Drug Formulations

Olanzapine Dosage Form

IR, ODT, Short-Acting Injection, Long-Acting Injection

Ondansetron Dosage Form

IR, Oral Solution, ODT, Oral Film, Short-Acting Injection

Two sweeteners that are well-tolerated

1. Aspartame

2. Saccharin

Sorbitol Side Effects

Gas, Cramping, Bloating (especially in IBS patients)

What happens if a patient has PKU (phenylketonuria) and they ingest Phenylalanine?

It is a dangerous sweetener for those with PKU, a genetic defect in which the enzyme that degrades phenylalanine is absent.

What is the most commonly used excipient?

Lactose

Sensitivity to lactose is variable and changes with age.

Indication and Dosage Form of Onzetra Xsail

Nasal Powder, Migraine

Sumatriptan

Cotempla Dosage Form

XR-ODT (a long-acting ODT) for ADHD

Methylphenidate Extended-Release

Reasons of use for ODT

Dysphagia

Children

Nausea

Non-Adherence (uncooperative patients)

ODT Examples (4)

Cotempla XR - ODT

Lamictal ODT

Ondansetron

Remeron SolTab

Zyprexa Zydis

Zydis Generic Name and Dosage

Olanzapine ODT

SolTab Generic Name and Dosage

Mirtazapine ODT

Edluar and Intermezzo Generic Name and Dosage

Zolpidem SL

Onset is faster, Less drug is lost to gut degradation and first-pass metabolism

Nitrostat Generic Name and Dosage

Nitroglycerin SL

Onset is faster, Less drug is lost to gut degradation and first-pass metabolism

Subsys, Actiq, Fenora Generic Name and Dosage

Fentanyl SL

Onset is faster, Less drug is lost to gut degradation and first-pass metabolism

Examples of Sublingual medication

Zolpidem SL (Edluar, Intermezzo)

Nitroglycerin SL (Nitrostat)

Fentanyl SL (Subsys, Actiq, Fenora)

Mycelex Generic Name and Dosage

Clotrimazole Lozenges

Used to treat conditions in the oral mucous, the drug is held in the mouth while the troche slowly dissolves.

Suprax Generic Name and Dosage

Cefixime Chewable Tablets

Singulair Generic Name and Dosage

Montelukast Chewable Tablets

Lamictal Generic Name and Dosage

Lamotrigine Chewable Tablet

Fosrenol Generic Name and Dosage

Lanthanum (Chewable Tablet) is a phosphate binder that must be chewed for the drug to bind phosphate in the gut.

Examples of Chewable Tablet medications

Cefixime (Suprax)

Montelukast (Singulair)

Lamotrigine (Lamictal)

Lanthanum (Fosrenol)

Adderall XR Generic Name and Dosage

Can it be sprinkled on food? If so, what food?

Dextroamphetamine/amphetamine ER Granules

Applesauce

Do not chew

Do not sit for too long in food or liquid

Do not add anything warm or hot

Coreg CR Generic Name and Dosage

Can it be sprinkled on food? If so, what food?

Carvedilol Granules

Applesauce

Do not chew

Do not sit for too long in food or liquid

Do not add anything warm or hot

Dexilant Generic Name and Dosage

Can it be sprinkled on food? If so, what food?

Dexlansoprazole Granules

Applesauce

Do not chew

Do not sit for too long in food or liquid

Do not add anything warm or hot

Focalin XR Generic Name and Dosage

Can it be sprinkled on food? If so, what food?

Dexmethylphenidate Granules

Applesauce

Do not chew

Do not sit for too long in food or liquid

Do not add anything warm or hot

Namenda XR Generic Name and Dosage

Can it be sprinkled on food? If so, what food?

Memantine Granules

Applesauce

Do not chew

Do not sit for too long in food or liquid

Do not add anything warm or hot

Nexium Generic Name and Dosage

Can it be sprinkled on food? If so, what food?

Esomeprazole Granules

Applesauce

Do not chew

Do not sit for too long in food or liquid

Do not add anything warm or hot

Ritalin LA Generic Name and Dosage

Can it be sprinkled on food? If so, what food?

Methylphenidate Granules

Applesauce

Do not chew

Do not sit for too long in food or liquid

Do not add anything warm or hot

Cambia Generic Name and Dosage

Diclofenac potassium powder, in water

Granules

Do not chew

Do not sit for too long in food or liquid

Do not add anything warm or hot

Creon Generic Name and Dosage

Pancreatic enzyme products (pancrelipase), on soft food with low pH

Granules

Do not chew

Do not sit for too long in food or liquid

Do not add anything warm or hot

Depakote Generic Name and Dosage

Valproic acid Granules

Do not chew

Do not sit for too long in food or liquid

Do not add anything warm or hot

Kadian Generic Name and Dosage

Morphine Granules

Do not chew

Do not sit for too long in food or liquid

Do not add anything warm or hot

Some long-acting opioids can be opened and the contents sprinkled on certain foods.

The capsule contents should not be crushed or chewed.

Micro-K Generic Name and Dosage

Potassium Granules

Do not chew

Do not sit for too long in food or liquid

Do not add anything warm or hot

Questran Generic Name and Dosage

Cholestyramine Granules

Do not chew

Do not sit for too long in food or liquid

Do not add anything warm or hot

Vyvanse Generic Name and Dosage

Lisdexamfetamine Granules

Do not chew

Do not sit for too long in food or liquid

Do not add anything warm or hot

Examples of Granule medications

Dextroamphetamine/amphetamine ER (Adrenal XR)

Carvedilol (Coreg CR)

Dexlansoprazole (Dexilant)

Dexmethylphenidate (Focalin XR)

Memantine (Namenda XR)

Esomeprazole (Nexium)

Methylphenidate (Ritalin LA)

Diclofenac (Cambia)

Pancrelipase (Creon)

Valproic Acid (Depakote)

Morphine (Kadian)

Potassium (Micro-K)

Cholestyramine (Questran)

Lisdexamfetamine (Vyvanse)

Detrol LA Generic Name and Dosage

Tolterodine Long-Acting Oral Tablets

It can treat overactive bladder symptoms.

Long-Acting Tablets reduce side effects.

Note the danger if long-acting formulations are crushed a fatal overdose could be released.

Xtampza ER Generic Name and Dosage

Oxycodone ER

Some long-acting opioids can be opened and the contents sprinkled on certain foods.

The capsule contents should not be crushed or chewed.

What long-acting formulations can be cut at the score line? NOT Crushed

Toprol XR, Sinemet CR

What is OROS?

Osmotic Release Oral System

Water from the gut is absorbed into the delivery system by osmosis, which increases pressure inside and forces the drug out through a small opening.

IR and ER formulation

What drugs have an OROS delivery system?

Concerta (Methylphenidate), Cardura XL (Doxazosin), Procardia XL (Nifedipine), Delzicol (Mesalamine)

Provides fast drug delivery, followed by an extended-release in one drug.

Imitrex Generic Name and Dosage

What is the frequency? Where is it given?

Room temp stability?

Sumatriptan, Nasal Spray

Sumatriptan, Injection (migraine, avoids nausea)

Not refrigerated

Upper arm, thigh

PRN at the first sign of a migraine

Faster onset, useful for acute conditions

Nasal sprays bypass the gut; proteins that would get destroyed in the gut (e.g. calcitonin) can be given nasally.

What nasal sprays treat localized systems?

Afrin (Oxymetazoline), Flonase (Fluticasone)

Voltaren Generic Name and Dosage

Diclofenac gel treats pain near the surface of the skin (Localized)

Twice daily

Topical treatments used for topical conditions have a decreased incidence of systemic side effects and generally provide faster relief.

AndroGel Generic Name, Dosage, Frequency

Androgel: Testosterone Topical (Systemic)

Androderm: Patch, daily

It is used for hypogonadism/testosterone deficiency.

Rowasa Generic Name and Dosage

Mesalamine enema to treat LOCAL disease such as distal UC.

Systemic treatment

Babylax Generic Name and Dosage

Glycerin suppository (treats constipation, stool in rectum)

Localized treatment

FeverAll Generic Name and Dosage

Acetaminophen suppository (treats pain/fever)

Localized treatment

Abilify Maintena Generic Name and Dosage

Long-acting Aripiprazole IM injection

Improved adherence

Decrease the need for more frequent (painful) injections.

Haldol Decanoate Generic Name and Dosage

Long-acting Haloperidol IM injection

Improved adherence

Decrease the need for more frequent (painful) injections.

Invega Sustenna, Invega Trinza Generic Name and Dosage

Long-acting Paliperidone IM injection

Improved adherence

Decrease the need for more frequent (painful) injections.

Lupron Depot Generic Name and Dosage

Long-acting Leuprolide IM injection

It can treat endometriosis, uterine fibroids, and premature puberty. It can also treat prostate cancer.

Improved adherence

Decrease the need for more frequent (painful) injections.

Risperdal Consta Generic Name and Dosage

Risperidone (long-acting IM injection)

Improved adherence

Decrease the need for more frequent (painful) injections.

Vivitrol, Revia Generic Name and Dosage

Naltrexone Long-acting IM injection

Improved adherence

Decrease the need for more frequent (painful) injections.

Zyprexa Relprevv Generic Name and Dosage

Olanzapine (long acting IM injection)

Improved adherence

Decrease the need for more frequent (painful) injections.

Examples of Long-Acting IM injection medications

Aripiprazole (Abilify)

Haloperidol (Haldol)

Paliperidone (Invega Sustenna, Invega Trinza)

Leuprolide (Lupron Depot)

Risperidone (Risperdol)

Naltrexone (Vivitrol, Revia)

Olanzapine (Zyprexa Relprevv)

Copaxone Generic Name and Dosage

What is the frequency? Where is it given?

Room temp stability?

Glatiramer Refrigerated Self-Administered Injections

It is used to treat multiple sclerosis.

Daily, or 3x/week

Abdomen, arms, hips, thighs

Up to 30 days

Enbrel Generic Name and Dosage

What is the frequency? Where is it given?

Room temp stability?

Etanercept Refrigeratored Self-Administered Injections

Stored up to 14 days

Thigh (preferred), abdomen, upper arm

Weekly

It is is used to treat autoimmune diseases by interfering with tumor necrosis factor, a soluble inflammatory cytokine, by acting as a TNF inhibitor

Humira Generic Name and Dosage

What is the frequency? Where is it given?

Room temp stability?

Adalimumab Refrigerated Self-Administered Injections

Stored up to 14 days

GIven in abdomen, thigh

Every other week

It can treat arthritis, plaque psoriasis, ankylosing spondylitis, Crohn's disease, and ulcerative colitis.

Cimzia Generic Name and Dosage

What is the frequency? Where is it given?

Room temp stability?

Certolizumab Refrigerated Self-Administered Injections

Prefilled syringes: up to 7 days

Abdomen, thigh

Every 2-4 weeks

It can treat Crohn's disease, rheumatoid arthritis, psoriatic arthritis, and ankylosing spondylitis.

Simponi Generic Name and Dosage

What is the frequency? Where is it given?

Room temp stability?

Golimumab Refrigerated Self-Administered Injections

Stored up to 30 days

Thigh, lower abdomen (below navel), upper arm

Monthly

It can treat rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis, and ulcerative colitis.

Forteo Generic Generic Name and Dosage

What is the frequency? Where is it given?

Room temp stability?

Teriparatide Injection (mostly SC)

Refrigerated, Should be stored in the refrigerator at all times

Thigh, Abdomen

DAILY

It is used for osteoporosis.

Rapid effect, For drugs that would get destroyed or not absorbed if given by oral administration.

Tymlos Generic Generic Name and Dosage

What is the frequency? Where is it given?

Room temp stability?

Abaloparatide Injection

Refrigerator (up to 30 days)

Abdomen

Daily

Parathyroid hormone-related protein analog drug used to treat osteoporosis.

Rapid effect, For drugs that would get destroyed or not absorbed if given by oral administration.

Examples of Refrigerated Self-Administered Injections

Glatiramer (Copaxone)

Etanercept (Enbrel)

Adalimumab (Humira)

Certolizumab (Cimzia)

Golimumab (Simponi)

Teriparatide (Forteo)

Abaloparatide (Tymlos)

Lovenox Generic Generic Name and Dosage

Storage? Where is it given? Frequency

Enoxaparin Injection

NOT Refrigerated

Abdomen > 1 inch from navel

Once or twice daily

Rapid effect, For drugs that would get destroyed or not absorbed if given by oral administration.

Arixtra Generic Name and Dosage

What is the frequency? Where is it given?

Room temp stability?

Fondaparinux Self-Administered Injection

Not Refrigerated

Injected in the abdomen >1 inch from navel

Once or twice daily

Otrexup Generic Name and Dosage

What is the frequency? Where is it given?

Room temp stability?

Methotrexate Self-Administered Injection

Not Refrigerated

Abdomen, thigh

Weekly

Examples of NON-Refrigerated Self-Administered Injections

Enoxaparin (Lovenox)

Fondaparinux (Arixtra)

Methotrexate (Otrexup)

Daytrana Generic Name and Dosage

Where is it given on the body? How often?

Methylphenidate patch

Patch on the hip

QAM 2 hours prior to school

Xulane Generic Name and Dosage

Where is it given on the body? How often?

Ethinyl Estradiol/Norelgestromin Patch

Patch on back, abdomen, or buttock

Weekly for 3 weeks, off for the 4th week

Oxytrol Generic Name and Dosage

Where is it given on the body? How often?

Oxybutynin patch (urinary incontinence)

Twice weekly

Abdomen, hip, buttock

Vivelle-Dot and Alora Generic Name and Dosage

Where is it given on the body? How often?

Estradiol transdermal patch (hot flashes)

Twice Weekly

Lower abdomen

Transderm-Scop Generic Name and Dosage

Where is it given on the body? How often?

Scopolamine Patch (antiemetic)

Given Q72H if needed

Behind the ear

Exelon Generic Name, Dosage, Frequency

Rivastigmine Patch

Daily

Lidoderm Generic Name, Dosage, Frequency

Lidocaine Patch

Daily

1-3 Patches on for 12 hours, then off for 12 hours (as needed)

Nitroglycerin Patch Frequency

On for 12-14 hours, then off for 10-12 hours

NicoDerm CQ Generic Name, Dosage, Frequency

Nicotine

Patch

Daily

Butrans Generic Name, Dosage, Frequency

Buprenorphine

Patch

Weekly

Catapres-TTS Generic Name, Dosage, Frequency

Clonidine

Patch

Weekly

Climara Generic Name, Dosage, Frequency

Estradiol

Patch

Weekly

Duragesic Generic Name, Dosage, Frequency

Fentanyl

Patch

Q72H, if it wears off after 48 hours, change to Q48 hours

Neupro Generic Name, Dosage, Frequency

Rotigotine patch

Daily

Emsam Generic Name, Dosage, Frequency

Selegiline patch

Daily

Examples of Patch Medications

Methylphenidate (Daytrana)

Ethinyl Estradiol/Norelgestromin (Xulane)

Oxybutynin (Oxytrol)

Estradiol (Vivelle-Dot, Alora)

Scopolamine (Transderm-scop)

Rivastigmine (Exelon)

Lidocaine (Lidoderm)

Nitroglycerin

Nicotine (NicoDerm)

Buprenorphine (Butrans)

Clonidine (Catapress-TTS)

Estradiol (Climara)

Fentanyl (Duragesic)

Rotigotine (Neupro)

Selegiline (Emsam)

Can I cut the patch into pieces?

Usually not, except lidoderm, which is designed to be cut and applied over the painful regions.

Can the patch be exposed to heat from an electric blanket, heating pad or body temperature >100.4 degrees?

Avoid heat exposure with most patches. Heat causes rapid absorption of the medication from the patch, resulting in toxicity.

With Fentanyl and buprenorphine, this can be quickly toxic (fatal).

The patch is bothering my skin. What can I do?

Never apply to skin that is irritated in any manner.

Alternate the application site.

The skin should NOT be shaved, cut short hair with scissors.

A topical steroid, such as hydrocortisone, can be applied after the patch is removed.

Which patches need to be removed prior to an MRI?

Patches containing metal (aluminum) need to be removed prior to an MRI or the metal will burn the skin

1. Clonidine

2. Rotigotine

3. Estrogen

4. Scopolamine

5. Testosterone

6. Diclofenac

The patch does not stick (it falls or peels off). Can the patch be covered with tape if it will not stick?

Most patches cannot be covered with tape. A few patches can be taped around the edges.

Fentanyl and Buprenorphine can be covered only with the permitted adhesive film dressing.

Tapes: Bioclusive or Tegaderm

Catapres-TTS comes with its own adhesive cover, which goes over the patch to hold it in place.

NEVER apply patches to the skin that is only.

When applied patches have to be smoothed out on the skin, and then pressed down for a number of seconds, usually 10-30 seconds (duragesic is 30 seconds).

How do I dispose of used patches?

Remove and fold the patch to press adhesive surfaces together for disposal. Throwing it away in a lidded container or flushing it down the toilet is fine.

Highly potent narcotic/amphetamine patches (duragesic, butrans, daytrana) can be fatal, especially to children/pets. The FDA recommends flushing it down the toilet.

Where is the drug located?

The drug can be in a raised pouch, a reservoir or it is directly incorporated into the adhesive of the patch.