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Medicines > routes : IM or Subcutaneous (abdomen or intranasal

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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) · 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:Vitamins|Vitamin]] (2) · [[GLP-1 receptor agonist]] · [[Antidiabetic medicines|Antidiabetic]] · [[Anti-obesity medicines|Anti-obesity]] · [[Cardiovascular risk reduction]] agent (2)
mechanism:
None (23) · Agonist of the [[GLP-1 receptor]]; exendin-4 derivative from Gila monster venom. (1) · Dual agonist of the [[GIP receptor]] and [[GLP-1 receptor]] ("twincretin"). (1) · 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) · Long-acting agonist of the [[GLP-1 receptor]]. (1) · Long-acting agonist of the [[GLP-1 receptor]]; Fc-fusion construct. (1) · Once-daily agonist of the [[GLP-1 receptor]]. (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:
preparations:
fda max:
None (1) · 1 g/d (oral); 6 g/d (IV) (1) · 1 mg/d typical Rx; higher in specific indications (1) · 1.8 mg/day SC (Victoza, T2DM)'"`UNIQ--ref-00000185-QINU`"' · 3.0 mg/day SC (Saxenda, obesity)'"`UNIQ--ref-00000186-QINU`"' (1) · 10 mg per 24 h (1) · 10 µg twice daily (Byetta)'"`UNIQ--ref-000000E7-QINU`"' · 2 mg once weekly (Bydureon BCise)'"`UNIQ--ref-000000E8-QINU`"' (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) · 15 mg/wk SC'"`UNIQ--ref-000002FE-QINU`"''"`UNIQ--ref-000002FF-QINU`"' (1) · 2 mg/wk SC (Ozempic)'"`UNIQ--ref-0000024B-QINU`"' · 2.4 mg/wk SC (Wegovy)'"`UNIQ--ref-0000024C-QINU`"' · 14 mg PO daily (Rybelsus)'"`UNIQ--ref-0000024D-QINU`"' (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) · 4.5 mg/wk SC'"`UNIQ--ref-00000055-QINU`"' (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) · 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 (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 strict ceiling; water-soluble vitamin, low toxicity (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 (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) · 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) · Glycemic effect within days; full weight effect over months'"`UNIQ--ref-00000301-QINU`"' (1) · Glycemic effect within days; near-maximal HbA1c effect by 4 weeks at any given dose'"`UNIQ--ref-00000057-QINU`"' (1) · Glycemic effect within days; weight effect over weeks to months'"`UNIQ--ref-00000188-QINU`"' (1) · Glycemic effect within days;<sup class="pcp-cn" title="This claim needs a citation.">&#91;[[Pharmacopedia:Citation needed|citation&nbsp;needed]]&#93;</sup> full weight effect over months'"`UNIQ--ref-00000250-QINU`"' (1) · Glycemic effect within hours (Byetta); weeks (Bydureon, extended-release microsphere)'"`UNIQ--ref-000000EA-QINU`"' (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) · 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) · 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)
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) · 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) · 8-12 hours (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) · ~10 hours (Byetta)'"`UNIQ--ref-000000EB-QINU`"' · ~7 days steady-state (Bydureon, after ~6–7 weeks of weekly dosing to reach steady state)'"`UNIQ--ref-000000EC-QINU`"' (1) · ~24 h (daily dosing)'"`UNIQ--ref-00000189-QINU`"' (1) · ~48 h sustained pain freedom in responders (1) · ~7 days (weekly dosing)'"`UNIQ--ref-00000058-QINU`"' (1) · ~7 days (weekly dosing)'"`UNIQ--ref-00000302-QINU`"' (1) · ~7 days (weekly SC dosing)'"`UNIQ--ref-00000251-QINU`"' · ~24 h (oral)'"`UNIQ--ref-00000252-QINU`"' (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. Discontinue at least 1 month before planned pregnancy. Animal data show embryofetal harm.'"`UNIQ--ref-0000005B-QINU`"' (1) · Avoid. Discontinue before planned pregnancy.'"`UNIQ--ref-000000EF-QINU`"' (1) · Avoid. Discontinue before planned pregnancy.'"`UNIQ--ref-0000018C-QINU`"' (1) · Avoid. Discontinue ≥1 month pre-conception. May reduce oral contraceptive efficacy during titration.'"`UNIQ--ref-00000304-QINU`"' (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; 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) · 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 (1) · 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) · Rx-only;'"`UNIQ--ref-0000005C-QINU`"' not a controlled substance (1) · Rx-only;'"`UNIQ--ref-000000F0-QINU`"' not a controlled substance (1) · Rx-only;'"`UNIQ--ref-0000018D-QINU`"' not a controlled substance (1) · Rx-only;'"`UNIQ--ref-00000256-QINU`"' not a controlled substance (1) · Rx-only;'"`UNIQ--ref-00000305-QINU`"' not a controlled substance (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]] 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 (15) · [[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)

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