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Nonbenzodiazepine Avoid chronic use (>90 days) hypnotics Benzodiazepine-receptor agonists that have adverse events similar Potential for hypotension generic cefixime 100mg antibiotics for boils; risk of precipitating myocardial ischemia generic cefixime 200 mg fast delivery antibiotics sinusitis. Topical vaginal cream: Ac- n Trimipramine ceptable to use low-dose intravaginal estrogen for the management of dyspareunia cefixime 100mg sale antibiotics for acne results, lower urinary tract infec- Antipsychotics generic cefixime 100 mg without a prescription antibiotic lock therapy idsa, frst- (conventional) and sec- Avoid use for behavioral problems of dementia unless tions, and other vaginal symptoms. Evidence that vaginal estrogens for treatment of vaginal dryness is Increased risk of cerebrovascular accident (stroke) and mortality in safe and effective in women with breast cancer, especially at dos- persons with dementia. Benzodiazepines Avoid benzodiazepines (any type) for treatment of insom- Minimal effect on weight; increases risk of thrombotic events and Short- and intermediate-acting: nia, agitation, or delirium. Glyburide: higher risk of severe prolonged hypoglycemia in older n Triazolam adults. Potential for aspiration and adverse effects; safer alternatives avail- Chloral hydrate* Avoid. Peripheral alpha blockers Not an effective oral analgesic in dosages commonly used; may n Doxazosin Increases risk of orthostatic hypotension or brady- cause neurotoxicity; safer alternatives available. Antipsychotics are associated with an increased risk n Carisoprodol Most muscle relaxants poorly tolerated by older adults, because of of cerebrovascular accident (stroke) and mortality in n Chlorzoxazone anticholinergic adverse effects, sedation, increased risk of fractures; persons with dementia. Chronic Oral antimuscarinics for urinary inconti- Avoid unless no other alternatives. The American Geriatrics Society gratefully acknowledges the support of the John A. Decisions about drug therapy must be based upon the independent judgment of the clinician, changing drug information, and evolving healthcare practices. Analgesics Mild / Moderate Pain Acetaminophen Both acute and chronic doses of acetaminophen are associated with hepatotoxicity. For this reason, this drug has been reformulated so the products are limited to 325 mg per dosage unit. Forms: Liquid, tablet, oral disintegrating tablet, caplet, rectal suppository, injectable Usual oral dosage:1,2 Children <12 years: 10-15 mg/kg/dose every 4-6 hours as needed (maximum90 mg/kg/24 hours,3 but not to exceed 2. Other children may be poor metabolizers of codeine with lower conversion to morphine and, consequently, under-respond to the narcotic. Forms: Liquids: 120 mg acetaminophen and 12 mg codeine/5 mL (Note: Te elixir and solution, but not suspension, contain alcohol. For acute pain, naproxen sodium may be preferred because of increased solubility leading to faster onset, higher peak concentration, and decreased adverse drug events. Forms: Suspension, tablet Usual dosage:2 Children >2 years up to 12 years: 5-7 mg/kg every 8-12 hours as needed Children >12 years: 200 mg every 8-12 hours as needed; may take 400 mg for initial dose (maximum 600 mg/24 hours) Adults: Initial dose of 500 mg, then 250 mg every 6-8 hours as needed (maximum 1250 mg/24 hours) Moderate/Severe Pain Acetaminophen with hydrocodone For pediatric patients, the practitioner should consider prescribing in accordance to body weight (mg/kg) and in 5 mL dosage increments. Forms: Liquids: 300 mg acetaminophen and 10 mg hydrocodone/15 mL 325 mg acetaminophen and 7. May titrate up to 5 mg/dose oxycodone every 4-6 hours (acetaminophen maximum90 mg/kg/24 hours,3 but not to exceed 2. Forms: Suspension, chewable tablet, tablet Usual oral dosage:1,2 (based on amoxicillin component): Children >3 months of age up to 40 kg: 25-45 mg/kg/day in doses divided every 12 hours (prescribe suspension or chewable tablet due to clavulanic acid component) Children >40 kg and adults: 500-875 mg every 12 hours (prescribe tablet) Azithromycin This drug is one of two options for patients with Type I allergy to penicillin and/or cephalosporin antibiotics. Caution: This drug can cause cardiac arrhythmias in patients with pre-existing cardiac conduction defects. Forms: Tablet, capsule, suspension, injectable Usual oral dosage:1,2 (Note: Doses may vary for extended release suspension depending on the reason for prescribing the antibiotic. Forms: Suspension, tablet, capsule Usual oral dosage:1,2 Children >1 year: 25-100 mg/kg/day in divided doses every 6-8 hours (maximum 4g/day) Adults: 250-1000 mg every 6 hours (maximum 4g/day) Endocarditis prophylaxis:2,9 50 mg/kg (maximum 2 g) 30-60 minutes before procedure Clindamycin Note: This is one of two options for patients with Type I allergic reactions to penicillin and/or cephalosporin antibiotics. This antibiotic is effective for infections (eg, abscesses) with gram-positive aerobic bacteria and gram-positive or gram-negative anaerobic bacteria. Due to these and other side efects, women who are pregnant and children <8 years old should not use this drug. Forms: Suspension, tablet, delayed release tablet, capsule, injectable Usual oral dosage for necrotizing ulcerative gingivitis:1,8 Children >8 years who weigh <45 kg: 2. Patients should avoid ingestion of alcohol as a beverage or ingredient in medications while taking metronidazole. Forms: Tablet, tablet extended release, capsule, injectable Usual oral dosage: For anaerobic skin and bone infection:1,3 Children: 30/mg/kg/day in divided doses every 6 hours (maximum 4 g/24 hours) Adolescents and adults: 7. Anaphylactic reactions have been demonstrated in patients receiving penicillin, most notably those with a history of beta-lactam hypersensitivity, sensitivity to multiple allergens, or prior IgE-mediated reactions (eg, angioedema, urticaria, anaphylaxis). Form: Suspension 10 mg/mL, 40 mg/mL; tablet: 50 mg, 100 mg, 150 mg, 200 mg; injectable 200 mg, 400 mg Usual dosage:1,2 Neonates >14 days: Single dose of 6 mg/kg on day 1; then decrease to 3 mg/kg once/day for 7 to 14 days Adolescents and adults: Single dose of 200 mg on day 1; then decrease to 100 mg once/day for 14 days Ketoconazole Form: Tablet, 200 mg Usual oral dosage:1,8 Children >2 years: 3. Miconazole nitrate Forms: Ointment 2%; cream 2% Usual dosage:1 Children >2 years and adults: Apply a thin layer to the corners of the mouth 4 times/day for 14 days or until complete healing. Nystatin Forms: Ointment, cream (100,000 units/g) Usual dosage:1 For all ages: Apply a thin layer to angles of mouth 4 times/day for 14 days or until complete healing. Nystatin, triamcinolone acetonide Forms: Ointment, cream (100,000 units nystatin/g and 0. Topical or transmucosal agents for oral candidiasis Clotrimazole Form: Lozenge 10 mg Usual dosage:1,2 (Note: Not for use in patients < 3 years of age. Miconazole (Oravig ) ® Form: Buccal tablet 50 mg Usual dosage:1,3 Adolescents >16 years and adults: One tablet/day for 14 days; apply to the gum region, just above the upper lateral incisor. Acyclovir Form: Cream 5% Usual dosage:1,3 Children >12 years and adults: Apply a thin layer on the lesion 5 times/day for 4 days. Acyclovir with hydrocortisone (Xerese®) Form: Cream (5% acyclovir with 1% hydrocortisone) Usual dosage:1,3 Children >12 years and adults: Apply a thin layer on the lesion 5 times/day for 5 days. Penciclovir Form: Cream 1% Usual dosage:1,3 Children >12 years and adults: Apply a thin layer on the lesion every 2 hours while awake for 4 days. Tere is a potential for lidocaine toxicity if oral suspension is overused, and there is an increased risk for aspiration if used in children who cannot expectorate. Form: Suspension [needs to be compounded by pharmacist; 50/50 mixture of liquid diphenhydramine hydrochloride (12. Note: Maximum dose of diphenhydramine hydrochloride in case the suspension is swallowed: Children 2 to <6 years: 37. Mupirocin Forms: Ointment 2%; cream 2% Usual dosage for localized impetigo or skin infection:1,3 (Note: For external use only; not for use in patients <2 months of age) Apply a small amount of ointment to the afected area 3 times/day. Pharmacogenetics of neonatal opioid toxicity following maternal use of codeine during breast-feeding: A case-control study. Prevention of infective endocarditis: Guidelines from the American Heart Association. The North Shore-Long Island Jewish Health System is not affliated with the owner of any of the brands referenced in this Guide. The user understands and accepts that if the health system were to accept the risk of harm to the user from use of this Guide, it would not be able to make the Guide available because the cost to cover the risk of harm to all users would be too great. Send inquiries to Offce of Legal Affairs, North Shore-Long Island Jewish Health System, Inc. Medications have been arranged on the card for ease of display and comparison, but dosing equivalence cannot be assumed. Each (ipatropium) works in about 15 minutes and lasts for 6–8 bronchodilator is different, based on 1.

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These groups do not limit talking time and incorporate cultural traditions and languages buy discount cefixime 100mg on line antibiotic 5897. Multiple clinical trials have demonstrated that several clinical procedures are effective in increasing participation in mutual aid groups generic 200mg cefixime amex virus 51, and increase the chances for sustained remission and recovery cheap cefixime 100 mg with amex antibiotics you can't take with alcohol. Health care professionals who help link patients with members of a mutual aid group can signifcantly increase the likelihood that the patients will attend the group discount 200 mg cefixime fast delivery infection diarrhea. Al-Anon Family Groups Friends and family members often suffer when a loved one has a substance use disorder. This may be due to worry about the loved one experiencing accidents, injuries, negative social and legal consequences, diseases, or death, as well as fear of the loved one engaging in destructive behavior, such as stealing, manipulating, or being verbally or physically aggressive. Consequently, a number of mutual aid groups have emerged to provide emotional support to concerned signifcant others and families and to help them systematically and strategically alter their own unproductive behaviors that have emerged in their efforts to deal with the substance use problems of their affected loved one. Al-Anon is a mutual aid group commonly sought by families dealing with substance use in a loved one. Clinical trials and other studies of Al-Anon show that participating family members experience reduced depression, anger, and relationship unhappiness, at rates and levels comparable to those of individuals receiving psychological therapies. Recovery Coaching Voluntary and paid recovery coach positions are a new development in the addiction feld. Coaches do not provide “treatment” per se, but they often help individuals discharging from treatment to connect to community services while addressing any barriers or problems that may hinder the recovery process. Some community-based recovery organizations offer training programs for recovery coaches, but no national standardized93 approach to training coaches has been developed. A descriptive study of 56 recently homeless veterans with substance use disorder Case management. A coordinated suggested that supplementing psychotherapy with recovery approach to delivering general health coaching increased length of abstinence at follow-up 6 care, substance use disorder treatment, 95 mental health, and social services. Recovery coaches may complement, although approach links clients with appropriate not replace, professional case management services in the services to address specifc needs and child welfare, criminal justice, and educational systems. One large randomized trial showed that providing recovery 1 coaches to mothers with a substance use disorder who were involved in the child welfare system reduced the likelihood of the mother’s child being arrested by 52 percent. Many residents stay in recovery housing during and/or after outpatient treatment, with self-determined residency lasting for several months to years. Residents often informally share resources with each other, giving advice borne of experience about how to access health care, fnd employment, manage legal problems, and interact with the social service system. Some recovery houses are connected with afliates of the National Alliance of Recovery Residences, a non- proft organization that serves 25 regional afliate organizations that collectively support more than 25,000 persons in recovery across over 2,500 certifed recovery residences. A leading example of recovery-supportive houses is Oxford Houses, which are peer-run, self-sustaining, substance-free residences that host 6 to 10 recovering individuals per house and require that all members maintain abstinence. A randomized controlled trial found that people with severe substance use disorders who were randomly assigned to live in an Oxford House after substance use disorder treatment were two times more likely to be abstinent and had higher monthly incomes and lower incarceration rates at follow- up 2 years later than similar individuals assigned to receive standard continuing care. Peer recovery coaches are… • Individuals in recovery who help others with substance use disorders achieve and maintain recovery using four types of support: Emotional (empathy, caring, concern); Informational (practical knowledge and vocational assistance); Instrumental (concrete assistance to help individuals gain access to health and social services); Affliational (introductions to healthy social contacts and recreational pursuits). Rather, they focus on instilling hope and modeling recovery through the personal, lived experience of addiction and recovery. Case management typically involves professional or patient service delivery models. The terms “peer” and “recovery coach” are used purposely to refect a mutual, peer-based collaboration to help people achieve sustained recovery. Peer recovery coaches do not espouse any specifc recovery pathway or orientation but rather facilitate all pathways to recovery. This stems from the newness of this practice and the diversity of the populations that recovery coaches serve. As use of this type of support expands, some national norms of practice and behavior will likely form over time, but with signifcant fexibility to enable sensitivity to local realities. Therefore, residence in the sober living home cannot be assumed to have caused the better outcomes observed. Taken together, these studies provide promising evidence to suggest that recovery-supportive housing can be both cost-effective and effective in supporting recovery. Each Oxford House is a While I resided at an Oxford House, I started self-supporting and democratically-run substance-free working for Oxford House, Inc. Outcomes: • An 87 percent abstinence rate at the end of a 2-year period living in an Oxford House, four to fve times greater than typical outcomes following detoxifcation and treatment. With the core components of tracking, assessment, linkage, engagement, and retention, patients are monitored quarterly for several years following an initial treatment. If a relapse occurs, the patient is connected with the necessary services and encouraged to remain in treatment. The main assumption is that early detection and treatment of relapse will improve long-term outcomes. It can be provided by professionals or by peers, although only the former approach has been rigorously studied. One example is an extended case monitoring intervention, which consisted of phone calls on a tapering schedule over the course of several years, with contact becoming more frequent when needed, such as when risk of relapse was high. This intervention was designed to optimize the cost-effectiveness of alcohol treatment through long-term engagement with clients beyond the relatively short treatment episodes. Case monitoring also reduced the costs of subsequent outpatient treatment by $240 per person at 1-year follow-up, relative to patients who did not receive the telephone monitoring. Telephone monitoring produced the highest rates of abstinence from alcohol at follow- up 12 months later. Many recovery community centers are typically operated by recovery community organizations. Recovery community centers are different from professionally-operated substance use disorder treatment programs because they offer support beyond the clinical setting. Recovery-based Education High school and college environments can be difcult for students in recovery because of perceived and actual high levels of substance use among other students, peer pressure to engage in substance use, and widespread availability of alcohol and drugs. Such schools support abstinence and student efforts to overcome personal issues that may compromise academic performance or threaten continued recovery. Rates of abstinence from “all alcohol and other drugs” increased from 20 percent during the 90 days before enrolling to 56 percent since enrolling. Students’ opinions of the schools were positive, with 87 percent reporting overall satisfaction. A rigorous outcomes study is nearing completion that will give a better idea of the impact of recovery high schools. Most provide some combination of recovery residence halls or recovery-specifc wings, counseling services, on-site mutual aid group meetings, and other educational and social supports. These services are provided within an environment that facilitates social role modeling of sobriety and connection among recovering peers. The programs often require participants to demonstrate 3 to 6 months with no use of alcohol and drugs as a requirement for admission. Recovering college peers may help these new students effectively manage the environmental risks present on many college campuses. Examples include recovery cafes and clubhouses, recovery sports leagues and other sporting activities, and a variety of recovery-focused creative arts, including music and musicians’ organizations, visual arts, and theatre and poetry events. Although research on the impact of these new tools is limited, studies are beginning to show positive benefts, particularly in preventing relapse and supporting recovery.

He is a shareholder with Novo Nordisk order cefixime 200mg without a prescription newest antibiotics for acne, Sanofi purchase cefixime 200 mg without a prescription antibiotic 3 days, Johnson & Johnson buy cefixime 100 mg otc antibiotics for acne uk, Janssen purchase cefixime 100mg antibiotics for uti not working, Merck, Amgen, Regeneron, Celgene, Allergan, and Biogen. Ryan reports that she serves on the advisory board and as a speaker for Novo Nordisk and Takeda. She also serves on the advisory board for Pfizer, Janssen, Real Appeal, and Gila Therapeutics. National, regional, and global trends in body-mass index since 1980: systematic analysis of health examination surveys and epidemiological studies with 960 country-years and 9. Prevalence and trends in obesity and severe obesity among children in the United States, 1999-2012. New tools for weight-loss therapy enable a more robust medical model for obesity treatment: rationale for a complications-centric approach. Challenging obesity: Patient, provider, and expert perspectives on the roles of available and emerging nonsurgical therapies. Clinical practice guidelines for the perioperative nutritional, metabolic, and nonsurgical support of the bariatric surgery patient--2013 update: cosponsored by American Association of Clinical Endocrinologists, the Obesity Society, and American Society for Metabolic & Bariatric Surgery. American Association of Clinical Endocrinologists and American College of Endocrinology consensus conference on obesity: building an evidence base for comprehensive action. American Association of Clinical Endocrinologists and American College of Endocrinology position statement on the 2014 advanced framework for a new diagnosis of obesity as a chronic disease. The Practical Guide: Identification, Evaluation and Treatment of Overweight and Obesity in Adults. American Association of Clinical Endocrinologists and American College of Endocrinology - clinical practice guidelines for developing a diabetes mellitus comprehensive care plan - 2015. Pharmacological management of obesity: an Endocrine Society clinical practice guideline. American Association of Clinical Endocrinologists protocol for standardized production of clinical practice guidelines. American Association of Clinical Endocrinologists Protocol for Standardized Production of Clinical Practice Guidelines-- 2010 update. Clinical practice guidelines for healthy eating for the prevention and treatment of metabolic and endocrine diseases in adults: cosponsored by the American Association of Clinical Endocrinologists/the American College of Endocrinology and the Obesity Society: executive summary. Exercise and type 2 diabetes: American College of Sports Medicine and the American Diabetes Association: joint position statement. Clinical practice guidelines for healthy eating for the prevention and treatment of metabolic and endocrine diseases in adults: cosponsored by the American Association of Clinical Endocrinologists/the American College of Endocrinology and the Obesity Society. Harmonizing the metabolic syndrome: a joint interim statement of the International Diabetes Federation Task Force on Epidemiology and Prevention; National Heart, Lung, and Blood Institute; American Heart Association; World Heart Federation; International Atherosclerosis Society; and International Association for the Study of Obesity. Effects of hypocaloric diets with different glycemic indexes on endothelial function and glycemic variability in overweight and in obese adult patients at increased cardiovascular risk. Differential effects of macronutrient content in 2 energy-restricted diets on cardiovascular risk factors and adipose tissue cell size in moderately obese individuals: a randomized controlled trial. Effects of dietary composition on energy expenditure during weight-loss maintenance. A randomized controlled trial on the efficacy of carbohydrate-reduced or fat-reduced diets in patients attending a telemedically guided weight loss program. A low carbohydrate Mediterranean diet improves cardiovascular risk factors and diabetes control among overweight patients with type 2 diabetes mellitus: a 1-year prospective randomized intervention study. Renal function following three distinct weight loss dietary strategies during 2 years of a randomized controlled trial. The effects of carbohydrate, unsaturated fat, and protein intake on measures of insulin sensitivity: results from the OmniHeart trial. Changes in weight loss, body composition and cardiovascular disease risk after altering macronutrient distributions during a regular exercise program in obese women. Effects of a popular exercise and weight loss program on weight loss, body composition, energy expenditure and health in obese women. Effects of moderate variations in macronutrient composition on weight loss and reduction in cardiovascular disease risk in obese, insulin-resistant adults. Effects of moderate variations in the macronutrient content of the diet on cardiovascular disease risk factors in obese patients with the metabolic syndrome. Adiponectin changes in relation to the macronutrient composition of a weight-loss diet. Low-fat versus low-carbohydrate weight reduction diets: effects on weight loss, insulin resistance, and cardiovascular risk: a randomized control trial. Effects of macronutrient composition of the diet on body fat in indigenous people at high risk of type 2 diabetes. One-year weight maintenance after significant weight loss in healthy overweight and obese subjects: does diet composition matter? Long-term effects of a low carbohydrate, low fat or high unsaturated fat diet compared to a no-intervention control. Influence of dietary macronutrient composition on eating behaviour and self-perception in young women undergoing weight management. Moderate carbohydrate, moderate protein weight loss diet reduces cardiovascular disease risk compared to high carbohydrate, low protein diet in obese adults: a randomized clinical trial. Short term effects of energy restriction and dietary fat sub-type on weight loss and disease risk factors. Effect of dietary macronutrient composition under moderate hypocaloric intake on maternal adaptation during lactation. Effect of the Mediterranean diet with and without weight loss on markers of inflammation in men with metabolic syndrome. The Mediterranean diet improves hepatic steatosis and insulin sensitivity in individuals with non-alcoholic fatty liver disease. A comparison of Mediterranean-style and MyPyramid diets on weight loss and inflammatory biomarkers in postpartum breastfeeding women. Body composition changes and cardiometabolic benefits of a balanced Italian Mediterranean Diet in obese patients with metabolic syndrome. Effect of the Mediterranean diet with and without weight loss on surrogate markers of cholesterol homeostasis in men with the metabolic syndrome. It does not apply to medications used in inpatient settings or administered in one of the Kaiser Permanente medical centers. You may have specific exclusions, copays, or coinsurance amounts that are not reflected in the formulary drug list. Please consult your Evidence of Coverage or Membership Agreement, for additional information regarding your pharmacy benefits, including any specific limitations or exclusions. Specialty drugs are high cost, prescription medications used to treat serious or chronic medical conditions and require special handling, administration or monitoring. The details of your outpatient prescription drug benefit, including any specific limitations or exclusions can be found in your Evidence of Coverage or Membership Agreement. Generic and Brand Name Medications Kaiser Permanente covers generic and brand name drugs. Brand name drugs are manufactured and sold by the pharmaceutical company that originally researched and developed the drug.

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Hepatotoxicity generic cefixime 200 mg free shipping antibiotic quadrant, histamine-related infusion reactions (flushing cefixime 200 mg free shipping antibiotics for uti or kidney infection, rash quality cefixime 100 mg virus 8 characteristics of life, pruritus safe 100mg cefixime antibiotics in milk, hypotension, and dyspnea are rare if infusion rate <1. Fever, thrombophlebitis, histamine-related infusion reactions (flushing, rash, pruritus, facial swelling, hypotension, dyspnea), hypokalemia, anemia, headache, hepatotoxicity, diarrhea Ceftriaxone Generally well-tolerated. Cholelithiasis, urolithiasis, pancreatitis, rash, diarrhea, drug fever, hemolytic anemia, C. Common or Serious Adverse Reactions Associated With Drugs Used for Preventing or Treating Opportunistic Infections (page 2 of 6) Drugs Common or Serious Adverse Reactions Cephalosporins (for Ceftriaxone, Hypersensitivity reaction, rash, nausea, vomiting, diarrhea, C. Nausea, vomiting, anorexia, metallic taste, increase in serum transaminases (rare) Cycloserine Neuropsychiatric toxicities (headache, somnolence, lethargy, vertigo, tremor, dysarthria, irritability, confusion, paranoia, psychosis), seizures (particularly in patients with history of chronic alcoholism), allergic dermatitis, rash, elevated transaminases, congestive heart failure (in patients receiving cycloserine 1-1. Headache, nausea, skin hyperpigmentation, diarrhea, rash Entecavir Generally well-tolerated. Common or Serious Adverse Reactions Associated With Drugs Used for Preventing or Treating Opportunistic Infections (page 3 of 6) Drugs Common or Serious Adverse Reactions Ethambutol Optic neuritis (dose dependent), peripheral neuropathy, headache, nausea, vomiting, anorexia, hepatotoxicity, hyperuricemia, hypersensitivity reaction, disorientation, hallucinations Ethionamide Dose-dependent gastrointestinal side effects (nausea, vomiting, diarrhea, abdominal pain, metallic taste, anorexia), dizziness, drowsiness, depression, postural hypotension, hepatotoxicity, hypothyroidism (with or without goiter), gynecomastia, impotence, hypoglycemia Famciclovir Generally well-tolerated. Nausea, vomiting Ledipasvir/Sofosbuvir Fatigue, headache, asthenia (most common), nausea, diarrhea, insomnia, mild transient asymptomatic lipase elevation, mild bilirubin elevation Levofloxacin Nausea, vomiting, abdominal pain, diarrhea, C. Common or Serious Adverse Reactions Associated With Drugs Used for Preventing or Treating Opportunistic Infections (page 4 of 6) Drugs Common or Serious Adverse Reactions Meropenem Generally well-tolerated. Histamine-related infusion reactions (such as flushing, rash, pruritus, hypotension, dyspnea) may occur, but these are rare if infusion lasts over 1 hour; anaphylaxis and anaphylactoid reaction, hepatotoxicity, thrombophlebitis, nausea, vomiting, diarrhea, hypokalemia, hemolysis (rare) Miconazole Buccal Tablets Dysgeusia, diarrhea, nausea, vomiting, upper abdominal pain, headache, local reactions (oral discomfort, burning, pain, tongue/mouth ulceration, gingival pruritus, swelling, dry mouth), hypersensitivity reaction (rare—may occur in patients with known hypersensitivity reaction to milk product concentrate) Miltefosine Nausea, vomiting, diarrhea, headache, motion sickness, leukocytosis, thrombocytosis, nephrotoxicity, retinal degeneration, elevated transaminases and bilirubin, teratogenic potential, impaired fertility Moxifloxacin Nausea, vomiting, abdominal pain, diarrhea, C. Nausea, vomiting, diarrhea, abdominal pain, headache Nystatin (Oral Preparations) Unpleasant taste, nausea, vomiting, anorexia, diarrhea, hypersensitivity reaction (rare) Penicillin G All Penicillin G Preparations: Hypersensitivity reactions (immediate or delayed reactions, including anaphylaxis), bone marrow suppression, nausea, vomiting, diarrhea, C. Please refer to product information Use individual formulation and adjust dose for dosing according to recommendations for individual recommendations drugs. Dosing Recommendations for Drugs Used in Treating or Preventing Opportunistic Infections Where Dosage Adjustment is Needed in Patients with Renal Insufficiency (page 4 of 7) Dosage Adjustment in Renal Insufficiency Drugs Usual Dose Creatinine Dose Clearance (mL/min)* Ganciclovir Induction Therapy: 50–69 2. Large experience in pregnancy symptomatic herpes outbreaks or varicella (>700 first-trimester exposures reported to registry); well-tolerated. Adefovir C No increase in malformations at 23 times Not recommended because of limited data (rats) and 40 times (rabbits) human dose. Report exposures during Limited experience with human use in pregnancy to Antiretroviral Pregnancy pregnancy. Large experience Susceptible bacterial infections clavulanate, ampicillin/ in human pregnancy does not suggest an sulbactam increase in adverse events. Amphotericin B B Not teratogenic in animals or in human Documented invasive fungal disease experience. Three cases reported of use in human not responsive to amphotericin B or (stibogluconate, pregnancy in second trimester with good pentamidine meglumine) outcome. Pending more data, use in the second and third trimesters, has not for malaria in first trimester only if other identified increased adverse events. Limited Susceptible bacterial infections human experience, but other beta-lactam antibiotics have not been associated with adverse pregnancy outcomes. Caspofungin C Embryotoxic, skeletal defects in rats, rabbits Invasive Candida or Aspergillus infections No experience with human use. Chloroquine C Associated with anophthalmia, Drug of choice for malaria prophylaxis and microophthalmia at fetotoxic doses in treatment of sensitive species in pregnancy. Cidofovir C Embryotoxic and teratogenic (meningocele, Not recommended skeletal abnormalities) in rats and rabbits. More than 1100 cases of quinolone use in human pregnancy have not been associated with arthropathy or birth defects. Two human studies, each with >100 first- trimester exposures, did not show increase in defects but one study found an increase in spontaneous abortion. Clindamycin B No concerns specific to pregnancy in animal Treatment of anaerobic bacterial or human studies. Limited experience reported (19 cases); no anomalies noted but red-brown skin discoloration reported in several infants exposed throughout pregnancy. Clotrimazole troches C Not teratogenic in animals at exposures Oral or vaginal Candida infections and expected from treatment of oral or vaginal prophylaxis Candida. Diphenoxylate C Limited animal and human data do not Symptomatic treatment of diarrhea indicate teratogenicity. Doxycycline, other D Risk of hepatic toxicity increased with No indications tetracyclines tetracyclines in pregnancy; staining of fetal bones and teeth contraindicates use in pregnancy. Emtricitabine B No concerns in pregnancy from limited As part of fully suppressive combination animal and human data. Entecavir C Animal data do not suggest teratogenicity at Not recommended because of limited data in human doses; limited experience in human pregnancy. Report exposures during pregnancy to Antiretroviral Pregnancy Registry: http://www. Famciclovir B No evidence of teratogenicity in rats or Recurrent genital herpes and primary rabbits, limited human experience. Report exposures during pregnancy to the Famvir Pregnancy Registry (1-888-669-6682). Fluconazole C Abnormal ossification, structural defects Single dose may be used for treatment of in rats, mice at high doses. Case reports vaginal Candida though topical therapy of rare pattern of craniofacial, skeletal and preferred. Not recommended for prophylaxis other abnormalities in five infants born to during early pregnancy. Can be used four women with prolonged exposure during for invasive fungal infections after first pregnancy; no increase in defects seen in trimester; amphotericin B preferred in first several series after single dose treatment. Foscarnet C Skeletal variants in rats, rabbits and lternate agent for treatment or secondary hypoplastic dental enamel in rats. Preferred agent for therapy in reports of safe use in human pregnancy after children. Imipenem, C/B Not teratogenic in animals; limited human Serious bacterial infections meropenem experience. Imiquimod B Not teratogenic in rats and rabbits; 8 Because of limited experience, other case reports of human use, only 2 in first treatment modalities such as cryotherapy trimester. Live vaccines, including All pregnant women should receive intranasal influenza vaccine, are injectable influenza vaccine because of the contraindicated in pregnancy. Approximately 30 cases of use of interferon-alfa in pregnancy reported; 14 in first trimester without increase in anomalies; possible increased risk of intrauterine growth retardation. Case Only for documented systemic fungal reports of craniofacial, skeletal abnormalities in disease, not prophylaxis. Consider humans with prolonged fluconazole exposure using amphotericin B in first trimester if during pregnancy; no increase in defect rate similar efficacy expected. Inhibits androgen and corticosteroid synthesis; may impact fetal male genital development; case reports of craniofacial, skeletal abnormalities in humans with prolonged fluconazole exposure during pregnancy. Treatment of hepatitis C generally not No experience in human pregnancy indicated in pregnancy. Leucovorin (folinic C Prevents birth defects of valproic acid, Use with pyrimethamine if use of acid) methotrexate, phenytoin, aminopterin in pyrimethamine cannot be avoided. Decreased fetal Serious bacterial infections weight and neonatal survival at ~ human exposures, possibly related to maternal toxicity.