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Medicines > fda max

: 40 mg/d

or 40 mg/d typical; up to 240 mg/d for Zollinger-Ellison

or 400 mg/d

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None (1) · Enalapril (and enalaprilat IV) (1) · Esomeprazole (1) · Flecainide (1) · Fluoxetine (1) · Metoclopramide (1) · Metoprolol (1) · Moxifloxacin (1) · Nebivolol (1) · Olmesartan (medoxomil) (1) · Pantoprazole (1) · Prazosin (1)

Avelox (oral/IV brand discontinued US); Vigamox, Moxeza (ophthalmic) (1) · Benicar (1) · Bystolic (1) · Lopressor (tartrate), Toprol XL (succinate) (1) · Minipress (1) · Nexium, Nexium 24HR (OTC) (1) · Protonix (1) · Prozac (1) · Reglan, Gimoti (intranasal), Metozolv ODT (1) · Tambocor (US brand discontinued) (1) · Vasotec, Vasotec IV, Epaned (1) · Viibryd (1)

None (4) · Cardioselective β1-adrenergic antagonist. Selectivity is dose-dependent and partially lost at higher doses. (1) · Selective alpha-1 adrenergic receptor antagonist. Lowers peripheral vascular resistance via vasodilation; in the CNS, blunts noradrenergic hyperarousal thought to drive trauma-related nightmares. (1) · The d-enantiomer is a highly β1-selective antagonist; the l-enantiomer triggers endothelial nitric-oxide–mediated vasodilation. Unique among beta blockers for this NO mechanism. (1) · TrkB/BDNF'"`UNIQ--ref-00000040-QINU`"' '"`UNIQ--vote-00000041-QINU`"' (1) · '"`UNIQ--vote-00000117-QINU`"' Compared with omeprazole, pantoprazole has a more linear pharmacokinetic profile and is metabolized predominantly via CYP2C19 with CYP3A4 contribution; less CYP2C19-driven drug interaction with clopidogrel than omeprazole'"`UNIQ--ref-00000118-QINU`"'. (1) · '"`UNIQ--vote-000008E1-QINU`"' Like omeprazole, it is an acid-activated prodrug that covalently and irreversibly binds the H+/K+ ATPase. CYP2C19 PGx remains clinically relevant for both'"`UNIQ--ref-000008E2-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-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 at bedtime (PTSD nightmares); 1 mg BID–TID (HTN) (1) · 10 mg (1) · 10 mg PO once daily × 7 days, then 20 mg × 7 days, then 40 mg as target dose (take with food) (1) · 10 mg PO/IV/IM QID, '''not to exceed 12 weeks''' (tardive dyskinesia risk); intranasal Gimoti 15 mg BID (1) · 20 mg PO once daily; titrate to 40 mg/d after 2 weeks if needed (1) · 20-40 mg PO once daily, 30-60 minutes before breakfast (1) · 25–50 mg BID (tartrate); 25–100 mg daily (succinate); 12.5 mg daily in HFrEF (1) · 40 mg PO or IV once daily (1) · 400 mg PO/IV once daily (1) · 5 mg daily (1) · 5-10 mg PO once daily (2.5 mg if on diuretic or in heart failure); titrate to 10-20 mg BID for HFrEF (1) · 50 mg PO BID; titrate to 100-200 mg BID; pill-in-pocket 200-300 mg PO single dose for AF conversion (1)

1, 2, 5 mg caps (1) · 10 mg, 20 mg, 40 mg caps (1) · 10 mg, 20 mg, 40 mg tablets (1) · 2.5, 5, 10, 20 mg tablets; 1 mg/mL oral solution (Epaned); 1.25 mg/mL IV (enalaprilat) (1) · 2.5, 5, 10, 20 mg tabs (1) · 20 mg, 40 mg delayed-release tablets; 40 mg IV vial; oral suspension 40 mg/packet (1) · 20, 40 mg delayed-release capsules; 2.5, 5, 10, 20, 40 mg oral suspension packets; 20, 40 mg IV (1) · 400 mg tablets; 400 mg/250 mL IV; 0.5% ophthalmic solution (1) · 5, 10 mg tablets; 5 mg/5 mL solution; 5 mg/mL IV; 15 mg/spray intranasal (1) · 5, 20, 40 mg tablets (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)

IM (1) · intranasal (1) · IV (6) · Oral (12) · topical ophthalmic (1)

None (1) · 1–2 h (1) · 1–2 h (PO); immediate (IV) (1) · 2-3 hours per dose; full acid suppression after 3-5 days (1) · 30–90 min (1) · 4-6 weeks for full antidepressant effect (claimed earlier onset for some patients due to 5HT1A partial agonism) (1) · Acid suppression within hours; full effect after 3-5 days of dosing (1) · AF conversion within hours of single PO dose (1) · BP effect 1 hour; max at 4-6 hours (1) · BP effect 1-2 weeks; max at 2-3 weeks (1) · Hours (1) · IV/IM 1-3 minutes; PO 30-60 minutes (1)

12 hours (1) · 12-24 hours (1) · 24 h (1) · 24 hours (2) · 24+ hours (irreversible enzyme binding) (1) · 24-72 hours per dose (irreversible enzyme binding) (1) · 4-6 hours (1) · 6–12 h (tartrate); 24 h (succinate) (1) · 6–8 h (1) · Daily dosing (1) · Very long (1)

1–4 days (7–15 days for norfluoxetine) (1) · 2–3 h (1) · 3–7 h (1) · 5-6 hours'"`UNIQ--ref-00000EF9-QINU`"' (1) · ~1 hour (plasma); pharmacodynamic effect persists 24+ hours'"`UNIQ--ref-0000011D-QINU`"' (1) · ~1.5 hours (plasma); pharmacodynamic effect 24+ hours via target turnover'"`UNIQ--ref-000008E8-QINU`"' (1) · ~10 h (CYP2D6 extensive metabolizers); up to 31 h (poor metabolizers) (1) · ~11 hours (enalaprilat, the active metabolite)'"`UNIQ--ref-00000B84-QINU`"' (1) · ~12 hours'"`UNIQ--ref-00000D82-QINU`"' (1) · ~13 hours'"`UNIQ--ref-0000056C-QINU`"' (1) · ~14 hours (adults); longer in elderly and renal impairment'"`UNIQ--ref-0000113F-QINU`"' (1) · ~25 hours (1)

70–90% (oral) (1) · ~12% (extensive metabolizers); ~96% (poor metabolizers) (1) · ~26% (oral; prodrug hydrolyzed by intestinal esterases to active olmesartan; not affected by food)'"`UNIQ--ref-0000056D-QINU`"' (1) · ~50% (1) · ~60% (1) · ~60% (oral; food does not affect absorption)'"`UNIQ--ref-00000B85-QINU`"' (1) · ~64-90% (oral; increases at higher doses and with multi-day dosing)'"`UNIQ--ref-000008E9-QINU`"' (1) · ~72% (with food); much lower fasting (~36%) (1) · ~77% (oral; not affected by food or antacids)'"`UNIQ--ref-0000011E-QINU`"' (1) · ~80% (oral; reduced by significant first-pass)'"`UNIQ--ref-00000EFA-QINU`"' (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-0000056E-QINU`"' (1) · '''Contraindicated in pregnancy''' (all trimesters); fetal renal injury, oligohydramnios, skull hypoplasia, hypotension. Stop on detection'"`UNIQ--ref-00000B86-QINU`"' (1) · Category C (3) · Category C'"`UNIQ--ref-00000045-QINU`"' (1) · Generally considered safe; widely used in obstetric reflux.[[[Pharmacopedia:Citation needed|citation needed]]] (1) · Limited data; weigh benefits/risks (1) · Use in fetal SVT (transplacental antiarrhythmic therapy) is established; otherwise weigh against alternatives.[[[Pharmacopedia:Citation needed|citation needed]]] (1) · Widely used for hyperemesis gravidarum; reassuring data.[[[Pharmacopedia:Citation needed|citation needed]]] (1) · Widely used in obstetric reflux; reassuring data.[[[Pharmacopedia:Citation needed|citation needed]]] (1)

OTC (20 mg, 14-day course) and [[USLegal:Prescription only|Rx-only]] (higher and longer durations) in US (1) · Rx (1) · Rx-only in US (3) · [[USLegal:Prescription only|Rx-only]] in US (4) · [[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 '''tardive dyskinesia''' (irreversible movement disorder), driving the 12-week chronic-use limit'"`UNIQ--ref-00000EFB-QINU`"' (1) · [[USLegal:Prescription only|Rx-only]] in US. Carries the same fluoroquinolone-class '''Boxed Warnings''' as ciprofloxacin/levofloxacin'"`UNIQ--ref-00000D84-QINU`"' (1)