Starting dose

Starting dose 1.25 mg/250 mg PO once or twice daily with meals, second-line therapy ... 

The treatment of elderly patients with hypertension, as well as those with isolated systolic hypertension, should follow the same approach as with other populations with the exception that lower starting doses may be warranted to avoid symptoms and with special attention paid to postural hypotension. This should include a careful assessment of orthostatic symptoms, measurement of blood pressure in the upright position, and caution to avoid volume depletion and rapid titration of antihypertensive therapy.2 In individuals with isolated systolic hypertension, the optimal level of diastolic pressure is not known, and although treated patients who achieve diastolic pressures less than 60 to 70 mm Hg had poorer outcomes in a landmark trial, their cardiovascular event rate was still lower than those receiving placebo.69... 

Theophylline Liquids, sustained-release Starting dose 10 mg/kg per Starting dose 10 mg/kg... 

Because p-blockers decrease blood pressure and heart rate, they should be started at low doses to increase tolerability. Propranolol is hepatically metabolized, and its half-life and pharmacologic effects are prolonged in portal hypertension. A reasonable starting dose of propranolol is 10 mg two to three times daily. 

Subcutaneous (SC) administration of ESA produces a more predictable and sustained response than IV administration, and is therefore the preferred route of administration for both agents. Intravenous administration is often utilized in patients who have established IV access or are receiving hemodialysis. Starting doses of ESAs depend on the patient s Hgb level, the target Hgb level, the rate of Hgb increase and clinical circumstances.31 The initial increase in Hgb should be 1-2 g/dL (0.6206-1.2404 mmol/L) per month. The starting doses of epoetin alfa previously recommended are 80 to 120 units/kg per week for SC administration and 120 to 180 units/kg per week for IV administration, divided two to three times per week. The starting dose of darbepoetin alfa is 0.45 mcg/kg administered SC or IV once weekly (Table 23-3). 

TABLE 23-3. Estimated Starting Doses of Darbepoetin Alfa Based on Previous Epoetin Alfa Dose... 

Compound Trade Name Content (mg) Content (mg) Starting Dose Comments... 

FIGURE 27-3. Serum concentrations of carbamazepine in the presence and absence of appropriate dose titration. Carbamazepine induces its own metabolism, so maintenance dose requirements are much greater than starting doses. To avoid excessive adverse effects, starting doses should be 25% to 30% of the target maintenance doses and increased gradually to the target maintenance dose, usually over 3 to 4 weeks. 

Starting dose 10 mg four times daily 5 mg daily 1.5 mg twice daily 4 mg twice daily or 8 mg daily 5 mg daily... 

Drug Starting Dose Maintenance Dose Comments... 

Fluphenazine 1.2 x oral fluphenazine daily dose, Based on starting dose and Can be administered IM or SC ... 

The starting dose is the usual therapeutic dose for most of the SSRIs, duloxetine, and mirtazapine, whereas there is usually need for at least some upward titration of venlafaxine, bupropion,... 

Medication Class Recommended Starting Dose (mg/day) Usual Therapeutic Dosage Range (mg/day)... 

Stimulants should be initiated at recommended starting doses and titrated up with a consistent dosing schedule to the appropriate response while minimizing side effects (Table 39-2). Generally, stimulants should not be used in patients who have glaucoma, severe hypertension or cardiovascular disease, hyperthyroidism, severe anxiety, or previous illicit or stimulant drug abuse. Further, stimulants can be used, albeit cautiously, in patients with seizure disorders, Tourette s syndrome, and motor tics.14... 

In patients younger than age 65 with overt hypothyroidism, the average LT4 replacement dose is 1.6 mcg/kg per day (use ideal body weight in obese patients25). If there is no history of cardiac disease, these patients may be started on the full replacement dose. The full replacement dose in patients over age 75 is lower, about 1 mcg/kg per day.26 In the elderly, the starting dose is 25 to 50 meg/day, and the dose is titrated to the... 

Large doses of iodide inhibit the synthesis and release of thyroid hormones. Serum T4 levels may be reduced within 24 hours, and the effects may last for 2 to 3 weeks. Iodides are used most commonly in Graves disease patients prior to surgery and to quickly reduce hormone release in patients with thyroid storm. Potassium iodide is administered either as a saturated solution (SSKI) that contains 38 mg iodide per drop or as Lugol s solution, which contains 6.3 mg iodide per drop. The typical starting dose is 120 to 400 mg/day. Iodide therapy should start 7 to 14 days prior to surgery. Iodide should not be... 

Drug Type and Agent Starting Dose Maximal Dose Side Effects Monitoring Suggestions Preferred Indication... 

Generic Name (Brand) Starting Dose Titrating Dose Usually Effective Dose Maximal Dose Dosing Frequency Adverse Effects Cost... 

The usual adult oral dose of cyclosporine ranges from 4 to 18 mg/kg per day in two divided doses.11 Appropriate selection of the starting dose usually depends on the organ type, the patient s preexisting disease states, and other concomitant immunosuppressive agents used. Cyclosporine microemulsion is available as 25 and 100 mg individually blister-packed capsules and... 

Oral starting doses of tacrolimus range from 0.1 to 0.2 mg/kg per day in two divided doses. Tacrolimus is available in 0.5, 1, and 5 mg capsules and as an injectable.11 The IV formulation usually is avoided owing to the risk of anaphylaxis because of its castor oil component. Tacrolimus C0 whole-blood levels should be monitored (12 hours after the last administered dose) and maintained between 5 and 15 ng/mL again, desired serum concentrations depend on the transplanted organ, the patient s condition, and the time since transplant.11 A once-daily modified formulation of tacrolimus is being studied currently. 

Mycophenolate mofetil is available in 250 mg capsules and 500 mg tablets, an oral suspension (100 mg/mlL, in cherry syrup), and an injectable.11 Usual doses of mycophenolate mofetil range from 1000 to 3000 mg/day in two to four divided doses. The conversion between oral and IV mycophenolate mofetil is 1 1. Enteric-coated mycophenolic acid is available in 180 and 360 mg tablets. For conversion between mycophenolate mofetil and enteric-coated MPA, 1000 mg mycophenolate mofetil is equivalent to 720 mg enteric-coated MPA.26,29 The recommended starting dose of enteric-coated mycophenolic acid is 720 mg given twice daily.11 It appears that conversion of mycophenolate mofetil to enteric-coated mycophenolic acid is safe, but more studies are needed to determine the exact role of enteric-coated MPA in the immunosuppressive armamentarium. Mycophenolic acid trough concentrations can be monitored, but they are not recommended routinely. 

Allopurinol Starting dose CrCI greater than 90 mL/minute = 300 mg/day CrCI 60-90 mL/minute = 200 mg/day CrCI 30-60 mL/minute = 100 mg/day CrCI less than 30 mL/minute = 50 mg/day Adjust dosage based on follow-up uric acid levels maximum 800 mg/day... 

The initial dose of allopurinol is based on the patient s renal function. Patients with creatinine clearances of 50 mL/minute or less should receive a starting dose of less than 300 mg/day to minimize adverse effects. The relationship between dose of allopurinol and its most severe side effects is controversial. However, the dose can be adjusted upward as needed and tolerated. It is reasonable to reduce the dose temporarily in patients who develop reversible acute renal failure. 

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