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Medicines > duration : 12 hours or 6-8 hours or N/A

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classes:
[[:Category:Antibacterials|Antibacterial]] (3) · [[:Category:Beta-lactam_antibiotics|β-lactam antibiotic]] (2)
mechanism:
None (12) · '"`UNIQ--vote-00000017-QINU`"' Anticholinergic and sedating, with the standard first-generation antihistamine Beers-list concerns in elderly patients'"`UNIQ--ref-00000018-QINU`"'. (1) · '"`UNIQ--vote-000001F6-QINU`"' CYP3A4 (primary) and P-glycoprotein substrate; strong dual inhibitors or inducers materially shift exposure. Reversal: andexanet alfa for life-threatening bleeding; 4F-PCC commonly used off-label when andexanet unavailable'"`UNIQ--ref-000001F7-QINU`"'. (1) · '"`UNIQ--vote-00000B40-QINU`"' The TRANSFORM-HF trial (2023) found no all-cause mortality difference between torsemide and furosemide in heart failure, although torsemide remains pharmacologically preferred where furosemide oral absorption is unreliable'"`UNIQ--ref-00000B41-QINU`"'. (1) · '"`UNIQ--vote-0000113A-QINU`"' Concomitant β-blocker or CCB is required when used for AF to prevent 1:1 atrial flutter conduction (flecainide can slow atrial rate to a level where AV conduction allows dangerous ventricular rates). CYP2D6 substrate'"`UNIQ--ref-0000113B-QINU`"'. (1) · '"`UNIQ--vote-0000124C-QINU`"' The 400 mg/d dose for migraine prophylaxis is supported by randomized trials (Schoenen 1998) and remains a low-risk evidence-based supplement option. Characteristic bright-yellow urine fluorescence with high-dose oral supplementation. (1) · '"`UNIQ--vote-000013B1-QINU`"' Topical application minimizes systemic antihistaminic burden; the characteristic bitter taste with nasal use (drainage to oropharynx) is the main tolerability issue'"`UNIQ--ref-000013B2-QINU`"'. (1) · '"`UNIQ--vote-000014BC-QINU`"' Topical ophthalmic and otic formulations remain widely used in ENT and ophthalmology. Subject to all fluoroquinolone-class restrictions (tendinitis/rupture, peripheral neuropathy, QT prolongation)'"`UNIQ--ref-000014BD-QINU`"'. (1) · '"`UNIQ--vote-00001580-QINU`"' First FDA-approved treatment for PBA. The 10 mg quinidine daily dose is far below antiarrhythmic levels but sufficient to nearly fully inhibit CYP2D6, the basis of the combination's pharmacokinetic rationale'"`UNIQ--ref-00001581-QINU`"'. (1)
uses:
'"`UNIQ--vote-00000019-QINU`"', '"`UNIQ--vote-0000001A-QINU`"', '"`UNIQ--vote-0000001B-QINU`"', '"`UNIQ--vote-0000001C-QINU`"', '"`UNIQ--vote-0000001D-QINU`"' (1) · '"`UNIQ--vote-0000001D-QINU`"', '"`UNIQ--vote-0000001E-QINU`"', '"`UNIQ--vote-0000001F-QINU`"', '"`UNIQ--vote-00000020-QINU`"', '"`UNIQ--vote-00000021-QINU`"', '"`UNIQ--vote-00000022-QINU`"' (1) · '"`UNIQ--vote-000001F8-QINU`"', '"`UNIQ--vote-000001F9-QINU`"', '"`UNIQ--vote-000001FA-QINU`"' (1) · '"`UNIQ--vote-00000475-QINU`"', '"`UNIQ--vote-00000476-QINU`"', '"`UNIQ--vote-00000477-QINU`"', '"`UNIQ--vote-00000478-QINU`"', '"`UNIQ--vote-00000479-QINU`"', '"`UNIQ--vote-0000047A-QINU`"', '"`UNIQ--vote-0000047B-QINU`"', '"`UNIQ--vote-0000047C-QINU`"' (1) · '"`UNIQ--vote-000004ED-QINU`"', '"`UNIQ--vote-000004EE-QINU`"', '"`UNIQ--vote-000004EF-QINU`"', '"`UNIQ--vote-000004F0-QINU`"', '"`UNIQ--vote-000004F1-QINU`"' (1) · '"`UNIQ--vote-00000B42-QINU`"', '"`UNIQ--vote-00000B43-QINU`"', '"`UNIQ--vote-00000B44-QINU`"', '"`UNIQ--vote-00000B45-QINU`"' (1) · '"`UNIQ--vote-00000BA0-QINU`"', '"`UNIQ--vote-00000BA1-QINU`"', '"`UNIQ--vote-00000BA2-QINU`"' (1) · '"`UNIQ--vote-00000C8F-QINU`"', '"`UNIQ--vote-00000C90-QINU`"', '"`UNIQ--vote-00000C91-QINU`"' (1) · '"`UNIQ--vote-00000D38-QINU`"', '"`UNIQ--vote-00000D39-QINU`"', '"`UNIQ--vote-00000D3A-QINU`"', '"`UNIQ--vote-00000D3B-QINU`"', '"`UNIQ--vote-00000D3C-QINU`"', '"`UNIQ--vote-00000D3D-QINU`"' (1) · '"`UNIQ--vote-00000E71-QINU`"', '"`UNIQ--vote-00000E72-QINU`"', '"`UNIQ--vote-00000E73-QINU`"', '"`UNIQ--vote-00000E74-QINU`"', '"`UNIQ--vote-00000E75-QINU`"' (1) · '"`UNIQ--vote-00000E91-QINU`"', '"`UNIQ--vote-00000E92-QINU`"', '"`UNIQ--vote-00000E93-QINU`"' (1) · '"`UNIQ--vote-00000FB3-QINU`"', '''adjunctive only''' (does not treat the underlying infection) (1) · '"`UNIQ--vote-0000113C-QINU`"', '"`UNIQ--vote-0000113D-QINU`"', '"`UNIQ--vote-0000113E-QINU`"' (1) · '"`UNIQ--vote-000011BA-QINU`"', '"`UNIQ--vote-000011BB-QINU`"', '"`UNIQ--vote-000011BC-QINU`"', '"`UNIQ--vote-000011BD-QINU`"' (1) · '"`UNIQ--vote-0000124D-QINU`"', '"`UNIQ--vote-0000124E-QINU`"', '"`UNIQ--vote-0000124F-QINU`"' (1) · '"`UNIQ--vote-000013B3-QINU`"', '"`UNIQ--vote-000013B4-QINU`"', '"`UNIQ--vote-000013B5-QINU`"' (1) · '"`UNIQ--vote-000013CF-QINU`"', '"`UNIQ--vote-000013D0-QINU`"' (1) · '"`UNIQ--vote-0000143C-QINU`"', '"`UNIQ--vote-0000143D-QINU`"', '"`UNIQ--vote-0000143E-QINU`"', '"`UNIQ--vote-0000143F-QINU`"', '"`UNIQ--vote-00001440-QINU`"', '"`UNIQ--vote-00001441-QINU`"' (1) · '"`UNIQ--vote-000014BE-QINU`"', '"`UNIQ--vote-000014BF-QINU`"', '"`UNIQ--vote-000014C0-QINU`"', '"`UNIQ--vote-000014C1-QINU`"', '"`UNIQ--vote-000014C2-QINU`"' (1) · '"`UNIQ--vote-00001582-QINU`"' (1)
starting dose:
1 capsule (20/10 mg dextromethorphan/quinidine) PO once daily × 7 days, then 1 capsule BID (1) · 10-20 mg PO/IV once daily; titrate by clinical response. 1:1 IV to PO conversion (unlike furosemide's 1:2) (1) · 100 mg PO BID; rickettsial 200 mg/d; doxy-PEP 200 mg within 72 hours after condomless sex (1) · 100-200 mg PO TID after meals × no more than 2 days when used with concurrent antibiotic (1) · 2 g PO BID with meals (4 g/d total) (1) · 250-500 mg PO every 6-8 hours (1) · 250-500 mg PO QID; 7.5-12.5 mg/kg IV q6h; topical and ophthalmic per formulation (1) · 50 mg PO BID; titrate to 100-200 mg BID; pill-in-pocket 200-300 mg PO single dose for AF conversion (1) · 500 mg PO every 6 hours, or 250 mg every 6 hours for mild infections (1) · ACS/PCI: 180 mg PO loading dose, then 90 mg PO BID for 12 months; long-term post-MI: 60 mg BID (1) · Allergy: 4 mg PO TID. Serotonin syndrome: 12 mg loading dose PO or by nasogastric tube, then 2 mg every 2 hours until clinical improvement. Appetite stimulation: 2-4 mg PO TID-QID (1) · Anxiety: 0.5-1 mg PO BID-TID. Insomnia: 1-2 mg PO at bedtime. Status epilepticus: 4 mg IV (adult), repeat after 5-10 minutes if needed. Acute agitation: 1-2 mg IM (1) · Intranasal 0.1% or 0.15%: 1-2 sprays/nostril BID; ophthalmic 0.05%: 1 drop in each eye BID (1) · Migraine prophylaxis: 400 mg PO daily; deficiency replacement 5-30 mg/d (1) · NVAF: 5 mg PO BID (2.5 mg BID if 2 of 3: age ≥80, weight ≤60 kg, serum creatinine ≥1.5 mg/dL); acute VTE: 10 mg BID for 7 days, then 5 mg BID (1) · Oral 200-400 mg BID; ophthalmic 1-2 drops in affected eye(s) q2-4h initially, then taper; otic 5-10 drops in affected ear BID (1) · Oral 300-450 mg PO QID; IV 600-900 mg q8h; topical 1% solution/gel BID; vaginal 100 mg ovule × 3 days or 2% cream × 7 days (1) · Topical: 0.5-5% cream/solution to lesions BID × 2-4 weeks; systemic IV: regimen-specific in cancer chemotherapy (1) · Topical: pea-sized amount to dry face at bedtime, building from 2-3×/week to nightly as tolerated; oral APL: 45 mg/m²/d in divided doses (1) · Treatment: 75 mg PO BID × 5 days (adult); pediatric weight-based; prophylaxis: 75 mg PO once daily × 7-10 days (1)
duration: (Click arrow to add another value)
halflife:
12-15 hours (intermediate); '''no active metabolites''' (key clinical feature)'"`UNIQ--ref-00000023-QINU`"' (1) · 16-22 hours'"`UNIQ--ref-0000047D-QINU`"' (1) · 3-4 hours (similar between PO and IV due to high oral bioavailability)'"`UNIQ--ref-00000B46-QINU`"' (1) · 8-16 hours'"`UNIQ--ref-0000001E-QINU`"' (1) · Dextromethorphan substantially prolonged by quinidine's CYP2D6 inhibition (typical extensive metabolizers see ~10× higher AUC); quinidine ~6-8 hours'"`UNIQ--ref-00001583-QINU`"' (1) · ~0.5-2 hours (oral)'"`UNIQ--ref-00000BA3-QINU`"' (1) · ~1 hour'"`UNIQ--ref-000004F2-QINU`"' (1) · ~1-2 hours plasma (riboflavin itself); FAD/FMN tissue cofactors are continuous (1) · ~1.5-2 hours'"`UNIQ--ref-00000D3E-QINU`"' (1) · ~10-20 minutes systemically (rapid hepatic and erythrocyte dihydropyrimidine dehydrogenase clearance)'"`UNIQ--ref-000011BE-QINU`"' (1) · ~12 hours'"`UNIQ--ref-000001FB-QINU`"' (1) · ~14 hours (adults); longer in elderly and renal impairment'"`UNIQ--ref-0000113F-QINU`"' (1) · ~2.5-3 hours'"`UNIQ--ref-00001442-QINU`"' (1) · ~22 hours; longer 54 hours (desmethylazelastine, active metabolite)'"`UNIQ--ref-000013B6-QINU`"' (1) · ~30-60 minutes'"`UNIQ--ref-00000E76-QINU`"' (1) · ~6-10 hours (oseltamivir carboxylate, the active metabolite)'"`UNIQ--ref-00000E94-QINU`"' (1) · ~7 hours (parent); ~9 hours (active AR-C124910XX metabolite, accounts for ~30-40% of activity)'"`UNIQ--ref-00000C92-QINU`"' (1) · ~7-10 hours (variable; longer in renal impairment)'"`UNIQ--ref-00000FB4-QINU`"' (1) · ~89 hours (EPA, the active metabolite)'"`UNIQ--ref-000013D1-QINU`"' (1) · ~9 hours'"`UNIQ--ref-000014C3-QINU`"' (1)
bioavailability:
90% (oral; food delays but does not reduce absorption)'"`UNIQ--ref-000004F3-QINU`"' (1) · High (oral)'"`UNIQ--ref-00000FB5-QINU`"' (1) · Increased substantially via CYP2D6 inhibition'"`UNIQ--ref-00001584-QINU`"' (1) · Intranasal ~40% systemic; ophthalmic minimal'"`UNIQ--ref-000013B7-QINU`"' (1) · Substantially improved with high-fat meal; take with food'"`UNIQ--ref-000013D2-QINU`"' (1) · Topical: minimal systemic absorption (oral systemic 5-FU not used due to poor and variable absorption)'"`UNIQ--ref-000011BF-QINU`"' (1) · Topical: minimal systemic absorption with normal skin; oral: variable, induced metabolism with repeated dosing'"`UNIQ--ref-00000BA4-QINU`"' (1) · ~30-65% (oral; acid-labile, hence enteric-coated formulations; food affects absorption variably)'"`UNIQ--ref-00000D3F-QINU`"' (1) · ~36% (oral)'"`UNIQ--ref-00000C93-QINU`"' (1) · ~50% (oral; not significantly affected by food)'"`UNIQ--ref-000001FC-QINU`"' (1) · ~50-60% (oral; food enhances) (1) · ~60% (oral; phenoxymethyl modification makes it acid-stable, unlike penicillin G which is destroyed by gastric acid)'"`UNIQ--ref-00000E77-QINU`"' (1) · ~75% (oral, as the active carboxylate after hepatic esterase activation)'"`UNIQ--ref-00000E95-QINU`"' (1) · ~80% (oral; predictable absorption — a substantive practical advantage over furosemide whose oral absorption is 10-100% variable)'"`UNIQ--ref-00000B47-QINU`"' (1) · ~90% (oral)'"`UNIQ--ref-00000024-QINU`"' (1) · ~90% (oral)'"`UNIQ--ref-00001140-QINU`"' (1) · ~90% (oral)'"`UNIQ--ref-00001443-QINU`"' (1) · ~95% (oral)'"`UNIQ--ref-0000001F-QINU`"' (1) · ~95% (oral)'"`UNIQ--ref-000014C4-QINU`"' (1) · ~95% (oral; reduced by dairy, antacids, iron via divalent-cation chelation, though less than for tetracycline itself)'"`UNIQ--ref-0000047E-QINU`"' (1)
pregnancy:
None (3) · '''Avoid in pregnancy where alternatives exist''' (animal cartilage toxicity; class-wide concern).<sup class="pcp-cn" title="This claim needs a citation.">&#91;[[Pharmacopedia:Citation needed|citation&nbsp;needed]]&#93;</sup> (1) · Avoid where possible; class concerns as for other loop diuretics.<sup class="pcp-cn" title="This claim needs a citation.">&#91;[[Pharmacopedia:Citation needed|citation&nbsp;needed]]&#93;</sup> (1) · Generally considered safe.<sup class="pcp-cn" title="This claim needs a citation.">&#91;[[Pharmacopedia:Citation needed|citation&nbsp;needed]]&#93;</sup> (1) · Generally considered safe; commonly used in pregnancy.<sup class="pcp-cn" title="This claim needs a citation.">&#91;[[Pharmacopedia:Citation needed|citation&nbsp;needed]]&#93;</sup> (1) · Generally considered safe; widely used.<sup class="pcp-cn" title="This claim needs a citation.">&#91;[[Pharmacopedia:Citation needed|citation&nbsp;needed]]&#93;</sup> (2) · Generally used when influenza treatment is indicated; pregnancy is a recognized risk factor for severe influenza.<sup class="pcp-cn" title="This claim needs a citation.">&#91;[[Pharmacopedia:Citation needed|citation&nbsp;needed]]&#93;</sup> (1) · Limited data.<sup class="pcp-cn" title="This claim needs a citation.">&#91;[[Pharmacopedia:Citation needed|citation&nbsp;needed]]&#93;</sup> (1) · Limited data; not first-line in pregnancy.<sup class="pcp-cn" title="This claim needs a citation.">&#91;[[Pharmacopedia:Citation needed|citation&nbsp;needed]]&#93;</sup> (1) · Limited data; quinidine has been used in pregnancy as antiarrhythmic.<sup class="pcp-cn" title="This claim needs a citation.">&#91;[[Pharmacopedia:Citation needed|citation&nbsp;needed]]&#93;</sup> (1) · Limited data; second-line to intranasal corticosteroids or PO loratadine/cetirizine.<sup class="pcp-cn" title="This claim needs a citation.">&#91;[[Pharmacopedia:Citation needed|citation&nbsp;needed]]&#93;</sup> (1) · Limited data; weigh against alternatives.<sup class="pcp-cn" title="This claim needs a citation.">&#91;[[Pharmacopedia:Citation needed|citation&nbsp;needed]]&#93;</sup> (1) · Limited human data; older agent with substantial use experience.<sup class="pcp-cn" title="This claim needs a citation.">&#91;[[Pharmacopedia:Citation needed|citation&nbsp;needed]]&#93;</sup> (1) · Safe at replacement and supplement doses.<sup class="pcp-cn" title="This claim needs a citation.">&#91;[[Pharmacopedia:Citation needed|citation&nbsp;needed]]&#93;</sup> (1) · Some signal for cleft lip/palate with first-trimester exposure (debated); neonatal sedation and withdrawal with third-trimester exposure.<sup class="pcp-cn" title="This claim needs a citation.">&#91;[[Pharmacopedia:Citation needed|citation&nbsp;needed]]&#93;</sup> (1) · Topical: avoid; systemic: contraindicated in pregnancy.<sup class="pcp-cn" title="This claim needs a citation.">&#91;[[Pharmacopedia:Citation needed|citation&nbsp;needed]]&#93;</sup> (1) · Use in fetal SVT (transplacental antiarrhythmic therapy) is established; otherwise weigh against alternatives.<sup class="pcp-cn" title="This claim needs a citation.">&#91;[[Pharmacopedia:Citation needed|citation&nbsp;needed]]&#93;</sup> (1)
legal:
OTC (Astepro 0.15%) and [[USLegal:Prescription only|Rx-only]] (other intranasal, ophthalmic, Dymista) in US (1) · OTC (lower doses) and [[USLegal:Prescription only|Rx-only]] (higher doses) in US (1) · OTC (ophthalmic ointment) and [[USLegal:Prescription only|Rx-only]] (other forms) in US (1) · OTC in US (1) · [[USLegal:Prescription only|Rx-only]] in US (10) · [[USLegal:Prescription only|Rx-only]] in US. '''Contraindicated in structural heart disease''' — CAST trial (1989) showed increased mortality from class IC agents in patients with prior MI; modern use is limited to structurally normal hearts'"`UNIQ--ref-00001141-QINU`"' (1) · [[USLegal:Prescription only|Rx-only]] in US. Carries a '''Boxed Warning''' for bleeding risk and against aspirin maintenance doses above 100 mg/d (reduces ticagrelor efficacy, per PLATO subgroup analysis)'"`UNIQ--ref-00000C94-QINU`"' (1) · [[USLegal:Prescription only|Rx-only]] in US. Carries a '''Boxed Warning''' for Clostridioides difficile colitis (one of the most C. difficile-inducing antibiotic classes)'"`UNIQ--ref-00001444-QINU`"' (1) · [[USLegal:Prescription only|Rx-only]] in US. Carries the same fluoroquinolone-class '''Boxed Warnings''' as ciprofloxacin/levofloxacin'"`UNIQ--ref-000014C5-QINU`"' (1) · [[USLegal:Prescription only|Rx-only]] in US. Caution with QT-prolonging medicines (quinidine itself is class IA antiarrhythmic, and the dose here, though sub-antiarrhythmic, still contributes to QT)'"`UNIQ--ref-00001585-QINU`"' (1) · [[USLegal:Schedule IV|Schedule IV controlled substance]] in US. Carries the benzodiazepine class '''Boxed Warning''' for risk of fatal respiratory depression, coma, and death when combined with opioids'"`UNIQ--ref-00000025-QINU`"' (1)

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