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l Zidovudine (ZDV) short course 5 страница
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Side Effects: The most common adverse effects of zidovudine are hematologic effects (i. e., anemia, neutropenia), nausea, and headache. Malaise, asthenia, agitation, dizziness, fatigue, insomnia, paresthesia, and somnolence have been reported in up to 63% of patients receiving zidovudine, most frequently in those who received high dosage of the drug.
Precautions and Contraindications: Zidovudine should be used with caution in patients who have compromised bone marrow function. Zidovudine should be used with caution in any patient with hepatomegaly, hepatitis, or other known risk factor for liver disease, and such patients should be monitored closely while receiving the drug. Because zidovudine is eliminated principally by renal excretion following metabolism in the liver, patients with impaired renal or hepatic function or decreased hepatic blood flow may be at increased risk of toxicity from the drug. Most clinicians do not consider pregnancy a contraindication for use of antiretroviral therapy when such therapy is indicated, especially during the second and third trimester.
Rimantadine Hydrochloride
Description: Rimantadine hydrochloride is a synthetic antiviral agent that is structurally related to amantadine and active against influenza A virus. The usual dosage of rimantadine hydrochloride for adults is 100 mg twice daily. Rimantadine hydrochloride is contraindicated in pregnancy because of its embryotoxic action; the drug should be used during pregnancy only when the potential benefits justify the possible risks to the fetus.
Blood Derivatives
Albumin Human
Description: Albumin human, a protein colloid, is a sterile solution of serum albumin prepared by fractionating pooled plasma from healthy human donors.
Indications: Albumin human solutions are used for plasma volume expansion and maintenance of cardiac output (fluid resuscitation) in the treatment of certain types of shock or impending shock including those resulting from burns, surgery, hemorrhage, or other trauma or conditions in which a circulatory volume deficit is present. The beneficial effect of albumin human for fluid resuscitation is thought to result principally from its contribution to colloid osmotic pressure (i. e., oncotic pressure).
Dosage and Administration: Albumin human solutions are administered by IV infusion. The concentration of albumin human administered depends on the fluid and protein requirements of the patient. Solutions containing 5% albumin human are usually indicated in hypovolemic patients, whereas the more concentrated 25% solutions should be used in patients in whom fluid and sodium intake must be minimized.
Side Effects: Adverse effects of albumin human occur infrequently. Adverse reactions (which may be caused by allergy or protein overload resulting from high dosage or repeated administration) include chills, fever, nausea, vomiting, increased salivation, urticaria, and variable effects on blood pressure, heart rate, and respiration.
Precautions and Contraindications: Because albumin human is prepared using pooled human plasma, it is a potential vehicle for transmission of human viruses, including hepatitis virus, or other infectious agents. Although donors are screened for certain viruses (e. g., human immunodeficiency virus [HIV], hepatitis B virus [HBV], hepatitis C virus [HCV]) and albumin human undergoes a pasteurization procedure to reduce viral infectious potential, a risk for transmission of infectious agents still remains.
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Plasma Protein Fraction
Description: Plasma protein fraction (PPF), a sterile 5% solution of selected proteins prepared from pooled plasma obtained from healthy human donors, is a protein colloid that has pharmacologic properties similar to those of its primary constituent, albumin.
Indications: Fluid resuscitation in the treatment of certain types of shock, including those resulting from burns, crushing injuries, abdominal emergencies, or any other cause where there is a predominant loss of plasma fluids and not red blood cells. PPF is also effective in the emergency treatment of shock due to hemorrhage.
Dosage and Administration: Plasma protein fraction (PPF) is administered by IV infusion. Dosage of PPF depends on the patient's condition and response to therapy. In the treatment of hypovolemic shock in adults, the usual minimum effective dose of PPF is 250-500 ml (12. 5-25 g of protein).
Side Effects: Adverse effects of PPF occur infrequently and may include flushing, tachycardia, erythema, urticaria, nausea, vomiting, chills, fever, headache, back pain, and hypersalivation.
Precautions and Contraindications: Because PPF is prepared using pooled human plasma, it is a potential vehicle for transmission of human viruses, including hepatitis viruses, or other infectious agents. Although donors are screened for certain viruses (e. g., human immunodeficiency virus [HIV], hepatitis B virus [HBV], hepatitis C virus [HCV]) and PPF undergoes a pasteurization procedure to reduce viral infectious potential, a risk for transmission of infectious agents still remains. It is not known whether PPF can affect reproductive capacity or can cause fetal harm when administered to pregnant women, and the protein colloid should be used during pregnancy only when clearly needed.
Cardiovascular Drugs
Antiarrhythmic Agents
Description: Amiodarone Hydrochloride.
Indications: Amiodarone appears to be effective in the management of a wide variety of ventricular as well as supraventricular arrhythmias. The drug is currently preferred or is an acceptable alternative in patients with severely impaired cardiac function for the management of supraventricular and ventricular arrhythmias. In addition, amiodarone is one of several preferred agents recommended for the management of hemodynamically stable monomorphic or polymorphic ventricular tachycardia in patients with normal baseline QT interval, particularly in those with impaired cardiac function. Amiodarone has been used in a limited number of patients for the management of chronic stable angina pectoris. Limited data suggest that amiodarone is more effective than sublingual nitroglycerin in increasing exercise tolerance and decreasing ST-segment depression in patients with chronic stable angina pectoris.
Dosage and Administration: Amiodarone hydrochloride is administered orally or by IV infusion. PO 1 g or more daily are administered usually, it is recommended that the drug be given in divided doses (e. g., twice daily) with meals. For IV: commercially available amiodarone hydrochloride concentrate for injection containing 50 mg of the drug per ml must be diluted prior to administration. To produce the solution required for the first rapid loading infusion or for supplemental amiodarone infusions, 3 ml of amiodarone hydrochloride concentrate should be added to 100 ml of 5% dextrose, resulting in a final concentration of 1. 5 mg/ml. To produce the solution for slow infusion and the maintenance infusion, 18 ml of amiodarone hydrochloride concentrate should be added to 500 ml of 5% dextrose, resulting in a final amiodarone concentration of 1. 8 mg/ml. For subsequent maintenance infusions, solutions containing a final amiodarone hydrochloride concentration of 1-6 mg/ml may be used. Amiodarone is a highly toxic drug, and the lowest effective dosage should be used to minimize the risk and occurrence of adverse effects.
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Side Effects: Adverse reactions to amiodarone are common in nearly all patients receiving the drug for the treatment of ventricular arrhythmias. The most severe reactions to oral amiodarone are pulmonary toxicity, arrhythmogenic effects, and rare, but potentially serious, liver injury; however, numerous other adverse reactions to the drug also may be clinically important.
Precautions and Contraindications: Amiodarone is a highly toxic drug and exhibits several potentially fatal toxicities, notably pulmonary toxicity. Because of its pharmacokinetic properties, difficult dosing schedule, and severity of adverse effects in patients who are improperly monitored, amiodarone should be administered only by physicians who are experienced in the management of life-threatening arrhythmias, who are thoroughly familiar with the risks and benefits associated with amiodarone therapy, and who have access to laboratory facilities necessary to adequately monitor the efficacy and adverse effects of the drug, including continuous ECG monitoring and electrophysiologic techniques for evaluating the patient in both ambulatory and hospital settings. Amiodarone crosses the placenta and leads to fetal sinus bradycardia, fetal congenital goiter/hypothyroidism and hyperthyroidism. Amiodarone should be used during pregnancy only when the potential benefits justify the possible risks to the fetus.
Cardiotonic Agents
Description: Digoxin (cardiac glycoside). Analoges: Digitek®, Bertek, Lanoxin®.
Cardiac glycosides increase the force and velocity of myocardial systolic contraction (positive inotropic action); the drugs also decrease conduction velocity through the atrioventricular (AV) node and prolong the effective refractory period of the AV node.
Indications: Cardiac glycosides are used principally in the prophylactic management and treatment of heart failure and to control the ventricular rate in patients with atrial fibrillation or flutter. The drugs are also used to treat and prevent recurrent paroxysmal atrial tachycardia. Digoxin is the most commonly used cardiac glycoside, primarily because it may be administered by various routes, it has an intermediate duration of action, and the pharmacokinetics of digoxin in patients with or without renal insufficiency have been extensively studied.
Dosage and Administration: Cardiac glycosides are usually administered orally. When oral therapy is not feasible or when rapid therapeutic effect is necessary, cardiac glycosides may be administered by IV injection. Although cardiac glycosides may also be given IM, this route of administration is rarely justified because these drugs frequently cause severe local irritation, pain, and muscle fasciculation at the site of injection and because IV administration produces more rapid, predictable effects. Cardiac glycosides should not be given subcutaneously. Therapy with an oral cardiac glycoside should replace IM or IV administration as soon as possible. For PO use initial adult daily oral dosage is 1-1. 25 mg in divided doses of 0. 25 mg (0. 25 mg 3-5 times a day). The daily dosage should be carefully decreased by 0. 25 mg depending on response (e. g. 0. 25 mg 3-1 times a day, then 0. 5-0. 25-0. 125 mg daily). IV use 0. 25-0. 5 mg (1-2 ml of 0. 025% solution) diluted in 10 ml of 10% solution of glucose, slowly.
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Precautions and Contraindications: Cardiac glycosides should be used with caution in patients with severe pulmonary disease, hypoxia, myxedema, acute myocardial infarction, severe heart failure, acute myocarditis (including rheumatic carditis) or an otherwise damaged myocardium, since the likelihood of cardiac glycoside-induced arrhythmias is increased in these patients. Digoxin has a long history of safe use during pregnancy. It is not teratogenic and not associated with adverse fetal effects when given in appropriate doses. However, it should be used during pregnancy only when the potential benefits justify the possible risks to the fetus.
Diuretics
Hydrochlorothiazide (Hypothiazide)
Description: Hydrochlorothiazide is a thiazide diuretic with saluretic action and antihypertensive agent. Analogues: Bendroflumethiazide, Chlorothiazide, Chlorothiazide Sodium, etc.
Indications: Thiazide diuretics are used in the management of edema resulting from a number of causes. Thiazide diuretics play a key role in the management of congestive heart failure because they produce symptomatic benefits more rapidly than any other drugs, relieving pulmonary and peripheral edema within hours or days compared with weeks or months for cardiac glycosides, angiotensin-converting enzyme (ACE) inhibitors, or ß -blockers. Edema associated with pregnancy generally responds well to thiazides except when caused by renal disease. Hypertension during pregnancy also responds well, but preeclampsia and eclampsia may require more potent diuretics. The routine use of thiazides is contraindicated in pregnant women with mild edema who are otherwise healthy. Thiazide diuretics are used alone or in combination with other classes of antihypertensive agents in the management of all stages of hypertension.
Dosage and Administration: Hydrochlorothiazide is administered orally. For the management of edema, the usual adult dosage of hydrochlorothiazide is 25-100 mg daily in 1-3 divided doses.
Bendroflumethiazide is administered orally. Bendroflumethiazide alone is usually used at a dosage of 5 mg daily.
Chlorothiazide is administered orally. Chlorothiazide sodium is administered by slow IV injection or by infusion; however, the IV route should be used only when patients are unable to take the drug orally or in emergency situations. The usual adult dosage of chlorothiazide is 250-500 mg to 2 g daily, administered orally or IV in 1 or 2 doses. The maximum adult oral dosage is 500 mg daily.
Side effects: One of the most common adverse effects of thiazides is potassium depletion which occurs in most patients. Potassium depletion may cause cardiac arrhythmias and is particularly important in patients receiving cardiac glycosides because hypokalemia potentiates the cardiac toxicity (e. g., increased ventricular irritability) of these agents. Dilutional hyponatremia may occasionally occur or be aggravated during thiazide therapy. Hypercalcemia may also occur infrequently in patients receiving thiazides. Thiazides and related diuretics can produce hyperglycemia and glycosuria in diabetics. GI adverse effects reported with thiazides include anorexia, gastric irritation, nausea, vomiting, cramping, diarrhea, constipation, intrahepatic cholestatic jaundice, and pancreatitis.
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Precautions and Contraindications: Electrolyte disturbances may occur during thiazide therapy, and patients should be observed for signs of electrolyte imbalance such as dryness of mouth, thirst, weakness, lethargy, drowsiness, restlessness, confusion, seizures, oliguria, or muscle pains or cramps, muscular fatigue, hypotension, tachycardia, or GI disturbances such as nausea and vomiting. Thiazides should be used with caution in patients with severe renal disease. Thiazides are contraindicated in patients with anuria and in those who are allergic to any of the thiazides. The routine use of thiazides is contraindicated in pregnant women with mild edema who are otherwise healthy. Thiazides cross the placenta and lead to thrombocytopenia in newborn infants of women receiving thiazides. Jaundice may also occur in the fetus or neonate. And so thiazides should be avoided during the first trimester of pregnancy if possible. On the other hand, patients with chronic hypertension who were receiving thiazides prior to pregnancy can continue to receive the drugs during pregnancy to minimize the fetal and maternal risks of hypertension. Thiazide diuretics are not recommended for the management of severe pregnancy-induced hypertension (e. g., preeclampsia).
Furosemide
Description: Furosemide is a sulfonamide, loop-type diuretic and antihypertensive agent.
Indications: Furosemide is used in the management of edema associated with congestive heart failure, nephrotic syndrome, and hepatic cirrhosis. IV furosemide may also be used as an adjunct in the treatment of acute pulmonary edema, hypertensive crises, especially when associated with acute pulmonary edema or renal failure. In addition to producing a rapid diuresis, furosemide enhances the effects of other hypotensive drugs and counteracts the sodium retention caused by some of these agents.
Dosage and Administration: Furosemide is usually administered orally. Furosemide may be given by IM or IV injection when a rapid onset of diuresis is desired or the patient is unable to take oral medication. The usual adult oral dose of furosemide for the management of edema is 40 mg given as a single dose, preferably in the morning. In adults who do not respond, the second and each succeeding oral dose may be increased in 20- to 40-mg increments every 6-8 hours until the desired diuretic response (including weight loss) is obtained. Adult oral dosage of furosemide may be carefully titrated up to 600 mg daily in severely edematous patients; higher dosages (e. g., up to 4 g daily IV or orally for severe, refractory congestive heart failure) are under investigation. For the management of acute pulmonary edema in adults, 40 mg of furosemide may be slowly injected IV over 1-2 minutes. If the initial adult dose does not produce a satisfactory response within 1 hour, the dose may be increased to 80 mg IV given over 1-2 minutes. In adults with hypertensive crises, who have normal renal function, 40-80 mg of furosemide (administered concomitantly with other hypotensive agents) may be given IV over 1-2 minutes; in patients with reduced renal function a higher dose may be required.
Side Effects: Furosemide may produce profound diuresis resulting in fluid and electrolyte depletion. Fluid and electrolyte depletion is especially likely to occur when large doses are given and/or in patients with restricted sodium intake. Potassium depletion occurs frequently in patients receiving furosemide. Adverse GI effects of furosemide include nausea, anorexia, oral and gastric irritation, vomiting, cramping, diarrhea, and constipation. Because furosemide oral solutions contain sorbitol, they may cause diarrhea, when high dosages are administered. Furosemide may produce hyperglycemia and glycosuria, possibly as a result of hypokalemia, in patients with predisposition to diabetes. Adverse nervous system effects of furosemide include dizziness, lightheadedness, vertigo, headache, xanthopsia, blurred vision, and paresthesias. Anemia, hemolytic anemia, leukopenia, neutropenia, and thrombocytopenia have occurred in patients receiving furosemide.
Precautions and Contraindications: Patients receiving furosemide must be carefully observed for signs of hypovolemia, hyponatremia, hypokalemia, hypocalcemia, hypochloremia, and hypomagnesemia. Furosemide is contraindicated in patients with anuria. The drug is contraindicated for further use if increasing azotemia and/or oliguria occur during the treatment of severe, progressive renal disease. Furosemide is not teratogenic but should be used cautiously in pregnancy. An increase in perinatal mortality and congenital defects has been associated with this agent, probably related to decrease of maternal plasma volume, resulting in placental hypoperfusion. Furosemide should be used during pregnancy only when the potential benefits justify the possible risks to the fetus.
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Mannitol
Description: Mannitol is an osmotic diuretic.
Indications: In conjunction with adequate replacement of water and electrolytes and maintenance of normal blood pressure, mannitol is used to promote diuresis for the prevention and/or treatment of the oliguric phase of acute renal failure which may occur after massive hemorrhage, trauma, shock, burns, transfusion reactions caused by mismatched blood, or major surgery. The drug may prevent or reverse acute functional renal failure before there is evidence of tubular necrosis or multiple vascular thromboses. Mannitol is used to reduce greatly increased intracranial pressure and for the treatment of cerebral edema. Mannitol is used to reduce elevated intraocular pressure when the pressure cannot be lowered by other means. The drug is especially useful for treating acute episodes of angle-closure, absolute, or secondary glaucoma and for lowering intraocular pressure prior to intraocular surgery.
Dosage and Administration: Mannitol injections are administered by IV infusion. The dosage, concentration of solution, and rate of administration of mannitol vary with the condition being treated and the patient's fluid requirements, urinary output, and response to the drug. Patients with marked oliguria or suspected inadequate renal function should receive a dose of about 0. 2 g/kg or 12. 5 g as a 15 or 20% solution infused over a period of 3-5 minutes to test renal response before mannitol therapy is initiated. A response is considered adequate if at least 30-50 ml of urine per hour is excreted over the next 2-3 hours. If an adequate response is not attained, a second test dose may be given. If a satisfactory response is not obtained after the second test dose, the patient should be reevaluated and mannitol should not be used. Generally, a concentrated solution of the drug is given initially followed by a 5 or 10% solution. For the treatment of oliguria, 100 g of mannitol is usually given as a 15 or 20% solution over 90 minutes to several hours.
Side Effects: The most severe adverse effects encountered during mannitol therapy are fluid and electrolyte imbalance. Hyponatremia or hypernatremia and hypokalemia or hyperkalemia may occur. Other adverse effects that have occurred during mannitol therapy include acidosis, dryness of the mouth, thirst, urinary retention, headache, blurred vision, uricosuria, nausea, vomiting, rhinitis, arm pain, backache, thrombophlebitis, chills, dizziness, urticaria, hypotension, hypertension, tachycardia, fever, transient muscle rigidity, and angina-like chest pain.
Precautions and Contraindications: Mannitol should not be administered until the adequacy of the patient's renal function and urine flow has been established. A test dose may be employed for this purpose. In patients with shock and oliguria, mannitol should not be administered until fluids, plasma, blood, and electrolytes have been replaced. The cardiovascular status of the patient should also be carefully evaluated prior to mannitol administration. Mannitol should be used during pregnancy only when clearly needed.
Spironolactone
Description: Spironolacton (Verospiron) is a potassium-sparing diuretic.
Indications: Spironolacton is used in treatment of edema associated with cardiovascular insufficiency, cirrhosis, and other diseases, associated with ascites and edema. Spironolacton is aldosterone antagonist. The diuretic effect of spironolacton is not so rapid; usually it appears after 3-5 days of administration.
Dosage and Administration: Verospiron is usually administered orally. The usual adult oral dose of spironolacton for the management of edema is 0. 1-0. 2 g in 2 or 4 doses. The daily dose is varying from 0. 075 to 0. 3 g.
Side Effects: nausea, dizziness, drowse, ataxy, skin eruption. Hyponatremia and hyperkalemia may occur.
Precautions and Contraindications: The drug is contraindicated in patients with acute renal insufficiency, nephritic stage of chronic nephritis, uremia. It is contraindicated in the 1st trimester of pregnancy.
Triamterene
Description: Triamterene is a potassium-sparing diuretic.
Indications: Triamterene is used in the management of edema associated with congestive heart failure, cirrhosis of the liver, or the nephrotic syndrome, as well as in the management of steroid-induced edema, idiopathic edema, and edema caused by secondary hyperaldosteronism. However, it may be used in combined initial therapy with more effective, rapidly acting diuretics such as thiazides, chlorthalidone, furosemide, or ethacrynic acid or after rapid initial diuresis has been achieved by other means. Triamterene may be particularly useful in patients excreting excessive amounts of potassium (especially those who cannot tolerate potassium supplements) and for those in whom potassium loss could be detrimental, such as digitalized patients or those with myasthenia gravis. Unlike spironolactone, the effectiveness of triamterene is independent of aldosterone concentrations; therefore, triamterene may be effective in some patients unresponsive to spironolactone.
Dosage and Administarion: Triamterene is administered orally. The usual initial adult dosage of triamterene in the management of edema is 100 mg twice daily after meals. Some patients may benefit from dividing the daily dosage into 2 doses. When triamterene is used in the management of hypertension (usually in combination with a kaliuretic diuretic), an initial dosage of 25 mg once daily has been recommended. Commercially available fixed-combination preparation that includes triamterene and hydrochlorothiazide named Triampur is useful too.
Side Effects: In general, adverse effects of triamterene are mild and respond to withdrawal of the drug. The most serious adverse effect of triamterene therapy is electrolyte imbalance, mainly hyperkalemia, especially in patients with renal insufficiency or diabetes, geriatric or severely ill patients, or those receiving prolonged therapy with large doses.
Precautions and Contraindications: When triamterene is used as a fixed-combination preparation that includes hydrochlorothiazide, the cautions, precautions, and contraindications associated with thiazide diuretics must be considered in addition to those associated with triamterene. There are no adequate and well-controlled studies using triamterene in pregnant women, and the drug should be used during pregnancy only when the potential benefits justify the possible risks (these include adverse effects reported in adults) to the fetus.
Hemorrheologic Agents
Pentoxifylline Trental
Description: Pentoxifylline, a synthetic xanthine derivative, is a hemorrheologic agent.
Indications: Pentoxifylline is used in treatment of hemorrheologic abnormalities, including increased erythrocyte and platelet aggregation and impaired erythrocyte flexibility, which are generally present in patients with peripheral vascular disease and are associated with a secondary hyperviscosity syndrome. Tissue hypoxia increases blood vessel wall permeability and intensifies the local influx of vasoactive substances and coagulation factors into the blood, which subsequently leads to increased local hemoconcentration and erythrocyte rigidity as a result of release of catabolites produced by anoxic parenchymal metabolism. These intravascular changes enhance intravascular coagulation and result in further impairment of blood flow in the already decompensated microcirculation in patients with peripheral vascular disease.
Dosage and Administration: Pentoxifylline is administered orally, preferably with meals. The usual adult dosage of pentoxifylline as extended-release tablets is 400 mg 3 times daily.
Side Effects: The most frequent adverse effects of pentoxifylline involve the GI tract. Dyspepsia, nausea, and vomiting occur in about 1-3% of patients receiving the drug as extended-release tablets. Belching, flatus, and/or bloating, abdominal discomfort and diarrhea also have been reported in patients receiving the drug as conventional capsules.
Precautoips and Contraindications: There are no adequate and controlled studies to date using pentoxifylline in pregnant women, and the drug should be used during pregnancy only when clearly needed.
Hormones and Synthetic Substitutes
Betamethasone (Betamethasone Acetate, Betamethasone Sodium Phosphate)
Description: Betamethasone is a synthetic glucocorticoid.
Indications: Betamethasone and its derivatives are used principally as antiinflammatory or immunosuppressant agents. It is also used for management of patients with mild persistent asthma. Short-course IM therapy with betamethasone is used in selected women with preterm labor to hasten fetal maturation (e. g., lungs, cerebral blood vessels), including women with preterm premature rupture of membranes, preeclampsia, or third-trimester hemorrhage.
Dosage and Administration: Betamethasone is administered orally. The initial adult dosage of betamethasone may range from 0. 6-7. 2 mg daily depending on the disease being treated, but is usually 2. 4-4. 8 mg daily administered in 2-4 divided doses. Antenatally betamethasone is used IM in a dose of 12 mg once daily for 2 days.
Side Effects: When given in supraphysiologic doses for prolonged periods, glucocorticoids may cause secondary adrenocortical insufficiency, muscle pain or weakness, osteoporosis and related fractures, increased susceptibility to infection, fluid and electrolyte disturbances, nausea, vomiting, anorexia.
Precaution and Contraindications: Corticosteroids should not be used in patients with peptic ulcer, hypothyroidism, diabetes mellitus, patients with known hypersensitivity to any of the other corticosteroids.
Dexamethasone, Dexamethasone Acetate, Dexamethasone Sodium Phosphate
Description: Dexamethasone is a synthetic glucocorticoid.
Indications: Dexamethasone is used principally as an antiinflammatory or immunosuppressant agent. Because it has only minimal mineralocorticoid properties, the drug is inadequate alone for the management of adrenocortical insufficiency. Dexamethasone sodium phosphate has been used by oral inhalation in the treatment of bronchial asthma. It may also be used for prevention of RDS of preterm neonates.
Dosage and Administration: Dexamethasone is administered orally as tablets, elixir, solution, or concentrate solution. The initial adult dosage of dexamethasone may range from 0. 75-9 mg daily, depending on the disease being treated, and is usually administered in 2-4 divided doses. Antenatally dexamethasone is used IM in a dose of 4-6 mg every 12 hours for 2-7 days.
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