Dosage and Administration. Dosage: _________________________________________________________________________________________________________________________________ Date(s) medication to be given: ___________________________________________________________________________________________________ Times medication to be given: _____________________________________________________________________________________________________ Reasons for medication: ____________________________________________________________________________________________________________ Possible side effects: ________________________________________________________________________________________________________________ Directions for storage: ______________________________________________________________________________________________________________ Name and phone number of the prescribing health care practitioner: ____________________________________________________ Parent and Practitioner Signature Child’s Health Care Practitioner Signature: _________________________________________ Date: ______________________ I, , (parent or guardian—Print name) authorize educators to administer Medication to my child as indicated above. ___________________________________________________________________ Parent/Legal Guardian Signature _________________________ Date Individual Health Care Plan Plan was created by: Plan is maintained by: ___ Parent ___ Doctor or Licensed Practitioner ___ Program’s Health Care Consultant ___ Other: _________________________ ___ Director ___ Assistant Director ___ Child’s Educator ___ Other: ____________________________ Name of Child: Date: Any Changes to the Child’s Health Care Plan? YES (Indicate changes below) NO (updated physician/parent signatures required) Name of chronic health care condition: Description of chronic health care condition: Symptoms: Medical treatment necessary while at the program: Potential side effects of treatment: Name of educators that received training addressing the medical condition: Person who trained the educator (Child’s Health Care Practitioner, Child’s Parent programs Health Care Consultant): Name of Licensed Health Care Practitioner (please print): _______________________________________ Licensed Health Care Practitioner Authorization: _____________________________Date: ______________
Dosage and Administration. The recommended daily dose in adults or elderly is 100 mg (50 mg every 12 hours). No significant increased benefit can be expected from higher daily doses. Contraindications Hypersensitivity to the active substance or to any of the excipients. Hepatic disease or baseline transaminases greater than 3 times the upper limit of normal. Patients who are pregnant or breast-feeding. In patients with impaired renal function, riluzole is not recommended for use in patients with impaired renal function, as studies at repeated doses have not been conducted in this population Side effects Asthenia, nausea, vomiting, headache, abdominal pain, dizziness, tachycardia, somnolence, oral paraesthesias, neutropenia, elevations in liver function tests. Asthenia, nausea, vomiting, headache, abdominal pain, dizziness, tachycardia, somnolence, oral paraesthesias, neutropenia, elevations in liver function tests. Drug Interactions1 There is no actual data to evaluate interactions with other drugs, however it is thought that CYP 1A2 is the principal isozyme involved in the initial oxidative metabolism of riluzole. Inhibitors of CYP 1A2 (e.g. caffeine, diclofenac, diazepam, TCAs, theophylline and quinolones) could potentially decrease the rate of riluzole elimination, while inducers of CYP 1A2 (e.g. cigarette smoke, rifampicin and omeprazole) could increase the rate of riluzole elimination.
Dosage and Administration. Neoral® capsules 10mg, 25mg, 50mg, 100mg or Oral solution 100mg/ml Maintenance dose in adult renal transplant patients: 2-6mg/kg/day (twice daily in divided doses). Dose adjusted according to trough blood-ciclosporin concentration and renal function. The concomitant intake of grapefruit juice has been reported to increase the bioavailability of ciclosporin . xxxx://xxx.xxxxxxxxx.xxx.xx Contraindication Known hypersensitivity to ciclosporin. Concomitant use of tacrolimus. Side Effects All suspected reactions (including those considered not to be serious and even where the causal link is uncertain) should be reported to the CSM. As with all immunosuppressants ciclosporin increases susceptibility to infections. Very common: renal dysfunction, hyperlipidaemia, tremor, headache, and hypertension Common: hyperuricaemia, hyperkalaemia, hypomagnesaemia, paraesthesia, anorexia, nausea, vomiting, abdominal pain, diarrhoea, gingival hyperplasia, hepatic dysfunction, hypertrichosis, muscle cramps, myalgia, fatigue Uncommon: anaemia, thrombocytopenia, signs of encephalopathy or demyelination, convulsions, confusion, disorientation, decreased responsiveness, agitation, insomnia, visual disturbances, cortical blindness, coma, paresis, cerebellar ataxia, allergic rashes, oedema, weight increase Rare: micro-angiopathic haemolytic anaemia, haemolytic uraemic syndrome, menstrual disturbances, gynaecomastia, hyperglycaemia, motor polyneuropathy, pancreatitis, muscle weakness, myopathy Very rare: optic disc oedema including papilloedema with possible visual impairment secondary to Benign Intracranial Hypertension. Drug Interactions – for detailed information refer to the SPC and Appendix 1 in BNF Drugs that decrease ciclosporin levels: Barbiturates, carbamazepine, phenytoin; rifampicin; octreotide; orlistat; hypericum perforatum (St John's Wort); ticlopidine. Drugs that increase ciclosporin levels:Macrolide antibiotics (mainly erythromycin and clarithromycin); ketoconazole, fluconazole, itraconazole; diltiazem, nicardipine, verapamil; metoclopramide; oral contraceptives; danazol; methylprednisolone (high dose); allopurinol; amiodarone; ursodeoxycholic acid; protease inhibitors. References Novartis® Pharmaceuticals UK Ltd. Summary of product characteristics, Feb 2005 xxxx://xxx.xxxxxxxxx.xxx.xx/ Ipswich Hospital. Shared care agreement for the treatment of chronic autoimmune joint & connective tissue disease, Feb 2005 BNF 51, March 2006.
Dosage and Administration. Etanercept is available as a 25mg or 50mg pre-filled syringe and a 50mg pre-filled pen for subcutaneous injection (other formulations available for paediatric use). Etanercept is administered by subcutaneous injection, either by the patient themselves or by a designated person (carer/relative). Some patients will require practice or district nurse input for administration. If this is not going to be possible please let the Rheumatology Department know as soon as possible. Contraindications and precautions for use ▪ The use of live vaccines with etanercept is contra-indicated. ▪ Patients taking Etanercept are more susceptible to serious infections (see below). ▪ Tuberculosis may be activated by etanercept. The patient will be appropriately screened by the rheumatologist as part of the initial decision-making process. ▪ Etanercept is contraindicated in moderate to severe heart failure (NYHA class III / IV) ▪ Etanercept must not be continued in patients who develop new or worsening symptoms of heart failure. ▪ The use of Etanercept in pregnant women is not recommended, and women of child-bearing potential should be advised not to get pregnant during etanercept therapy. They should use effective contraception to prevent pregnancy during therapy and for at least 3 months after discontinuation of therapy. Women must not breast feed during Etanercept therapy or for at least 3 months after Etanercept therapy is discontinued. ▪ It is also recommended that male partners receiving etanercept should use effective contraception for the time periods stated above. Side Effects (also state any specific side-effects which require the consultant to be notified) ▪ Headache, cough, nasopharyngeal pain, rash, pruritis, lower respiratory infections, viral infections (influenza, herpes), candidiasis, bacterial infections (including urinary tract infections), upper respiratory infection, injection site reaction (including pain, swelling, redness or pruritis), hepatic enzymes increased, diarrhoea, abdominal pain, stomatitis and mouth ulceration, nausea. ▪ Rare: pulmonary oedema, pancreatitis, pneumonitis. ▪ Etanercept can cause leucopenia and neutropenia. Patients who develop a new infection while undergoing treatment with Etanercept should be monitored closely. ▪ Administration of Etanercept should be discontinued if a patient develops a serious infection i.e. one that requires antibiotic therapy. Antibiotic therapy, where indicated, must be commenced promptly and only once the c...
Dosage and Administration. The maintenance dose is 10 to 20 mg/day for RA and 20 mg/day for PsA. A washout period should be followed when switching to another hepato- or haematotoxic drug, or in cases of acute leflunomide toxicity (see the BNF or SPC for more details). Contraindications and Precautions Leflunomide must not be used in patients with Xxxxxxx-Xxxxxxx syndrome, toxic epidermal necrolysis or erythema multiforme. Leflunomide is also contraindicated in patients with impaired immune, liver or bone marrow function; serious infections, or severe hypoproteinaemia. While taking leflunomide, women of child-bearing age should use adequate contraception and consider a drug wash-out before becoming pregnant and men should avoid fathering a child. See the SPC for further details. Side Effects The most common adverse events with leflunomide treatment in clinical trials were gastrointestinal effects, pruritus, rash, hypertension, alopecia and liver enzyme elevations. Post-marketing, there have been rare reports of serious hepatic reactions and pancytopenia. See the SPC for more details on adverse events. Monitoring FBC, creatinine / eGFR, ALT (or AST) and albumin every 2 weeks until dose and monitoring stable for 6 weeks; thereafter monthly for three months, then at least every 12 weeks. Patients who have been stable for 12 months can be considered for reduced frequency monitoring on an individual patient basis. Dose increases should be monitored by FBC, creatinine / eGFR, ALT (or AST) and albumin every 2 weeks until on stable dose for 6 weeks then revert to previous schedule. Action required if abnormal results Contact specialist team urgently and consider interruption in treatment if any of the following develop: WCC <3.5 x109/L Neutrophils <1.6 x 109/L Unexplained eosinophilia >0.5 x 109/l Platelet count <140 x 109/L MCV > 105 f/L Creatinine >30% above baseline and/or calculated GFR <60ml/min ALT (or AST) >100 units/L Unexplained fall in serum albumin < 30g/l As well as responding to absolute values in laboratory tests, it is also relevant to observe trends in results (e.g. gradual decreases in white blood cells or albumin, or increasing liver enzymes). Drug Interactions Recent treatment with hepatotoxic or haematotoxic drugs may result in increased side effects; care should be taken when initiating leflunomide therapy. The British Society for Rheumatology guideline advises a maximum of 10mg/day if used concomitantly with another potentially hepatotoxic DMARD such as methotrexate. S...
Dosage and Administration. Cellcept 250mg capsules, 500mg tablets or Oral suspension 1g/5ml Dose in adult renal transplant patients: 1g twice daily Contraindications Hypersensitivity to mycophenolate mofetil or mycophenolic acid. Contraindicated in breast-feeding women. For information on use in pregnancy see Summary of Product Characteristics (SPC). Side Effects All suspected reactions (including those considered not to be serious and even where the causal link is uncertain) should be reported to the CSM. xxx.xxxx.xxx.xx/Xxxxxxxxxxxxxxxxx/Xxxxxxxxxxxxxxxxxxxxxxx/xxxxx.xxx As with all immunosuppressants mycophenolate increases susceptibility to infections. The most frequent side effects seen with mycophenolate include neutropenia and gastrointestinal disturbances including diarrhoea, constipation, vomiting and indigestion. Less common side effects include gastrointestinal haemorrhage, hypertension, oedema, hyper- and hypokalaemia, hyperglycaemia, Hypophosphataemia, hypercholesterolaemia, dyspnoea, headache, dizziness, insomnia and tremor. Drug Interactions – for detailed information refer to the SPC and Appendix 1 in BNF. Aciclovir: increased plasma concentrations of aciclovir and mycophenolic acid glucuronide have been observed on concurrent administration of MMF and aciclovir.
Dosage and Administration. Initial Stabilisation Treatment should be started with 200mg, three times a day and may be continued for 1 week. The dosage should then be reduced to 200mg, twice daily for a further week.
Dosage and Administration. Recommended dose of bicalutamide is one tablet (50 mg) taken once daily.
Dosage and Administration. The dose of Dronedarone is 400mg twice daily and should be taken with meals Treatment with Dronedarone can be initiated in an outpatient setting If a dose is missed, patients should take the next dose at the regular scheduled time and should not double the dose There is no need for a loading dose or for titration. There is no clinically relevant interaction with warfarin, however, since Dronedarone is a P-glycoprotein inhibitor, it increases plasma concentrations of Dabigatran; therefore concomitant use of the two drugs has to be avoided. Treatment with Class I or III antiarrhythmics (such as flecainide, propafenone, quinidine, disopyramide, dofetilide, sotalol, amiodarone) must be stopped before starting dronedarone. A washout period of one month is recommended before dronedarone is started for patients currently receiving amiodarone. For patients receiving Dronedarone who are to receive amiodarone a washout period of two weeks is recommended. Contraindications Hypersensitivity to the active substance or to any of the excipients. Second- or third- degree atrioventricular block or sick sinus syndrome (except when used in conjunction with a functioning pacemaker). Bradycardia <50 beats per minute (bpm). Permanent AF with an AF duration of ≥ 6 months (or duration unknown) and attempts to restore sinus rhythm no longer considered by the physician Patients in unstable hemodynamic conditions History of, or current heart failure or left ventricular dysfunction Patients with liver and lung toxicity related to previous use of amiodarone Co-administration with potent cytochrome P 450 (CYP) 3A4 inhibitors, such as ketoconazole, itraconazole, voriconazole, posaconazole, telithromycin, clarithromycin, nefadazone and ritonavir. Medicinal products inducing torsades de pointes such as phenothiazines, cisapride, bepridil, tricyclic antidepressants, terfenadine and certain oral macrolides, Class 1 and III antiarrhythmics. QTc Xxxxxxx interval ≥ 500 milliseconds. Severe hepatic impairment. Severe renal impairment (CrCl <30ml/min) Side Effects Dronedarone is a black triangle drug. Continue to report to the MHRA and the Commission on Human medicines all suspected adverse reactions via the Yellow Card Scheme. Common side effects include diarrhoea, abdominal discomfort, rash, bradycardia, fatigue, asthenia, nausea, vomiting, raised creatinine ( 10% five days after treatment initiation, tubular secretion of creatinine is decreased without affecting GFR) and prolonged QT Interval...
Dosage and Administration dosage at two grams per day, taken as two capsules once daily, with or without food;
