk category X

 

Action

Inhibits gamma-aminobutyric acid, a neurotransmitter that activates receptors at limbic, thalamic, and hypothalamic levels of CNS

Availability

Tablets: 0.125 mg, 0.25 mg, 0.5 mg

Indications and dosages

Insomnia

Adults: 0.125 to 0.5 mg P.O. at bedtime p.r.n. After 7 to 10 days, decrease dosage gradually and then discontinue.

Dosage adjustment

• Elderly or debilitated patients

Off-label uses

• Presurgical hypnotic

Contraindications

• Hypersensitivity to drug or other benzodiazepines
• Concurrent use of itraconazole, ketoconazole, or nefazodone
• Pregnancy

Precautions

Use cautiously in:
• hepatic or renal dysfunction, sleep apnea, respiratory compromise, psychosis
• history of suicide attempt or drug abuse
• elderly or debilitated patients
• breastfeeding patients
• children younger than age 18 (safety and efficacy not established).

Administration

• Don't give with grapefruit juice.

Adverse reactions

CNS: dizziness, excessive sedation, hangover, headache, anterograde or traveler's amnesia, confusion, incoordination, lethargy, depression, paradoxical excitation, light-headedness, psychological disturbance, euphoria

GI: nausea, vomiting

Other: physical or psychological drug dependence, drug tolerance, withdrawal symptoms (tremor, abdominal and muscle cramps, vomiting, diaphoresis, dysphoria, perceptual disturbances, insomnia)

Interactions

Drug-drug.Antidepressants, antihistamines, chloral hydrate, opioid analgesics, other psychotropic drugs: additive CNS depression

Cimetidine, disulfiram, fluconazole, hormonal contraceptives, isoniazid, itraconazole, ketoconazole, nefazodone, rifampin, and other drugs that inhibit CYP450-3A4-mediated metabolism: decreased oxidative metabolism and increased action of triazolam

Digoxin: increased digoxin blood level, greater risk of toxicity

Macrolide anti-infectives (such as azithromycin, clarithromycin, erythromycin): increased triazolam bioavailability

Probenecid: rapid onset and prolonged effects of triazolam

Ranitidine: increased triazolam blood level

Theophylline: decreased sedative effect of triazolam

Drug-food.Grapefruit juice: increased triazolam blood level and effects

Drug-herbs.Chamomile, hops, kava, skullcap, valerian: increased CNS depression

Drug-behaviors.Alcohol use: increased CNS depression

Smoking: increased triazolam clearance

Patient monitoring

• Monitor neurologic status. Watch for paradoxical or rebound drug effects.
• Observe for signs of drug hoarding and drug abuse.

Patient teaching

• Tell patient to take at bedtime with a liquid other than grapefruit juice.
• Explain that drug is meant only for short-term use (7 to 10 days).
• Tell patient rebound insomnia may occur for 1 to 2 nights after he discontinues drug.
• Instruct patient to avoid alcohol use and smoking.
• Caution patient to avoid driving and other hazardous activities while under drug's influence.
• As appropriate, review all other significant adverse reactions and interactions, especially those related to the drugs, foods, herbs, and behaviors mentioned above.


trifluoperazine hydrochloride

Apo-Trifluoperazine (CA), Novo-Trifluzine (CA), PMS-Trifluoperazine (CA), Terfluzine (CA)


Pharmacologic class: Piperazine phenothiazine

Therapeutic class: Antipsychotic

Pregnancy risk category C

 

Action

Unknown. Thought to act on subcortical levels of hypothalamic and limbic systems by producing antidopaminergic effects. Also lowers seizure threshold and exhibits some adrenergic, muscarinic, and anticholinergic activity.

Availability

Tablets: 1 mg, 2 mg, 5 mg, 10 mg

Indications and dosages

Schizophrenia

Adults: 2 to 5 mg P.O. b.i.d.; may increase gradually to obtain adequate response. Usual maintenance dosage is 15 to 20 mg/day.

Children ages 6 to 12: Initially, 1 mg P.O. once or twice daily in hospitalized patients or those under close supervision; may increase gradually up to 15 mg/day P.O. until symptoms are controlled or adverse reactions are intolerable.

Nonpsychotic anxiety

Adults: 1 to 2 mg P.O. b.i.d. Do not exceed 6 mg/day or 12 weeks' duration.

Dosage adjustment

• Hepatic disease
• Elderly or debilitated patients

Contraindications

• Hypersensitivity to drug, other phenothiazines, or bisulfites
• Severe hepatic disease
• Bone marrow depression
• Blood dyscrasias
• Coma
• Concomitant use of other CNS depressants in high doses

Precautions

Use cautiously in:
• seizure disorders, cardiovascular disorders, GI obstruction, glaucoma, retinopathy
• elderly or debilitated patients
• pregnant or breastfeeding patients.

Administration

• Be aware that dosage should be adjusted to needs of individual. Lowest effective dosage should always be used.

Adverse reactions

CNS: sedation, dizziness, drowsiness, insomnia, fatigue, extrapyramidal effects, tardive dyskinesia, neuroleptic malignant syndrome (NMS)

CV: tachycardia, hypotension, orthostatic hypotension, peripheral edema, prolonged QT interval, torsades de pointes

EENT: dry eyes, blurred vision, miosis, mydriasis, epithelial keratopathy, pigmentary retinopathy

GI: constipation, biliary stasis, dry mouth, anorexia, adynamic ileus

GU: urinary retention, glycosuria, amenorrhea, ejaculatory disorders, galactorrhea, gynecomastia

Hematologic: leukopenia, agranulocytosis

Hepatic: cholestatic jaundice

Musculoskeletal: muscle weakness

Skin: photosensitivity, altered pigmentation, erythema, rash

Other: mild fever, weight gain, allergic reaction

Interactions

Drug-drug.Alpha-adrenergic blockers: additive effect

Antacids containing aluminum: decreased trifluoperazine absorption

Anticholinergics, anticholinergic-like drugs (including antidepressants, antihistamines, disopyramide, other phenothiazines, quinidine): additive anticholinergic effects

Anticonvulsants: decreased seizure threshold

Antihistamines, CNS depressants, general anesthetics, opioids, sedative-hypnotics: additive CNS depression

Barbiturates: decreased blood levels of both drugs

Guanethidine: decreased antihypertensive effect

Lithium: increased risk of extrapyramidal reactions, disorientation, and unconsciousness

Oral anticoagulants: decreased anticoagulant effect

Phenytoin: interference with phenytoin metabolism, causing phenytoin toxicity

Propranolol: increased blood levels of both drugs

Thiazide diuretics: additive orthostatic hypotension

Drug-diagnostic tests.Hepatic enzymes: increased levels

Phenylketonuria test: false-positive result

Prolactin: increased level, causing interference with gonadotropin tests

Urine bilirubin: false-positive result

Drug-herbs.St. John's wort: increased risk of photosensitivity

Drug-behaviors.Alcohol use: additive CNS depression and hypotension

Sun exposure: increased risk of photosensitivity

Patient monitoring

• Monitor ECG and blood pressure. Watch closely for hypotension.
• Assess CBC (including platelet count) and liver function tests. Stay alert for signs and symptoms of hepatic damage and blood dyscrasias.

Monitor neurologic status, especially for indications of NMS (unstable blood pressure, high fever, sweating, stupor, muscle rigidity, and autonomic dysfunction). Immediately discontinue drug if these symptoms occur.
• If signs and symptoms of tardive dyskinesia appear (repetitive, involuntary, purposeless movements, such as grimacing, tongue protrusion, lip smacking, and rapid eye blinking), consider discontinuing drug. However, some patients may require treatment despite presence of the syndrome.

Patient teaching

• Tell patient that drug's full effect usually occurs in 1 to 2 weeks.
• Instruct patient to move slowly when sitting up or standing, to avoid dizziness from sudden blood pressure drop.

Teach patient to recognize and immediately report signs and symptoms of NMS and tardive dyskinesia.
• Caution patient to avoid driving and other hazardous activities until he knows how drug affects him.
• Tell patient to avoid alcohol and certain herbs.
• Advise patient to avoid sun exposure and to wear sunscreen and protective clothing when going outdoors.
• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs, tests, herbs, and behaviors mentioned above.


trihexyphenidyl hydrochloride

Apo-Trihex (CA), Broflex (UK), PMS-Trihexyphenidyl (CA)


Pharmacologic class: Anticholinergic

Therapeutic class: Antidyskinetic

Pregnancy risk category C

 

Action

Inhibits parasympathetic nervous system, relaxing smooth muscles and decreasing involuntary movements

Availability

Syrup: 2 mg/5 ml

Tablets: 2 mg, 5 mg

Indications and dosages

Adjunct in idiopathic, postencephalitic, or arteriosclerotic parkinsonism

Adults: 1 mg P.O. on first day; may increase in 2-mg increments q 3 to 5 days, up to a maximum of 6 to 10 mg/day. In postencephalitic parkinsonism, 12 to 15 mg P.O. daily.

Drug-induced extrapyramidal symptoms

Adults: Initially, 1 mg P.O. daily, increased progressively if extrapyramidal symptoms aren't controlled within several hours. Usual dosage range is 5 to 15 mg/day P.O. in divided doses.

Dosage adjustment

• Concurrent use of levodopa or other parasympathetic inhibitor
• Elderly patients

Off-label uses

• Dystonia

Contraindications

• Hypersensitivity to drug or its components
• Angle-closure glaucoma
• Pyloric or duodenal obstruction
• Stenosing peptic ulcer
• Megacolon
• Prostatic hypertrophy or bladder-neck obstruction
• Achalasia
• Myasthenia gravis

Precautions

Use cautiously in:
• chronic renal, hepatic, pulmonary, or cardiac disease; hypertension; tachycardia secondary to cardiac insufficiency; hyperthyroidism
• elderly patients
• pregnant or breastfeeding patients
• children (safety not established).

Administration

• Give with meals. However, if drug causes severe dry mouth, give before meals.
• Administer last dose at bedtime.

Adverse reactions

CNS: dizziness, nervousness, drowsiness, asthenia, headache

CV: orthostatic hypotension, tachycardia

EENT: blurred vision, mydriasis, increased intraocular pressure (IOP), angle-closure glaucoma (with long-term use)

GI: nausea, vomiting, constipation, dry mouth

GU: urinary hesitancy or retention

Interactions

Drug-drug.Amantadine, other anticholinergics (including disopyramide, phenothiazines, quinidine, tricyclic antidepressants): additive anticholinergic effects

Other CNS depressants (such as antihistamines, opioids, sedative-hypnotics): additive CNS depression

Phenothiazines: decreased phenothiazine effects

Drug-herbs.Angel's trumpet, jimsonweed, scopolia: increased anticholinergic effects

Drug-behaviors.Alcohol use: additive CNS depression

Patient monitoring

• With prolonged use, monitor vision and IOP regularly.
• Assess drug efficacy to help guide dosage titration.
• Monitor vital signs. Watch for orthostatic hypotension.
• Closely monitor fluid intake and output. Stay alert for urinary retention.

Patient teaching

• Instruct patient to take with meals or, if severe dry mouth occurs, before meals.
• Tell patient drug has a bitter taste, which may be followed by numbness and tingling in mouth.
• Stress importance of follow-up eye exams.
• Instruct patient to consult prescriber before taking over-the-counter preparations or herbs.
• Advise patient to avoid alcohol and hazardous activities during drug therapy.
• Tell patient to move slowly when sitting up or standing, to avoid dizziness from sudden blood pressure decrease.
• As appropriate, review all other significant adverse reactions and interactions, especially those related to the drugs, herbs, and behaviors mentioned above.


trimethobenzamide hydrochloride

Tigan


Pharmacologic class: Anticholinergic

Therapeutic class: Antiemetic

Pregnancy risk category C

 

Action

Unclear. Thought to block dopamine receptors and emetic impulses in chemoreceptor trigger zone, preventing nausea and vomiting.

Availability

Capsules: 300 mg

Injection: 100 mg/ml in 2-ml ampules and prefilled syringes and in 20-ml vials

Indications and dosages

Nausea and vomiting

Adults: 300 mg P.O. three to four times daily or 200 mg I.M. three to four times daily

Dosage adjustment

• Renal impairment

Contraindications

• Hypersensitivity to drug
• Parenteral form in children

Precautions

Use cautiously in:
• renal impairment, arrhythmias, encephalitis, gastroenteritis, dehydration, electrolyte imbalances
• concurrent alcohol use
• elderly or debilitated patients
• pregnant or breastfeeding patients
• children with known or suspected viral illnesses.

Administration

• In I.M. use, inject deep into upper outer quadrant of gluteus maximus.
• Withhold drug in children with signs or symptoms of Reye's syndrome.

Adverse reactions

CNS: drowsiness, dizziness, headache, depression, disorientation, parkinsonian symptoms, coma, seizures

CV: hypotension

EENT: blurred vision

Hematologic: blood dyscrasias

Hepatic: jaundice

Musculoskeletal: muscle cramps, opisthotonos

Skin: rash, urticaria, flushing

Other: pain and stinging at I.M. injection site, hypersensitivity reaction

Interactions

Drug-drug.Antidepressants, antihistamines, CNS depressants, opioids, sedative-hypnotics: additive CNS depression

Drug-behaviors.Alcohol use: additive CNS depression

Patient monitoring

• Monitor neurologic status, especially for parkinsonian symptoms and other serious adverse reactions.
• Assess CBC and liver function tests. Watch for blood dyscrasias and jaundice.
• Evaluate injection site for pain and stinging.
• Closely monitor patient's nutritional and hydration status. Report continuing nausea.

Patient teaching

• Advise patient to take as needed for nausea and vomiting, but only as prescribed.
• Tell patient to contact prescriber promptly if nausea persists despite therapy.
• Instruct patient to minimize nausea and vomiting by eating small, frequent servings of healthy food and drinking plenty of fluids.
• Advise patient to avoid alcohol.
• Caution patient to avoid driving and other hazardous activities until drug effects are known.
• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs and behaviors mentioned above.


triptorelin pamoate

Decapeptyl SR (UK), Gonapeptyl Depot (UK), Trelstar Depot, Trelstar LA


Pharmacologic class: Synthetic agonist analog of luteinizing hormone-releasing hormone (LHRH)

Therapeutic class: Antineoplastic

Pregnancy risk category X

 

Action

Initially causes surge in luteinizing hormone (LH), follicle-stimulating hormone (FSH), and testosterone levels. After several weeks of therapy, LH and FSH secretion decrease, causing sustained testosterone reduction equivalent to pharmacologic castration.

Availability

Microgranules for injection (lyophilized): 3.75 mg (depot), 11.25 mg (long-acting), 22.5 mg (long-acting)

Indications and dosages

Palliative treatment of advanced prostate cancer

Adults: 3.75 mg (depot) I.M. monthly as a single injection or 11.25 mg (long-acting) I.M. q 12 weeks as a single injection or 22.5 mg (long-acting) I.M. q 24 weeks

Off-label uses

• Infertility
• Endometriosis
• Uterine fibroids
• Precocious puberty

Contraindications

• Hypersensitivity to drug, LHRH, or other LHRH agonists
• Pregnancy
• Women of childbearing potential

Precautions

Use cautiously in:
• renal insufficiency
• prostate cancer with impending spinal cord compression or severe urinary tract disorder
• breastfeeding patients (use not recommended).

Administration

• Reconstitute with 2 ml of sterile water for injection, using accompanying syringe (don't use other diluents). Add syringe contents to vial containing particles; shake well. Withdraw vial contents and inject I.M. immediately.
• Inject deep I.M. into either buttock. Rotate injection sites.

Keep epinephrine and emergency equipment at hand in case of anaphylactic reaction.

Adverse reactions

CNS: insomnia, dizziness, headache, emotional lability, fatigue, stroke

CV: hypertension, increased risk of myocardial infarction and sudden cardiac death

GI: vomiting, diarrhea

GU: urinary retention, urinary tract infection, gynecomastia, erectile dysfunction, testicular atrophy

Hematologic: anemia

Metabolic: hyperglycemia

Musculoskeletal: skeletal or leg pain

Skin: pruritus

Other: leg edema, temporary worsening of disease, edema, hot flashes, pain at injection site, hypersensitivity reactions including anaphylaxis

Interactions

Drug-diagnostic tests.Hemoglobin: decreased value

Pituitary-gonadal function tests: misleading results (with continuous or long-term use)

Serum glucose: increased

Patient monitoring

• Monitor serum testosterone and prostate-specific antigen levels periodically to assess drug efficacy.

Monitor patient for signs and symptoms suggestive of cardiovascular disease and manage as appropriate.

Patient teaching

• Explain drug therapy to patient. Stress need for follow-up laboratory tests.
• Tell patient prostate cancer symptoms may worsen during first few weeks of therapy.
• Instruct patient to monitor weight and report sudden weight gain or leg swelling.
• Advise female patient to tell prescriber before starting therapy if she is or plans to become pregnant. Caution her not to breastfeed during therapy.
• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs and tests mentioned above.


tromethamine

Tham


Pharmacologic class: Protein substrate

Therapeutic class: Systemic alkalizer

Pregnancy risk category C

 

Action

Combines with hydrogen ions to form bicarbonate and a buffer, correcting acidosis. Also shows some diuretic activity.

Availability

Injection: 18 g/500 ml

Indications and dosages

Metabolic acidosis associated with cardiac bypass surgery

Adults: 9 ml/kg (0.32 g/kg) by slow I.V. infusion; 500 ml (18 g) is usually adequate. Maximum single dosage is 500 mg/kg infused over at least 1 hour.

Metabolic acidosis associated with cardiac arrest

Adults: 3.6 to 10.8 g by I.V. injection into large peripheral vein if chest isn't open, or 2 to 6 g I.V. directly into ventricular cavity if chest is open. After reversal of cardiac arrest, patient may need additional amounts to control persistent acidosis.

To correct acidity of acid-citrate-dextrose (ACD) blood in cardiac bypass surgery

Adults: 0.5 to 2.5 g added to each 500 ml of ACD blood used for priming pump-oxygenator. Usual dosage is 2 g.

Dosage adjustment

• Elderly patients

Contraindications

• Hypersensitivity to drug
• Anuria
• Uremia

Precautions

Use cautiously in:
• renal disease, severe respiratory disease, respiratory depression
• pregnant patients
• infants.

Administration

Keep intubation equipment nearby in case respiratory depression occurs.
• For metabolic acidosis associated with cardiac bypass surgery, give by slow I.V. infusion through large-bore I.V. catheter into large antecubital vein. Elevate arm after infusion.
• If extravasation occurs, discontinue drug and infiltrate affected area with 1% procaine hydrochloride (containing hyaluronidase).
• Be aware that in cardiac arrest, drug is used with standard resuscitative measures. When giving by direct I.V. injection into open chest, never inject into cardiac muscle.

Adverse reactions

GU: oliguria

Hepatic: hemorrhagic hepatic necrosis

Metabolic: metabolic alkalosis, transient hypoglycemia, fluid-solute overload, hyperkalemia

Respiratory: respiratory depression

Other: fever; I.V. site infection; extravasation with venous thrombosis or phlebitis, inflammation, necrosis, and sloughing

Interactions

Drug-diagnostic tests.Glucose: decreased level

Potassium: increased level

Patient monitoring

• Maintain continuous cardiac monitoring.
• Monitor arterial blood gas levels. Watch for alkalosis and signs and symptoms of respiratory depression.
• Assess liver function tests. Stay alert for signs and symptoms of hepatic impairment.
• Monitor glucose and potassium levels. Watch for hypoglycemia and hyperkalemia.
• Closely monitor fluid intake and output. Check for fluid and electrolyte imbalances and oliguria related to hyperkalemia.

Patient teaching

• Explain drug therapy to patient. Assure him he will be monitored continuously.
• As appropriate, review all significant and life-threatening adverse reactions and interactions, especially those related to the tests mentioned above.


trospium chloride

Regurin (UK), Sanctura, Sanctura XR


Pharmacologic class: Anticholinergic, antimuscarinic

Therapeutic class: Renal and genitourinary agent, antispasmodic

Pregnancy risk category C

 

Action

Antagonizes effects of acetylcholine on muscarinic receptors in cholinergically innervated organs, reducing bladder smooth muscle tone

Availability

Capsules (extended-release): 60 mg

Tablets: 20 mg

Indications and dosages

Overactive bladder with symptoms of urge urinary incontinence, urgency, and urinary frequency

Adults: 20 mg P.O. twice daily 1 hour before meals or on empty stomach, or 1 60-mg capsule daily in morning with water at least 1 hour before a meal

Dosage adjustment

• Severe renal impairment
• Patients age 75 and older

Contraindications

• Hypersensitivity to drug or its components
• Preexisting or risk of urinary or gastric retention or uncontrolled angle-closure glaucoma

Precautions

Use cautiously in:
• moderate renal impairment, moderate to severe hepatic impairment, decreased GI motility, controlled angle-closure glaucoma, clinically significant bladder outflow obstruction or GI obstructive disorders
• patients at risk for heat prostration
• elderly patients
• pregnant or breastfeeding patients
• children (safety and efficacy not established).

Administration

• Give at least 1 hour before meals or on empty stomach.

Adverse reactions

CNS: headache, fatigue, syncope, hallucinations, delirium, dizziness, drowsiness

CV: tachycardia, chest pain

EENT: dry eyes, blurred vision, dry throat

GI: vomiting, constipation (new-onset or aggravated), upper abdominal pain, dyspepsia, flatulence, abdominal distention, dry mouth

GU: urinary retention

Skin: dry skin

Other: altered taste, heat prostration, angioedema

Interactions

Drug-drug.Anticholinergics: additive anticholinergic effects

Digoxin, metformin, morphine, pancuronium, procainamide, tenofovir, vancomycin: increased blood levels of both drugs

Drug-behaviors.Alcohol use: increased risk of drowsiness

Patient monitoring

• Monitor renal and hepatic function tests.
• Monitor patient for decreased GI motility and urinary retention.

If patient has controlled angle-closure glaucoma, stay alert for severe eye pain accompanied by nausea, rainbows around lights, red eye, and blurred vision. Be prepared to treat immediately, as appropriate.

Be aware that angioedema associated with life-threatening upper airway swelling may occur. If involvement of the tongue, hypopharynx, or larynx occurs, promptly discontinue drug and provide appropriate treatment.

Patient teaching

• Instruct patient to take tablet 1 hour before meals on an empty stomach or to take capsule in morning with water at least 1 hour before a meal.
• Instruct patient not to consume alcohol within 2 hours of taking extended-release capsule.
• Advise patient to consult prescriber before taking over-the-counter products such as antihistamines because these may increase risk of side effects.
• Inform patient that drug increases risk of heat prostration; describe symptoms and advise him to seek prompt medical attention if these occur.
• Caution patient to avoid driving and other hazardous activities until drug effects are known.
• Advise patient to avoid alcohol use.
• As appropriate, review all other significant adverse reactions and interactions, especially those related to the drugs and behaviors mentioned above.

trimethobenzamide

(trye-meth-oh-ben-za-mide) ,

Tigan

(trade name)

Classification

Therapeutic: antiemetics
Pharmacologic: anticholinergics
Pregnancy Category: C

Indications

Mild to moderate nausea and vomiting.

Action

Inhibits emetic stimulation of the chemoreceptor trigger zone in the medulla.

Therapeutic effects

Decreased nausea and vomiting.

Pharmacokinetics

Absorption: Complete absorption following oral and IM administration.
Distribution: Unknown.
Metabolism and Excretion: Metabolized by the liver; 30–50% excreted unchanged in urine.
Half-life: 7–9 hr.

Time/action profile (antiemetic effect)

ROUTEONSETPEAKDURATION
PO10–40 minunknown3–4 hr
IM15–35 minunknown2–3 hr

Contraindications/Precautions

Contraindicated in: Hypersensitivity.
Use Cautiously in: Pediatric: Children; Geriatric: Appears on Beers list. Potential for extrapyramidal side effects may outweigh potential benefit; Obstetric / Lactation: Safety not established.

Adverse Reactions/Side Effects

Central nervous system

  • coma (life-threatening)
  • seizures (life-threatening)
  • drowsiness (most frequent)
  • depression
  • extrapyramidal reactions

Cardiovascular

  • hypotension (most frequent)

Gastrointestinal

  • diarrhea
  • hepatitis

Dermatologic

  • rashes

Hematologic

  • blood dyscrasias

Local

  • pain (most frequent)
  • burning at IM injection site
  • redness at IM injection site
  • stinging at IM injection site

Interactions

Drug-Drug interaction

↑ CNS depression with other CNS depressants, including alcohol, antidepressants, antihistamines, opioid analgesics, and sedative/hypnotics.

Route/Dosage

Oral (Adults) 300 mg 3–4 times daily.
Intramuscular (Adults) 200 mg 3–4 times daily as needed.

Renal Impairment

(Adults) CCr ≤70 mL/min—↓ dose or ↑ dosing interval.

Availability (generic available)

Capsules: 300 mg
Injection: 100 mg/mL

Nursing implications

Nursing assessment

  • Assess patient for nausea and vomiting prior to and 30–60 min following administration.
  • Assess BP for hypotension following parenteral administration.

Potential Nursing Diagnoses

Risk for deficient fluid volume (Indications)
Risk for injury (Side Effects)

Implementation

  • Oral: Capsules can be opened and contents mixed with food or fluids for patients with difficulty swallowing.
  • Intramuscular: Inject deep into well-developed muscle mass to minimize tissue irritation.
    • Trimethobenzamide is not receommended for IV use.

Patient/Family Teaching

  • Instruct patient to take medication as directed. Take missed doses as soon as remembered unless almost time for next dose; do not double doses.
  • Advise patient to make position changes slowly to minimize orthostatic hypotension following parenteral doses.
  • May cause drowsiness. Caution patient to avoid driving or other activities requiring alertness until response to medication is known.
  • Caution patient to avoid taking alcohol or other CNS depressants concurrently with this medication.
  • Instruct patient to notify health care professional promptly if sore throat, fever, unusual weakness or tiredness, tremors, or yellowing of the skin and eyes occurs.

Evaluation/Desired Outcomes

  • Prevention and relief of nausea and vomiting.

Tigan

a trademark for an antiemetic (trimethobenzamide hydrochloride).
References in periodicals archive ?
Michael Dorn joined the series in season four as Lieutenant Commander Worf and Nicole deBoer joined in the seventh year as Lieutenant Ezri Dax.