Miscellaneous Archives - MPR

Approximate Practical Equivalents

Haymarket Media — Tue, 10 Mar 2015 16:00:00 +0000

APPROXIMATE PRACTICAL EQUIVALENTS
The listing of approximate practical equivalents is included to aid the practitioner in calculating and converting dosages among the various systems.
WEIGHT EQUIVALENTS
1 grain (gr)	=	65 milligrams (mg)	1 ounce apothecary (℥)	=	31.1 grams (g)
1 milligram (mg)	=	0.015 grains (gr)	1 pound avoirdupois (lb)	=	454 grams (g)
1 gram (g)	=	15.432 grains (gr)	1 pound avoirdupois (lb)	=	0.45 kilograms (kg)
1 gram (g)	=	0.035 ounces (oz)	1 kilogram (kg)	=	2.2 pounds avoirdupois (lb)
1 ounce avoirdupois (oz)	=	28.35 grams (g)
VOLUME EQUIVALENTS
1 milliliter (mL)	=	16.23 minims ()	1 pint (pt or ⃝ or Oct)	=	473 milliliter (mL)
1 cubic centimeter* (cc)	=	1.0 milliliter (mL)	1 quart (qt)	=	946 milliliter (mL)
1 fluidram (fl ʒ)	=	3.7 milliliter (mL)	1 liter (L)	=	33.8 fluid ounces (fl ℥)
1 teaspoonful (tsp)	=	5 milliliter (mL)	1 gallon (gal or C or cong)	=	3785 milliliter (mL)
1 tablespoonful (tbsp)	=	15 milliliter (mL)	1 milliliter (mL)	=	20 drops
1 fluid ounce (fl ℥)	=	29.57 milliliter (mL)
WEIGHT TO VOLUME EQUIVALENTS
1 milligram per deciliter (mg/dL)	=	10 micrograms per milliliter (μ/mL)	1% solution	=	10 milligram per milliliter (mg/mL)
1 milligram per deciliter (mg/dL)	=	1 milligram percent (mg %)	1 part per million (ppm)	=	1 milligram per liter (mg/L)
LINEAR EQUIVALENTS
1 millimeter (mm)	=	0.04 inches (in)	1 meter (m)	=	39.37 inches (in)
1 inch (in)	=	25.4 millimeters (mm)	1 inch (in)	=	0.025 meters (m)
1 inch (in)	=	2.54 centimeters (cm)
*Cubic centimeter and milliliter are equivalent. (Rev. 10/2023)

Common Medical Abbreviations

Haymarket Media — Tue, 21 Oct 2014 16:30:00 +0000

Common Medical Abbreviations

COMMON MEDICAL ABBREVIATIONS

aa	of each
ABG	arterial blood gas
ac	before meals
ACE	angiotensin converting enzyme
AD	right ear
ad lib	as desired
ADR	adverse drug reaction
AF, AFib	atrial fibrillation
AM	morning; before noon
AMA	against medical advice
AMI	acute myocardial infarction
ANDA	Abbreviated New Drug Application
ante	before
APAP	acetaminophen
aq	water; aqueous
AS	left ear
ASA	aspirin
AU	both ears
AUC	area under the curve
bid, BID	twice a day
biw	twice weekly
BMI	body mass index
BP	blood pressure
BUN	blood urea nitrogen
c	with (c with bar above it)
C	Centigrade
Ca	calcium
cap(s)	capsule(s)
cath	catheter
CBC	complete blood count
cc	cubic centimeter
CHF	congestive heart failure
Cl	chloride
cm	centimeter
C_max	maximum effective plasma concentration
C_min	minimum effective plasma concentration
c/o	complains of
comp	compounded of
CR	controlled-release
CV	cardiovascular
DAW	dispense as written
d/c	discontinue
DC	discharge
DNR	do not resuscitate
DR	delayed-release
Dx	diagnosis
ECG, EKG	electrocardiogram
ED	emergency department
EENT	Eye, Ear, Nose & Throat
ER	extended-release
etc	and so on
EtOH	alcohol
exp	expired
ext	extract, external
F	Fahrenheit

FBS	fasting blood sugar
FUO	fever of unknown origin
Fe	iron
fl	fluid
fl dr	fluidram
fl oz	fluid ounce
Fx	fracture
g, gm	gram
gr	grain
gtt(s)	drop(s)
H, h, hr	hour
H₂O	water
HDL-C	high-density lipoprotein-cholesterol
HR	heart rate
HRT	hormone replacement therapy
hs	at bedtime, hour of sleep
h/o	history of
IM	intramuscular
INDA	Investigational New Drug Application
inh	inhalation
INH	isoniazid
inj	injection
IPPB	intermittent positive pressure breathing
IR	immediate-release
IU	international units
IV	intravenous
kg	kilogram
L	liter, left, put left first
lb	pound
LDL-C	low-density lipoprotein-cholesterol
liq	liquid
MAOI	monoamine oxidase inhibitor
mcg	microgram
MDI	metered dose inhaler
mEq	milliequivalent
mg	milligram
mL	milliliter
mm	millimeter
MOM	milk of magnesia
MRSA	methicillin-resistant Staphylococcus aureus
Na	sodium
NaCl	sodium chloride
NDA	New Drug Application
neg	negative
NKA	no known allergies
NPO	nothing by mouth
NR	no refill
NSAID	nonsteroidal anti-inflammatory drug
OD	right eye
oint	ointment
OS	left eye
OTC	over the counter
OU	each eye

oz	ounce
P	pulse
pc	after meals
per	by
PI	Package Insert
PM	evening; after noon
po	by mouth; orally
prn	as needed; whenever necessary
pt	patient, pint
pwdr	powder
q	every
q4h	every 4 hours
q6h	every 6 hours
qh, qhr	every hour
qid	four times per day
qiw	four times per week
ql	as much as desired
qs	a sufficient quantity
qt	quart
qw	once per week
R/O	rule out
Rx	prescription only
SC, SQ	subcutaneously
sig	label; let it be printed
SL	sublingual
SOB	shortness of breath
sos	if necessary or required
s/s	signs and symptoms
ss	one half
stat	immediately
supp	suppository
susp	suspension
Sx	symptoms
t_½	half life
tab(s)	tablets
tbsp	tablespoonful
temp	temperature
tid	three times per day
tiw	three times per week
T_max	time to maximum concentration
TPN	total parenteral nutrition
tr, tinc, tinct	tincture
tsp	teaspoonful
Tx	treatment
ud	as directed
UD	unit-dose package
ung	ointment
URI	upper respiratory infection
USP	United States Pharmacopoeia
UTI	urinary tract infection
vag	vaginal
vol	volume
VS	vital signs
wt	weight
x	times

(Rev. 10/2023)

Common Systems of Weights and Measures

Haymarket Media — Tue, 10 Mar 2015 17:30:00 +0000

Common Systems of Weights and Measures

COMMON SYSTEMS OF WEIGHTS AND MEASURES
METRIC SYSTEM
	Metric Weight			Metric Liquid Measure
	1 femtogram (fg)	=	0.001pg	1 femtoliter (fL)	=	0.001pL
	1 picogram (pg)	=	0.001ng	1 picoliter (pL)	=	0.001nL
	1 nanogram (ng)	=	0.001μg	1 nanoliter (nL)	=	0.001μL
	1 microgram (μg)	=	0.001mg	1 microliter (μL)	=	0.001mL
	1 milligram (mg)	=	0.001g	1 milliliter (mL)	=	0.001L
	1 centigram (cg)	=	0.01g	1 centiliter (cL)	=	0.01L (10 mL)
	1 decigram (dg)	=	0.1g	1 deciliter (dL)	=	0.1L (100 mL)
	1 gram (g)	=	1g	1 liter (L)	=	1L (1000 mL)
	1 dekagram (dag)	=	10g	1 dekaliter (daL)	=	10L
	1 hectogram (hg)	=	100g	1 hectoliter (hL)	=	100L
	1 kilogram (kg)	=	1000g	1 kiloliter (kL)	=	1000L
APOTHECARY SYSTEM¹
	Apothecary Weight Equivalents			Apothecary Volume Equivalents
	1 grain² (gr)	=	1 gr	1 minim ()	=	1
	1 scruple (℈)	=	20 gr	1 fluidram (fʒ)	=	60
	1 dram (ʒ)	=	60 gr = 3 ℈	1 fluid ounce (f℥)	=	480 = 8 fʒ
	1 ounce (℥)	=	480 gr = 8 ʒ	1 pint (pt or 0)	=	7680 = 16 f℥
	1 pound (lb)	=	5760 gr = 12 ℥	1 quart (qt)	=	15360 = 32 f℥
				1 gallon (gal or cong)	=	61440 = 128 f℥
AVOIRDUPOIS SYSTEM³
Avoirdupois equivalents
	1 ounce (oz)	=	437.5 grains (gr)	1 pound (lb)	=	16 ounces (oz) = 7000 grains (gr)
¹Apothecary—used in preparation of pharmaceuticals. ²The grain in each of the above systems has the same value and thus serves as a basis for the interconversion of the other units. ³Avoirdupois is used by manufacturers and wholesalers. (Rev. 10/2023)

Confused Drug Names

Haymarket Media — Tue, 18 Sep 2012 16:29:23 +0000

Confused Drug Names

CONFUSED DRUG NAMES
This list of confused drug names, which includes look-alike and sound-alike name pairs, consists of those name pairs that have been published in the Institute for Safe Medication Practices’ (ISMP) ISMP Medication Safety Alert! and the ISMP Medication Safety Alert!Community/AmbulatoryCare Edition. Events involving these medications were reported to ISMP through the ISMP National Medication Errors Reporting Program ISMP MERP). This list can be used to determine which medications require special safeguards to reduce the risk of errors. This may include strategies such as: using both the brand and generic names; including the purpose of the medication on prescriptions; configuring computer selection screens to prevent look-alike names from appearing consecutively; and changing the appearance of look-alike product names.
Drug Name	Confused Drug Name
Abelcet	amphotericin B
Accupril	Aciphex
acetaminophen	acetaZOLAMIDE
acetaZOLAMIDE	acetaminophen
acetaZOLAMIDE	acetoHEXAMIDE
acetic acid for irrigation	glacial acetic acid
acetoHEXAMIDE	acetaZOLAMIDE
Aciphex	Accupril
Aciphex	Aricept
Activase	Cathflo Activase
Activase	TNKase
Actonel	Actos
Actos	Actonel
Adacel (Tdap)	Daptacel (DTaP)
Adderall	Adderall XR
Adderall	Inderal
Adderall XR	Adderall
ado-trastuzumab emtansine	trastuzumab
Advair	Advicor
Advicor	Advair
Advicor	Altocor
Afrin (oxymetazoline)	Afrin (saline)
Afrin (saline)	Afrin (oxymetazoline)
Aggrastat	argatroban
Aldara	Alora
ALfentanil	fentaNYL
ALfentanil	SUFentanil
Alkeran	Leukeran
Alkeran	Myleran
Allegra (fexofenadine)	Allegra Anti-Itch Cream (diphenhydrAMINE/allantoin)
Allegra	Viagra
Allegra Anti-Itch Cream (diphenhydrAMINE/allantoin)	Allegra (fexofenadine)
Alora	Aldara
ALPRAZolam	clonazePAM
ALPRAZolam	LORazepam
Altocor	Advicor
amantadine	amiodarone
Amaryl	Reminyl
Ambien	ambrisentan
ambrisentan	Ambien
Ambisome	amphotericin B
Amicar	Omacor
Amikin	Kineret
aMILoride	amLODIPine
amiodarone	amantadine
amLODIPine	aMILoride
amphotericin B	Abelcet
amphotericin B	Ambisome
amphotericin B	amphotericin B liposomal
amphotericin B liposomal	amphotericin B
Anacin	Anacin-3
Anacin-3	Anacin
antacid	Atacand
anticoagulant citrate dextrose solution formula A	anticoagulant sodium citrate solution
anticoagulant sodium citrate solution	anticoagulant citrate dextrose solution formula A
Antivert	Axert
Anzemet	Avandamet
Apidra	Spiriva
apixaban	axitinib
Apresoline	Priscoline
argatroban	Aggrastat
argatroban	Orgaran
Aricept	Aciphex
Aricept	Azilect
ARIPiprazole	proton pump inhibitors
ARIPiprazole	RABEprazole
Arista AH (absorbable hemostatic agent)	Arixtra
Arixtra	Arista AH (absorbable hemostatic agent)
Asacol	Os-Cal
Atacand	antacid
atomoxetine	atorvastatin
atorvastatin	atomoxetine
Atrovent	Natru-Vent
Avandamet	Anzemet
Avandia	Coumadin
Avandia	Prandin
AVINza	Evista
AVINza	INVanz
Axert	Antivert
axitinib	apixaban
azaCITIDine	azaTHIOprine
azaTHIOprine	azaCITIDine
Azilect	Aricept
B & O (belladonna and opium)	Beano
BabyBIG	HBIG (hepatitis B immune globulin)
bamlanivimab	belimumab
Bayhep-B	Bayrab
Bayhep-B	Bayrho-D
Bayrab	Bayhep-B
Bayrab	Bayrho-D
Bayrho-D	Bayhep-B
Bayrho-D	Bayrab
belimumab	bamlanivimab
Benadryl	benazepril
benazepril	Benadryl
Benicar	Mevacor
Betadine (with povidone-iodine)	Betadine (without povidone-iodine)
Betadine (without povidone-iodine)	Betadine (with povidone-iodine)
betaine (anhydrous form)	betaine HCl
betaine HCl	betaine (anhydrous form)
Bextra	Zetia
Bicillin C-R	Bicillin L-A
Bicillin L-A	Bicillin C-R
Bicitra	Polycitra
Bidex	Videx
Brethine	Methergine
Bio-T-Gel	T-Gel
Brevibloc	Brevital
Brevital	Brevibloc
Brilinta	Brintellix
Brilinta	Briviact
Briviact	Brilinta
Brintellix	Brilinta
BUPivacaine	ROPivacaine
buprenorphine	HYDROmorphone
buPROPion	busPIRone
busPIRone	buPROPion
Capadex [non-US product]	Kapidex
Capex	Kapidex
Carac	Kuric
captopril	carvedilol
carBAMazepine	OXcarbazepine
CARBOplatin	CISplatin
Cardene	Cardizem
Cardizem	Cardene
Cardura	Coumadin
carvedilol	captopril
Casodex	Kapidex
Cathflo Activase	Activase
Cedax	Cidex
ceFAZolin	cefoTEtan
ceFAZolin	cefOXitin
ceFAZolin	cefTAZidime
ceFAZolin	cefTRIAXone
cefoTEtan	ceFAZolin
cefoTEtan	cefOXitin
cefoTEtan	cefTAZidime
cefoTEtan	cefTRIAXone
cefOXitin	cefFAZolin
cefOXitin	cefoTEtan
cefOXitin	cefTAZidime
cefOXitin	cefTRIAXone
cefTAZidime	ceFAZolin
cefTAZidime	cefoTEtan
cefTAZidime	cefOXitin
cefTAZidime	cefTRIAXone
cefTRIAXone	cefoTEtan
cefTRIAXone	cefOXitin
cefTRIAXone	cefTAZidime
cefTRIAXone	ceFAZolin
cefuroxime	sulfaSALAzine
CeleBREX	CeleXA
CeleBREX	Cerebyx
CeleXA	CeleBREX
CeleXA	Cerebyx
CeleXA	ZyPREXA
Cerebyx	CeleBREX
Cerebyx	CeleXA
cetirizine	sertraline
cetirizine	stavudine
chlordiazePOXIDE	chlorproMAZINE
chlorproMAZINE	chlordiazePOXIDE
chlorproMAZINE	chlorproPAMIDE
chlorproPAMIDE	chlorproMAZINE
Cidex	Cedax
CISplatin	CARBOplatin
citalopram	escitalopram
Clarispray (fluticasone propionate)	Claritin (loratadine)
Claritin (loratadine)	Claritin Eye (ketotifen fumarate)
Claritin (loratadine)	Clarispray (fluticasone propionate)
Claritin-D	Claritin-D 24
Claritin-D 24	Claritin-D
Claritin Eye (ketotifen fumarate)	Claritin (loratadine)
Clindesse	Clindets
Clindets	Clindesse
cloBAZam	clonazePAM
clomiPHENE	clomiPRAMINE
clomiPRAMINE	clomiPHENE
clonazePAM	ALPRAZolam
clonazePAM	cloBAZam
clonazePAM	cloNIDine
clonazePAM	cloZAPine
clonazePAM	LORazepam
cloNIDine	clonazePAM
cloNIDine	cloZAPine
cloNIDine	KlonoPIN
cloZAPine	clonazePAM
cloZAPine	cloNIDine
Clozaril	Colazal
coagulation factor IX (recombinant)	factor IX complex, vapor heated
codeine	Lodine
coenzyme Q10 (CoQ10)	Cometriq
Colace	Cozaar
Cometriq	coenzyme Q10 (CoQ10)
Colazal	Clozaril
colchicine	Cortrosyn
Comvax	Recombivax HB
Cortrosyn	colchicine
Coumadin	Avandia
Coumadin	Cardura
Covaryx HS	Covera HS
Covera HS	Covaryx HS
Cozaar	Colace
Cozaar	Zocor
Cubicin	Cubicin RF
Cubicin RF	Cubicin
cycloPHOSphamide	cycloSERINE
cycloSERINE	cycloPHOSphamide
cyclophosphamide	cycloSPORINE
cycloSERINE	cycloSPORINE
cycloSPORINE	cyclophosphamide
cycloSPORINE	cycloSERINE
cycloSPORINE	cycloSPORINE modified
cycloSPORINE modified	cycloSPORINE
Cymbalta	Symbyax
dabigatran	vigabatrin
DACTINomycin	DAPTOmycin
Daptacel (DTaP)	Adacel (Tdap)
DAPTOmycin	DACTINomycin
Darvocet	Percocet
Darvon	Diovan
DAUNOrubicin	DAUNOrubicin citrate liposomal
DAUNOrubicin	DOXOrubicin
DAUNOrubicin	IDArubicin
DAUNOrubicin citrate liposomal	DAUNOrubicin
Denavir	indinavir
Depakote	Depakote ER
Depakote ER	Depakote
DEPO-Medrol	SOLU-Medrol
Depo-Provera	Depo-subQ provera 104
Depo-subQ provera 104	Depo-Provera
desipramine	disopyramide
desmopressin	vasopressin
Desyrel	SEROquel
dexamethasone	dexmedetomidine
Dexilant	DULoxetine
dexmedetomidine	dexamethasone
dexmethylphenidate	dexmethylphenidate mixed salts
dexmethylphenidate	methadone
dexmethylphenidate mixed salts	dexmethylphenidate
Diabenese	Diamox
Diabeta	Zebeta
Diamox	Diabenese
diazePAM	dilTIAZem
Diflucan	Diprivan
Dilacor XR	Pilocar
Dilaudid	Dilaudid-5
Dilaudid-5	Dilaudid
dilTIAZem	diazePAM
dimenhyDRINATE	diphenhydrAMINE
diphenhydrAMINE	dimenhyDRINATE
Dioval	Diovan
Diovan	Darvon
Diovan	Dioval
Diovan	Zyban
Diprivan	Diflucan
Diprivan	Ditropan
disopyramide	desipramine
Ditropan	Diprivan
DOBUTamine	DOPamine
DOCEtaxel	PACLitaxel
DOPamine	DOBUTamine
Doribax	Zovirax
Doxil	Paxil
DOXOrubicin	DAUNOrubicin
DOXOrubicin	DOXOrubicin liposomal
DOXOrubicin	IDArubicin
DOXOrubicin liposomal	DOXOrubicin
Dramamine (dimenhyDRINATE)	Dramamine (ginger root)
Dramamine (dimenhyDRINATE)	Dramamine (meclizine)
Dramamine (ginger root)	Dramamine (dimenhyDRINATE)
Dramamine (ginger root)	Dramamine (meclizine)
Dramamine (meclizine)	Dramamine (dimenhyDRINATE)
Dramamine (meclizine)	Dramamine (ginger root)
droNABinol	droPERidol
droPERidol	droNABinol
Dulcolax (bisacodyl)	Dulcolax (docusate sodium)
Dulcolax (docusate sodium)	Dulcolax (bisacodyl)
DULoxetine	Dexilant
DULoxetine	FLUoxetine
DULoxetine	PARoxetine
Durasal	Durezol
Durezol	Durasal
Duricef	Ultracet
Dynacin	Dynacirc
Dynacirc	Dynacin
edetate calcium disodium	edetate disodium
edetate disodium	edetate calcium disodium
Effexor	Effexor XR
Effexor XR	Effexor
Effexor XR	Enablex
elvitegravir, cobicistat, emtricitabine, and tenofovir alafenamide	elvitegravir, cobicistat, emtricitabine, and tenofovir disoproxil fumarate
elvitegravir, cobicistat, emtricitabine, and tenofovir disoproxil fumarate	elvitegravir, cobicistat, emtricitabine, and tenofovir alafenamide
Enablex	Effexor XR
Enbrel	Levbid
Engerix-B adult	Engerix-B pediatric/adolescent
Engerix-B pediatric/adolescent	Engerix-B adult
Enjuvia	Januvia
ePHEDrine	EPINEPHrine
EPINEPHrine	ePHEDrine
epiRUBicin	eriBULin
eriBULin	epiRUBicin
escitalopram	citalopram
Estratest	Estratest HS
Estratest HS	Estratest
ethambutol	Ethmozine
ethaverine [non-US name]	etravirine
Ethmozine	ethambutol
etravirine	ethaverine [non-US name]
Evista	AVINza
factor IX complex, vapor heated	coagulation factor IX (recombinant)
Fanapt	Xanax
Farxiga	Fetzima
Fastin (phentermine)	Fastin (dietary supplement)
Fastin (dietary supplement)	Fastin (phentermine)
Femara	Femhrt
Femhrt	Femara
fentaNYL	ALfentanil
fentaNYL	SUFentanil
Fetzima	Farxiga
Fioricet	Fiorinal
Fiorinal	Fioricet
flavoxATE	fluvoxaMINE
Flonase	Flovent
Floranex	Florinef
Florastor	Florinef
Florinef	Floranex
Florinef	Florastor
Flovent	Flonase
fluPHENAZine	fluvoxaMINE
flumazenil	influenza virus vaccine
FLUoxetine	DULoxetine
FLUoxetine	Loxitane
FLUoxetine	PARoxetine
fluvoxaMINE	flavoxATE
fluvoxaMINE	fluPHENAZine
Fluzone High-Dose Quadrivalent	Fluzone Quadrivalent
Fluzone Quadrivalent	Fluzone High-Dose Quadrivalent
Focalgin B	Focalin
Focalin	Focalgin B
Folex	Foltx
folic acid	folinic acid (leucovorin calcium)
folinic acid (leucovorin calcium)	folic acid
Foltx	Folex
fomepizole	omeprazole
Foradil	Fortical
Foradil	Toradol
Fortical	Foradil
gabapentin	gemfibrozil
gemfibrozil	gabapentin
gentamicin	gentian violet
gentian violet	gentamicin
glacial acetic acid	acetic acid for irrigation
glipiZIDE	glyBURIDE
Glucotrol	Glycotrol
glyBURIDE	glipiZIDE
Glycotrol	Glucotrol
Granulex	Regranex
guaiFENesin	guanFACINE
guanFACINE	guaiFENesin
HBIG (hepatitis B immune globulin)	BabyBIG
Healon	Hyalgan
heparin	Hespan
Hespan	heparin
HMG-CoA reductase inhibitors ("statins")	nystatin
HumaLOG	HumuLIN
HumaLOG	NovoLOG
HumaLOG Mix 75/25	HumuLIN 70/30
Humapen Memoir (for use with HumaLOG)	Humira Pen
Humira Pen	Humapen Memoir (for use with HumaLOG)
HumuLIN	NovoLIN
HumuLIN	HumaLOG
HumuLIN 70/30	HumaLOG Mix 75/25
HumuLIN R U-100	HumuLIN R U-500
HumuLIN R U-500	HumuLIN R U-100
Hyalgan	Healon
hydrALAZINE	hydroCHLOROthiazide
hydrALAZINE	HYDROmorphone
hydrALAZINE	hydrOXYzine
Hydrea	Lyrica
hydroCHLOROthiazide	hydrALAZINE
hydroCHLOROthiazide	hydroxychloroquine
hydroCHLOROthiazide	hydrOXYzine
HYDROcodone	oxyCODONE
Hydrogesic	hydrOXYzine
HYDROmorphone	buprenorphine
HYDROmorphone	hydrALAZINE
HYDROmorphone	hydrOXYzine
HYDROmorphone	morphine
HYDROmorphone	oxyMORphone
hydroxychloroquine	hydroCHLOROthiazide
hydroxychloroquine	hydroxyurea
HYDROXYprogesterone	medroxyPROGESTERone
hydroxyurea	hydroxychloroquine
hydroxyurea	hydrOXYzine
hydroxyurea	Ure-Na (palatable form of oral urea)
hydrOXYzine	hydrALAZINE
hydrOXYzine	hydroCHLOROthiazide
hydrOXYzine	Hydrogesic
hydrOXYzine	HYDROmorphone
hydrOXYzine	hydroxyurea
IDArubicin	DAUNOrubicin
IDArubicin	DOXOrubicin
IDArubicin	idaruCIZUmab
idaruCIZUmab	IDArubicin
Ilaris	Ilumya
Ilumya	Ilaris
Inderal	Adderall
indinavir	Denavir
inFLIXimab	riTUXimab
influenza virus vaccine	flumazenil
influenza virus vaccine	perflutren lipid microspheres
influenza virus vaccine	tuberculin purified protein derivative (PPD)
Inspra	Spiriva
Intuniv	Invega
INVanz	AVINza
Invega	Intuniv
iodine	Lodine
Isordil	Plendil
ISOtretinoin	tretinoin
Jantoven	Janumet
Jantoven	Januvia
Janumet	Jantoven
Janumet	Januvia
Janumet	Sinemet
Januvia	Enjuvia
Januvia	Jantoven
Januvia	Janumet
K-Phos Neutral	Neutra-Phos-K
Kaopectate (bismuth subsalicylate)	Kaopectate (docusate calcium)
Kaopectate (docusate calcium)	Kaopectate (bismuth subsalicylate)
Kadian	Kapidex
Kaletra	Keppra
Kapidex	Capadex [non-US product]
Kapidex	Capex
Kapidex	Casodex
Kapidex	Kadian
Kay Ciel	Kayexalate
Kayexalate	Kay Ciel
Keflex	Keppra
Keppra	Kaletra
Keppra	Keflex
Ketalar	ketorolac
ketamine	ketorolac
ketorolac	Ketalar
ketorolac	ketamine
ketorolac	methadone
Kineret	Amikin
KlonoPIN	cloNIDine
Kuric	Carac
Kwell	Qwell
labetalol	LaMICtal
labetalol	lamoTRIgine
LaMICtal	labetalol
LaMICtal	LamISIL
LamISIL	LaMICtal
lamiVUDine	lamoTRIgine
lamoTRIgine	labetalol
lamoTRIgine	lamiVUDine
lamoTRIgine	levETIRAcetam
lamoTRIgine	levothyroxine
Lanoxin	levothyroxine
Lanoxin	naloxone
lanthanum carbonate	lithium carbonate
Lantus	Latuda
Lantus	Lente
Lariam	Levaquin
Lasix	Luvox
Lasix	Wakix
Latuda	Lantus
Lente	Lantus
Letairis	Letaris [non-US product]
Letaris [non-US product]	Letairis
leucovorin calcium	Leukeran
leucovorin calcium	LEVOleucovorin
Leukeran	Alkeran
Leukeran	leucovorin calcium
Leukeran	Myleran
Levaquin	Lariam
Levbid	Enbrel
Levemir	Lovenox
levETIRAcetam	lamoTRIgine
levETIRAcetam	levOCARNitine
levETIRAcetam	levoFLOXacin
levOCARNitine	levETIRAcetam
levoFLOXacin	levETIRAcetam
LEVOleucovorin	leucovorin calcium
levothyroxine	lamoTRIgine
levothyroxine	Lanoxin
levothyroxine	liothyronine
Lexapro	Loxitane
Lexiva	Pexeva
linaCLOtide	linaGLIPtin
linaGLIPtin	linaCLOtide
liothyronine	levothyroxine
Lipitor	Loniten
Lipitor	ZyrTEC
lithium	Ultram
lithium carbonate	lanthanum carbonate
Lodine	codeine
Lodine	iodine
Loniten	Lipitor
Lopressor	Lyrica
LORazepam	ALPRAZolam
LORazepam	clonazePAM
LORazepam	Lovaza
Lotronex	Protonix
Lovaza	LORazepam
Lovenox	Levemir
Loxitane	FLUoxetine
Loxitane	Lexapro
Loxitane	Soriatane
Lunesta	Neulasta
Lupron Depot-3 Month	Lupron Depot-Ped
Lupron Depot-Ped	Lupron Depot-3 Month
Luvox	Lasix
Lyrica	Hydrea
Lyrica	Lopressor
Maalox	Maalox Total Stomach Relief
Maalox Total Stomach Relief	Maalox
Malarone	mefloquine
Matulane	Materna
Materna	Matulane
Maxzide	Microzide
medroxyPROGESTERone	HYDROXYprogesterone
medroxyPROGESTERone	methylPREDNISolone
medroxyPROGESTERone	methylTESTOSTERone
mefloquine	Malarone
memantine	methadone
Menactra	Menomune
Menomune	Menactra
Mephyton	methadone
Metadate	methadone
Metadate CD	Metadate ER
Metadate ER	Metadate CD
Metadate ER	methadone
metFORMIN	metroNIDAZOLE
methadone	dexmethylphenidate
methadone	ketorolac
methadone	memantine
methadone	Mephyton
methadone	Metadate
methadone	Metadate ER
methadone	methylphenidate
methadone	metOLazone
Methergine	Brethine
methazolAMIDE	methIMAzole
methazolAMIDE	metOLazone
methIMAzole	methazolAMIDE
methIMAzole	metOLazone
methotrexate	metOLazone
methotrexate	MTX Patch (lidocaine and menthol)
methylene blue	VisionBlue
methylphenidate	methadone
methylPREDNISolone	medroxyPROGESTERone
methylPREDNISolone	methylTESTOSTERone
methylTESTOSTERone	medroxyPROGESTERone
methylTESTOSTERone	methylPREDNISolone
metyraPONE	metyroSINE
metyroSINE	metyraPONE
metOLazone	methadone
metOLazone	methazolAMIDE
metOLazone	methIMAzole
metOLazone	methotrexate
metoprolol succinate	metoprolol tartrate
metoprolol tartrate	metoprolol succinate
metroNIDAZOLE	metFORMIN
Mevacor	Benicar
Micronase	Microzide
Microzide	Maxzide
Microzide	Micronase
midodrine	Midrin
Midrin	midodrine
miFEPRIStone	miSOPROStol
migalastat	miglustat
miglustat	migalastat
Miralax	Mirapex
Mirapex	Miralax
miSOPROStol	miFEPRIStone
mitoMYcin	mitoXANTRONE
mitoXANTRONE	mitoMYcin
mitoXANTRONE	MTX Patch (lidocaine and menthol)
morphine	HYDROmorphone
morphine – non-concentrated oral liquid	morphine – oral liquid concentrate
morphine – oral liquid concentrate	morphine – non-concentrated oral liquid
Motrin	Neurontin
MS Contin	OxyCONTIN
MTX Patch (lidocaine and menthol)	methotrexate
MTX Patch (lidocaine and menthol)	mitoXANTRONE
Mucinex (guaiFENesin)	Mucinex Allergy (fexofenadine)
Mucinex	Mucomyst
Mucinex Allergy (fexofenadine)	Mucinex (guaiFENesin)
Mucinex D	Mucinex DM
Mucinex DM	Mucinex D
Mucomyst	Mucinex
Myleran	Alkeran
Myleran	Leukeran
nalbuphine	naloxone
naloxone	Lanoxin
naloxone	nalbuphine
Narcan	Norcuron
Natru-Vent	Atrovent
Navane	Norvasc
Neo-Synephrine (oxymetazoline)	Neo-Synephrine (phenylephrine)
Neo-Synephrine (phenylephrine)	Neo-Synephrine (oxymetazoline)
neratinib	nilotinib
neratinib	niraparib
Neulasta	Lunesta
Neulasta	Nuedexta
Neulasta	Neumega
Neumega	Neulasta
Neumega	Neupogen
Neupogen	Neumega
Neurontin	Motrin
Neurontin	Noroxin
Neutra-Phos-K	K-Phos Neutral
NexAVAR	NexIUM
NexIUM	NexAVAR
niCARdipine	NIFEdipine
niCARdipine	niMODipine
NIFEdipine	niCARdipine
NIFEdipine	niMODipine
nilotinib	neratinib
nilotinib	niraparib
niMODipine	niCARdipine
niMODipine	NIFEdipine
niraparib	neratinib
niraparib	nilotinib
nizatidine	tiZANidine
Norcuron	Narcan
Normodyne	Norpramin
Noroxin	Neurontin
Norpramin	Normodyne
Norvasc	Navane
NovoLIN	HumuLIN
NovoLIN	NovoLOG
NovoLIN 70/30	NovoLOG Mix 70/30
NovoLOG	HumaLOG
NovoLOG	NovoLIN
NovoLOG Flexpen	NovoLOG Mix 70/30 Flexpen
NovoLOG Mix 70/30 Flexpen	NovoLOG Flexpen
NovoLOG Mix 70/30	NovoLIN 70/30
Nuedexta	Neulasta
nystatin	HMG-CoA reductase inhibitors ("statins")
Occlusal-HP	Ocuflox
Ocuflox	Occlusal-HP
OLANZapine	QUEtiapine
Omacor	Amicar
omeprazole	fomepizole
opium tincture	paregoric (camphorated tincture of opium)
Oracea	Orencia
Orencia	Oracea
Orgaran	argatroban
Ortho Tri-Cyclen	Ortho Tri-Cyclen LO
Ortho Tri-Cyclen LO	Ortho Tri-Cyclen
Os-Cal	Asacol
oxaprozin	OXcarbazepine
OXcarbazepine	oxaprozin
OXcarbazepine	carBAMazepine
oxyBUTYnin	oxyCODONE
oxyBUTYnin	OxyCONTIN
oxyBUTYnin	oxyMORphone
oxyCODONE	HYDROcodone
oxyCODONE	oxybutynin
oxyCODONE	OxyCONTIN
oxyCODONE	oxyMORphone
OxyCONTIN	MS Contin
OxyCONTIN	oxyCODONE
OxyCONTIN	oxyBUTYnin
OxyCONTIN	oxyMORphone
OxyCONTIN	oxytocin
oxyMORphone	HYDROmorphone
oxyMORphone	oxyCODONE
oxyMORphone	OxyCONTIN
oxyMORphone	oxyBUTYnin
oxytocin	OxyCONTIN
PACLitaxel	DOCEtaxel
PACLitaxel	PACLitaxel protein-bound particles
PACLitaxel protein-bound particles	PACLitaxel
Pamelor	Panlor DC
Pamelor	Tambocor
Panlor DC	Pamelor
paregoric (camphorated tincture of opium)	opium tincture
PARoxetine	DULoxetine
PARoxetine	FLUoxetine
PARoxetine	piroxicam
Patanol	Platinol
Pavulon	Peptavlon
Paxil	Doxil
Paxil	Plavix
Paxil	Taxol
Paxil	Trexall
PAZOPanib	PONATinib
PEMEtrexed	PRALAtrexate
penicillin	penicillAMINE
penicillAMINE	penicillin
Peptavlon	Pavulon
Percocet	Darvocet
Percocet	Procet
perflutren lipid microspheres	influenza virus vaccine
Pexeva	Lexiva
PENTobarbital	PHENobarbital
PHENobarbital	PENTobarbital
PHYSostigmine	pyRIDostigmine
Pilocar	Dilacor XR
piroxicam	PARoxetine
Pitocin	Pitressin
Pitressin	Pitocin
Platinol	Patanol
Plavix	Paxil
Plavix	Pradax [Non-US Product]
Plavix	Pradaxa
Plendil	Isordil
pneumococcal 7-valent vaccine	pneumococcal polyvalent vaccine
pneumococcal polyvalent vaccine	pneumococcal 7-valent vaccine
Polycitra	Bicitra
polyethylene glycol	propylene glycol
PONATinib	PAZOPanib
potassium acetate	sodium acetate
PRALAtrexate	PEMEtrexed
pralidoxime	pyridoxine
Pradax [Non-US Product]	Plavix
Pradaxa	Plavix
Prandin	Avandia
Precare	Precose
Precose	Precare
prednisoLONE	predniSONE
predniSONE	prednisoLONE
Prenexa	Ranexa
PriLOSEC	Pristiq
PriLOSEC	PROzac
Priscoline	Apresoline
Pristiq	PriLOSEC
probenecid	Procanbid
Procan SR	Procanbid
Procanbid	probenecid
Procanbid	Procan SR
Procardia XL	Protain XL
Procet	Percocet
Prograf	Proscar
Prograf	PROzac
propylene glycol	polyethylene glycol
propylthiouracil	Purinethol
Proscar	Prograf
Proscar	Provera
Protain XL	Procardia XL
protamine	Protonix
proton pump inhibitors	ARIPiprazole
Protonix	Lotronex
Protonix	protamine
Provera	Proscar
Provera	PROzac
PROzac	Prograf
PROzac	PriLOSEC
PROzac	Provera
Purinethol	propylthiouracil
Pyridium	pyridoxine
pyridoxine	Pyridium
pyRIDostigmine	PHYSostigmine
pyRIDostigmine	pyridoxine
pyridoxine	pralidoxime
pyridoxine	Pyridium
pyridoxine	pyridostigmine
QUEtiapine	OLANZapine
quiNIDine	quiNINE
quiNINE	quiNIDine
Qwell	Kwell
RABEprazole	ARIPiprazole
Ranexa	Prenexa
raNITIdine	riMANTAdine
Rapaflo	Rapamune
Rapamune	Rapaflo
rasageline	repaglinide
Razadyne	Rozerem
Recombivax HB	Comvax
Regranex	Granulex
Remeron	Rozerem
Reminyl	Amaryl
Reminyl	Robinul
Renagel	Renvela
Renvela	Renagel
repaglinide	rasageline
Reprexain	ZyPREXA
Restoril	RisperDAL
Retrovir	ritonavir
ribavirin	riboflavin
riboflavin	ribavirin
rifabutin	rifapentine
Rifadin	Rifater
Rifamate	rifAMPin
rifAMPin	Rifamate
rifAMPin	rifAXIMin
rifapentine	rifabutin
Rifater	Rifadin
rifAXIMin	rifAMPin
riMANTAdine	raNITIdine
RisperDAL	Restoril
RisperDAL	rOPINIRole
risperiDONE	rOPINIRole
Ritalin	ritodrine
Ritalin LA	Ritalin SR
Ritalin SR	Ritalin LA
ritodrine	Ritalin
ritonavir	Retrovir
Rituxan	Rituxan Hycela
Rituxan Hycela	Rituxan
riTUXimab	inFLIXimab
Robinul	Reminyl
rocuronium	Romazicon
Romazicon	rocuronium
romiDEPsin	romiPLOStim
romiPLOStim	romiDEPsin
rOPINIRole	RisperDAL
rOPINIRole	risperiDONE
Roxanol	Roxicet
ROPivacaine	BUPivacaine
Roxanol	Roxicodone Intensol
Roxicet	Roxanol
Roxicodone Intensol	Roxanol
Rozerem	Razadyne
Rozerem	Remeron
Salagen	selegiline
SandIMMUNE	SandoSTATIN
SandoSTATIN	SandIMMUNE
saquinavir	SINEquan
saquinavir (free base)	saquinavir mesylate
saquinavir mesylate	saquinavir (free base)
Sarafem	Serophene
sAXagliptin	SITagliptin
selegiline	Salagen
Serophene	Sarafem
SEROquel	Desyrel
SEROquel	SEROquel XR
SEROquel	Serzone
SEROquel	SINEquan
SEROquel XR	SEROquel
sertraline	cetirizine
sertraline	Soriatane
Serzone	SEROquel
silodosin	sirolimus
Sinemet	Janumet
SINEquan	saquinavir
SINEquan	SEROquel
SINEquan	Singulair
SINEquan	Zeniquin [veterinary drug]
SINEquan	Zonegran
Singulair	SINEquan
sirolimus	silodosin
SITagliptin	sAXagliptin
SITagliptin	SUMAtriptan
Slynd	Syeda
sodium acetate	potassium acetate
Solu-CORTEF	SOLU-Medrol
SOLU-Medrol	DEPO-Medrol
SOLU-Medrol	Solu-CORTEF
Sonata	Soriatane
SORAfenib	SUNItinib
Soriatane	Loxitane
Soriatane	sertraline
Soriatane	Sonata
sotalol	Sudafed
Spiriva	Apidra
Spiriva	Inspra
Spravato	Steglatro
stavudine	cetirizine
Steglatro	Spravato
Sudafed	sotalol
Sudafed	Sudafed PE
Sudafed 12 Hour	Sudafed 12 Hour Pressure + Pain
Sudafed 12 Hour Pressure + Pain	Sudafed 12 Hour
Sudafed PE	Sudafed
SUFentanil	ALfentail
SUFentanil	fentaNYL
sulfADIAZINE	sulfaSALAzine
sulfADIAZINE	sulfiSOXAZOLE
sulfaSALAzine	cefuroxime
sulfaSALAzine	sulfADIAZINE
sulfiSOXAZOLE	sulfADIAZINE
SUMAtriptan	SITagliptin
SUMAtriptan	ZOLMitriptan
SUNItinib	SORAfenib
Syeda	Slynd
Symbyax	Cymbalta
T-Gel	Bio-T-Gel
tacrolimus	tamsulosin
Tambocor	Pamelor
tamsulosin	tacrolimus
Tanzeum	Toujeo
Tanzeum	Tradjenta
Tanzeum	Tresiba
Tanzeum	Trulicity
Tarceva	Tresiba
Taxol	Paxil
Taxol	Taxotere
Taxotere	Taxol
TEGretol	TEGretol XR
TEGretol	Tequin
TEGretol	TRENtal
TEGretol XR	TEGretol
Tenex	Xanax
Tequin	TEGretol
Tequin	Ticlid
Testoderm	Testoderm TTS
Testoderm	Testoderm with Adhesive
Testoderm TTS	Testoderm
Testoderm TTS	Testoderm with Adhesive
Testoderm with Adhesive	Testoderm
Testoderm with Adhesive	Testoderm TTS
tetanus diptheria toxoid (Td)	tuberculin purified protein derivative (PPD)
Thalomid	Thiamine
Thiamine	Thalomid
Thrombate III	thrombin topical (recombinant)
thrombin topical (recombinant)	Thrombate III
tiaGABine	tiZANidine
Tiazac	Ziac
Ticlid	Tequin
tiZANidine	tiaGABine
tiZANidine	nizatidine
TNKase	Activase
TNKase	t-PA (Activase)
Tobradex	Tobrex
Tobrex	Tobradex
TOLAZamide	TOLBUTamide
TOLBUTamide	TOLAZamide
Topamax	Toprol-XL
Toprol-XL	Topamax
Toradol	Foradil
Toujeo	Tanzeum
Toujeo	Tradjenta
Toujeo	Tresiba
Toujeo	Trulicity
t-PA (Activase)	TNKase
Tracleer	Tricor
Tradjenta	Tanzeum
Tradjenta	Toujeo
Tradjenta	Tresiba
Tradjenta	Trulicity
traMADol	traZODone
trastuzumab	ado-trastuzumab emtansine
traZODone	traMADol
TRENtal	TEGretol
Tresiba	Tanzeum
Tresiba	Tarceva
Tresiba	Toujeo
Tresiba	Tradjenta
Tresiba	Trulicity
tretinoin	ISOtretinoin
Trexall	Paxil
Tricor	Tracleer
tromethamine	Trophamine
Trophamine	tromethamine
Trulicity	Tanzeum
Trulicity	Toujeo
Trulicity	Tradjenta
Trulicity	Tresiba
tuberculin purified protein derivative (PPD)	influenza virus vaccine
tuberculin purified protein derivative (PPD)	tetanus diptheria toxoid (Td)
Tylenol	Tylenol PM
Tylenol PM	Tylenol
Ultracet	Duricef
Ultram	lithium
Ure-Na (palatable form of oral urea)	hydroxyurea
valACYclovir	valGANciclovir
Valcyte	Valtrex
valGANciclovir	valACYclovir
Valtrex	Valcyte
Varivax	VZIG (varicella-zoster immune globulin)
vasopressin	desmopressin
Venofer	Vfend
Venofer	Vimpat
Vesanoid	Vesicare
Vesicare	Vesanoid
Vesicare	Vessel Care (nutritional supplement)
Vessel Care (nutritional supplement)	Vesicare
Vexol	Vosol
Vfend	Venofer
Vfend	Vimpat
Viagra	Allegra
Vicodin	Visicol
Videx	Bidex
vigabatrin	dabigatran
Vimpat	Venofer
Vimpat	Vfend
vinBLAStine	vinCRIStine
vinCRIStine	vinBLAStine
Viokase	Viokase 8
Viokase 8	Viokase
Vioxx	Zyvox
Viracept	Viramune
Viramune	Viracept
Viramune (nevirapine)	Viramune (herbal product)
Viramune (herbal product)	Viramune (nevirapine)
Visicol	Vicodin
VisionBlue	methylene blue
Volumen	Voluven
Voluven	Volumen
Vosol	Vexol
VZIG (varicella-zoster immune globulin)	Varivax
Wakix	Lasix
Wellbutrin SR	Wellbutrin XL
Wellbutrin XL	Wellbutrin SR
Xanax	Fanapt
Xanax	Tenex
Xanax	Zantac
Xeloda	Xenical
Xenical	Xeloda
Yasmin	Yaz
Yaz	Yasmin
Zantac	Xanax
Zantac (raNITIdine) [no longer marketed in US]	Zantac 360° (famotidine)
Zantac 360° (famotidine)	Zantac (raNITIdine) [no longer marketed in US]
Zantac	ZyrTEC
Zavesca (escitalopram) [non-US product]	Zavesca (miglustat)
Zavesca (miglustat)	Zavesca (escitalopram) [non-US product]
Zebeta	Diabeta
Zebeta	Zetia
Zegerid	Zestril
Zelapar (Zydis formulation)	ZyPREXA Zydis
Zemplar	Zemuron
Zemuron	Zemplar
Zeniquin [veterinary drug]	SINEquan
Zerit	ZyrTEC
Zestril	Zegerid
Zestril	Zetia
Zestril	ZyPREXA
Zetia	Bextra
Zetia	Zebeta
Zetia	Zestril
Ziac	Tiazac
Zocor	Cozaar
Zocor	ZyrTEC
ZOLMitriptan	SUMAtriptan
zolpidem	Zyloprim
Zonegran	SINEquan
Zostrix	Zovirax
Zovirax	Doribax
Zovirax	Zostrix
Zovirax	Zyvox
Zyban	Diovan
Zyloprim	zolpidem
ZyPREXA	CeleXA
ZyPREXA	Reprexain
ZyPREXA	Zestril
ZyPREXA	ZyrTEC
ZyPREXA Zydis	Zelapar (Zydis formulation)
ZyrTEC	Lipitor
ZyrTEC	Zantac
ZyrTEC	Zerit
ZyrTEC	Zocor
ZyrTEC	ZyPREXA
ZyrTEC	ZyrTEC-D
ZyrTEC (cetirizine)	ZyrTEC Itchy Eye Drops (ketotifen fumarate)
ZyrTEC-D	ZyrTEC
ZyrTEC Itchy Eye Drops (ketotifen fumarate)	ZyrTEC (cetirizine)
Zyvox	Vioxx
Zyvox	Zovirax
NOTES
Brand names always start with an uppercase letter; generics/other products are in lower case and italicized. Both the FDA-approved and the ISMP-recommended tall man letters are included in this list.
REFERENCES
Source: Institute for Safe Medication Practices (ISMP). ISMP List of Confused Drug Names. ISMP; 2023. Available at: https://www.ismp.org/recommendations/confused-drug-names-list. Accessed October 6, 2023. (Rev. 10/2023)

Do Not Crush or Chew

Haymarket Media — Thu, 12 Jul 2012 18:30:00 +0000

Do Not Crush or Chew

DO NOT CRUSH OR CHEW
Allergic Disorders • Orally-Disintegrating Tablets: Claritin Reditabs, Desloratadine ODT Cardiovascular DISEASE • Sustained-Release: Altoprev, Calan SR, Cardizem CD¹, Cardizem LA, Coreg CR¹, felodipine, Inderal LA, Innopran XL, Kapvay, Lescol XL, Niacin ER, Nifedipine ER, Norpace CR, pentoxifylline, Procardia XL, Ranexa, Rythmol SR, Sular, Tiazac¹, Toprol XL⁶, Verelan¹, Verelan PM¹ • Sublingual: Isosorbide dinitrate, Nitrostat • Misc: Letairis, Lovaza, Pradaxa⁸ Dermatological Disorders • Sustained-Release: Acetazolamide ER, Doryx¹, Oracea, Solodyn • Misc: Minocin², Propecia⁴ Endocrine Disorders • Sustained-Release: Glucotrol XL, Glumetza, Janumet XR, Kombiglyze XR, Metformin ER, Rayos, Zemplar • Misc: Sensipar⁷ GASTROHEPATIC DISORDERS • Sustained-Release: Apriso, Colestid, Dexilant, Lialda, Pentasa, Uceris, Zegerid • Enteric Coated: AcipHex, Asacol HD, Azulfidine EN‑tabs, Creon¹, Dulcolax⁵, Entocort EC, Fleet, Nexium¹, Prevacid¹, Prilosec¹, Protonix • Orally-Disintegrating Tablets: Ondansetron ODT, Prevacid Solutab • Misc: Amitiza⁵, Colace¹⁰, Marinol⁵, Pepto-Bismol Caplet⁷	IMMUNE DISORDERS & ONCOLOGY • Sustained-Release: Myfortic • Misc: Afinitor, Cellcept⁴, Erivedge ^2,4, Jakafi³, Rapamune⁸, Revlimid⁴, Sprycel^4,9, Tasigna⁸, Temodar², Votrient⁸, Zolinza², Zortress INFECTIOUS DISEASES • Sustained-Release: Amoxicillin/Clavulanic acid ER, Cipro XR, Clarithromycin XR, Doryx, Ery-Tab, Noxafil • Enteric-Coated: Eryc • Misc: Aptivus⁵, Biltricide¹⁰, Cefuroxime¹⁰, Clotrimazole Troches, Kaletra⁹, Minocin², Valcyte^4,9 Musculoskeletal Disorders • Sustained-Release: Amrix, Atelvia⁸, Indomethacin ER, Mestinon Timespan, Naprelan, Tylenol Arthritis, Vimovo • Enteric-Coated: Arthrotec, Azulfidine EN‑tabs, Bayer Arthritis, EC‑Naprosyn, Ecotrin • Misc: Actonel², Boniva², Evista^4,9,10, Feldene², Fosamax², Fosamax+ D² NEUROLOGIC & PSYCHIATRIC DISORDERS • Sustained-Release: Adderall XR¹, Ambien CR, Ampyra, Aplenzin, Carbatrol¹, Carbidopa/levodopa ER⁶, Concerta, Cymbalta, Depakote, Depakote ER, Depakote Sprinkles, Effexor XR¹, Equetro¹, Focalin XR¹, Horizant, Intuniv, Invega, Keppra XR⁹, Lithobid, Metadate CD¹, Mirapex ER, Namenda XR, Paxil CR, Phenytek, Pristiq, Razadyne ER, Ritalin LA¹, Ropinirole XL, Seroquel XR, Tecfidera, Tegretol XR, Topiramate sprinkle¹, Valproic acid, Wellbutrin SR/XL, Xanax XR • Orally-Disintegrating Tablets: Donepezil ODT, Lamictal ODT, Remeron Solutab, Risperidone ODT, Zelapar, Zyprexa Zydis • Sublingual: Zolpidem SL • Misc: Strattera¹¹, Treximet⁸, Zonegran⁷	Nutrition • Sustained-Release: Diethylpropion SR, Ferro-Sequels, Klor‑Con, Klor‑Con M⁶, Mag-Tab SR, Slow‑Fe, Slow Fe+ Folic Acid • Enteric Coated: Feosol • Misc: Drisdol⁵, K‑Lyte³ PAIN MANAGEMENT • Sustained-Release: Actiq (lozenge), Gralise, Morphine sulfate ER¹, MS Contin, Nucynta ER^7,8 Oxycontin, Topiramate sprinkle¹, Tramadol ER • Orally-Disintegrating Tablets: Maxalt‑MLT, Zomig ZMT • Buccal: Fentora Poisoning & Drug Dependence • Sustained-Release: Bupropion SR • Enteric-Coated: Acamprosate • Sublingual: Suboxone • Misc: Exjade³ Respiratory DISORDERS • Sustained-Release: Alavert D‑12, Allegra‑D, Clarinex‑D, Claritin‑D, Mucinex, Sudafed12/24HR, Theo‑24, VoSpire ER, Zyflo CR, Zyrtec‑D • Misc: Tessalon^2,5 UROLOGICAL DISORDERS • Sustained-Release: Cardura XL, Detrol LA, Ditropan XL, Enablex, Flomax, Myrbetriq, Toviaz, Trospium XR, Uroxatral • Enteric-Coated: Urocit‑K • Misc: Avodart⁷, Jalyn, Proscar⁴, Renagel⁸, Vesicare⁹	Allergic Disorders • Orally-Disintegrating Tablets: Claritin Reditabs, Desloratadine ODT Cardiovascular DISEASE • Sustained-Release: Adalat CC, Altoprev, Calan SR, Cardizem CD¹, Cardizem LA, Coreg CR¹, Dilatrate SR, felodipine, Inderal LA, Innopran XL, Kapvay, Lescol XL, Niaspan, Norpace CR, pentoxifylline, Procardia XL, Ranexa, Rythmol SR, Sular, Tiazac¹, Toprol XL⁶, Verelan¹, Verelan PM¹ • Sublingual: Isosorbide dinitrate, Nitrostat • Misc: Letairis, Lovaza, Pradaxa⁸ Dermatological Disorders • Sustained-Release: Diamox, Doryx¹, Oracea, Solodyn • Misc: Minocin², Propecia⁴ Endocrine Disorders • Sustained-Release: Glucophage XR, Glucotrol XL, Glumetza, Janumet XR, Kombiglyze XR, Rayos, Zemplar • Buccal: Striant • Misc: Sensipar⁷ GASTROHEPATIC DISORDERS • Sustained-Release: Apriso, Colestid, Dexilant, Lialda, Pentasa, Uceris, Zegerid • Enteric Coated: AcipHex, Asacol, Azulfidine EN‑tabs, Creon¹, Dulcolax⁵, Entocort EC, Fleet, Nexium¹, Prevacid¹, Prilosec¹, Protonix • Orally-Disintegrating Tablets: Ondansetron ODT, Prevacid Solutab • Misc: Amitiza⁵, Colace¹⁰, Marinol⁵, Pepto-Bismol Caplet⁷ IMMUNE DISORDERS & ONCOLOGY • Sustained-Release: Myfortic • Misc: Afinitor, Cellcept⁴, Erivedge ^2,4, Jakafi³, Rapamune⁸, Revlimid⁴, Sprycel^4,9, Tasigna⁸, Temodar², Votrient⁸, Zolinza², Zortress INFECTIOUS DISEASES • Sustained-Release: Augmentin XR, Cipro XR, Clarithromycin XR, Doryx, Ery-Tab, Flagyl ER, Noxafil • Enteric-Coated: Eryc, Videx EC • Misc: Aptivus⁵, Biltricide¹⁰, Ceftin¹⁰, Clotrimazole Troches, Kaletra⁹, Minocin², Valcyte^4,9 Musculoskeletal Disorders • Sustained-Release: Amrix, Atelvia⁸, Indomethacin ER, Mestinon Timespan, Naprelan, Tylenol Arthritis, Vimovo • Enteric-Coated: Arthrotec, Azulfidine EN‑tabs, Bayer Arthritis, EC‑Naprosyn, Ecotrin • Misc: Actonel², Boniva², Evista^4,9,10, Feldene², Fosamax², Fosamax+ D² NEUROLOGIC & PSYCHIATRIC DISORDERS • Sustained-Release: Adderall XR¹, Ambien CR, Ampyra, Aplenzin, Carbatrol¹, Concerta, Cymbalta, Depakene, Depakote, Depakote ER, Depakote Sprinkles, Effexor XR¹, Equetro¹, Focalin XR¹, Horizant, Intuniv, Invega, Keppra XR⁹, Lithobid, Metadate CD¹, Mirapex ER, Namenda XR, Paxil CR, Phenytek, Pristiq, Razadyne ER, Requip XL, Ritalin LA¹, Seroquel XR, Sinemet CR⁶, Tecfidera, Tegretol XR Topamax¹, Wellbutrin SR/XL, Xanax XR • Orally-Disintegrating Tablets: Aricept ODT, Lamictal ODT, Remeron Solutab, Risperdal M‑Tabs, Zelapar, Zyprexa Zydis • Sublingual: Zolpidem SL • Misc: Strattera¹¹, Treximet⁸, Zonegran⁷ Nutrition • Sustained-Release: Diethylpropion SR, Ferro-Sequels, Klor‑Con, Klor‑Con M⁶, Mag-Tab SR, Slow‑Fe, Slow Fe+ Folic Acid • Enteric Coated: Feosol • Misc: Drisdol⁵, K‑Lyte³ PAIN MANAGEMENT • Sustained-Release: Actiq (lozenge), Gralise, Kadian¹, MS Contin, Nucynta ER^7,8 Oxycontin, Topamax¹, Tramadol ER • Orally-Disintegrating Tablets: Maxalt‑MLT, Zomig ZMT • Buccal: Fentora Poisoning & Drug Dependence • Sustained-Release: Zyban • Enteric-Coated: Acamprosate • Sublingual: Suboxone • Misc: Exjade³ Respiratory DISORDERS • Sustained-Release: Alavert D‑12, Allegra‑D, Clarinex‑D, Claritin‑D, Mucinex, Sudafed12/24HR, Theo‑24, VoSpire ER, Zyflo CR, Zyrtec‑D • Misc: Tessalon^2,5 UROLOGICAL DISORDERS • Sustained-Release: Cardura XL, Detrol LA, Ditropan XL, Enablex, Flomax, Myrbetriq, Toviaz, Trospium XR, Uroxatral • Enteric-Coated: Urocit‑K • Misc: Avodart⁷, Jalyn, Proscar⁴, Renagel⁸, Vesicare⁹
NOTES
¹ Contents in caps can be mixed with applesauce to be swallowed immediately and not chewed or crushed. Mixture cannot be stored for later use. See full labeling. ² Can cause irritation to skin and/or mucous membranes. ³ Must be dissolved in liquid. See literature. ⁴ May be teratogenic. Pregnant women or women who may become pregnant should avoid contact. ⁵ Caps are liquid-filled. ⁶ Scored tabs, can be broken in half but not crushed or chewed. ⁷ Manufacturer recommends swallowing whole. ⁸ Pharmacokinetic properties may be compromised if crushed, chewed, or broken apart. ⁹ Film-coated ¹⁰ Taste ¹¹ Ocular irritant
Not an inclusive list of medications. Please see drug monograph at www.eMPR.com and/or contact company for full drug labeling. (Rev. 3/2022)

DO NOT CRUSH OR CHEW

Allergic Disorders

• Orally-Disintegrating Tablets: Claritin Reditabs, Desloratadine ODT

Cardiovascular DISEASE

• Sustained-Release: Altoprev, Calan SR, Cardizem CD¹, Cardizem LA, Coreg CR¹, felodipine, Inderal LA, Innopran XL, Kapvay, Lescol XL, Niacin ER, Nifedipine ER, Norpace CR, pentoxifylline, Procardia XL, Ranexa, Rythmol SR, Sular, Tiazac¹, Toprol XL⁶, Verelan¹, Verelan PM¹

• Sublingual: Isosorbide dinitrate, Nitrostat

• Misc: Letairis, Lovaza, Pradaxa⁸

Dermatological Disorders

• Sustained-Release: Acetazolamide ER, Doryx¹, Oracea, Solodyn

• Misc: Minocin², Propecia⁴

Endocrine Disorders

• Sustained-Release: Glucotrol XL, Glumetza, Janumet XR, Kombiglyze XR, Metformin ER, Rayos, Zemplar

• Misc: Sensipar⁷

GASTROHEPATIC DISORDERS

• Sustained-Release: Apriso, Colestid, Dexilant, Lialda, Pentasa, Uceris, Zegerid

• Enteric Coated: AcipHex, Asacol HD, Azulfidine EN‑tabs, Creon¹, Dulcolax⁵, Entocort EC, Fleet, Nexium¹, Prevacid¹, Prilosec¹, Protonix

• Orally-Disintegrating Tablets: Ondansetron ODT, Prevacid Solutab

• Misc: Amitiza⁵, Colace¹⁰, Marinol⁵, Pepto-Bismol Caplet⁷

IMMUNE DISORDERS & ONCOLOGY

• Sustained-Release: Myfortic

• Misc: Afinitor, Cellcept⁴, Erivedge ^2,4, Jakafi³, Rapamune⁸, Revlimid⁴, Sprycel^4,9, Tasigna⁸, Temodar², Votrient⁸, Zolinza², Zortress

INFECTIOUS DISEASES

• Sustained-Release: Amoxicillin/Clavulanic acid ER, Cipro XR, Clarithromycin XR, Doryx, Ery-Tab, Noxafil

• Enteric-Coated: Eryc

• Misc: Aptivus⁵, Biltricide¹⁰, Cefuroxime¹⁰, Clotrimazole Troches, Kaletra⁹, Minocin², Valcyte^4,9

Musculoskeletal Disorders

• Sustained-Release: Amrix, Atelvia⁸, Indomethacin ER, Mestinon Timespan, Naprelan, Tylenol Arthritis, Vimovo

• Enteric-Coated: Arthrotec, Azulfidine EN‑tabs, Bayer Arthritis, EC‑Naprosyn, Ecotrin

• Misc: Actonel², Boniva², Evista^4,9,10,
Feldene², Fosamax², Fosamax+ D²

NEUROLOGIC & PSYCHIATRIC DISORDERS

• Sustained-Release: Adderall XR¹, Ambien CR, Ampyra, Aplenzin, Carbatrol¹, Carbidopa/levodopa ER⁶, Concerta, Cymbalta, Depakote, Depakote ER, Depakote Sprinkles, Effexor XR¹, Equetro¹, Focalin XR¹, Horizant, Intuniv, Invega, Keppra XR⁹, Lithobid, Metadate CD¹, Mirapex ER, Namenda XR, Paxil CR, Phenytek, Pristiq, Razadyne ER, Ritalin LA¹, Ropinirole XL, Seroquel XR,
Tecfidera, Tegretol XR, Topiramate sprinkle¹, Valproic acid, Wellbutrin SR/XL, Xanax XR

• Orally-Disintegrating Tablets: Donepezil ODT, Lamictal ODT, Remeron Solutab, Risperidone ODT, Zelapar, Zyprexa Zydis

• Sublingual: Zolpidem SL

• Misc: Strattera¹¹, Treximet⁸, Zonegran⁷

Nutrition

• Sustained-Release: Diethylpropion SR, Ferro-Sequels, Klor‑Con, Klor‑Con M⁶, Mag-Tab SR, Slow‑Fe, Slow Fe+ Folic Acid

• Enteric Coated: Feosol

• Misc: Drisdol⁵, K‑Lyte³

PAIN MANAGEMENT

• Sustained-Release: Actiq (lozenge), Gralise, Morphine sulfate ER¹, MS Contin, Nucynta ER^7,8 Oxycontin, Topiramate sprinkle¹, Tramadol ER

• Orally-Disintegrating Tablets: Maxalt‑MLT, Zomig ZMT

• Buccal: Fentora

Poisoning & Drug Dependence

• Sustained-Release: Bupropion SR

• Enteric-Coated: Acamprosate

• Sublingual: Suboxone

• Misc: Exjade³

Respiratory DISORDERS

• Sustained-Release: Alavert D‑12,
Allegra‑D, Clarinex‑D, Claritin‑D, Mucinex, Sudafed12/24HR, Theo‑24, VoSpire ER, Zyflo CR, Zyrtec‑D

• Misc: Tessalon^2,5

UROLOGICAL DISORDERS

• Sustained-Release: Cardura XL, Detrol LA, Ditropan XL, Enablex, Flomax, Myrbetriq, Toviaz, Trospium XR, Uroxatral

• Enteric-Coated: Urocit‑K

• Misc: Avodart⁷, Jalyn, Proscar⁴, Renagel⁸, Vesicare⁹

Allergic Disorders

• Orally-Disintegrating Tablets: Claritin Reditabs, Desloratadine ODT

Cardiovascular DISEASE

• Sustained-Release: Adalat CC, Altoprev, Calan SR, Cardizem CD¹, Cardizem LA, Coreg CR¹, Dilatrate SR, felodipine, Inderal LA, Innopran XL, Kapvay, Lescol XL, Niaspan, Norpace CR, pentoxifylline, Procardia XL, Ranexa, Rythmol SR, Sular, Tiazac¹, Toprol XL⁶, Verelan¹, Verelan PM¹

• Sublingual: Isosorbide dinitrate, Nitrostat

• Misc: Letairis, Lovaza, Pradaxa⁸

Dermatological Disorders

• Sustained-Release: Diamox, Doryx¹, Oracea, Solodyn

• Misc: Minocin², Propecia⁴

Endocrine Disorders

• Sustained-Release: Glucophage XR, Glucotrol XL, Glumetza, Janumet XR, Kombiglyze XR, Rayos, Zemplar

• Buccal: Striant

• Misc: Sensipar⁷

GASTROHEPATIC DISORDERS

• Sustained-Release: Apriso, Colestid, Dexilant, Lialda, Pentasa, Uceris, Zegerid

• Enteric Coated: AcipHex, Asacol, Azulfidine EN‑tabs, Creon¹, Dulcolax⁵, Entocort EC, Fleet, Nexium¹, Prevacid¹, Prilosec¹, Protonix

• Orally-Disintegrating Tablets: Ondansetron ODT, Prevacid Solutab

• Misc: Amitiza⁵, Colace¹⁰, Marinol⁵, Pepto-Bismol Caplet⁷

IMMUNE DISORDERS & ONCOLOGY

• Sustained-Release: Myfortic

• Misc: Afinitor, Cellcept⁴, Erivedge ^2,4, Jakafi³, Rapamune⁸, Revlimid⁴, Sprycel^4,9, Tasigna⁸, Temodar², Votrient⁸, Zolinza², Zortress

INFECTIOUS DISEASES

• Sustained-Release: Augmentin XR, Cipro XR, Clarithromycin XR, Doryx, Ery-Tab, Flagyl ER, Noxafil

• Enteric-Coated: Eryc, Videx EC

• Misc: Aptivus⁵, Biltricide¹⁰, Ceftin¹⁰, Clotrimazole Troches, Kaletra⁹, Minocin², Valcyte^4,9

Musculoskeletal Disorders

• Sustained-Release: Amrix, Atelvia⁸, Indomethacin ER, Mestinon Timespan, Naprelan, Tylenol Arthritis, Vimovo

• Enteric-Coated: Arthrotec, Azulfidine EN‑tabs, Bayer Arthritis, EC‑Naprosyn, Ecotrin

• Misc: Actonel², Boniva², Evista^4,9,10,
Feldene², Fosamax², Fosamax+ D²

NEUROLOGIC & PSYCHIATRIC DISORDERS

• Sustained-Release: Adderall XR¹, Ambien CR, Ampyra, Aplenzin, Carbatrol¹, Concerta, Cymbalta, Depakene, Depakote, Depakote ER, Depakote Sprinkles, Effexor XR¹, Equetro¹, Focalin XR¹, Horizant, Intuniv, Invega, Keppra XR⁹, Lithobid, Metadate CD¹, Mirapex ER, Namenda XR, Paxil CR, Phenytek, Pristiq, Razadyne ER, Requip XL, Ritalin LA¹, Seroquel XR, Sinemet CR⁶,
Tecfidera, Tegretol XR Topamax¹, Wellbutrin SR/XL, Xanax XR

• Orally-Disintegrating Tablets: Aricept ODT, Lamictal ODT, Remeron Solutab, Risperdal M‑Tabs, Zelapar, Zyprexa Zydis

• Sublingual: Zolpidem SL

• Misc: Strattera¹¹, Treximet⁸, Zonegran⁷

Nutrition

• Sustained-Release: Diethylpropion SR, Ferro-Sequels, Klor‑Con, Klor‑Con M⁶, Mag-Tab SR, Slow‑Fe, Slow Fe+ Folic Acid

• Enteric Coated: Feosol

• Misc: Drisdol⁵, K‑Lyte³

PAIN MANAGEMENT

• Sustained-Release: Actiq (lozenge), Gralise, Kadian¹, MS Contin, Nucynta ER^7,8 Oxycontin, Topamax¹, Tramadol ER

• Orally-Disintegrating Tablets: Maxalt‑MLT, Zomig ZMT

• Buccal: Fentora

Poisoning & Drug Dependence

• Sustained-Release: Zyban

• Enteric-Coated: Acamprosate

• Sublingual: Suboxone

• Misc: Exjade³

Respiratory DISORDERS

• Sustained-Release: Alavert D‑12,
Allegra‑D, Clarinex‑D, Claritin‑D, Mucinex, Sudafed12/24HR, Theo‑24, VoSpire ER, Zyflo CR, Zyrtec‑D

• Misc: Tessalon^2,5

UROLOGICAL DISORDERS

• Sustained-Release: Cardura XL, Detrol LA, Ditropan XL, Enablex, Flomax, Myrbetriq, Toviaz, Trospium XR, Uroxatral

• Enteric-Coated: Urocit‑K

• Misc: Avodart⁷, Jalyn, Proscar⁴, Renagel⁸, Vesicare⁹

NOTES

¹ Contents in caps can be mixed with applesauce to be swallowed immediately and not chewed or crushed. Mixture cannot be stored for later use. See full labeling.

² Can cause irritation to skin and/or mucous membranes.

³ Must be dissolved in liquid. See literature.

⁴ May be teratogenic. Pregnant women or women who may become pregnant should avoid contact.

⁵ Caps are liquid-filled.

⁶ Scored tabs, can be broken in half but not crushed or chewed.

⁷ Manufacturer recommends swallowing whole.

⁸ Pharmacokinetic properties may be compromised if crushed, chewed, or broken apart.

⁹ Film-coated

¹⁰ Taste

¹¹ Ocular irritant

Not an inclusive list of medications. Please see drug monograph at www.eMPR.com and/or contact company for full drug labeling.

(Rev. 3/2022)

Dosages for the Elderly

Haymarket Media — Mon, 09 Jul 2012 20:35:00 +0000

Dosages for the Elderly

DOSAGES FOR THE ELDERLY
1) Renal Function: Glomerular filtration rate, renal tubular secretion and blood flow tend to decrease with advancing age, while the incidence of renal pathology increases. 2) Drug Sensitivity: Elderly patients may show unusual sensitivity or paradoxical reactions to a number of drugs. Refer to the complete prescribing information. 3) Drug Distribution: The ratio of fat to lean body weight may increase in the elderly, which affects the volume of distribution of fat-soluble drugs. Plasma albumin concentrations may be decreased in the elderly. This potentiates plasma-protein bound drugs and increases the potential for drug interactions caused by plasma-protein displacement. 4) Polypharmacy: It is important to determine the patient’s current medication use, including nonprescription products, before adding any medication to determine any possible interactions. 5) Hepatic Function: Reduced function of metabolic enzymes in the liver may occur in the elderly.

DOSAGES FOR THE ELDERLY

Special caution is advised when prescribing drugs for elderly patients. Keep the following points in mind when prescribing drugs for patients of approximately 60 years or older:

1) Renal Function: Glomerular filtration rate, renal tubular secretion and blood flow tend to decrease with advancing age, while the incidence of renal pathology increases.

2) Drug Sensitivity: Elderly patients may show unusual sensitivity or paradoxical reactions to a number of drugs. Refer to the complete prescribing information.

3) Drug Distribution: The ratio of fat to lean body weight may increase in the elderly, which affects the volume of distribution of fat-soluble drugs. Plasma albumin concentrations may be decreased in the elderly. This potentiates plasma-protein bound drugs and increases the potential for drug interactions caused by plasma-protein displacement.

4) Polypharmacy: It is important to determine the patient’s current medication use, including nonprescription products, before adding any medication to determine any possible interactions.

5) Hepatic Function: Reduced function of metabolic enzymes in the liver may occur in the elderly.

Error-Prone Abbreviations

Haymarket Media — Tue, 21 Oct 2014 22:36:00 +0000

Error-Prone Abbreviations

ERROR-PRONE ABBREVIATIONS
The abbreviations found in this table have been reported to the Institute for Safe Medical Practices (ISMP) through the ISMP Medication Error Reporting Program as being frequently misinterpreted and involved in harmful medication errors. These abbreviations should never be used when communicating medical information. This includes internal communications; verbal, handwritten, or electronic prescriptions; handwritten and computer-generated medication labels; drug storage bin labels; medication administration records; and screens associated with pharmacy and prescriber computer order entry systems, automated dispensing cabinets, smart infusion pumps, and other medication-related technologies.
Abbreviations	Intended Meaning	Misinterpretation	Correction
Doses or Measurement Units
cc	Cubic centimeters	Mistaken as “u” (units)	Use “mL”
IU*	International unit(s)	Mistaken as “IV” (intravenous) or the number 10	Use “unit(s)” (International units can be expressed as units alone)
l	Liter	Lowercase letter “l” mistaken as the number 1	Use “L”
ml	Milliliter	Lowercase letter “l” mistaken as the number 1	Use “mL”
MM or M	Million	Mistaken as “thousand” (M has been used to abbreviate both million and thousand)	Use “million”
M or K	Thousand	Mistaken as “million” (M has been used to abbreviate both million and thousand)	Use “thousand”
Ng or ng	Nanogram	Mistaken as “mg” or “nasogastric”	Use “nanogram” or “nanog”
U or u*	Unit(s)	Mistaken as 0 or 4, causing a 10-fold overdose or greater (eg, 4U seen as 40 or 4u seen as 44); mistaken as “cc” so dose given in volume instead of units (eg, 4u seen as 4cc)	Use “unit(s)”
μg	Microgram	Mistaken as “mg”	Use “mcg”
Route of Administration
AD, AS, AU	Right ear, left ear, each ear	Mistaken as “OD, OS, OU” (right eye, left eye, each eye)	Use “right ear”, “left ear”, or “each ear”
IJ	Injection	Mistaken as “IV” or “intrajugular”	Use “injection”
IN	Intranasal	Mistaken as “IM” (intramuscular) or “IV”	Use “NAS” or “intranasal”
IT	Intrathecal	Mistaken as “intratracheal”, “intratumor”, “intratympanic”, or “inhalation therapy”	Use “intrathecal”
OD, OS, OU	Right eye, left eye, each eye	Mistaken as “AD, AS, AU” (right ear, left ear, each ear)	Use “right eye”, “left eye”, or “each eye”
Per os	By mouth, orally	The “os” can be mistaken as “left eye” (OS)	Use “PO”, “by mouth”, or “orally”
SC, SQ, sq, or sub q	Subcutaneous(ly)	“SC” and “sc” mistaken as “SL” or “sl” (sublingual); SQ mistaken as “5 every”; The “q” in “sub q” has been mistaken as “every”	Use “SUBQ” or “subcutaneous(ly)”
Frequency or Instructions
HS	Half-strength	Mistaken as “bedtime”	Use “half-strength”
hs	At bedtime, hours of sleep	Mistaken as “half-strength”	Use “HS” for bedtime
o.d. or OD	Once daily	Mistaken as “right eye” (OD), leading to oral liquid medications given in the eye	Use “daily”
Q.D., QD, q.d., or qd*	Every day	Mistaken as q.i.d. (four times daily), especially if the period after the “q” or the tail of the “q” is misunderstood as an “i”	Use “daily”
Qhs	Nightly at bedtime	Mistaken as “qhr” (every hour)	Use “nightly” or “HS” for bedtime
Qn	Nightly or at bedtime	Mistaken as “qh” (every hour)	Use “nightly” or “HS” for bedtime
Q.O.D., QOD, q.o.d., or qod*	Every other day	Mistaken as “qd” (daily) or “qid” (four times daily) if the “o” is poorly written	Use “every other day”
q1d	Daily	Mistaken as “qid” (four times daily)	Use “daily”
q6PM, etc.	Every evening at 6 PM	Mistaken as “every 6 hours”	Use “daily at 6 PM” or “6 PM daily”
SSRI	Sliding scale regular insulin	Mistaken as selective-serotonin reuptake inhibitor	Use “sliding scale (insulin)”
SSI	Sliding scale insulin	Mistaken as Strong Solution of Iodine (Lugol’s)	Use “sliding scale (insulin)”
TIW or tiw	3 times a week	Mistaken as “3 times a day” or “twice in a week”	Use “3 times weekly”
BIW or biw	2 times a week	Mistaken as “2 times a day”	Use “2 times weekly”
UD	As directed (ut dictum)	Mistaken as unit dose (eg, order of “dilTIAZem infusion UD” mistakenly given as a unit [bolus] dose)	Use “as directed”
Miscellaneous
BBA	Baby boy A (twin)	B in BBA can be mistaken as twin B rather than gender (boy)	Use mother’s last name, baby’s gender (boy or girl), and distinguishing identifier for all multiples when assigning identifiers to newborns (eg, Smith girl A, Smith girl B)
BGB	Baby girl B (twin)	B at end of BGB can be mistaken as gender (boy) not twin B
D/C	Discharge or discontinue	Premature discontinuation of medications if D/C (intended to mean “discharge”) mistaken as “discontinued” on a medication list	Use “discharge” and “discontinue” or “stop”
OJ	Orange juice	Mistaken as “OD or OS” (right or left eye); drugs meant to be diluted in orange juice may be given in the eye	Use “orange juice”
Period following abbreviations (eg, mg., mL.)	mg or mL	Unnecessary period mistaken as the number 1, especially if written poorly	Use without a terminal period (eg, “mg”, “mL”, etc.)
SS or ss	Single strength, sliding scale (insulin), signs and symptoms, or ½ (apothecary)	Mistaken for each other or the number “55”	Use “single strength”, “sliding scale”, “signs and symptoms”, or “one-half” or “½”
* Included on The Joint Commission’s “Do Not Use” list (Information Management standard IM.02.02.01) and must be included on an organization’s “Do Not Use” list.
REFERENCES
Source: Institute for Safe Medication Practices (ISMP). ISMP List of Error-Prone Abbreviations, Symbols, and Dose Designations. ISMP; 2021. Available at: https://www.ismp.org/recommendations/error-prone-abbreviations-list. Accessed October 5, 2023. (Rev. 10/2023)

Error-Prone Drug Name Abbreviations

Haymarket Media — Tue, 21 Oct 2014 23:10:00 +0000

Error-Prone Drug Name Abbreviations

ERROR-PRONE DRUG NAME ABBREVIATIONS
The drug name abbreviations found in this table have been reported to the Institute for Safe Medical Practices (ISMP) through the ISMP Medication Error Reporting Program as being frequently misinterpreted and involved in harmful medication errors. These drug name abbreviations should never be used when communicating medical information; complete drug names should be used. This includes internal communications; verbal, handwritten, or electronic prescriptions; handwritten and computer-generated medication labels; drug storage bin labels; medication administration records; and screens associated with pharmacy and prescriber computer order entry systems, automated dispensing cabinets, smart infusion pumps, and other medication-related technologies.
Drug Name Abbreviations	Intended Meaning	Misinterpretation	Correction
Antiretroviral medications (eg, DOR, TAF, TDF)	DOR: doravirine TAF: tenofovir alafenamide TDF: tenofovir disoproxil fumarate	DOR: Dovato (dolutegravir and lamiVUDine) TAF: tenofovir disoproxil fumarate TDF: tenofovir alafenamide	Use complete drug names
APAP	acetaminophen	Not recognized as acetaminophen	Use complete drug name
ARA A	vidarabine	Mistaken as cytarabine (ARA C)	Use complete drug name
AT II and AT III	AT II: angiotensin II (Giapreza) AT III: antithrombin III (Thrombate III)	AT II (angiotensin II) mistaken as AT III (antithrombin III) and vice versa	Use complete drug names
AZT	zidovudine (Retrovir)	Mistaken as azithromycin, azaTHIOprine, or aztreonam	Use complete drug name
CPZ	Compazine (prochlorperazine)	Mistaken as chlorproMAZINE	Use complete drug name
DTO	diluted tincture of opium, or deodorized tincture of opium (Paregoric)	Mistaken as tincture of opium	Use complete drug name
HCT	hydrocortisone	Mistaken as hydroCHLOROthiazide	Use complete drug name
HCTZ	hydroCHLOROthiazide	Mistaken as hydrocortisone (seen as HCT250mg)	Use complete drug name
MgSO4*	magnesium sulfate	Mistaken as morphine sulfate	Use complete drug name
MS, MSO4*	morphine sulfate	Mistaken as magnesium sulfate	Use complete drug name
MTX	methotrexate	Mistaken as mitoXANTRONE	Use complete drug name
Na at the beginning of a drug name (eg, Na bicarbonate)	Sodium bicarbonate	Mistaken as no bicarbonate	Use complete drug name
NoAC	novel/new oral anticoagulant	Mistaken as no anticoagulant	Use complete drug name
OXY	oxytocin	Mistaken as oxyCODONE, OxyCONTIN	Use complete drug name
PCA	procainamide	Mistaken as patient controlled analgesia	Use complete drug name
PIT	Pitocin (oxytocin)	Mistaken as Pitressin (vasopressin)	Use complete drug name
PNV	prenatal vitamins	Mistaken as penicillin VK	Use complete drug name
PTU	propylthiouracil	Mistaken as Purinethol (mercaptopurine)	Use complete drug name
T3	Tylenol with codeine No. 3 (acetaminophen with codeine)	Mistaken as liothyronine (sometimes referred to as T3)	Use complete drug name
TAC or tac	triamcinolone or tacrolimus	Mistaken as tetracaine, Adrenalin and cocaine; or as Taxotere, Adriamycin, and cyclophosphamide	Use complete drug name. Avoid drug regimen or protocol acronyms that may have a dual meaning or may be confused with other common acronyms, even if defined in an order set.
TNK	TNKase	Mistaken as “TPA”	Use complete drug name
TPA or tPA	tissue plasminogen activator, Activase (alteplase)	Mistaken as TNK (TNKase, tenecteplase), TXA (tranexamic acid), or less often as Retavase (retaplase)	Use complete drug names
TXA	tranexamic acid	Mistaken as TPA (tissue plasminogen activator)	Use complete drug name
ZnSO4	zinc sulfate	Mistaken as morphine sulfate	Use complete drug name
Stemmed Drug Names	Intended Meaning	Misinterpretation	Correction
Coined names for compounded products (eg, magic mouthwash, banana bag)	Specific ingredients compounded together	Mistaken ingredients	Use complete drug/product names for all ingredients
“Levo”	levofloxacin	Mistaken as Levophed (norepinephrine)	Use complete drug name
“Neo”	Neo-Synephrine (phenylephrine)	Mistaken as neostigmine	Use complete drug name
“Nitro” drip	nitroglycerin infusion	Mistaken as sodium nitroprusside infusion	Use complete drug name
Number embedded in drug name (not part of the official name) (eg, 5-fluorouracil, 6-mercaptopurine)	fluorouracil, mercaptopurine	Embedded number mistaken as the dose or number of tablets/capsules to be given	Use complete drug names, without an embedded number
“IV Vanc”	intravenous vancomycin	Mistaken as Invanz (ertapenem)	Use complete drug name
NOTES
*Included on The Joint Commission’s “minimum list” of dangerous abbreviations, acronyms, and symbols that must be included on an organization’s “Do Not Use” list, effective January 1, 2004. For more information visit http://www.jointcommission.org.
REFERENCES
Source: Institute for Safe Medication Practices (ISMP). List of Error-Prone Abbreviations, Symbols, and Dose Designations. ISMP; 2021. Available at: https://www.ismp.org/recommendations/error-prone-abbreviations-list. Accessed October 5, 2023. (Rev. 10/2023)

Error-Prone Symbols

Haymarket Media — Tue, 21 Oct 2014 23:03:00 +0000

Error-Prone Symbols

ERROR-PRONE SYMBOLS
The symbols found in this table have been reported to the Institute for Safe Medical Practices (ISMP) through the ISMP Medication Error Reporting Program as being frequently misinterpreted and involved in harmful medication errors. These symbols should never be used when communicating medical information. This includes internal communications; verbal, handwritten, or electronic prescriptions; handwritten and computer-generated medication labels; drug storage bin labels; medication administration records; and screens associated with pharmacy and prescriber computer order entry systems, automated dispensing cabinets, smart infusion pumps, and other medication-related technologies.
Symbol	Intended Meaning	Misinterpretation	Correction
ʒ	Dram	Mistaken as “3”	Use the metric system
	Minim	Mistaken as “mL”	Use the metric system
x1	Administer once	Administer for 1 day	Use explicit words (eg, “for 1 dose”)
> and <	More than and less than	Mistaken as opposite of intended; incorrect symbol used mistakenly; “<” mistaken as “4” when handwritten (eg, “<10” mistaken as “40”)	Use “more than” or “less than”
↑ and ↓	Increase and decrease	Mistaken as opposite of intended; incorrect symbol used mistakenly; ↑ mistaken as the letter T, leading to misinterpretation as the start of a drug name, or mistaken as the numbers 4 or 7	Use “increase” and “decrease”
/ (slash mark)	Separates two doses or indicates “per”	Mistaken as the number 1 (eg, “25 units/10units” mistaken as “25 units and 110 units”)	Use “per” rather than a slash mark to separate doses
@	At	Mistaken as “2”	Use “at”
&	And	Mistaken as “2”	Use “and”
+	Plus or and	Mistaken as “4”	Use “plus”, “and”, or “in addition to”
°	Hour	Mistaken as a zero (eg, q2° seen as q 20)	Use “hr”, “h”, or “hour”
Φ or ∅	Zero, null sign	Mistaken as numerals 4, 6, 8, and 9	Use “0” or “zero”, or describe intent using whole words
#	Pound(s)	Mistaken as a number sign	Use the metric system (kg or g) rather than pounds; if referring to pounds, use “lb”
REFERENCES
Source: Institute for Safe Medication Practices (ISMP). ISMP List of Error-Prone Abbreviations, Symbols, and Dose Designations. ISMP; 2021. Available at: https://www.ismp.org/recommendations/ error-prone-abbreviations-list. Accessed October 5, 2023. (Rev. 10/2023)

FDA Codes and Therapeutic Definitions

Haymarket Media — Thu, 12 Jul 2012 18:00:00 +0000

FDA Codes and Therapeutic Definitions

FDA CODES AND THERAPEUTIC DEFINITIONS
“A” CODES Drug products that are considered to be therapeutically equivalent to other pharmaceutically equivalent products.
AA	Products not presenting bioequivalence problems in conventional dosage forms.
AB	Products meeting necessary bioequivalence requirements.
AN	Solutions and powders for aerosolization.
AO	Injectable oil solutions.
AP	Injectable aqueous solutions, and in certain instances, intravenous non-aqueous solutions.
AT	Topical products.
“B” CODES Drug products that the FDA does not at this time consider to be therapeutically equivalent to other pharmaceutically equivalent products.
B*	Drug products that require further FDA investigation and review to determine therapeutic equivalence.
BC	Extended-release dosage forms such as capsules, injectables, and tablets (extended-release products for which such bioequivalence data are available have been coded AB).
BD	Active ingredients and dosage forms with documented bioequivalence problems.
BE	Delayed-release oral dosage forms (delayed-release oral dosage forms for which bioequivalence data are available are coded AB).
BN	Products in aerosol-nebulizer drug delivery systems.
BP	Active ingredients and dosage forms with POTENTIAL bioequivalence problems.
BR	Suppositories or enemas for systemic absorption.
BS	Products having standard deficiencies (if the drug standards for an active ingredient in a particular dosage form are found by FDA to be deficient so as to prevent an FDA evaluation of either pharmaceutical or therapeutic equivalence, all drug products containing that active ingredient in that dosage form are coded BS.
BT	Topical products with bioequivalence issues.
BX	Insufficient data—These products are presumed to be therapeutically inequivalent until adequate information becomes available for full evaluation of therapeutic equivalence.
REFERENCE
U.S. Food and Drug Administration. Approved Drug Products with Therapeutic Equivalence Evaluations. Orange Book Preface. 42nd Edition. https://www.fda.gov/media/71474/download. Accessed December 21, 2022. (Rev. 1/2023)

FDA-Approved Biosimilars

Haymarket Media — Thu, 15 Aug 2019 13:34:42 +0000

FDA-Approved Biosimilars

FDA-APPROVED BIOSIMILARS
An FDA-approved biosimilar is a biological product which demonstrates that it is highly similar to an already-approved biological product and has no clinically meaningful differences in terms of safety, purity and potency from the reference product, as well as meeting other criteria specified by law. An approved biosimilar is not interchangeable with its reference product, or with another biosimilar of the same reference product.
Biosimilar	Brand	Company	Dosage Form	Indication^†
REFERENCE PRODUCT: AVASTIN
bevacizumab-adcd	Vegzelma	Celltrion	soln for IV infusion	• Colorectal carcinoma • Non-squamous non-small cell lung cancer • Recurrent glioblastoma • Renal cell carcinoma • Cervical cancer • Epithelial ovarian, fallopian tube or primary peritoneal cancer
bevacizumab-awwb	Mvasi	Amgen
bevacizumab-bvzr	Zirabev	Pfizer
bevacizumab-maly	Alymsys	Amneal
REFERENCE PRODUCT: ENBREL
etanercept-szzs	Erelzi*	Sandoz			soln for SC inj	• Rheumatoid arthritis • Polyarticular juvenile idiopathic arthritis • Ankylosing spondylitis
etanercept-ykro	Eticovo*	Merck	soln for SC inj	• Rheumatoid arthritis • Polyarticular juvenile idiopathic arthritis • Psoriatic arthritis • Ankylosing spondylitis • Plaque psoriasis
REFERENCE PRODUCT: HERCEPTIN
trastuzumab-anns	Kanjinti	Amgen	pwd for IV infusion	• Breast cancer • Gastric or gastroesophageal junction adenocarcinoma
trastuzumab-dkst	Ogivri	Mylan
trastuzumab-dttb	Ontruzant	Merck
trastuzumab-pkrb	Herzuma	Celltrion and Teva
trastuzumab-qyyp	Trazimera	Pfizer
REFERENCE PRODUCT: HUMIRA
adalimumab-aacf	Idacio	Fresenius Kabi	soln for SC inj	• Rheumatoid arthritis • Juvenile idiopathic arthritis • Psoriatic arthritis • Ankylosing spondylitis • Crohn’s disease • Ulcerative colitis • Plaque psoriasis • Hidradenitis suppurativa
adalimumab-aaty	Yuflyma	Celltrion
adalimumab-adaz	Hyrimoz	Sandoz
adalimumab-adbm	Cyltezo	Boehringer Ingelheim
adalimumab-afzb	Abrilada	Pfizer
adalimumab-atto	Amjevita	Amgen
adalimumab-aqvh	Yusimry	Coherus
adalimumab-bwwd	Hadlima	Organon and Samsung Bioepis
adalimumab-fkjp	Hulio	Biocon
REFERENCE PRODUCT: LANTUS
insulin glargine-aglr	Rezvoglar	Eli Lilly	soln for SC inj	Diabetes
insulin glargine-yfgn	Semglee	Mylan	soln for SC inj	Diabetes
REFERENCE PRODUCT: LUCENTIS
ranibizumab	Susvimo	Genentech	intravitreal implant	• Neovascular (wet) age-related macular degeneration
ranibizumab-eqrn	Cimerli	Coherus	soln for oph intravitreal inj	• Neovascular (wet) age-related macular degeneration • Macular edema following retinal vein occlusion • Diabetic macular edema • Diabetic retinopathy • Myopic choroidal neovascularization
ranibizumab-nuna	Byooviz	Biogen	soln for oph intravitreal inj	• Neovascular (wet) age-related macular degeneration • Macular edema following retinal vein occlusion • Myopic choroidal neovascularization
REFERENCE PRODUCT: NEULASTA
pegfilgrastim-apgf	Nyvepria	Pfizer	soln for SC inj	Decrease incidence of infection (febrile neutropenia) in patients on myelosuppressive chemotherapy
pegfilgrastim-bmez	Ziextenzo	Sandoz
pegfilgrastim-cbqv	Udenyca	Coherus Biosciences
pegfilgrastim-fpgk	Stimufend	Fresenius Kabi
pegfilgrastim-jmdb	Fulphila	Mylan
pegfilgrastim-pbbk	Fylnetra	Amneal
REFERENCE PRODUCT: NEUPOGEN
filgrastim-aafi	Nivestym	Pfizer	soln for SC inj or IV infusion		• Decrease incidence of infection (febrile neutropenia) in patients on myelosuppressive chemotherapy • Reduce time to neutrophil recovery and fever duration after induction/consolidation in AML • Reduce duration and incidence of neutropenia • Mobilization of hematopoietic progenitor cells
filgrastim-ayow	Releuko	Amneal
filgrastim-sndz	Zarxio	Sandoz
REFERENCE PRODUCT: PROCRIT OR EPOGEN
epoetin alfa-epbx	Retacrit	Pfizer	soln for IV or SC inj	• Anemia due to chronic kidney disease • Anemia due to zidovudine in HIV • Chemotherapy-induced anemia in patients with non-myeloid malignancies • Reduction of allogeneic red blood cell transfusion in anemic patients undergoing surgery
REFERENCE PRODUCT: REMICADE
infliximab-abda	Renflexis	Merck	pwd for IV infusion	• Rheumatoid arthritis • Psoriatic arthritis • Ankylosing spondylitis • Crohn’s disease • Ulcerative colitis • Plaque psoriasis
infliximab-axxq	Avsola	Amgen
infliximab-dyyb	Inflectra	Pfizer
REFERENCE PRODUCT: RITUXAN
rituximab-abbs	Truxima	Celltrion and Teva	soln for IV infusion	• Rheumatoid arthritis • Non-Hodgkin’s lymphoma • Chronic lymphocytic leukemia • Granulomatosis with polyangiitis (Wegener’s granulomatosis) • Microscopic polyangiitis
rituximab-arrx	Riabni	Amgen	soln for IV infusion	• Non-Hodgkin’s lymphoma • Chronic lymphocytic leukemia • Granulomatosis with polyangiitis (Wegener’s granulomatosis) • Microscopic polyangiitis
rituximab-pvvr	Ruxience	Pfizer	soln for IV infusion	• Rheumatoid arthritis • Non-Hodgkin’s lymphoma • Chronic lymphocytic leukemia • Granulomatosis with polyangiitis (Wegener’s granulomatosis) • Microscopic polyangiitis
NOTES
* Drug is currently pending for launch. Please contact company for estimated availability dates or for more information. ^† See drug monographs or full labeling for detailed description of indications. Not an inclusive list. Please see drug monographs or visit www.eMPR.com. (Rev. 7/2023)

High-Alert Medications

Haymarket Media — Tue, 21 Oct 2014 16:46:00 +0000

High-Alert Medications

HIGH-ALERT MEDICATIONS
High-alert medications are drugs that bear a heightened risk of causing significant patient harm when they are used in error. Although mistakes may or may not be more common with these drugs, the consequences of an error are clearly more devastating to patients. This list may be used to determine which medications require special safeguards to reduce the risk of errors. This may include strategies such as standardizing the ordering, storage, preparation, and administration of these products; improving access to information about these drugs; limiting access to high-alert medications; using auxiliary labels and automated alerts; and employing redundancies such as automated or independent double-checks when necessary. (Note: manual independent double-checks are not always the optimal error-reduction strategy and may not be practical for all of the medications on the list).
SPECIFIC MEDICATIONS
EPINEPHrine, IM, SC	Oxytocin, IV
Epoprostenol (Flolan), IV	Nitroprusside sodium for injection
Insulin U-500 (special emphasis*)	Potassium chloride for injection concentrate
Magnesium sulfate injection	Potassium phosphates injection
Methotrexate, oral, non-oncologic use	Promethazine injection
Opium tincture	Vasopressin, IV or intraosseous
CLASSES/CATEGORIES OF MEDICATIONS
Adrenergic agonists, IV (eg, EPINEPHrine, phenylephrine, norepinephrine)
Adrenergic antagonists, IV (eg, propranolol, metoprolol, labetalol)
Anesthetic agents, general, inhaled and IV (eg, propofol, ketamine)
Antiarrhythmics, IV (eg, lidocaine, amiodarone)
Antithrombotic agents, including: • Anticoagulants (eg, warfarin, low-molecular-weight heparin, unfractionated heparin) • Direct oral anticoagulants and Factor Xa inhibitors (eg, dabigatran, rivaroxaban, apixaban, edoxaban, betrixaban, fondaparinux) • Direct thrombin inhibitors (eg, argatroban, bivalirudin, dabigatran) • Thrombolytics (eg, alteplase, reteplase, tenecteplase) • Glycoprotein IIb/IIIa inhibitors (eg, eptifibatide)
Cardioplegic solutions
Chemotherapeutic agents, parenteral and oral
Dextrose, hypertonic (20% or greater)
Dialysis solutions, peritoneal and hemodialysis
Epidural or intrathecal medications
Inotropic medications, IV (eg, digoxin, milrinone)
Insulin, subcutaneous and IV
Liposomal forms of drugs (eg, liposomal amphotericin B) and conventional counterparts (eg, amphotericin B desoxycholate)
Moderate sedation agents, IV (eg, dexmedetomidine, midazolam, LORazepam)
Moderate and minimal sedation agents, oral, for children (eg, chloral hydrate, midazolam, ketamine [using IV form])
Narcotics/opioids, IV, transdermal, oral (including liquid concentrates, immediate and sustained-release forms)
Neuromuscular blocking agents (eg, succinylcholine, rocuronium, vecuronium)
Parenteral nutrition preparations
Sterile water for injection, inhalation, and irrigation (excluding pour bottles) in containers of 100mL or more
Sodium chloride for injection, hypertonic, greater than 0.9% concentration
Sulfonylurea hypoglycemics, oral (eg, chlorproPAMIDE, glimepiride, glyBURIDE, glipiZIDE, TOLBUTamide)
NOTES
* All forms of insulin, SC and IV, are considered high-alert medications. Insulin U-500 has been singled out for special emphasis to bring attention to the need for distinct strategies to prevent the types of errors that occur with this concentrated form of insulin. Based on error reports submitted to the Institute of Safe Medication Practices (ISMP) National Medication Errors Reporting Program, reports of harmful errors in the literature, and input from practitioners and safety experts, ISMP created and periodically updates a list of potential high-alert medications. During June and July 2018, practitioners responded to an ISMP survey designed to identify which drugs were most frequently considered high-alert medications by individuals and organizations. Further, to assure relevance and completeness, the clinical staff at ISMP and members of the ISMP advisory board were asked to review the potential list. This list of medications and drug categories reflects the collective thinking of all who provided input.
REFERENCES
Source: Institute for Safe Medication Practices (ISMP). ISMP List of High-Alert Medications in Acute Care Settings. ISMP; 2018. Available at: https://www.ismp.org/recommendations/high-alert-medications-acute-list. Accessed October 5, 2023. (Rev. 10/2023)

Overview of Biological Products

Haymarket Media — Tue, 21 Oct 2014 18:10:00 +0000

Overview of Biological Products

OVERVIEW OF BIOLOGICAL PRODUCTS
Biological products are a diverse category of products and are generally large, complex molecules that may not be completely defined or easily characterized. They may be produced through biotechnology in a living system (eg, microorganism, plant or animal cell) and are often more difficult to characterize than small molecule drugs. Examples of biological products include monoclonal antibodies, therapeutic proteins, cellular and gene therapy, and vaccines.
	Reference Product	Biosimilar	Interchangeable Product
Definition	A single biological product already approved by the FDA based on a full complement of safety and effectiveness data, against which a proposed biosimilar product is compared	A biological product that is highly similar to and has no clinically meaningful differences in safety, purity, and potency from an existing FDA-approved reference product, except for minor differences in clinically inactive components	A biosimilar product that meets additional requirements based on further evaluation and testing outlined by the Biologics Price Competition and Innovation Act. Expected to produce the same clinical result as the reference product in any given patient. Risk in terms of safety and reduced efficacy of alternating or switching between the products has been evaluated.
Approval Process	Submitted through the BLA process with the following requirements: • Applicant information: includes name and addresses of manufacturing facilities • Product/Manufacturing information: source material/raw material; manufacturing process and controls; formulation; facility information; contamination/cross-contamination information; environment assessment or categorical exclusion • Pre-clinical studies: safety, efficacy, and use • Clinical studies: safety, efficacy, and use • Labeling: safety, efficacy, and use	A biosimilar product application must include data demonstrating biosimilarity to the reference product, including: • Analytical studies: include structural analysis (eg, structural characteristics of the protein, post-translational modifications, and/or other potential variants) and functional assays to evaluate the pharmacologic activity of the protein (eg, potency, MOA) • Animal studies: include toxicity, PK and PD measures, and immunogenicity • Clinical studies: Human pharmacology data (PK/PD), clinical immunogenicity assessment, and clinical safety and efficacy data to demonstrate safety, purity, and potency for the condition(s) the reference product is licensed and intended to be used for	In addition to the steps for biosimilar product application, an interchangeable product must also include data demonstrating that: • The proposed interchangeable product is expected to produce the same clinical result as the reference product in any given patient, AND • For a product administered more than once to an individual, alternating or switching between the proposed interchangeable product and the reference product does not increase safety risks or decrease effectiveness compared to using the reference product without such alternation or switch
BLA Type	351(a)	351(k)	351(k)
Nonproprietary Naming	Previously includes a core name only The FDA now requires new reference products to include a unique FDA-designated four-letter suffix*. Previously approved biologics may submit a prior approval labeling supplement that include proposed suffixes.	Includes a core name (same as the reference product) attached by a hyphen to a unique FDA-designated four-letter suffix*	May include a core name and a suffix, however, FDA continues to consider the appropriate format of the suffix for interchangeable products
Prescribing	Physicians specialized in the reference product’s indication can prescribe	Substitution of a biosimilar for a reference product is a matter of state pharmacy law	May be substituted for the reference product without the intervention of the prescriber
NOTES
Key: BLA = Biologic License Application; FDA = Food & Drug Administration; MOA = mechanism of action; PD = pharmacodynamics; PK = pharmacokinetics * The distinguishing suffix is devoid of meaning and composed of 4 lowercase letters of which at least 3 are distinct. If the FDA does not find the proposed suffix acceptable, or the applicant does not propose suffix candidates within an appropriate time frame for FDA review, FDA may elect to assign a four-letter suffix at the time of approval.
REFERENCES
Biosimilars. U.S. Food & Drug Administration Web site. https://www.fda.gov/drugs/therapeutic-biologics-applications-bla/biosimilars. Published February 3, 2020. Accessed March 23, 2021. FDA Overview of Biosimilar Products. U.S. Food & Drug Administration Web site. https://www.accessdata.fda.gov/cder/bio/course/framework/index.html. Accessed March 24, 2021. U.S. Department of Health and Human Services Food and Drug Administration, Center for Drug Evaluation and Research (CDER), and Center for Biologics Evaluation and Research (CBER). Nonproprietary Naming of Biological Products. U.S. Food & Drug Administration Web site. https://www.fda.gov/files/drugs/published/Nonproprietary-Naming-of-Biological-Products-Guidance-for-Industry.pdf. Published January 2017. Accessed March 24, 2021. (Rev. 1/2023)

Pharmacogenetic Associations

Haymarket Media — Tue, 20 May 2014 19:06:58 +0000

Pharmacogenetic Associations

PHARMACOGENETIC ASSOCIATIONS
This table is limited to pharmacogenetic associations that are related to drug metabolizing enzyme gene variants, drug transporter gene variants, and gene variants for which data exists to support recommendations for therapeutic management.
Generic	Brand	Gene/ Enzyme	Affected Subgroups	Description and Dosing
abacavir	Ziagen	HLA-B	*57:01 allele positive	Increased risk of adverse reactions (hypersensitivity reactions) in HLA-B57:01 allele carriers. Screen for presence of HLA-B57:01 allele prior to initiation or reinitiation; if positive, use is contraindicated.
abrocitinib	Cibinqo	CYP2C19	Poor metabolizers	Higher systemic concentrations and increased risk of adverse reactions in PMs. Initiate at 50mg/day; consider increasing to max 100mg/day if inadequate response after 12wks
allopurinol	Aloprim	HLA-B	*58:01 allele positive	Increased risk of adverse reactions (severe skin reactions) in HLA-B58:01 allele carriers. Genotype testing prior to initiation in genetically at-risk populations (eg, African, Asian, Native Hawaiian/Pacific Islander ancestry); avoid use if positive for HLA-B58:01 unless benefits clearly outweigh the risks.
amifampridine	Firdapse	NAT2	Poor metabolizers	Higher systemic concentrations and increased risk of adverse reactions in PMs. Initiate at 15mg/day in 3 divided doses.
amphetamine	Adderall XR	CYP2D6	Poor metabolizers	Systemic concentrations may be affected, and increased risk of adverse reactions in PMs. Consider lower initial dose or use alternatives.
	Dyanavel XR
	Evekeo
aripiprazole	Abilify	CYP2D6	Poor metabolizers	Higher systemic concentrations in PMs. Reduce dose by 50%. For PMs on concomitant strong CYP3A4 inhibitors¹, reduce dose by 75%.
	Abilify Maintena	CYP2D6	Poor metabolizers	Higher systemic concentrations in PMs. Reduce dose to 300mg monthly. For PMs on concomitant strong CYP3A4 inhibitors¹ for >14 days, reduce dose to 200mg monthly.
	Aristada	CYP2D6	Poor metabolizers	Higher systemic concentrations in PMs. Avoid use due to inability to make dose adjustments with a single-dose syringe. For PMs on concomitant strong CYP3A4 inhibitors¹ maintained on higher Aristada doses, reduce dose to 441mg monthly.
atomoxetine	Strattera	CYP2D6	Poor metabolizers	Higher systemic concentrations and increased risk of adverse reactions in PMs. Initiate dose at 0.5mg/kg/day; only increase to usual target dose of 1.2mg/kg/day if no improvement after 4wks and if tolerated.
azathioprine	Imuran	TPMT and/or NUDT15	Intermediate or poor metabolizers	Systemic active metabolite concentrations and dosing requirements altered, and increased risk of adverse reactions (myelosuppression). Consider alternatives in PMs. IMs may require dose reductions.
belinostat	Beleodaq	UGT1A1	28/28 allele positive	Higher systemic concentrations and increased risk of adverse reactions in UGT1A128/28 allele carriers. Reduce starting dose to 750mg/m².
belzutifan	Welireg	CYP2C19 and/or UGT2B17	Poor metabolizers	Higher systemic concentrations and increased risk of adverse reactions (anemia, hypoxia) in PMs. Monitor closely; may need dose reductions.
brexpiprazole	Rexulti	CYP2D6	Poor metabolizers	Higher systemic concentrations in PMs. Reduce dose by 50%. For PMs on concomitant strong/moderate CYP3A4 inhibitors¹, reduce dose by 75%.
brivaracetam	Briviact	CYP2C19	Poor metabolizers	Higher systemic concentrations and increased risk of adverse reactions in PMs. Consider dose reductions.
capecitabine	Xeloda	DPYD	Intermediate or poor metabolizers	Increased risk of adverse reactions in IMs and PMs. Withhold or discontinue in the presence of early-onset or unusually severe toxicity.
carbamaze– pine	Equetro	HLA-B	*15:02 allele positive	Strong association between the risk of developing severe skin reactions (SJS/TEN) and the presence of HLA-B15:02 esp. in patients of Chinese ancestry. Test for HLA-B15:02 prior to initiation; avoid use if positive for the HLA-B*15:02 allele unless benefits clearly outweigh the risks of serious skin reactions. Risk may be increased with concomitant drugs associated with a risk of SJS/TEN.
carbamaze– pine	Tegretol	HLA-B	*15:02 allele positive
celecoxib	Celebrex	CYP2C9	Poor metabolizers	Higher systemic concentrations in PMs. Reduce starting dose by 50%. Consider alternatives in patients with JRA.
citalopram	Celexa	CYP2C19	Poor metabolizers	Higher systemic concentrations and increased risk of adverse reactions (QT prolongation) in PMs. Max 20mg/day.
clobazam	Onfi	CYP2C19	Poor metabolizers	Higher systemic concentrations of the active metabolite and increased risk of adverse reactions in PMs. Initiate at 5mg/day and titrate slowly as tolerated to 50% of recommended dose. May further titrate to max 20mg/day (≤30kg) or 40mg/day (>30kg) starting on Day 21.
clobazam	Sympazan	CYP2C19	Poor metabolizers
clopidogrel	Plavix	CYP2C19	Poor metabolizers	Lower systemic concentrations of the active metabolite, lower antiplatelet response, and possibly higher cardiovascular risk in PMs. Consider alternative platelet P2Y12 inhibitor.
clozapine	Clozaril	CYP2D6	Poor metabolizers	Higher systemic concentrations in PMs. May need dose reductions.
clozapine	Versacloz	CYP2D6	Poor metabolizers
codeine	—	CYP2D6	Ultrarapid metabolizers	Higher systemic concentrations of the active metabolite and increased risk of life-threatening respiratory depression and death in ultrarapid metabolizers. Avoid use. Do not breastfeed. Contraindicated in children <12yrs and in <18yrs following tonsillectomy and/or adenoidectomy.
deutetra– benazine	Austedo	CYP2D6	Poor metabolizers	Higher systemic concentrations and increased risk of adverse reactions (QT prolongation) in PMs. Max 18mg/dose and 36mg/day.
dronabinol	Marinol	CYP2C9	Intermediate or poor metabolizers	May result in higher systemic concentrations and increased risk of adverse reactions in IMs and PMs. Monitor closely.
dronabinol	Syndros	CYP2C9	Intermediate or poor metabolizers
eliglustat	Cerdelga	CYP2D6	Ultrarapid, extensive, intermediate, or poor metabolizers	Systemic concentrations, efficacy, and risk of adverse reactions (QT prolongation) altered. Ultrarapid metabolizers may not achieve adequate concentrations to achieve a therapeutic effect. Contraindicated in IMs and PMs with concomitant strong CYP3A inhibitors¹. EMs and IMs: 84mg twice daily. PMs: 84mg/day; monitor.
erdafitinib	Balversa	CYP2C9	3/3 allele positive	May result in higher systemic concentrations and increased risk of adverse reactions in CYP2C9 3/3 allele carriers. Monitor closely.
flibanserin	Addyi	CYP2C19	Poor metabolizers	May result in higher systemic concentrations and increased risk of adverse reactions in PMs. Monitor closely.
fluorouracil	—	DPYD	Intermediate or poor metabolizers	Increased risk of adverse reactions in IMs and PMs. Withhold or discontinue in the presence of early-onset or unusually severe toxicity.
flurbiprofen	—	CYP2C9	Poor metabolizers or *3 allele carriers	Higher systemic concentrations in PMs; reduce dose.
fosphenytoin	Cerebyx	CYP2C9	Intermediate or poor metabolizers	Higher systemic concentrations and increased risk of adverse reactions (CNS toxicity) in IMs and PMs. Consider initiating at lower end of dose range; monitor. CYP2C9*3 allele carriers may be at increased risk of severe skin reactions; consider avoiding as an alternative for carbamazepine.
fosphenytoin	Cerebyx	HLA-B	*15:02 allele positive	Increased risk of adverse reactions (severe skin reactions such as Stevens Johnson Syndrome, Toxic Epidermal Necrolysis) in HLA-B*15:02 allele carriers; consider avoiding as an alternative for carbamazepine.
gefitinib	Iressa	CYP2D6	Poor metabolizers	Higher systemic concentrations and increased risk of adverse reactions in PMs. Monitor closely.
iloperidone	Fanapt	CYP2D6	Poor metabolizers	Higher systemic concentrations and increased risk of adverse reactions (QT prolongation) in PMs. Reduce dose by 50%.
irinotecan	Camptosar	UGT1A1	28/28 allele positive	Higher systemic concentrations of the active metabolite and increased risk of adverse reactions (severe neutropenia) in UGT1A128/28 allele carriers. Consider reducing starting dose by at least 1 level and individualize.
lofexidine	Lucemyra	CYP2D6	Poor metabolizers	Higher systemic concentrations and increased risk of adverse reactions in PMs. Monitor for orthostatic hypotension and bradycardia.
meclizine	—	CYP2D6	Ultrarapid, intermediate, or poor metabolizers	Systemic concentrations may be affected. Monitor closely.
meloxicam	Anjeso	CYP2C9	Poor metabolizers	Higher systemic concentrations and increased risk of adverse reactions in PMs. Consider dose reduction; monitor.
mercapto– purine	—	TPMT and/or NUDT15	Intermediate or poor metabolizers	Systemic active metabolite concentrations and dosing requirements altered, and increased risk of adverse reactions (myelosuppression). Reduce initial dose; PMs typically require 10% or less of recommended dose. IMs may require dose reductions based on tolerability; greater reductions may be needed in IMs for both genes.
metoclo– pramide	Reglan	CYP2D6	Poor metabolizers	Higher systemic concentrations and increased risk of adverse reactions in PMs. GERD: 5mg 4 times daily or 10mg 3 times daily; max 30mg/day. Gastroparesis: 5mg 4 times daily; max 20mg/day.
mivacurium	—	BCHE	Intermediate or poor metabolizers	Higher systemic concentrations and increased risk of adverse reactions (prolonged neuromuscular blockade). Avoid use in PMs.
nateglinide	—	CYP2C9	Poor metabolizers	Higher systemic concentrations and increased risk of adverse reactions (hypoglycemia) in PMs. Reduce dose and monitor.
oliceridine	Olinvyk	CYP2D6	Poor metabolizers	Higher systemic concentrations and increased risk of adverse reactions (respiratory depression and sedation) in PMs. May require less frequent dosing; monitor closely.
pantoprazole	Protonix	CYP2C19	Poor metabolizers	Higher systemic concentrations in PMs. Consider dose reduction in children.
phenytoin	Dilantin	CYP2C9	Intermediate or poor metabolizers	Higher systemic concentrations and increased risk of adverse reactions (CNS toxicity) in IMs and PMs. CYP2C9*3 allele carriers may be at increased risk of severe skin reactions; consider avoiding as an alternative for carbamazepine.
phenytoin	Dilantin	HLA-B	*15:02 allele positive	Increased risk of adverse reactions (severe skin reactions such as Stevens Johnson Syndrome, Toxic Epidermal Necrolysis) in HLA-B*15:02 allele carriers; consider avoiding as an alternative for carbamazepine.
pitolisant	Wakix	CYP2D6	Poor metabolizers	Higher systemic concentrations in PMs. Initiate at 8.9mg daily and titrate to max 17.8mg daily after 7 days.
pimozide	—	CYP2D6	Poor metabolizers	Higher systemic concentrations in PMs. Max 0.05mg/kg/day in children or 4mg/day in adults; do not increase dose earlier than 14 days.
piroxicam	Feldene	CYP2C9	Poor metabolizers	Higher systemic concentrations in PMs. Consider dose reduction.
propafenone	Rythmol SR	CYP2D6	Poor metabolizers	Higher systemic concentrations and increased risk of adverse reactions (arrhythmia). Avoid use in PMs with concomitant CYP3A4 inhibitor.
sacituzumab govitecan	Trodelvy	UGT1A1	28/28 allele positive	Higher systemic concentrations and increased risk of adverse reactions (neutropenia) in UGT1A128/28 allele carriers. Monitor closely.
siponimod	Mayzent	CYP2C9	1/3, 2/3, 3/3 allele positive	Higher systemic concentrations in CYP2C9 variants. Genotype testing prior to initiation. CYP2C91/3 or 2/3: initiate 4-day titration (0.25mg on Days 1-2, 0.5mg on Day 3, 0.75mg on Day 4); reduce maintenance dose to 1mg daily starting on Day 5 CYP2C93/3: contraindicated.
succinylcholine	Quelicin	BCHE	Intermediate or poor metabolizers	Higher systemic concentrations and increased risk of adverse reactions (prolonged neuromuscular blockade). Avoid use in PMs. May give test dose to assess sensitivity and infuse slowly with caution.
tacrolimus	Envarsus XR	CYP3A5	Intermediate or normal metabolizers	Lower systemic concentrations, lower probability of achieving target concentrations and may increase rejection risk. Measure drug concentrations and adjust dose based on tacrolimus trough levels.
tacrolimus	Prograf	CYP3A5	Intermediate or normal metabolizers
tetrabenazine	Xenazine	CYP2D6	Extensive, intermediate, or poor metabolizers	Higher systemic concentrations of active metabolites in PMs. Perform genotyping prior to initiation to determine status for doses >50mg/day. EMs or IMs: max 37.5mg/dose and 100mg/day. PMs: max 25mg/dose and 50mg/day.
thioguanine	—	TPMT and/or NUDT15	Intermediate and poor metabolizers	Systemic active metabolite concentrations and dosing requirements altered, and increased risk of adverse reactions (myelosuppression) in PMs. Reduce initial dose; PMs typically require 10% or less of recommended dose. IMs may require dose reductions based on tolerability.
thioridazine	—	CYP2D6	Poor metabolizers	Higher systemic concentrations and increased risk of adverse reactions (QT prolongation) in PMs. Contraindicated.
tramadol	Ultram	CYP2D6	Ultrarapid metabolizers	Higher systemic and breast milk concentrations of the active metabolite and increased risk of life-threatening respiratory depression and death in ultrarapid metabolizers. Avoid use. Do not breastfeed. Contraindicated in children <12yrs and in <18yrs following tonsillectomy and/or adenoidectomy.
valbenazine	Ingrezza	CYP2D6	Poor metabolizers	Higher systemic concentrations of the active metabolite and increased risk of adverse reactions (QT prolongation) in PMs. Max 40mg/day.
venlafaxine	—	CYP2D6	Poor metabolizers	Systemic parent drug and metabolite concentrations altered in PMs. Consider dose reductions.
venlafaxine	Effexor XR	CYP2D6	Poor metabolizers
vortioxetine	Trintellix	CYP2D6	Poor metabolizers	Higher systemic concentrations in PMs. Max 10mg/day.
warfarin	—	CYP2C9	Intermediate or poor metabolizers	Variability in dose requirements. Select initial dosing based on clinical and genetic factors. Monitor and adjust doses based on INR.
warfarin	—	VKORC1	-1639G>A variant carriers
NOTES
Key: BCHE = butyrylcholinesterase; DPYD = dihydropyrimidine dehydrogenase; EM = extensive metabolizer; HLA = human leukocyte antigen; IM = intermediate metabolizer; JRA = juvenile rheumatoid arthritis; NAT2 = N-acetyltransferase 2; NUDT15 = nudix hydrolase 15; PM = poor metabolizer; SJS = Stevens Johnson syndrome; TEN = toxic epidermal necrolysis; TPMT = thiopurine methyltransferase; UGT = uridine diphosphate-glucuronosyl transferase; VKORC = vitamin K epoxide reductase complex ¹ Strong CYP3A4 inhibitors include itraconazole, ketoconazole, clarithromycin. ² Include amitriptyline, clomipramine, desipramine, doxepin, imipramine, nortriptyline, trimipramine. Not an inclusive list of medications and/or official indications. Please see drug monograph at www.eMPR.com and/or contact company for full drug labeling.
REFERENCES
Table of Pharmacogenetic Associations. Food and Drug Administration Web site. https://www.fda.gov/medical-devices/precision-medicine/table-pharmacogenetic-associations. Published February 25, 2020. Updated October 26, 2022. Accessed December 29, 2022. (Rev. 1/2023)

Pharmacological Effects of Grapefruit Juice with Medications

Haymarket Media — Thu, 09 Aug 2012 17:51:00 +0000

Pharmacological Effects of Grapefruit Juice With Medications

PHARMACOLOGICAL EFFECTS OF GRAPEFRUIT JUICE WITH MEDICATIONS
Grapefruit or grapefruit juice has been shown to affect the metabolism of many medications, increasing the risk of toxicity and adverse events. Characteristics of oral medications that may interact with grapefruit include extensive metabolism through the intestinal cytochrome P450 3A4 (CYP3A4) system, low bioavailability, and a narrow therapeutic index. Grapefruit juice interacts through the intestinal CYP3A4 system and can inhibit the concentration for 24–72hrs. Not an exclusive list of medications that may interact with grapefruit. Caution should be taken by both patient and physician and monitor adverse reactions when taking medications that may interact with grapefruit or juice.
Generic	Brand	Clinical Implications of Co‑administration with Grapefruit or Grapefruit Juice
ANTI-INFECTIVES
erythromycin	Ery-Tab, Eryped, E.E.S.	Inhibits CYP3A4-mediated metabolism resulting in increased erythromycin bioavailability.
maraviroc	Selzentry	May increase plasma concentrations of maraviroc and should be avoided.
praziquantel	Biltricide	1.6-fold increase in the C_max and a 1.9-fold increase in the AUC of praziquantel. The effect of this increase on the efficacy and safety of praziquantel has not been systemically evaluated.
primaquine phosphate	Primaquine	Increases bioavailability of primaquine resulting in increased adverse effects. Avoid co-administration.
rilpivirine	Edurant	May increase plasma concentrations of rilpivirine and should be avoided.
CARDIOVASCULAR AGENTS
amiodarone	—	Inhibits CYP3A4-mediated metabolism of oral amiodarone resulting in increase plasma levels of amiodarone. Avoid co‑administration.
apixaban	Eliquis	May moderately inhibit CYP3A4-mediated metabolism of apixaban. If co-administration is necessary, use with caution.
atorvastatin	Lipitor	Inhibits CYP3A4 and can increase plasma concentrations of atorvastatin, especially with excessive grapefruit juice consumption (>1.2L/day).
clopidogrel	Plavix	May impair the efficacy of clopidogrel. Avoid co-administration.
dofetilide	Tikosyn	Inhibitor of the CYP3A4 isoenzyme, thus could increase systemic dofetilide exposure. If co-administration is necessary, use with caution.
dronedarone	Multaq	Moderate inhibitor of CYP3A, results in a 3-fold increase in dronedarone exposure and a 2.5-fold increase in C_max. Avoid co-administration.
eplerenone	Inspra	May increase plasma concentrations of eplerenone resulting in hyperkalemia and serious arrhythmias.
felodipine	—	2-fold increase in felodipine AUC and C_max with no prolongation of half-life. Avoid co-administration prior to and during treatment.
lovastatin	—	Inhibits CYP3A4 and can increase plasma concentrations of lovastatin. Avoid co-administration.
nifedipine	Procardia	2-fold increase in nifedipine AUC and C_max with no change in half-life. Avoid co-administration.
nisoldipine	Sular	3-fold increase in nisoldipine C_max and 2-fold increase in nisoldipine AUC. Avoid co-administration.
simvastatin	Zocor	Inhibits CYP3A4 and can increase plasma concentrations of simvastatin and may increase risk of myopathy. Avoid co-administration.
verapamil	Verelan	May significantly increase concentrations of verapamil. Increased S-and R-verapamil AUC0-12 by 36% and 28%, respectively. Steady state C_max and C_min of S-verapamil increased by 57% and 16.7%, respectively compared to control. C_max and C_min of R-verapamil increased by 40% and 13%, respectively. No clinical consequences expected.
ticagrelor	Brilinta	Increases ticagrelor exposure by more than 2-fold, resulting to an enhanced and prolonged antiplatelet effect.
IMMUNOSUPRESSANTS
cyclosporine	Neoral	Affects metabolism and increases blood concentrations of cyclosporine. Avoid co-administration.
everolimus	Zortress	Inhibits CYP3A4 and P-gp activity and should therefore be avoided.
sirolimus	Rapamune	Reduces CYP3A4-mediated drug metabolism and must not be taken with or used for dilution of sirolimus.
tacrolimus	Prograf	Inhibits CYP3A-mediated metabolism resulting in increased tacrolimus whole blood trough concentrations. Avoid co-administration.
ONCOLOGY AGENTS
axitinib	Inlyta	May increase plasma concentrations of axitinib and should be avoided.
crizotinib	Xalkori	May increase plasma concentrations of crizotinib and should be avoided.
dasatinib	Sprycel	May increase plasma concentrations of dasatinib and should be avoided.
erlotinib	Tarceva	May increase plasma concentrations of erlotinib and should be avoided.
everolimus	Afinitor	May increase exposures of everolimus and should be avoided.
lapatanib	Tykerb	May increase plasma concentrations of lapatinib and should be avoided.
nilotinib	Tasigna	May increase plasma concentrations of nilotinib and should be avoided.
pazopanib	Votrient	May increase plasma concentrations of pazopanib and should be avoided.
ruxolitinib	Jakafi	The recommended starting dose of ruxolitinib is 10mg twice daily for patients with a platelet count ≥100 × 10⁹/L. Concurrent administration of ruxolitinib should be avoided in patients with platelet counts <100 × 10⁹/L.
sunitinib	Sutent	May increase plasma concentrations of sunitinib and should be avoided.
vandetanib	Caprelsa	May increase plasma concentrations of vandetanib and should be avoided.
vemurafenib	Zelboraf	May increase plasma concentrations of vemurafenib and should be avoided.
PAIN MEDICATIONS
dihydroergotamine mesylate	—	A potential risk for serious toxicity (including vasospasm) exists.
ergotamine tartrate + caffeine	—	A potential risk for serious toxicity (including vasospasm) exists.
fentanyl (oral)	Fentora	May result in a potentially dangerous increase in plasma concentrations, which could increase or prolong adverse drug effects and may cause potentially fatal respiratory depression.
oxycodone	Oxycontin	May result in a potentially dangerous increase in plasma concentrations, which could increase or prolong adverse drug effects and may cause potentially fatal respiratory depression.
PSYCHOTROPIC AGENTS
buspirone	—	4.3 fold increase in C_max; 9.2 fold increase in AUC. Avoid drinking large amounts (200mL double-strength 3 times daily) of grapefruit juice.
lurasidone	Latuda	May increase plasma concentrations of lurasidone resulting in increased adverse effects.
pimozide	—	Inhibits CYP3A4-mediated metabolism of pimozide. Avoid co-administration.
quetiapine	Seroquel	May increase plasma concentrations of quetiapine resulting in increased adverse effects.
triazolam	Halcion	Increases the C_max of triazolam by 25%, increases AUC by 48%, and increases half-life by 18%. Avoid co-administration.
ziprasidone	Geodon	May increase plasma concentrations of ziprasidone resulting in increased adverse effects.
UROLOGIC AGENTS
tadalafil	Cialis	Likely increases of tadalafil exposure.
vardenafil	—	Increased systemic concentration of vardenafil. Avoid co-administration.
OTHERS
budesonide	Entocort EC	After extensive intake of grapefruit juice, the systemic exposure for oral budesonide increased about 2 times. Ingestion of grapefruit or grapefruit juice should be avoided.
cilostazol	—	Increase in the C_max of cilostazol by ~ 50%, but has no effect on AUC. Avoid or reduce dose to 50mg with co-administration.
colchicine	Colcrys	Increases the risk of colchicine-induced toxic effects; significant increase in colchicine plasma concentration is anticipated. Grapefruit and grapefruit juice should not be consumed during colchicine treatment.
dextromethorphan	Robitussin	Increases bioavailability of dextromethorphan resulting in increased adverse effects.
fexofenadine	Allegra	May reduce bioavailability and exposure of fexofenadine. In a bioequivalence study, the bioavailability of fexofenadine was reduced by 36%. Take with water.
ivacaftor	Kalydeco	Co-administration may increase exposure of ivacaftor. Grapefruit or Seville oranges should be avoided during treatment.
tolvaptan	Samsca	Co-administration results in a 1.8-fold increase in exposure to tolvaptan.
REFERENCES
Bailey DG, Dresser G, Arnold JMO. Grapefruit–medication interactions: Forbidden fruit or avoidable consequences? CMAJ. 2013 March 05; 185(4): 309-316. doi: https://doi.org/10.1503/cmaj.120951. Stump AL, Mayo T, Blum A. Management of Grapefruit-Drug Interactions. Am Fam Physician. 2006 Aug 15; 74(4): 605-608. (Rev. 2/2023)