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Medicines > routes : Subcutaneous (abdomen or Topical or rectal

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generic:
brand:
classes:
[[:Category:Corticosteroids|Corticosteroid]] (6) · [[:Category:Analgesics|Analgesic]] (4) · [[:Category:Antibacterials|Antibacterial]] (3) · [[:Category:Glucocorticoids|Glucocorticoid]] (3) · [[:Category:Antiemetics|Antiemetic]] (2) · [[:Category:Antifungals|Antifungal]] (2) · [[:Category:Antipyretics|Antipyretic]] (2) · [[:Category:Inhaled_corticosteroids|Inhaled corticosteroid (ICS)]] (2) · [[:Category:NSAIDs|Non-steroidal anti-inflammatory (NSAID)]] (2) · [[:Category:Topical_antifungals|Topical antifungal]] (2) · [[GLP-1 receptor agonist]] · [[Antidiabetic medicines|Antidiabetic]] · [[Anti-obesity medicines|Anti-obesity]] · [[Cardiovascular risk reduction]] agent (2)
mechanism:
None (30) · 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) · 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) · 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-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-00001067-QINU`"' Chronic use is associated with cathartic colon (colonic dilation, loss of haustration), hypokalemia, and laxative dependence; reserved for short-term use or bowel prep with breaks between courses'"`UNIQ--ref-00001068-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)
uses:
'"`UNIQ--vote-0000001B-QINU`"', '"`UNIQ--vote-0000001C-QINU`"', '"`UNIQ--vote-0000001D-QINU`"', '"`UNIQ--vote-0000001E-QINU`"', '"`UNIQ--vote-0000001F-QINU`"' (3)
starting dose:
preparations:
fda max:
None (1) · '''4.5 mg/kg (without epinephrine), 7 mg/kg (with epinephrine)''' for infiltration; serum level monitoring required for prolonged IV antiarrhythmic use (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 µg twice daily (Byetta)'"`UNIQ--ref-000000E7-QINU`"' · 2 mg once weekly (Bydureon BCise)'"`UNIQ--ref-000000E8-QINU`"' (1) · 100 mg/day (adult) (1) · 15 mg/wk SC'"`UNIQ--ref-000002FE-QINU`"''"`UNIQ--ref-000002FF-QINU`"' (1) · 150 mg/day (oral); use lowest effective dose for shortest duration per FDA NSAID class guidance (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) · 200 mg/day (typical adult oral) (1) · 250 mg/d (1) · 30 mg/d for short-term use (1) · 300 mg/day (depression, hospitalized); 150 mg/day outpatient; 6 mg/day for insomnia (1) · 300 mg/day (oral) (1) · 4 g/d (rarely tolerated due to GI effects) (1) · 4 g/d in healthy adults; 3 g/d conservative limit; 2 g/d in cirrhosis or chronic alcohol use (1) · 4% topical; limit duration of use (1) · 4.5 mg/wk SC'"`UNIQ--ref-00000055-QINU`"' (1) · 4.8 g/d (IV severe infection) (1) · 40 mg/day (oral, anxiety) (1) · 4000 mg/day (analgesic) (1) · 50 g/week (cream/ointment); 2-week continuous limit; 4-week maximum cumulative (1) · BID topical; once daily nail lacquer (1) · Formulation-specific; ~4.8 g/d typical maximum oral (1) · ICS 880 mcg/d (asthma); intranasal 200 mcg/d (1) · Indication-specific (4) · Indication-specific; high-dose IV regimens for encephalitis or disseminated disease (1) · Indication-specific; titrated to effect (1) · Intranasal 200 mcg/d (adults); inhaled 880 mcg/d (1) · Limit topical to 10-day courses to reduce resistance pressure (1) · No fixed ceiling; titrate to clinical effect and tolerability with CDC opioid prescribing guidance constraints on morphine-milligram-equivalent (MME) totals (1) · Per formulation (1) · Single 200-400 mcg/kg per dose for systemic indications (1) · Titrated; risk of hypercalcemia is the limiting factor (1) · Topical: BID; troche: 5×/day (1) · Topical: nightly; oral APL: 45 mg/m²/d (1) · Topical: nightly; systemic: regimen-specific (1) · Topical: per formulation; oral supplement age-dependent (1) · ~4 g/d (severe systemic infection) (1) · ~500 mg/d typical (1)
routes: (Click arrow to add another value)
onset:
None (1) · 1-3 days (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) · 30-60 minutes (oral); rapid relief in acute gout (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) · Antiplatelet effect within 30-60 minutes; analgesic effect 30-60 minutes (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) · 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) · Hours (5) · Hours to days (1) · Hours to days for inflammation; substantial improvement within 1 week (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) · Minutes (1) · PO 6-12 hours; PR 15-60 minutes (1) · PO: 30-60 minutes; IV: minutes (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 improvement 2-4 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) · '''Antiplatelet effect lasts the platelet's lifetime (~7-10 days)''' due to irreversible COX-1 acetylation; analgesic 4-6 hours (1) · 12-24 hours per dose (1) · 24 hours (2) · 24 hours (HS dosing) (1) · 24 hours (most ER formulations) (1) · 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 (3) · 4-6 hours (IR); 24 hours (ER) (1) · 6-24 hours (parent); much longer when accounting for the long-lived active metabolites (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 36-54 hours (long-acting) (1) · Biologic ~8-12 hours (short-acting) (1) · Hours (2) · 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) · N/A (2) · Persistent activity 6+ hours (residual binding to skin and oral surfaces) (1) · SL: 30 minutes; patch: 12-14 hours; IV continuous (1) · Variable (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) · ~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) · Avoid from 20 weeks gestation onward per FDA's 2020 expanded NSAID warning (fetal renal dysfunction, oligohydramnios); contraindicated from 30 weeks (risk of premature ductus arteriosus closure)'"`UNIQ--ref-0000002B-QINU`"' (1) · Avoid from 20 weeks gestation onward per FDA's 2020 expanded NSAID warning; contraindicated from 30 weeks (risk of premature ductus arteriosus closure, which is paradoxically the basis of the neonatal PDA-closure indication)'"`UNIQ--ref-00000028-QINU`"' (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) · Chronic third-trimester exposure produces neonatal opioid withdrawal syndrome and respiratory depression at delivery.<sup class="pcp-cn" title="This claim needs a citation.">&#91;[[Pharmacopedia:Citation needed|citation&nbsp;needed]]&#93;</sup> (1) · Extensive use experience in obstetric anesthesia; broadly considered safe'"`UNIQ--ref-00000022-QINU`"' (1) · Generally avoided in pregnancy.<sup class="pcp-cn" title="This claim needs a citation.">&#91;[[Pharmacopedia:Citation needed|citation&nbsp;needed]]&#93;</sup> (1) · Generally considered acceptable for short-term use.<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 absorption).<sup class="pcp-cn" title="This claim needs a citation.">&#91;[[Pharmacopedia:Citation needed|citation&nbsp;needed]]&#93;</sup> (2) · 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 at standard doses; benefits typically outweigh in active IBD.<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.<sup class="pcp-cn" title="This claim needs a citation.">&#91;[[Pharmacopedia:Citation needed|citation&nbsp;needed]]&#93;</sup> (2) · Generally considered safe; commonly used 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; 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; generally avoided in pregnancy for the cosmetic indication of onychomycosis.<sup class="pcp-cn" title="This claim needs a citation.">&#91;[[Pharmacopedia:Citation needed|citation&nbsp;needed]]&#93;</sup> (1) · Limited data; risk-benefit case by case; pregnancy is not a strict contraindication in WHO mass drug administration programs.<sup class="pcp-cn" title="This claim needs a citation.">&#91;[[Pharmacopedia:Citation needed|citation&nbsp;needed]]&#93;</sup> (1) · Long the preferred analgesic-antipyretic in pregnancy; recent observational studies have raised speculative neurodevelopmental signals that remain under investigation.<sup class="pcp-cn" title="This claim needs a citation.">&#91;[[Pharmacopedia:Citation needed|citation&nbsp;needed]]&#93;</sup> (1) · Low-dose (81 mg) safe and indicated for preeclampsia prophylaxis after 12 weeks in high-risk patients per USPSTF; high-dose aspirin avoid third trimester due to premature ductus arteriosus closure and bleeding risk (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) · Safe at routine fluoride levels.<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) · TCA class signal; limited human data specific to doxepin.<sup class="pcp-cn" title="This claim needs a citation.">&#91;[[Pharmacopedia:Citation needed|citation&nbsp;needed]]&#93;</sup> (1) · Topical and vaginal generally considered safe; widely used.<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/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) · 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) · 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 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:
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) · OTC and [[USLegal:Prescription only|Rx-only]] (IV, combination products) in US (1) · OTC in US (2) · Plant unrestricted; pharmaceutical atropine 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) · [[USLegal:Over-the-counter|OTC]] for most oral and topical formulations; [[USLegal:Prescription only|Rx-only]] for injectable (1) · [[USLegal:Over-the-counter|OTC]] in US at all standard strengths (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]] in US (13) · [[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 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:Schedule II|Schedule II controlled substance]] in US; WHO essential medicine'"`UNIQ--ref-00000022-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-0000002C-QINU`"' (1)

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