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Drilldown: Medicines

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Medicines > mechanism: None & routes: IM & legal: [[USLegal:Prescription only|Rx-only]] in US

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generic:
Bumetanide (1) · Cefuroxime (axetil oral, sodium IV) (1) · Dexamethasone (1) · Furosemide (1) · Hydralazine (1) · Ketorolac (tromethamine) (1) · Ondansetron (1) · Tobramycin (1)
brand:
Apresoline (historical); mostly generic; combination with isosorbide dinitrate marketed as BiDil for self-identified Black patients with HFrEF (1) · Bumex (1) · Ceftin (oral), Zinacef (IV) (1) · Decadron (historical), Dexpak (taper pack), Hemady, Ozurdex (intravitreal) (1) · Lasix (1) · Tobrex (ophthalmic), Tobi, Tobi Podhaler, Bethkis (inhaled, cystic fibrosis), generic IV (1) · Toradol (IV/IM, US brand discontinued), Sprix (nasal spray), Acular and Acuvail (ophthalmic) (1) · Zofran, Zofran ODT (1)
classes:
high-potency)]] (1) · [[:Category:5-HT3_antagonists|5-HT3 receptor antagonist]] (1) · [[:Category:Aminoglycosides|Aminoglycoside antibiotic]] (1) · [[:Category:Analgesics|Analgesic (opioid-sparing parenteral)]] (1) · [[:Category:Antibacterials|Antibacterial]] (1) · [[:Category:Antiemetics|Antiemetic]] (1) · [[:Category:Antihypertensives|Antihypertensive]] (1) · [[:Category:Beta-lactam_antibiotics|β-lactam antibiotic]] (1) · [[:Category:Cephalosporins|Cephalosporin (second-generation)]] (1) · [[:Category:Corticosteroids|Corticosteroid]] (1) · [[:Category:Direct_vasodilators|Direct arteriolar vasodilator]] (1) · [[:Category:Diuretics|Diuretic]] (1) · [[:Category:Glucocorticoids|Glucocorticoid (long-acting (1) · [[:Category:Immunosuppressants|Immunosuppressant]] (1) · [[:Category:Loop_diuretics|Loop diuretic]] (2) · [[:Category:NSAIDs|Non-steroidal anti-inflammatory (NSAID)]] (1)
mechanism: (Click arrow to add another value)
uses:
'"`UNIQ--vote-0000001B-QINU`"', '"`UNIQ--vote-0000001C-QINU`"', '"`UNIQ--vote-0000001D-QINU`"', '"`UNIQ--vote-0000001E-QINU`"', '"`UNIQ--vote-0000001F-QINU`"' (1) · '"`UNIQ--vote-0000021C-QINU`"', '"`UNIQ--vote-0000021D-QINU`"', '"`UNIQ--vote-0000021E-QINU`"', '"`UNIQ--vote-0000021F-QINU`"', '"`UNIQ--vote-00000220-QINU`"', '"`UNIQ--vote-00000221-QINU`"' (1) · '"`UNIQ--vote-00000374-QINU`"', '"`UNIQ--vote-00000375-QINU`"', '"`UNIQ--vote-00000376-QINU`"', '"`UNIQ--vote-00000377-QINU`"' (1) · '"`UNIQ--vote-00000683-QINU`"', '"`UNIQ--vote-00000684-QINU`"', '"`UNIQ--vote-00000685-QINU`"', '"`UNIQ--vote-00000686-QINU`"' (1) · '"`UNIQ--vote-00000DDF-QINU`"', '"`UNIQ--vote-00000DE0-QINU`"', '"`UNIQ--vote-00000DE1-QINU`"', '"`UNIQ--vote-00000DE2-QINU`"' (1) · '"`UNIQ--vote-00000E23-QINU`"', '"`UNIQ--vote-00000E24-QINU`"', '"`UNIQ--vote-00000E25-QINU`"', '"`UNIQ--vote-00000E26-QINU`"', '"`UNIQ--vote-00000E27-QINU`"', '"`UNIQ--vote-00000E28-QINU`"', '"`UNIQ--vote-00000E29-QINU`"', '"`UNIQ--vote-00000E2A-QINU`"' (1) · '"`UNIQ--vote-00000FF3-QINU`"', '"`UNIQ--vote-00000FF4-QINU`"', '"`UNIQ--vote-00000FF5-QINU`"', '"`UNIQ--vote-00000FF6-QINU`"', '"`UNIQ--vote-00000FF7-QINU`"', '"`UNIQ--vote-00000FF8-QINU`"' (1) · '"`UNIQ--vote-000010AF-QINU`"', '"`UNIQ--vote-000010B0-QINU`"', '"`UNIQ--vote-000010B1-QINU`"', '"`UNIQ--vote-000010B2-QINU`"' (1)
starting dose:
0.5-1 mg PO/IV once or twice daily; titrate to clinical response. Approximate equipotency: bumetanide 1 mg ≈ furosemide 40 mg ≈ torsemide 20 mg (1) · 20-40 mg PO/IV; titrate by clinical response. In diuretic-resistant heart failure or CKD, doses to 200 mg or higher may be needed (1) · 250-500 mg PO BID × 7-14 days; IV 1.5 g q8h for serious infections (1) · 4-8 mg PO or IV every 8 hours as needed; 16 mg single dose preoperatively for PONV prevention (1) · IM: 60 mg single dose or 30 mg every 6 hours. IV: 30 mg every 6 hours. Oral (continuation only): 10-20 mg every 4-6 hours. Sprix nasal: 31.5 mg every 6-8 hours. '''Maximum 5 days total combined use''' (1) · Indication-specific: 0.5-9 mg PO/IV daily for inflammation; 4 mg IV q6h for cerebral edema; 40 mg PO once weekly in MM; 6 mg PO/IV daily ×10 days for severe COVID-19; 0.6 mg/kg PO single dose for croup (max 16 mg) (1) · IV: traditional 1-1.7 mg/kg q8h or extended-interval 5-7 mg/kg q24h with target-trough monitoring; inhaled CF 300 mg BID × 28 days on / 28 days off; ophthalmic 1-2 drops in affected eye(s) q4h (1) · PO 10 mg QID; IV 5-10 mg every 20-30 minutes for hypertensive emergency (1)
preparations:
0.5, 0.75, 1, 1.5, 2, 4, 6 mg tablets; oral solution; 4, 10, 20, 100 mg/mL IV; intravitreal implant (Ozurdex) (1) · 0.5, 1, 2 mg tablets; 0.25 mg/mL IV (1) · 10, 25, 50, 100 mg tablets; 20 mg/mL IV (1) · 125, 250, 500 mg tablets; 125 mg/5 mL, 250 mg/5 mL suspension; 750 mg, 1.5 g IV vials (1) · 20, 40, 80 mg tablets; 10 mg/mL oral solution; 10 mg/mL IV (1) · 4 mg, 8 mg, 24 mg tablets; 4 mg, 8 mg orally disintegrating tablets; 4 mg/5 mL oral solution; IV (2 mg/mL) (1) · IV 10 mg/mL, 40 mg/mL; inhaled 300 mg/5 mL solution (Tobi, Bethkis); Podhaler dry powder; 0.3% ophthalmic solution and ointment (1) · Tablets 10 mg; injection 15 mg/mL and 30 mg/mL; nasal spray 15.75 mg/spray (Sprix); ophthalmic solution 0.4%, 0.45%, 0.5% (1)
fda max:
1 g/d (oral); 6 g/d (IV) (1) · 120 mg/day (IV/IM); 40 mg/day (oral); '''5-day maximum total combined therapy''' to mitigate the GI bleeding, AKI, and platelet dysfunction risks (1) · 300 mg/d typical practical limit (toxicity rises sharply above) (1) · 600 mg/d typical practical ceiling in heart failure (1) · Indication-specific (1) · IV: monitored by levels (trough <1 mg/L for extended-interval; <2 mg/L for traditional) (1) · Single doses ≤16 mg (FDA 2012 advisory withdrew the 32 mg single IV dose for QT-prolongation risk); 24-32 mg/d divided (1) · ~10 mg/d typical (1)
routes: (Click arrow to add another value)
onset:
30 minutes (IM); 30-60 minutes (oral) (1) · 30 minutes PO; minutes IV (1) · Hours (2) · Hours (systemic); minutes (ophthalmic) (1) · IV: 5 minutes; PO: 30-60 minutes (1) · IV: 5-20 minutes; PO: 30-60 minutes (1) · PO 30-60 minutes; IV minutes (1)
duration:
4-12 hours (1) · 4-6 hours (2) · 6-12 hours systemic (1) · 8-12 hours (1) · Biologic 36-72 hours (long-acting) (1) · IV: 1-4 hours; PO: 3-8 hours (1) · IV: ~2 hours; PO: 6-8 hours (1)
halflife:
1-1.5 hours'"`UNIQ--ref-00000DE3-QINU`"' (1) · 1.5-2 hours (longer in renal failure)'"`UNIQ--ref-00000222-QINU`"' (1) · 2-3 hours (normal renal function); markedly prolonged in renal impairment'"`UNIQ--ref-000010B3-QINU`"' (1) · 3-6 hours (longer in hepatic impairment)'"`UNIQ--ref-00000378-QINU`"' (1) · 3-7 hours (slow acetylators) vs 1-3 hours (rapid acetylators) via NAT2 polymorphism'"`UNIQ--ref-00000687-QINU`"' (1) · 5-6 hours'"`UNIQ--ref-00000020-QINU`"' (1) · Plasma ~3-4.5 hours; biologic ~36-72 hours'"`UNIQ--ref-00000E2B-QINU`"' (1) · ~1.5 hours'"`UNIQ--ref-00000FF9-QINU`"' (1)
bioavailability:
IV/IM ~100%; inhaled: minimal systemic; oral: negligible (not used orally for systemic infection)'"`UNIQ--ref-000010B4-QINU`"' (1) · ~100% (oral, but oral use is limited to continuation from parenteral)'"`UNIQ--ref-00000021-QINU`"' (1) · ~25-50% (oral; substantial first-pass via NAT2 acetylation, phenotype-dependent)'"`UNIQ--ref-00000688-QINU`"' (1) · ~37% (oral, as axetil prodrug; food modestly improves absorption)'"`UNIQ--ref-00000FFA-QINU`"' (1) · ~50% (oral; highly variable, 10-100%, hence the standard 1:2 IV-to-PO conversion)'"`UNIQ--ref-00000223-QINU`"' (1) · ~60% (oral)'"`UNIQ--ref-00000379-QINU`"' (1) · ~80% (oral)'"`UNIQ--ref-00000E2C-QINU`"' (1) · ~80-95% (oral; more reliable than furosemide, comparable to torsemide)'"`UNIQ--ref-00000DE4-QINU`"' (1)
pregnancy:
None (1) · Aminoglycoside-class ototoxicity in fetal cochlea is documented; use only when alternatives have failed.<sup class="pcp-cn" title="This claim needs a citation.">&#91;[[Pharmacopedia:Citation needed|citation&nbsp;needed]]&#93;</sup> (1) · Avoid from 20 weeks gestation onward per FDA's 2020 expanded NSAID warning; contraindicated from 30 weeks. Specifically contraindicated in labor and delivery due to inhibition of uterine contractions'"`UNIQ--ref-00000022-QINU`"' (1) · Avoid where possible; can reduce uteroplacental perfusion and produce neonatal electrolyte disturbance. Reserved for compelling indications.<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 in pregnancy.<sup class="pcp-cn" title="This claim needs a citation.">&#91;[[Pharmacopedia:Citation needed|citation&nbsp;needed]]&#93;</sup> (1) · One of the historically preferred IV agents for severe hypertension in pregnancy alongside labetalol and nifedipine.<sup class="pcp-cn" title="This claim needs a citation.">&#91;[[Pharmacopedia:Citation needed|citation&nbsp;needed]]&#93;</sup> (1) · Used in antenatal lung maturation (24-34 weeks gestation; 6 mg IM q12h × 4 doses); broader use weighs benefits against fetal HPA suppression.<sup class="pcp-cn" title="This claim needs a citation.">&#91;[[Pharmacopedia:Citation needed|citation&nbsp;needed]]&#93;</sup> (1)
legal: (Click arrow to add another value)

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