Drug | Preparations | Major Toxicitiesa | Special Instructions | |
|---|---|---|---|---|
Indicating Need for Medical Attention | Indicating Need for Medical Attention if Persistent or Bothersome | |||
| Acyclovir | Oral Suspension
Capsules
Tablets
IV 500 mg | More Frequent
Less Frequent
Rare Parenteral Form Only
Parenteral and Oral Forms
| More Frequent
Less Frequent (More Common in Adults Than Children)
| Requires dose adjustment in children with renal impairment. Avoid other nephrotoxic drugs. To avoid renal tubular damage related to crystalluria, administer IV preparation by slow IV infusion over at least 1 hour at a final concentration not to exceed 7 mg/mL. This must be accompanied by adequate hydration. Use caution with IV preparation in children with underlying neurological conditions, serious hepatic or electrolyte abnormalities, or substantial hypoxia. |
| Albendazole | Tablet
| More Frequent
Less Frequent
Rare
| Less Frequent
Rare
| Should be given with food. Recommend giving with a high-fat meal to increase absorption. May crush or chew tablets and give with water. Monitor CBC and LFTs prior to each cycle and every 2 weeks during therapy. Pregnancy tests may be administered. |
| Amikacin | IV
| More Frequent
Less Frequent
Rare
| N/A |
Must be infused over 30 to 60 minutes to avoid neuromuscular blockade. Requires dose adjustment in children with impaired renal function. Should monitor renal function and hearing periodically (e.g., monthly) in children on prolonged therapy. TDM indicated. Use with caution in children on ECMO; PK may be altered. Dose adjustment with close monitoring necessary. |
| Amphotericin B Deoxycholate | IV 50 mg | More Frequent
Less Frequent or Rare
|
| Monitor BUN, Cr, CBC, electrolytes, LFTs, fluid status and input/output, signs of hypokalemia. Infuse over 1 to 2 hours; in children with azotemia, hyperkalemia, or getting doses >1 mg/kg, infuse over 3 to 6 hours. Requires dose reduction in children with impaired renal function. Avoid other nephrotoxic drugs, when possible, because nephrotoxicity is exacerbated with concomitant use of other nephrotoxic drugs; permanent nephrotoxicity is related to cumulative dose. Nephrotoxicity may be ameliorated by hydration with 0.9% saline IV over 30 minutes prior to the amphotericin B infusion. Infusion-related reactions are less frequent in children than adults; the onset is usually 1 to 3 hours after infusion, duration <1 hour; frequency decreases over time. Addition of heparin to infusion solution may reduce phlebitis. Flush line with dextrose; NS may cause precipitate. Pre-treatment with acetaminophen and/or diphenhydramine may alleviate febrile reactions. |
| Amphotericin B Lipid Complex | IV
| More Frequent:
Less Frequent
|
| Monitor BUN, Cr, CBC, electrolytes, and LFTs. Infuse diluted solution at a rate of 2.5 mg/kg/hour. To minimize immediate infusion-related reactions, premedicate with the following 30 to 60 minutes prior to administration: acetaminophen, diphenhydramine, and/or hydrocortisone. Adequate hydration and pre-infusion administration of NS may decrease risk of nephrotoxicity. In-line filters should not be used. Do not dilute with saline solutions or mix with other drugs or electrolytes (compatibility has not been established). Use with caution with bone marrow suppressants or other nephrotoxic drugs; renal toxicity is dose-dependent, but less renal toxicity than seen with conventional amphotericin B. Consider dose reduction in children with impaired renal function. |
| Amphotericin B Liposome | IV
| More Frequent
Less Frequent
Rare
|
| Monitor BUN, Cr, CBC, electrolytes, and LFTs. Infuse over 2 hours. Do not use in-line filter less than 1 micron to administer. Consider dose reduction in children with impaired renal function. Flush line with D5W before and after infusion. |
| Artesunate | IV
| Rare
|
| Monitor CBC, LFTs, and electrolytes. Artesunate is preferred over quinidine for severe malaria because of decreased mortality. Monitor signs and symptoms of hemolytic anemia, Hb, and renal function for 4 weeks after therapy. |
| Atovaquone | Oral Suspension
| Frequent
| Frequent:
| Should be administered with a meal to enhance absorption; bioavailability increases threefold when administered with a high-fat meal. Avoid suspension in neonates due to benzyl alcohol. Monitor CBC with differential, liver enzymes, bilirubin, serum electrolytes, and serum amylase. |
Atovaquone/ Proguanil | Tablets
| Less Frequent
| N/A | Pediatric tablets are available to make dosing easier. Atovaquone taken with a high-fat meal significantly increases the rate and extent of absorption. Side effects requiring discontinuation in ~1% to 2% of people.b Not recommended for prophylaxis in children with CrCl <30 mL/min. |
| Azithromycin | Oral Suspension
Tablets
Oral Powder Packet
IV
| More Frequent
Rare
|
| Administer 1 hour before or 2 hours after a meal; do not administer with aluminum- and magnesium-containing antacids. IV should be infused at a concentration of 1 mg/mL over a 3‑hour period, or 2 mg/mL over a 1-hour period; IV should not be administered as a bolus. Use with caution in children with hepatic function impairment; biliary excretion is the main route of elimination. Potential drug interactions. See Table 5. Significant Drug Interactions for Drugs Used to Treat or Prevent Opportunistic Infections and the Drug–Drug Interactions section of the Adult and Adolescent Antiretroviral Guidelines for more information. |
| Bedaquiline | Tablets
| Less Frequent
Rare
| More Frequent
Less Frequent
Rare
| Monitor serum potassium, calcium, and magnesium at baseline. Monitor ALT, AST, alkaline phosphatase, and bilirubin at baseline and monthly during treatment. Monitor EKG at baseline and monthly during treatment. Give with food (standard meal approximately 22 g of fat and 558 calories) to increase bioavailability twofold. |
| Capreomycin | IV/IM
| More Frequent
Less Frequent
| N/A | Rarely used in the United States because of efficacy concerns. Administer only by deep IM injection into large muscle mass (superficial injections may result in sterile abscess). Requires dose adjustment in children with impaired renal function. Monitor renal function and hearing periodically (e.g., monthly) in children on prolonged therapy. Monitor LFTs and electrolytes. |
| Caspofungin | IV
| More Frequent
Rare
|
| Requires dose adjustment in moderate-to-severe hepatic insufficiency. Administer IV infusion over 1 hour in normal saline (do not use diluents containing dextrose). Higher doses (150 mg or greater) should be infused over at least 2 hours. |
| Chloroquine Phosphate | Tablets
| More Frequent
Less Frequent, but More Severe
|
| Store in child-proof containers and protect from light. Overdose can be toxic. Chloroquine phosphate is bitter tasting, so consider administering with foods such as chocolate syrup that can mask the taste. Use with caution in children with G6PD deficiency or seizure disorder. Genetic testing is recommended. Monitor CBC; periodic neurologic and ophthalmologic exams are recommended in children on prolonged therapy. Monitor EKG at baseline and as clinically indicated in children with elevated risk of QT prolongation. |
| Cidofovir | IV
| More Frequent
Less Frequent
Rare
|
| Infuse over 1 hour. Should not be used in children with severe renal impairment. Nephrotoxicity risk is decreased with prehydration with IV NS and probenecid with each infusion; probenecid is administered prior to each dose and repeated for two additional doses after infusion. Additional hydration after infusion is recommended if tolerated. Concurrent use of other nephrotoxic drugs should be avoided. Perform ophthalmologic exams and monitor renal function, urinalysis, electrolytes, and CBC. |
| Ciprofloxacin | Oral Suspension
Tablets
XR Tablets
IV
| Less Frequent
Rare
| More Frequent
Less Frequent
| Administer oral formulations at least 2 hours before or 6 hours after taking sucralfate, antacids, or other products containing calcium, zinc, or iron (including daily products or calcium-fortified juices). Take with full glass of water to avoid crystalluria. Possible phototoxicity reactions with sun exposure. IV infusions should be over 1 hour. Do not split, crush, or chew XR tablets. QT prolongation is concentration-dependent and occurs with use of two or more medications that prolong QT interval. |
| Clarithromycin | Oral Suspension
Tablets
| Rare
| More Frequent
Less Frequent
| Requires dose adjustment in children with impaired renal function. Can be administered without regard to meals. Reconstituted suspension should not be refrigerated. Potential drug interactions exist. See Table 5. Significant Drug Interactions for Drugs Used to Treat or Prevent Opportunistic Infections and Drug-Drug Interactions section of the Adult and Adolescent Antiretroviral Guidelines for more information. |
| Clindamycin | Oral Solution
Capsules
IV/IM
| More Frequent
Less Frequent
| More Frequent
Less Frequent
| IV preparation not recommended for use in neonates because of benzyl alcohol. IV preparation must be diluted prior to administration. Do not exceed 600 mg in a single IM injection. Capsule formulation should be taken with food or a full glass of water to avoid esophageal irritation. Reconstituted oral solution should not be refrigerated. Some products may contain tartrazine and can cause allergic reactions. Allergic reactions are frequently observed in people who also have aspirin hypersensitivity. |
| Cycloserine | Capsule
| More Frequent
Less Frequent
Rare
| More Frequent
Rare
| Take with food to minimize gastric irritation. Neurotoxicity is related to excessive serum concentrations; serum concentrations should be maintained at 25–30 mcg/mL. Monitor serum levels if possible. Requires dose adjustment in children with impaired renal function. Do not administer to children with severe renal impairment (because of increased risk of neurotoxicity). Should coadminister pyridoxine at the same time. May increase Vitamin B12 and folic acid requirements. Monitor renal function, LFTs, and CBC. |
| Dapsone | Oral Suspension (extemporaneously prepared from 25 mg tablets)
Tablets
| More Frequent
Rare
|
| Protect from light; dispense syrup in amber glass bottles. Monitor CBC and LFTs. Use with caution in children with G6PD deficiency, Hb M deficiency, and methemoglobin reductase deficiency. |
| Doxycycline | Tablets and Capsules
Oral Suspension and Syrup
IV
| More Frequent
Less Frequent
|
| Swallow with adequate amounts of fluids. Avoid antacids, milk, dairy products, and iron for 1 hour before and 2 hours after administration of doxycycline. Avoid high-fat meals that can reduce doxycycline serum levels. Use with caution in hepatic and renal disease. IV doses should be infused over 1 to 4 hours. Children should avoid prolonged exposure to direct sunlight (skin sensitivity). Monitor renal function, CBC, and LFTs if therapy is prolonged. |
| Erythromycin | Erythromycin-Base Tablet
DR Tablet
DR Capsule
Erythromycin Ethyl Succinate Suspension
Oral Drops
Chewable Tablet
Tablet
Erythromycin Estolate Suspension
Erythromycin Stearate Tablet
Erythromycin Gluceptate IV
Erythromycin Lactobionate IV
| Less Frequent
Rare
|
| Use with caution in liver disease. Oral therapy should replace IV therapy as soon as possible. Give oral doses after meals. Parenteral administration should consist of a continuous drip or slow infusion over 1 hour or longer. Adjust dose in renal failure. Erythromycin should be used with caution in neonates; hypertrophic pyloric stenosis and life-threatening episodes of ventricular tachycardia associated with prolonged QTc interval have been reported. IV formulations contain benzyl alcohol derivatives and are not recommended in neonates. |
| Ethambutol | Tablets
| Less Frequent
Rare
|
| Requires dose adjustment in children with impaired renal function. Take with food (e.g., gelatin, chocolate pudding) to minimize gastric irritation. Tablets may be crushed. Monitor visual acuity and red-green color discrimination. Document normal vision at baseline. Monitor renal function, LFTs, and CBC. Avoid concomitant use of neurotoxic drugs. Evaluate pregnancy status prior to treatment. |
| Ethionamide | Tablet
| Less Frequent
Rare
| More Frequent
Rare
| Avoid use of other neurotoxic drugs that could increase potential for peripheral neuropathy and optic neuritis. Administration of pyridoxine may alleviate peripheral neuritis. Avoid alcohol. Take with food to minimize gastric irritation. Monitor LFTs, glucose, and thyroid function. Perform periodic ophthalmologic exams. Monitor for signs and symptoms of SCARs. |
| Fluconazole | Oral Suspension
Tablets
IV
| Less Frequent
Rare
| More Frequent
Less Frequent
| Can be given orally without regard to meals. Shake suspension well before dosing. Requires dose adjustment in children with impaired renal function. IV administration should be administered over 1–2 hours at a rate of ≤200 mg/hour. Daily dose is the same for oral and IV administration. Multiple potential drug interactions exist. See Table 5. Significant Drug Interactions for Drugs Used to Treat or Prevent Opportunistic Infections andDrug-Drug Interactions section of the Adult and Adolescent Antiretroviral Guidelines for more information. Monitor periodic LFTs, renal function, and CBC. |
| Flucytosine | Capsules
Oral Liquid
| More Frequent
Less Frequent
Rare
|
Rare
| Monitor serum concentrations and adjust dose to maintain therapeutic levels and minimize risk of bone marrow suppression. Requires dose adjustment in children with impaired renal function; use with extreme caution. Fatal aplastic anemia and agranulocytosis rarely have been reported. Consider determination of dihydropyridine dehydrogenase (DPD) enzyme deficiency in children who develop drug toxicity. Oral preparations should be administered with food over a 15‑minute period to minimize GI side effects. QT prolongation may occur. Monitor CBC, LFTs, renal function, and electrolytes. |
| Foscarnet | IV
| More Frequent
Less Frequent
Rare
| Frequent
| Requires dose adjustment in children with impaired renal function. Use adequate hydration to decrease nephrotoxicity. Avoid concomitant use of other drugs with nephrotoxicity. Monitor serum electrolytes, ECG, renal function, and CBC. IV solution of 24 mg/mL can be administered via central line; must be diluted to a final concentration ≤12 mg/mL if given via peripheral line. Must be administered at a constant rate by infusion pump over ≥2 hours (or no faster than 1 mg/kg/minute). |
| Ganciclovir | Capsules
IV
| More Frequent
Less Frequent
Rare
|
| Requires dose adjustment in children with renal impairment. Avoid other nephrotoxic drugs. IV infusion over at least 1 hour; in-line filter required. Flush line well with NS before and after administration. Maintain good hydration. Undiluted IV solution is alkaline (pH 11); use caution when handling and preparing solutions, and avoid contact with skin and mucus membranes. Administer oral doses with a high-fat meal to increase absorption. Do not open or crush capsules. Perform ophthalmologic examinations and monitor CBC, LFTs, and renal function. |
| Imipenem/Cilastatin | IV
| More Frequent
Less Frequent
Rare
| Rare
| Administer by IV intermittent infusion. Doses ≤500 mg may be infused over 20 to 30 minutes. Doses >500 mg should be infused over 40 to 60 minutes. If nausea and vomiting occur during infusion, decrease rate of IV infusion. |
| Isavuconazole | Oral Capsules
IV
| More Frequent
Less Frequent
Rare
| More Frequent
Less Frequent
Rare
| Administer IV over a minimum of 1 hour via infusion, set with in-line filter. Give capsules with or without food. Swallow capsules whole. Do not chew, crush, dissolve, or open capsules. Some dosage forms contain propylene glycol. Large amounts administered have been associated with potentially fatal toxicities in neonates, including metabolic acidosis, seizures, renal failure, and CNS depression. |
| Isoniazid | Oral Syrup
Tablets
IV/IM
| More Frequent
Rare
|
| Take with food to minimize gastric irritation. Take ≥1 hour before aluminum-containing antacids. Avoid taking isoniazid with histamine and tyramine-containing foods. Increase dietary intake of folate, niacin, and magnesium. Use with caution in children with hepatic function impairment, severe renal failure, or history of seizures. Pyridoxine supplementation should be provided for all children with HIV. Monitor LFTs and perform periodic ophthalmologic examinations. |
| Itraconazole | Oral Solution
Capsule
IV
| Less Frequent
Rare
| More Frequent
Less Frequent
| Oral Solution
Capsule
Itraconazole oral solution has 60% greater bioavailability compared with capsules, and the oral solution and capsules should not be used interchangeably. Administer IV infusion over at least 1 hour. Multiple potential drug interactions. See Table 5. Significant Drug Interactions for Drugs Used to Treat or Prevent Opportunistic Infections and Drug-Drug Interactions section of the Adult and Adolescent Antiretroviral Guidelines for more information. Monitor LFTs and potassium levels. Monitor serum concentrations (TDM) in severe infections after 2 weeks of therapy. Levels may be drawn any time during the dosing interval. Box warning: May cause or exacerbate HF. Discontinue to reassess risk-benefit if signs or symptoms of HF occur. |
| Kanamycin | IV/IM
| More Frequent
Less Frequent
Rare
| N/A | Must be infused over 30 to 60 minutes to avoid neuromuscular blockade. Requires dose adjustment in children with impaired renal function. Monitor renal function and auditory function periodically (e.g., monthly) in children on prolonged therapy. Monitor serum concentrations (TDM). |
| Ketoconazole | Tablet
Topical
Oral Suspension
| Less Frequent
Rare
| More Frequent
Less Frequent
Rare
| Adverse GI effects occur less often when administered with food. Drugs that decrease gastric acidity or sucralfate should be administered ≥2 hours after ketoconazole. Administer with acidic liquid (non-diet cola or orange juice) in children with achlorhydria. Disulfiram-like reactions have occurred in pediatric patients accidentally ingesting alcohol. Hepatotoxicity is an idiosyncratic reaction, usually reversible when stopping the drug, but rare fatalities can occur any time during therapy; more common in females and adults >40 years, but cases have been reported in children. High-dose ketoconazole suppresses corticosteroid secretion and lowers serum testosterone concentration (reversible). Multiple potential drug interactions exist. Monitor LFTs. |
| Mefloquine | Tablet
| More Frequent
Rare
|
| Side effects are less prominent in children. Administer with food and plenty of water. Tablets can be crushed and added to food; administer with foods such as chocolate syrup or gelatin to mask the bitter taste of crushed tablets. Monitor LFTs. |
| Nitazoxanide | Oral Suspension
Tablet
| N/A | More Frequent
Rare
| Should be given with food. Shake suspension well prior to dosing. Use with caution in neonates. Nitazoxanide products may contain benzyl alcohol derivatives that can be associated with gasping syndrome. |
| p-Aminosalicylic Acid | DR Granules
| Rare
|
| Should not be administered to children with severe renal disease. Drug should be discontinued at first sign of hypersensitivity reaction (rash, fever, and GI symptoms typically precede jaundice). Vitamin B12 therapy should be considered in children receiving for >1 month. Administer granules by sprinkling on acidic foods (e.g., applesauce, yogurt) or a fruit drink (e.g., tomato juice, orange juice). Maintain urine at neutral or alkaline pH to avoid crystalluria. The granule's soft “skeleton” may be seen in the stool. Monitor CBC and LFTs. |
| Pentamidine | IV/IM/Aerosol
| For IV Administration More Frequent
Less Frequent
For Aerosol Administration More Frequent
| For IV Administration More Frequent
Less Frequent
For Aerosol Administration More Frequent
| Rapid infusion may result in precipitous hypotension; IV infusion should be administered over ≥1 hour (preferably 2 hours). Cytolytic effect on pancreatic beta islet cells, leading to insulin release, can result in prolonged severe hypoglycemia (usually occurs after 5–7 days of therapy, but can also occur after the drug is discontinued); risk increased with higher dose, longer duration of therapy, and retreatment within 3 months of prior treatment. Hyperglycemia and diabetes mellitus can occur up to several months after drug is discontinued. Monitor LFTs, renal function, glucose, electrolytes, and BP. Inhalation
|
| Posaconazole | IR Oral Suspension
Oral Powder Packet
DR Tablet
DR Oral Suspension
IV
| Less Frequent
Rare
|
| Must be given with meals to ensure adequate absorption. Monitor LFTs, renal function, and electrolytes. Monitor serum drug concentrations (TDM). Shake suspension prior to dosing. Various oral formulations are not interchangeable. Administer reconstituted DR suspension within 1 hour of prep and administer with food. Administer IR suspension during or within 20 minutes following a full meal. Infuse IV over 90 minutes via central line only. |
| Primaquine | Tablet
| More Frequent
Less Frequent
Rare
|
| Take with meals or antacids to minimize gastric irritation. Store in a light-resistant container. Combat bitter taste with chocolate syrup, applesauce, or jelly. Monitor CBC. Recommend G6PD testing. |
| Pyrazinamide | Tablet
Oral Suspension
| More Frequent
Less Frequent
Rare
|
| Avoid in children with severe hepatic impairment. Reduce dose in children with renal or hepatic impairment. Monitor LFTs and uric acid. |
| Pyrimethamine | Tablet
Oral Suspension
| Less Frequent
Rare
|
| To prevent hematologic toxicity, administer with leucovorin. Monitor CBC. Administer with meals to avoid GI side effects. Recommend G6PD testing. |
| Quinidine | Tablet (XR)
Tablet
| Serious
| Very Frequent Cinchonism (dose-dependent)—syndrome of tinnitus, reversible high-frequency hearing loss, deafness, vertigo, blurred vision, diplopia, photophobia, headache, confusion, and delirium. | Monitor CBC and LFTs. Hemolysis may occur in children with G6PD. |
| Ribavirin | Powder for Solution for Nebulization
Oral Solution
Capsule
Tablets
| More Frequent
Less Frequent
|
| Should not be used in children with severe renal impairment. Should not be used as monotherapy for treatment of hepatitis C but rather, used in combination with IFN-α. Intracellular phosphorylation of pyrimidine nucleoside analogues (zidovudine, stavudine, zalcitabine) decreased by ribavirin, may have antagonism; use with caution. Enhances phosphorylation of didanosine; use with caution due to increased risk of pancreatitis/ mitochondrial toxicity. Oral solution contains propylene glycol. This drug is teratogenic/embryocidal and contraindicated in pregnant women and their partners. Avoid pregnancy for an additional 6 months after treatment. In combination therapy with IFN-α, ribavirin may cause a reduction in growth velocity in children and adolescents 5–17 years of age. Monitor CBC, renal function, LFTs, and thyroid function. Perform pregnancy tests regularly while on therapy. High-fat meals increase AUC and Cmax. Be consistent with fat content of meals. |
| Rifabutin | Capsule
Oral Suspension
| More Frequent
Less Frequent
Rare
|
| Preferably take on an empty stomach, but may be administered with food in children with GI intolerance. The contents of capsules may be mixed with applesauce for children who are unable to swallow capsules. May cause reddish to brown-orange color urine, feces, saliva, sweat, skin, or tears (can discolor soft contact lenses). Uveitis seen with high-dose rifabutin (i.e., >300 mg/day in adults), especially when combined with clarithromycin. Multiple potential drug interactions exist. Use with caution in children with renal or hepatic impairment. Monitor CBC and LFTs; conduct ophthalmologic examinations. Reduce dose in children with renal impairment. |
| Rifampin | Oral Suspension
Capsules
IV
| Less Frequent
Rare
|
| Preferably taken on an empty stomach, but can be administered with food in children with GI intolerance; take with full glass of water. Suspension formulation stable for 30 days. Shake well prior to dosing. May mix contents of capsule with applesauce or jelly. May cause reddish to brown-orange color urine, feces, saliva, sweat, skin, or tears (can discolor soft contact lenses). Multiple potential drug interactions Use with caution in children with hepatic impairment. Administer IV by slow infusion. Extravasation may cause local irritation and inflammation. Monitor CBC and LFTs. |
| Streptomycin | IV/IM
| More Frequent
Less Frequent
Rare
|
| Usual route of administration is deep IM injection into large muscle mass. For children who cannot tolerate IM injections, dilute to 12–15 mg in 100 mL of 0.9% sodium chloride; must be infused over 30–60 minutes to avoid neuromuscular blockade. Requires dose adjustment in children with impaired renal function. Monitor renal function and hearing periodically (e.g., monthly) in children on prolonged therapy. Monitor serum concentrations (TDM). |
| Sulfadiazine | Tablet
Oral Suspension
| Rare
|
| Ensure adequate fluid intake to avoid crystalluria. Monitor CBC, renal function, and urinalysis. Monitor serum concentrations (TDM) if serious infection. May potentially lead to hyperbilirubinemia and kernicterus in neonates and young infants. Avoid use in infants <2 months unless other options are not available. |
Trimethoprim- Sulfamethoxazole (TMP-SMX) | Oral Suspension
Tablets Single Strength
Double Strength
IV
| More Frequent
Less Frequent
Rare
|
| Requires dose adjustment in children with impaired renal function. Maintain adequate fluid intake to prevent crystalluria and stone formation; take with full glass of water. Potential for photosensitivity skin reaction with sun exposure. May displace bilirubin from protein binding sites which may lead to hyperbilirubinemia in neonates and young infants. Oral suspension may contain propylene glycol that can lead to fatal toxicities, such as metabolic acidosis, renal failure, or respiratory depression in neonates. Administer IV infusion over 60–90 minutes. Monitor CBC and renal function. |
| Valacyclovir | Tablets
Note: An oral suspension formulation of 50 mg/mL can be prepared in Ora-Sweet or SyrPalta syrups) | Rare
| More Frequent
Less Frequent
| Thrombotic thrombocytopenic purpura/hemolytic uremic syndrome has been reported in adults with HIV with advanced disease receiving high (i.e., 8 g/day) but not low doses. Monitor CBC and renal function. Avoid other nephrotoxic drugs. Maintain adequate hydration. |
| Valganciclovir | Tablet
Oral Solution
| More Frequent
Less Frequent
|
| Requires dose adjustment in children with renal impairment. Avoid other nephrotoxic drugs. Tablets should not be broken or crushed. Monitor CBC and renal function. Potentially teratogenic and carcinogenic. |
| Voriconazole | Tablets
Oral Suspension
IV
| Less Frequent
Rare
| More Frequent
Less Frequent
| Oral tablets should be taken 1 hour before or after a meal. Shake oral suspension well prior to dosing. Maximum IV infusion rate should be 3 mg/kg/hour over 1–2 hours. Use oral administration for children with impaired renal function, if possible, because of accumulation of IV vehicle in children with renal insufficiency. Dose adjustment is needed if hepatic insufficiency exists. Visual disturbances are common (>30%) but are transient and reversible when drug is discontinued. Multiple potential drug interactions exist. Monitor renal function, electrolytes, and LFTs. Consider monitoring serum concentrations (TDM). |
a The toxicities listed in the table have been selected based on their potential clinical significance and are not inclusive of all side effects reported for a particular drug. b Source: Atovacquone/Proguanil. ScienceDirect. https://www.sciencedirect.com/topics/medicine-and-dentistry/atovaquone-proguanil. Key: ALT = alanine transaminase; AST= aspartate transaminase; AUC = area under the curve; BP = blood pressure; BUN = blood urea nitrogen; CBC = complete blood count; Cmax = maximum plasma concentration; CNS = central nervous system; Cr = creatinine; CrCl = creatinine clearance; D5W = dextrose 5% in water; DR = delayed-release; ECMO = extracorporeal membrane oxygenation; EKG = electrocardiogram; G6PD = glucose-6-phosphate dehydrogenase; GI = gastrointestinal; Hb = hemoglobin; HF = heart failure; IFN-α = interferon alfa; IM = intramuscular; IR = immediate-release; IV = intravenous; LFT = liver function test; NS = normal saline; PK = pharmacokinetics; QT = interval between Q and T waves; QTc = QT interval corrected for heart rate; SCAR = severe cutaneous adverse reactions; SJS = Stevens-Johnson Syndrome; SMX = sulfamethoxazole; TDM = therapeutic drug monitoring; TMP = trimethoprim; XR = extended-release. | ||||