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Table of Contents
Advisory Board ..... vi
Preface ..... viii
Acknowledgements ..... xiii
Brand Names of Drugs ..... xiv
Generic Drug Entries ..... 1

Appendices ..... 957
Food & Drug Administration Pregnancy Categories ..... 958
Common Aminoglycosides ..... 959
First Generation Cephalosporins ..... 961
Second Generation Cephalosporins ..... 962
Third Generation Cephalosporins ..... 964
Fourth Generation Cephalosporin ..... 966
Macrolides: Susceptible Organisms ..... 967
Quinolones: General Information ..... 969
Antifungal Agents ..... 972
Oral Contraceptives ..... 975
Forewords & Introductions
A recent article published in the New York Times quoted the astounding statistic that as many as 7,000-10,000 deaths in the United States can be attributed on an annual basis to prescription errors. Countless hospital days, loss of productivity, and an atmosphere of distrust of modern medicine all result from such errors. Many causes can be found for these mistakes; drugs with completely different properties, uses, and toxicity profiles may have similar names. Polypharmacy, a common phenomenon in the elderly, places patients at risk for complex drug-drug interactions. Difficulty with high-volume record keeping and the loss of personal interaction with the "family pharmacist" certainly result in more patients receiving the wrong medication or dosage when a prescription is filled. Finally, the rapid pace of modern medical practices coupled with the ever-bewildering numbers of medications on the market result in a situation in which the busy practitioner may have difficulty keeping abreast of important aspects of the drugs they are prescribing. It was with these concerns in mind that we undertook the task of writing a manual of drug prescription for the practicing clinician. No one can be expected to commit to memory everything important about all the drugs available on the market. It can be quite time consuming and frustrating to search for important information on individual entries in a large comprehensive volume such as the Physician's Desk Reference. Thus, our main objective in creating this book was to provide the most essential information on all commonly prescribed drugs in a concise, accurate and easy-to-read manner.
In producing this book, it is our hope that we can help clinicians give the best care possible to patients taking prescription drugs. We believe this book will benefit you in looking up drugs that are not frequently prescribed. In addition, you will have an opportunity to reacquaint yourself with details about familiar drugs when using this book "at the bedside."

The book does not have complete entries for all prescription drugs. Some have been left out simply because of lack of sufficient available information or because of very limited use. In addition, we have not included many drug combinations because of space considerations. Furthermore, we have restricted our discussion in the case of drugs that are members of the same drug class. Most if not all of the drugs in a particular pharmacologic class have similar if not identical characteristics, for example, side effects, drug-drug interactions, contraindications. Accordingly, we have selected one or more drugs to serve as prototypes and these have been given a complete entry (as described below). For other members of the particular class, we have presented only essential information, referring the reader in each case to the prototype for additional details.

On the other hand, we have discussed in full a number of widely used drugs that for one reason or another are not listed in the Physician's Drug Reference 2000 or for which only the drug name is stated without any details. In other instances, we provide even more complete information than offered by the manufacturer. For example, no drug-drug interactions are listed by the manufacturers for benzodiazepines in the Physician's Desk Reference, whereas we list a number of these interactions that are clinically important The reader should note that some information provided may differ from that contained in the manufacturer's package insert. The decision to include or exclude information is based on our best judgment or on the advice of our Advisory Board after reviewing all available data.

A handbook such as this, with its emphasis on conciseness, can present only a relatively small fraction of the total knowledge available about any particular drug. Thus, it is our considered opinion that the clinician attempt to review available product information sheets as approved by the Food and Drug Administration should the need arise to expand on the information presented herein. We strongly believe that accessing the information provided with the easy-to-follow format we have created for this manual will make this book an important reference for clinicians in a wide variety of settings. If, overall, we are able to assist the health care provider to administer medications to their patients safely and effectively and thereby to treat their ailments as well as prevent complications of drug therapy, we will have achieved our desired goals.

The following format is used for all drugs:

Brand name: For drugs that have multiple brand names, we have listed those drugs that are widely prescribed.

Mechanism of action: This is stated succinctly, using at most one or two lines.

Indications/dosage/route: All approved indications are listed; occasionally, widely used unapproved indications are mentioned. For the most part, dosages recommended by the manufacturer are listed. Dosages are mainly the usual adult dose (persons <60 or 65 years). The following specific information about dosing is included wherever possible: initial dose, follow-up dose, maintenance and maximum doses, duration of drug administration, details for parenteral (in particular IV) administration. Wherever available, doses for children and the elderly are included. Adjustment of dosage: Related primarily to kidney and liver disease. Guidelines are presented for adjusting dosage in relation to creatinine clearance or creatinine blood levels. We indicate if there is no need to adjust dosage for kidney or liver disease or for elderly or pediatric patients. Also stated are age limits for prescribing the drug for children or if the drug should be prescribed for this age group at all.

Onset of action, peak effect, and duration: Wherever available, time of onset of action, peak effect, and duration are listed. This information is considered most important for the proper spacing of drug administration. Other aspects of pharmacokinetics- serum levels, bioavailability, protein binding, half-life-as included in many sources, are not considered of utmost importance in pharmacotherapy per se and are not included.

Food: Wherever possible, mention is made of those foods to be avoided and whether or not the drug should be taken with food. Pregnancy: The pregnancy category as proposed by the Food and Drug Administration is indicated for each drug. See Table 1 on page 958 for the definition of these categories.

Lactation: Available information regarding the presence of the drug in breast milk is given. Guidelines as set forth by the American Academy of Pediatrics, if available, are presented. A general guideline provided in a brief statement (such as "avoid breastfeeding") is provided.

Warnings/precautions: All warnings provided by the manufacturer have been set forth as succinctly as possible. Other statements are made to alert the health provider to potential problems with the drug and how to avoid them. Advice to patients: This represents our opinions regarding what the treating clinician needs to tell the patient to attempt to avoid or minimize problems with the drug. Included are the following "tips": when to avoid alcohol or other CNS depressants because of adverse interactions; how to protect oneself if the drug causes photosensitivity reactions; when to anticipate and minimize orthostatic hypotension; when to avoid driving; which appropriate contraceptive measures to use; when to avoid heat, cold, extreme exertion; how to cope with anticholinergic drug side effects; when and how to stop taking the drug.

Adverse reactions: These are defined as common (occurring in ≥10% of the patients taking the drug in pre- or postmarketing testing) and serious (potentially life threatening or with the risk of causing organ damage). Side effects that are serious as well as common are listed as serious but in boldface type.

Clinically important drug interactions: All too frequently, drug compendia list too many such interactions and/or fail to indicate which of these enhance or diminish the actions of a particular drug. Our list of drug interactions includes only those that, by consensus, are clinically relevant and include a statement regarding the actual effect of the interaction.

Parameters to monitor: We consider it to be of great importance that the treating clinician follow up on how a drug is acting on the patient by monitoring various vital functions. If these suggestions are followed, we believe many serious adverse reactions may be avoided or minimized. The following are some of the suggested parameters to be monitored: blood testing, hemodynamics, blood pressure, ECG, liver and kidney function, drug levels and efficacy of the drug in achieving its intended result. Judgment regarding actual monitoring in individual patients must ultimately be made by the treating clinician.

Editorial comments: Finally, the editors and their advisors have presented information in the, form of editorial comments regarding certain aspects of many of drugs included in this manual that are not covered by the preceding.

All drugs are listed by generic name in alphabetical order. Across referenced list of brand name drugs is supplied in the front matter. With respect to the actual use of this book, the authors state the following:

Despite our best efforts to provide accurate information and opinions about each drug considered, the authors, members of the Advisory Board, and publisher do not guarantee that all of the material presented is completely accurate. The authors, reviewers, and publishers are not responsible for any errors, either those of omission or commission, that may arise in applying the enclosed information. Furthermore, not all authorities will agree with all our facts and/or evaluations. Accordingly, we can consider the material presented only as guidelines for drug administration, not the final word. The clinician or other health care provider must use his or her personal, independent judgment in applying the information in actual practice. In this regard, it is suggested that if the clinician disagrees with something in our drug monograph, he or she should check with the manufacturer's label for the particular drug before using it.

The authors, reviewers, and publisher disclaim any liability for any claim for losses or alleged losses that may have resulted from the use of the information contained herein whether directly or indirectly applied.

The authors, reviewers, and publisher have no connection with any pharmaceutical company or federal agency. They have not received compensation from any such organization. This book was commissioned solely by McGraw-Hill Company and the authors have written it without endorsement from any pharmaceutical company or federal agency. Any opinions expressed herein are solely those of the authors and members of their Advisory Board.

The authors, Advisory Board, and publisher will not be held liable if the material presented is misused or not applied appropriately by the clinician.

In many instances, a particular drug may have several brand names. We have included those that in our opinion are commonly used. Inclusion of one or more brand names should not be construed as an endorsement of the product just as its exclusion does not imply that we have rejected the product or consider it inferior to another. The publisher does not endorse or reject any of the products described and has no opinion regarding any of the products. The publisher has not engaged in or provided any kind of financial support for any of the products described herein.