S

salmeterol

BLACK BOX ALERT Long-acting beta₂-adrenergic agonists may increase risk of asthma-related deaths and asthma-related hospitalizations in pediatric and adolescents. Use only as adjuvant therapy.

Do not confuse salmeterol with Solu-Medrol, or Serevent with Atrovent, Combivent, Serentil, or Sinemet.

Pharmacokinetics

Route	Onset	Peak	Duration
Inhalation (asthma)	30–45 min	2–4 hrs	12 hrs
Inhalation (COPD)	2 hrs	3.25–4.75 hrs	12 hrs

Low systemic absorption; acts primarily in lungs. Protein binding: 95%. Metabolized in liver by hydroxylation. Primarily eliminated in feces. Half-life: 5.5 hrs.

Uses

Maintenance therapy for asthma; prevention of exercise-induced bronchospasm, bronchospasm in pts with reversible obstructive airway disease including those with symptoms of nocturnal asthma. Long-term maintenance treatment of bronchospasm associated with COPD.

Precautions

Contraindications: Status asthmaticus, acute episodes of asthma or COPD. Use without concurrent long-term asthma control medications (e.g., inhaled corticosteroids). Cautions: Not for acute symptoms; may cause paradoxical bronchospasm, severe asthma. Pts with cardiovascular disorders (coronary insufficiency, arrhythmias, hypertension), seizure disorders, diabetes, hyperthyroidism, hepatic impairment, hypokalemia.

Lifespan considerations

Pregnancy/Lactation: Unknown if distributed in breast milk. Pregnancy Category C. Children: No age-related precautions in pts older than 4 yrs. Elderly: Lower dosages may be needed (may be more susceptible to tachycardia, tremors).

Interactions

DRUG: Beta-blockers reduce effect, may produce bronchospasm. CYP3A4 inhibitors (e.g., ketoconazole, protease inhibitors) may increase concentration, risk of QT prolongation. MAOIs, tricyclic antidepressants may increase concentration/effects, toxicity (wait 14 days after stopping MAOIs, tricyclic antidepressants before starting salmeterol). HERBAL: None significant. FOOD: None known. LAB VALUES: May decrease serum potassium. May increase serum glucose.

Availability (Rx)

Powder for Oral Inhalation: 50 mcg/inhalation.

Administration/handling

Inhalation

• Shake container well, instruct pt to exhale completely through mouth; place mouthpiece between lips, holding inhaler upright. • Inhale deeply through mouth while fully depressing top of canister. Pt should hold breath as long as possible before exhaling slowly. • Allow at least 2 min before second dose (allows for deeper bronchial penetration). • Rinse mouth with water immediately after inhalation (prevents mouth/throat dryness).

Indications/routes/dosage

Maintenance and prevention therapy for asthma

Inhalation (Diskus): ADULTS, ELDERLY, CHILDREN 4 YRS AND OLDER: 1 inhalation (50 mcg) q12h.

Prevention of exercise-induced bronchospasm

Inhalation (Diskus): ADULTS, ELDERLY, CHILDREN 4 YRS AND OLDER: 1 inhalation at least 30 min before exercise. Additional doses should not be given for 12 hrs. Do not administer if already giving salmeterol twice daily.

Maintenance therapy for COPD

Inhalation (Diskus): ADULTS, ELDERLY: 1 inhalation (50 mcg) q12h.

Side effects

Frequent (28%): Headache. Occasional (7%–3%): Cough, tremor, dizziness, vertigo, throat dryness/irritation, pharyngitis. Rare (less than 3%): Palpitations, tachycardia, nausea, heartburn, GI distress, diarrhea.

Adverse effects/toxic reactions

May prolong QT interval (can precipitate ventricular arrhythmias). Hypokalemia, hyperglycemia may occur.

Nursing considerations

Baseline assessment

Obtain baseline EKG and monitor for changes.

Intervention/evaluation

Monitor rate, depth, rhythm, type of respiration; quality/rate of pulse, B/P. Assess lungs for wheezing, rales, rhonchi. Periodically evaluate serum potassium levels.

Patient/family teaching

• Not for relief of acute episodes. • Keep canister at room temperature (cold decreases effects). • Do not stop medication or exceed recommended dosage. • Notify physician promptly of chest pain, dizziness. • Wait at least 1 full min before second inhalation. • Administer dose 30–60 min before exercise when used to prevent exercise-induced bronchospasm. • Avoid excessive use of caffeine derivatives (coffee, tea, colas, chocolate).

saquinavir

sa-kwin-a-veer

(Invirase)

Do not confuse saquinavir with Sinequan.

classification

PHARMACOTHERAPEUTIC: Protease inhibitor. CLINICAL: Antiretroviral (see pp. 71C, 120C).

Action

Inhibits HIV protease, rendering the enzyme incapable of processing polyprotein precursors needed to generate functional proteins in HIV-infected cells. Therapeutic Effect: Interferes with HIV replication, slowing progression of HIV infection.

Pharmacokinetics

Poorly absorbed after PO administration (absorption increased with high-calorie, high-fat meals). Protein binding: 99%. Metabolized in liver. Primarily eliminated in feces. Unknown if removed by hemodialysis. Half-life: 13 hrs.

Uses

Treatment of HIV infection in combination with at least two other antiretroviral agents.

Precautions

Contraindications: Concurrent use with alfuzosin, amiodarone, bepridil, dofetilide, ergot derivatives, flecainide, lidocaine, lovastatin, midazolam (oral), propafenone, quinidine, rifampin, ritonavir, sildenafil (when used for pulmonary arterial hypertension), simvastatin, trazodone, triazolam. Congenital or acquired QT prolongation, refractory hypokalemia or hypomagnesemia, concurrent medications that prolong QT interval, complete AV block (without pacemaker), severe hepatic impairment. Cautions: Preexisting conduction abnormalities, cardiovascular disease, mild to moderate hepatic impairment, hepatitis B or C, hemophilia, chronic alcoholism, cirrhosis, history of QT prolongation.

Lifespan considerations

Pregnancy/Lactation: Breastfeeding not recommended (possibility of HIV transmission). Pregnancy Category B. Children: Safety and efficacy not established. Elderly: Age-related renal/hepatic/cardiac impairment may require dosage adjustment.

Interactions

DRUG: May increase concentration/effects of atorvastatin, cyclosporine, tacrolimus, calcium channel-blocking agents, rifabutin, sildenafil, tadalafil, vardenafil. May decrease concentration/effects of efavirenz, methadone, oral contraceptives. CYP3A4 inhibitors (e.g., carbamazepine), phenobarbital, phenytoin, rifabutin may decrease concentration/effects. Delavirdine, atazanavir may increase concentration, toxicity. HERBAL: Garlic, St. John’s wort may decrease concentration/effects. FOOD: High calorie, high fat meal increases absorption. Grapefruit products may increase concentration (clinical significance unknown). LAB VALUES: May increase serum ALT, AST, amylase, creatine kinase, GGT, LDH, bilirubin, calcium, potassium, sodium, cholesterol, triglycerides. May decrease neutrophils, platelets, WBC count.

Availability (Rx)

Capsules (Invirase): 200 mg. Tablets (Invirase): 500 mg.

Administration/handling

PO

• Give within 2 hrs after a full meal. • Avoid grapefruit juice.

Indications/routes/dosage

Note: Do not initiate therapy if QT interval greater than 450 msec.

HIV infection in combination with other antiretrovirals

PO: ADULTS, ELDERLY: 1,000 mg (5 × 200 mg or 2 × 500 mg) twice a day in combination with ritonavir 100 mg twice a day.

Side effects

Occasional: Diarrhea, abdominal discomfort/pain, nausea, photosensitivity, stomatitis. Rare: Confusion, ataxia, asthenia (loss of strength, energy), headache, rash.

Adverse effects/toxic reactions

None known.

Nursing considerations

Baseline assessment

Obtain baseline laboratory testing, esp. hepatic function tests, before beginning therapy and at periodic intervals during therapy. Offer emotional support. Obtain medication history.

Intervention/evaluation

Monitor serum hepatic function tests, triglycerides, glucose, CD4 cell count, HIV RNA levels. Closely monitor for evidence of GI discomfort. Monitor daily pattern of bowel activity, stool consistency. Inspect mouth for signs of mucosal ulceration. Monitor serum chemistry tests for marked laboratory abnormalities. If serious or severe toxicities occur, interrupt therapy, contact physician.

Patient/family teaching

• Report persistent abdominal pain, nausea, vomiting. • Avoid exposure to sunlight, artificial light sources. • Continue therapy for full length of treatment. • Doses should be evenly spaced. • Saquinavir is not a cure for HIV infection, nor does it reduce risk of transmission to others. • Pts may continue to acquire illnesses associated with advanced HIV infection. • Take within 2 hrs after a full meal. • Avoid administration with grapefruit products.

sargramostim (granulocyte macrophage colony-stimulating factor, GM-CSF)

sar-gram-o-stim

(Leukine)

Do not confuse Leukine with leucovoran or Leukerin.

classification

PHARMACOTHERAPEUTIC: Colony-stimulating factor. CLINICAL: Hematopoietic, antineutropenic agent.

Action

Stimulates proliferation/differentiation of hematopoietic cells to activate mature granulocytes and macrophages. Therapeutic Effect: Assists bone marrow in making new WBCs, increases their chemotactic, antifungal, antiparasitic activity. Increases cytoneoplastic cells, activates neutrophils to inhibit tumor cell growth.

Pharmacokinetics

Route	Onset	Peak	Duration
IV (increase WBCs)	7–14 days	N/A	1 wk

Detected in serum within 5 min after subcutaneous administration. Peak serum levels: 1–3 hrs. Half-life: IV: 1 hr; Subcutaneous: 3 hrs.

Uses

Accelerates myeloid recovery in pts undergoing autologous or allogeneic bone marrow transplant or in pts who have undergone hematopoietic stem cell transplant following myeloablative chemotherapy. Prolongs survival in pts following bone marrow transplant in whom engraftment has been delayed or has failed. Enhances peripheral progenitor cell yield in autologous hematopoietic stem cell transplant. Shortens time to neutrophil recovery following induction chemotherapy of acute myelogenous leukemia (AML).

Precautions

Contraindications: Concurrent (24 hrs preceding or following) myelosuppressive chemotherapy or radiation, excessive leukemic myeloid blasts in bone marrow or peripheral blood (greater than 10%), known hypersensitivity to yeast-derived products. Cautions: Preexisting HF, fluid retention; autoimmune, chronic inflammatory disease; hypertention; cardiovascular disease; pulmonary disease (hypoxia, pulmonary infiltrates); renal/hepatic impairment.

Lifespan considerations

Pregnancy/Lactation: Unknown if drug crosses placenta or is distributed in breast milk. Pregnancy Category C. Children: Safety and efficacy not established. Elderly: No age-related precautions noted.

Interactions

DRUG: None significant. HERBAL: None significant. FOOD: None known. LAB VALUES: May increase serum bilirubin, creatinine, hepatic enzymes. May decrease serum albumin.

Availability (Rx)

Injection, Powder for Reconstitution: 250 mcg. Injection Solution: 500 mcg/ml.

Administration/handling

IV

Reconstitution • To 250-mcg vial, add 1 ml Sterile Water for Injection (preservative free) or Bactiostatic Water for Injection. Direct diluent to side of vial, gently swirl contents to avoid foaming; do not shake or vigorously agitate. • After reconstitution, further dilute in 25–50 ml 0.9% NaCl to a concentration of 10 mcg/ml or greater. If final concentration less than 10 mcg/ml, add 1 mg albumin/ml 0.9% NaCl to provide a final albumin concentration of 0.1% (e.g., 1 ml 5% albumin per 50 ml 0.9% NaCl).

◀ ALERT ▶ Albumin is added before addition of sargramostim (prevents drug adsorption to components of drug delivery system).

Rate of Administration • Give each single dose over 30 min, 2 hr, 6 hr, or continuous infusion.

Storage • Refrigerate powder, reconstituted solution, diluted solution for injection. • Do not shake. • Reconstituted solutions are clear, colorless. • Use within 6 hrs; discard unused portions. • Use 1 dose per vial; do not reenter vial.

IV incompatibilities

Amphotericin B complex (Abelcet, AmBisome, Amphotec), ondansetron (Zofran).

IV compatibilities

Dexamethasone (Decadron), diphenhydramine (Benadryl), famotidine (Pepcid), granisetron (Kytril), heparin, metoclopramide (Reglan), promethazine (Phenergan).

Indications/routes/dosage

Neutrophil recovery following chemotherapy in AML

IV Infusion: ADULTS, ELDERLY: 250 mcg/m²/day (as 4-hr infusion) starting approximately 4 days following completion of induction chemotherapy. Continue until ANC is greater than 1,500 cells/mm³ for 3 consecutive days to a maximum of 42 days.

Myeloid recovery following bone marrow transplant (BMT)

IV Infusion: ADULTS, ELDERLY: Usual parenteral dosage: 250 mcg/m²/day (as 2-hr infusion). Begin 2–4 hrs after autologous bone marrow infusion and not less than 24 hrs after last dose of chemotherapy or last radiation treatment. Continue until ANC is over 1,500 cells/mm³ for 3 consecutive days. Discontinue if blast cells appear or underlying disease progresses.

Bone marrow transplant failure, engraftment delay

IV Infusion: ADULTS, ELDERLY: 250 mcg/m²/day for 14 days. Infuse over 2 hrs. May repeat after 7 days off therapy if engraftment has not occurred. A third course with 500 mcg/m²/day for 14 days may be tried if engraftment still has not occurred.

Stem cell transplant, mobilization of peripheral blood progenitor cells

IV, Subcutaneous: ADULTS: 250 mcg/m²/day (IV as 24-hr infusion). Continue until ANC is over 1,500 cells/mm³ for 3 consecutive days.

Side effects

Frequent: GI disturbances (nausea, diarrhea, vomiting, stomatitis, anorexia, abdominal pain), arthralgia or myalgia, headache, malaise, rash, pruritus. Occasional: Peripheral edema, weight gain, dyspnea, asthenia (loss of strength, energy), fever, leukocytosis, capillary leak syndrome (fluid retention, irritation at local injection site, peripheral edema). Rare: Rapid/irregular heartbeat, thrombophlebitis.

Adverse effects/toxic reactions

Pleural/pericardial effusion occurs rarely after infusion.

Nursing considerations

Baseline assessment

Obtain baseline pulmonary function testing, weight, vital signs. Obtain baseline chemistry studies (CBC with differential, serum renal/hepatic function tests).

Intervention/evaluation

Monitor CBC with differential, serum renal/hepatic function, pulmonary function, vital signs, weight. Monitor for supraventricular arrhythmias during administration (particularly in pts with history of cardiac arrhythmias). Assess closely for dyspnea during and immediately following infusion (particularly in pts with history of lung disease). If dyspnea occurs during infusion, cut infusion rate by half. If dyspnea continues, stop infusion immediately. If neutrophil count exceeds 20,000 cells/mm³ or platelet count exceeds 500,000/mm³, stop infusion or reduce dose by half, based on clinical condition of pt. Blood counts return to normal or baseline 3–7 days after discontinuation of therapy.

saxagliptin

sax-a-glip-tin

(Onglyza)

Do not confuse saxagliptin with sitagliptin or sumatriptan.

Fixed-combination(s)

Kombiglyze XR: saxagliptin/metformin (an antidiabetic): 2.5 mg/1,000 mg, 5 mg/500 mg, 5 mg/1,000 mg.

classification

PHARMACOTHERAPEUTIC: DDP-4 inhibitor (gliptins). CLINICAL: Antidiabetic agent (see p. 44C).

Action

Slows the inactivation of incretin hormones by inhibiting DDP-4 enzyme. Incretin hormones increase insulin synthesis/release from pancreas and decrease glucagon secretion. Therapeutic Effect: Regulates glucose homeostasis.

Pharmacokinetics

Route	Onset	Peak	Duration
Oral	—	—	24 hrs

Rapidly absorbed following PO administration. Extensively metabolized (metabolite is active). Eliminated by both renal and hepatic pathways. Half-life: 2.5 hrs; metabolite, 3.1 hrs.

Uses

Adjunctive treatment to diet and exercise to improve glycemic control in pts with type 2 diabetes mellitus as monotherapy or in combination with other antidiabetic agents.

Precautions

Contraindications: None known. Cautions: Concurrent use of other glucose-lowering agents may increase risk of hypoglycemia, moderate to severe renal impairment, end-stage renal disease requiring hemodialysis, concurrent strong CYP3A4 inhibitors (e.g., clarithromycin).

Lifespan considerations

Pregnancy/Lactation: Unknown if distributed in breast milk. Pregnancy Category B. Children: Safety and efficacy not established. Elderly: Age-related renal impairment may require dosage adjustment.

Interactions

DRUG: CYP3A4 inhibitors (e.g., clarithromycin, itraconazole, ketoconazole) may increase concentration. CYP3A4 inducers (e.g., rifampin) may decrease concentration. HERBAL: Herbal supplements that have hypoglycemic effects increase risk of hypoglycemia. FOOD: Grapefruit products may increase concentration. LAB VALUES: May slightly decrease WBCs, particularly lymphocyte count. May increase serum creatinine.

Availability (Rx)

Tablets, Film-Coated: 2.5 mg, 5 mg.

Administration/handling

PO

• May give without regard to food. • Do not break, crush, dissolve, or divide film-coated tablets.

Indications/routes/dosage

Type 2 diabetes mellitus

PO: ADULTS OVER 18 YRS, ELDERLY: 2.5 or 5 mg once daily. Moderate to Severe Renal Impairment (CrCl Less Than 50 ml/min): 2.5 mg once daily. Concurrent Strong CYP3A4 Inhibitors (e.g., ketoconazole): 2.5 mg once daily. Hemodialysis: Give dose after dialysis.

Side effects

Occasional (7%): Headache. Rare (3%–1%): Peripheral edema, sinusitis, abdominal pain, gastroenteritis, vomiting, rash.

Adverse effects/toxic reactions

Lymphopenia, rash occur rarely. Upper respiratory tract infection, urinary tract infection occur in approximately 7% of pts.

Nursing considerations

Baseline assessment

Check blood glucose concentration before administration. Discuss lifestyle to determine extent of learning, emotional needs. Ensure follow-up instruction if pt or family does not thoroughly understand diabetes management or glucose-testing technique.

Intervention/evaluation

Assess for hypoglycemia (diaphoresis, tremors, dizziness, anxiety, headache, tachycardia, perioral numbness, hunger, diplopia, difficulty concentrating), hyperglycemia (polyuria, polyphagia, polydipsia, nausea, vomiting, dim vision, fatigue, deep, rapid breathing). Be alert to conditions that alter glucose requirements (fever, increased activity or stress, surgical procedures).

Patient/family teaching

• Diabetes mellitus requires lifelong control. Prescribed diet and exercise are principal parts of treatment; do not skip or delay meals. • Continue to adhere to dietary instructions, regular exercise program, regular testing of blood glucose. • When taking combination drug therapy or when glucose demands are altered (fever, infection, trauma, stress, heavy physical activity), have a source of glucose available to treat symptoms of hypoglycemia.

scopolamine

skoe-pol-a-meen

(Trans-Derm Scop, Transderm-V )

Fixed-combination(s)

Donnatal: scopolamine/atropine (anticholinergic)/hyoscyamine (anticholinergic)/phenobarbital (sedative): 0.0065 mg/0.0194 mg/0.1037 mg/16.2 mg.

classification

PHARMACOTHERAPEUTIC: Anticholinergic. CLINICAL: Antinausea, antiemetic.

Action

Competitively inhibits action of acetylcholine at muscarinic receptors. Reduces excitability of labyrinthine receptors, depressing conduction in vestibular cerebellar pathway. Therapeutic Effect: Prevents motion-induced nausea/vomiting.

Uses

Prevention of motion sickness, postop nausea/vomiting. OFF-LABEL: Breakthrough treatment of nausea/vomiting associated with chemotherapy.

Precautions

Contraindications: Narrow-angle glaucoma, GI/GU obstruction, myasthenia gravis, paralytic ileus, tachycardia secondary to cardiac insufficiency, thyrotoxicosis. Cautions: Hepatic/renal impairment, cardiac disease (hypertension, heart failure), seizures, psychoses, coronary artery disease, prostatic hyperplasia, urinary retention, reflux esophagitis, ulcerative colitis, hyperthyroidism.

Lifespan considerations

Pregnancy/Lactation: Crosses placenta; unknown if distributed in breast milk. Pregnancy Category C. Children: May be more susceptible to adverse effects. Elderly: Dizziness, hallucinations, confusion may require dosage adjustment.

Interactions

DRUG: Anticholinergics, antihistamines, tricyclic antidepressants may increase anticholinergic effects. CNS depressants may increase CNS depression. HERBAL: None significant. FOOD: Grapefruit products may increase concentration/effects. LAB VALUES: May interfere with gastric secretion test.

Availability (Rx)

Transdermal System (Trans-Derm Scop): 1.5 mg.

Administration/handling

Transdermal

• Apply patch to hairless area behind one ear. • If dislodged or on for more than 72 hrs, replace with fresh patch.

Indications/routes/dosage

Prevention of motion sickness

Transdermal: ADULTS: One system at least 4 hrs prior to exposure (best if 12 hrs before) and q72h as needed.

Postop nausea/vomiting

Transdermal: ADULTS, ELDERLY: 1 system no sooner than 1 hr before surgery and removed 24 hrs after surgery.

Side effects

Frequent (Greater Than 15%): Dry mouth, drowsiness, blurred vision. Rare (5%–1%): Dizziness, restlessness, hallucinations, confusion, difficulty urinating, rash.

Adverse effects/toxic reactions

None known.

Nursing considerations

Baseline assessment

Obtain baseline hepatic function tests. Assess for use of other CNS depressants, drugs with anticholinergic action, history of narrow-angle glaucoma.

Intervention/evaluation

Monitor serum hepatic/renal function tests. Observe for improvement of symptoms.

Patient/family teaching

• Avoid tasks requiring alertness, motor skills until response to drug is established (may cause drowsiness, disorientation, confusion). • Use only 1 patch at a time; do not cut. • Wash hands after administration.

selegiline

se-le-ji-leen

(Apo-Selegiline , Eldepryl, Emsam, Novo-Selegiline , Zelapar)

BLACK BOX ALERT Transdermal: Increased risk of suicidal thinking and behavior in children, adolescents, young adults 18–24 yrs with major depressive disorder, other psychiatric disorders.

Do not confuse Eldepryl with Elavil or enalapril, selegiline with Salagen, sertraline, or Stelazine, or Zelapar with Zaleplon, Zemplar, or Zyprexa.

classification

PHARMACOTHERAPEUTIC: MAOI. CLINICAL: Antiparkinson agent (see p. 146C).

Action

Irreversibly inhibits activity of monoamine oxidase type B (enzyme that breaks down dopamine), thereby increasing dopaminergic action. Therapeutic Effect: Relieves signs/symptoms of Parkinson’s disease (tremor, akinesia, posture/equilibrium disorders, rigidity).

Pharmacokinetics

Route	Onset	Peak	Duration
PO	1 hr	—	24–72 hrs

Rapidly absorbed from GI tract. Crosses blood-brain barrier. Protein binding: 90%. Metabolized in liver. Primarily excreted in urine. Half-life: PO: 10 hrs. Transdermal: 18–25 hrs.

Uses

Oral: Adjunct to levodopa/carbidopa in treatment of Parkinson’s disease. Transdermal: Treatment of major depressive disorder (MDD). OFF-LABEL: Treatment of ADHD, early Parkinson’s disease.

Precautions

Contraindications: Concurrent use of meperidine. Orally disintegrating tablet (additional): Concurrent use of dextromethorphan, methadone, tramadol, oral selegine, other MAOIs. Transdermal (additional): Pheochromocytoma; concurrent use of bupropion, selective serotonin reuptake inhibitors (e.g., fluoxetine), dual serotonin/norepinephrine reuptake inhibitors (e.g., duloxetine), tricyclic antidepressants, buspirone, tramadol, methadone, dextromethorphan, St. John’s wort, mirtazapine, cyclobenzaprine, oral selegine, other MAOIs, carbamazepine, oxcarbazepine. Elective surgery requiring general anesthesia, local anesthesia containing sympathomimetics; foods high in tyramine content. Cautions: Pts at high risk for suicide, depression, renal/hepatic impairment. Transdermal: Pts at risk for hypotension (cerebrovascular, cardiovascular disease, hypovolemia).

Lifespan considerations

Interactions

DRUG: Fluoxetine, fluvoxamine, paroxetine, sertraline, venlafaxine may cause mania, serotonin syndrome (altered mental status, restlessness, diaphoresis, diarrhea, fever). Meperidine may cause potentially fatal reaction (e.g., excitation, diaphoresis, rigidity, hypertension/hypotension, coma, death). Tricyclic antidepressants may cause asystole, diaphoresis, hypertension, syncope, altered mental status, hyperpyrexia, seizures, tremors (wait 14 days between stopping selegiline and starting tricyclic antidepressants). HERBAL: Kava kava, SAMe, St. John’s wort, valerian may increase risk of serotonin syndrome, excessive sedation. FOOD: Tyramine-rich foods may produce hypertensive reactions. LAB VALUES: None significant.

Availability (Rx)

Capsules (Eldepryl): 5 mg. Tablets (Eldepryl): 5 mg. Tablets (Orally Disintegrating [Zelapar]): 1.25 mg. Transdermal (Emsam): 6 mg/24 hrs, 9 mg/24 hrs, 12 mg/24 hrs.

Administration/handling

PO

• Give without regard to meals. • Avoid tyramine-containing foods, large quantities of caffeine-containing beverages.

PO (orally disintegrating tablets)

• Give in morning before breakfast and without liquid. • Peel off backing with dry hands (do not push tablets through foil). • Immediately place on top of tongue, allow to disintegrate. • Avoid food, liquids for 5 min before and after taking selegiline.

Transdermal

• Apply to dry, intact skin on upper torso or thigh, outer surface of upper arm.

Indications/routes/dosage

Adjunctive treatment of Parkinson’s disease

PO: ADULTS (ELDEPRYL): 10 mg/day in divided doses, such as 5 mg at breakfast and lunch, given concomitantly with each dose of carbidopa and levodopa. ELDERLY: Initially, 5 mg in the morning. May increase up to 10 mg/day. ADULTS, ELDERLY (ZELAPAR): Initially, 1.25 mg daily for at least 6 wks. May increase to 2.5 mg/day.

Major depressive disorder

Transdermal: ADULTS: Initially, 6 mg/24 hrs. May increase in 3 mg/24 hrs increments at minimum of 2 wks. Maximum: 12 mg/24 hrs. ELDERLY: 6 mg/24 hrs.

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Tags: Saunders Nursing Drug Handbook 2015

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