Rimatadine

Rimatadine
Rimatadine (Flumadine? is an antiviral agent indicated for prophylaxis and treatment of illness caused by various strains of the influenza A virus in adults. It is also used in children for prophylaxis against the influenza A Virus. The use of rimantadine in individuals in the same household can lead to the development of resistant strains; 10% to 30% of patients with an initially sensitive strain of the virus will shed rimantadine-resistant virus after treatment.

The most common side effects of rimantadine are insomnia, nausea, and dizziness. Rimantadine may be useful for the treatment of some of the patients who would have traditionally received amantadine (Symmetrel?, because it is reported to cause fewer CNS side effects than amantadine.

The usual adult dose is 100 mg twice a day. For prophylaxis in children under 10 years of age, the dose is 5 mg/kg per day and should not exceed 150 mg per day. Rimantadine is available as a 100 mg tablet and a 50 mg per 5 ml syrup. Therapy should be initiated as soon as possible after exposure. It is preferable to begin therapy within 48 hours after the onset of symptoms of influenza A infection. The therapy is continued for seven days from the initial onset of symptoms. Patients with renal insufficiency should be monitored for adverse effects due to potential accumulation of the drug. The dose should be adjusted accordingly.

NOTE: Rimantadine sounds and looks like ranitidine. Be careful to double check orders for these medications, especially when the drug strength does not appear correct.

Fentanyl Transdermal Patches: Deaths Associated With Misuse
Fentanyl transdermal patches (Duragesic? have been implicated in four preventable patient deaths since market introduction in early 1991. Some examples of such misuse have included use of the product in a 9-year-old after tonsillectomy and in a 17-year-old after wisdom teeth extraction. To prevent further misuse the product labeling has been revised to carry the following boxed warning statement.

Because serious or life-threatening hypoventilation could occur, Duragesic(R) is contraindicated:

In the management of acute or post-operatiave pain, including use in outpatient surgeries;
In the management of mild or intermittent pain responsive to PRN or non-opioid therapy; and
In doses exceeding 25 mcg/hour at the initiation of opioid therapy

Duragesic(R) should not be administered to children under 12 years of age or patients under 18 years of age who weight less than 50 kg (110 lbs) except in an authorized investigational research setting.

Duragesic(R) is indicated for treatment of chronic pain (such as that of malignancy) that:

cannot be managed by lesser means such as acetaminophen-opioid combinations, non-steroidal analgesics, or PRN dosing with whort-acting opioids and;
requires continuous opioid administration

The 50, 75, and 100 mcg/hour dosages should ONLY be used in patients who are already on and are tolerant to opioid therapy.

Formulary Antacids At UIHC
The UIHC Pharmacy stocks a number of antacid preparations. Gaviscon?tablets contain alginic acid, aluminum hydroxide, sodium bicarbonate, and magnesium trisilicate. Aluminum hydroxide products (Alternagel? Amphogel? and Alu-Cap?, calcium products (Tums?and oral suspensions), magnesium oxide, sodium bicarbonate, and magnesium and aluminum combinations products are also listed in the Formulary and Handbook as antacids. However, magnesium and aluminum combinations products are the antacids routinely used for treatment of peptic and duodenal ulcers, esophageal reflux, GI bleeding, and stress ulcer prophylaxis. The Pharmacy and Therapeutics Subcommittee considers magnesium and aluminum antacids and magnesium and aluminum antacids with simethicone to be therapeutically equivalent and may be used interchangeably. High-potency antacids have twice the acid neutralizing capacity of low-potency antacids. The high-potency antacids, Maalox?and Mylanta?II, are interchangeable, as are the low-potency antacids, Maalox?and Mylanta? Typically, the low-potency antacids are dosed at 30 ml and the high-potency antacids are dosed at 15 ml.

Magnesium Hydroxide*

Aluminum Hydroxide*

Simethicone*

Maalox(R) Liquid

200 mg

225 mg

-

Mylanta(R) Liquid

200 mg

200 mg

20 mg

Maalox(R) TC Liquid

300 mg

600 mg

-

Mylanta(R) II Liquid

400 mg

400 mg

40 mg

Maalox(R) Plus Extra
Strength Tablet

200 mg

200 mg

25 mg

_______
*Above strengths are listed for single tablet and 5 ml of liquid.

	Magnesium Hydroxide*	Aluminum Hydroxide*	Simethicone*
Maalox(R) Liquid	200 mg	225 mg	-
Mylanta(R) Liquid	200 mg	200 mg	20 mg
Maalox(R) TC Liquid	300 mg	600 mg	-
Mylanta(R) II Liquid	400 mg	400 mg	40 mg
Maalox(R) Plus Extra Strength Tablet	200 mg	200 mg	25 mg
_______ *Above strengths are listed for single tablet and 5 ml of liquid.