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Medicines > routes : Intranasal or topical & legal: [[USLegal:Prescription only|Rx-only]] in US

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classes:
APL)]] (1) · high-potency)]] (1) · super-potent)]] (1) · [[:Category:Analgesics|Analgesic (opioid-sparing parenteral)]] (1) · [[:Category:Analgesics|Analgesic]] (1) · [[:Category:Anti-herpesvirus_agents|Anti-herpesvirus agent]] (1) · [[:Category:Antianginals|Antianginal]] (1) · [[:Category:Antibacterials|Antibacterial (anaerobic)]] (1) · [[:Category:Antibacterials|Antibacterial]] (1) · [[:Category:Antifungals|Antifungal]] (2) · [[:Category:Antimetabolites|Antimetabolite (pyrimidine analog)]] (1) · [[:Category:Antimigraine medicines|Antimigraine medicine]] (1) · [[:Category:Antimuscarinics|Antimuscarinic]] (1) · [[:Category:Antineoplastics|Antineoplastic (oral (1) · [[:Category:Antineoplastics|Antineoplastic]] (1) · [[:Category:Antiprotozoals|Antiprotozoal]] (1) · [[:Category:Antivirals|Antiviral]] (1) · [[:Category:Bronchodilators|Bronchodilator]] (1) · [[:Category:Corticosteroids|Corticosteroid]] (2) · [[:Category:Glucocorticoids|Glucocorticoid (long-acting (1) · [[:Category:Glucocorticoids|Glucocorticoid]] (1) · [[:Category:Hormones|Hormone (steroid)]] (1) · [[:Category:Hydroxypyridones|Hydroxypyridone]] (1) · [[:Category:Nitrates|Organic nitrate]] (1) · [[:Category:Nitroimidazoles|Nitroimidazole antibiotic]] (1) · [[:Category:NSAIDs|Non-steroidal anti-inflammatory (NSAID)]] (1) · [[:Category:Nucleoside_analogs|Nucleoside analog]] (1) · [[:Category:Polyene_antifungals|Polyene antifungal]] (1) · [[:Category:Retinoids|Retinoid]] (1) · [[:Category:Short-acting_muscarinic_antagonists|Short-acting muscarinic antagonist (SAMA)]] (1) · [[:Category:Topical_antibiotics|Topical antibiotic]] (1) · [[:Category:Topical_antifungals|Topical antifungal]] (1) · [[:Category:Topical_corticosteroids|Topical corticosteroid (Class I (1) · [[:Category:Topical_corticosteroids|Topical corticosteroid (high-to-super-high potency depending on ester)]] (1) · [[:Category:Topical_retinoids|Topical retinoid]] (1) · [[:Category:Triptans|Triptan (5-HT1B/1D agonist)]] (1) · [[:Category:Vasodilators|Vasodilator]] (1) · [[:Category:Vitamin_D_analogs|Vitamin D analog (active form)]] (1)
uses:
'"`UNIQ--vote-00000013-QINU`"', '"`UNIQ--vote-00000014-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-0000079C-QINU`"', '"`UNIQ--vote-0000079D-QINU`"' (1) · '"`UNIQ--vote-00000909-QINU`"', '"`UNIQ--vote-0000090A-QINU`"', '"`UNIQ--vote-0000090B-QINU`"', '"`UNIQ--vote-0000090C-QINU`"', '"`UNIQ--vote-0000090D-QINU`"', '"`UNIQ--vote-0000090E-QINU`"' (1) · '"`UNIQ--vote-000009FF-QINU`"', '"`UNIQ--vote-00000A00-QINU`"', '"`UNIQ--vote-00000A01-QINU`"' (1) · '"`UNIQ--vote-00000BA0-QINU`"', '"`UNIQ--vote-00000BA1-QINU`"', '"`UNIQ--vote-00000BA2-QINU`"' (1) · '"`UNIQ--vote-00000BE3-QINU`"', '"`UNIQ--vote-00000BE4-QINU`"', '"`UNIQ--vote-00000BE5-QINU`"', '"`UNIQ--vote-00000BE6-QINU`"', '"`UNIQ--vote-00000BE7-QINU`"', '"`UNIQ--vote-00000BE8-QINU`"', '"`UNIQ--vote-00000BE9-QINU`"', '"`UNIQ--vote-00000BEA-QINU`"' (1) · '"`UNIQ--vote-00000C0A-QINU`"', '"`UNIQ--vote-00000C0B-QINU`"', '"`UNIQ--vote-00000C0C-QINU`"', '"`UNIQ--vote-00000C0D-QINU`"', '"`UNIQ--vote-00000C0E-QINU`"' (1) · '"`UNIQ--vote-00000D13-QINU`"', '"`UNIQ--vote-00000D14-QINU`"', '"`UNIQ--vote-00000D15-QINU`"', '"`UNIQ--vote-00000D16-QINU`"' (1) · '"`UNIQ--vote-00000F78-QINU`"', '"`UNIQ--vote-00000F79-QINU`"', '"`UNIQ--vote-00000F7A-QINU`"' (1) · '"`UNIQ--vote-00001016-QINU`"', '"`UNIQ--vote-00001017-QINU`"', '"`UNIQ--vote-00001018-QINU`"', '"`UNIQ--vote-00001019-QINU`"' (1) · '"`UNIQ--vote-0000115F-QINU`"', '"`UNIQ--vote-00001160-QINU`"', '"`UNIQ--vote-00001161-QINU`"', '"`UNIQ--vote-00001162-QINU`"', '"`UNIQ--vote-00001163-QINU`"' (1) · '"`UNIQ--vote-000011BA-QINU`"', '"`UNIQ--vote-000011BB-QINU`"', '"`UNIQ--vote-000011BC-QINU`"', '"`UNIQ--vote-000011BD-QINU`"' (1) · '"`UNIQ--vote-00001235-QINU`"', '"`UNIQ--vote-00001236-QINU`"', '"`UNIQ--vote-00001237-QINU`"', '"`UNIQ--vote-00001238-QINU`"' (1)
starting dose:
500 mg PO TID × 7-10 days (most indications); 2 g single dose for trichomoniasis; 500 mg IV q8h for severe anaerobic infection; rectal 1 g BID (1) · Antenatal: Celestone Soluspan 12 mg IM q24h × 2 doses; topical: pea-sized amount BID; intra-articular varies by joint (1) · Apply a thin film to affected area BID; '''limit to 2 weeks''' continuous use and ≤50 g/week (cream/ointment); ≤50 mL/week (foam/solution); avoid face, intertriginous areas (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) · Initial genital herpes 400 mg PO TID × 7-10 days; episodic 800 mg TID × 2 days; suppression 400 mg BID; herpes zoster 800 mg 5×/day × 7 days; HSV encephalitis 10 mg/kg IV q8h × 14-21 days (1) · Nebulized 500 mcg q6-8h (or with albuterol as DuoNeb); MDI 17 mcg/puff, 2 puffs QID; nasal 0.03% or 0.06% spray BID-TID (1) · Oral 0.25 mcg daily, titrate by serum calcium and PTH; IV in CKD 0.5-3 mcg three times weekly (1) · Oral: 4-6 mL (400,000-600,000 units) suspension QID swish-and-swallow; topical: BID-QID; vaginal tablet 1 daily for 2 weeks (1) · Oral: 50-100 mg at migraine onset, may repeat in 2 hours if needed. SC: 6 mg, may repeat in 1 hour. Nasal: 5-20 mg per nostril, may repeat in 2 hours (1) · SL 0.3-0.6 mg every 5 minutes up to 3 doses for acute angina (call EMS if not resolved after the third); IV infusion 5-10 mcg/min titrated; transdermal patch 0.2-0.4 mg/hr for 12-14 hours daily (nitrate-free interval prevents tolerance) (1) · Topical cream/lotion BID; shampoo twice weekly; nail lacquer (Penlac) once daily for up to 48 weeks (1) · Topical: 0.5-5% cream/solution to lesions BID × 2-4 weeks; systemic IV: regimen-specific in cancer chemotherapy (1) · Topical: apply small amount to affected area TID × 5-10 days; nasal: apply half the contents of a single-use tube into each nostril BID × 5 days (1) · Topical: pea-sized amount to dry face at bedtime, building from 2-3×/week to nightly as tolerated; oral APL: 45 mg/m²/d in divided doses (1)
preparations:
0.25, 0.5 mcg oral capsules; 1 mcg/mL oral solution; 1 mcg/mL IV; 3 mcg/g topical ointment (1) · 0.5% (Carac), 1% (Fluoroplex), 5% (Efudex) topical creams/solutions; 50 mg/mL IV (1) · 0.6 mg/5 mL oral solution; Celestone Soluspan 6 mg/mL IM/IA (mix of sodium phosphate + acetate); 0.05% and 0.1% topical cream/ointment/lotion/foam (various salts); augmented betamethasone 0.05% (super-high potency) (1) · 0.77% topical cream, lotion, suspension; 1% shampoo; 8% nail lacquer (Penlac) (1) · 100,000 units/mL oral suspension; 500,000 unit tablets; 100,000 units/g cream, ointment, powder; vaginal tablets (1) · 2% ointment; 2% cream; 2% nasal ointment (Bactroban Nasal) (1) · 200, 400, 800 mg tablets; 200 mg capsules; 200 mg/5 mL suspension; 500, 1000 mg IV vials; 5% cream and ointment (topical) (1) · 250, 500 mg tablets; 750 mg ER; 500 mg/100 mL IV; 0.75-1% topical gel/cream; 0.75% vaginal gel; suppository (1) · Atrovent HFA 17 mcg/actuation MDI; 500 mcg/2.5 mL nebulizer solution; 0.03% and 0.06% intranasal sprays; with albuterol as DuoNeb / Combivent Respimat (1) · Cream, ointment, lotion, foam, solution, shampoo, spray at 0.025-0.05%; emollient and non-emollient bases (1) · Oral tablets 25, 50, 100 mg; SC injection 4, 6 mg autoinjector; needle-free SC 6 mg (Sumavel); nasal spray 5, 20 mg; nasal powder 22 mg (Onzetra Xsail); low-dose autoinjector 3 mg (Zembrace SymTouch) (1) · SL 0.3, 0.4, 0.6 mg tablets; lingual spray 0.4 mg/spray; ER 2.5-9 mg capsules; transdermal patch 0.1-0.8 mg/hr; 2% ointment; 0.4% rectal ointment; 5 mg/mL IV (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) · Topical 0.01-0.1% creams, gels, micropsheres, lotions; oral 10 mg capsules (Vesanoid) (1)
routes: (Click arrow to add another value)
bioavailability:
Essentially zero systemic absorption from oral or topical routes — the topical-action-only profile is the basis of its safety'"`UNIQ--ref-00000D18-QINU`"' (1) · High (oral)'"`UNIQ--ref-00001165-QINU`"' (1) · Highly route-dependent: SL bypasses first-pass; oral has extensive first-pass (used only for chronic ER preparations); transdermal predictable'"`UNIQ--ref-00000C10-QINU`"' (1) · Inhaled lung deposition with minimal systemic absorption (the basis of the favorable safety profile vs systemic antimuscarinics)'"`UNIQ--ref-00000F7C-QINU`"' (1) · Oral ~70%; depot IM provides sustained release over weeks'"`UNIQ--ref-0000101B-QINU`"' (1) · Topical with minimal systemic absorption'"`UNIQ--ref-0000123A-QINU`"' (1) · Topical with variable systemic absorption depending on body site, occlusion, and skin integrity; HPA-axis suppression is documented even with brief courses to large areas'"`UNIQ--ref-0000079F-QINU`"' (1) · Topical: minimal systemic absorption (oral systemic 5-FU not used due to poor and variable absorption)'"`UNIQ--ref-000011BF-QINU`"' (1) · Topical: minimal systemic absorption with normal skin; oral: variable, induced metabolism with repeated dosing'"`UNIQ--ref-00000BA4-QINU`"' (1) · Topical; minimal systemic absorption'"`UNIQ--ref-00000A03-QINU`"' (1) · ~100% (oral, but oral use is limited to continuation from parenteral)'"`UNIQ--ref-00000021-QINU`"' (1) · ~14% (oral; substantial first-pass); ~97% (subcutaneous); ~17% (nasal)'"`UNIQ--ref-00000016-QINU`"' (1) · ~20% (oral; valacyclovir prodrug raises this to ~55%)'"`UNIQ--ref-00000910-QINU`"' (1) · ~80% (oral)'"`UNIQ--ref-00000BEC-QINU`"' (1)
pregnancy:
None (2) · 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) · Generally considered safe (minimal systemic absorption).<sup class="pcp-cn" title="This claim needs a citation.">&#91;[[Pharmacopedia:Citation needed|citation&nbsp;needed]]&#93;</sup> (1) · Generally considered safe after the first trimester; first-trimester use weighed against indication.<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 (no systemic absorption).<sup class="pcp-cn" title="This claim needs a citation.">&#91;[[Pharmacopedia:Citation needed|citation&nbsp;needed]]&#93;</sup> (1) · Generally considered safe; minimal systemic exposure.<sup class="pcp-cn" title="This claim needs a citation.">&#91;[[Pharmacopedia:Citation needed|citation&nbsp;needed]]&#93;</sup> (1) · Limited data; generally considered acceptable when needed.<sup class="pcp-cn" title="This claim needs a citation.">&#91;[[Pharmacopedia:Citation needed|citation&nbsp;needed]]&#93;</sup> (1) · Limited human data; pregnancy registry data have been broadly reassuring relative to baseline malformation rates.<sup class="pcp-cn" title="This claim needs a citation.">&#91;[[Pharmacopedia:Citation needed|citation&nbsp;needed]]&#93;</sup> (1) · Topical corticosteroids in pregnancy: use lowest potency and smallest area; super-potent agents like clobetasol are reserved for compelling indications.<sup class="pcp-cn" title="This claim needs a citation.">&#91;[[Pharmacopedia:Citation needed|citation&nbsp;needed]]&#93;</sup> (1) · Topical: avoid; systemic: contraindicated in pregnancy.<sup class="pcp-cn" title="This claim needs a citation.">&#91;[[Pharmacopedia:Citation needed|citation&nbsp;needed]]&#93;</sup> (1) · Used in obstetric emergencies (uterine relaxation, severe hypertension) when needed; otherwise limited routine use.<sup class="pcp-cn" title="This claim needs a citation.">&#91;[[Pharmacopedia:Citation needed|citation&nbsp;needed]]&#93;</sup> (1) · Used when needed for hypoparathyroidism or renal osteodystrophy in pregnancy.<sup class="pcp-cn" title="This claim needs a citation.">&#91;[[Pharmacopedia:Citation needed|citation&nbsp;needed]]&#93;</sup> (1) · Widely used in pregnancy for HSV/VZV indications; reassuring registry data.<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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