Drilldown: Medicines

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

Armour Thyroid, NP Thyroid, Nature-Throid, WP Thyroid (1) · Coumadin (discontinued in US but name in common use), Jantoven (1) · Lantus, Basaglar, Semglee, Toujeo (U-300) (1) · Synthroid, Levoxyl, Tirosint, Unithroid, Euthyrox (1) · Tresiba (1)

[[:Category:Anticoagulants|Anticoagulant]] (1) · [[:Category:Basal_insulins|Basal insulin]] (2) · [[:Category:Hormone_replacement|Hormone replacement]] (2) · [[:Category:Insulins|Insulin]] (2) · [[:Category:Long-acting_insulins|Long-acting insulin analog]] (1) · [[:Category:Thyroid_hormones|Thyroid hormone]] (2) · [[:Category:Ultra-long-acting_insulins|Ultra-long-acting insulin analog]] (1) · [[:Category:Vitamin_K_antagonists|Vitamin K antagonist]] (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-0000001B-QINU`"', '"`UNIQ--vote-0000001C-QINU`"', '"`UNIQ--vote-0000001D-QINU`"', '"`UNIQ--vote-0000001E-QINU`"', '"`UNIQ--vote-0000001F-QINU`"' (1) · '"`UNIQ--vote-00000033-QINU`"', '"`UNIQ--vote-00000034-QINU`"', '"`UNIQ--vote-00000035-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) · Typical 5 mg PO daily; 2.5 mg in elderly, low body weight, malnutrition, hepatic dysfunction. Genotype-guided initial dosing per CPIC/IWPC algorithms (CYP2C9, VKORC1, CYP4F2) is one of the most-established PGx applications in current practice (1) · ~10 units SC at the same time daily, or 0.1-0.2 units/kg/d; titrate by fasting glucose (2)

1, 2, 2.5, 3, 4, 5, 6, 7.5, 10 mg tablets (color-coded by strength) (1) · 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)

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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IV (1) · IV (rarely used; same dose) (1) · Oral (3) · Subcutaneous (never IV; not for use in insulin pumps) (2)

1-2 hours (1) · Anticoagulant effect at 24-72 hours; full INR effect 5-7 days (1) · TSH normalization 4-8 weeks (1) · TSH normalization 4-8 weeks; symptomatic improvement weeks to months (1) · ~1 hour (1)

2-5 days after stopping (factor II resynthesis-limited) (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)

36-42 hours (R/S enantiomers differ; S-warfarin is 2-5× more potent and cleared by CYP2C9)'"`UNIQ--ref-00000020-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% (oral)'"`UNIQ--ref-00000021-QINU`"' (1) · ~100% from subcutaneous depot (1) · ~100% from subcutaneous depot (by definition of the route) (1)

'''Contraindicated in pregnancy''' (warfarin embryopathy, fetal hemorrhage) except in mechanical mitral valves where the maternal mortality of alternative agents may exceed fetal risk.'"`UNIQ--ref-00000022-QINU`"' (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:Prescription only|Rx-only]] in US (5)