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Medicines > routes : IM or Intranasal or Sublingual

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brand:
classes:
[[:Category:Corticosteroids|Corticosteroid]] (9) · [[:Category:Antiemetics|Antiemetic]] (4) · [[:Category:Antibacterials|Antibacterial]] (3) · [[:Category:Glucocorticoids|Glucocorticoid (intermediate-acting)]] (3) · [[:Category:Glucocorticoids|Glucocorticoid]] (3) · [[:Category:Immunosuppressants|Immunosuppressant]] (3) · [[:Category:Inhaled_corticosteroids|Inhaled corticosteroid (ICS)]] (3) · [[:Category:Sleep aids|Sleep aid]] (3) · high-potency)]] (2) · [[:Category:B-vitamins|B-vitamin]] (2) · [[:Category:Glucocorticoids|Glucocorticoid (long-acting (2) · [[:Category:H1_receptor_antagonists|Histamine H1 receptor antagonist]] (2) · [[:Category:Hematinics|Hematinic]] (2) · [[:Category:Loop_diuretics|Loop diuretic]] (2) · [[:Category:Mast_cell_stabilizers|Mast cell stabilizer]] (2) · [[:Category:Schedule IV controlled substances|Schedule IV controlled substance]] (2) · [[:Category:Vitamins|Vitamin]] (2)
mechanism:
None (27) · Endogenous androgen binding to androgen receptors; mediates male secondary sex characteristics, anabolism, libido, erythropoiesis, and CNS effects on mood/energy/aggression. Aromatized peripherally to estradiol; reduced to DHT. (1) · High-affinity D2 receptor antagonist (1) · Positive allosteric modulator of the GABA<sub>A</sub> receptor at the benzodiazepine binding site; increases frequency of Cl<sup>−</sup> channel opening, producing anxiolytic, sedative, hypnotic, anticonvulsant, and skeletal-muscle relaxant effects. (1) · Small-molecule CGRP receptor antagonist; intranasal formulation (1) · '"`UNIQ--vote-0000001D-QINU`"' Major Beers-list concern in elderly patients for cognitive and fall risks. CYP2D6 substrate. At massive overdose, also produces sodium channel blockade with cardiac toxicity'"`UNIQ--ref-0000001E-QINU`"'. '"`UNIQ--effect-0000001F-QINU`"' (1) · '"`UNIQ--vote-00000037-QINU`"' Hypertonic 3% is the standard urgent treatment of severely symptomatic hyponatremia'"`UNIQ--ref-00000038-QINU`"'. (1) · '"`UNIQ--vote-00000860-QINU`"' Activates the glucocorticoid receptor to broadly remodel inflammatory, immune, and metabolic transcription. Unlike prednisone, it does not require hepatic activation, making it the preferred oral choice in severe hepatic dysfunction'"`UNIQ--ref-00000861-QINU`"'. (1) · '"`UNIQ--vote-000008BE-QINU`"' Preferred over prednisone in advanced hepatic dysfunction where hepatic 11β-HSD1 activation is impaired. Liquid formulations are the workhorse pediatric oral corticosteroid for asthma and croup'"`UNIQ--ref-000008BF-QINU`"'. (1) · '"`UNIQ--vote-000009FD-QINU`"' Active against gram-positive cocci including MRSA; the unique target underlies the absence of cross-resistance with other antibiotic classes. High-level resistance (plasmid-mediated mupA) is rising and limits prolonged or repeated use'"`UNIQ--ref-000009FE-QINU`"'. (1) · '"`UNIQ--vote-00000E4A-QINU`"' The narrow safe-bolus window for IV use (sharp risk of arrhythmia, hypertensive emergency, intracerebral hemorrhage) is why anaphylaxis dosing is '''IM, not IV''', outside critical care'"`UNIQ--ref-00000E4B-QINU`"'. (1) · '"`UNIQ--vote-00001014-QINU`"' Activates the glucocorticoid receptor to broadly remodel inflammatory, immune, and metabolic transcription. The dipropionate, valerate, and augmented dipropionate ester forms determine topical potency (high to super-high)'"`UNIQ--ref-00001015-QINU`"'. (1) · '"`UNIQ--vote-000011D5-QINU`"' Minimal systemic absorption and the dual mechanism underlie its first-line role in seasonal allergic conjunctivitis. Comfort drops without preservatives are available for sensitive patients'"`UNIQ--ref-000011D6-QINU`"'. (1) · '"`UNIQ--vote-000013B1-QINU`"' Topical application minimizes systemic antihistaminic burden; the characteristic bitter taste with nasal use (drainage to oropharynx) is the main tolerability issue'"`UNIQ--ref-000013B2-QINU`"'. (1)
uses:
starting dose:
None (2) · '''5 mg PO at bedtime for women, 5-10 mg for men''' (per FDA's 2013 sex-specific dose reduction for women due to slower clearance). Ambien CR 6.25 mg women / 6.25-12.5 mg men. Intermezzo SL 1.75 mg women / 3.5 mg men (1) · 0.4 mg PO daily (general prevention); 0.8-1 mg/d in pregnancy; 4 mg/d for women with prior NTD-affected pregnancy; 1 mg/d during methotrexate therapy (1) · 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) · 0.5-3 mg PO 30-60 minutes before bedtime. Some patients respond to micro-doses (0.3 mg) without additional benefit at higher doses. For circadian phase shifting, timing relative to dim-light melatonin onset matters more than absolute dose (1) · 10 mg (one spray) intranasally in one nostril (1) · 10 mg PO/IV/IM QID, '''not to exceed 12 weeks''' (tardive dyskinesia risk); intranasal Gimoti 15 mg BID (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) · Allergy: 25 mg PO BID-QID. Nausea/vomiting: 12.5-25 mg PO/IM/IV/PR every 4-6 hours. Motion sickness: 25 mg PO 30-60 minutes before travel. '''Pediatric <2 years: contraindicated''' (1) · Allergy: 25-50 mg PO every 4-6 hours. Insomnia: 25-50 mg PO at bedtime. IV (acute dystonia, severe allergic reaction): 25-50 mg slow IV push (1) · Anaphylaxis IM 0.3-0.5 mg (adult) into lateral thigh, repeat q5-15 minutes prn; pediatric 0.01 mg/kg IM (max 0.3 mg, max 0.5 mg in adolescents); cardiac arrest 1 mg IV/IO q3-5 minutes; severe asthma neb 0.1 mg/kg up to 5 mg; never IV bolus for anaphylaxis outside critical care (1) · Antenatal: Celestone Soluspan 12 mg IM q24h × 2 doses; topical: pea-sized amount BID; intra-articular varies by joint (1) · Anxiety: 2-10 mg PO 2-4 times daily. Alcohol withdrawal: 10-20 mg PO/IV every 4-6 hours, symptom-triggered. Status epilepticus: 5-10 mg IV. Breakthrough seizures: Diastat rectal 0.2-0.5 mg/kg or Valtoco intranasal 5-20 mg (1) · Contraception: Depo-Provera 150 mg IM every 13 weeks; Depo-SubQ 104 mg SC every 12-13 weeks; oral cycling: 5-10 mg PO daily ×5-10 days for amenorrhea (1) · Formulation-dependent. Gels: 40–50 mg topically daily. Cypionate/enanthate IM: 50–100 mg weekly. Undecanoate IM: 750 mg q10w. Patch: 4 mg/d. (1) · ICS Pulmicort Flexhaler 180-360 mcg BID; intranasal Rhinocort 64 mcg/spray, 1-2 sprays/nostril daily; Entocort EC 9 mg PO daily for active Crohn's; Symbicort 80/4.5 or 160/4.5 mcg, 2 puffs BID (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) · Inhaled (Flovent HFA) 88 mcg BID; intranasal (Flonase) 2 sprays/nostril daily; topical (Cutivate) 0.05% cream BID (1) · Intranasal 0.1% or 0.15%: 1-2 sprays/nostril BID; ophthalmic 0.05%: 1 drop in each eye BID (1) · Intranasal Nasonex 2 sprays/nostril daily (50 mcg/spray); inhaled Asmanex 220 mcg DPI 1-2 inhalations daily/BID; topical Elocon 0.1% cream daily (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) · 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) · No current medical indication. Historical anesthetic dose 0.25 mg/kg IV (Sernyl). (1) · No medical dose. Active recreational doses reported in the 0.5–1.5 mg range (similar potency to alprazolam). (1) · Ophthalmic Pataday 0.7%: 1 drop in each eye once daily (24-hour formulation); Patanol 0.1% BID; intranasal Patanase 2 sprays/nostril BID (1) · Oral 300-450 mg PO QID; IV 600-900 mg q8h; topical 1% solution/gel BID; vaginal 100 mg ovule × 3 days or 2% cream × 7 days (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) · Pediatric 1-2 mg/kg/d (max 60 mg) PO for asthma exacerbation; adult dosing similar to prednisone milligram-for-milligram (~1:1 potency) (1) · Physiologic replacement 15-25 mg/d divided (e.g., 10 mg AM, 5 mg noon, 5 mg afternoon); stress dose 50-100 mg IV q6-8h; adrenal crisis 100 mg IV then 50-100 mg q6h; topical 0.5-2.5% applied 2-4×/d (1) · PO 10 mg QID; IV 5-10 mg every 20-30 minutes for hypertensive emergency (1) · PO Medrol Dosepak (5-day taper from 24 mg to 4 mg) is the prototypic short-course outpatient regimen; IV pulse 1 g daily for 3-5 days for MS relapse; intra-articular 4-80 mg per joint q1-5 weeks (1) · Replacement: 1000 mcg IM daily for 1 week, then weekly for 4 weeks, then monthly; or 1000-2000 mcg PO daily (effective even in pernicious anemia via passive diffusion); intranasal 500 mcg weekly (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 0.025-0.5% cream/ointment BID; intra-articular 5-40 mg per joint q3-6 months; intranasal Nasacort 110 mcg/spray, 2 sprays/nostril daily; oral paste 0.1% to lesion 2-3×/d (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) · Volume and concentration titrated to clinical status; symptomatic hyponatremia: 3% NaCl 100-150 mL bolus, reassess (1)
preparations:
fda max:
None (1) · 1 g/d (oral); 6 g/d (IV) (1) · 1 mg/d typical Rx; higher in specific indications (1) · 10 mg per 24 h (1) · 10 mg/day (IR); 12.5 mg/day (CR) (1) · 100 mg/day (adult) (1) · 12 puffs MDI/d typical; nebulized 2000 mcg/d (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) · 2 sprays/nostril BID (1) · 200 mg/day (oral); 12 mg/day (SC); 40 mg/day (nasal spray); 44 mg/day (Onzetra) (1) · 300 mg/d typical practical limit (toxicity rises sharply above) (1) · 300 mg/day (oral) (1) · 4.8 g/d (IV severe infection) (1) · 40 mg/d (1) · 40 mg/day (oral, anxiety) (1) · 600 mg/d typical practical ceiling in heart failure (1) · Formulation-dependent (1) · ICS 880 mcg/d (asthma); intranasal 200 mcg/d (1) · ICS ~1280 mcg/d; intranasal 256 mcg/d; Entocort 9 mg/d standard (1) · Indication-specific (7) · Indication-specific; ACLS no fixed cumulative ceiling (1) · Indication-specific; titrated to effect (1) · Intranasal 200 mcg/d (adults); inhaled 880 mcg/d (1) · IV: monitored by levels (trough <1 mg/L for extended-interval; <2 mg/L for traditional) (1) · Limit topical to 10-day courses to reduce resistance pressure (1) · N/A (never approved) (1) · N/A (no current medical indication) (1) · No fixed maximum; titrated; sodium correction rate in chronic hyponatremia must not exceed 8-10 mEq/L per 24 hours to avoid osmotic demyelination (1) · No formal hard ceiling; in MOUD maintenance, doses typically remain at or below 120 mg/day with higher doses reserved for documented under-treatment after careful clinical assessment (1) · No strict ceiling; water-soluble vitamin, low toxicity (1) · Not formally established (dietary supplement); doses above ~3-5 mg show no additional efficacy but increase next-day sedation risk (1) · Once daily (Pataday 0.7%); BID (other ophthalmic) (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:
10 minutes (SC); 15-30 minutes (nasal); 30-60 minutes (oral) (1) · 15 minutes (1) · 15-30 minutes (1) · 15-30 minutes (oral); 1-2 minutes (IV) (1) · 15-60 minutes (oral); 1-5 minutes (IV); 4-10 minutes (rectal or intranasal) (1) · 20 minutes (oral); 5 minutes (IV) (1) · 30 minutes (IM); 30-60 minutes (oral) (1) · 30 minutes PO; minutes IV (1) · 30-60 minutes (immediate-release oral) (1) · Bronchodilation 15-30 minutes (1) · Contraceptive within 24 hours if given in first 5 days of cycle; otherwise backup for 7 days (1) · Days (1) · Hematologic response within days (1) · Hours (6) · Hours (systemic); minutes (ophthalmic) (1) · Hours (transdermal); days (IM esters) (1) · IM: 5-10 minutes; IV: seconds; nebulized: 5-10 minutes (1) · Immediate (IV) (1) · Inhaled: bronchial effect 1-2 weeks; nasal: symptom relief 12-24 hours; topical: hours (1) · Inhaled: bronchial effect 1-2 weeks; oral GI effect 1-2 weeks (1) · Intranasal: symptom relief 12-24 hours; inhaled: bronchial effect 1-2 weeks (1) · IV pulse: hours; PO: hours; intra-articular: days (1) · IV/IM 1-3 minutes; PO 30-60 minutes (1) · IV: 5 minutes; PO: 30-60 minutes (1) · IV: 5-20 minutes; PO: 30-60 minutes (1) · Oral analgesic effect 30-60 minutes; opioid-withdrawal suppression 30 minutes (oral); IV ~10 minutes (1) · Pain relief reported within 15 min in trials (1) · PO 1–2 h; IM 30–60 min; IV 5–20 min (1) · PO 30-60 minutes; IV minutes (1) · Reticulocyte response at 3-5 days; neurologic recovery weeks to months (and may be incomplete if longstanding) (1) · SL/spray: 1-3 minutes; IV: minutes; patch: 30-60 minutes (1) · Smoked 2-5 min; insufflated 5-15 min; oral 30-60 min; IV / IM ~5-15 min (1) · Symptom relief within 30-60 minutes (1) · Topical hours; intra-articular days to weeks (1) · ~20–40 min PO; faster sublingual/intranasal. (1)
duration:
12 hours (1) · 12-24 hours (1) · 12-24 hours per dose (1) · 12–24 h (oral); decanoate IM 3–4 weeks (1) · 2-4 hours; headache recurrence rate ~20-30% within 24 hours (1) · 24 hours (1) · 24 hours (0.7% formulation); 8-12 hours (lower-strength) (1) · 3-4 hours (1) · 4-12 hours (1) · 4-6 hours (6) · 4-8 hours typical; longer at high doses; residual cognitive and perceptual effects up to 48 hours (1) · 5-15 minutes (1) · 6-12 hours systemic (1) · 6-24 hours (parent); much longer when accounting for the long-lived active metabolites (1) · 6-8 hours (1) · 6-8 hours (IR); 8 hours (CR via biphasic release) (1) · 6–10 h subjective; full pharmacologic effect considerably longer. (1) · 8-12 hours (1) · Analgesic effect 4-8 hours (much shorter than half-life would suggest, due to receptor kinetics); MOUD effect (opioid withdrawal suppression) 24-36 hours per single daily dose (1) · Biologic 12-36 hours (intermediate-acting) (1) · Biologic 12-36 hours (intermediate-acting); Depo-Medrol depot weeks (1) · Biologic 36-54 hours (long-acting) (1) · Biologic 36-72 hours (long-acting) (1) · Biologic ~8-12 hours (short-acting) (1) · Depot IM 13 weeks (designed); often persists longer (1) · Hours (nasal); ~24 h (gel/patch); 1–2 weeks (cypionate/enanthate IM); ~10 weeks (undecanoate IM) (1) · Hours per application (1) · Intra-articular 3-6 months (depot effect of acetonide microcrystals) (1) · IV: 1-4 hours; PO: 3-8 hours (1) · IV: ~2 hours; PO: 6-8 hours (1) · N/A (replacement) (2) · Roughly 20-25% of an IV bolus remains intravascular at 1 hour (1) · SL: 30 minutes; patch: 12-14 hours; IV continuous (1) · ~48 h sustained pain freedom in responders (1)
halflife:
bioavailability:
pregnancy:
None (4) · 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) · Avoid. Benzodiazepines are associated with neonatal sedation, floppy-infant syndrome, and withdrawal; teratogenic signal weak but non-zero. Designer benzo with no safety data, assume worst-case. (1) · Category C (1) · Category X, contraindicated; teratogenic (virilization of female fetus) (1) · Contraindicated in known pregnancy.<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) · Generally considered safe.<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> (2) · Inhaled and intranasal generally considered safe; widely used in asthma in pregnancy.<sup class="pcp-cn" title="This claim needs a citation.">&#91;[[Pharmacopedia:Citation needed|citation&nbsp;needed]]&#93;</sup> (1) · Intranasal long considered acceptable; widely used in obstetric rhinitis.<sup class="pcp-cn" title="This claim needs a citation.">&#91;[[Pharmacopedia:Citation needed|citation&nbsp;needed]]&#93;</sup> (1) · Limited data; avoid (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 data; second-line to intranasal corticosteroids or PO loratadine/cetirizine.<sup class="pcp-cn" title="This claim needs a citation.">&#91;[[Pharmacopedia:Citation needed|citation&nbsp;needed]]&#93;</sup> (1) · Limited human data; case reports of neonatal sedation with late-pregnancy exposure.<sup class="pcp-cn" title="This claim needs a citation.">&#91;[[Pharmacopedia:Citation needed|citation&nbsp;needed]]&#93;</sup> (1) · Limited human data; endogenous hormone, but supplemental pharmacological doses are not well characterized in pregnancy.<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) · Long the preferred ICS in pregnancy (Pulmicort) due to the most pregnancy data among the class.<sup class="pcp-cn" title="This claim needs a citation.">&#91;[[Pharmacopedia:Citation needed|citation&nbsp;needed]]&#93;</sup> (1) · Older agent with substantial use experience, including in hyperemesis gravidarum; broadly reassuring observational data'"`UNIQ--ref-00000024-QINU`"' (1) · Older agent with substantial use experience; broadly considered safe in pregnancy'"`UNIQ--ref-00000028-QINU`"' (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) · Routinely supplemented in pregnancy and preconception to prevent neural tube defects.<sup class="pcp-cn" title="This claim needs a citation.">&#91;[[Pharmacopedia:Citation needed|citation&nbsp;needed]]&#93;</sup> (1) · Routinely supplemented in vegan pregnancies and pernicious anemia.<sup class="pcp-cn" title="This claim needs a citation.">&#91;[[Pharmacopedia:Citation needed|citation&nbsp;needed]]&#93;</sup> (1) · Some signal for cleft palate with first-trimester exposure (debated); neonatal sedation and withdrawal with third-trimester exposure.<sup class="pcp-cn" title="This claim needs a citation.">&#91;[[Pharmacopedia:Citation needed|citation&nbsp;needed]]&#93;</sup> (1) · Standard fluid and electrolyte management (1) · Topical/intranasal generally low-risk; intra-articular and high-dose injection: weigh risk individually.<sup class="pcp-cn" title="This claim needs a citation.">&#91;[[Pharmacopedia:Citation needed|citation&nbsp;needed]]&#93;</sup> (1) · Use when benefits outweigh; small association with oral clefts debated.<sup class="pcp-cn" title="This claim needs a citation.">&#91;[[Pharmacopedia:Citation needed|citation&nbsp;needed]]&#93;</sup> (1) · Use when benefits outweigh; small association with oral clefts in first trimester debated.<sup class="pcp-cn" title="This claim needs a citation.">&#91;[[Pharmacopedia:Citation needed|citation&nbsp;needed]]&#93;</sup> (1) · Use when benefits outweigh; widely used at physiologic doses for adrenal insufficiency.<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) · Used in life-threatening obstetric anaphylaxis without hesitation; benefits clearly outweigh.<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) · Widely used for hyperemesis gravidarum; reassuring data.<sup class="pcp-cn" title="This claim needs a citation.">&#91;[[Pharmacopedia:Citation needed|citation&nbsp;needed]]&#93;</sup> (1)
legal:
None (3) · OTC (Astepro 0.15%) and [[USLegal:Prescription only|Rx-only]] (other intranasal, ophthalmic, Dymista) in US (1) · OTC (intranasal Flonase) and [[USLegal:Prescription only|Rx-only]] (inhaled, topical) in US (1) · OTC (intranasal Rhinocort Allergy) and [[USLegal:Prescription only|Rx-only]] (other forms) in US (1) · OTC (low-dose topicals) and [[USLegal:Prescription only|Rx-only]] (other forms) in US (1) · OTC (low-dose) and [[USLegal:Prescription only|Rx-only]] (1 mg, injectable) in US (1) · OTC (low/mid-dose oral) and [[USLegal:Prescription only|Rx-only]] (injection, intranasal) in US (1) · OTC (lowest-strength topicals) and [[USLegal:Prescription only|Rx-only]] (higher strengths, injectable) in US (1) · OTC (Nasonex 24HR) and [[USLegal:Prescription only|Rx-only]] (other forms) in US (1) · OTC (Pataday ophthalmic) and [[USLegal:Prescription only|Rx-only]] (Patanase intranasal) in US (1) · Rx (1) · Rx-only (1) · Schedule III (DEA, US) (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:Over-the-counter|OTC]] dietary supplement in the US ('''not FDA-regulated as a medicine'''; multiple studies show OTC products contain 50-470% of labeled melatonin content); [[USLegal:Prescription only|Rx-only]] in the EU and UK (1) · [[USLegal:Over-the-counter|OTC]] for most oral and topical formulations; [[USLegal:Prescription only|Rx-only]] for injectable (1) · [[USLegal:Prescription only|Rx-only]] for parenteral formulations; OTC for oral, nasal, and many nebulizer products (1) · [[USLegal:Prescription only|Rx-only]] in US (16) · [[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 a '''Boxed Warning''' for bone mineral density loss with prolonged use (≥2 years; partially reversible after discontinuation)'"`UNIQ--ref-00000F22-QINU`"' (1) · [[USLegal:Prescription only|Rx-only]] in US. Carries a '''Boxed Warning''' for Clostridioides difficile colitis (one of the most C. difficile-inducing antibiotic classes)'"`UNIQ--ref-00001444-QINU`"' (1) · [[USLegal:Schedule IV|Schedule IV controlled substance]] in US. Carries the benzodiazepine class '''Boxed Warning''' for risk of fatal respiratory depression, coma, and death when combined with opioids'"`UNIQ--ref-00000028-QINU`"' (1) · [[USLegal:Schedule IV|Schedule IV controlled substance]] in US. Carries the FDA '''Boxed Warning''' for '''complex sleep behaviors''' (sleep-driving, sleep-walking, sleep-eating, other parasomnias) added in 2019'"`UNIQ--ref-0000001C-QINU`"' (1)

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