generic / dose

acetaminophen 300mg / codeine 30mg

1-2 tablets q4-6h (max of 4g APAP/day)

Limit use to 5 days for acute pain and 3 days for fever

acetaminophen (APAP)

PO: 650 mg q 4-6 h (max of 4g APAP/day)

IV:

acyclovir

shingles
PO: 800mg 5 times/day for 7-10 days
initiate at earliest sign or symptom
most effective when initiated ≤72 hours after rash onset

IV: 10-15 mg/kg/dose Q8H for 10-14 days

adalimumab

Ankylosing spondylitis: SQ injection - 40mg every other week

Crohn's disease:
initial 160mg x1 day then 80mg 2 weeks later (day 15)
maintenance: 40mg QW or every other

Psoriatic arthritis: 40mg QOW

Plaque psoriasis: initial 80mg x1 dose then 40mg QOW (one week after initial dose)

albuterol inhaler

inhaled: 1-2 puffs Q4-6H prn

aledronate

prophylaxis: 5mg QD or 35mg QW

treatment: 10mg QD or 70mg QW

allopurinol

PO: 100-300mg QD (800mg max/day in divided doses)

IV: 200-400 mg/m2/day (given in single daily dose)

alprazolam

titrate dose as needed and as tolerated. periodic reassessment and consideration of dosage reductions is recommended

IR: 0.25-0.5mg TID (usual max: 4 mg/day)

ER: 0.5-1mg QD
titrate dose every 3-4 days in increments ≤1 mg/day
(rang: 3-6 mg/day)

amiodarone

PO: 200-1600 mg/day in 1-2 divided dose

IV: 150-300mg infused over 10 minutes

amitriptyline

depression

(PO): 25-50mg QD at bedtime or in divided doses can gradually increase to 100-300 mg daily

amlodipine

PO: 2.5-10mg QD

amoxicillin

PO: 500mg - 1g Q8-12H

amoxicillin/ potassium clavulanate

IR: 500mg Q8-12H or 875mg Q12H

ER: 2g Q12H

ampicillin / sulbactam

combination product formulated in a 2:1 ratio - dosage recommendations are expressed as total grams of amp/sulbactam

IM/IV: 1-2g ampicillin as 1.5-3g Unasyn Q6H

anastrozole

PO: 1 mg QD

apixaban

nonvalvular atrial fibrillation (PO): 5mg BID

UNLESS the patient has one of the following: age ≥80 YO/ body weight ≤60 kg/ or Scr ≥1.5 mg/dL (then reduce to 2.5mg BID)

aripiprazole

PO: 10-15mg QD (30mg/day)
IM (extended release): 400mg QM (doses should be separated by ≥26 days)

aspirin

acute coronary syndrome (ACS) PO initial: 162-325mg to maintenance: 81-325mg QD

analgesic/antipyretic: IR 325-650mg Q4H prn (4g/day)

atenolol

PO: 25-100mg QD

atomoxetine

PO: 40-80mg QD (100mg/day max)

atorvastatin

PO: 10-80mg QD

azelastine

Nasal: 1-2 sprays in each nostril BID or 2 sprays QD

azithromycin

CAP IV: dose depends on illness: 500mg IV QD for at least 3 days then 500mg PO QD to complete 7-10 days of therapy

CAP PO: 500mg on day 1 then 250mg QD x4 days

baclofen

PO: 5mg TID

Range 40-80mg daily

benazepril

PO: 5-40mg QD in 1 or 2 daily doses

benzonatate

PO: 100-200mg TID (max: 600mg/day)

bimatoprost

ocular: instill one drop into affected eye(s) QPM

bisacodyl

PO: 5-15mg QD prn
Rectal: 10mg QD prn

bisoprolol

PO: initial 2.5-5mg (max 20mg/day)

brimonidine

ocular: instill one drop into the affected eyes Q8H (max QID)

budesonide

nasal: one spray (32 mcg) or 2 sprays in each nostril QD

inhalant: 360-720 mcg BID

budesonide / formoterol

inhaled: 1-2 inhalations BID

bupropion

PO: 150mg QD (max: 450 mg/day) for HCL salt

buprenorphine / naloxone

Suboxone (each has different dosing)

sublingual: initial buprenorphine 2mg / naloxone 0.5mg
OR buprenorphine 4mg / naloxone 1mg

may titrate dose

buspirone

PO: 10-15 mg/day in 2-3 divided doses
(max 60 mg/day)

canagliflozin

PO: 100mg prior to the first meal (max 300 mg/day)

carbamazepine

PO: initial 400 mg/day divided in 2 doses OR 4 doses titrated up to 800-1200 mg/day

IV: 70% of oral dose Q6H x7 days

carbidopa / levodopa

IR (PO): 25mg/100mg or 10mg/100mg TID

ER (PO): 50mg/200mg BID (at least 6 hours apart)

carisoprodol

PO: 250-350mg TID and at bedtime

carvedilol

CHF
IR (PO): 3.125-50mg BID

ER (PO): 10-80mg QD

cefazolin

dose depends on condition
IV: 250mg-2g Q6-12H

cefdinir

depending on condition
PO: 300mg BID or 600mg QD for 5-7 days

cefepime

IV: 1-2g Q8-12H

cefoxitin

IM/IV: 1-2g Q6-8H

ceftriaxone

IM/IV: 1-2g Q12-24H

cefuroxime

PO: 250-500mg BID

IV: 750mg-1.5g Q8H

celecoxib

PO: 100mg BID or 200mg QD

cephalexin

PO: 250-1000mg Q6H or 500mg Q12H (max 4g/day)

cetirizine

PO: 10mg QD
up to 40mg daily depending on condition and response

chlorhexidine

oral rinse: swish and spit for 30 seconds with 15mL BID after brushing teeth

ciprofloxacin

depends on condition:

PO: 250-750mg Q12H

IV: 400mg Q12H

citalopram

depression (PO): 10-40mg QD
(max: 40mg due to risk of QT prolongation)
lower max daily dose of 20mg is recommended in patients \>60YO/ significant hepatic impairment/ patients concurrently receiving medications that increase citalopram levels (cimetidine/ omeprazole)

clarithromycin

PO: 250-500mg Q12H or 1000mg (2 500mg ER tablets) QD

clinamycin

PO: 600-1800 mg/day in 2 to 4 divided doses: up to 2400 mg/day in 4 divided doses for severe infections

IM/IV: 600-2700 mg/day in 2-4 divided doses: up to 4800 mg/day IV (in divided doses) can be used in life-threatening situations
max IM: 600 mg/dose

clonazepam

PO: 0.25-2 mg BID
(max 4 mg/day)

clonidine

PO: 0.1-0.2 mg BID (max 2.4 mg/day)
transdermal patch: 0.1-0.3mg QW

clopidogrel

PO: 75-150mg QD depending on condition

clozapine

PO: 12.5mg QD or BID increased to 300-450 mg/day (max 900 mg/day)

colchicine

PO: 0.6mg QD or BID

colesevelam

PO: 3.75g QD in 1 or 2 divided doses

conjugated estrogens

PO: 0.3-0.625mg QD or on a cycle: higher doses can be used for other conditions

IM/IV: 25mg may repeat in 6-12 hours PRN or 25mg IV repeated Q4-6H for 24 hours

cyanocobalamin

intranasal: 500mcg in one nostril QW may increase dose if vitamin B12 levels decline after 1 month

PO: 1000-2000 mcg QD for 1-2 weeks maintenance: 1000 mcg QD

IM/deep SC: 100mcg QD for 6-7 days if improvement: administer same dose on alternate days for 7 doses then every 2-4 days for 2-3 weeks: once hematologic values have returned to normal - maintenance dose: 100mcg monthly

cyclobenzaprine

PO (ER): 15mg QD (some patients may require 30mg QD)

PO (IR): 5mg TID: may increase up to 10mg TID if needed

cyclosporine (ophthalmic)

ocular: 1 drop in both eyes Q12H

dabigatran

PO: 150mg BID

darbepoetin

Individualize dosing and use the lowest dose necessary to reduce the need for red blood cell (RBC) transfusions

SC/IV: 6.25-200 mcg per week based on hemoglobin value

desvenlafaxine

PO: 25-50mg QD (some studies support titration up to 400mg QD)

When discontinuing antidepressants that has lasted \>3 weeks

dexamethasone

PO/IM/IV: 0.5-9 mg/day in divided doses Q6-12H
dose depends on condition being treated and response of patient

dexlansoprazole

healing: PO 60mg QD for up to 8 weeks

maintenance: PO 30mg QD

dexmedetomidine

ICU Sedation
IV: 1 mcg/kg over 10 minutes followed by 0.2-0.7 mcg/kg/hr maintenance for ICU sedation

Procedural Sedation:
IV: loading 1 mcg/kg over 10 minutes with 0.6mcg/kg/hour for maintenance

dexmethylphenidate

IR PO: 2.5mg BID (max 20mg/day)

ER PO: 10mg QD (max 40mg/day)

dextroamphetamine / amphetamine

IR PO: 5mg QD or BID: may increase daily dose in 5 mg increments at weekly intervals until optimal response
usual dosage range: 5-40 mg/day I n1-3 divided doses

XR PO: 20mg QAM (max 60mg QD)

diazepam

anxiety
PO: 2-10mg 2-4 times per day PRN

IM/IV: 2-10mg 2-4 times per day PRN (IM has erratic absorption and is not recommended)

rectal: 0.2-0.5 mg/kg (max 20mg)

diclofenac

PO: 50mg two-three times per day

patch: apply one patch twice daily to most painful area

gel: apply 2-4g of 1% gel to affected areas QID

dicyclomine

PO: 20mg up to 4 times per day PRN abdominal symptoms

digoxin

PO: 0.125-0.25mg QD

Total digitalizing dose: initial: 0.25-0.5mg over several minutes

diltiazem

PO: 60-360mg given in either 12 hour intervals or QD depending on dosage form (480mg/day)

IV continuous infusion: 5-10 mg/hr - may increase up to 15mg/hr PRN

diphenoxylate / atropine

PO: 5mg diphenoxylate component QID PRN (20mg/day max)

docusate (sodium/calcium)

Calcium: PO: 240mg QD

Sodium: PO: 50-360mg QD

Rectal: 283mg per 5mL qd-tid

donepezil

Initial PO: 5mg QD
may increase to 10mg QD after 4-6 weeks

doxazosin

IR PO: 1mg QD titrated up to 8 mg/day

ER PO: 4mg QD titrated up to 8 mg/day

doxycycline

available as hyclate/ monohydrate/ and calcium salt - all doses are expressed as doxycycline base

PO: 100-200 mg/day in 1-2 divided doses
IV: 100mg Q12H

duloxetine

PO: 30-60mg QD (120mg/day)

dutasteride

PO: 0.5mg QD

edoxaban

PO: 60mg QD
dosage adjustments for renal function: weight

emtricitabine / tenofovir alafenamide

PO: 1 tablet (emtricitabine 200mg/tenofovir alafenamide 25 mg) once daily

enalapril/enalaprilat (IV)

PO: 2.5-40mg QD

IV: 1.25mg/dose over 5 minutes every 6h up to 5mg/dose

enoxaparin

prophylaxis: 30mg BID or 40mg QD SQ

treatment: 1mg/kg QD or 1.5mg/kg QD SQ

epinephrine

IV: 1mg Q3-5mins until return of spontaneous circulation

IM: 0.3mg followed by one dose if needed for allergic reaction

epoetin

consider initiating treatment when hemoglobin is less than 10g/dL
IV/SC: Initial dose: 50 to 100 units/kg once weekly

escitalopram

PO: 10-20mg QD (20mg/day)

esomeprazole

PO/IV: 20-40mg QD

estradiol

IM: validate 10-20mg every 4 weeks

Intravaginal: vaginal ring (Femring)

initial: 0.05mg intravaginally- following insertion dose is released daily for 3 months. Usual dose: 0.05mg to 0.1mg intravaginally every 3 months

PO (Estrace): 0.5-1 mg/day

Topical gel (EstroGel): 1.25 g/day applied at the same time each day

eszopiclone

PO: 1-3mg at bedtime (max 3mg)

etanercept

SC: 50mg once-twice weekly depending on disease state

ethinyl estradiol / etonogestrel

vaginal: insert 1 ring vaginally and leave in for 3 weeks: then remove for 1 week

ethinyl estradiol / norethindrone

schedule 1 PO (Sunday starter): dose begins on the first Sunday after onset of menstruation: if the menstrual period starts on Sunday: take first tablet that very same day (additional method of contraception should be used util after the first 7 days of consecutive administration)

Schedule 2 PO (day 1 starter): dose starts on the first day of menstrual cycle taking 1 tablet daily

evolucumab

SQ: 140mg every 2 weeks OR 420mg QM

exenatide

IR SC: 5 mcg BID within 60 minutes of eating: may be increased to 10mcg BID

ER SC: 2mg QW

ezetimibe

PO 10mg QD