Drilldown: Medicines

None (2) · Atenolol (1) · Insulin aspart (1) · Insulin degludec (1) · Insulin lispro (1) · Nortriptyline (hydrochloride) (1)

Humalog, Admelog, Lyumjev (1) · NovoLog, Fiasp (ultra-rapid), Trurapi (1) · Pamelor (US brand discontinued; generic widely available), Aventyl (1) · Rexulti (1) · Sunosi (1) · Tenormin (1) · Tresiba (1)

5HT1A activity than aripiprazole (1) · 5HT2A (1) · Atypical antipsychotic (1) · D2/5HT1A partial agonist with stronger α1A (1) · Norepinephrine-dopamine reuptake inhibitor (NDRI) (1) · secondary amine)]] (1) · wake-promoting agent (1) · [[:Category:Antidepressants|Antidepressant]] (1) · [[:Category:Antihypertensives|Antihypertensive]] (1) · [[:Category:Basal_insulins|Basal insulin]] (1) · [[:Category:Beta blockers|Beta blocker (cardioselective β1)]] (1) · [[:Category:Insulins|Insulin]] (3) · [[:Category:Mealtime_insulins|Mealtime (bolus) insulin]] (2) · [[:Category:Migraine prophylactics|Migraine prophylactic]] (1) · [[:Category:Neuropathic pain medicines|Neuropathic pain medicine]] (1) · [[:Category:Rapid-acting_insulins|Rapid-acting insulin analog]] (2) · [[:Category:Tricyclic antidepressants|Tricyclic antidepressant (TCA (1) · [[:Category:Ultra-long-acting_insulins|Ultra-long-acting insulin analog]] (1)

None (2) · Partial agonist at D2 and 5HT1A. Antagonist at 5HT2A, α1A, α1B, α2C. More potent 5HT2A antagonism, 5HT1A partial agonism, and α1 antagonism (relative to D2 partial agonism) than aripiprazole, proposed to reduce akathisia and enhance affective/cognitive effects. (1) · Selective dopamine and norepinephrine reuptake inhibitor (DAT and NET inhibition). Unlike amphetamine, does not significantly release monoamines, pure reuptake inhibition. (1) · '"`UNIQ--vote-00000019-QINU`"' Therapeutic plasma-level monitoring is standard practice for TCAs given the narrow therapeutic index and the established plasma-level-efficacy correlation. CYP2D6 substrate; CPIC PGx guidance applies for dose individualization'"`UNIQ--ref-0000001A-QINU`"'. (1) · '"`UNIQ--vote-00000584-QINU`"' Binds the same insulin receptor as endogenous insulin with comparable mitogenic-to-metabolic ratio. Ultra-rapid formulations (Lyumjev) add treprostinil and citrate to accelerate absorption further'"`UNIQ--ref-00000585-QINU`"'. (1) · '"`UNIQ--vote-00001356-QINU`"' Binds the same insulin receptor as endogenous insulin with comparable mitogenic-to-metabolic ratio'"`UNIQ--ref-00001357-QINU`"'. (1)

Excessive daytime sleepiness in adults with narcolepsy or obstructive sleep apnea (OSA) (1) · Schizophrenia (FDA-approved 2015). Adjunctive treatment of major depressive disorder (2015). '''Agitation associated with dementia due to Alzheimer disease''' (FDA-approved May 2023, first agent specifically approved for this problem). Investigational for PTSD (combined with sertraline). (1) · '"`UNIQ--vote-0000001B-QINU`"', '"`UNIQ--vote-0000001C-QINU`"', '"`UNIQ--vote-0000001D-QINU`"', '"`UNIQ--vote-0000001E-QINU`"', '"`UNIQ--vote-0000001F-QINU`"' (2) · '"`UNIQ--vote-00000586-QINU`"', '"`UNIQ--vote-00000587-QINU`"', '"`UNIQ--vote-00000588-QINU`"' (1) · '"`UNIQ--vote-000005EF-QINU`"', '"`UNIQ--vote-000005F0-QINU`"', '"`UNIQ--vote-000005F1-QINU`"' (1) · '"`UNIQ--vote-00001358-QINU`"', '"`UNIQ--vote-00001359-QINU`"' (1)

25-50 mg PO once daily; titrate to 100 mg/day (1) · Depression: 25 mg PO TID-QID or 75 mg at bedtime, titrate to 75-150 mg/day. Neuropathic pain: 10-25 mg at bedtime, titrate to 50-100 mg/day. Elderly: 10 mg at bedtime (Beers-list cautions, though less than amitriptyline) (1) · Narcolepsy: 75 mg PO once daily upon awakening, titrate every 3 days. OSA: 37.5 mg PO once daily, titrate. (1) · SC 4-6 units (or 1 unit per 10-15 g carbs) at meals; titrate to postprandial glucose (1) · SC 4-6 units (or 1 unit per 10-15 g carbs) at meals; titrate to postprandial glucose. Typical total daily dose 0.5-1 U/kg/d split between basal and prandial coverage in T1DM (1) · Schizophrenia: 1 mg PO daily × 4 days, then 2 mg daily × 3 days, then 4 mg daily. MDD adjunct: 0.5-1 mg daily, increase to 2 mg max. AD agitation: 0.5 mg daily, titrate to 2-3 mg daily. (1) · ~10 units SC at the same time daily, or 0.1-0.2 units/kg/d; titrate by fasting glucose (1)

0.25 mg, 0.5 mg, 1 mg, 2 mg, 3 mg, 4 mg tablets (1) · 100 U/mL (FlexTouch pen) and 200 U/mL (FlexTouch pen, higher-dose convenience) (1) · 100 U/mL (Humalog, Admelog, Lyumjev) vials, pens, cartridges; 200 U/mL Humalog KwikPen (1) · 100 U/mL (NovoLog, Fiasp) vials, pens, cartridges (1) · 75 mg, 150 mg tablets (1) · Capsules 10, 25, 50, 75 mg; oral solution 10 mg/5 mL (1) · Tablets 25, 50, 100 mg (1)

100-200 mg/day depending on indication (1) · 150 mg/d (1) · 150 mg/day; therapeutic plasma-level monitoring recommended (target 50-150 ng/mL window) (1) · 4 mg/d (schizophrenia); 3 mg/d (AD agitation); 3 mg/d (MDD adjunct) (1) · Titrated to glucose; no fixed ceiling (1) · Titrated to glucose; no fixed maximum (2)

insulin pumps (2) · IV (1) · IV (continuous infusion for DKA) (1) · Oral (4) · Subcutaneous (2) · Subcutaneous (never IV; not for use in insulin pumps) (1)

BP effect within hours; full effect over 1-2 weeks (1) · Pain and migraine prophylaxis effect 1-4 weeks; antidepressant effect 4-6 weeks (1) · SC: 5-15 minutes (Fiasp 2.5 minutes earlier on average) (1) · SC: 5-15 minutes; ultra-rapid Lyumjev faster (1) · Weeks for psychosis/depression; AD agitation benefit emerges over weeks (1) · ~1 hour (1) · ~30-60 min (1)

24 hours (HS dosing) (1) · 24 hours (once-daily dosing supported by long elimination) (1) · 3-5 hours (2) · >42 hours per dose (effectively flat once at steady state) (1) · Daily dosing (1) · ~9 hours (1)

18-44 hours'"`UNIQ--ref-00000020-QINU`"' (1) · 6-9 hours (substantially longer in renal impairment due to renal elimination)'"`UNIQ--ref-00000020-QINU`"' (1) · ~1 hour SC'"`UNIQ--ref-00000589-QINU`"' (1) · ~25 hours apparent (functional duration well over 42 hours from multi-hexamer depot)'"`UNIQ--ref-0000135A-QINU`"' (1) · ~7.1 hours (1) · ~80 minutes SC'"`UNIQ--ref-000005F2-QINU`"' (1) · ~91 hours (1)

None · 100% (IV) · ~100% from subcutaneous depot · ~80% (oral)'"`UNIQ--ref-00000027-QINU`"' · 70–90% (oral) · ~100% (oral)'"`UNIQ--ref-0000001C-QINU`"' · ~50% (oral)'"`UNIQ--ref-00000021-QINU`"' · ~95% · '''Saturable''' via the LAT-1 amino-acid transporter, producing nonlinear pharmacokinetics: ~60% at 300 mg single dose, falling to ~35% at 1200 mg single dose'"`UNIQ--ref-0000002A-QINU`"' · 10-20% (oral; reduced by food, calcium, antacids, PPIs, tea/coffee; enhanced by ascorbate) · 100% (IV); essentially complete (oral) · 100% (IV); rapidly neutralized by gastric acid (oral) · 16-21% capsule, 25% suspension (oral; iron and antacids reduce absorption substantially)'"`UNIQ--ref-000009E5-QINU`"' · 25 mg: ~29%; 50 mg: ~35%; food reduces absorption'"`UNIQ--ref-00000C4F-QINU`"' · 30-40% (oral; increases with repeated dosing as gastric pH rises)'"`UNIQ--ref-000000DF-QINU`"' · 40-45% (oral; not significantly affected by food)'"`UNIQ--ref-0000025C-QINU`"' · 40-80% (oral); reduced by food, calcium, iron, PPIs, fiber; take fasting with water'"`UNIQ--ref-00000037-QINU`"' · 42-58% (oral; dose-dependent)'"`UNIQ--ref-00000AEF-QINU`"' · 50-60% (oral; decreased with food, but food given anyway for GI tolerance)'"`UNIQ--ref-00000019-QINU`"' · 60-70% PO at low doses; saturable at high doses (parenteral routes preferred above 15-25 mg/week)'"`UNIQ--ref-000007C9-QINU`"'

Other values:

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'''Documented fetal growth restriction with chronic exposure'''; avoid in pregnancy if alternative β-blockers are appropriate. The β-blocker most consistently associated with intrauterine growth concerns'"`UNIQ--ref-00000022-QINU`"' (1) · Insulin is the preferred glucose-lowering therapy in pregnancy; aspart is widely used.<sup class="pcp-cn" title="This claim needs a citation.">&#91;[[Pharmacopedia:Citation needed|citation&nbsp;needed]]&#93;</sup> (1) · Insulin is the preferred glucose-lowering therapy in pregnancy; degludec has reassuring observational data.<sup class="pcp-cn" title="This claim needs a citation.">&#91;[[Pharmacopedia:Citation needed|citation&nbsp;needed]]&#93;</sup> (1) · Insulin is the preferred glucose-lowering therapy in pregnancy; lispro is widely used.<sup class="pcp-cn" title="This claim needs a citation.">&#91;[[Pharmacopedia:Citation needed|citation&nbsp;needed]]&#93;</sup> (1) · Limited data; National Pregnancy Registry available (1) · Limited data; pregnancy exposure registry available (1) · TCA class signal; limited human data specific to nortriptyline.<sup class="pcp-cn" title="This claim needs a citation.">&#91;[[Pharmacopedia:Citation needed|citation&nbsp;needed]]&#93;</sup> (1)

Rx (1) · Rx, Schedule IV (US) (1) · [[USLegal:Prescription only|Rx-only]] in US (3) · [[USLegal:Prescription only|Rx-only]] in US (some OTC formulations exist) (1) · [[USLegal:Prescription only|Rx-only]] in US. Carries the antidepressant '''Boxed Warning''' for suicidality in children, adolescents, and young adults'"`UNIQ--ref-00000022-QINU`"' (1)