gabapentin H
gah-bah-pen-tin
(Apo-Gabapentin J, Gabarone, Neurontin, Novo-Gabapentin J)
Do not confuse Neurontin with Neoral, Noroxin.
G CLASSIFICATION
CLINICAL: Anticonvulsant, antineuralgic.
ACTION
An anticonvulsant and antineuralgic agent whose exact mechanism unknown. May increase the synthesis or accumulation of gamma-aminobutyric acid by binding to as-yet-undefined receptor sites in brain tissue. Therapeutic Effect: Reduces seizure activity and neuropathic pain.
PHARMACOKINETICS
Well absorbed from the GI tract (not affected by food). Protein binding: less than 5%. Widely distributed. Crosses the blood-brain barrier. Primarily excreted unchanged in urine. Removed by hemodialysis. Half-life: 5U7 hr (increased in impaired renal function and the elderly).
USES
Adjunct in treatment of partial seizures in children 12 yr and older and adults (with or without secondary generalized seizures, partial seizures in children 3U12 yr); adjunct in treatment of neuropathic pain, postherpetic neuralgia. OFF-LABEL: Treatment of bipolar disorder, chronic pain, diabetic peripheral neuropathy, essential tremor, hot flashes, hyperhidrosis, migraines, psychiatric disorders (social phobia).
PRECAUTIONS
CONTRAINDICATIONS: None known. CAUTIONS: Renal impairment.
B LIFESPAN CONSIDERATIONS: Pregnancy/Lactation: Unknown whether it is distributed in breast milk. Pregnancy Category C. Children: Safety and efficacy not established in those 3 yr and younger. Elderly: Age-related renal impairment may require dosage adjustment.
INTERACTIONS
DRUG: Antacids (aluminum- and magnesium-containing): May decrease gabapentin's effectiveness. HERBAL: None known. FOOD: None known. LAB VALUES: May decrease serum WBC count.
AVAILABILITY (Rx)
CAPSULES (NEURONTIN): 100 mg, 300 mg, 400 mg. ORAL SOLUTION (NEURONTIN): 250 mg/5 ml. TABLETS (NEURONTIN): 100 mg, 300 mg, 400 mg, 600 mg, 800 mg.
ADMINISTRATION/HANDLING
PO
N Give without regard to meals; may give with food to avoid or reduce GI upset. N If treatment is discontinued or anticonvulsant therapy is added, do so gradually over at least 1 wk (reduces risk of loss of seizure control).
INDICATIONS/ROUTES/DOSAGE
ADJUNCTIVE THERAPY FOR SEIZURE CONTROL
PO: ADULTS, ELDERLY, CHILDREN OLDER THAN 12 YR: Initially, 300 mg 3 times a day. May titrate dosage. Range: 900U1,800 mg/day in 3 divided doses. Maximum: 3,600 mg/day. CHILDREN 3U12 YR: Initially, 10U15 mg/kg/day in 3 divided doses. May titrate up to 25U35 mg/kg/day (for children 5U12 yr) and 40 mg/kg/day (for children 3U4 yr). 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. Range: 8U35 mg/kg/day in 3 divided doses.
POSTHERPETIC NEURALGIA
PO: ADULTS, ELDERLY: 300 mg on day 1, 300 mg twice a day on day 2, and 300 mg 3 times a day on day 3. Titrate up to 1,800 mg/day.
DOSAGE IN RENAL IMPAIRMENT
Dosage and frequency are modified based on creatinine clearance:
Creatinine Clearance Dosage
60 ml/min or higher 400 mg q8h
30U59 ml/min 300 mg q12h
16U29 ml/min 300 mg daily
Less than 16 ml/min 300 mg every other day
Hemodialysis 200U300 mg after each 4-hr hemodialysis session
SIDE EFFECTS
FREQUENT (19%U10%): Fatigue, somnolence, dizziness, ataxia. OCCASIONAL (8%U3%): Nystagmus, tremor, diplopia, rhinitis, weight gain. RARE (less than 2%): Nervousness, dysarthria, memory loss, dyspepsia, pharyngitis, myalgia.
ADVERSE REACTIONS/TOXIC EFFECTS
Abrupt withdrawal may increase seizure frequency. Overdosage may result in diplopia, slurred speech, drowsiness, lethargy, and diarrhea.
NURSING CONSIDERATION
BASELINE ASSESSMENT
Review history of seizure disorder (type, onset, intensity, frequency, duration, level of consciousness [LOC]). Routine laboratory monitoring of serum levels unnecessary for safe use.
INTERVENTION/EVALUATION
Provide safety measures as needed. Monitor seizure frequency/duration, renal function, weight, behavior in children.
PATIENT/FAMILY TEACHING
N Take gabapentin only as prescribed; do not abruptly stop taking drug (may increase seizure frequency). N Avoid tasks that require alertness, motor skills until response to drug is established. N Avoid alcohol. N Carry identification card/bracelet to note seizure disorder/anticonvulsant therapy.
gabapentin H
gah-bah-pen-tin
(Apo-Gabapentin J, Gabarone, Neurontin, Novo-Gabapentin J)
Do not confuse Neurontin with Neoral, Noroxin.
G CLASSIFICATION
CLINICAL: Anticonvulsant, antineuralgic.
ACTION
An anticonvulsant and antineuralgic agent whose exact mechanism unknown. May increase the synthesis or accumulation of gamma-aminobutyric acid by binding to as-yet-undefined receptor sites in brain tissue. Therapeutic Effect: Reduces seizure activity and neuropathic pain.
PHARMACOKINETICS
Well absorbed from the GI tract (not affected by food). Protein binding: less than 5%. Widely distributed. Crosses the blood-brain barrier. Primarily excreted unchanged in urine. Removed by hemodialysis. Half-life: 5U7 hr (increased in impaired renal function and the elderly).
USES
Adjunct in treatment of partial seizures in children 12 yr and older and adults (with or without secondary generalized seizures, partial seizures in children 3U12 yr); adjunct in treatment of neuropathic pain, postherpetic neuralgia. OFF-LABEL: Treatment of bipolar disorder, chronic pain, diabetic peripheral neuropathy, essential tremor, hot flashes, hyperhidrosis, migraines, psychiatric disorders (social phobia).
PRECAUTIONS
CONTRAINDICATIONS: None known. CAUTIONS: Renal impairment.
B LIFESPAN CONSIDERATIONS: Pregnancy/Lactation: Unknown whether it is distributed in breast milk. Pregnancy Category C. Children: Safety and efficacy not established in those 3 yr and younger. Elderly: Age-related renal impairment may require dosage adjustment.
INTERACTIONS
DRUG: Antacids (aluminum- and magnesium-containing): May decrease gabapentin's effectiveness. HERBAL: None known. FOOD: None known. LAB VALUES: May decrease serum WBC count.
AVAILABILITY (Rx)
CAPSULES (NEURONTIN): 100 mg, 300 mg, 400 mg. ORAL SOLUTION (NEURONTIN): 250 mg/5 ml. TABLETS (NEURONTIN): 100 mg, 300 mg, 400 mg, 600 mg, 800 mg.
ADMINISTRATION/HANDLING
PO
N Give without regard to meals; may give with food to avoid or reduce GI upset. N If treatment is discontinued or anticonvulsant therapy is added, do so gradually over at least 1 wk (reduces risk of loss of seizure control).
INDICATIONS/ROUTES/DOSAGE
ADJUNCTIVE THERAPY FOR SEIZURE CONTROL
PO: ADULTS, ELDERLY, CHILDREN OLDER THAN 12 YR: Initially, 300 mg 3 times a day. May titrate dosage. Range: 900U1,800 mg/day in 3 divided doses. Maximum: 3,600 mg/day. CHILDREN 3U12 YR: Initially, 10U15 mg/kg/day in 3 divided doses. May titrate up to 25U35 mg/kg/day (for children 5U12 yr) and 40 mg/kg/day (for children 3U4 yr). 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. Range: 8U35 mg/kg/day in 3 divided doses.
POSTHERPETIC NEURALGIA
PO: ADULTS, ELDERLY: 300 mg on day 1, 300 mg twice a day on day 2, and 300 mg 3 times a day on day 3. Titrate up to 1,800 mg/day.
DOSAGE IN RENAL IMPAIRMENT
Dosage and frequency are modified based on creatinine clearance:
Creatinine Clearance Dosage
60 ml/min or higher 400 mg q8h
30U59 ml/min 300 mg q12h
16U29 ml/min 300 mg daily
Less than 16 ml/min 300 mg every other day
Hemodialysis 200U300 mg after each 4-hr hemodialysis session
SIDE EFFECTS
FREQUENT (19%U10%): Fatigue, somnolence, dizziness, ataxia. OCCASIONAL (8%U3%): Nystagmus, tremor, diplopia, rhinitis, weight gain. RARE (less than 2%): Nervousness, dysarthria, memory loss, dyspepsia, pharyngitis, myalgia.
ADVERSE REACTIONS/TOXIC EFFECTS
Abrupt withdrawal may increase seizure frequency. Overdosage may result in diplopia, slurred speech, drowsiness, lethargy, and diarrhea.
NURSING CONSIDERATION
BASELINE ASSESSMENT
Review history of seizure disorder (type, onset, intensity, frequency, duration, level of consciousness [LOC]). Routine laboratory monitoring of serum levels unnecessary for safe use.
INTERVENTION/EVALUATION
Provide safety measures as needed. Monitor seizure frequency/duration, renal function, weight, behavior in children.
PATIENT/FAMILY TEACHING
N Take gabapentin only as prescribed; do not abruptly stop taking drug (may increase seizure frequency). N Avoid tasks that require alertness, motor skills until response to drug is established. N Avoid alcohol. N Carry identification card/bracelet to note seizure disorder/anticonvulsant therapy.
gatifloxacin
gat-ih-flocks-ah-sin
(Tequin, Tequin Teqpaq, Zymar)
G CLASSIFICATION
PHARMACOTHERAPEUTIC: Fluoroquinolone. CLINICAL: Antibiotic.
ACTION
A fluoroquinolone that inhibits two enzymes, topoisomerase II and IV, in susceptible microorganisms. Therapeutic Effect: Interferes with bacterial DNA replication. Prevents or delays resistance emergence. Bactericidal.
PHARMACOKINETICS
Well absorbed from the GI tract after PO administration. Protein binding: 20%. Widely distributed. Metabolized in liver. Primarily excreted in urine. Half-life: 7U14 hr.
USES
Treatment of susceptible infections due to S. pneumoniae, S. aureus, S. pyogenes, H. influenzae, M. catarrhalis, E. coli, M. pneumoniae, C. pneumoniae, Legionella pneumophila, P. mirabilis, N. gonorrhoeae including infections due to acute bacterial exacerbation of chronic bronchitis, acute sinusitis, community-acquired pneumonia, uncomplicated skin and skin-structure infections, cystitis, complicated UTIs, pyelonephritis, urethral gonorrhea in men and women, endocervical and rectal gonorrhea in women. Ophthalmic: Topical treatment of bacterial conjunctivitis due to susceptible strains of bacteria.
PRECAUTIONS
CONTRAINDICATIONS: Hypersensitivity to quinolones diabetic patients. CAUTIONS: Renal or hepatic impairment, CNS disorders, cerebral atherosclerosis, seizures, those with prolonged QT interval, other medications known to prolong the QT interval (e.g., erythromycin, tricyclic antidepressants), uncorrected hypokalemia, those receiving quinidine, procainamide, amiodarone, sotalol.
B LIFESPAN CONSIDERATIONS: Pregnancy/Lactation: Unknown if distributed in breast milk. Pregnancy Category C. Children: Safety and efficacy not established. Elderly: Age-related renal impairment may require dosage adjustment.
INTERACTIONS
DRUG: Antacids, digoxin, iron preparations: May decrease gatifloxacin plasma concentration and half-life. Probenecid: May increase gatifloxacin plasma concentration and half-life. HERBAL: None known. FOOD: None known. LAB VALUES: None known.
AVAILABILITY (Rx)
TABLETS (TEQUIN, TEQUIN TEQPAQ): 200 mg, 400 mg. INJECTION (TEQUIN): 200-mg, 400-mg vials. OPHTHALMIC SOLUTION (ZYMAR): 0.3%.
ADMINISTRATION/HANDLING
L IV
Rate of administration N Infuse over 60 min N Do not give by rapid or bolus IV.
Storage N Available prediluted and ready for use N Also available in 20- and 40-ml vials, which must be diluted in 100U200 ml D5W, 0.9% NaCl.
PO
N Give without regard to meals. N Oral gatifloxacin should be administered 4 hr before giving antacids, multivitamins, ferrous sulfate, buffered tablets or solutions.
OPHTHALMIC
N Tilt patient's head backward, have patient look up. N Gently pull lower eyelid down until pocket formed. N Hold dropper above pocket and without touching eyelid or conjunctival sac place drops into center of pocket. N Close eyes gently, apply gentle finger pressure to lacrimal sac at inner canthus. N Remove excess solution around eye with a tissue.
IV INCOMPATIBILITIES
Amphotericin (Fungizone), potassium phosphate.
IV COMPATIBILITIES
Aminophylline, calcium gluconate, hydromorphone (Dilaudid), lidocaine, lorazepam (Ativan), magnesium sulfate, methylprednisolone (Solu-Medrol), metoclopramide (Reglan), midazolam (Versed), morphine, nitroglycerin, potassium chloride, sodium phosphate.
INDICATIONS/ROUTES/DOSAGE
CHRONIC BRONCHITIS, COMPLICATED URINARY TRACT INFECTIONS, PYELONEPHRITIS, SKIN INFECTIONS
PO, IV: ADULTS, ELDERLY: 400 mg/day for 7U10 days (5 days for chronic bronchitis).
SINUSITIS
PO, IV: ADULTS, ELDERLY: 400 mg/day for 10 days.
PNEUMONIA
PO, IV: ADULTS, ELDERLY: 400 mg/day for 7U14 days.
CYSTITIS
PO, IV: ADULTS, ELDERLY: 400 mg as a single dose or 200 mg/day for 3 days.
URETHRAL GONORRHEA IN MEN AND WOMEN, ENDOCERVICAL AND RECTAL GONORRHEA IN WOMEN
PO, IV: ADULTS, ELDERLY: 400 mg as a single dose.
TOPICAL TREATMENT OF BACTERIAL CONJUNCTIVITIS DUE TO SUSCEPTIBLE STRAINS OF BACTERIA
OPHTHALMIC: ADULTS, ELDERLY, CHILDREN 1 YR AND OLDER: 1 drop q2h while awake for 2 days, then 1 drop up to 4 times/day for days 3U7.
DOSAGE IN RENAL IMPAIRMENT
Creatinine Clearance Dosage
40 ml/min 400 mg/day
Less than 40 ml/min Initially, 400 mg/day then 200 mg/day
Hemodialysis Initially, 400 mg/day then 200 mg/day
Peritoneal dialysis Initially, 400 mg/day then 200 mg/day
SIDE EFFECTS
OCCASIONAL (8%U3%): Nausea, vaginitis, diarrhea, headache, dizziness. Ophthalmic: conjunctival irritation, increased tearing, corneal inflammation. RARE (3%U0.1%): Abdominal pain, constipation, dyspepsia, stomatitis, edema, insomnia, abnormal dreams, diaphoresis, altered taste, rash. Ophthalmic: corneal swelling, dry eye, eye pain, eyelid swelling, headache, red eye, reduced visual acuity, altered taste.
ADVERSE REACTIONS/TOXIC EFFECTS
Pseudomembranous colitis, as evidenced by severe abdominal pain and cramps, severe watery diarrhea, and fever, may occur. Superinfection, manifested as genital or anal pruritus, ulceration or changes in oral mucosa, and moderate to severe diarrhea, may occur.
NURSING CONSIDERATION
BASELINE ASSESSMENT
Determine hypersensitivity to gatifloxacin, quinolones before beginning drug therapy.
INTERVENTION/EVALUATION
Determine pattern of bowel activity and stool consistency. Assist with ambulation if dizziness occurs. Assess for headache, nausea, vaginitis. Monitor WBC, signs of infection, mental status.
PATIENT/FAMILY TEACHING
N Do not skip dose; take full course of therapy. N Take with 8 oz water; drink several glasses of water between meals. N Do not take antacids within 4 hr of medication (reduces or destroys effectiveness). N Avoid exposure to direct sunlight during therapy and for several days following treatment. N Avoid tasks that require alertness, motor skills until response to drug is established (potential for dizziness).
gemcitabine hydrochloride A
gem-cih-tah-bean
(Gemzar)
G CLASSIFICATION
PHARMACOTHERAPEUTIC: Antimetabolite. CLINICAL: Antineoplastic.
ACTION
An antimetabolite that inhibits ribonucleotide reductase, the enzyme necessary for catalyzing DNA synthesis. Therapeutic Effect: Produces death in cells undergoing DNA synthesis.
PHARMACOKINETICS
Not extensively distributed after IV infusion (increased with length of infusion). Protein binding: less than 10%. Excreted primarily in urine as metabolite. Half-life: 42U94 min (influenced by gender of patient and duration of infusion).
USES
Metastatic breast cancer in combination with paclitaxel. Treatment of locally advanced (stage II, III) or metastatic (stage IV) adenocarcinoma of pancreas. Indicated for patients previously treated with 5-fluorouracil. Monotherapy or in combination with cisplatin for treatment for locally advanced or metastatic nonUsmall cell lung cancer. OFF-LABEL: Treatment of biliary tract carcinoma, gall bladder carcinoma, germ cell tumors (e.g. ovarian, testicular), Hodgkin's lymphoma, non-Hodgkin's lymphoma.
PRECAUTIONS
CONTRAINDICATIONS: None known. CAUTIONS: Renal or hepatic impairment.
B LIFESPAN CONSIDERATIONS: Pregnancy/Lactation: If possible, avoid use during pregnancy, especially first trimester. May cause fetal harm. Unknown if distributed in breast milk. Breast-feeding not recommended. Pregnancy Category D. Children: Safety and efficacy not established. Elderly: Increased risk of hematologic toxicity.
INTERACTIONS
DRUG: Bone marrow depressants: May increase the risk of myelosuppression. Live virus vaccines: May potentiate virus replication, increase vaccine side effects, and decrease the patient's antibody response to the vaccine. HERBAL: None known. FOOD: None known. LAB VALUES: May increase BUN level and serum alkaline phosphatase, bilirubin, creatinine, AST, and ALT levels.
AVAILABILITY (Rx)
POWDER FOR RECONSTITUTION: 200 mg, 1-g vials.
ADMINISTRATION/HANDLING
L IV
Reconstitution N Use gloves when handling or preparing gemcitabine. N Reconstitute 200-mg or 1-g vial with 0.9% NaCl injection without preservative (5 ml or 25 ml, respectively) to provide a concentration of 40 mg/ml. N Shake to dissolve.
Rate of administration N May give without further dilution. N May be further diluted with 0.9% NaCl to a concentration as low as 0.1 mg/ml. N Infuse over 30 min.
Storage N Store at room temperature (refrigeration may cause crystallization). N Reconstituted solution is stable for 24 hr at room temperature.
IV INCOMPATIBILITIES
Acyclovir (Zovirax), amphotericin B (Fungizone), cefoperazone (Cefobid), furosemide (Lasix), ganciclovir (Cytovene), imipenem and cilastatin (Primaxin), irinotecan (Camptosar), methotrexate, methylprednisolone (Solu-Medrol), mitomycin (Mutamycin), piperacillin and 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.
INDICATIONS/ROUTES/DOSAGE
BREAST CANCER
IV INFUSION (IN COMBINATION WITH PACLITAXEL): ADULTS, ELDERLY: 1,250 mg/m2 over 30 min on days 1 and 8 of each 21-day cycle.
NON SMALL-CELL LUNG CANCER (IN COMBINATION WITH CISPLATIN)
IV: ADULTS, ELDERLY, CHILDREN: 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.
PANCREATIC CANCER
IV: ADULTS: 1,000 mg/m2 once weekly for up to 7 wk 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 wk out of every 4 wk. For patients 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
Dosage adjustments should be based on granulocyte count and platelet count, as follows:
Absolute Platelet Count % of Full Dose
Granulocyte (cells/mm3) Counts(cells/mm3)
1,000 and 100,000 100
Less than 500 or Less than 50,000 Hold
SIDE EFFECTS
FREQUENT: Nausea and vomiting (69%); generalized pain (48%); fever (41%); mild to moderate pruritic rash (30%); mild to moderate dyspnea, constipation (23%); peripheral edema (20%). OCCASIONAL (19%U10%): Diarrhea, petechiae, alopecia, stomatitis, infection, somnolence, paresthesia. RARE: Diaphoresis, rhinitis, insomnia, malaise.
ADVERSE REACTIONS/TOXIC EFFECTS
Severe myelosuppression, as evidenced by anemia, thrombocytopenia, and leukopenia, is a common reaction.
NURSING CONSIDERATIONS
BASELINE ASSESSMENT
CBC, renal and liver function tests should be performed before starting therapy and periodically thereafter. Drug should be suspended or dosage modified if bone marrow suppression is detected.
INTERVENTION/EVALUATION
Assess all lab results before giving each dose. Monitor for dyspnea, fever, pruritic rash, dehydration due to vomiting. Assess oral mucosa for erythema, ulceration at inner margin of lips, sore throat, difficulty swallowing (stomatitis). Assess skin for rash. Monitor for and report diarrhea. Provide antiemetics as needed.
PATIENT/FAMILY TEACHING
N Avoid crowds and exposure to infection. N Maintain fastidious oral hygiene. N Promptly report fever, sore throat, signs of local infection, easy bruising, rash. N Contact physician if nausea or vomiting continues at home.
glimepiride A
glim-eh-purr-eyd
(Amaryl)
Do not confuse glimepiride with glipizide or glyburide.
FIXED-COMBINATION(S)
Avandaryl: glimepiride, rosiglitazone (an antidiabetic): 1 mg/4 mg, 2 mg/4 mg, 4 mg/4 mg.
CLASSIFICATION
PHARMACOTHERAPEUTIC: Second-generation sulfonylurea. CLINICAL: Hypoglycemic
ACTION
A second-generation sulfonylurea that promotes release of insulin from beta cells of the pancreas and increases insulin sensitivity at peripheral sites. Therapeutic Effect: Lowers blood glucose concentration.
PHARMACOKINETICS
Route Onset Peak Duration
PO N/A 2U3 hr 24 hr
Completely absorbed from the GI tract. Protein binding: greater than 99%. Metabolized in the liver. Excreted in urine and eliminated in feces. Half-life: 5U9.2 hr.
USES
Adjunct to diet, exercise in management of nonUinsulin dependent diabetes mellitus (type 2, NIDDM). Use in combination with insulin or metformin in patients whose diabetes is not controlled by diet, exercise in conjunction with oral hypoglycemic agent.
PRECAUTIONS
CONTRAINDICATIONS: Diabetic complications, such as ketosis, acidosis, and diabetic coma; monotherapy for type 1 diabetes mellitus; severe hepatic or renal impairment; stress situations, including severe infection, trauma, and surgery. CAUTIONS: Severe diarrhea, intestinal obstruction, prolonged vomiting, hepatic disease, hyperthyroidism (uncontrolled), impaired renal function, adrenal insufficiency, debilitation, malnutrition, pituitary insufficiency.
B LIFESPAN CONSIDERATIONS: Pregnancy/Lactation: Not recommended for use during pregnancy. Unknown if distributed in breast milk. Pregnancy Category C. Children: Safety and efficacy not established. Elderly: Hypoglycemia may be difficult to recognize. Age-related renal impairment may increase sensitivity to glucose-lowering effect.
INTERACTIONS
DRUG: Beta blockers: May increase the hypoglycemic effect of glimepiride and mask signs of hypoglycemia. Cimetidine, ciprofloxacin, fluconazole, MAOIs, quinidine, ranitidine, large doses of salicylates: May increase the effects of glimepiride. Corticosteroids, lithium, thiazide diuretics: May decrease the effects of glimepiride. Oral anticoagulants: May increase the effects of oral anticoagulants. HERBAL: None known. FOOD: None known. LAB VALUES: May increase BUN and LDH concentrations and serum alkaline phosphatase, creatinine, and AST levels.
AVAILABILITY (Rx)
TABLETS: 1 mg, 2 mg, 4 mg.
ADMINISTRATION/HANDLING
PO
N Give with breakfast or first main meal.
INDICATIONS/ROUTES/DOSAGE
DIABETES MELLITUS
PO: ADULTS, ELDERLY: Initially, 1U2 mg once a day, with breakfast or first main meal. Maintenance: 1U4 mg once a day. After dose of 2 mg is reached, dosage should be increased in increments of up to 2 mg q1U2wk, based on blood glucose response. Maximum: 8 mg/day.
DOSAGE IN RENAL IMPAIRMENT
PO: ADULTS: 1 mg once/day.
SIDE EFFECTS
FREQUENT: Altered taste sensation, dizziness, somnolence, weight gain, constipation, diarrhea, heartburn, nausea, vomiting, stomach fullness, headache. OCCASIONAL: Increased sensitivity of skin to sunlight, peeling of skin, itching, rash.
ADVERSE REACTIONS/TOXIC EFFECTS
Overdose or insufficient food intake may produce hypoglycemia, especially with increased glucose demands. GI hemorrhage, cholestatic hepatic jaundice, leukopenia, thrombocytopenia, pancytopenia, agranulocytosis, and aplastic or hemolytic anemia occur rarely.
NURSING CONSIDERATIONS
BASELINE ASSESSMENT
Check blood glucose level. Discuss lifestyle to determine extent of learning, emotional needs. Ensure follow-up instruction if patient or family do not thoroughly understand diabetes management or blood glucose-testing technique.
INTERVENTION/EVALUATION
Monitor blood glucose level, food intake. Assess for hypoglycemia (cool, wet skin, tremors, dizziness, anxiety, headache, tachycardia, perioral numbness, hunger, diplopia), hyperglycemia (polyuria, polyphagia, polydipsia, nausea, vomiting, dim vision, fatigue, deep or rapid breathing). Be alert to conditions that alter glucose requirements: fever, increased activity or stress, surgical procedure.
PATIENT/FAMILY TEACHING
N Prescribed diet is principal part of treatment; do not skip or delay meals. N Carry candy, sugar packets, other sugar supplements for immediate response to hypoglycemia. N Wear medical alert identification. N Check with physician when glucose demands are altered (e.g., fever, infection, trauma, stress, heavy physical activity).
glipiZIDE HA
glip-ih-zide
(Glucotrol, Glucotrol XL)
Do not confuse glipizide with glimepiride or glyburide.
FIXED-COMBINATION(S)
Metaglip: glipizide/metformin (an antidiabetic): 2.5 mg/250 mg; 2.5 mg/500 mg; 5 mg/500 mg.
CLASSIFICATION
PHARMACOTHERAPEUTIC: Second-generation sulfonylurea. CLINICAL: Hypoglycemic.
ACTION
A second-generation sulfonylurea that promotes the release of insulin from beta cells of the pancreas and increases insulin sensitivity at peripheral sites. Therapeutic Effect: Lowers blood glucose concentration.
PHARMACOKINETICS
Route Onset Peak Duration
PO 15U30 min 2U3 hr 12U24 hr
Extended-release 2U3 hr 6U12 hr 24 hr
Well absorbed from the GI tract. Protein binding: 99%. Metabolized in the liver. Excreted in urine. Half-life: 2U4 hr.
USES
Adjunct to diet, exercise in management of stable, mild to moderately severe nonUinsulin dependent diabetes mellitus (type 2, NIDDM). May be used to supplement insulin in those with type 1 diabetes mellitus. May be used concomitantly with insulin or metformin to improve glycemic control.
PRECAUTIONS
CONTRAINDICATIONS: Diabetic ketoacidosis with or without coma, type 1 diabetes mellitus. CAUTIONS: Adrenal or pituitary insufficiency, hypoglycemic reactions, hepatic or renal impairment.
B LIFESPAN CONSIDERATIONS: Pregnancy/Lactation: Insulin is drug of choice during pregnancy; glipizide given within 1 mo of delivery may produce neonatal hypoglycemia. Drug crosses placenta. Distributed in breast milk. Pregnancy Category C. Children: Safety and efficacy not established. Elderly: Hypoglycemia may be difficult to recognize. Age-related renal impairment may increase sensitivity to glucose-lowering effect.
INTERACTIONS
DRUG: Beta blockers: May increase the hypoglycemic effect of glipizide and mask signs of hypoglycemia. Cimetidine, ciprofloxacin, fluconazole, MAOIs, quinidine, ranitidine, large doses of salicylates: May increase the effects of glipizide. Corticosteroids, lithium, thiazide diuretics: May decrease the effects of glipizide. Oral anticoagulants: May increase the effects of oral anticoagulants. HERBAL: None known. FOOD: None known. LAB VALUES: May increase BUN and LDH concentrations and serum alkaline phosphatase, creatinine, and AST levels.
AVAILABILITY (Rx)
TABLETS (GLUCOTROL): 5 mg, 10 mg. TABLETS (EXTENDED-RELEASE [GLUCOTROL XL]): 2.5 mg, 5 mg, 10 mg.
ADMINISTRATION/HANDLING
PO
N May give with food (response better if taken 15U30 min before meals) N Do not crush extended-release tablets.
INDICATIONS/ROUTES/DOSAGE
DIABETES MELLITUS
PO: ADULTS: Initially, 5 mg/day or 2.5 mg in the elderly or those with hepatic disease. Adjust dosage in 2.5- to 5-mg increments at intervals of several days. Maximum single dose: 15 mg. Maximum dose/day: 40 mg. Maintenance (extended-release tablet): 20 mg/day. ELDERLY: Initially, 2.5U5 mg/day. May increase by 2.5U5 mg/day q1U2wk.
SIDE EFFECTS
FREQUENT: Altered taste sensation, dizziness, somnolence, weight gain, constipation, diarrhea, heartburn, nausea, vomiting, stomach fullness, headache. OCCASIONAL: Increased sensitivity of skin to sunlight, peeling of skin, itching, rash.
ADVERSE REACTIONS/TOXIC EFFECTS
Overdose or insufficient food intake may produce hypoglycemia, especially with increased glucose demands. GI hemorrhage, cholestatic hepatic jaundice, leukopenia, thrombocytopenia, pancytopenia, agranulocytosis, and aplastic or hemolytic anemia occurs rarely.
NURSING CONSIDERATIONS
BASELINE ASSESSMENT
Check blood glucose level. Discuss lifestyle to determine extent of learning, emotional needs. Ensure follow-up instruction if patient or family does not thoroughly understand diabetes management or blood glucose-testing technique.
INTERVENTION/EVALUATION
Monitor blood glucose level, food intake. Assess for hypoglycemia (cool, wet skin, tremors, dizziness, anxiety, headache, tachycardia, perioral numbness, hunger, diplopia), 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 procedure.
PATIENT/FAMILY TEACHING
N Prescribed diet is principal part of treatment; do not skip or delay meals. N Carry candy, sugar packets, other sugar supplements for immediate response to hypoglycemia. N Wear medical alert identification. N Check with physician when glucose demands are altered (e.g., fever, infection, trauma, stress, heavy physical activity).
glipiZIDE HA
glip-ih-zide
(Glucotrol, Glucotrol XL)
Do not confuse glipizide with glimepiride or glyburide.
FIXED-COMBINATION(S)
Metaglip: glipizide/metformin (an antidiabetic): 2.5 mg/250 mg; 2.5 mg/500 mg; 5 mg/500 mg.
G CLASSIFICATION
PHARMACOTHERAPEUTIC: Second-generation sulfonylurea. CLINICAL: Hypoglycemic.
ACTION
A second-generation sulfonylurea that promotes the release of insulin from beta cells of the pancreas and increases insulin sensitivity at peripheral sites. Therapeutic Effect: Lowers blood glucose concentration.
PHARMACOKINETICS
Route Onset Peak Duration
PO 15U30 min 2U3 hr 12U24 hr
Extended-release 2U3 hr 6U12 hr 24 hr
Well absorbed from the GI tract. Protein binding: 99%. Metabolized in the liver. Excreted in urine. Half-life: 2U4 hr.
USES
Adjunct to diet, exercise in management of stable, mild to moderately severe nonUinsulin dependent diabetes mellitus (type 2, NIDDM). May be used to supplement insulin in those with type 1 diabetes mellitus. May be used concomitantly with insulin or metformin to improve glycemic control.
PRECAUTIONS
CONTRAINDICATIONS: Diabetic ketoacidosis with or without coma, type 1 diabetes mellitus. CAUTIONS: Adrenal or pituitary insufficiency, hypoglycemic reactions, hepatic or renal impairment.
B LIFESPAN CONSIDERATIONS: Pregnancy/Lactation: Insulin is drug of choice during pregnancy; glipizide given within 1 mo of delivery may produce neonatal hypoglycemia. Drug crosses placenta. Distributed in breast milk. Pregnancy Category C. Children: Safety and efficacy not established. Elderly: Hypoglycemia may be difficult to recognize. Age-related renal impairment may increase sensitivity to glucose-lowering effect.
INTERACTIONS
DRUG: Beta blockers: May increase the hypoglycemic effect of glipizide and mask signs of hypoglycemia. Cimetidine, ciprofloxacin, fluconazole, MAOIs, quinidine, ranitidine, large doses of salicylates: May increase the effects of glipizide. Corticosteroids, lithium, thiazide diuretics: May decrease the effects of glipizide. Oral anticoagulants: May increase the effects of oral anticoagulants. HERBAL: None known. FOOD: None known. LAB VALUES: May increase BUN and LDH concentrations and serum alkaline phosphatase, creatinine, and AST levels.
AVAILABILITY (Rx)
TABLETS (GLUCOTROL): 5 mg, 10 mg. TABLETS (EXTENDED-RELEASE [GLUCOTROL XL]): 2.5 mg, 5 mg, 10 mg.
ADMINISTRATION/HANDLING
PO
N May give with food (response better if taken 15U30 min before meals) N Do not crush extended-release tablets.
INDICATIONS/ROUTES/DOSAGE
DIABETES MELLITUS
PO: ADULTS: Initially, 5 mg/day or 2.5 mg in the elderly or those with hepatic disease. Adjust dosage in 2.5- to 5-mg increments at intervals of several days. Maximum single dose: 15 mg. Maximum dose/day: 40 mg. Maintenance (extended-release tablet): 20 mg/day. ELDERLY: Initially, 2.5U5 mg/day. May increase by 2.5U5 mg/day q1U2wk.
SIDE EFFECTS
FREQUENT: Altered taste sensation, dizziness, somnolence, weight gain, constipation, diarrhea, heartburn, nausea, vomiting, stomach fullness, headache. OCCASIONAL: Increased sensitivity of skin to sunlight, peeling of skin, itching, rash.
ADVERSE REACTIONS/TOXIC EFFECTS
Overdose or insufficient food intake may produce hypoglycemia, especially with increased glucose demands. GI hemorrhage, cholestatic hepatic jaundice, leukopenia, thrombocytopenia, pancytopenia, agranulocytosis, and aplastic or hemolytic anemia occurs rarely.
NURSING CONSIDERATIONS
BASELINE ASSESSMENT
Check blood glucose level. Discuss lifestyle to determine extent of learning, emotional needs. Ensure follow-up instruction if patient or family does not thoroughly understand diabetes management or blood glucose-testing technique.
INTERVENTION/EVALUATION
Monitor blood glucose level, food intake. Assess for hypoglycemia (cool, wet skin, tremors, dizziness, anxiety, headache, tachycardia, perioral numbness, hunger, diplopia), 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 procedure.
PATIENT/FAMILY TEACHING
N Prescribed diet is principal part of treatment; do not skip or delay meals. N Carry candy, sugar packets, other sugar supplements for immediate response to hypoglycemia. N Wear medical alert identification. N Check with physician when glucose demands are altered (e.g., fever, infection, trauma, stress, heavy physical activity).
*glyBURIDE A
glye-byoo-ride
(Daonil J, DiaBeta, Euglucon J, Glycron, Glynase, Glynase Pres-Tab, Micronase)
Do not confuse glyburide with glimepiride or glipizide, or Micronase with Micro-K, Micronor.
FIXED-COMBINATION(S)
Glucovance: glyburide/metformin (an antidiabetic): 1.25 mg/250 mg; 2.5 mg/500 mg; 5 mg/500 mg.
CLASSIFICATION
PHARMACOTHERAPEUTIC: Second-generation sulfonylurea. CLINICAL: Hypoglycemic.
ACTION
A second-generation sulfonylurea that promotes release of insulin from beta cells of the pancreas and increases insulin sensitivity at peripheral sites. Therapeutic Effect: Lowers blood glucose concentration.
PHARMACOKINETICS
Route Onset Peak Duration
PO 0.25U1 hr 1U2 hr 12U24 hr
Well absorbed from the GI tract. Protein binding: 99%. Metabolized in the liver to weakly active metabolite. Primarily excreted in urine. Not removed by hemodialysis. Half-life: 1.4U1.8 hr.
USES
Adjunct to diet, exercise in management of stable, mild to moderately severe nonUinsulin dependent diabetes mellitus (type 2, NIDDM). May be used to supplement insulin in those with type 1 diabetes mellitus. May be used concomitantly with insulin or metformin to improve glycemic control.
PRECAUTIONS
CONTRAINDICATIONS: Diabetic ketoacidosis with or without coma, monotherapy for type 1 diabetes mellitus. CAUTIONS: Adrenal or pituitary insufficiency, hypoglycemic reactions, hepatic or renal impairment.
B LIFESPAN CONSIDERATIONS: Pregnancy/Lactation: Crosses placenta. Distributed in breast milk. May produce neonatal hypoglycemia if given within 2 wk of delivery. Pregnancy Category C. Children: Safety and efficacy not established. Elderly: Hypoglycemia may be difficult to recognize. Age-related renal impairment may increase sensitivity to glucose-lowering effect.
INTERACTIONS
DRUG: Beta blockers: May increase the hypoglycemic effect of glyburide and mask signs of hypoglycemia. Cimetidine, ciprofloxacin, fluconazole, MAOIs, quinidine, ranitidine, large doses of salicylates: May increase the effects of glyburide. Corticosteroids, lithium, thiazide diuretics: May decrease the effects of glyburide. Oral anticoagulants: May increase the effects of oral anticoagulants. HERBAL: None known. FOOD: None known. LAB VALUES: May increase BUN and LDH concentrations and serum alkaline phosphatase, creatinine, and AST levels.
AVAILABILITY (Rx)
TABLETS (DIABETA, MICRONASE): 1.25 mg, 2.5 mg, 5 mg. TABLETS (MICRONIZED [GLYCRON, GLYNASE]): 1.5 mg, 3 mg, 4.5 mg, 6 mg.
ADMINISTRATION/HANDLING
PO
N May give with food (response better if taken 15U30 min before meals).
INDICATIONS/ROUTES/DOSAGE
DIABETES MELLITUS
PO: ADULTS: Initially 2.5U5 mg. May increase by 2.5 mg/day at weekly intervals. Maintenance: 1.25U20 mg/day. Maximum: 20 mg/day. ELDERLY: Initially, 1.25U2.5 mg/day. May increase by 1.25U2.5 mg/day at 1- to 3-wk intervals.
PO (MICRONIZED TABLETS): ADULTS, ELDERLY: Initially 0.75U3 mg/day. May increase by 1.5 mg/day at weekly intervals. Maintenance: 0.75U12 mg/day as a single dose or in divided doses.
DOSAGE IN RENAL IMPAIRMENT
Glyburide is not recommended in patients with creatinine clearance less than 50 ml/min.
SIDE EFFECTS
FREQUENT: Altered taste sensation, dizziness, somnolence, weight gain, constipation, diarrhea, heartburn, nausea, vomiting, stomach fullness, headache. OCCASIONAL: Increased sensitivity of skin to sunlight, peeling of skin, itching, rash.
ADVERSE REACTIONS/TOXIC EFFECTS
Overdose or insufficient food intake may produce hypoglycemia, especially in patients with increased glucose demands. Cholestatic jaundice, leukopenia, thrombocytopenia, pancytopenia, agranulocytosis, and aplastic or hemolytic anemia occur rarely.
NURSING CONSIDERATIONS
BASELINE ASSESSMENT
Check blood glucose level. Discuss lifestyle to determine extent of learning, emotional needs. Ensure follow-up instruction if patient or family does not thoroughly understand diabetes management or glucose-testing technique.
INTERVENTION/EVALUATION
Monitor blood glucose level, food intake. Assess for hypoglycemia (cool, wet skin; tremors, dizziness, anxiety, headache, tachycardia, perioral numbness, hunger, diplopia) 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 procedure.
PATIENT/FAMILY TEACHING
N Prescribed diet is principal part of treatment; do not skip or delay meals. N Carry candy, sugar packets, other sugar supplements for immediate response to hypoglycemia. N Wear medical alert identification. N Check with physician when glucose demands are altered (e.g., fever, infection, trauma, stress, heavy physical activity).
goserelin acetate A
gos-er-ah-lin
(Zoladex, Zoladex LA J)
CLASSIFICATION
PHARMACOTHERAPEUTIC: Gonadotropin-releasing hormone analogue. CLINICAL: Antineoplastic.
ACTION
A gonadotropin-releasing hormone analogue and antineoplastic agent that stimulates the release of luteinizing hormone (LH) and follicle-stimulating hormone (FSH) from the anterior pituitary gland. In males, increases testosterone concentrations initially, then suppresses secretion of LH and FSH, resulting in decreased testosterone levels. Therapeutic Effect: In females, causes a reduction in ovarian size and function, reduction in uterine and mammary gland size, and regression of sex-hormone-responsive tumors. In males, produces pharmacologic castration and decreases the growth of abnormal prostate tissue.
PHARMACOKINETICS
Protein binding: 27%. Metabolized in liver. Excreted in urine. Half-life: 4.2 hr (male); 2.3 hr (female).
USES
Treatment of advanced carcinoma of prostate as alternative when orchiectomy, estrogen therapy is either not indicated or unacceptable to patient. In combination with flutamide before and during radiation therapy for early stages of prostate cancer. Management of endometriosis. Treatment of advanced breast cancer in premenopausal and perimenopausal women. Endometrial thinning before ablation for dysfunctional uterine bleeding.
PRECAUTIONS
CONTRAINDICATIONS: Pregnancy. CAUTIONS: None known.
B LIFESPAN CONSIDERATIONS: Pregnancy/Lactation: Crosses placenta; unknown if distributed in breast milk. Pregnancy Category D (advanced breast cancer), X (endometriosis, endometrial thinning). Children: Safety and efficacy not established. Elderly: No age-related precautions noted.
INTERACTIONS
DRUG: None known. HERBAL: None known. FOOD: None known. LAB VALUES: May increase serum prostatic acid phosphatase and testosterone levels.
AVAILABILITY (Rx)
IMPLANT (ZOLADEX): 3.6 mg, 10.8 mg.
ADMINISTRATION/HANDLING
IMPLANT
N Inspect the package for damage before opening. If the package is damaged, don't use the syringe. N Remove the sterile syringe from the package immediately before use. Examine the syringe for damage, and check that goserelin is visible in the translucent chamber. N Clean an area of skin on the upper abdominal wall with an alcohol swab. N Grasp the safety clip tab, pull it out and away from the needle, and discard it immediately. Then remove the needle cover. N Using aseptic technique, stretch or pinch the patient's skin with one hand, and grip the syringe barrel. Insert the needle into the subcutaneous tissue.
O ALERT P The goserelin syringe should not be used for aspiration. If the needle penetrates a large vessel, you'll see blood instantly in the syringe chamber. If a vessel is penetrated, withdraw the needle and use a new syringe elsewhere.
N Direct the needle so that it parallels the abdominal wall. Push the needle in until the barrel hub touches the patient's skin. Withdraw the needle 1 cm to create a space to discharge goserelin. Fully depress the plunger to discharge the drug. N Withdraw the needle. Then bandage the site. Confirm the discharge of goserelin by ensuring that the tip of the plunger is visible within the tip of the needle. N Dispose of the used needle and syringe in a safe manner.
INDICATIONS/ROUTES/DOSAGE
PROSTATIC CARCINOMA
IMPLANT: ADULTS OLDER THAN 18 YR, ELDERLY: 3.6 mg every 28 days or 10.8 mg q12wk subcutaneously into upper abdominal wall.
BREAST CARCINOMA, ENDOMETRIOSIS
IMPLANT: ADULTS: 3.6 mg every 28 days subcutaneously into upper abdominal wall.
ENDOMETRIAL THINNING
IMPLANT: ADULTS: 3.6 mg subcutaneously into upper abdominal wall as a single dose or in 2 doses 4 wk apart.
SIDE EFFECTS
FREQUENT: Headache (60%), hot flashes (55%), depression (54%), diaphoresis (45%), sexual dysfunction (21%), decreased erection (18%), lower urinary tract symptoms (13%). OCCASIONAL (10%U5%): Pain, lethargy, dizziness, insomnia, anorexia, nausea, rash, upper respiratory tract infection, hirsutism, abdominal pain. RARE: Pruritus.
ADVERSE REACTIONS/TOXIC EFFECTS
Arrhythmias, CHF, and hypertension occur rarely. Ureteral obstruction and spinal cord compression have been observed. An immediate orchiectomy may be necessary if these conditions occur.
NURSING CONSIDERATIONS
INTERVENTION/EVALUATION
Monitor patient closely for worsening signs and symptoms of prostatic cancer, especially during first month of therapy.
PATIENT/FAMILY TEACHING
N Use contraceptive measures during therapy. N Inform physician if patient becomes pregnant or regular menstruation persists. N Breakthrough menstrual bleeding may occur if dose is missed. N Use nonhormonal methods of contraception.
granisetron
gran-is-eh-tron
(Kytril)
CLASSIFICATION
PHARMACOTHERAPEUTIC: Serotonin receptor antagonist. CLINICAL: Antiemetic.
ACTION
A 5-HT3 receptor antagonist that acts centrally in the chemoreceptor trigger zone or peripherally at the vagal nerve terminals. Therapeutic Effect: Prevents nausea and vomiting.
PHARMACOKINETICS
Route Onset Peak Duration
IV 1U3 min N/A 24 hr
Rapidly and widely distributed to tissues. Protein binding: 65%. Metabolized in the liver to active metabolite. Eliminated in urine and feces. Half-life: 10U12 hr (increased in the elderly).
USES
Prevents nausea, vomiting associated with emetogenic cancer therapy (includes high-dose cisplatin). Prevention and treatment of postop nausea, vomiting. Prophylaxis of nausea and vomiting associated with cancer radiation therapy. OFF-LABEL: PO: Prophylaxis of nausea or vomiting associated with radiation therapy.
PRECAUTIONS
CONTRAINDICATIONS: None known. CAUTIONS: Safety in children younger than 2 yr not established. The use of granisetron following abdominal surgery or with chemotherapy-induced nausea and vomiting may mask a progressive ileus and/or gastric distention.
B LIFESPAN CONSIDERATIONS: Pregnancy/Lactation: Unknown if drug is distributed in breast milk. Pregnancy Category B. Children: Safety and efficacy not established in patients younger than 2 yr. Elderly: No age-related precautions noted.
INTERACTIONS
DRUG: Hepatic enzyme inducers: May decrease the effects of granisetron. HERBAL: None known. FOOD: None known. LAB VALUES: May increase AST and ALT levels.
AVAILABILITY (Rx)
ORAL SOLUTION: 2 mg/10 ml. TABLETS: 1 mg. INJECTION: 0.1 mg/ml, 1 mg/ml.
ADMINISTRATION/HANDLING
L IV
Reconstitution N May be given undiluted or dilute with 20U50 ml 0.9% NaCl or D5W. Do not mix with other medications.
Rate of administration N May give undiluted as IV push over 30 sec. N For IV piggyback, infuse over 5U20 min depending on volume of diluent used.
Storage N Appears as a clear, colorless solution. N Store at room temperature. N After dilution, is stable for at least 24 hr at room temperature. N Inspect for particulates, discoloration.
IV INCOMPATIBILITY
Amphotericin B (Fungizone).
IV COMPATIBILITIES
Allopurinol (Aloprim), bumetanide (Bumex), calcium gluconate, carboplatin (Paraplatin), cisplatin (Platinol), cyclophosphamide (Cytoxan), cytarabine (Ara-C), dacarbazine (DTIC-Dome), dexamethasone (Decadron), diphenhydramine (Benadryl), docetaxel (Taxotere), doxorubicin (Adriamycin), etoposide (VePesid), gemcitabine (Gemzar), magnesium, mitoxantrone (Novantrone), paclitaxel (Taxol), potassium.
INDICATIONS/ROUTES/DOSAGE
PREVENTION OF CHEMOTHERAPY- INDUCED NAUSEA AND VOMITING
PO: ADULTS, ELDERLY: 2 mg 1 hr before chemotherapy or 1 mg 1 hr before and 12 hr after chemotherapy.
IV: ADULTS, ELDERLY, CHILDREN 2 YR AND OLDER: 10 mcg/kg/dose (or 1 mg/dose) within 30 min of chemotherapy.
PREVENTION OF RADIATION-INDUCED NAUSEA AND VOMITING
PO: ADULTS, ELDERLY: 2 mg once a day, given 1 hr before radiation therapy.
POSTOPERATIVE NAUSEA OR VOMITING
PO: ADULTS, ELDERLY, CHILDREN 4 YR AND OLDER: 20U40 mcg/kg as a single postoperative dose.
IV: ADULTS, ELDERLY: 1 mg as a single postoperative dose. CHILDREN OLDER THAN 4 YR: 20U40 mcg/kg. Maximum: 1 mg.
SIDE EFFECTS
FREQUENT (21%U14%): Headache, constipation, asthenia. OCCASIONAL (8%U6%): Diarrhea, abdominal pain. RARE (less than 2%): Altered taste, hypersensitivity reaction.
ADVERSE REACTIONS/TOXIC EFFECTS
Hypertension, hypotension, arrhythmias such as sinus bradycardia, atrial fibrillation, varying degrees of AV block, ventricular ectopy including non-sustained tachycardia, and EKG abnormalities have been observed. Rare cases of hypersensitivity reactions, sometimes severe (e.g., anaphylaxis, shortness of breath, hypotension, urticaria) have been reported.
NURSING CONSIDERSTION
BASELINE ASSESSMENT
Ensure that granisetron is given within 30 min of starting chemotherapy.
INTERVENTION/EVALUATION
Monitor for therapeutic effect. Assess for headache. Monitor frequency/consistency of stools.
PATIENT/FAMILY TEACHING
N Granisetron is effective shortly following administration; prevents nausea, vomiting. N Explain that transitory taste disorder may occur.
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