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Medicines > routes : Subcutaneous or ophthalmic or topical

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generic:
None (3)
brand:
classes:
[[:Category:Corticosteroids|Corticosteroid]] (7) · [[:Category:Antibacterials|Antibacterial]] (5) · [[:Category:Immunosuppressants|Immunosuppressant]] (4) · [[:Category:Analgesics|Analgesic]] (3) · [[:Category:Glucocorticoids|Glucocorticoid]] (3) · [[:Category:Insulins|Insulin]] (3) · Anti-CGRP ligand monoclonal antibody (2) · [[:Category:Antifungals|Antifungal]] (2) · [[:Category:Antineoplastics|Antineoplastic]] (2) · [[:Category:Biologics|Biologic]] (2) · [[:Category:DMARDs|DMARD]] (2) · [[:Category:Glucocorticoids|Glucocorticoid (intermediate-acting)]] (2) · [[:Category:Inhaled_corticosteroids|Inhaled corticosteroid (ICS)]] (2) · [[:Category:Mealtime_insulins|Mealtime (bolus) insulin]] (2) · [[:Category:NSAIDs|Non-steroidal anti-inflammatory (NSAID)]] (2) · [[:Category:Rapid-acting_insulins|Rapid-acting insulin analog]] (2) · [[:Category:Topical_antifungals|Topical antifungal]] (2)
mechanism:
None (32) · Humanized IgG2 monoclonal antibody binding both isoforms of CGRP peptide (1) · Humanized IgG2 monoclonal antibody binding the CGRP receptor (not the peptide); blocks CGRP-mediated vasodilation and nociceptive signaling (1) · Humanized IgG4 monoclonal antibody binding CGRP peptide; prevents CGRP from activating its receptor (1) · Tropane alkaloids: hyoscyamine (dominant; the racemic form is atropine), scopolamine. Competitive muscarinic antagonism. (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-00000584-QINU`"' Binds the same insulin receptor as endogenous insulin with comparable mitogenic-to-metabolic ratio. Ultra-rapid formulations (Lyumjev) add treprostinil and citrate to accelerate absorption further'"`UNIQ--ref-00000585-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-00000D11-QINU`"' Same mechanistic family as amphotericin B but with prohibitive systemic toxicity at therapeutic doses, hence restriction to topical and luminal-gut indications. No clinically meaningful resistance after decades of use'"`UNIQ--ref-00000D12-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-000010F8-QINU`"' Pre-treatment screening for latent TB (PPD or IGRA) and chronic hepatitis B is standard. Anti-drug antibody formation is a recognized cause of secondary loss of response'"`UNIQ--ref-000010F9-QINU`"'. (1) · '"`UNIQ--vote-00001233-QINU`"' Onychomycosis cure rates with nail lacquer are modest (mycologic cure ~30-50%, complete cure ~5-12% at 48 weeks); oral terbinafine remains substantially more effective when systemic therapy is acceptable'"`UNIQ--ref-00001234-QINU`"'. (1) · '"`UNIQ--vote-000014BC-QINU`"' Topical ophthalmic and otic formulations remain widely used in ENT and ophthalmology. Subject to all fluoroquinolone-class restrictions (tendinitis/rupture, peripheral neuropathy, QT prolongation)'"`UNIQ--ref-000014BD-QINU`"'. (1)
uses:
'"`UNIQ--vote-0000001B-QINU`"', '"`UNIQ--vote-0000001C-QINU`"', '"`UNIQ--vote-0000001D-QINU`"', '"`UNIQ--vote-0000001E-QINU`"', '"`UNIQ--vote-0000001F-QINU`"' (4) · Preventive treatment of migraine in adults (episodic and chronic) (2)
starting dose:
preparations:
fda max:
Indication-specific (5) · Titrated to glucose; no fixed maximum (2)
routes: (Click arrow to add another value)
onset:
None (1) · 1-2 hours (1) · 10 minutes (SC); 15-30 minutes (nasal); 30-60 minutes (oral) (1) · 15-30 minutes (oral); 1-2 minutes (IV) (1) · 30 minutes (IM); 30-60 minutes (oral) (1) · 30-60 minutes (oral); slower for topical (1) · 5-10 minutes (IV); 30 minutes (oral IR); slower for ER and rectal (1) · <1 minute (IV); 1-2 minutes (infiltration); 30+ minutes (patch on adult skin, faster on thinner pediatric skin) (1) · BP effect within hours (oral); IOP reduction within 30 minutes, full effect 1-2 weeks (ophthalmic) (1) · Caries reduction over months to years of consistent use (1) · Clinical and mycologic cure follows the full course; nail clearance over months of regrowth (1) · Days (2) · Days for calcium effect; weeks for PTH suppression (1) · Days for dermatophyte clearance; nail clearance over months (1) · Days for immunosuppressive effect (1) · Hours (7) · Hours (systemic); minutes (ophthalmic) (1) · Hours to days (1) · Hours to days for inflammation; substantial improvement within 1 week (1) · Immediate (IV) (1) · Inhaled: bronchial effect 1-2 weeks; nasal: symptom relief 12-24 hours; topical: hours (1) · Intranasal: symptom relief 12-24 hours; inhaled: bronchial effect 1-2 weeks (1) · LDL reduction ~50-60% from baseline at 1-2 weeks (1) · Minutes (1) · Onset of preventive effect over weeks; some patients respond after first dose (1) · Over weeks (2) · Rheumatologic effect at 4-8 weeks; ectopic resolution over 2-3 weeks (1) · SC: 5-15 minutes (Fiasp 2.5 minutes earlier on average) (1) · SC: 5-15 minutes; ultra-rapid Lyumjev faster (1) · SL/spray: 1-3 minutes; IV: minutes; patch: 30-60 minutes (1) · Sleep effect from first dose; antidepressant effect over 1-4 weeks (1) · Symptom relief within 24-48 hours of starting episodic treatment (1) · Symptom relief within days (1) · Symptomatic effect within weeks; full response by 12-24 weeks (1) · Topical hours; intra-articular days to weeks (1) · Topical: inflammation, erythema, crusting at 2 weeks; complete response weeks to months after course (1) · Topical: irritation within days; acne improvement 6-12 weeks; oral APL response within days (1) · Visible lightening at 4-12 weeks (1)
duration:
None (1) · 12 hours (1) · 12 hours (oral BID); 24 hours (Timoptic-XE) (1) · 12-24 hours per dose (1) · 2 weeks per dose (1) · 2-4 hours; headache recurrence rate ~20-30% within 24 hours (1) · 2-4 weeks per dose (1) · 24 hours (2) · 24 hours (HS dosing) (1) · 3-5 hours (2) · 3-5 hours (IR); 8-24 hours (ER); 12-24 hours (epidural / intrathecal) (1) · 30-90 minutes (infiltration without epinephrine); 90-200 minutes (with epinephrine); 12 hours (patch) (1) · 4-6 hours (2) · 6-12 hours systemic (1) · 6-8 hours (2) · 6-8 hours (IR oral); 12-24 hours (ER) (1) · 8 hours per oral dose (1) · 8-12 hours (1) · Biologic 12-36 hours (intermediate-acting) (1) · Biologic 36-54 hours (long-acting) (1) · Biologic ~8-12 hours (short-acting) (1) · Dosing-frequency dependent (1) · Hours per application (5) · Hours per dose (much shorter biologic effect than ergocalciferol/cholecalciferol because it is the already-active form, not the storage form) (1) · Hours per topical application (1) · Hours to days per application (1) · Intra-articular 3-6 months (depot effect of acetonide microcrystals) (1) · Monthly dosing (2) · Monthly or quarterly dosing (1) · N/A (2) · Once-weekly dosing in rheumatology (1) · Persistent activity 6+ hours (residual binding to skin and oral surfaces) (1) · Roughly 20-25% of an IV bolus remains intravascular at 1 hour (1) · SL: 30 minutes; patch: 12-14 hours; IV continuous (1) · Variable (1) · ~12-24 hours (dose-dependent; BID dosing often needed at higher doses) (1)
halflife:
bioavailability:
~100% from subcutaneous depot (2)
pregnancy:
None (4) · Limited data; avoid (3) · 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> (2)
legal:
None (1) · OTC (intranasal Flonase) and [[USLegal:Prescription only|Rx-only]] (inhaled, topical) in US (1) · OTC (low-dose topicals) and [[USLegal:Prescription only|Rx-only]] (other forms) in US (1) · OTC (lower strengths) and [[USLegal:Prescription only|Rx-only]] (combination with betamethasone) in US (1) · OTC (lower-concentration washes) and [[USLegal:Prescription only|Rx-only]] (Peridex oral rinse, ChloraPrep) in US (1) · OTC (lowest-strength topicals) and [[USLegal:Prescription only|Rx-only]] (higher strengths, injectable) in US (1) · OTC (most dentifrice and rinse) and [[USLegal:Prescription only|Rx-only]] (high-concentration paste/gel, supplements) in US (1) · OTC (Nasonex 24HR) and [[USLegal:Prescription only|Rx-only]] (other forms) in US (1) · OTC (ophthalmic ointment) and [[USLegal:Prescription only|Rx-only]] (other forms) in US (1) · OTC (topical) and [[USLegal:Prescription only|Rx-only]] (oral) in US (1) · Plant unrestricted; pharmaceutical atropine Rx-only (1) · Rx (3) · [[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 most formulations; some low-concentration topical formulations are [[USLegal:Over-the-counter|OTC]] (4% cream) (1) · [[USLegal:Prescription only|Rx-only]] for oral and most topical formulations in US; Voltaren Arthritis Pain 1% gel switched to [[USLegal:Over-the-counter|OTC]] in 2020 (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 (20) · [[USLegal:Prescription only|Rx-only]] in US (some OTC formulations exist) (1) · [[USLegal:Prescription only|Rx-only]] in US (the veterinary preparations are not for human use) (1) · [[USLegal:Prescription only|Rx-only]] in US since 2020 (OTC 2% formulations withdrawn under CARES Act due to safety concerns) (1) · [[USLegal:Prescription only|Rx-only]] in US. Carries '''Boxed Warning''' for risk of malignancy and serious infection; nephrotoxicity, hypertension, and immunosuppression-associated complications'"`UNIQ--ref-00000A93-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:Prescription only|Rx-only]] in US. Carries the antidepressant '''Boxed Warning''' for suicidality in children, adolescents, and young adults'"`UNIQ--ref-00000022-QINU`"' (1) · [[USLegal:Prescription only|Rx-only]] in US. Carries the same fluoroquinolone-class '''Boxed Warnings''' as ciprofloxacin/levofloxacin'"`UNIQ--ref-000014C5-QINU`"' (1) · [[USLegal:Schedule II|Schedule II controlled substance]] in US; WHO essential medicine'"`UNIQ--ref-00000022-QINU`"' (1)

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