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3 days, unless treating tetanus; if condition persists, may repeat therapy after drug-free interval of 48 hr 1500 mg PO q6hr for 48-72 hours; not to exceed 8 g/day THEN decrease to 4-4.5 g/day divided q4-8hr Adjunct therapy: Initial 1-2 g IV injection (at 300 mg/min), THEN Additional 1-2 g IV infusion for total dose of 3 g initially May repeat 1-2 g IV q6hr until can give NG or PO Total of 24 g PO may be needed Drowsiness Dizziness Leukopenia (IV) Lhtheadedness Blurred vision Headache Fever Nausea Anorexia Adynamic ileus Dysgeusia GI upset Nystagmus Diplopia Flushing Verto Mild muscular incoordination Syncope Hypotension Bradycardia Urticaria Pruritus Rash Skin eruptions Conjunctivitis with nasal congestion Anaphylactic reactions Thrombopebitis (IV) Sloughing (IV) Injection site pain (IV) Hemolysis (IV) Increased Hgb and RBCs in urine (IV) Seizures (IV) May cause drowsiness/dizziness; patients should not ingest alcohol or other CNS depressants May take with food to avoid stomach upset Half-life increases with hepatic impairment IV formulation not for use in renal impairment (contains polyethylene glycol; injection rate should not exceed 3 m L/min May interfere with screening tests for 5-HIAA and vanillylmandelic acid (VMA) Use injection with caution in patients with a history of seizures Sedative effects potentiated when used with other sedatives Medication is poorly tolerated in the elderly Pediatric IV dosing approved only for tetanus Liver (dealkylation and hydroxylation) Metabolites: Glucuronide and sulfate conjugates of 3-(2-hydroxyphenoxy)-1,2-propanediol-1-carbamate and 3-(4-hydroxy-2-methoxyphenoxy)-1,2-propanediol-1-carbamate; unidentified metabolites Direct IV: Administer undiluted at not to exceed 3 m L (=300 mg undiluted)/min Infusion: Dilute 1 g with up to 250 m L D5W or NS; avoid extravasation, since injection is hypertonic Monitor closely for extravasation Administer IV while in recumbent position Maintain position 15-30 min following infusion The above information is provided for general informational and educational purposes only.

Drug Categories of Concern in the Elderly - Geriatrics - Merck.

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As pharmacists and health care professionals, one of our major concerns is preventing harm to our patients. Drug-poisoning Deaths Involving Opioid Analgesics: United States, 1999- 2011 [Internet].

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Mark Ruscin, Pharm D, Southern Illinois University Edwardsville School of Pharmacy ; Sunny A.


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