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Medicines (732)

Medicines > starting dose

: 1 mg PO once daily

or 10 mg PO once daily; may increase to 20 mg as tolerated, or decrease to 5 mg if needed

or None

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None (238)

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Research material (131) · Classic Psychedelic (70) · Stimulant (43) · Opioid (29) · Sedative-Hypnotic (29) · Phenethylamine (26) · Tryptamine (26) · Botanical (23) · Benzodiazepine (22) · Anticonvulsant (19) · Dissociative (19) · Antidepressant (18) · Antiparkinsonian (16) · Antipsychotic (16) · Empathogen (16) · Analgesic (15) · Neuroleptic (15) · Plant Medicine (15) · Cathinone (14)

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5-HT2A agonist (27) · GABAA positive allosteric modulator (22) · None (20) · Monoamine releasing agent (11) · CB1/CB2 agonist (7) · Potent mu-opioid receptor agonist (6) · Sodium channel blocker (6) · Dopamine/norepinephrine reuptake inhibitor (5) · GABAA potentiator; NMDA antagonist (5) · Phenothiazine D2 antagonist (5) · Potent 5-HT2A agonist (5) · 5-HT1B/1D agonist (4) · LSD analogue; 5-HT2A agonist (4) · Mu-opioid receptor agonist (4) · Muscarinic receptor antagonist (4) · Prodrug of LSD; 5-HT2A agonist (4) · Selective norepinephrine reuptake inhibitor (4)

None (399) · 1 mg tablets (1) · 5 mg, 10 mg, 20 mg tablets (1) · A ''betel quid'': areca nut slice + betel leaf + slaked lime (calcium hydroxide) ± tobacco ± spices, chewed (1) · Acid/base extraction of fresh young grass for tryptamines; combined with an MAOI (1) · Bark/woody stem decocted with a DMT-source plant (''Psychotria viridis'', ''Diplopterys cabrerana'') to make ayahuasca (1) · Bicillin L-A 600,000; 1.2M; 2.4M U IM; aqueous crystalline (Pfizerpen) 5M, 20M U IV; procaine 600,000 U/mL IM (1) · Bright red seeds, traditionally ingested or smoked. Highly toxic, narrow margin between active and lethal (1) · Dried leaves and twigs, infused in a gourd (''mate'') and drunk through a metal straw (''bombilla'') (1) · Fermented and roasted seeds, ground. Mexican tradition: drunk with chili, cornmeal, achiote. European tradition: with sugar and milk (1) · Flowers or leaves infused or smoked. Highly variable potency; narrow toxic margin (1) · Fresh nuts chewed; also dried and powdered (1) · IR tablets 25, 100, 150, 200 mg; chewable dispersible tablets 2, 5, 25 mg; ODT 25, 50, 100, 200 mg; XR tablets 25, 50, 100, 200, 250, 300 mg (1) · Leaves and seeds, traditionally smoked or infused. Possibly the original Pythia oracle plant (1) · Leaves chewed with a pinch of slaked lime (the lime converts cocaine HCl to freebase for buccal absorption); also drunk as tea (''mate de coca'') (1) · Leaves, berries, root. Historically: belladonna cigarettes ("Asthmador") OTC in US until the 1970s (1) · Lithium carbonate: immediate-release capsules (150 mg, 300 mg, 600 mg) and tablets (300 mg); extended-release tablets (300 mg, 450 mg). Lithium citrate: oral solution (8 mEq/5 mL, equivalent to 300 mg lithium carbonate per 5 mL) for patients unable to swallow tablets. (1) · Oral tablets 50 mg (ReVia, Depade, generics); Vivitrol extended-release IM suspension 380 mg single-dose vial; Contrave (naltrexone 8 mg + bupropion 90 mg ER tablets); compounded 1, 2, 3, 4.5 mg tablets/capsules for LDN (1) · Parotid-gland venom expressed onto a glass plate, dried into a shellac-like resin, vaporized and inhaled (1) · Roasted seeds ground to powder, mixed with water; commercial syrups and energy drinks (1) · Root bark acid/base-extracted for DMT; or as the resurrected ''jurema preta'' brew (decocted with an MAOI such as ''Peganum harmala'') (1) · Root, traditionally carved into ''mannikens'' or infused into wine (1) · Tablets 5, 10, 40 mg (40 mg dispersible restricted to OTPs); oral concentrate 10 mg/mL; oral solution 1, 2, 10 mg/mL; injection 10 mg/mL (1) · Tablets: 100 mg, 200 mg (scored). [[Armodafinil]] (Nuvigil), the R-enantiomer of modafinil, is available separately as 50 mg, 150 mg, 200 mg, and 250 mg tablets. (1) · Toasted leaves and twigs decocted to a near-black concentrate (1)

None (414) · 1 mg/d (1) · 20 mg/d (1) · 400 mg/day (bipolar monotherapy); 700 mg/day (epilepsy with enzyme-inducing comedication) (1) · 400 mg/day.'"`UNIQ--ref-00000069-QINU`"' (1) · 50 mg/day oral; 380 mg/4 weeks IM (Vivitrol); 32 mg + 360 mg naltrexone/bupropion daily (Contrave maximum after titration) (1) · Indication-specific (1) · MOUD: typical effective max 24 mg/day sublingual (doses above offer limited additional mu-occupancy due to ceiling). Pain (Belbuca): 900 mcg every 12 hours. (1) · No defined absolute maximum; dosing is guided by serum level monitoring. Levels above 1.5 mEq/L carry increasing toxicity risk. Levels consistently above 1.2 mEq/L are generally not maintained in clinical practice.'"`UNIQ--ref-00000055-QINU`"' (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)

None (392) · buccal (Belbuca for pain) (1) · buccal); refined cocaine has its own profile (1) · IM (2) · IM (benzathine (1) · inhalation (2) · Inhalation (vaporized) (1) · insufflated (1) · intramuscular (depot) (1) · IV (2) · IV (aqueous crystalline); '''NEVER IV for benzathine — fatal cardiopulmonary events reported''' (1) · IV/IM (Buprenex). Oral swallowed: very low bioavailability due to first-pass; not therapeutic. (1) · Oral (23) · Oral (buccal) (1) · Oral (leaf (1) · Oral (primary) (1) · Oral (with MAOI) (2) · PR (1) · procaine) (1) · SC (1) · SC depot (Sublocade) (1) · smoked (extracted DMT) (1) · Sublingual (primary for MOUD) (1) · sublingual; rectal off-label (1) · topical (1) · transdermal (1) · transdermal (Butrans) (1)

None (407) · 20–60 min (oral) (1) · 30–60 min (1) · 30–60 minutes (1) · 45-75 min (oral) (1) · Antiepileptic effect within days at therapeutic level; mood-stabilizing effect emerges over weeks (1) · Antimanic effects begin within 5-7 days of reaching therapeutic serum levels, with full response often requiring 2-3 weeks. For acute mania, a neuroleptic is typically added for rapid sedation while lithium takes effect.'"`UNIQ--ref-00000056-QINU`"' (1) · Estrogen suppression within days; clinical effect over months (1) · IV: minutes; IM benzathine: depot levels last weeks (1) · Mood: 2–4 weeks. Pain: often within 1–2 weeks. (1) · Oral analgesic effect 30-60 minutes; opioid-withdrawal suppression 30 minutes (oral); IV ~10 minutes (1) · Oral peak plasma 1 hour; therapeutic opioid blockade within hours of first dose. IM Vivitrol: peak plasma 2-3 days; therapeutic blockade through the dosing interval. (1) · Peak plasma concentration in 2-4 hours after oral administration. Clinically perceptible wakefulness-promoting effects typically begin within 1-2 hours of dosing.[[[Pharmacopedia:Citation needed|citation needed]]] (1) · PO 1–2 h; IM 30–60 min; IV 5–20 min (1) · Seconds (1) · Sublingual analgesic effect 30-60 minutes; MOUD craving suppression within hours; Butrans patch steady-state in 3 days. (1) · Typical antidepressant 4-6 week onset (1)

None (407) · 12–24 h (oral); decanoate IM 3–4 weeks (1) · 24 hours (1) · 24 hours (often divided BID at higher doses) (1) · 4-8 h (1) · 8–12 hours (1) · About 20 minutes (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) · Chronic daily dosing (1) · Daily dosing (1) · Effective duration approximately 12-15 hours at the 200 mg dose, consistent with the elimination half-life. A single morning dose generally sustains wakefulness throughout the day without substantially disrupting nighttime sleep onset when taken early.'"`UNIQ--ref-0000006A-QINU`"' (1) · IM benzathine: 3-4 weeks of detectable levels (1) · IR 3–5 h; LA/SR 6–8 h; Concerta 10–12 h; Daytrana ~9 h wear time (1) · IR 4–6 h; XR 8–12 h (1) · MOUD: 24-72 hours per sublingual dose (long; permits every-other-day or three-times-weekly dosing in stable patients); Butrans patch: 7 days; Sublocade depot: 28+ days; Buprenex IV/IM: 6-8 hours. (1) · Oral mu-blockade clinically meaningful for 24-72 hours; IM Vivitrol blockade through 4 weeks. (1) · ~15 min (1)

None (409) · 14–26 h (oral); ~3 weeks (decanoate) (1) · 2.2 h (IR parent); ~3 h (XR parent) (1) · 2–3 h (parent compound) (1) · 3–5 hours (1) · 9–12 minutes (intravenous) (1) · Approximately 18-24 hours after acute administration; may extend to 36-48 hours with chronic dosing as tissue compartments equilibrate. Serum trough levels should be drawn 12 hours after the last dose for accurate interpretation.'"`UNIQ--ref-00000058-QINU`"' (1) · Aqueous crystalline ~30 minutes; benzathine effective ~3 weeks via depot release'"`UNIQ--ref-00001419-QINU`"' (1) · Buprenorphine sublingual: 24-42 hours (long, contributes to extended dosing intervals). Norbuprenorphine (active metabolite, weaker mu-agonist): 24-48 hours.'"`UNIQ--ref-0000004F-QINU`"' (1) · Naltrexone parent ~4 hours (oral); 6-beta-naltrexol (active metabolite) ~13 hours. Vivitrol depot terminal half-life 5-10 days with sustained release from microspheres maintaining blockade for the 4-week dosing interval.'"`UNIQ--ref-0000004F-QINU`"' (1) · Not well characterized (1) · ~12 hours (1) · ~25-33 hours alone; ~15 hours with enzyme inducers; '''≥60 hours with valproate''' (UGT inhibition)'"`UNIQ--ref-00000025-QINU`"' (1) · ~50 hours'"`UNIQ--ref-00000B64-QINU`"' (1) · ~66 hours (1)

None (409) · 70–90% (oral) (1) · Acid-labile; not effective orally (oral form available outside US as penicillin G salts but penicillin V is preferred for oral use)'"`UNIQ--ref-0000141A-QINU`"' (1) · High (oral; not significantly affected by food)'"`UNIQ--ref-00000B65-QINU`"' (1) · Not well characterized (1) · Oral bioavailability is not precisely established in the label but absorption is rapid and essentially complete. Food delays peak plasma concentration by approximately one hour but does not reduce the extent of absorption.'"`UNIQ--ref-0000006C-QINU`"' (1) · ~22–25% (1) · ~30% (high first-pass) (1) · ~30% (sublingual; the primary therapeutic route); ~10-20% (oral swallowed, low due to first-pass); ~50% (buccal Belbuca); transdermal Butrans bypasses first-pass.'"`UNIQ--ref-00000050-QINU`"' (1) · ~5-40% (oral, highly variable due to extensive first-pass metabolism; mean ~5-10% for parent naltrexone with the majority of pharmacologic effect coming from 6-beta-naltrexol). IM Vivitrol bypasses first-pass entirely.'"`UNIQ--ref-00000050-QINU`"' (1) · ~50% (highly variable) (1) · ~60–70% (oral) (1) · ~70-85% (oral, high relative to other opioids) (1) · ~75% (1) · ~98% (oral)'"`UNIQ--ref-00000026-QINU`"' (1)

None (413) · '''Among the safest mood stabilizers in pregnancy''' with reassuring monotherapy registry data, in sharp contrast to valproate. Estrogen-containing contraceptives accelerate lamotrigine metabolism, requiring dose adjustments at start and stop of contraception'"`UNIQ--ref-00000027-QINU`"' (1) · Category C (3) · Contraindicated in pregnancy (only used in postmenopausal women); D class historically.[[[Pharmacopedia:Citation needed|citation needed]]] (1) · Limited data; weigh benefits/risks (1) · Not established (2) · Penicillin G is the only fully effective syphilis treatment in pregnancy; penicillin-allergic pregnant patients require desensitization.[[[Pharmacopedia:Citation needed|citation needed]]] (1) · Pregnancy categories were retired by FDA in 2015. Limited reproductive data with small observational signal for cardiac malformations; risk-benefit decision, with many patients deferring ADHD treatment during pregnancy. See pregnancy_details for the full discussion. (1)

None (408) · 5-MeO-DMT is Schedule I in US (since 2011); the toad itself is protected in several southwestern states (1) · Leaves legal in Bolivia, Peru, Colombia; cocaine internationally controlled (1) · Not a controlled substance in the United States, European Union, United Kingdom, Canada, or Australia. Prescription-only in all of these jurisdictions due to the narrow therapeutic index and the need for serum monitoring. No abuse potential has been identified. (1) · Plant unrestricted; pharmaceutical atropine Rx-only (1) · Rx (1) · Rx-only (2) · Schedule I (United States) (1) · Schedule II (2) · [[USLegal:DEA Schedule I|Schedule I]] (United States) (2) · [[USLegal:Prescription only|Rx-only]] in US (2) · [[USLegal:Prescription only|Rx-only]] in US. Carries the FDA '''Boxed Warning for serious skin reactions''' including Stevens-Johnson syndrome and toxic epidermal necrolysis, with the risk concentrated in the first 2-8 weeks of therapy and elevated by rapid titration'"`UNIQ--ref-00000028-QINU`"' (1)