ࡱ>  .bjbj**  .@@&+((   8Dt dtvvvvvv,a````Ft`t```P϶F``0``````( :   Commonly Prescribed Urological Medications Eric Yarnell, ND, RH(AHG) last updated 26 Sept 2015 All doses are adult doses and oral unless otherwise noted. BENIGN PROSTATIC HYPERPLASIA Generic (Trade) NamesDoseKey Clinical InfoAlpha Blockers (Alpha-1 adrenergic antagonists)Alfuzosin (Uroxatral) $Start 5 mg bid (SR: 10 mg qd)Postural hypotension. Give first dose seated in office to avoid fainting.Doxazosin (Cardura)Start 4 mg qd; Range: 4-8 mg qdPostural and nonpostural hypotension. Give first dose seated in office to avoid fainting.Prazosin (Minipress)Start 10 mg bidPostural and nonpostural hypotension, H2O & Na+ retention. Give first dose seated in office to avoid fainting.Tamsulosin (Flomax) $Start 0.2 mg qd; Range 0.2-0.8 mg qdRetrograde ejaculation, rhinitis, postural hypotension (rare)Terasozin (Hytrin)Start 2 mg qd; Range 2-20 mg qdPostural and nonpostural hypotension. Give first dose seated in office to avoid fainting.5-alpha-reductase inhibitors (5aRi)Finasteride (Proscar)5 mg qdMinimum 6 mon to work ED, low libido, lowers PSA by halfDutasteride (Avodart) $0.5 mg qdMinimum 6 mon to work ED, low libido, lowers PSA by half BLADDER CANCER Generic (Trade) NamesDoseKey Clinical InfoImmunomodulatorBCG vaccine, intravesicalChemotherapy CHRONIC PROSTATITIS Alpha Blockers: see BPH above Generic (Trade) NamesDoseKey Clinical InfoAntibioticsCiprofloxacin (Cipro)500 mg bid x 14-28 dCan cause long-lasting tendon/ligament weakness and damage (consider giving magnesium contemporaneously but not simultaneously to prevent), give with probioticsLevofloxacin (Levaquin)500 mg qd x 14-28 dCan cause long-lasting tendon/ligament weakness and damage (consider giving magnesium contemporaneously but not simultaneously to prevent), give with probioticsTrimethoprim-sulfamethoxazole (TMP-SX, Bactrim)160 mg-800 mg bid x 10-14 dCI in those with sulfa allergies, give with probioticsUrothelial Repair AgentPentosan polysulfate (Elmiron)100 mg tid away from food CHRONIC RENAL FAILURE Generic (Trade) NamesDoseKey Clinical InfoPhosphate BlockersNiacinamideStart 250 mg cc Later 500 mg cc if toleratedMonitor platelet levels monthly for three months (stop testing if no decline; stop the vitamin if levels decline to below normal), particularly in Asian patients. May occasionally cause flushing. Target serum phosphorous: <5.5 mg/dlCalcium acetate (PhosLo)Start 667 mg tab (contains 169 mg calcium) x2 cc Range 667 mg x2-4 ccMonitor serum calcium q3-12mon. Target serum phosphorous: <5.5 mg/dlSevelamer (Renagel) $Start 800 mg cc Range 800-1,600 mg ccTarget serum phosphorous: <5.5 mg/dl. ExpensiveLanthanum (Fosrenol) $Start 250-500 mg cc Range 250-750 mg ccTarget serum phosphorous: <5.5 mg/dl. Expensive, possible long-term toxicity (heavy metal).Erythropoietin (EPO)EPO, recombinant; epoetin alfa (Epogen, Procrit) $Start 50-100 units/kg IV or subQ 3x/wk Range increase dose 25% if Hgb <10 g/dl and hasnt increased 1 g/dl after 4 wk; decrease dose 25% if Hgb approaches 12 g/dl or rises more than 1 g/dl in 4 wk periodTarget hemoglobin 10-12 g/dl (do not go higher). Raising Hgb too quickly or too high increases risk of death.Darbepoietin alfa (Aranesp) $Start 0.45 mcg/kg IV or subQ 1x/wk Range increase dose 25% if Hgb <10 g/dl and hasnt increased 1 g/dl after 4 wk; decrease dose 25% if Hgb approaches 12 g/dl or rises more than 1 g/dl in 4 wk periodTarget hemoglobin 10-12 g/dl (do not go higher). Raising Hgb too quickly or too high increases risk of death.Angiotensin Converting Enzyme Inhibits (ACEi)Benazepril (Lotensin)Start 5 mg qd Range 5-10 mg qdCommonly causes cough. May raise serum potassium levels.Enalapril (Vasotec)Start 2.5 mg qd Range 2.5-5 mg qdCommonly causes cough. May raise serum potassium levels.Fosinopril (Monopril)Start 10 mg qdCommonly causes cough. May raise serum potassium levels.Lisinopril (Prinivil)Start 5 mg qd Range 5-10 mg qdCommonly causes cough. May raise serum potassium levels.Angiotensin Receptor Blockers (ARB)Candesartan (Atacand)Start 4 mg qd Range 4-32 mg qd or 4-16 mg bidMay raise serum potassium levels.Irbesartan (Avapro)Start 75 mg qd Range 75-300 mg qdMay raise serum potassium levels.Losartan (Cozaar)Start 25 mg qd Range 25-100 mg qd or 25-50 mg bidMay raise serum potassium levels.Olmesartan (Benicar)Start 10 mg qd Range 10-40 mg qdMay raise serum potassium levels.Telmisartan (Micardis)Start 20 mg qd Range 20-80 mg qdMay raise serum potassium levels.Valsartan (Diovan)Start 40 mg qd or 20 mg bid Range 80-320 mg qd or 40-80 mg bidMay raise serum potassium levels.Vitamin D-Related DrugsCalcitriol (1,25-dihyroxyvitamin D3)Start 0.25 mcg qd Range 0.25-2.5 mcg qdMonitor baseline urine calcium and urine calcium as well as iPTH every1-2 wk; if <250 mg/g Cr and iPTH still >300 pg/ml then increase dose by 0.25 mcg. Goal is for serum 1,25-(OH)2-D and iPTH to be in normal range. Overdose runs high risk of hypercalcium, kidney stones, death.Cinecalcet (Sensipar) DIURETICS Generic (Trade) NamesDoseKey Clinical InfoThiazide DiureticsHydrochlorothiazideStart 25 mg qd Range 25-100 mg qd-bidNot recommended in most cases: much more likely to impair glucose control, cause dyslipidemia, and worsen gout than other drugs in class. Depletes Mg2+, K+. Avoid if eGFR/CrCl <30 ml/min.ChlorthalidoneStart 25 mg qd Range 25-100 mg qdAvoid if eGFR/CrCl <30 ml/min.Loop DiureticsSpironolactoneOther KIDNEY STONES, ACUTE (RENAL COLIC) Alpha blockers: see BPH above Diuretics: see above Generic (Trade) NamesDoseKey Clinical InfoAnalgesicsIbuprofen800 mg q4-8hWatch for GI bleeding, ulceration, and kidney damage.Indomethacin Rectal suppository: 100 mg PROSTATE CANCER 5aRi: see BPH above Androgen deprivation therapy (ADT) options: ADT x 1 = GnRH superagonist/GnRH antagonist alone (combine with AR blocker initially to prevent T flare) ADT x 2 = GnRH superagonist or GnRH antagonist + AR blocker ADT x 3 = GnRH superagonist or GnRH antagonist + AR blocker + 5aRi ADT x 4 = GnRH superagonist or GnRH antagonist + AR blocker + 5aRi + adrenal androgen synthesis blocker Generic (Trade) NamesDoseKey Clinical InfoGnRH SuperagonistsBuserelin (Suprefact)Start 200 mcg (2 sprays) per nostril tid or 500 mcg subQ tid Maintenance 200 mcg subQ qd Causes initial testosterone flare: couple with androgen receptor antagonist for at least first 1-2 wk. Causes androgen deprivation syndrome.Goserelin (Zoladex)3.6 or 10.8 mg subQ onceCauses initial testosterone flare: couple with androgen receptor antagonist for at least first 1-2 wk. Causes androgen deprivation syndrome.Histrelin (Supprelin)50 mg subQ implant q12monCauses initial testosterone flare: couple with androgen receptor antagonist for at least first 1-2 wk. Causes androgen deprivation syndrome.Leuprolide (Lupron) $1 mg subQ qd or 7.5 mg depot IM or subQ q mon or 22.5 mg depot IM q3mon or 30 mg depot IM q4mon or 45 mg depot IM q6mon or 65 mg subQ implant q12monCauses initial testosterone flare: couple with androgen receptor antagonist for at least first 1-2 wk. Causes androgen deprivation syndrome.GnRH AntagonistAbarelix (Plenaxis)Start 100 mg IM q2wk for 3 doses Maintenance 100 mg IM q1monCauses androgen deprivation syndrome.Cetrorelix (Cetrotide)Start 10 mg subQ qd x 5d Maintenance 1-2 mg subQ qdCauses androgen deprivation syndrome.Degarelix (Firmagon)Start 120 mg subQ bid x 1d Maintenance 80 mg subQ q1monCauses androgen deprivation syndrome.Androgen Receptor BlockersBicalutamide (Casodex)50 mg qdCauses androgen deprivation syndrome. Causes high aromatization to estrogens thus gynecomastia.Flutamide (Eulexin)250 mg tid Causes androgen deprivation syndrome. Causes high aromatization to estrogens thus gynecomastia.Nilutamide (Nilandron)Start 300 mg qd x 30 d Maintenance 150 mg qdCauses androgen deprivation syndrome. Causes high aromatization to estrogens thus gynecomastia.Enzalutamide (Xtandi) $160 mg qd Causes androgen deprivation syndrome. Causes high aromatization to estrogens thus gynecomastia.Adrenal Androgen Synthesis BlockersKetoconazole, high-dose200 mg tid icMust be taken with a corticosteroid. High risk of liver damage (abiraterone much preferred); monitor transaminases monthly.Spironolactone100-600 mg qdMust be taken with a corticosteroid. High rates of feminization and hyperkalemia.Abiraterone (Zytiga) $1 g qdMust be taken with a corticosteroid. Hypokalemia and hypophosphatemia may occur. PYELONEPHRITIS Generic (Trade) NamesDoseKey Clinical InfoAntibiotics RENAL CELL CARCINOMA Generic (Trade) NamesDoseKey Clinical InfoChemotherapy URINARY TRACT INFECTION, UNCOMPLICATED Generic (Trade) NamesDoseKey Clinical InfoAntibioticsNitrofurantoin (Macrobid)Long-acting: 100 mg bid x 3-7 d Short-acting: 50 mg qid x 3-7 dNot useful for prostatitis or pyelonephritis. Safe in pregnancy.Trimethoprim-sulfamethoxazole (TMP-SX, Bactrim)160/800 mg bid x 3-7 d TMP alone: 200 mg bid x 3-7 dSX causes almost all the problems but you cant easily get TMP alone in the US. Safe in pregnancy.Methenamine hippurate1 g bid x 7 dRequires urine pH <5.5 to work; CI in gout, renal failure, pregnancy, use with sulfa drugs. Resistance does not develop.Ciprofloxacin (Cipro)250 mg bid x 3-7 dCan cause long-lasting tendon/ligament weakness and damage (consider giving magnesium contemporaneously but not simultaneously to prevent), give with probiotics. CI in pregnancy.Urinary AnalgesicPhenazopyridine (Pyridium)Start 200 mg tid pc Range 100-200 mg tid pcTurns urine orange/red. Can stain contacts, skin, nails. Interferes with dipstick urinalysis. Available OTC. 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