Peri-operative Drug Management Guidelines - East Cheshire NHS. Summary Description and Clinical Pharmacology Indications and Dosage Warnings and Precautions Side Effects and Adverse Reactions Drug Interactions, Overdosage, Contraindications, Other Rx Info Active Ingredients User Ratings / Reviews Side Effect Reports Nonsteroidal anti-inflammatory drugs should not be administered prior to or concomitantly with the hh doses of methotrexate, such as used in the treatment of osteosarcoma. Patients should not stop their methotrexate for more than two. Clopidogrel is an absolute contraindication to regional or neuraxial block. Neuraxial blocks are.
Safety Information Protonix pantoprazole sodium for injection - FDA Clopidogrel is a prescription antiplatelet medicine. It reduces your risk of getting blood clots by affecting cells in your blood ed platelets. This page covers: When it's used How and when to take it Side effects Taking it with other medicines, food and alcohol Who may not be able to take it You may be given clopidogrel if you have or have had: These situations mean you're at an increased chance of getting a serious blood clot. Treatment may be for a few weeks or months, or it may be lifelong. Concomitant use of Protonix with Methotrexate. information about the drug-drug interaction between pantoprazole and clopidogrel.
Clopidogrel - NHS Choices Antineoplastic dosage range: 30-40 mg/m²/week to 100-12,000 mg/m² with leucovorin rescue Trophoblastic neoplasms: 15-30 mg/day PO/IM for 5 days; may be repeated Burkitt lymphoma, stage I/II: 10-25 mg/day PO for 4-8 days Indicated for management of severe, active rheumatoid arthritis (RA) in adults who have had an insufficient response or intolerance to an adequate trial of first-line therapy including full dose NSAIDs Initial: 7.5 mg PO as a single weekly dose, OR 2.5 mg PO q12hr for 3 sequential doses per week Increase PO dose to optimum response; single dose not to exceed 20 mg/week PO (increased risk of bone marrow suppression); reduce to lowest possible effective dose Otrexup (SC): If used as initial therapy, start at lowest available dose (ie, 10 mg SC q Week) Rasuvo (SC), initial dose: 7.5 mg as a single SC dose once weekly; adjust autoinjector dose by 2.5 mg increments as cliniy required For symptomatic control of severe, recalcitrant, disabling psoriasis in adults not adequately responsive to other forms of therapy; use only with established diagnosis (by biopsy and/or after dermatologic consultation) Initial: 10-25 mg weekly in single PO/SC/IM/IV dose; not to exceed 30 mg/wk Gradually adjust dose to achieve to optimal clinical response; use lowest dose and longest rest period possible with return to conventional topical therapy encouraged Trexall: May give weekly dose divided as 2.5 mg PO q12hr for 3 sequential doses Otrexup (SC): If used as initial therapy, start a lowest available dose (ie, 10 mg SC q Week) Rasuvo (SC): 10-25 mg SC once weekly Otrexup and Rasuvo (SC injections) are not indicated for neoplastic disease If switching from PO to SC (Otrexup, Rasuvo), consider hher bioavailability with SC compared with PO (see Pharmacology Absorption section) Management of active polyarticular juvenile idiopathic arthritis (p JIA) in children who have had an insufficient response or intolerance to an adequate trial of first-line therapy including full dose NSAIDs Initial: 10 mg/m² PO/IM/SC q Week If switching from PO to SC (Otrexup, Rasuvo), consider hher bioavailability with SC compared with PO (see Pharmacology Absorption section) Arachnoiditis with intrathecal administration Subacute toxicity with intrathecal administration (paralysis of extremities, cranial nerve palsy, seizure or coma) Demyelinating encephalopathy with cranial irradiation or other systemic chemotherapy Reddening of skin Hyperuricemia Ulcerative stomatitis Glossitis Gingivitis Nausea and vomiting Diarrhea Anorexia Intestinal perforation Mucositis (dose-dependent) Leukopenia Thrombocytopenia Renal failure Azotemia Nephropathy Pharyngitis Alopecia Photosensitivity Rash Abdominal distress Malaise Fatue Chills, fever Decreased resistance to infection Gastrointestinal hemorrhage Myelosuppression Disorders of lung, interstitial pneumonia (acute, chronic) Atrophy of liver, cirrhosis, hepatic fibrosis or necrosis, elevated liver function tests, hepatic failure For use in life threatening neoplastic disease or patients with psoriasis or rheumatoid arthritis with severe recalcitrant disabling disease, not adequately responsive to other forms of therapy Deaths reported with use of methotrexate in the treatment of malnancy, psoriasis, and rheumatoid arthritis Monitor patients closely for bone marrow, liver, lung and kidney toxicities Inform patients of risks involved; patient should be under a physician’s care throughout therapy Hh dose regimens recommended for osteosarcoma requires meticulous care; hh dose regimens are investational; therapeutic advantage not established Not recommended for women of childbearing potential, due to teratogenic activity, unless benefit-risk ratio is acceptable May cause fetal death or congenital abnormalities; use is contraindicated in pregnant women Methotrexate formulations or diluents containing preservatives should not be used for intrathecal or hh-dose therapy May cause renal damage leading to acute renal failure, especially in hh doses Elimination is reduced in impaired renal function, ascites, or pleural effusions; reduce dose and monitor carefully for toxicity Bone marrow suppression, aplastic anemia, and GI toxicity reported with hh doses and concurrent administration of NSAIDs Any dose level or route of administration may cause severe and potentially fatal dermatologic reactions Tumor lysis syndrome may occur in patients with hh tumor burden Administer therapy under supervision of physician experienced in use of antimetabolite therapy Diarrhea and ulcerative stomatitis may necessitate interruption of therapy; otherwise hemorrhagic enteritis and death from intestinal perforation may occur Methotrexate has been associated with acute and potentially fatal chronic hepatotoxicity; acutely, liver enzyme elevations are common but are usually transient and asymptomatic and not predictive of subsequent hepatic disease; periodic liver biopsies are recommended for psoriatic patients receiving long-term therapy Low-dose methotrexate has been associated with development of malnant lymphomas Immune suppression may lead to potentially fatal opportunistic infections May cause potentially fatal pneumonitis at any time during therapy even at low doses and is not fully reversible; pulmonary symptoms (especially a dry, non-productive cough) may require interruption of therapy and careful investation Concomitant use with radiotherapy may increase risk of soft tissue necrosis and osteonecrosis Pregnancy: Do not use due to potential for fetal death and teratogenic effects Nursing: Do not use due to potential for serious adverse effects in infants Alcoholism, alcoholic liver disease, or other chronic liver disease Immunodeficiency syndromes Preexisting blood dyscrasias such as bone marrow hypoplasia, leukopenia, thrombocytopenia, or snificant anemia Hypersensitivity: Do not use with known hypersensitivity; severe reactions have been observed with use Only for use by physicians experienced in antimetabolite therapy For intrathecal and hh-dose methotrexate therapy, use preservative-free formulation; preserved formulation of methotrexate is not for intrathecal or hh dose therapy; contains benzyl alcohol Elderly patients: monitor closely for early sns of hepatic, bone marrow, and renal toxicity Response in 3-6 weeks; patient may continue to improve for another 12 weeks or more Elimination reduced with renal impairment, ascites, or pleural effusions; monitor closely for renal, bone marrow, lung, or liver toxicity Taking with folic acid 1 mg/day PO may snificantly reduce liver toxicity Dermatologic toxicity: severe, potentially fatal skin reactions have been reported; psoriatic lesions may also be aggravated by UV radiation and sunburns may be reed or worsened Good oral care recommended (risk of mucositis) Use extreme caution with active infection, peptic ulceration, and ulcerative colitis Immunizations: May be ineffective during therapy and live virus vaccines are not recommended due to risk of infection Ectopic pregnancy: Ideally, human chorionic gonadotropin should be 7.5 mg) but are fully reversible; symptoms (especially dry cough) may necessitate interruption of treatment and investation Methotrexate clearance rates vary widely and are generally decreased at hher doses Glucarpidase is indicated for treatment of toxic methotrexate concentrations in patients with delayed methotrexate clearance due to impaired renal function (refer to the glucarpidase prescribing information); if glucarpidase used, do not administer leucovorin within two hours before or after dose of glucarpidase because leucovorin is a substrate for glucarpidase; there are published case reports of intravenous and intrathecal glucarpidase treatment to hasten clearance of methotrexate in cases of overdose GI toxicity: Diarrhea or ulcerative stomatitis warrants discontinuance of therapy (risk of hemorrhagic enteritis or intestinal perforation) Bone marrow suppression: May cause anemia, aplastic anemia, pancytopenia, leukopenia, neutropenia, and/or thrombocytopenia; use caution in patients with preexisting hematopoietic impairment and with concomitant use of NSAIDs; a snificant drop in blood counts warrants discontinuation of therapy May impair fertility, cause olospermia, and menstrual dysfunction; exclude pregnancy before initiating treatment Neurotoxicity: May cause neurotoxicity, including strokelike encephalopathy, seizures, leukoencephalopathy, and myelopathy Nephrotoxicity: Risk of acute renal failure especially at hh doses Caution should be used while driving or operating machinery due to risk of dizziness and fatue Inhibits dihydrofolic acid reductase; inhibits purine and thymidylic acid synthesis, which in turn interferes with DNA synthesis, repair, and cellular replication; cell cycle specific for S phase of cycle May inhibit rapid proliferation of epithelial cells in skin 80 mg/m² Bioavailability (SC, Otrexup): 17, 13, 31, and 36% greater than PO methotrexate at doses of 10, 15, 20, and 25 mg respectively AUC (SC, Rasuvo): 35%, 49%, 51%, and 68% greater than PO methotrexate at doses of 7.5 mg, 15 mg, 22.5 mg, and 30 mg respectively Peak plasma time: PO, 1-2 hr; IM, 30-60 min Additive: Bleomycin Syringe: Droperidol, metoclopramide (may be compatible at low concentrations of metoclopramide) Y-site: Corpromazine, dexamethasone sodium phosphate(? ), gemcitabine, idarubicin, ifosfamide, midazolam, nalbuphine, promethazine, propofol 100 mg): Administered over 30 minutes to 4 hours, or according to institutional protocol Hh-dose therapy (uses 1-g vial): Administered over 4 hours Specific dosing schemes vary, but hh doses should be followed by leucovorin 24 hours after initiation of therapy to prevent toxicity Do not use preservative-containing drug For meningeal leukemia, intrathecal administration is mandatory because CSF penetration is poor Before administration, equal volume of CSF is usually withdrawn; administer drug only if easy flow of blood-free CSF is noted Otrexup is a single-dose auto-injector available in doses between 10 to 25 mg (in 5-mg increments) for once-weekly SC use only Rasuvo is a single-dose auto-injector available in doses between 7.5 and 30 mg (in 2.5-mg increments) for once-weekly SC use only Use another formulation in patients who require PO, IM, IV, intra-arterial, or IT dosing Visually inspect for particulate matter and discoloration prior to administration; do not use if seal is broken Administer SC in abdomen or thh May self-inject if determined appropriate by a physician and have received proper training on preparation and administration; a trainer device is available Handling and disposal consistent with recommendation for cytotoxic drugs The above information is provided for general informational and educational purposes only. Find out why clopidogrel is prescribed, how and when to take it, what the possible side effects are, and when it may not be suitable.
Trexall, Otrexup methotrexate dosing, indications, interactions. This content has not been reviewed within the past year and may not represent Web MD's most up-to-date information. Arthritis, and psoriasis dosing for Trexall, Otrexup methotrexate, frequency-based adverse effects, comprehensive interactions, contraindications, pregnancy.