Furadantin
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Furadantin
[fūr″ah-dan´tin]nicotine transdermal system
Adalat CC, Adalat LA (UK), Adalat P.A., Adalat Retard (UK), Adalat XL, Adipine (UK), Afeditab CR, Angiopine (UK), Apo-Nifed, Calchan (UK), Cardilate MR (UK), Coracten (UK), Fortipine (UK), Gen-Nifedical, Hypolar Retard (UK), Neozipine XL (UK), Nifediac CC, Nifedical XL, Nifedipress MR (UK), Nifopress MR (UK), Novo-Nifedin, Nu-Nifed, Procardia, Procardia XL, Slofedipine (UK), Tensipine (UK), Valni Retard (UK), Valni XL (UK)TasignaAnandron, NilandronNimotopSular, Syscor (UK)AliniaApo-Nitrofurantoin, Furadantin, Novo-Furantoin
Pharmacologic class: Cholinergic
Therapeutic class: Smoking deterrent
Pregnancy risk category C (gum), D (inhalation, nasal, transdermal)
Pregnancy risk category C (gum), D (inhalation, nasal, transdermal)
Pharmacologic class: Calcium channel blocker
Therapeutic class: Antianginal, anti-hypertensive
Pregnancy risk category C
Pharmacologic class: Protein-tyrosine kinase inhibitor
Therapeutic class: Antineoplastic
Pregnancy risk category D
Pharmacologic class: Antiandrogen
Therapeutic class: Antineoplastic
Pregnancy risk category C
Pharmacologic class: Calcium channel blocker
Therapeutic class: Cerebral vasodilator
Pregnancy risk category C
Pharmacologic class: Antiprotozoal
Therapeutic class: Anti-infective
Pregnancy risk category B
FDA Box Warning
Drug prolongs QT interval and may lead to sudden death. Don't give to patients with hypokalemia, hypomagnesemia, or long-QT syndrome. Correct hypokalemia or hypomagnesemia before starting drug and monitor for these imbalances periodically. Avoid concomitant drugs known to prolong QT interval; also avoid strong CYP3A4 inhibitors. Instruct patient not to eat 2 hours before or 1 hour after taking dose. Obtain ECG to monitor QTc at baseline, 7 days after drug initiation, periodically thereafter, and after dosage adjustments.
Reduce dosage in patients with hepatic impairment.
Action
Supplies nicotine during controlled withdrawal from cigarette smoking. Binds selectively to nicotinic-choliner-gic receptors in central and peripheral nervous systems, autonomic ganglia, adrenal medulla, and neuromuscular junction. At low doses, has a stimulating effect; at high doses, a reward effect.
Availability
Chewing gum: 2 mg, 4 mg
Inhalation: 42 cartridges/system, each containing 10 mg nicotine (delivers 4 mg)
Nasal spray: 10 mg/ml (0.5 mg/spray) in 10-ml bottles (100 doses)
Transdermal patch: 7 mg/day, 11 mg/day, 14 mg/day, 15 mg/day, 21 mg/day, 22 mg/day
⊘Indications and dosages
➣ Adjunctive therapy (with behavior modification) for nicotine withdrawal Transdermal system-
Adults: 21 mg/day transdermally (Habitrol) for 4 to 8 weeks, then 14 mg/day for 2 to 4 weeks, then 7 mg/day for 2 to 4 weeks, for a total of 8 to 16 weeks; patient must wear system 24 hours/day. Or 21 mg/day transdermally (Nicoderm CQ) for 6 weeks, then 14 mg/day for 2 weeks, then 7 mg/day for 2 weeks, for a total of 10 weeks; patient must wear system 24 hours/day. Or 15 mg/day transdermally (one Nicotrol patch) for 6 weeks; patient must wear system 16 hours/day, removing it at bedtime.
Adults, adolescents, and children weighing less than 45 kg (100 lb) who smoke fewer than 10 cigarettes daily or have underlying cardiovascular disease: 14 mg/day transdermally (Habitrol) for 4 to 8 weeks, then 7 mg/day for 2 to 4 weeks, for a total of 6 to 8 weeks; patient must wear system 24 hours/day. Or 14 mg/day transdermally (Nicoderm CQ) for 6 weeks, then 7 mg/day for 2 weeks, for a total of 8 weeks; patient must wear system 24 hours/day. Nasal spray-
Adults: One spray intranasally in each nostril once or twice per hour, up to five times per hour or 40 times per day, for no longer than 6 months Inhalation-
Adults: For optimal response, at least six cartridges inhaled daily for first 3 to 6 weeks, to a maximum of 16 cartridges daily for up to 12 weeks. Patient self-titrates dosage to required nicotine level (usually 6 to 16 cartridges daily), followed by gradual withdrawal over 6 to 12 weeks.
Chewing gum-
Adults: Use as needed depending on smoking urge or chewing rate, or use on fixed schedule q 1 to 2 hours. Initial requirement may range from 18 to 48 mg/day, not to exceed 60 mg/day.
Contraindications
• Hypersensitivity to drug or its components or to menthol (inhaler only)
• Allergy to adhesive (transdermal forms only)
Precautions
Use cautiously in:
• cardiovascular disease, hypertension, bronchospastic disease, diabetes mellitus, pheochromocytoma, peripheral vascular disease, hyperthyroidism, peptic ulcer disease, hepatic disease
• immediately after myocardial infarction, severe arrhythmia, or severe or worsening angina (use not recommended)
• skin disorders (transdermal form)
• dental disorders, esophagitis, pharyngitis, stomatitis (gum form)
• females of childbearing age
• pregnant or breastfeeding patients.
• children under age 18 (safety and efficacy not established).
Administration
• Apply patch when patient awakens and remove patch (as prescribed) at same time each day.
• Administer nasal spray regularly during first week, to help patient get used to irritant effects.
• With inhalation use, give at least six cartridges daily for first 3 to 6 weeks.
• Encourage patient to titrate dosage to level required, followed by gradual withdrawal.
Adverse reactions
CNS: headache, dizziness, drowsiness, poor concentration, nervousness, weakness, paresthesia, insomnia, abnormal dreams
CV: chest pain, hypertension, tachycardia, atrial fibrillation
EENT: sinusitis; pharyngitis (with gum); mouth and throat irritation (with inhaler); nasopharyngeal irritation, rhinitis, sneezing, watering eyes, eye irritation (with nasal spray)
GI: nausea, vomiting, diarrhea, constipation, abdominal pain, dry mouth, dyspepsia; increased salivation, sore mouth (with gum)
GU: dysmenorrhea
Musculoskeletal: joint pain, back pain, myalgia; jaw ache (with gum)
Respiratory: increased cough (with nasal spray or inhaler), bronchospasm
Skin: burning at patch site, erythema, pruritus, cutaneous hypersensitivity, rash, sweating (all with transdermal patch)
Other: abnormal taste, increased appetite (with gum), allergy, hiccups
Interactions
Drug-drug.Acetaminophen, adrenergic antagonists (such as prazosin, labetalol), clozapine, furosemide, imipramine, oxazepam, pentazocine, propranolol and other beta-adrenergic blockers, theophylline: increased effects of these drugs
Bupropion: treatment-emergent hypertension
Insulin: decreased insulin requirement
Isoproterenol, phenylephrine: increased requirements for these drugs
Propoxyphene: decreased nicotine metabolism
Drug-food.Caffeine-containing foods and beverages: increased nicotine effects
Drug-behaviors.Cigarette smoking: increased nicotine metabolism and effects
Patient monitoring
• Assess for signs and symptoms of nicotine withdrawal (irritability, drowsiness, fatigue, headache).
Watch for bronchospasm and evidence of nicotine toxicity (nausea, vomiting, diarrhea, increased salivation, headache, dizziness, visual disturbances).
Patient teaching
Caution patient against any type of smoking during therapy. Urge him to immediately report chest tightness or difficulty breathing.
• If patient uses gum, advise him to chew one piece whenever nicotine craving occurs. Instruct him to chew it slowly until he feels a tingling sensation, then store it between cheek and gum until tingling disappears.
• Instruct patient to apply transdermal patch to clean, dry skin of upper arm or torso when he awakens; to keep it in place when showering, bathing, or swimming; and to remove it at same time each day.
• If patient uses nasal spray, instruct him to tilt head back slightly when spraying. Remind him not to sniff, swallow, or inhale through nose.
• If patient uses inhalation form, teach him to puff continuously for 20 minutes and to use at least six cartridges daily for first 3 to 6 weeks.
• As appropriate, review all significant and life-threatening adverse reactions and interactions, especially those related to the drugs, foods, and behaviors mentioned above.
nifedipine
Pharmacologic class: Calcium channel blocker
Therapeutic class: Antianginal, anti-hypertensive
Pregnancy risk category C
Action
Inhibits calcium transport into myocardial and vascular smooth muscle cells, suppressing contractions. Dilates main coronary arteries and arterioles and inhibits coronary artery spasm, increasing oxygen delivery to heart and decreasing frequency and severity of angina attacks.
Availability
Capsules: 5 mg, 10 mg, 20 mg
Tablets (extended-release): 10 mg, 20 mg, 30 mg, 60 mg, 90 mg
⊘Indications and dosages
➣ Vasospastic (Prinzmetal's) angina; chronic stable angina
Adults: Initially, 10 mg P.O. (immediate-release) t.i.d. titrated over 7 to 14 days; usual effective range is 10 to 20 mg t.i.d., not to exceed 180 mg/day. Patient may be switched to extended-release at nearest equivalent of immediate-release daily dosage (for instance, 30-mg immediate-release dose may be switched to 90-mg extended-release dose). Total extended-release dosage should not exceed 90 mg/day.
➣ Hypertension
Adults: 30 to 60 mg/day P.O. (extended-release only) titrated over 7 to 14 days to a maximum of 120 mg/day
Off-label uses
• Aortic regurgitation
• Heart failure
• Migraine
• Prevention of labor
Contraindications
• Hypersensitivity to drug
Precautions
Use cautiously in:
• chronic renal insufficiency
• hypotension, aortic stenosis, heart failure, significant left ventricular dysfunction (especially when used with beta-adrenergic blockers), peripheral edema
• elderly patients
• pregnant or breastfeeding patients (safety not established)
• children (safety not established).
Administration
• Give immediate-release form with or without food. If GI upset occurs, give with meals, but never with grapefruit or grapefruit juice.
• Don't crush or break extended-release tablet. Make sure patient swallows it whole. Give on empty stomach, and not with grapefruit or grapefruit juice.
• Know that Procardia XL and Adalat CC are not equivalent because of their pharmacokinetic differences.
• Be aware that only extended-release tablets are used to treat hypertension.
Adverse reactions
CNS: headache, dizziness, fatigue, asthenia, paresthesia, vertigo
CV: peripheral edema, chest pain, hypotension
EENT: epistaxis, rhinitis
GI: nausea, constipation
GU: urinary frequency, erectile dysfunction
Musculoskeletal: leg cramps
Skin: flushing, rash
Interactions
Drug-drug.Beta-adrenergic blockers: increased risk of heart failure, severe hypotension, or angina exacerbation
Cimetidine: increased nifedipine blood level
Coumarin anticoagulants: increased prothrombin time
Digoxin: increased risk of digoxin toxicity
Quinidine: decreased quinidine blood level
Drug-diagnostic tests.Antinuclear antibody, direct Coombs' test false-positive results
Drug-food.Grapefruit, grapefruit juice: increased nifedipine blood level and effects
Drug-herbs.Ephedra (ma huang), yohimbine: antagonism of nifedipine effect
Ginkgo, ginseng: increased nifedipine blood level
St. John's wort: decreased nifedipine blood level
Drug-behaviors.Alcohol use: additive hypotension
Patient monitoring
• Monitor vital signs and cardiovascular status. Stay alert for chest pain and edema.
• Watch for rash.
Patient teaching
• Tell patient he may take immediate-release form with or without meals. If GI upset occurs, tell him to take it with meals, but never with grapefruit or grapefruit juice.
• Caution patient not to crush or break extended-release tablets. Tell him to swallow them whole. Advise him to take on empty stomach, and not with grapefruit or grapefruit juice.
• Inform patient that angina attacks may occur 30 minutes after a dose. Explain that these attacks are usually temporary and don't mean that drug should be withdrawn.
Tell patient to report rash immediately.
• Caution patient to avoid driving and other hazardous activities until he knows how drug affects concentration, balance, and alertness.
• Instruct patient to consult prescriber before taking herbs or over-the-counter drugs (especially cold remedies).
• As appropriate, review all other significant adverse reactions and interactions, especially those related to the drugs, tests, foods, herbs, and behaviors mentioned above.
nilotinib
Pharmacologic class: Protein-tyrosine kinase inhibitor
Therapeutic class: Antineoplastic
Pregnancy risk category D
FDABOXED WARNING
Drug prolongs QT interval and may lead to sudden death. Don't give to patients with hypokalemia, hypomagnesemia, or long-QT syndrome. Correct hypokalemia or hypomagnesemia before starting drug and monitor for these imbalances periodically. Avoid concomitant drugs known to prolong QT interval; also avoid strong CYP3A4 inhibitors. Instruct patient not to eat 2 hours before or 1 hour after taking dose. Obtain ECG to monitor QTc at baseline, 7 days after drug initiation, periodically thereafter, and after dosage adjustments.
Reduce dosage in patients with hepatic impairment.
Action
Inhibits proliferation of murine leukemic cell lines mediated by BCR-ABL kinase and human cell lines derived from patients with Philadelphia chromosome-positive (Ph+) chronic myeloid leukemia (CML)
Availability
Capsules: 200 mg
⊘Indications and dosages
➣ Chronic-phase or accelerated-phase Ph+ CML in patients resistant or intolerant to previous imatinib therapy
Adults: 400 mg P.O. q 12 hours
➣ Newly diagnosed Philadelphia chromosome positive CML Adults: 300 mg P.O. q 12 hours
Dosage adjustment
• QTc longer than 480 msec
• Hematologic toxicity
• Moderate or severe non-hematologic toxicity
• Concomitant use of CYP3A4 inducers
• Hepatic impairment
Off-label uses
• Ph+ acute lymphoblastic leukemia (ALL)
• Systemic mastocytosis with c-kit receptor activation
• Hypereosinophilic syndrome
Contraindications
• Hypokalemia
• Hypomagnesemia
• Long-QT syndrome
Precautions
Use cautiously in:
• hepatic impairment
• rare hereditary problems of galactose intolerance, severe lactase deficiency, or glucose-galactose malabsorption (use not recommended)
• myelosuppression
• electrolyte abnormalities
• history of pancreatitis
• pregnant or breastfeeding patients
• children (safety and efficacy not established).
Administration
Correct hypophosphatemia and hypokalemia before starting drug.
• Don't give with food. Know that patient shouldn't consume food for at least 2 hours before or 1 hour after dose.
• Administer capsule whole with water.
• Be aware that drug may be given in combination with hematopoietic growth factors, if indicated.
Adverse reactions
CNS: headache, fatigue, asthenia, insomnia, dizziness, paresthesia, vertigo, intracranial hemorrhage
CV: palpitations, hypertension, flushing, QT interval prolongation and sudden death
EENT: dysphonia, nasopharyngitis
GI: nausea, vomiting, diarrhea, constipation, abdominal pain, abdominal discomfort, dyspepsia, flatulence, anorexia
Hematologic: anemia, neutropenia, thrombocytopenia, leukopenia, pan-cytopenia, febrile neutropenia
Hepatic: hepatotoxicity
Metabolic: electrolyte abnormalities
Musculoskeletal: arthralgia, myalgia, extremity pain, bone pain, muscle spasms, back pain, chest pain
Respiratory: cough, dyspnea, exertional dyspnea, pneumonia
Skin: rash, pruritus, eczema, urticaria, alopecia, erythema, hyperhidrosis, dry skin
Other: fever, peripheral edema, night sweats, weight changes
Interactions
Drug-drug.Drugs eliminated by CYP2B6, CYP2C8, or CYP2C9: decreased blood levels of these drugs
Drugs eliminated by CYP3A4 (such as warfarin), CYP2C8, CYP2C9, CYP2D6, or UGT1A1: increased blood levels of these drugs
Drugs that inhibit P-glycoprotein
ABCB1: increased nilotinib blood level
Midazolam: increased midazolam exposure
P-glycoprotein substrates: increased blood levels of these drugs
Strong CYP3A4 inducers (such as carba-mazepine, dexamethasone, phenytoin, rifabutin, rifampin, rifapentin, phenobarbital): decreased nilotinib blood level
Strong CYP3A4 inhibitors (such as atazanavir, clarithromycin, indinavir, itraconazole, ketoconazole, nefazodone, nelfinavir, ritonavir, saquinavir, telithromycin, voriconazole): increased nilotinib blood level
Drug-diagnostic tests.Albumin, calcium, magnesium, neutrophils, phosphorus, platelets, sodium, white blood cells: decreased levels
ALP, ALT, AST, bilirubin, blood glucose, creatinine, serum amylase, serum lipase: increased levels
Potassium: increased or decreased level
Drug-food.Grapefruit products: increased nilotinib blood level
High-fat meal: increased nilotinib onset
Drug-herbs.St. John's wort: decreased nilotinib blood level
Patient monitoring
Closely monitor for prolonged QT interval if patient has hepatic impairment or is receiving strong CYP3A4 inhibitors.
• Obtain complete blood count every 2 weeks for first 2 months of therapy and monthly thereafter, or as indicated.
• Periodically monitor electrolyte and lipase levels and liver function tests.
Patient teaching
• Tell patient not to take drug with food and not to consume food for at least 2 hours before or 1 hour after dose.
• Advise patient to take capsules whole with water.
Instruct patient to avoid grapefruit products and St. John's wort.
• Tell lactose-intolerant patient that drug contains lactose.
Instruct patient to immediately notify prescriber if symptoms of QTc prolongation (faintness or irregular heartbeat) occur.
Urge patient to immediately report signs or symptoms of liver damage, such as nausea, fatigue, anorexia, yellowing of skin or eyes, dark urine, light-colored stools, itching, or abdominal tenderness.
• Advise female patient that drug may harm fetus. Caution her to avoid pregnancy.
• Advise breastfeeding patient to seek guidance to help her decide whether to discontinue breastfeeding or discontinue drug.
• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs, tests, food, and herbs mentioned above.
nilutamide
Pharmacologic class: Antiandrogen
Therapeutic class: Antineoplastic
Pregnancy risk category C
FDABOXED WARNING
Drug may cause interstitial pneumonitis. Though rare, interstitial changes have led to hospitalization and death postmarketing. Most cases occurred within first 3 months of therapy and reversed after drug was stopped. Obtain routine chest X-ray before starting treatment, and be prepared to obtain baseline pulmonary function tests if ordered. Instruct patient to report new or worsening shortness of breath; this symptom warrants immediate drug withdrawal pending evaluation.
Action
Inhibits testosterone uptake in target tissue, preventing normal androgenic response and arresting tumor growth in androgen-sensitive tissue
Availability
Tablets: 50 mg, 150 mg
⊘Indications and dosages
➣ Metastatic prostate cancer (used with surgical castration)
Adults: 300 mg/day P.O. for 30 days, starting on day of or day after surgery; then 150 mg/day P.O.
Contraindications
• Hypersensitivity to drug or its components
• Severe hepatic or respiratory insufficiency
Precautions
Use cautiously in:
• renal impairment.
Administration
• Give with or without food.
• Start therapy on same day as or day after surgical castration.
Adverse reactions
CNS: dizziness, depression, hyperes-thesia, insomnia
CV: hypertension, peripheral edema, heart failure
EENT: abnormal vision, impaired dark and light adaptation, chromatopsia
GI: nausea, vomiting, constipation, dyspepsia, anorexia
GU: hematuria, nocturia, urinary tract infection, gynecomastia, testicular atrophy, decreased libido, erectile dysfunction
Hematologic: anemia, aplastic anemia
Hepatic: hepatitis
Respiratory: dyspnea, upper respiratory infection, interstitial pneumonia
Other: flulike symptoms, pain, fever, hot flushes, alcohol intolerance
Interactions
Drug-drug.Phenytoin, theophylline, vitamin K: increased risk of toxicity from these drugs
Drug-diagnostic tests.Alanine aminotransferase, aspartate aminotransferase: increased levels
Drug-behaviors.Alcohol use: disulfiram-like reaction
Patient monitoring
• Check for signs and symptoms of hepatitis. Monitor liver function tests.
• Monitor CBC.
• Assess fluid intake and output and weight. Watch for signs and symptoms of heart failure.
• Monitor respiratory status, including chest X-rays.
Patient teaching
• Advise patient he may take with or without food.
• Tell patient therapy will start on day of or day after surgical castration.
• Caution patient not to stop taking drug without consulting prescriber.
• Instruct patient to weigh himself daily and report sudden increases.
Advise patient to report new onset or worsening of dyspnea as well as signs and symptoms of hepatotoxicity, such as nausea, vomiting, abdominal pain, unusual tiredness, or yellowing of skin or eyes.
• Advise patient to avoid alcohol during therapy, because serious adverse reactions may occur.
• Tell patient drug may impair his adaptation to darkness and light, which may cause difficulty driving at night or through tunnels.
• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs, test, and behaviors mentioned above.
nimodipine
Pharmacologic class: Calcium channel blocker
Therapeutic class: Cerebral vasodilator
Pregnancy risk category C
FDABOXED WARNING
Don't give by I.V. or other parenteral route. Deaths and serious or life-threatening adverse events have occurred when capsule contents have been injected parenterally.
Action
Inhibits calcium transport into vascular smooth muscle cells, suppressing contractions; also dilates coronary and cerebral arteries
Availability
Capsules: 30 mg
⊘Indications and dosages
➣ Subarachnoid hemorrhage
Adults: 60 mg P.O. q 4 hours for 21 days. Therapy should start within 96 hours of subarachnoid hemorrhage.
Dosage adjustment
• Hepatic impairment
Contraindications
None
Precautions
Use cautiously in:
• hepatic impairment, hypotension
• elderly patients
• pregnant or breastfeeding patients (safety not established)
• children (safety not established).
Administration
• Give at least 1 hour before or 2 hours after meals. Don't let patient consume grapefruit or grapefruit juice within 1 hour before or 2 hours after dose.
• If patient can't swallow capsule, puncture it with sterile needle and empty contents into syringe. Administer through nasogastric tube, then flush with normal saline solution (30 ml).
Adverse reactions
CNS: headache, depression
CV: hypotension, peripheral edema, ECG abnormalities, bradycardia, tachycardia
GI: nausea, diarrhea, abdominal discomfort
Musculoskeletal: muscle cramps
Respiratory: dyspnea
Skin: acne, flushing, rash
Interactions
Drug-drug.Other calcium channel
blockers: enhanced cardiovascular effects
Drug-diagnostic tests.Liver function
tests: abnormal results
Drug-food.Any food: decreased drug blood level and effects
Grapefruit juice, grapefruit juice: increased drug blood level and effects
Drug-herbs.Ephedra (ma huang),
yohimbine: antagonism of nimodipine effects
St. John's wort: decreased drug blood level
Drug-behaviors.Alcohol use: increased hypotension
Patient monitoring
• Monitor weight and fluid intake and output. Stay alert for fluid retention.
• Assess neurologic status and mood, watching for signs of depression.
• Check vital signs and ECG.
Patient teaching
• Tell patient to complete full course of therapy (21 days).
• Advise patient to take on an empty stomach 1 hour before or 2 hours after a meal. Instruct him to not to consume grapefruit or grapefruit juice within 1 hour before or 2 hours after taking drug.
• Tell patient to report irregular heartbeat, shortness of breath, rash, or swollen hands or feet.
• Instruct patient to minimize GI upset by eating small, frequent meals.
• Advise patient to weigh himself daily and report sudden weight gain.
• As appropriate, review all other significant adverse reactions and interactions, especially those related to the drugs, tests, foods, herbs, and behaviors mentioned above.
nisoldipine
Pharmacologic class: Calcium channel blocker
herapeutic class: Antihypertensive
Pregnancy risk category C
Action
Suppresses calcium transport into vascular smooth muscle cells. This suppression inhibits vasoconstriction and dilates coronary arteries, improving myocardial oxygen uptake.
Availability
Tablets (extended-release): 8.5 mg, 17 mg, 22.5 mg, 34 mg
⊘Indications and dosages
➣ Hypertension
Adults: Initially, 17 mg P.O. daily; may increase by 8.5 mg per week or longer intervals to attain adequate blood pressure control. Usual maintenance dosage is 17 to 34 mg daily.
Contraindications
• Hypersensitivity to drug or dihydropyridine calcium channel blockers
Precautions
Use cautiously in:
• heart failure and left ventricular dysfunction, hepatic impairment, renal disease, coronary artery disease, hypotension
• concurrent phenytoin use
• elderly patients
• pregnant or breastfeeding patients
• children (safety not established).
Administration
• Give with meals, but not with high-fat meals, grapefruit, or grapefruit juice.
• Don't crush or break extended-release tablets. Make sure patient swallows them whole.
• Know that drug may be given alone or with other antihypertensives.
Adverse reactions
CNS: headache, dizziness
CV: peripheral edema, chest pain, vasodilation, hypotension, palpitations
EENT: pharyngitis, sinusitis
GI: nausea
Skin: rash
Interactions
Drug-drug.Cimetidine: increased nisoldipine blood level
Phenytoin, other CYP3A4 inducers: decreased nisoldipine blood level and efficacy
Drug-food.Grapefruit juice: significantly increased drug blood level and effects
High-fat meal: decreased drug blood level
Drug-herbs.Ephedra (ma huang), yohimbine: antagonism of nimodipine effects
St. John's wort: decreased nimodipine blood level
Drug-behaviors.Alcohol use: increased hypotensive effects
Patient monitoring
• Check vital signs and ECG.
• Monitor fluid intake and output. Watch for peripheral edema.
Patient teaching
• Tell patient to swallow extended-release tablets whole and not to crush or break them.
• Advise patient to take with food, but not high-fat food. Recommend small, frequent meals.
• Instruct patient to avoid high-fat meals, alcohol, grapefruit, and grapefruit juice.
• Tell patient to immediately report irregular heart beat, shortness of breath, swelling, pronounced dizziness, rash, or chest pain.
• As appropriate, review all other significant adverse reactions and interactions, especially those related to the drugs, foods, herbs, and behaviors mentioned above.
nitazoxanide
Pharmacologic class: Antiprotozoal
Therapeutic class: Anti-infective
Pregnancy risk category B
Action
Impedes pyruvate:ferredoxin oxidoreductase enzyme-dependent electron transfer reaction, which is essential to anaerobic energy metabolism
Availability
Oral suspension: 100 mg/5 ml
Tablets: 500 mg
⊘Indications and dosages
➣ Diarrhea caused by Giardia lamblia or Cryptosporidium parvum
Adults and children ages 12 and older: 500 mg (tablet or 25 ml suspension) P.O. every 12 hours with food for 3 days
Children ages 4 to 11: 200 mg (10 ml suspension) P.O. every 12 hours with food for 3 days
Children ages 1 to 3: 100 mg (5 ml suspension) P.O. every 12 hours with food for 3 days
Contraindications
• Hypersensitivity to drug or its components
Precautions
Use cautiously in:
• renal, hepatic, or biliary disease or dysfunction; immunodeficiency (including human immunodeficiency virus); diabetes mellitus (suspension)
• concurrent use of warfarin or other highly plasma protein-bound drugs
• elderly patients
• pregnant or breastfeeding patients
• children younger than age 11 (tablets) or age 1 (suspension).
Administration
• Give with food.
• Because a single tablet contains more nitazoxanide than recommended for pediatric dosing, don't give tablets to children younger than age 11.
• Keep suspension container tightly closed and shake well before each use. Suspension may be stored for 7 days; after that, discard unused portion.
Adverse reactions
CNS: headache
GI: nausea, vomiting, diarrhea, abdominal pain
Interactions
Drug-drug.Warfarin and other highly plasma protein-bound drugs with narrow therapeutic index: competition for binding sites, resulting in increased nitazoxanide blood level and efficacy
Patient monitoring
• Monitor renal and liver function tests frequently in patients with renal, hepatic, or biliary dysfunction.
• Monitor blood glucose levels in diabetic patients taking oral suspension.
Patient teaching
• Instruct patient to take drug with food.
• Inform diabetic patient that oral suspension contains sucrose.
• As appropriate, review all other significant adverse reactions and interactions, especially those related to the drugs mentioned above.