Drilldown: Medicines

Insulin degludec (1) · Insulin glargine (1) · Levothyroxine (1) · Phencyclidine (1) · Thyroid (desiccated) (1)

Armour Thyroid, NP Thyroid, Nature-Throid, WP Thyroid (1) · Lantus, Basaglar, Semglee, Toujeo (U-300) (1) · Sernyl (human, withdrawn 1965); Sernylan (veterinary, withdrawn 1978) (1) · Synthroid, Levoxyl, Tirosint, Unithroid, Euthyrox (1) · Tresiba (1)

[[:Category:Anesthetics|Anesthetic (historical)]] (1) · [[:Category:Arylcyclohexylamines|Arylcyclohexylamine]] (1) · [[:Category:Basal_insulins|Basal insulin]] (2) · [[:Category:Dissociatives|Dissociative]] (1) · [[:Category:Hormone_replacement|Hormone replacement]] (2) · [[:Category:Insulins|Insulin]] (2) · [[:Category:Long-acting_insulins|Long-acting insulin analog]] (1) · [[:Category:NMDA_receptor_antagonists|NMDA receptor antagonist]] (1) · [[:Category:Sigma-1_receptor_agonists|Sigma-1 receptor agonist]] (1) · [[:Category:Thyroid_hormones|Thyroid hormone]] (2) · [[:Category:Ultra-long-acting_insulins|Ultra-long-acting insulin analog]] (1)

None (1) · Synthetic T4 (thyroxine); peripherally deiodinated to T3 (triiodothyronine), the active hormone. '"`UNIQ--vote-00000031-QINU`"' Narrow therapeutic index; brand-to-generic switches can shift TSH and require re-titration'"`UNIQ--ref-00000032-QINU`"'. (1) · '"`UNIQ--vote-00000016-QINU`"' Brand-to-brand and lot-to-lot variability in T3:T4 ratio is greater than with synthetic levothyroxine, which is why endocrine guidelines prefer the synthetic'"`UNIQ--ref-00000017-QINU`"'. (1) · '"`UNIQ--vote-00000237-QINU`"' Binds the same insulin receptor as endogenous insulin with comparable mitogenic-to-metabolic ratio; provides basal hepatic glucose suppression and peripheral glucose uptake without prandial peaks'"`UNIQ--ref-00000238-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)

'"`UNIQ--vote-00000018-QINU`"', '"`UNIQ--vote-00000019-QINU`"' (1) · '"`UNIQ--vote-00000033-QINU`"', '"`UNIQ--vote-00000034-QINU`"', '"`UNIQ--vote-00000035-QINU`"' (1) · '"`UNIQ--vote-00000063-QINU`"', '"`UNIQ--vote-00000064-QINU`"' (1) · '"`UNIQ--vote-00000239-QINU`"', '"`UNIQ--vote-0000023A-QINU`"' (1) · '"`UNIQ--vote-00001358-QINU`"', '"`UNIQ--vote-00001359-QINU`"' (1)

1.6 mcg/kg/d in young healthy adults; 25-50 mcg/d in elderly or cardiac disease, titrated by TSH at 6-8 weeks (1) · 30 mg PO daily (1/2 grain); titrate by TSH at 6-8 weeks; 60 mg desiccated thyroid is approximately equivalent to 88-100 mcg levothyroxine (1) · No current medical indication. Historical anesthetic dose 0.25 mg/kg IV (Sernyl). (1) · ~10 units SC at the same time daily, or 0.1-0.2 units/kg/d; titrate by fasting glucose (2)

100 U/mL (FlexTouch pen) and 200 U/mL (FlexTouch pen, higher-dose convenience) (1) · 100 U/mL (Lantus, Basaglar, Semglee) vials and pens; 300 U/mL (Toujeo) pens (1) · 15, 30, 60, 90, 120, 180, 240, 300 mg tablets (1/4 to 5 grains; 1 grain = 60 mg) (1) · 25, 50, 75, 88, 100, 112, 125, 137, 150, 175, 200, 300 mcg tablets; oral capsule and IV/IM also available (1) · Historical: Sernyl 25 mg tablets, 10 mg/mL injection (human); Sernylan 100 mg/mL injection (veterinary). Illicit: white crystalline powder, oily liquid, "dipped" cigarettes ("wet"), tablets. (1)

None · Indication-specific · 40 mg/d · 10 mg/d · 20 mg/d · 80 mg/d · 10 mg/d (adults) · 100 mg/d · 4 g/d · 400 mg/d · 40 mg/d typical; up to 240 mg/d for Zollinger-Ellison · 5 mg/d · 50 mg/d · 600 mg/d · No fixed ceiling; titrate to clinical effect and tolerability with CDC opioid prescribing guidance constraints on morphine-milligram-equivalent (MME) totals · No fixed maximum; titrated to TSH target · TID per eye · Titrated to glucose; no fixed ceiling · Titrated to glucose; no fixed maximum · '''20 mg/day in adults >60 years''' per FDA's 2011-2012 QT-prolongation warning; 40 mg/day in adults ≤60

Other values:

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IM (1) · insufflated (1) · IV (2) · Oral (3) · smoked (1) · Subcutaneous (never IV; not for use in insulin pumps) (2)

1-2 hours (1) · Smoked 2-5 min; insufflated 5-15 min; oral 30-60 min; IV / IM ~5-15 min (1) · TSH normalization 4-8 weeks (1) · TSH normalization 4-8 weeks; symptomatic improvement weeks to months (1) · ~1 hour (1)

4-8 hours typical; longer at high doses; residual cognitive and perceptual effects up to 48 hours (1) · >42 hours per dose (effectively flat once at steady state) (1) · Steady-state at 4-6 weeks (2) · ~24 hours per dose (peakless profile by design) (1)

Highly variable, 7-46 hours (mean ~21 h); lipophilic deposition in fat with delayed re-release contributes to wide range'"`UNIQ--ref-00000065-QINU`"' (1) · T4 ~7 days; T3 ~1 day'"`UNIQ--ref-0000001A-QINU`"' (1) · ~12 hours apparent (functional duration ~24 hours due to depot release kinetics)'"`UNIQ--ref-0000023B-QINU`"' (1) · ~25 hours apparent (functional duration well over 42 hours from multi-hexamer depot)'"`UNIQ--ref-0000135A-QINU`"' (1) · ~7 days (euthyroid); longer in hypothyroidism (~9-10 days), shorter in hyperthyroidism'"`UNIQ--ref-00000036-QINU`"' (1)

40-80% (oral); reduced by food, calcium, iron, PPIs, fiber; take fasting with water'"`UNIQ--ref-00000037-QINU`"' (1) · Variable; reduced by food, calcium, iron, PPIs'"`UNIQ--ref-0000001B-QINU`"' (1) · ~100% from subcutaneous depot (1) · ~100% from subcutaneous depot (by definition of the route) (1) · ~72% oral; ~85% smoked'"`UNIQ--ref-00000066-QINU`"' (1)

None (1) · First-line in pregnancy; dose typically increased 25-30% due to estrogen-driven rise in TBG and fetal demand. Lactation safe at physiologic doses.<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; glargine has reassuring observational data, though NPH and detemir remain the traditional choices.<sup class="pcp-cn" title="This claim needs a citation.">&#91;[[Pharmacopedia:Citation needed|citation&nbsp;needed]]&#93;</sup> (1) · Synthetic levothyroxine is the standard-of-care in pregnancy; desiccated thyroid use in pregnancy is not well studied.'"`UNIQ--ref-0000001C-QINU`"' (1)

[[USLegal:DEA Schedule II|Schedule II]] controlled substance in US (rescheduled from Schedule III in 1978). No accepted medical use. UN Convention on Psychotropic Substances Schedule II internationally.'"`UNIQ--ref-00000067-QINU`"' (1) · [[USLegal:Prescription only|Rx-only]] in US (4)