DIAZEPAM

Indikasi:Use: Labeled Indications Management of anxiety disorders, ethanol withdrawal symptoms; skeletal muscle relaxant; status epilepticus; muscle spasm associated with tetanus Rectal gel: Management of selected, refractory epilepsy patients on stable regimens of antiepileptic drugs (AEDs) requiring intermittent use of diazepam to control episodes of increased seizure activityUse: Unlabeled/Investigational Panic disorders; preoperative sedation, light anesthesia, amnesiaUse: Dental Oral medication for preoperative dental anxiety; sedative component in I.V. conscious sedation in oral surgery patients; skeletal muscle relaxantDosis Regimen perindikasi: Dosing: Adults Note: Oral absorption is more reliable than I.M. Acute ethanol withdrawal:Oral: 10 mg 3-4 times during first 24 hours, then decrease to 5 mg 3-4 times/day as neededAnticonvulsant (acute treatment):Rectal gel: 0.2 mg/kg. Note: Dosage should be rounded upward to the next available dose, 2.5, 5, 7.5, 10, 12.5, 15, 17.5, and 20 mg/dose; dose may be repeated in 4-12 hours if needed; do not use for more than 5 episodes per month or more than one episode every 5 days.Anxiety (symptoms/disorders): Oral: 2-10 mg 2-4 times/day I.M., I.V.: 2-10 mg, may repeat in 3-4 hours if needed Muscle spasm:I.V., I.M.: Initial: 5-10 mg; then 5-10 mg in 3-4 hours, if necessary. Larger doses may be required if associated with tetanus.Sedation in the ICU patient:I.V.: 0.03-0.1 mg/kg every 30 minutes to 6 hoursSkeletal muscle relaxant (adjunct therapy):Oral: 2-10 mg 3-4 times/dayStatus epilepticus:I.V.: 5-10 mg every 5-10 minutes given over 5 mg/minute (maximum dose: 30 mg) Rectal gel: Premonitory/out-of-hospital treatment: 10 mg once; may repeat once if necessaryRapid tranquilization of agitated patient (administer every 30-60 minutes): Oral: 5-10 mg; average total dose for tranquilization: 20-60 mgDosing: Elderly Oral absorption is more reliable than I.M.. Elderly and/or debilitated patients:Oral: 2-2.5 mg 1-2 times/day initially; increase gradually as needed and tolerated.Rectal gel: Due to the increased half-life in elderly and debilitated patients, consider reducing dose.Dosing: Pediatric Anticonvulsant (acute treatment):Rectal gel:Children 30 days: 1-2 mg/dose every 3-4 hours as neededChildren 5 years: 5-10 mg/dose every 3-4 hours as neededSedation or muscle relaxation or anxiety:Oral: Children: 0.12-0.8 mg/kg/day in divided doses every 6-8 hours I.M., I.V.: Children: 0.04-0.3 mg/kg/dose every 2-4 hours to a maximum of 0.6 mg/kg within an 8-hour period if needed Status epilepticus:I.V.: Infants >30 days and Children: 0.1-0.3 mg/kg given over 5 mg/minute; may repeat dose after 5-10 minutes; maximum: 10 mg/dose (Hegenbarth, 2008)Rectal: 0.5 mg/kg/dose then 0.25 mg/kg/dose in 10 minutes if needed (prepare dose using parenteral formulation)Dosing: Renal Impairment No dose adjustment recommended; decrease dose if administered for prolonged periods.I.V.: Risk of propylene glycol toxicity; monitor closely if using for prolonged periods or at high doses.Hemodialysis: Not dialyzable (0% to 5%); supplemental dose is not necessary.DRP: Drug Interactions Alcohol (Ethyl): CNS Depressants may enhance the CNS depressant effect of Alcohol (Ethyl). Risk C: Monitor therapyAntifungal Agents (Azole Derivatives, Systemic): May decrease the metabolism of Benzodiazepines (metabolized by oxidation). Risk D: Consider therapy modificationAprepitant: May increase the serum concentration of Benzodiazepines (metabolized by oxidation). Risk C: Monitor therapyCalcium Channel Blockers (Nondihydropyridine): May decrease the metabolism of Benzodiazepines (metabolized by oxidation). Risk D: Consider therapy modificationCarBAMazepine: May increase the metabolism of Benzodiazepines (metabolized by oxidation). Risk C: Monitor therapyCimetidine: May decrease the metabolism of Benzodiazepines (metabolized by oxidation). Risk C: Monitor therapyClozapine: Benzodiazepines may enhance the adverse/toxic effect of Clozapine. Risk D: Consider therapy modificationCNS Depressants: May enhance the adverse/toxic effect of other CNS Depressants. Risk C: Monitor therapyCYP2C19 Inducers (Strong): May increase the metabolism of CYP2C19 Substrates. Risk C: Monitor therapyCYP2C19 Inhibitors (Moderate): May decrease the metabolism of CYP2C19 Substrates. Risk C: Monitor therapyCYP2C19 Inhibitors (Strong): May decrease the metabolism of CYP2C19 Substrates. Risk D: Consider therapy modificationCYP3A4 Inducers (Strong): May increase the metabolism of CYP3A4 Substrates. Risk C: Monitor therapyCYP3A4 Inhibitors (Moderate): May decrease the metabolism of CYP3A4 Substrates. Risk C: Monitor therapyCYP3A4 Inhibitors (Strong): May decrease the metabolism of CYP3A4 Substrates. Risk D: Consider therapy modificationDasatinib: May increase the serum concentration of CYP3A4 Substrates. Risk C: Monitor therapyDeferasirox: May decrease the serum concentration of CYP3A4 Substrates. Risk C: Monitor therapyDisulfiram: May decrease the metabolism of Benzodiazepines (metabolized by oxidation). Risk C: Monitor therapyFluconazole: May decrease the metabolism of Benzodiazepines (metabolized by oxidation). Risk D: Consider therapy modificationFosaprepitant: May increase the serum concentration of Benzodiazepines (metabolized by oxidation). Specifically, the active metabolite aprepitant is likely responsible for this effect. Risk C: Monitor therapyGrapefruit Juice: May decrease the metabolism of Benzodiazepines (metabolized by oxidation). Risk D: Consider therapy modificationIsoniazid: May decrease the metabolism of Benzodiazepines (metabolized by oxidation). Risk C: Monitor therapyMacrolide Antibiotics: May decrease the metabolism of Benzodiazepines (metabolized by oxidation). Exceptions: Azithromycin; Dirithromycin [Off Market]; Spiramycin. Risk D: Consider therapy modificationNefazodone: May decrease the metabolism of Benzodiazepines (metabolized by oxidation). Risk D: Consider therapy modificationOral Contraceptive (Estrogens): May decrease the metabolism of Benzodiazepines (metabolized by oxidation). Risk C: Monitor therapyOral Contraceptive (Progestins): May decrease the metabolism of Benzodiazepines (metabolized by oxidation). Risk C: Monitor therapyPhenytoin: Benzodiazepines may increase the serum concentration of Phenytoin. Short-term exposure to benzodiazepines may not present as much risk as chronic therapy. Risk C: Monitor therapyProtease Inhibitors: May decrease the metabolism of Benzodiazepines (metabolized by oxidation). Management: Amprenavir, atazanavir, darunavir, indinavir, nelfinavir, ritonavir, and tipranavir are contraindicated with midazolam and triazolam according to each protease inhibitor's prescribing information. Risk D: Consider therapy modificationProton Pump Inhibitors: May increase the serum concentration of Benzodiazepines (metabolized by oxidation). Exceptions: Lansoprazole; Pantoprazole; Rabeprazole. Risk C: Monitor therapyRifamycin Derivatives: May increase the metabolism of Benzodiazepines (metabolized by oxidation). Risk D: Consider therapy modificationSelective Serotonin Reuptake Inhibitors: May decrease the metabolism of Benzodiazepines (metabolized by oxidation). Exceptions: Citalopram; Escitalopram; PARoxetine; Sertraline. Risk C: Monitor therapySt Johns Wort: May increase the metabolism of Benzodiazepines (metabolized by oxidation). Risk C: Monitor therapyTheophylline Derivatives: May diminish the therapeutic effect of Benzodiazepines. Risk D: Consider therapy modificationEthanol/Nutrition/Herb Interactions Ethanol: Avoid ethanol (may increase CNS depression). Food: Diazepam serum levels may be increased if taken with food. Diazepam effect/toxicity may be increased by grapefruit juice; avoid concurrent use. Herb/Nutraceutical: St John's wort may decrease diazepam levels. Avoid valerian, St John's wort, kava kava, gotu kola (may increase CNS depression).

Monitoring Parameters : Respiratory, cardiovascular, and mental status; check for orthostasis

Bentuk Sediaan & Nama Dagang: Decazepam : Diazepam 5 mg/tablet. Indikasi: Neuroleptikum. Km: 20 x 10 tabletMentalium: Tablet 2mg??Stesolid: Diazepam 10 mg/2ml injeksi; 2 mg/5 ml sirop; 2 mg; 5 mg/tablet; 5 mg/2,5 ml; 10 mg/2,5 ml dalam tubeTrazep: ??Valdimex: 5 mg/ml (ampul)Valisanbe: Diazepam 5 mg (ampul)??Valium: Diazepam 10 mg/ml injeksiDEXTROSE SOLUTION??

Dosis Regimen Perindikasi: 5% and 10% solutions: Peripheral infusion to provide calories and fluid replacement 25% (hypertonic) solution: Treatment of acute symptomatic episodes of hypoglycemia in infants and children to restore depressed blood glucose levels; adjunctive treatment of hyperkalemia when combined with insulin 50% (hypertonic) solution: Treatment of insulin-induced hypoglycemia (hyperinsulinemia or insulin shock) and adjunctive treatment of hyperkalemia in adolescents and adults 10% solutions: Infusion after admixture with amino acids for nutritional supportDosing: Adults Treatment of hypoglycemia: Doses may be repeated in severe cases Oral: 10-20 g as single dose; repeat in 10 minutes if necessary I.V.: 10-25 g (40-100 mL of 25% solution or 20-50 mL of 50% solution) Treatment of hyperkalemia: I.V. (in combination with insulin): 25-50 g dextrose (250-500 mL D10W) combined with 10 units regular insulin administered over 30-60 minutes; repeat as needed or as an alternative 25 g dextrose (50 mL D50W) combined with 5-10 units regular insulin infused over 5 minutes; repeat as needed Note: More rapid infusions (2 years: Refer to adult dosing. I.V.: Infants 6 months: 0.25-0.5 g/kg/dose (1-2 mL/kg/dose of 25% solution); maximum: 25 g/dose Infants >6 months and Children: 0.5-1g/kg/dose (2-4 mL/kg/dose of 25% solution); maximum: 25 g/dose Adolescents: Refer to adult dosing. Treatment of hyperkalemia: I.V. (in combination with insulin): Infants and Children: 0.5-1 g/kg (using 25% or 50% solution) combined with regular insulin 1 unit for every 4-5 g dextrose given; infuse over 2 hours (infusions as short as 30 minutes have been recommended); repeat as needed Adolescents: Refer to adult dosing.DRP:

Drug Interactions There are no known significant interactions.Monitoring Parameters Blood and urine sugar, serum electrolytes, I & O, caloric intakeNama Sediaan dan Dagang: Infusan D5 + ns : (Sanbe Farma) Tiap 1000 ml infus: Na+ 77 mEq /L, Cl- 77 mEq /L, Dekstrosa 50 g/L (Natrium klorida 4,5 g, air untuk injeksi 1000 ml), osmolaritas 432 mOsm/LInfusan R+D : (Sanbe Farma) Tiap 1000 ml infus: Na+ 147 mEq /L, Cl- 156 mEq /L, K+ 4 mEq /L, Dextrose 50g/L (Natrium korida 8,6 gram, Kalium klorida 0,3 gram, Kalisium klorida 0,48 g, air untuk injeksi 1000 ml), osmolaritas 586 mOsm/LOtsu d-5??Tridex 27A: (Sanbe) Tiap 1000 mL infus: Na+ 60 mEq /L, Cl- 50 mEq /L, K+ 10 mEq /L, Laktat 20 mEq /L, Dekstrosa 27 g/L (Natrium klorida 2,34 g, Kalium klorida 0,75 g, Natrium laktat 2,24 g, air untuk injeksi 1000 mL), osmolaritas 290 mOsm/LTridex 27B: (Sanbe Farma) Tiap 1000 mL infus: Na+ 50 mEq /L, Cl- 50 mEq /L, K+ 20 mEq /L, Laktat 20 mEq /L, Dekstrosa 27 g/L (Natrium klorida 1,75 g, Kalium klorida 1,5 g, Natrium laktat 2,24 g, air untuk injeksi 1000 mL), osmolaritas 290 mOsm/L.Tridex 100: (Sanbe) Tiap 1000 mL infus: Na+ 50 mEq /L, Cl- 50 mEq /L, K+ 20 mEq /L, Laktat 20 mEq /L, Dekstrosa 100 g/L (Natrium klorida 1,75 g, Kalium klorida 1,5 g, Natrium laktat 2,24 g, air untuk injeksi 1000 mL), osmolaritas 695 mOsm/L.Triparen no. 1: (Otsuka) Dekstrosa anhidrat 133 g, fruktosa 67 g, xylitol 33 g, kalori 933 kkal, KCl 1,1 g, K-asetat 1 g, Ca- glukonat 1,7 g, Mg sulfat 1 g, K- fosfat 1,7 g, Zn-sulfat 4,8 mg, asam sitrat 1,4 g, Na 5 mEq, K 45 mEq, Mg 8 mEq, sulfat 8 mEq, Ca 8 mEq, glukonat 8 mEq, asetat 10 mEq, sitrat 20 mEq, P 302 mg, Zn 17 mol tiap liter larutan infus.Triparen no: 2: (Otsuka) Dekstrosa anhidrat 167 g, fruktosa 83 g, xylitol 42 g, kalori 1168 kkal, NaCl 2,2 g, KCl 2,6 g, Na sitrat 1,5 g, Ca- glukonat 1,7 g, Mg sulfat 1 g, Na- fosfat 1,3 g, Zn-sulfat 4,8 mg, asam sitrat 0,33 g, Na 58 mEq, K 45 mEq, Mg 8 mEq, Ca 8 mEq, Cl 73 mEq, sulfat 8 mEq, glukonat 8 mEq, asetat 10 mEq, sitrat 20 mEq, P 295 mg, Zn 17 mol tiap liter larutan infus Triparen no.2.

DEFEROXAMINE

Dosis Perindikasi: Dosing: Adults Acute iron toxicity: I.M., I.V.: Initial: 1000 mg, may be followed by 500 mg every 4 hours for up to 2 doses; subsequent doses of 500 mg have been administered every 4-12 hours Maximum recommended dose: 6 g/day (per manufacturer, however, higher doses have been administered) Note: I.V. route is used when severe toxicity is evidenced by systemic symptoms (coma, shock, metabolic acidosis, or severe gastrointestinal bleeding) or potentially severe intoxications (serum iron level >500 mcg/dL). When severe symptoms are not present, the I.M. route may be preferred (per manufacturer); however, the use of deferoxamine in situations where the serum iron concentration is 200 mcg/LTreatment of aluminum toxicity with CKD (unlabeled use): I.V.: 5-10 mg/kg 4-6 hours before dialysis. Administer every 7-10 days with 3-4 dialysis procedures between doses. Do not use if aluminum serum levels are >200 mcg/L.Dosing: Elderly Refer to adult dosing.Dosing: Pediatric Acute iron toxicity: Children 3 years: Refer to "Note" in adult dosing.I.M.: 90 mg/kg/dose every 8 hours (maximum: 6 g/24 hours) I.V.: 15 mg/kg/hour (maximum: 6 g/24 hours)Chronic iron overload: Children 3 years:SubQ: 20-40 mg/kg/day over 8-12 hours (maximum: 1000-2000 mg/day)I.V.: 15 mg/kg/hour (maximum: 6 g/24 hours)DRP:Drug Interactions Ascorbic Acid: May enhance the adverse/toxic effect of Deferoxamine. Left ventricular dysfunction is of particular concern. Risk D: Consider therapy modificationTest Interactions TIBC may be falsely elevated with high serum iron concentrations or deferoxamine therapy. Imaging results may be distorted due to rapid urinary excretion of deferoxamine-bound gallium-67; discontinue deferoxamine 48 hours prior to scintigraphy.

Monitoring Parameters Serum iron; ophthalmologic exam (fundoscopy, slit-lamp exam) and audiometry with chronic therapy; growth and body weight in children (every 3 months)Bentuk sediaan dan nama dagang