G

gabapentin

(Apo-Gabapentin , Gralise, Horizant, Neurontin)

Do not confuse Neurontin with Motrin, Neoral, nitrofurantoin, Noroxin, or Zarontin.

Tablets, Extended-Release: (Horizant) 600 mg.

Administration/handling

PO

• Give without regard to meals; may give with food to avoid, reduce GI upset. • If treatment is discontinued or anticonvulsant therapy is added, do so gradually over at least 1 wk (reduces risk of loss of seizure control). Swallow extended-release tablets whole; do not break, crush, dissolve, or divide.

Indications/routes/dosage

Note: When given 3 times/day, maximum time between doses should not exceed 12 hrs.

Adjunctive therapy for seizure control

PO: ADULTS, ELDERLY, CHILDREN 13 YEARS AND OLDER: Initially, 300 mg 3 times a day. May titrate dosage. Range: 900–1,800 mg/day in 3 divided doses. Maximum: 3,600 mg/day. CHILDREN 3–12 YRS: Initially, 10–15 mg/kg/day in 3 divided doses. May titrate up to 25–35 mg/kg/day (for children 5–12 yrs) and 40 mg/kg/day (for children 3–4 yrs). Maximum: 50 mg/kg/day.

Adjunctive therapy for neuropathic pain

PO: ADULTS, ELDERLY: Initially, 100 mg 3 times a day; may increase by 300 mg/day at weekly intervals. Maximum: 3,600 mg/day in 3 divided doses. CHILDREN: Initially, 5 mg/kg/dose at bedtime, followed by 5 mg/kg/dose for 2 doses on day 2, then 5 mg/kg/dose for 3 doses on day 3. Maximum: 300 mg. Range: 8–35 mg/kg/day in 3 divided doses.

Postherpetic neuralgia

PO: ADULTS, ELDERLY: (Neurontin): 300 mg once on day 1, 300 mg twice a day on day 2, and 300 mg 3 times a day on day 3 as needed. Range: 1,800–3,600 mg/day. (Gralise): 300 mg once on day 1; 600 mg once on day 2; 900 mg once daily on days 3–6; 1,200 mg once daily on days 7–10; 1,500 mg once daily on days 11–14; then 1,800 mg once daily.

RLS

PO: ADULTS, ELDERLY (HORIZANT): 600 mg once daily at 5 PM.

Dosage in renal impairment

Dosage and frequency are modified based on creatinine clearance:

Creatinine Clearance	Dosage (Immediate-release)	(Extended-release)
60 ml/min or higher	300–1,200 mg tid	1,800 mg once/day
30–59 ml/min	200–700 mg q12h	600–1,800 mg once/day
16–29 ml/min	200–700 mg once daily	Not recommended
Less than 16 ml/min	100–300 mg once daily	Not recommended
Hemodialysis	125–350 mg after each 4-hr hemodialysis session

Horizant not recommended in pts with creatinine clearance less than 30 ml/min or pts on hemodialysis.

Side effects

Frequent (19%–10%): Fatigue, drowsiness, dizziness, ataxia. Occasional (8%–3%): Nystagmus (rapid eye movements), tremor, diplopia (double vision), rhinitis, weight gain. Rare (less than 2%): Anxiety, dysarthria (speech difficulty), memory loss, dyspepsia, pharyngitis, myalgia.

Adverse effects/toxic reactions

Abrupt withdrawal may increase seizure frequency, increased risk of suicidal behavior/thoughts. Overdosage may result in slurred speech, drowsiness, lethargy, diarrhea.

Nursing considerations

Baseline assessment

Review history of seizure disorder (type, onset, intensity, frequency, duration, LOC). Assess location, intensity of neuralgia/neuropathic pain.

Intervention/evaluation

Provide safety measures as needed. Monitor seizure frequency/duration, renal function, weight, behavior in children. Monitor signs/symptoms of depression, suicidal tendencies, other unusual behavior.

Patient/family teaching

• Use only as prescribed; do not abruptly stop taking drug (may increase seizure frequency). • Avoid tasks that require alertness, motor skills until response to drug is established. • Avoid alcohol. • Carry identification card/bracelet to note seizure disorder/anticonvulsant therapy. • Report suicidal ideation, depression, unusual behavioral changes (esp. with changes in dosage), worsening of seizure activity or loss of seizure control.

galantamine

gal-an-ta-meen

(Razadyne, Razadyne ER, Reminyl , Reminyl ER )

Do not confuse Razadyne with Rozerem, or Reminyl with Amaryl.

classification

PHARMACOTHERAPEUTIC: Cholinesterase inhibitor. CLINICAL: Antidementia.

Action

Elevates acetylcholine concentrations by slowing degeneration of acetylcholine released by still intact cholinergic neurons (Alzheimer’s disease involves degeneration of cholinergic neuronal pathways). Therapeutic Effect: Slows progression of Alzheimer’s disease.

Pharmacokinetics

Rapidly, completely absorbed from GI tract. Protein binding: 18%. Distributed to blood cells; binds to plasma proteins, mainly albumin. Metabolized in liver. Excreted in urine. Half-life: 7 hrs.

Uses

Treatment of mild to moderate dementia of Alzheimer’s type. OFF-LABEL: Severe dementia associated with Alzheimer’s disease, mild to moderate dementia associated with Parkinson’s disease, Lewy body dementia.

Precautions

Contraindications: None known. Cautions: Moderate renal/hepatic impairment (not recommended in severe impairment), history of ulcer disease, asthma, COPD, bladder outflow obstruction, supraventricular cardiac conduction conditions (except with pacemaker), seizure disorder, concurrent medications that slow cardiac conduction through SA or AV node.

Lifespan considerations

Pregnancy/Lactation: Unknown if drug crosses placenta or is distributed in breast milk. Pregnancy Category B. Children: Not prescribed for this pt population. Elderly: No age-related precautions noted, but use is not recommended in those with severe hepatic/renal impairment (creatinine clearance less than 9 ml/min).

Interactions

DRUG: May interfere with the effects of bethanechol, succinylcholine. Cimetidine, ketoconazole, paroxetine may increase concentration/effect. HERBAL: St. John’s wort may decrease concentration. FOOD: None known. LAB VALUES: None significant.

Availability (Rx)

Oral Solution (Razadyne): 4 mg/ml. Tablets (Razadyne): 4 mg, 8 mg, 12 mg.

Capsules (Extended-Release [Razadyne ER]): 8 mg, 16 mg, 24 mg.

Administration/handling

PO

• Give tablet or solution with morning and evening meals. • Mix oral solution with nonalcoholic beverage, take immediately. • Capsule should be given at breakfast.

Indications/routes/dosage

Alzheimer’s disease

PO (Immediate-Release Tablets, Oral Solution): ADULTS, ELDERLY: Initially, 4 mg twice a day (8 mg/day). After a minimum of 4 wks (if well tolerated), may increase to 8 mg twice a day (16 mg/day). After another 4 wks, may increase to 12 mg twice daily (24 mg/day). Range: 16–24 mg/day in 2 divided doses.

PO (Extended-Release): ADULTS, ELDERLY: Initially, 8 mg once daily for 4 wks; then increase to 16 mg once daily for 4 wks or longer. If tolerated, may increase to 24 mg once daily. Range: 16–24 mg once daily.

Dosage in renal/hepatic impairment

For moderate impairment, maximum dosage is 16 mg/day. Drug is not recommended for pts with severe impairment.

Side effects

Frequent (17%–7%): Nausea, vomiting, diarrhea, anorexia, weight loss. Occcasional (5%–4%): Abdominal pain, insomnia, depression, headache, dizziness, fatigue, rhinitis. Rare (less than 3%): Tremors, constipation, confusion, cough, anxiety, urinary incontinence.

Adverse effects/toxic reactions

Overdose may cause cholinergic crisis (increased salivation, lacrimation, urination, defecation, bradycardia, hypotension, muscle weakness). Treatment aimed at generally supportive measures, use of anticholinergics (e.g., atropine).

Nursing considerations

Baseline assessment

Assess cognitive, behavioral, functional deficits of pt. Obtain baseline serum hepatic/renal function tests.

Intervention/evaluation

Monitor cognitive, behavioral, functional status of pt. Evaluate EKG, periodic rhythm strips in pts with underlying arrhythmias. Assess for evidence of GI disturbances (nausea, vomiting, diarrhea, anorexia, weight loss).

Patient/family teaching

• Take with meals (reduces risk of nausea). • Avoid tasks that require alertness, motor skills until response to drug is established. • Report persistent GI disturbances, excessive salivation, diaphoresis, excessive tearing, excessive fatigue, insomnia, depression, dizziness, increased muscle weakness.

ganciclovir

gan-sye-kloe-veer

(Cytovene, Zirgan)

BLACK BOX ALERT Toxicity presents as neutropenia, thrombocytopenia, anemia. Studies suggest carcinogenic and teratogenic effects, inhibition of spermatogenesis.

Do not confuse Cytovene with Cytosar, or ganciclovir with acyclovir.

classification

PHARMACOTHERAPEUTIC: Synthetic nucleoside. CLINICAL: Antiviral (see p. 70C).

Action

Competes with viral DNA polymerase and incorporation into growing viral DNA chains. Therapeutic Effect: Interferes with DNA synthesis, viral replication.

Pharmacokinetics

Widely distributed (including CSF and ocular tissue). Protein binding: 1%–2%. Excreted primarily in urine. Removed by hemodialysis. Half-life: 1.7–5.8 hrs (increased in renal impairment).

Uses

Parenteral: Treatment of cytomegalovirus (CMV) retinitis in immunocompromised pts (e.g., HIV), prophylaxis of CMV infection in transplant pts. Ophthalmic: Treatment of acute herpetic keratitis. OFF-LABEL: CMV retinitis.

Precautions

Contraindications: Absolute neutrophil count less than 500/mm³, platelet count less than 25,000/mm³, hypersensitivity to acyclovir, ganciclovir. Cautions: Neutropenia, thrombocytopenia, renal impairment; children (long-term safety not determined due to potential for long-term carcinogenic, adverse reproductive effects).

Lifespan considerations

Pregnancy/Lactation: Effective contraception should be used during therapy; ganciclovir should not be used during pregnancy. Breastfeeding should be discontinued; may be resumed no sooner than 72 hrs after the last dose. Pregnancy Category C. Children: Safety and efficacy not established in those younger than 12 yrs. Elderly: Age-related renal impairment may require dosage adjustment.

Interactions

DRUG: Bone marrow depressants may increase myelosuppression. Imipenem may increase risk for generalized seizures. HERBAL: None significant. FOOD: None known. LAB VALUES: May increase BUN, serum creatinine, alkaline phosphatase, bilirubin, AST, ALT.

Availability (Rx)

Injection, Powder for Reconstitution (Cytovene): 500 mg. Ophthalmic Gel (Zirgan): 0.15%.

Administration/handling

IV

Reconstitution • Reconstitute 500-mg vial with 10 ml Sterile Water for Injection to provide concentration of 50 mg/ml; do not use Bacteriostatic Water (contains parabens, which is incompatible with ganciclovir). • Further dilute with 250–1,000 ml D₅W, 0.9% NaCl to provide a concentration of 10 mg/ml or less for infusion.

Rate of Administration • Administer only by IV infusion over at least 1 hr. • Do not give by IV push or rapid IV infusion (increases risk of toxicity); protect from infiltration (high pH causes severe tissue irritation). • Use large veins to permit rapid dilution, dissemination of ganciclovir (minimizes phlebitis); central venous ports may reduce catheter-associated infection.

Storage • Store vials at room temperature. Do not refrigerate. • Reconstituted solution in vial is stable for 12 hrs at room temperature. • After dilution, stable for 5 days at room tempearture or if refrigerated. • Discard if precipitate forms, discoloration occurs. • Avoid exposure to skin, eyes, mucous membranes. • Use latex gloves, safety glasses during preparation/handling of solution. • Avoid inhalation. • If solution contacts skin or mucous membranes, wash thoroughly with soap and water; rinse eyes thoroughly with plain water.

IV incompatibilities

Aldesleukin (Proleukin), amifostine (Ethyol), aztreonam (Azactam), cefepime (Maxipime), cytarabine (ARA-C), doxorubicin (Adriamycin), fludarabine (Fludara), foscarnet (Foscavir), gemcitabine (Gemzar), ondansetron (Zofran), piperacillin and tazobactam (Zosyn), sargramostim (Leukine), vinorelbine (Navelbine).

IV compatibilities

Amphotericin B, enalapril (Vasotec), filgrastim (Neupogen), fluconazole (Diflucan), granisetron (Kytril), propofol (Diprivan).

Indications/routes/dosage

Cytomegalovirus (CMV) retinitis

IV: ADULTS, CHILDREN 3 MOS AND OLDER: 5 mg/kg/dose q12h for 14–21 days, then 5 mg/kg/day as a single daily dose or 6 mg/kg 5 days a wk.

Prevention of CMV in transplant pts

IV: ADULTS, CHILDREN: 5 mg/kg/dose q12h for 7–14 days, then 5 mg/kg/day as a single daily dose dependent on clinical condition and degree of immunosuppression.

Congenital CMV

IV: NEONATES: 6 mg/kg/dose q12h for 6 wks (if HIV positive, longer duration considered).

Acute herpetic keratitis

Ophthalmic: ADULTS, ELDERLY: 1 drop 5 times/day until ulcer heals, then 1 drop 3 times/day for 7 days.

Dosage in renal impairment

Dosage and frequency are modified based on creatinine clearance (see table).

	Dosage
Creatinine Clearance	IV Induction	IV Maintenance
50–69 ml/min	2.5 mg/kg q12h	2.5 mg/kg q24h
25–49 ml/min	2.5 mg/kg q24h	1.25 mg/kg q24h
10–24 ml/min	1.25 mg/kg q24h	0.625 mg/kg q24h
Less than 10 ml/min	1.25 mg/kg 3 times/wk	0.625 mg/kg 3 times/wk
Hemodialysis (give after HD on HD days)	1.25 mg/kg q48–72h	0.625 mg/kg q48–72h
Peritoneal dialysis	1.25 mg/kg 3 times/wk	0.625 mg/kg 3 times/wk
Continuous renal replacement therapy Continuous venovenous hemofiltration Continuous venovenous hemodialysis/continuous venovenous hemodiafiltration	2.5 mg/kg q24h 2.5 mg/kg q12h	1.25 mg/kg q24h 2.5 mg/kg q24h

Side effects

Frequent (41%–13%): Diarrhea, fever, nausea, abdominal pain, vomiting. Occasional (11%–6%): Diaphoresis, infection, paresthesia, flatulence, pruritus. Rare (4%–2%): Headache, stomatitis, dyspepsia, phlebitis.

Adverse effects/toxic reactions

Hematologic toxicity occurs commonly: leukopenia (41%–29%), anemia (25%–19%). Intraocular implant occasionally results in visual acuity loss, vitreous hemorrhage, retinal detachment. GI hemorrhage occurs rarely.

Nursing considerations

Baseline assessment

Evaluate hematologic baseline. Perform baseline ophthalmic exam. Obtain specimens for support of differential diagnosis (urine, feces, blood, throat) since retinal infection is usually due to hematogenous dissemination.

Intervention/evaluation

Monitor I&O, ensure adequate hydration (minimum 1,500 ml/24 hrs). Diligently evaluate hematology reports for neutropenia, thrombocytopenia, leukopenia. Obtain periodic ophthalmic examinations. Question pt regarding visual acuity, therapeutic improvement, complications. Assess for rash, pruritus.

Patient/family teaching

• Ganciclovir provides suppression, not cure, of cytomegalovirus (CMV) retinitis. • Frequent blood tests, eye exams are necessary during therapy due to toxic nature of drug. • Report any new symptom promptly. • May temporarily or permanently inhibit sperm production in men, suppress fertility in women. • Barrier contraception should be used during and for 90 days after therapy due to mutagenic potential.

gefitinib

ge-fi-ti-nib

(Iressa)

Do not confuse gefitinib with erlotinib, dasatinib, imatinib, or lapatinib.

classification

PHARMACOTHERAPEUTIC: Tyrosine kinase inhibitor. CLINICAL: Antineoplastic (see p. 86C).

Action

Inhibits epidermal growth factor receptor–tyrosine kinase (EGFR-TK), a key driver in tumor cell growth. Interrupts angiogenesis and metastasis. Therapeutic Effect: Inhibits tumor cell proliferation and survival.

Pharmacokinetics

Slowly absorbed after PO administration. Peak plasma levels in 3–7 hrs. Protein binding: 90%. Metabolized in liver. Excreted primarily in feces (86%). Half-life: 48 hrs.

Uses

Treatment of locally advanced or metastatic non–small-cell lung cancer (NSCLC) after failure with platinum-based or docetaxel therapies. OFF-LABEL: First-line treatment of NSCLC with known EGFR mutation.

Precautions

◀ ALERT ▶ Product contains lactose. Not recommended for pts who are lactose intolerant.

Contraindications: None known. Cautions: Hepatic impairment, lung disease, ocular disease, concurrent administration of CYP3A4 inducers and inhibitors.

Lifespan considerations

Pregnancy/Lactation: Avoid pregnancy. Unknown if crosses placenta or is distributed in breast milk. Nursing mothers must either discontinue breastfeeding or discontinue therapy. Pregnancy Category D. Children: Safety and efficacy not established in those younger than 18 yrs. Elderly: No age-related precautions noted.

Interactions

DRUG: CYP3A4 inhibitors (e.g., clarithromycin, ketoconazole) may increase concentration. CYP3A4 inducers (e.g., phenytoin, rifampin) may decrease concentration. H₂ antagonists (e.g., ranitidine) may decrease concentration. May increase bleeding risk with warfarin. HERBAL: St. John’s wort may decrease effectiveness. FOOD: Avoid grapefruit products. LAB VALUES: May increase serum AST, ALT, bilirubin, urine protein.

Availability (Rx)

Tablets: 250 mg.

Administration/handling

• May give without regard to meals. • Avoid grapefruit products. • Do not crush or cut. Swallow whole or administer as dispersion in water. Gently swirl glass for up to 20 min and immediately ingest once dispersed.

Indications/routes/dosage

Non–small-cell lung cancer

PO: ADULTS: 250 mg daily. (Concomitant CYP3A4 inducers: consider increasing dose to 500 mg daily.)

Side effects

Frequent: Diarrhea, anorexia, hematuria, epistaxis, vomiting, nausea, stomatitis, rash, pruritus, asthenia (loss of strength, energy). Occasional: Conjunctivitis, blepharitis, dry eye, dehydration, dry mouth, alopecia, pyrexia. Rare: Aberrant eyelash growth, urticaria.

Adverse effects/toxic reactions

Hepatotoxicity, pancreatitis, Stevens-Johnson syndrome (toxic epidermal necrolysis), cutaneous vasculitis, cystitis, corneal ulcer/erosion, ocular bleeding, hypothyroidism was reported. Interstitial lung disease (ILD) reported in 1.3% of pts; must consider interrupting treatment and promptly investigate. Allergic reactions including angioedema, urticaria reported in 1.5%.

Nursing considerations

Baseline assessment

Obtain baseline CBC with differential, serum chemistries, hepatic function test, thyroid function test, PT/INR (if taking warfarin), EGRF mutation serostatus. Question possibility of pregnancy or plans of breastfeeding. Receive full medication history including vitamins, minerals, herbal products. Assess visual acuity.

Intervention/evaluation

Assess vital signs, O₂ saturation routinely. Routinely monitor CBC with differential, hepatic function tests. Worsening cough, fever, or shortness of breath may indicate interstitial lung disease. Consider ophthalmologic evaluation for vision changes. Monitor for bruising, hematuria, jaundice, right upper abdominal pain, weight loss, or acute infection (fever, diaphoresis, lethargy, productive cough). Monitor for skin lesions.

Patient/family teaching

• Blood levels will be drawn routinely. • Report urine changes, bloody or clay-colored stools, upper abdominal pain, nausea, vomiting, bruising, fever, cough, difficulty breathing. • Immediately report any newly prescribed medications, suspected pregnancy, vision changes (eye pain, bleeding, sensitivity to light), or persistent diarrhea, dehydration. • Avoid alcohol. • Avoid grapefruit products.

gemcitabine

jem-sye-ta-been

(Gemzar)

Do not confuse gemcitabine with gemtuzumab, Gemzar with Zinecard.

classification

PHARMACOTHERAPEUTIC: Antimetabolite. CLINICAL: Antineoplastic (see p. 86C).

Action

Inhibits ribonucleotide reductase, the enzyme necessary for catalyzing DNA synthesis. Therapeutic Effect: Produces death of cells undergoing DNA synthesis.

Pharmacokinetics

Not extensively distributed after IV infusion (increased with length of infusion). Protein binding: less than 10%. Metabolized intracellularly by nucleoside kinases. Excreted primarily in urine. Half-life: Influenced by duration of infusion. Infusion 1 hr or less: 42–94 min; infusion 3–4 hrs: 4–10.5 hrs.

Uses

Metastatic breast cancer in combination with paclitaxel. Treatment of locally advanced (stage II, III) or metastatic (stage IV) adenocarcinoma of pancreas. Indicated for pts previously treated with 5-fluorouracil. Monotherapy or in combination with cisplatin for treatment of locally advanced or metastatic non–small-cell lung cancer (NSCLC), ovarian cancer. OFF-LABEL: Treatment of biliary tract carcinoma, bladder carcinoma, germ cell tumors (e.g., testicular), Hodgkin’s lymphoma, non-Hodgkin’s lymphoma, acute leukemia; cervical, head, and neck cancer.

Precautions

Contraindications: None known. Cautions: Renal/hepatic impairment, pregnancy, elderly, concurrent radiation therapy.

Lifespan considerations

Pregnancy/Lactation: If possible, avoid use during pregnancy, esp. first trimester. May cause fetal harm. Unknown if distributed in breast milk. Breastfeeding not recommended. Pregnancy Category D. Children: Safety and efficacy not established. Elderly: Increased risk of hematologic toxicity.

Interactions

DRUG: Bone marrow depressants may increase risk of myelosuppression. Live virus vaccines may potentiate virus replication, increase vaccine side effects, decrease pt’s antibody response to vaccine. HERBAL: Echinacea may decrease effects. FOOD: None known. LAB VALUES: May increase BUN, serum alkaline phosphatase, bilirubin, creatinine, AST, ALT. May decrease Hgb, Hct, leukocyte count, platelet count.

Availability (Rx)

Injection, Powder for Reconstitution: 200-mg, 1-g, 2-g vials. Injection, Solution: 38 mg/ml.

Administration/handling

IV

Reconstitution • Use gloves when handling/preparing gemcitabine. • Reconstitute 200-mg or 1-g vial with 0.9% NaCl injection without preservative (5 ml or 25 ml, respectively) to provide concentration of 38 mg/ml. • Shake to dissolve.

Rate of Administration • May give without further dilution. • May be further diluted with 50–500 ml 0.9% NaCl to a concentration as low as 0.1 mg/ml. • Infuse over 30 min. • Infusion time greater than 60 min increases toxicity.

Storage • Store at room temperature (refrigeration may cause crystallization). • Reconstituted solution is stable for 24 hrs at room temperature. Do not refrigerate.

IV incompatibilities

Acyclovir (Zovirax), amphotericin B (Fungizone), cefotaxime (Claforan), furosemide (Lasix), ganciclovir (Cytovene), imipenem and cilastatin (Primaxin), irinotecan (Camptosar), methotrexate, methylprednisolone (Solu-Medrol), mitomycin (Mutamycin), piperacillin/tazobactam (Zosyn), prochlorperazine (Compazine).

IV compatibilities

Bumetanide (Bumex), calcium gluconate, dexamethasone (Decadron), diphenhydramine (Benadryl), dobutamine (Dobutrex), dopamine (Intropin), granisetron (Kytril), heparin, hydrocortisone (Solu-Cortef), lorazepam (Ativan), ondansetron (Zofran), potassium chloride.

Indications/routes/dosage

◀ ALERT ▶ Dosage is individualized based on clinical response, tolerance to adverse effects. When used in combination therapy, consult specific protocols for optimum dosage, sequence of drug administration.

Breast cancer

IV: ADULTS, ELDERLY: (in combination with paclitaxel): 1,250 mg/m² over 30 min on days 1 and 8 of each 21-day cycle.

Non–small-cell lung cancer (NSCLC)

IV: ADULTS, ELDERLY, CHILDREN: (in combination with cisplatin): 1,000 mg/m² on days 1, 8, and 15, repeated every 28 days; or 1,250 mg/m² on days 1 and 8. Repeat every 21 days.

Ovarian cancer

IV: ADULTS, ELDERLY: (in combination with carboplatin): 1,000 mg/m² on days 1 and 8 of each 21-day cycle.

Pancreatic cancer

IV: ADULTS: 1,000 mg/m² once weekly for up to 7 wks or until toxicity necessitates decreasing dosage or withholding the dose, followed by 1 wk of rest. Subsequent cycles should consist of once-weekly dose for 3 consecutive wks out of every 4 wks. For pts completing cycles at 1,000 mg/m², increase dose to 1,250 mg/m² as tolerated. Dose for next cycle may be increased to 1,500 mg/m².

Dosage reduction guidelines

Pancreatic cancer, non–small-cell lung cancer (NSCLC)

Dosage adjustments should be based on granulocyte count and platelet count, as follows:

Absolute Granulocyte Counts (cells/mm³)	Platelet Count (cells/mm³)	% of Full Dose
1,000 and	100,000	100
500–999 or	50,000–99,000	75
Less than 500 or	Less than 50,000	Hold

Breast cancer

Absolute Granulocyte Counts (cells/mm³)	Platelet Count (cells/mm³)	% of Full Dose
Equal to or greater than 1,200 and	Greater than 75,000	100
1,000–1,199 or	50,000–75,000	75
700–999 and	Equal to or greater than 50,000	50
Less than 700 or	Less than 50,000	Hold

Ovarian cancer

Absolute Granulocyte Counts (cells/mm³)	Platelet Count (cells/mm³)	% of Full Dose
1,500 or greater and	100,000 or greater	100
1,000–1,499 and/or	75,000–99,999	50
Less than 1,000 and/or	Less than 75,000	Hold