Commonly used drugs (medications) and doses

Drugs and pregnancy

In general, it’s best to avoid taking any medication when pregnant (particularly during the first trimester, or first third, of pregnancy) to avoid the risk of fetal malformation, or illness or injury in the newly born child. A pregnant woman should be discouraged from taking over-the-counter drugs. However, women can certainly become ill during pregnancy, so it’s important to know what can be administered safely and what should be absolutely avoided. Fortunately, many of the drugs that are labeled “potentially hazardous” have only been proved hazardous in laboratory animals, frequently in relative doses that far exceed their common usage in humans. There is limited data on the safety of most drugs during pregnancy.

The following list reflects recommendations compiled from the current medical literature and should be used only as guidance and with the understanding that recommendations change. Whenever possible, a pregnant woman contemplating use of a medication should seek advice in advance from her physician.

Allergic reaction to a drug

If a person develops an allergic reaction to a drug (itching, shortness of breath, swollen tongue, difficulty talking, skin rash, hives, and so on), immediately discontinue the drug and follow the instructions on page 78.

Overview of epinephrine

Epinephrine is a life-saving medication used for multiple medical conditions including severe allergic reactions and severe asthma.

• Epinephrine (adrenaline) 1:1000 aqueous solution (1mg/mL). Adult dose 0.3 to 0.5 mL injected intramuscularly (see page 469) into the lateral thigh. This may be repeated at 5 to 20 minute intervals (or sooner!) depending on the situation. Patients should carry more than one dose of their epinephrine and at least two autoinjectors in case a repeat dose is needed. If a repeat dose is needed, then inject in a new location. If a patient does not respond after second or third dose, then other interventions and rapid evacuation may be necessary. The pediatric dose is 0.01 mg/kg (0.01 mL/kg of the 1 mg/mL concentration), not to exceed 0.3 mg, injected intramuscularly into the lateral thigh. If the thigh is obese, whether in an adult or a child, such that the needle might not reach into muscle, then inject into the lower thigh. If obesity is extreme, consider injecting into the mid-calf. Don’t delay use of epinephrine in a patient that may need it. Use with caution in patients with preexisting conditions such as heart disease and elderly patients.

  • Side effects: Rapid heartbeat, nervousness.

  • The drug is available in preloaded syringes in certain allergy kits (see Fig. 308 ) or may be drawn up from a vial using a syringe (see page 469).

  • Preloaded syringes include the EpiPen auto-injector (0.3 mg) and EpiPen Jr. auto-injector (0.15 mg), Auvi-Q autoinjectors, Adrenaclick auto-injectors, and SYMJEPI prefilled (with epinephrine) syringes. FDA-approved generic products are sometimes less expensive. Other devices worldwide are the Jext, Emerade, Allerject, and Anapen. Instructions for use accompany the kits. For dosing purposes, a 0.3-mg autoinjector should be used for adults and children over 66 lb (30 kg) in weight. Children 66 lb and under should be injected with a 0.15 mg autoinjector. When injecting into a child’s leg, be sure to hold the leg firmly so that it doesn’t move in order to prevent creating a cut. Never reinsert an autoinjector needle.

  • See Fig. 308 , How to use epinephrine auto-injector.

  • Take particular care to handle preloaded syringes properly, to avoid inadvertent injection into an unintended location, such as a finger or toe. Don’t intentionally inject epinephrine into the buttocks or a vein. Epinephrine should not be exposed to heat or sun but does not need to be kept refrigerated. Protect epinephrine from freezing. According to manufacturers, epinephrine should be stored between 68°F to 77°F (20°C to 25°C) with brief excursions permitted to 59°F to 86°F (15°C to 30°C). If clear (liquid) epinephrine turns cloudy or discolored, it should be discarded. When administering an injection, never share needles between people.

Overview of metered-dose inhalers, albuterol

Metered dose inhalers are used to administer a variety of medications for a variety of conditions. Albuterol is a common medication contained in an inhaler and used to treat a variety of breathing conditions such as asthma, severe allergy, and chronic obstructive pulmonary disease (COPD) as noted in the following pages.

• Albuterol (Ventolin) or metaproterenol (Alupent) metered-dose inhaler . Adult dose two to four puffs every 20 minutes for 1 hour during attack (may need more frequent dosing), followed by two to four puffs every 3 to 6 hours as needed.

  • Side effects: Rapid heartbeat, nervousness (“jitters”).

  • The proper technique for using a metered-dose inhaler device is as follows (see Fig. 309 ):

    • 1.

      Shake the inhaler vigorously for 5 seconds before each use.

    • 2.

      Invert the inhaler so that the opening is downward if directed to do so. Hold the inhaler 4 cm (1.6 inches) in front of an open mouth, or place a spacer on the opening, around which the lips will be sealed.

    • 3.

      Exhale fully. Close your lips around the spacer, or hold the device about 4 cm (1.6 inches) from your mouth, or close your lips around the mouthpiece.

    • 4.

      Activate the inhaler at the beginning of inspiration.

    • 5.

      Inhale slowly and deeply to full lung capacity.

    • 6.

      Hold your breath for 10 seconds, then exhale slowly.

    • 7.

      Wait 1 minute before repeating all steps before the next puff. Shake the inhaler before each puff.

Overview of steroids

There are different types of steroids, and steroids are used to treat many different conditions.

Corticosteroids (“steroids”) are interchangeable to a certain degree. If you must substitute, here is a rough measure of equivalence: 20 mg prednisone equals 16 mg methylprednisolone equals 3 mg dexamethasone.

Corticosteroids should always be taken with the understanding that a rare side effect is serious deterioration of the head (“ball” of the ball-and-socket joint) of the femur, the long bone of the thigh.

When corticosteroids are administered to a person for a sufficiently long period of time, the adrenal glands (which manufacture the same hormones) are suppressed. To allow the adrenal glands to recover, the following rules should be observed:

If someone has been receiving a high (nontapered) dose of a corticosteroid for 5 days or less, then the medication can be abruptly discontinued without consideration for adrenal suppression.

If someone has been receiving a high (nontapered) dose of a corticosteroid for 6 to 10 days, then the medication should be tapered over an additional 7 days.

For relief from a severe allergic reaction

• Epinephrine (adrenaline) 1:1000 aqueous solution (1mg/mL) . Adult dose 0.3 to 0.5 mL injected intramuscularly (see page 469) into the lateral thigh. See Overview of Epinephrine on page 484 and Fig. 308 .

  

• Diphenhydramine (Benadryl). Adult dose 25 to 50 mg every 4 to 6 hours; pediatric dose 1 mg/kg (2.2 lb) of body weight.

  • Side effects: Drowsiness, paradoxical hyperactivity (children).

• Albuterol (Ventolin) or metaproterenol (Alupent) metered-dose inhaler . Adult dose two puffs every 3 to 6 hours as needed. See Overview of Metered-Dose Inhalers page 485 and Fig. 309 .

  • Side effects: Rapid heartbeat, nervousness (“jitters”).

  

• Prednisone. Adult dose 50 to 80 mg the first day. Each day, the dose is decreased by 10 mg. The pediatric dose is 1 mg/kg of body weight the first day, tapered every 4 days by halving the dose. Administer with food or with an antacid if possible. Corticosteroids are interchangeable to a certain degree. See Overview of Steroids above.

• For a severe skin reaction to poison ivy, oak, or sumac, see the instructions on page 255.

• For a severe sunburn, see the instructions on page 249.

For relief from a mild allergic reaction or hay fever

• Diphenhydramine (Benadryl). Adult dose 25 to 50 mg every 4 to 6 hours; pediatric dose 1 mg/kg of body weight.

• Diphenhydramine (25 mg) with pseudoephedrine (60 mg) (Benadryl Decongestant). Adult dose one tablet every 8 hours.

• Cetirizine hydrochloride (Zyrtec). Dose 5 to 10 mg every 24 hours; don’t use in children under 6 years of age. Pediatric dose: children ages 6 to 11 years 5 or 10 mg every 24 hours; ages 6 months to 5 years 2.5 mg every 24 hours.

• Fexofenadine (Allegra). Adult dose 60 mg every 12 hours. In adults, it may also be administered as 180 mg once a day. Pediatric dose for children ages 2 to 11 years 30 mg twice a day. Rarely causes drowsiness. Allegra-D: fexofenadine 60 mg with pseudoephedrine 120 mg extended-release tablet.

• Loratadine (Claritin). Adult dose 10 mg every 24 hours. Pediatric dose children ages 2 to 6 years 5 mg every 24 hours. Rarely causes drowsiness. Claritin-D: loratadine 5 mg with pseudoephedrine 120 mg. Claritin-D 24 Hour: loratadine 10 mg with pseudoephedrine 240 mg.

• Cyproheptadine (Periactin). Adult dose 4 mg every 8 hours. Pediatric dose: children 7 to 14 years 4 mg every 8 to 12 hours; ages 2 to 6 years 2 mg every 8 to 12 hours.

• Prednisone. Adult dose 50 to 80 mg the first day for severe seasonal allergies that don’t respond to other medications. Each day, the dose is decreased by 10 mg. The pediatric dose is 1 mg/kg of body weight the first day, tapered every 4 days by halving the dose. Administer with food or with an antacid, if possible. See Overview of Steroids page 486.

• Triprolidine with pseudoephedrine (Actifed). Adult dose 1 tablet every 8 hours; pediatric dose (6 to 12 years of age) half tablet every 8 hours.

  • Side effect: Drowsiness.

For relief from severe asthma or chronic obstructive pulmonary disease

Many asthma and COPD medications are administered by metered dose inhaler. The proper technique for using this device is discussed on page 487 and Fig. 309 . Albuterol ( Ventolin ) metered-dose inhaler. Adult dose two puffs every 4 hours as needed. In an acute asthma attack, start with four puffs and consider going up to 10 puffs as needed with more frequent repeat dosing.

• Epinephrine (adrenaline) 1:1000 aqueous solution (1mg/mL). Adult dose 0.3 to 0.5 mL injected intramuscularly (see page 469) into the lateral thigh. This may be repeat at 20-minute intervals for total of three doses. (See page 485 and Fig. 308 ) The pediatric dose is 0.01 mL /kg (2.2 lb) of body weight, not to exceed 0.3 mL. Don’t use epinephrine for treatment of COPD.

  • Side effects: Rapid heartbeat, nervousness.

• Prednisone. Adult dose 50 to 80 mg the first day. Each day, the dose is decreased by 10 mg. The pediatric dose is 1 mg/kg (2.2 lb) of body weight the first day, tapered every 4 days by halving the dose. Administer with food or with an antacid, if possible. See Overview of Steroids page 486.

For treatment of chest pain (angina)

• Nitroglycerin 0.4 mg or lingual aerosol (0.4 mg metered dose per spray). Adult dose one tablet dissolved under the tongue, or one spray under the tongue, for treatment of angina. This may be repeated every 10 minutes for two additional doses.

  • Side effects: Dizziness (low blood pressure), headache. If a person uses nitroglycerin and becomes faint, they should lie down with their legs elevated until their skin color returns to normal and they feel better (usually, in a minute or two). If chest pain or weakness persists, this might indicate a heart attack (see page 57).

• Nitroglycerin patch 0.4 to 0.6 mg. Apply for 12 to 24 hours.

• Isosorbide mononitrate or dinitrate (short-acting formulation). Adult dose 20 to 60 mg by mouth twice daily.

• Isosorbide mononitrate or dinitrate (sustained-release formulation). Adult dose 60 to 120 mg by mouth twice daily.

  • Side effects: Headache, dizziness, nausea, irregular heartbeat (palpitations). This drug should not be given with medications for erectile dysfunction (e.g., sildenafil citrate [Viagra]).

• Metoprolol (short-acting formulation). Adult dose 50 to 150 mg by mouth twice daily.

• Metoprolol (sustained-release formulation). Adult dose 100 to 300 mg once daily.

  • Side effects: Fatigue, shortness of breath, wheezing, weakness, dizziness. Should be used with caution in persons with COPD, diabetes, depression, severe peripheral vascular disease, certain abnormal heart rhythms, or erectile dysfunction.

• Nifedipine (sustained-release formulation). Adult dose 30 to 90 mg by mouth once daily.

• Verapamil (short-acting formulation). Adult dose 20 to 120 mg two to three times by mouth daily.

• Verapamil (sustained-release formulation). Adult dose 180 to 240 mg by mouth once or twice daily.

• Diltiazem (sustained-release formulation). Adult dose 120 to 480 mg by mouth once daily.

For treatment of congestive heart failure

• Furosemide (Lasix) diuretic (promotes urination). Adult dose 1 to 4 tablets (20 to 80 mg) each day for the fluid retention associated with heart failure. Diuretics should not be used for fluid retention not associated with heart failure (such as that from high altitude) or for weight reduction.

• Digoxin (Lanoxin). Adult dose 0.125 to 0.25 mg per day.

For treatment of seizures (epilepsy)

Doses of antiseizure medications vary widely, depending on the age and size of the patient, whether other drugs are also being taken, any underlying chronic diseases, and other factors. Therapeutic levels are closely monitored by the patient’s neurologist. Therefore, the doses for these medications are listed for reference only as possible maintenance doses.

• Diphenylhydantoin (Dilantin). Adult dose 300 to 400 mg per day; pediatric dose 2.5 mg/kg of body weight twice a day.

• Phenobarbital. Adult dose 60 to 120 mg three times per day; pediatric dose 1 to 1.5 mg/kg of body weight three times a day.

• Carbamazepine (Tegretol). Adult dose 400 to 1200 mg a day in two to three divided doses; pediatric dose 10 to 20 mg/kg (2.2 lb) of body weight each day in two to three divided doses.

• Levetiracetam (Keppra). Adult dose 500 to 1500 mg twice a day; pediatric dose 10 to 30 mg/kg (2.2 lb) of body weight twice a day.

• Lamotrigine (Lamictal). Adult dose 100 to 200 mg once a day; pediatric dose for children ages 2 to 12 years 1 to 5 mg/kg (2.2 lb) body weight in one or two divided doses.

• Pregabalin (Lyrica) . Adult dose 150 to 600 mg once a day.

• Valproic acid (Depakote) . Adult and pediatric (ages 10 years and older) dose 10 to 50 mg/kg (2.2 lb) body weight once a day.

• Clonazepam (Klonopin) . Adult dose 1.5 to 20 mg per day in three divided doses; pediatric dose (up to 10 years of age) 0.1 to 0.2 mg/kg (2.2 lb) of body weight in three divided doses.

• Gabapentin (Neurontin) . Adult dose 900 to 1800 mg per day in three divided doses; pediatric dose ages 3 to 12 years 25 to 40 mg/kg (2.2 lb) per day in three divided doses.

• Trimethadione (Tridione) . Adult dose 300 to 600 mg three or four times a day; pediatric dose 100 to 300 mg three or four times a day.

• Primidone (Mysoline) . Adult and pediatric (ages 8 years and over) dose 250 mg three or four times a day.

• Ethosuximide (Zarontin) . Adult and pediatric dose ages 3 years of age and older 20 mg/kg (2.2 lb) per day not to exceed 1.5 g daily.

For relief from pain (see also for relief from muscle aches or minor arthritis)

We are in the midst of an opioid epidemic. It is best to avoid opioid treatment unless patients have severe pain, and if used, to wean the patient as soon as possible (e.g., in less than 1 week). See treatment of opioid overdose below.

• Acetylsalicylic acid (aspirin). Adult dose 325 to 1000 mg every 4 to 6 hours (maximum dose 4000 mg per day); pediatric dose 10 to 15 mg/kg (not to exceed 90 mg/kg/day) every 4 to 6 hours. Do not use aspirin in children <18 years recovering from viral or flu-like illness because of increased risk (of Reye syndrome).

  • Side effect: Stomach irritation. Don’t administer to a person with an ulcer or upset stomach. Take with food or an antacid, if possible. Enteric-coated aspirin (such as Ecotrin) helps prevent stomach irritation and should be used whenever possible.

• Acetaminophen (Tylenol). Adult dose 500 to 1000 mg every 4 to 6 hours (maximum dose 4000 mg per day); pediatric dose: up to 1 year, 60 mg; 1 to 3 years, 60 to 120 mg; 3 to 6 years, 120 mg; 6 to 12 years, 240 mg. Acetaminophen taken in too high a quantity acutely or over time can cause liver failure, so it is very important to keep track of the amount ingested, including as part of combination medications.

• Codeine. Adult dose 30 to 60 mg every 6 to 8 hours; pediatric dose 0.5 to 1 mg/kg of body weight.

  • Side effects: Codeine is a narcotic and has side effects of drowsiness and alteration of mental status. In addition, it might cause constipation.

• Acetaminophen (Tylenol) 325 mg with codeine 30 mg. Adult dose one to two tablets every 4 to 6 hours.

• Hydrocodone 5 mg with acetaminophen 500 mg (Vicodin). Adult dose one to two tablets every 4 to 6 hours. This is a narcotic drug and should not be taken in any situation in which altered mental status will be dangerous.

• Ketorolac (Toradol) 10 mg. Adult dose one tablet every 6 to 8 hours. This is an antiinflammatory drug that is particularly useful for persons suffering kidney stones.