Akorn

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Akorn Drugs

Physostigmine Salicylat...

Physostigmine Salicylate

Past Anesthesia Care: 0.5 to 1.0 mg intramuscularly or intravenously. INTRAVENOUS ADMINISTRATION SHOULD BE AT A SLOW CONTROLLED RATE OF NO MORE THAN 1 MG PER MINUTE. Dosage may be repeated at intervals of 10 to 30 minutes if desired patient response is not obtained.
Terbutaline Sulfate

Terbutaline Sulfate

Ampules should be used only for subcutaneous administration and not intravenous infusion. Sterility and accurate dosing cannot be assured if the ampules are not used in accordance with DOSAGE AND ADMINISTRATION.

The usual subcutaneous dose of Terbutaline Sulfate Injection, USP is 0.25 mg injected into the lateral deltoid area. If significant clinical improvement does not occur within 15-30 minutes, a second dose of 0.25 mg may be administered. If the patient then fails to respond within another 15-30 minutes, other therapeutic measures should be considered. The total dose within 4 hours should not exceed 0.5 mg.

Note: Parenteral drug products should be inspected visually for particulate matter and discoloration prior to administration, whenever solution and container permit.
Capastat Sulfate

Capastat Sulfate

Capastat Sulfate may be administered intramuscularly or intravenously following reconstitution. Reconstitution is achieved by dissolving the vial contents (1 g) in 2 mL of 0.9% Sodium Chloride Injection or Sterile Water for Injection. Two to 3 minutes should be allowed for complete dissolution.

Intravenously — For intravenous infusion, reconstituted Capastat Sulfate should be diluted in 100 mL of 0.9% Sodium Chloride Injection and administered over 60 minutes.

Intramuscularly — Reconstituted Capastat Sulfate should be given by deep intramuscular injection into a large muscle mass, since superficial injection may be associated with increased pain and the development of sterile abscesses.

For administration of a 1-g dose, the entire contents of the vial should be given. For doses lower than 1 g, the following dilution table may be used.

* Equivalent to capreomycin activity. Approximated concentration takes into account the retention volume.
DILUTION TABLE Diluent Added to1-g, 10-mL Vial Volume of CapastatSulfate Solution Concentration(Approx) 2.15 mL 2.85 mL 370 mg*/mL 2.63 mL 3.33 mL 315 mg*/mL 3.3 mL 4 mL 260 mg*/mL 4.3 mL 5 mL 210 mg*/mL
The solution may acquire a pale straw color and darken with time, but this is not associated with loss of potency or the development of toxicity. After reconstitution, all solutions of Capastat Sulfate may be stored for up to 24 hours under refrigeration.

Capreomycin is always administered in combination with at least 1 other antituberculosis agent to which the patient's strain of tubercle bacilli is susceptible. The usual dose is 1 g daily (not to exceed 20 mg/kg/day) given intramuscularly or intravenously for 60 to 120 days, followed by 1 g by either route 2 or 3 times weekly. (Note — Therapy for tuberculosis should be maintained for 12 to 24 months. If facilities for administering injectable medication are not available, a change to appropriate oral therapy is indicated on the patient's release from the hospital.)

Patients with reduced renal function should have dosage reduction based on creatinine clearance using the guidelines included in Table 1. These dosages are designed to achieve a mean steady-state capreomycin level of 10 μg/mL.
Table 1. Estimated Dosages to Attain Mean Steady-State Serum Capreomycin Concentration of 10 μg/mL (Based on Creatinine Clearance)
a For patients with renal impairment, initial maintenance dose estimates are given for optional dosing intervals; longer dosing intervals are expected to provide greater peak and lower trough serum capreomycin levels than shorter dosing intervals.

b The usual dosage for patients with normal renal function is 1000 mg daily, not to exceed 20 mg/kg/day, for 60 to 120 days, then 1000 mg 2 to 3 times weekly.
Capreomycin Dosea (mg/kg) for the Following CrCl Clearance Half-life Dosing Intervals (mL/min) (L/kg/h x 10-2) (hours) 24 h 48 h 72 h 0 0.54 55.5 1.29 2.58 3.87 10 1.01 29.4 2.43 4.87 7.30 20 1.49 20.0 3.58 7.16 10.7 30 1.97 15.1 4.72 9.45 14.2 40 2.45 12.2 5.87 11.7 50 2.92 10.2 7.01 14.0 60 3.40 8.8 8.16 80 4.35 6.8 10.4b 100 5.31 5.6 12.7b 110 5.78 5.2 13.9b
Parenteral drug products should be inspected visually for particulate matter and discoloration prior to administration, whenever solution and container permit.
Ak-fluor

Ak-fluor

2.1 Dosing

Adult Dose

The recommended dosage of AK-FLUOR® 10% (100 mg/mL) and of 25% (250 mg/mL) is 500 mg via intravenous administration.

Pediatric Dose

For children, the dose is 7.7 mg/kg (actual body weight) up to a maximum of 500 mg, via intravenous infusion calculated on the basis of 35 mg for each 10 lbs. (4.54 kg) of body weight.

2.2 Preparation for Administration

Parenteral drug products should be inspected visually for particulate matter and discoloration prior to administration. Do not mix or dilute with other solutions or drugs.

2.3 Administration

Inject the dose (over 5-10 seconds is normally recommended) into the antecubital vein, after taking precautions to avoid extravasation. A syringe, filled with AK-FLUOR®, may be attached to transparent tubing and a 23 gauge butterfly needle for injection. Insert the needle and draw the patient's blood to the hub of the syringe so that a small air bubble separates the patient's blood in the tubing from the fluorescein. With the room lights on, slowly inject the blood back into the vein while watching the skin over the needle tip. If the needle has extravasated, the patient's blood will be seen to bulge the skin and the injection should be stopped before any fluorescein is injected. When assured that extravasation has not occurred, the room light may be turned off and the fluorescein injection completed. Luminescence usually appears in the retina and choroidal vessels in 7 to 14 seconds and can be observed by standard viewing equipment.

Reduction in dose from 500 mg to 200 mg of AK-FLUOR® 10% may be appropriate in cases when a highly sensitive imaging system e.g., scanning laser ophthalmoscope is used.
Alfenta

Alfenta

The dosage of ALFENTA (alfentanil hydrochloride) should be individualized and titrated to the desired effect in each patient according to body weight, physical status, underlying pathological condition, use of other drugs, and type and duration of surgical procedure and anesthesia. In obese patients (more than 20% above ideal total body weight), the dosage of ALFENTA should be determined on the basis of lean body weight. The dose of ALFENTA should be reduced in elderly or debilitated patients (see PRECAUTIONS).

Vital signs should be monitored routinely.

See Dosage Guidelines for the use of ALFENTA: 1) by incremental injection as an analgesic adjunct to anesthesia with barbiturate/nitrous oxide/oxygen for short surgical procedures (expected duration of less than one hour); 2) by continuous infusion as a maintenance analgesic with nitrous oxide/oxygen for general surgical procedures; and 3) by intravenous injection in anesthetic doses for the induction of anesthesia for general surgical procedures with a minimum expected duration of 45 minutes; and 4) by intravenous injection as the analgesic component for monitored anesthesia care (MAC).
DOSAGE GUIDELINES DOSAGE SHOULD BE INDIVIDUALIZED AND TITRATED FOR USE DURING GENERAL ANESTHESIA SPONTANEOUSLY BREATHING/ASSISTED VENTILATION Induction of Analgesia: 8-20 mcg/kgMaintenance of Analgesia: 3-5 mcg/kg q 5-20 min or 0.5 to 1 mcg/kg/minTotal dose: 8-40 mcg/kg ASSISTED OR CONTROLLED VENTILATION Incremental Injection (To attenuate response to laryngoscopy and intubation) Induction of Analgesia: 20-50 mcg/kgMaintenance of Analgesia: 5-15 mcg/kg q 5-20 minTotal dose: Up to 75 mcg/kg Continuous Infusion (To provide attenuation of response to intubation and incision) Infusion rates are variable and should be titrated to the desired clinical effect.SEE INFUSION DOSAGE GUIDELINES BELOW.Induction of Analgesia: 50-75 mcg/kgMaintenance of Analgesia: 0.5 to 3 mcg/kg/min (Average rate 1 to 1.5 mcg/kg/min)Total dose: Dependent on duration of procedure Anesthetic Induction Induction of Anesthesia: 130-245 mcg/kgMaintenance of Anesthesia: 0.5 to 1.5 mcg/kg/min or general anestheticTotal dose: Dependent on duration of procedureAt these doses, truncal rigidity should be expected and a muscle relaxant should be utilized.Administer slowly (over 3 minutes). Concentration of inhalation agents reduced by 30-50% for initial hour. MONITORED ANESTHESIA CARE (MAC) (For sedated and responsive, spontaneously breathing patients) Induction of MAC: 3-8 mcg/kgMaintenance of MAC: 3-5 mcg/kg q 5-20 min or 0.25 to 1 mcg/kg/minTotal dose: 3-40 mcg/kg INFUSION DOSAGE Continuous Infusion: 0.5-3 mcg/kg/min administered with nitrous oxide/oxygen in patients undergoing general surgery. Following an anesthetic induction dose of ALFENTA, infusion rate requirements are reduced by 30-50% for the first hour of maintenance. Changes in vital signs that indicate a response to surgical stress or lightening of anesthesia may be controlled by increasing the alfentanil to a maximum of 4 mcg/kg/min and/or administration of bolus doses of 7 mcg/kg. If changes are not controlled after three bolus doses given over a five minute period, a barbiturate, vasodilator, and/or inhalation agent should be used. Infusion rates should always be adjusted downward in the absence of these signs until there is some response to surgical stimulation. Rather than an increase in infusion rate, 7 mcg/kg bolus doses of ALFENTA or a potent inhalation agent should be administered in response to signs of lightening of anesthesia within the last 15 minutes of surgery. ALFENTA infusion should be discontinued at least 10-15 minutes prior to the end of surgery.
Usage in Children

Clinical data to support the use of ALFENTA in patients under 12 years of age are not presently available. Therefore, such use is not recommended.

Premedication

The selection of preanesthetic medications should be based upon the needs of the individual patient.

Neuromuscular Blocking Agents

The neuromuscular blocking agent selected should be compatible with the patient's condition, taking into account the hemodynamic effects of a particular muscle relaxant and the degree of skeletal muscle relaxation required (see CLINICAL PHARMACOLOGY, WARNINGS and PRECAUTIONS sections).

In patients administered anesthetic (induction) dosages of ALFENTA, it is essential that qualified personnel and adequate facilities are available for the management of intraoperative and postoperative respiratory depression.

Also see WARNINGS and PRECAUTIONS sections.

For purposes of administering small volumes of ALFENTA accurately, the use of a tuberculin syringe or equivalent is recommended.

The physical and chemical compatibility of ALFENTA have been demonstrated in solution with normal saline, 5% dextrose in normal saline, 5% dextrose in water and Lactated Ringers. Clinical studies of ALFENTA infusion have been conducted with ALFENTA diluted to a concentration range of 25 mcg/mL to 80 mcg/mL.

As an example of the preparation of ALFENTA for infusion, 20 mL of ALFENTA added to 230 mL of diluent provides 40 mcg/mL solution of ALFENTA.

Parenteral drug products should be inspected visually for particulate matter and discoloration prior to administration, whenever solution and container permit.

SAFETY AND HANDLING

ALFENTA (alfentanil hydrochloride) is supplied in individually sealed dosage forms which pose no known risk to health-care providers having incidental contact. Accidental dermal exposure to ALFENTA should be treated by rinsing the affected area with water.

Storage: Store at 20° to 25°C (68° to 77°F) [see USP Controlled Room Temperature]. Protect from light.
Ketorolac Tromethamine ...

Ketorolac Tromethamine Solution Drops

2.1 Recommended Dosing

Patient Dosing

One drop of Ketorolac Tromethamine Ophthalmic Solution should be applied to the affected eye twice daily beginning 1 day prior to cataract surgery, continued on the day of surgery, and through the first 2 weeks of the postoperative period.

2.2 Use with Other Topical Ophthalmic Medications

Ketorolac Tromethamine Ophthalmic Solution may be administered in conjunction with other topical ophthalmic medications such as alpha-agonists, beta-blockers, carbonic anhydrase inhibitors, cycloplegics, and mydriatics. Drops should be administered at least 5 minutes apart.
Cosopt

Cosopt

The dose is one drop of COSOPT in the affected eye(s) two times daily. If more than one topical ophthalmic drug is being used, the drugs should be administered at least five minutes apart [see Drug Interactions (7.3)].

Akorn

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Akorn Drugs