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Medicines > routes : Inhaled or Topical ophthalmic or thigh

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classes:
[[:Category:Alpha-2_agonists|Alpha-2 adrenergic agonist]] (1) · [[:Category:Aminoglycosides|Aminoglycoside antibiotic]] (1) · [[:Category:Antibacterials|Antibacterial]] (4) · [[:Category:Carbonic_anhydrase_inhibitors|Carbonic anhydrase inhibitor (topical)]] (1) · [[:Category:Corticosteroids|Corticosteroid]] (3) · [[:Category:Fluoroquinolones|Fluoroquinolone antibiotic]] (3) · [[:Category:Glaucoma_medications|Glaucoma medication]] (4) · [[:Category:Glucocorticoids|Glucocorticoid]] (3) · [[:Category:H1_receptor_antagonists|Histamine H1 receptor antagonist]] (3) · [[:Category:Inhaled_corticosteroids|Inhaled corticosteroid (ICS)]] (3) · [[:Category:Intranasal_antihistamines|Intranasal antihistamine]] (1) · [[:Category:Mast_cell_stabilizers|Mast cell stabilizer]] (3) · [[:Category:Ocular_hypotensive_agents|Ocular hypotensive agent]] (4) · [[:Category:Ophthalmic_antihistamines|Ophthalmic antihistamine]] (2) · [[:Category:Prostaglandin_analogs|Prostaglandin F2α analog]] (2) · [[GLP-1 receptor agonist]] · [[Antidiabetic medicines|Antidiabetic]] · Fc-fusion biologic (1) · [[GLP-1 receptor agonist]] · [[Antidiabetic medicines|Antidiabetic]] · First-in-class incretin mimetic (1) · [[GLP-1 receptor agonist]] · [[Antidiabetic medicines|Antidiabetic]] · [[Anti-obesity medicines|Anti-obesity]] · [[Cardiovascular risk reduction]] agent (2) · [[GLP-1 receptor agonist]] · [[GIP receptor agonist]] · [[Antidiabetic medicines|Antidiabetic]] · [[Anti-obesity medicines|Anti-obesity]] · "Twincretin" (1)
uses:
[[Type 2 diabetes mellitus]] (adjunct, second-line) (1) · [[Type 2 diabetes mellitus]] (incl. pediatric ≥10 y) · [[Obesity]] (incl. pediatric ≥12 y) · [[Cardiovascular risk reduction]] in T2DM (1) · [[Type 2 diabetes mellitus]] · [[Cardiovascular risk reduction]] in T2DM (1) · [[Type 2 diabetes mellitus]] · [[Obesity]] · [[Cardiovascular risk reduction]] in obesity without diabetes · [[MASH]] with stage 2–3 fibrosis · [[Chronic kidney disease]] in T2DM (1) · [[Type 2 diabetes mellitus]] · [[Obesity]] · [[Obstructive sleep apnea]] in obesity (1) · '"`UNIQ--vote-000001D9-QINU`"', '"`UNIQ--vote-000001DA-QINU`"', '"`UNIQ--vote-000001DB-QINU`"', '"`UNIQ--vote-000001DC-QINU`"' (1) · '"`UNIQ--vote-00000415-QINU`"', '"`UNIQ--vote-00000416-QINU`"' (1) · '"`UNIQ--vote-00000932-QINU`"', '"`UNIQ--vote-00000933-QINU`"', '"`UNIQ--vote-00000934-QINU`"', '"`UNIQ--vote-00000935-QINU`"', '"`UNIQ--vote-00000936-QINU`"', '"`UNIQ--vote-00000937-QINU`"' (1) · '"`UNIQ--vote-0000099F-QINU`"', '"`UNIQ--vote-000009A0-QINU`"', '"`UNIQ--vote-000009A1-QINU`"', '"`UNIQ--vote-000009A2-QINU`"', '"`UNIQ--vote-000009A3-QINU`"', '"`UNIQ--vote-000009A4-QINU`"' (1) · '"`UNIQ--vote-00000B08-QINU`"', '"`UNIQ--vote-00000B09-QINU`"' (1) · '"`UNIQ--vote-00000CEF-QINU`"', '"`UNIQ--vote-00000CF0-QINU`"', '"`UNIQ--vote-00000CF1-QINU`"', '"`UNIQ--vote-00000CF2-QINU`"', '"`UNIQ--vote-00000CF3-QINU`"', '"`UNIQ--vote-00000CF4-QINU`"' (1) · '"`UNIQ--vote-00000D7C-QINU`"', '"`UNIQ--vote-00000D7D-QINU`"', '"`UNIQ--vote-00000D7E-QINU`"', '"`UNIQ--vote-00000D7F-QINU`"', '"`UNIQ--vote-00000D80-QINU`"', '"`UNIQ--vote-00000D81-QINU`"' (1) · '"`UNIQ--vote-00000D9E-QINU`"', '"`UNIQ--vote-00000D9F-QINU`"', '"`UNIQ--vote-00000DA0-QINU`"' (1) · '"`UNIQ--vote-00000F98-QINU`"', '"`UNIQ--vote-00000F99-QINU`"', '"`UNIQ--vote-00000F9A-QINU`"', '"`UNIQ--vote-00000F9B-QINU`"' (1) · '"`UNIQ--vote-000010AF-QINU`"', '"`UNIQ--vote-000010B0-QINU`"', '"`UNIQ--vote-000010B1-QINU`"', '"`UNIQ--vote-000010B2-QINU`"' (1) · '"`UNIQ--vote-000010CE-QINU`"', '"`UNIQ--vote-000010CF-QINU`"', '"`UNIQ--vote-000010D0-QINU`"' (1) · '"`UNIQ--vote-000011D7-QINU`"', '"`UNIQ--vote-000011D8-QINU`"' (1) · '"`UNIQ--vote-00001286-QINU`"' (1) · '"`UNIQ--vote-000013B3-QINU`"', '"`UNIQ--vote-000013B4-QINU`"', '"`UNIQ--vote-000013B5-QINU`"' (1)
starting dose:
0.75 mg SC weekly'"`UNIQ--ref-00000053-QINU`"' (1) · 1 drop in affected eye(s) TID (monotherapy); BID with timolol (Cosopt) (1) · 1 drop in the affected eye(s) once daily in the evening (1) · 1 drop in the affected eye(s) once daily in the evening (Lumigan); Latisse applied to upper lash line at bedtime (1) · 2.5 mg SC weekly × 4 wk (non-therapeutic ramp)'"`UNIQ--ref-000002FB-QINU`"' (1) · 400 mg PO/IV once daily (1) · 500-750 mg PO BID; 400 mg IV q8-12h (1) · 500-750 mg PO/IV once daily (1) · Byetta: 5 µg SC twice daily, within 60 min before morning and evening meals'"`UNIQ--ref-000000E3-QINU`"' · Bydureon BCise: 2 mg SC once weekly'"`UNIQ--ref-000000E4-QINU`"' (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) · 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) · Ophthalmic 1 drop in affected eye(s) TID; topical Mirvaso 0.33% gel applied to face daily (1) · Ophthalmic 1 drop in each eye every 8-12 hours (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) · Ozempic: 0.25 mg SC weekly × 4 wk'"`UNIQ--ref-00000245-QINU`"' · Wegovy: 0.25 mg SC weekly × 4 wk'"`UNIQ--ref-00000246-QINU`"' · Rybelsus: 3 mg PO daily × 30 d'"`UNIQ--ref-00000247-QINU`"' (1) · Victoza: 0.6 mg SC daily × 1 wk'"`UNIQ--ref-00000181-QINU`"' · Saxenda: 0.6 mg SC daily × 1 wk'"`UNIQ--ref-00000182-QINU`"' (1)
preparations:
0.005% ophthalmic solution (50 mcg/mL); typical 2.5 mL bottle (1) · 0.01%, 0.03% ophthalmic solution (1) · 0.025%, 0.035% ophthalmic solutions (1) · 0.1% (Patanol), 0.2% (Pataday once-daily original), 0.7% (Pataday 24-hour) ophthalmic solutions; 0.6% nasal spray (1) · 0.1%, 0.15% intranasal spray; 0.05% ophthalmic solution; combination Dymista (azelastine 0.137 mg + fluticasone 50 mcg/spray) (1) · 0.1%, 0.15%, 0.2% ophthalmic solutions; 0.33% topical gel; combinations with timolol (Combigan) and brinzolamide (Simbrinza) (1) · 2% ophthalmic solution (Trusopt); 2%/0.5% fixed combination with timolol (Cosopt, Cosopt PF) (1) · 250, 500, 750 mg IR tablets; 500, 1000 mg ER tablets (XR); 250, 500 mg/5 mL oral suspension; 200, 400 mg IV; 0.3% ophthalmic solution and ointment; 0.2% otic (1) · 250, 500, 750 mg tablets; 25 mg/mL oral solution; 25 mg/mL IV (premix bags 250, 500, 750 mg); 0.5%, 1.5% ophthalmic solutions (1) · 400 mg tablets; 400 mg/250 mL IV; 0.5% ophthalmic solution (1) · Byetta pre-filled multi-dose pen: 5 µg / 10 µg per dose'"`UNIQ--ref-000000E5-QINU`"' · Bydureon BCise single-dose autoinjector: 2 mg extended-release microsphere suspension'"`UNIQ--ref-000000E6-QINU`"' (1) · Inhaled MDI 44/110/220 mcg per actuation; DPI (Diskus) 50/100/250 mcg; nasal spray 50 mcg/actuation; cream/ointment 0.005%, 0.05% (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) · Nasonex 50 mcg/actuation intranasal; Asmanex HFA MDI 100/200 mcg; Asmanex Twisthaler DPI 110/220 mcg; Elocon 0.1% cream/ointment/lotion; Sinuva sinus implant; Dulera (with formoterol) (1) · Pre-filled multi-dose pen (0.25 / 0.5 / 1 / 2 mg, Ozempic;'"`UNIQ--ref-00000248-QINU`"' 0.25 / 0.5 / 1 / 1.7 / 2.4 mg, Wegovy'"`UNIQ--ref-00000249-QINU`"') · Oral tablet 3 / 7 / 14 mg co-formulated with SNAC absorption enhancer (Rybelsus)'"`UNIQ--ref-0000024A-QINU`"' (1) · Pre-filled multi-dose pen (3 mL): Victoza 6 mg/mL (0.6 / 1.2 / 1.8 mg per day);'"`UNIQ--ref-00000183-QINU`"' Saxenda 6 mg/mL (0.6 / 1.2 / 1.8 / 2.4 / 3.0 mg per day)'"`UNIQ--ref-00000184-QINU`"' (1) · Pre-filled single-dose pen and vial: 2.5 / 5 / 7.5 / 10 / 12.5 / 15 mg'"`UNIQ--ref-000002FC-QINU`"''"`UNIQ--ref-000002FD-QINU`"' (1) · Pre-filled single-dose pen: 0.75 / 1.5 / 3 / 4.5 mg'"`UNIQ--ref-00000054-QINU`"' (1) · Pulmicort Flexhaler DPI 90, 180 mcg/dose; Pulmicort Respules 0.25, 0.5, 1 mg/2 mL nebulized; Rhinocort intranasal 32 mcg/spray; Entocort EC 3 mg capsules; Uceris 9 mg ER tablets and rectal foam (1)
routes: (Click arrow to add another value)
halflife:
2-3 hours (normal renal function); markedly prolonged in renal impairment'"`UNIQ--ref-000010B3-QINU`"' (1) · 4 hours'"`UNIQ--ref-00000938-QINU`"' (1) · Not meaningfully described for ophthalmic use'"`UNIQ--ref-00001287-QINU`"' (1) · ~12 hours'"`UNIQ--ref-00000D82-QINU`"' (1) · ~13 hours'"`UNIQ--ref-0000018A-QINU`"' (1) · ~165 hours (~1 week), among the longest of any GLP-1 RA'"`UNIQ--ref-00000253-QINU`"' (1) · ~17 minutes (free acid, the active form, in aqueous humor)'"`UNIQ--ref-00000417-QINU`"' (1) · ~2-3.6 hours (plasma)'"`UNIQ--ref-000009A5-QINU`"' (1) · ~2.4 hours (Byetta, short, hence the BID schedule)'"`UNIQ--ref-000000ED-QINU`"' · Effective release half-life ~2 weeks (Bydureon)'"`UNIQ--ref-000000EE-QINU`"' (1) · ~22 hours; longer 54 hours (desmethylazelastine, active metabolite)'"`UNIQ--ref-000013B6-QINU`"' (1) · ~3 hours (systemic, when measurable; topical action dominates)'"`UNIQ--ref-000011D9-QINU`"' (1) · ~3 hours'"`UNIQ--ref-000010D1-QINU`"' (1) · ~4 months in erythrocytes (carbonic anhydrase binding in red cells; not relevant to topical IOP duration)'"`UNIQ--ref-00000B0A-QINU`"' (1) · ~45 minutes (free acid in aqueous humor)'"`UNIQ--ref-00000DA1-QINU`"' (1) · ~5 days (~120 h)'"`UNIQ--ref-00000059-QINU`"' (1) · ~5 days (~120 h)'"`UNIQ--ref-00000303-QINU`"' (1) · ~5 hours (plasma)'"`UNIQ--ref-00000F9C-QINU`"' (1) · ~6-8 hours'"`UNIQ--ref-00000CF5-QINU`"' (1) · ~7.8 hours (fluticasone propionate, inhaled systemic exposure)'"`UNIQ--ref-000001DD-QINU`"' (1)
bioavailability:
<1% oral (extensive first-pass via CYP3A4); ~30% inhaled lung deposition'"`UNIQ--ref-000001DE-QINU`"' (1) · Intranasal ~40% systemic; ophthalmic minimal'"`UNIQ--ref-000013B7-QINU`"' (1) · Intranasal: <1% systemic; inhaled lung deposition with extensive first-pass clearance'"`UNIQ--ref-00000F9D-QINU`"' (1) · IV/IM ~100%; inhaled: minimal systemic; oral: negligible (not used orally for systemic infection)'"`UNIQ--ref-000010B4-QINU`"' (1) · SC ~47%–65%'"`UNIQ--ref-0000005A-QINU`"' (1) · SC ~55%'"`UNIQ--ref-0000018B-QINU`"' (1) · SC ~65%–75%<sup class="pcp-cn" title="This claim needs a citation.">&#91;[[Pharmacopedia:Citation needed|citation&nbsp;needed]]&#93;</sup> (1) · SC ~80%<sup class="pcp-cn" title="This claim needs a citation.">&#91;[[Pharmacopedia:Citation needed|citation&nbsp;needed]]&#93;</sup> (1) · SC ~89%<sup class="pcp-cn" title="This claim needs a citation.">&#91;[[Pharmacopedia:Citation needed|citation&nbsp;needed]]&#93;</sup> · Oral ~0.4–1% (SNAC-enhanced)'"`UNIQ--ref-00000254-QINU`"' (1) · Topical with measurable systemic absorption (small CA inhibition observed clinically with chronic use)'"`UNIQ--ref-00000B0B-QINU`"' (1) · Topical with minimal systemic absorption'"`UNIQ--ref-000011DA-QINU`"' (1) · Topical with minimal systemic absorption'"`UNIQ--ref-00001288-QINU`"' (1) · Topical; clinically meaningful systemic absorption can produce systemic α2 effects (somnolence, hypotension), especially in children'"`UNIQ--ref-000010D2-QINU`"' (1) · Topical; minimal systemic absorption'"`UNIQ--ref-00000418-QINU`"' (1) · Topical; minimal systemic absorption'"`UNIQ--ref-00000DA2-QINU`"' (1) · ~6-13% inhaled lung deposition; ~10% oral (Entocort EC; extensive first-pass via CYP3A4 — this is the basis of the favorable hepatic-targeted local-effect profile in IBD)'"`UNIQ--ref-000009A6-QINU`"' (1) · ~70% (oral; reduced by divalent cations — antacids, iron, calcium, dairy)'"`UNIQ--ref-00000939-QINU`"' (1) · ~90% (oral; not affected by food but reduced by divalent cations)'"`UNIQ--ref-00000D83-QINU`"' (1) · ~99% (oral; matched 1:1 IV-to-PO conversion)'"`UNIQ--ref-00000CF6-QINU`"' (1)
pregnancy:
None (1) · '''Avoid in pregnancy where alternatives exist''' (animal cartilage toxicity).<sup class="pcp-cn" title="This claim needs a citation.">&#91;[[Pharmacopedia:Citation needed|citation&nbsp;needed]]&#93;</sup> (1) · '''Avoid in pregnancy where alternatives exist''' (animal cartilage toxicity; class-wide concern).<sup class="pcp-cn" title="This claim needs a citation.">&#91;[[Pharmacopedia:Citation needed|citation&nbsp;needed]]&#93;</sup> (1) · '''Avoid in pregnancy where alternatives exist''' (animal cartilage toxicity; class-wide concern); use only when benefit clearly outweighs.<sup class="pcp-cn" title="This claim needs a citation.">&#91;[[Pharmacopedia:Citation needed|citation&nbsp;needed]]&#93;</sup> (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. 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) · 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) · 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) · 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.<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 data; weigh against alternatives, though systemic exposure is low.<sup class="pcp-cn" title="This claim needs a citation.">&#91;[[Pharmacopedia:Citation needed|citation&nbsp;needed]]&#93;</sup> (1) · Limited data; weigh against alternatives.<sup class="pcp-cn" title="This claim needs a citation.">&#91;[[Pharmacopedia:Citation needed|citation&nbsp;needed]]&#93;</sup> (2) · 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)

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