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Medicines > fda max

: 100 mg/d

or 20 mg/d

or 400 mg/d

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None (2) · Bisoprolol (1) · Flecainide (1) · Flibanserin (1) · Losartan (1) · Metoprolol (1) · Moxifloxacin (1) · Sitagliptin (1) · Terazosin (1) · Vardenafil (1)

Addyi (1) · Avelox (oral/IV brand discontinued US); Vigamox, Moxeza (ophthalmic) (1) · Belsomra (1) · Cozaar (1) · Hytrin (US brand discontinued); mostly generic (1) · Januvia; with metformin Janumet/Janumet XR (1) · Levitra, Staxyn (1) · Lopressor (tartrate), Toprol XL (succinate) (1) · Tambocor (US brand discontinued) (1) · Trintellix (US), Brintellix (formerly) (1) · Zebeta (1)

None (1) · 5-HT1A agonist, 5-HT2A antagonist, with weaker activity at D4 and other receptors. Net effect involves enhanced prefrontal dopaminergic/noradrenergic tone with decreased serotonergic inhibition of sexual desire. (1) · Cardioselective β1-adrenergic antagonist. Selectivity is dose-dependent and partially lost at higher doses. (1) · Competitive antagonist at OX1R and OX2R. First-in-class DORA. Receptor dissociation slower than lemborexant or daridorexant. (1) · Highly β1-selective adrenergic antagonist. Greater selectivity than metoprolol or atenolol. (1) · Selective inhibitor of PDE5. Slightly higher PDE5/PDE6 selectivity vs sildenafil (less visual side effect) but more PDE1 cross-activity (occasional QT effects at high doses). (1) · '"`UNIQ--vote-000000B6-QINU`"' Active metabolite EXP3174 is ~10-40-fold more potent than the parent and accounts for most of the antihypertensive effect; CYP2C9 polymorphism affects conversion'"`UNIQ--ref-000000B7-QINU`"'. (1) · '"`UNIQ--vote-00000762-QINU`"' Largely renally cleared, hence the eGFR-tiered dosing. Rare but well-documented signals: acute pancreatitis (uncertain causal contribution), severe joint pain, and bullous pemphigoid (class effect, especially in older Asian patients)'"`UNIQ--ref-00000763-QINU`"'. (1) · '"`UNIQ--vote-00000D7A-QINU`"' Substantial QT-interval prolongation — the most QT-prolonging fluoroquinolone — limits use in patients on other QT-prolonging agents or with electrolyte abnormalities'"`UNIQ--ref-00000D7B-QINU`"'. (1) · '"`UNIQ--vote-0000111B-QINU`"' Intraoperative floppy iris syndrome is a recognized class effect. Recently emerging evidence (observational) suggests possible Parkinson's disease risk reduction via PGK1 binding — investigational and not a clinical indication'"`UNIQ--ref-0000111C-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)

1 mg PO at bedtime to limit first-dose syncope; titrate weekly to 5-10 mg (1) · 10 mg PO 30 min before bedtime (with ≥7 hours of sleep planned) (1) · 10 mg PO once daily; may increase to 20 mg as tolerated, or decrease to 5 mg if needed (1) · 10 mg ~1 h before sexual activity (1) · 100 mg at bedtime daily (1) · 100 mg PO once daily (50 mg if CrCl 30-44; 25 mg if <30 or dialysis) (1) · 2.5–5 mg daily (HTN); 1.25 mg daily (HFrEF, slow titration) (1) · 25–50 mg BID (tartrate); 25–100 mg daily (succinate); 12.5 mg daily in HFrEF (1) · 400 mg PO/IV once daily (1) · 50 mg PO BID; titrate to 100-200 mg BID; pill-in-pocket 200-300 mg PO single dose for AF conversion (1) · 50 mg PO daily (25 mg in volume depletion or hepatic impairment) (1)

1, 2, 5, 10 mg capsules and tablets (1) · 100 mg tabs (1) · 2.5, 5, 10, 20 mg tabs (Levitra); 10 mg ODT (Staxyn) (1) · 25 mg, 50 mg, 100 mg tablets (1) · 25, 50, 100 mg tablets; combination tablets with metformin (1) · 400 mg tablets; 400 mg/250 mL IV; 0.5% ophthalmic solution (1) · 5 mg, 10 mg, 15 mg, 20 mg tablets (1) · 5 mg, 10 mg, 20 mg tablets (1) · 5, 10 mg tabs (1) · 50, 100, 150 mg tablets (1) · Tartrate: 25, 50, 100 mg tabs; 1 mg/mL IV. Succinate ER: 25, 50, 100, 200 mg. (1)

IV (2) · Oral (11) · topical ophthalmic (1)

1–2 h (1) · 1–2 h (PO); immediate (IV) (1) · AF conversion within hours of single PO dose (1) · BP and symptomatic LUTS improvement within 1-2 weeks (1) · BP effect 1-2 weeks; antihypertensive peak 3-6 weeks (1) · Effects accumulate over weeks; assess at 8 weeks (1) · Hours (1) · Postprandial glucose effect within days; HbA1c by 12 weeks (1) · Typical antidepressant 4-6 week onset (1) · ~30 min (2)

12 hours (1) · 24 h (1) · 24 hours (4) · 4–5 h (1) · 6–12 h (tartrate); 24 h (succinate) (1) · Continuous daily dosing (1) · Daily dosing (1) · ~7-8 hours (1)

2 hours (parent); 6-9 hours for active carboxylic acid metabolite EXP3174'"`UNIQ--ref-000000BC-QINU`"' (1) · 3–7 h (1) · 4–5 h (1) · 9–12 h (1) · ~11 h (1) · ~12 hours (1) · ~12 hours'"`UNIQ--ref-00000D82-QINU`"' (1) · ~12 hours'"`UNIQ--ref-0000111F-QINU`"' (1) · ~12.4 hours'"`UNIQ--ref-00000765-QINU`"' (1) · ~14 hours (adults); longer in elderly and renal impairment'"`UNIQ--ref-0000113F-QINU`"' (1) · ~66 hours (1)

>90% (oral; not significantly affected by food)'"`UNIQ--ref-00001120-QINU`"' (1) · ~15% (extensive hepatic first-pass) (1) · ~33% (1) · ~33% (extensive first-pass via CYP2C9 and CYP3A4)'"`UNIQ--ref-000000BD-QINU`"' (1) · ~50% (1) · ~75% (1) · ~82% (1) · ~87% (oral)'"`UNIQ--ref-00000766-QINU`"' (1) · ~90% (low first-pass) (1) · ~90% (oral)'"`UNIQ--ref-00001140-QINU`"' (1) · ~90% (oral; not affected by food but reduced by divalent cations)'"`UNIQ--ref-00000D83-QINU`"' (1)

'''Avoid in pregnancy where alternatives exist''' (animal cartilage toxicity).[[[Pharmacopedia:Citation needed|citation needed]]] (1) · '''Contraindicated in pregnancy''' (all trimesters); fetal renal injury, oligohydramnios, hypocalvaria, hypotension. Stop on detection'"`UNIQ--ref-000000BE-QINU`"' (1) · Category B (1) · Category C (2) · Limited data.[[[Pharmacopedia:Citation needed|citation needed]]] (1) · Limited data; avoid (1) · Limited data; switch to insulin where feasible.[[[Pharmacopedia:Citation needed|citation needed]]] (1) · Limited data; weigh benefits/risks (1) · Not indicated; pregnancy effects unknown (1) · Use in fetal SVT (transplacental antiarrhythmic therapy) is established; otherwise weigh against alternatives.[[[Pharmacopedia:Citation needed|citation needed]]] (1)

Rx (1) · Rx, Schedule IV (US) (1) · Rx-only in US (3) · Rx-only in US (REMS program) (1) · [[USLegal:Prescription only|Rx-only]] in US (3) · [[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 the same fluoroquinolone-class '''Boxed Warnings''' as ciprofloxacin/levofloxacin'"`UNIQ--ref-00000D84-QINU`"' (1)